���� (pp. 193�C94) The Act neither requires nor restricts the inclusion of other information, such as displaying a toll-free telephone quitline or links to online cessation resources. Nor does the Act specify timelines for revising or ��rotating�� new health warnings, although selleck bio this presumably falls within the Secretary��s mandate to make changes to the warnings should they promote greater understanding of the health risks. Existing Evidence on Health Warnings To date, more than 30 countries have implemented pictorial warnings on cigarette packages��see example in Figure 2 (Hammond, 2009). A wide range of study designs and measures have been used to evaluate health warnings on cigarette packages. A full discussion of these methodological issues are beyond the scope of this paper but have been reviewed elsewhere (Hammond, 2011; International Agency for Research on Cancer, 2008).

Large health warnings displayed on the principal display faces of tobacco packages are a prominent source of health information (Hammond, Fong, et al., 2006). Findings from Canada, Thailand, and elsewhere also indicate that considerable proportions of nonsmokers report awareness and knowledge of package health warnings (Brown, Diener, Ahmed, & Hammond, 2005; Environics Research Group, 2005; European Commission, 2009; Shanahan & Elliot, 2009). Several studies demonstrate that increases to the size of text warnings enhance their impact (Environics Research Group, 1999).

For example, in experimental studies where youth and adults are asked to rate the effectiveness of different health warnings, the largest warnings are most likely to be rated as effective, including among more vulnerable nonsmokers (AGB Spectrum Research Ltd., 1987; Centre for Behavioral Research in Cancer, ACCV, 1992; Environics Research Group, 1999; Les ��tudes De Marche Createc, 2008a, 2008b; Linthwaite, 1985). Warnings that appear on the ��front�� or principal display area of packages are also likely to have greater impact (Rootman & Flay, 1995). Features that distinguish the warning messages from the package design have also been found to increase the salience and recall of warnings, including contrasting colors, such as black lettering on a white background (Laugesen, 1990; Nilsson, 1991). Cigarette warning labels can have a significant impact on smokers�� GSK-3 understanding of the risks of tobacco use. Research has shown that large text-based warnings are associated with increased perceptions of risk (Borland & Hill, 1997; Environics Research Group, 2007a, 2007b; Tandemar Research Inc., 1996). For example, several studies have evaluated the enhancement of text warnings in European Union member states in 2003 to a minimum of 30% of the front and back of packages (Borland et al., 2009; Fong et al.