Cancer Causes & Control

, Volume 23, Supplement 1, pp 57–67 | Cite as

Perceived effectiveness of pictorial health warnings among Mexican youth and adults: a population-level intervention with potential to reduce tobacco-related inequities

  • David HammondEmail author
  • James Thrasher
  • Jessica L. Reid
  • Pete Driezen
  • Christian Boudreau
  • Edna Arillo Santillán
Original paper



Pictorial health warnings on cigarette packages are a prominent and effective means of communicating the risks of smoking; however, there is little research on effective types of message content and socio-demographic effects. This study tested message themes and content of pictorial warnings in Mexico.


Face-to-face surveys were conducted with 544 adult smokers and 528 youth in Mexico City. Participants were randomized to view 5–7 warnings for two of 15 different health effects. Warnings for each health effect included a text-only warning and pictorial warnings with various themes: “graphic” health effects, “lived experience”, symbolic images, and testimonials.


Pictorial health warnings were rated as more effective than text-only warnings. Pictorial warnings featuring “graphic” depictions of disease were significantly more effective than symbolic images or experiences of human suffering. Adding testimonial information to warnings increased perceived effectiveness. Adults who were female, older, had lower education, and intended to quit smoking rated warnings as more effective, although the magnitude of these differences was modest. Few interactions were observed between socio-demographics and message theme.


Graphic depictions of disease were perceived by youth and adults as the most effective warning theme. Perceptions of warnings were generally similar across socio-demographic groups.


Health communication Tobacco Smoking Socioeconomic factors Product labelling 



We wish to thank Códice Comunicación Diálogo y Conciencia S·C. and Instituto Nacional de Salud Publica (INSP) for their assistance in conducting this work. We would also like to acknowledge the assistance of Ana Dorantes (field manager for Mexico) and Samantha Daniel. The project described in this paper was funded by the National Institutes of Health (grant number 1 P01 CA138-389-01: “Effectiveness of Tobacco Control Policies in High vs. Low Income Countries”). Additional support was provided by the Propel Centre for Population Health Impact, a Canadian Institutes of Health Research New Investigator Award and the Canadian Cancer Society Research Institute Junior Investigator Award.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • David Hammond
    • 1
    Email author
  • James Thrasher
    • 2
    • 3
  • Jessica L. Reid
    • 4
  • Pete Driezen
    • 4
  • Christian Boudreau
    • 5
  • Edna Arillo Santillán
    • 3
  1. 1.School of Public Health & Health SystemsUniversity of WaterlooWaterlooCanada
  2. 2.Department of Health Promotion, Education and Behavior, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  3. 3.Departamento de Investigaciones sobre Tabaco, Centro de Investigación en Salud PoblacionalInstituto Nacional de Salud Publica (INSP)CuernavacaMexico
  4. 4.Propel Centre for Population Health ImpactUniversity of WaterlooWaterlooCanada
  5. 5.Department of Statistics and Actuarial ScienceUniversity of WaterlooWaterlooCanada

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