Original Article

Journal of Public Health

, Volume 22, Issue 2, pp 175-185

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Young children’s perceptions of health warning labels on cigarette packages: a study in six countries

  • Dina L. G. BorzekowskiAffiliated withDepartment Behavioral and Community Health, School of Public Health, University of Maryland Email author 
  • , Joanna E. CohenAffiliated withJohns Hopkins Bloomberg School of Public Health



Health warning labels on cigarette packages are one way to reach youth thinking about initiating tobacco use. The purpose of this study was to examine awareness and understanding of current health warning labels among 5 and 6 year old children.

Subjects and methods

Researchers conducted one-on-one interviews with urban and rural 5 and 6 year olds from Brazil, China, India, Nigeria, Pakistan, and Russia.


Among the 2,423 participating children, 62 % were unaware of the health warnings currently featured on cigarette packages, with the lowest levels of awareness in India and the highest levels in Brazil. When shown the messages, the same percentage of participating children (62 %) showed no level of message understanding.


While youth are receiving social and informational messages promoting tobacco use, health warning labels featured on cigarette packages are not effectively reaching young children with anti-smoking messages.


Warning labels Cigarettes Tobacco Global Awareness