Executive summary............................................... 1
Background, objectives, method and sample ............ 5

Scientific knowledge on health labelling.............. 7
• How consumers look at packaging / labels 7
• Effectiveness of warning labels generally 8

Scientific knowledge on tobacco warning labels..... 9
• Background information on tobacco warning labelling 9
• Review of scientific knowledge on general tobacco warning labelling 10
• Evaluation of the effectiveness of TEXT ONLY tobacco health warnings 14
• Evaluation of the effectiveness of specific pictorial tobacco health warnings 20

Principles of effective tobacco warning labels ...... 40
• Effectiveness of graphic warnings versus text only messages 40
• Analysis of warning effectiveness 42
• Key design parameters to create effective warning labels 46

Scientific evidence of health effects of tobacco ... 49
• Overview of the main illnesses related to smoking and second-hand smoke 49
• Review of the scientific evidence of the health effects of tobacco 51
• Health and other benefits from smoking cessation 80

Proposals for new tobacco health warnings............. 81
• Proposed new warning messages 81

Overall conclusions and recommendations.............. 108
• Main findings and overall conclusions 108
• Recommendations 110

Appendices .......................................... 111
• Appendix 1 – References regarding effectiveness of health warnings 112
• Appendix 2 – Evidence on effectiveness of tobacco health warning labels in general 117
• Appendix 3 – Evidence of effectiveness of pictorial warnings versus text only 127
• Appendix 4 - Overview of tobacco warning messages used with pictorial warnings 131
• Appendix 5 -Information on health labelling in non-tobacco sectors 135
• Appendix 6 – The 42 pictorials used in the EU 141
• Appendix 7 – Plain packaging and its likely impact 146
• Appendix 8 – References regarding the health effects of smoking 149
• Appendix 9 – List of people contacted for feedback 153