Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies

Diane B. Francis, Nia Mason, Jennifer Cornacchione Ross, Seth M. Noar

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


INTRODUCTION We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults. METHODS We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes. RESULTS Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs. CONCLUSIONS The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.

Original languageEnglish
Article number41
JournalTobacco Induced Diseases
Issue numberMay
StatePublished - 2019

Bibliographical note

Publisher Copyright:
© 2019 International Society for the Prevention of Tobacco Induced Diseases. All rights reserved.


  • Pictorial warning labels
  • Systematic review
  • Tobacco control
  • Youth

ASJC Scopus subject areas

  • Health(social science)
  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health


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