PT  - JOURNAL ARTICLE
AU  - Ranney, Leah M
AU  - Clark, Sonia A
AU  - Jarman, Kristen L
AU  - Lazard, Allison J
AU  - Kowitt, Sarah D
AU  - Cornacchione Ross, Jennifer
AU  - Baler, Guido
AU  - Thrasher, James F
AU  - Goldstein, Adam O
TI  - How do current tobacco warnings compare to the WHO FCTC guidelines: a content analysis of combustible tobacco warnings worldwide
AID  - 10.1136/bmjopen-2022-062033
DP  - 2023 Mar 01
TA  - BMJ Open
PG  - e062033
VI  - 13
IP  - 3
4099  - http://bmjopen.bmj.com/content/13/3/e062033.short
4100  - http://bmjopen.bmj.com/content/13/3/e062033.full
SO  - BMJ Open2023 Mar 01; 13
AB  - Objective Many countries have adopted warning labels for combustible tobacco products, yet little research exists describing tobacco warning characteristics globally and to what extent they meet the WHO Framework Convention for Tobacco Control (FCTC) Guidelines. This study evaluates characteristics of combustible tobacco warnings.Design We conducted a content analysis to describe the overall landscape of warnings using descriptive statistics and compared to the WHO FCTC Guidelines.Setting We searched existing warning databases for combustible tobacco warnings from English-speaking countries. We compiled warnings meeting inclusion criteria and coded for message and image characteristics using a pre-defined codebook.Primary and secondary outcomes measures Characteristics of combustible tobacco warning text statements and warning images were the primary study outcomes. There were no secondary study outcomes.Results We identified a total of 316 warnings from 26 countries or jurisdictions worldwide. Of these warnings, 94% included warning text and an image. Warning text statements most often described health effects to the respiratory (26%), circulatory (19%) and reproductive systems (19%). Cancer was the most frequently mentioned health topic (28%). Fewer than half of warnings included a Quitline resource (41%). Few warnings included messages about secondhand smoke (11%), addiction (6%) or cost (1%). Of warnings with images, most were in colour and showed people (88%), mostly adults (40%). More than 1 in 5 warnings with images included a smoking cue (ie, cigarette).Conclusions While most tobacco warnings followed WHO FCTC guidance on effective tobacco warnings, such as communicating health risks and inclusion of images, many did not include local Quitline or cessation resources. A sizeable minority include smoking cues that could inhibit effectiveness. Full alignment with WHO FCTC guidelines will improve warnings and better achieve the WHO FCTC objectives.Data are available upon reasonable request. Please email a reasonable request to the corresponding author for access to the research data.