A 1950 article by Wynder and Graham for the American Cancer Society, published in the Journal of the American Medical Association, stated: ‘Excessive and prolonged use of tobacco, especially cigarettes, seems to be an important factor in the induction of bronchogenic carcinoma’ ^[8]Wynder, E.L. and Graham, E.A. (1950) Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma. A study of six hundred and eighty-four proved cases, Journal of the American Medical … Continue reading. William Leib, in an equally ground-breaking article published in the Readers Digest in 1953, argued that “Used to excess, tobacco may be the cause – sometimes unsuspected – of grave physical ills.”^[9]Leib, W. (1953). Can the poisons in cigarettes be avoided? Readers Digest, 61, December, 45–7.^[10]White, C., Oliffe, J.L. and Bottorff, J.L. (2013), Tobacco and the invention of quitting: a history of gender, excess and will-power. Sociology of Health & Illness, 35: 778-792. … Continue reading

September 1955: The Federal Trade Commission (FTC) told cigarette manufacturers to make no health implications in their advertising.

In June 1956, the US Public Health Service formed a scientific study group on the subject of smoking and health, the group concluded, similarly: ‘there is a causal relationship between excessive smoking of cigarettes and lung cancer.’^[11]US Department of Health, Education, and Welfare (1988) The Health Consequences of Smoking: Nicotine Addiction. Report of the Advisory Committee to the Surgeon General of the Public Health Service. … Continue reading^[12]White, C., Oliffe, J.L. and Bottorff, J.L. (2013), Tobacco and the invention of quitting: a history of gender, excess and will-power. Sociology of Health & Illness, 35: 778-792. … Continue reading

John A. Blatnik (1911 –1991) US Congressman, Minnesota.

During hearings led by Representative John Blatnik of Minnesota, regarding cigarette advertising, Surgeon General Leroy E. Burney testified: ‘It is clear there is an increasing and consistent body of evidence that excessive cigarette smoking is one of the causative factors in lung cancer.’ ^[13]Federal Trade Commission (1964) Trade Regulation Rule for the Prevention of Unfair or Deceptive Advertising and Labeling of Cigarettes in Relation to the Health Hazards of Smoking and Accompanying … Continue reading The emphasis on excessive smoking continued throughout the next decade. In 1959 the American Public Health Association called for action on tobacco because ‘scientific evidence has established that excessive cigarette smoking is a major factor [in lung cancer]’^[14]Federal Trade Commission (1964) Trade Regulation Rule for the Prevention of Unfair or Deceptive Advertising and Labeling of Cigarettes in Relation to the Health Hazards of Smoking and Accompanying … Continue reading^[15]White, C., Oliffe, J.L. and Bottorff, J.L. (2013), Tobacco and the invention of quitting: a history of gender, excess and will-power. Sociology of Health & Illness, 35: 778-792. … Continue reading.

Surgeon General, Dr. Leroy Burney (serving 1956-1961)

July 1957: Surgeon General Leroy Burney states that statistics indicate that excessive cigarette smoking is a causative factor in lung cancer.

Rep. Blatnik of Minnesota introduces a bill to give the FTC power to control filter cigarette advertising, requiring a statement of tar and nicotine content if the word “filter” is used.

Dr. Luther Terry

On January 11, 1964, the Surgeon General of the Public Health Service, Luther Terry, and the Advisory Committee to the Surgeon General, released the 1964 landmark report linking smoking cigarettes with several diseases including lung cancer and heart disease. The report held cigarette smoking responsible for a 70 percent increase in the mortality rate of smokers over non-smokers. The report estimated that average smokers had a nine to tenfold risk of developing lung cancer compared to non-smokers and heavy smokers had at least a twenty-fold risk. The risks increase with the duration of smoking and diminish with the cessation of smoking. The report also named smoking the most important cause of chronic bronchitis and pointed to a correlation between smoking and emphysema, and smoking, and coronary heart disease. It noted that smoking during pregnancy reduced the average weight of newborns.^[16]“The 1964 Report on Smoking and Health | Reports of the Surgeon General – Profiles in Science.” U.S. National Library of Medicine, National Institutes of Health, … Continue reading

On January 29, 1964, George Weissman, the CEO of Philip Morris International, wrote to Joseph Cullman, 3rd, CEO of Philip Morris,^[17]“Joseph Cullman III, 92; Made Philip Morris a Power”, Los Angeles Times, 3 May 2004 regarding his analysis of the Surgeon General’s Report. In it, he states, “we must in the near future give smokers a psychological crutch and a self-rationale to continue smoking. The answers must also point to weaknesses in the Report and the path to future research.”

Suggested Industry Actions:
– Filters, etc.
– More research is needed
– Back a mild federal labeling act
– Counterpoise labeling act health cautions with the benefits of tobacco
– Keep it as a federal matter – many hearings
– It’s an individual choice of psychological benefit versus the alleged hazard

The Federal Cigarette Labeling and Advertising Act of 1965 (Public Law 89–92) required that the warning “Caution: Cigarette Smoking May Be Hazardous to Your Health” be placed in small print on one of the side panels of each cigarette package. The act prohibited additional labeling requirements at the federal, state, or local levels.

Principal provisions:
– Cigarette packs must bear a health caution label.
– Federal and state agencies may not make labeling or advertising requirements in connection with smoking and health until at least, July 1, 1969.
– FTC and the Department of Health, Education, and Welfare (SEW) are to keep Congress informed on the issue through annual reports.

In 1969 Congress passed the Public Health Cigarette Smoking Act (Public Law 91–222), which prohibited cigarette advertising on television and radio and required that each cigarette package contain the label “Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health.^[18]“2000 Surgeon General’s Report Highlights: Warning Labels.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 21 July 2015, … Continue reading. April 1, 1970, President Richard Nixon signs legislation.^[19]A&E Television Networks. (2009, November 16). President Nixon signs legislation banning cigarette ads on TV and Radio. History.com. Retrieved June 6, 2022, from … Continue reading

The last televised cigarette ad ran at 11:50 p.m. during
The Johnny Carson Show on January 1, 1971

Congress enacts the Comprehensive Smoking Education Act of 1984 (Public Law 98–474), which required four specific health warnings on all cigarette packages and advertisements. The warnings appear on the side of packs in various contrasts and have not changed since that time.^[20]Hammond D, Fong GT, McNeill A, et al Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country … Continue reading

By the mid-1980s scientific evidence revealed that smokeless tobacco use causes oral cancer, nicotine addiction, and other health problems. The Comprehensive Smokeless Tobacco Health Education Act of 1986 (Public Law 99–252) requires rotating warning labels on smokeless tobacco packaging and advertisements:

WARNING: This product may cause mouth cancer.
WARNING: This product may cause gum disease and tooth loss.
WARNING: This product is not a safe alternative to cigarettes.
WARNING: Smokeless tobacco is addictive.

In 2001, a directive of the European Parliament and Council concerning the use of health warnings on cigarette packages became law. As a result, European Commission (EC) member states are to display text warnings covering at least 30% of the “front” and 40% of the “back” of packages (45% for member states with two official languages and 50% for member states with three official languages). In addition, the EC provided a series of 42 optional pictorial warnings. They prohibit the terms “light” and “mild” on packages. In addition, Tar, nicotine, and carbon monoxide emission numbers must appear on the pack side. Emission numbers are generated using the ISO machine smoking method.

A new Tobacco Product Directive came into force on May 20, 2016. The new Directive requires pictorial health warnings covering the top 65% of the front and back of the package. Three different sets of 14 warnings are rotated annually. “Slim” packages, as well as promotional and misleading descriptors such as “lite,” “natural,” and “organic,” are prohibited. Member states have the option to require plain standardized packaging.^[21]Canada. Tobacco Labeling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

Canada became the first country to implement pictorial health warnings on cigarette packages in June 2001. Health warnings covered 50% of the front and 50% of the back of the package (one side in English and the other side in French). Canada required tar, nicotine, carbon monoxide, formaldehyde, hydrogen cyanide and benzene emission numbers to appear on the side of packages. Two numbers appeared from each emission: one from the ISO and one from the Health Canada machine smoking method.^[22]Canada. Tobacco Labeling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

In 2001 Brazil became the first country to ban the use of misleading descriptors on cigarette packs. Product descriptors such as light, ultra-low tar, low tar, smooth, soft, moderate tar, and high tar or any other descriptors that may induce consumers to interpret tar levels in cigarettes. Descriptors can cause smokers to believe that these products cause fewer health problems than other cigarettes.

The World Health Organization Framework Convention on Tobacco Control (FCTC). The FCTC is a legally binding treaty that requires countries bound by the treaty — or Parties — to implement evidence-based measures to reduce tobacco use and exposure to tobacco smoke. There are 182 Parties to the FCTC as of 2021. When effectively implemented, the FCTC is a powerful tool to reduce the devastating global consequences of tobacco products on health, lives, and economies. This includes Article 11: Packaging and labeling of tobacco products. The FCTC and its implementing guidelines commit Parties to:

• Protect their public health measures from the commercial and other vested interests of the tobacco industry;
• Protect all people from tobacco smoke exposure in all indoor public places, indoor workplaces, on all means of public transport, and, as appropriate, other places;
• Ban or restrict tobacco advertising, promotion, and sponsorship;
• Place large graphic health warnings on tobacco products and prohibit the use of false and misleading labeling and packaging that may imply that one tobacco product is less harmful than another;
• Consider price and tax measures to reduce the demand for tobacco, which may include prohibiting or restricting sales to or importations of duty-free tobacco products;
• Eliminate the illicit trade of tobacco products;
• Regulate the content of tobacco products and require disclosure of ingredients;
• Provide cessation assistance and treatment for tobacco dependence;
• Provide education, communication, training, and public awareness measures about the harms of the tobacco products and the tactics used by the tobacco industry to undermine the public health;
• Consider taking action to deal with criminal and civil liability related to tobacco harms, including compensation where appropriate; and
• Take other action aimed at reducing tobacco use and exposure to tobacco smoke.

In 2003, Bhutan passed a law prohibiting the sale of cigarettes.The law was updated 2010 to ban the cultivation, harvest, and production of tobacco products. Smoking rates are low in Bhutan and there is strong societal disapproval of smoking.

Uruguay first implemented its pictorial health warnings policy in 2005 when a set of 8 pictorial health warnings were rotated on cigarette packages. Uruguay updated warning labels regularly. The second set of 3 health warnings was implemented in 2008, followed by the third set of 9 warnings in January 2009; the fourth set of 6 warnings in March 2010; the fifth set of 2 warnings in 2012; the sixth set of 4 warnings in 2013; the seventh set of 4 warnings in 2014; and most recently, the eighth set of 4 warnings in 2015.

Australia first implemented pictorial health warnings on March 1, 2006. Health warnings were required to cover 30% of the front and 90% of the back of all cigarette packages. Two different sets of seven health warnings were rotated on cigarette packages every 12 months. In December 2012, two new sets of seven images were adopted. The new warnings are larger, and now cover 75% of the front surface of the pack and 90% of the back surface.^[23]Canada. Tobacco Labelling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

Hong Kong implemented its current health warnings policy starting in October 2007. Cigarette packages are required to have a health warning covering 50% of the front and back of the package, in both Chinese and English. Overall, 50% of the package space is appropriated to health warnings. In total, a set of 6 health warnings are rotated on cigarette packages each year, with each warning being shown in equal proportions over that period.^[24]Canada. Tobacco Labelling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

New Zealand implemented pictorial health warnings in February 2008. Health warnings are required to cover 30% of the front and 90% of the back of all cigarette packages. All warnings are written in both English and Maori, the two official spoken languages of New Zealand. Two sets of 7 warnings are rotated every 12 months.

In 2007, the United Kingdom approved regulations requiring pictorial health warnings on tobacco packages. Beginning October 2008, new tobacco product stock was required to display graphic warnings. Warnings were to cover 43% of the front and 53% of the back of all cigarette packages (48% overall). The UK rotated a set of 15 packaging images. Tar, nicotine, and carbon monoxide emission numbers are required on the packages’ side. The terms “light” and “mild” are prohibited from appearing on packages.^[25]Canada. Tobacco Labelling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

Iran approved a law on May 29, 2008, requiring picture-based warnings to be displayed on all cigarette packages. The picture-based warnings were implemented in Iran starting on January 20, 2009. The warnings are required to cover 50% of the front and back of all cigarette packages meaning.^[26]Canada. Tobacco Labelling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

The 2009 Family Smoking Prevention and Tobacco Control Act granted the Food and Drug Administration the authority to regulate tobacco products and put in place important measures to protect public health, including the update of tobacco warning labels.

In December 2009, Turkey finalized legislation that required all cigarette packs to carry pictorial health warnings. In 2010, fourteen health warnings were rotated on cigarette packages, covering 65% of the front and 43% of the back packaging (54% overall). In 2012, Turkey increased the size of the health warnings. The warnings are now required to occupy 65% of the packages’ front and back. In December 2016, the Turkish Health Minister announced plans to introduce plain packaging in 2017.

In 2009 Mongolia made the decision to require pictorial health warnings on all cigarette packs. A set of six images appeared on all packs sold in Mongolia beginning January of 2010. The warnings covered the lower 33% of the package front and back. In March 2013, a new set of 4 warnings were adopted. The new warnings are larger, and must cover 50% of the front and back of cigarette packages, and front cover of pipe tobacco or other tobacco packages.^[27]Canada. Tobacco Labeling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

Originally, the health warnings were required to cover 50% of the front and 50% of the back of all cigarette packages. In March 2010, the health warning size was increased; the warnings are now required to cover 80% of the front and 80% of the back of all cigarette packages. Uruguay was the first country in the world to require 80% of the package to be appropriated to health warnings. Uruguay also prohibits the terms “light” and “mild” from appearing on packages, and requires one descriptive message on emissions and constituents on the side of packages. Cigarette brand families are limited to one pack presentation (one brand per brand family).^[28]Canada. Tobacco Labelling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

Mexico first implemented pictorial health warnings in September 2010. Tobacco packages are required to bear three warnings: a pictorial warning with text covering at least 30% of the front; a text-only warning covering 100% of the back, and a related text-only message covering 100% of one of the side panels. New sets of warnings were adopted in 2011, 2012, 2013, and 2014.

Uruguay allows for only one product per brand, eliminating new brand versions. Instead of multiple versions of a brand, manufacturers must offer only one. Uruguay’s determination to have a single brand presentation has been effective in reducing smokers’ misinformation with respect to the risk associated with different types of cigarettes.

France made the decision to require pictorial health warnings on all cigarette packs in April 2010. Packages were required to display the pictorial warnings by April 2011.

Packages are required to bear two warnings: a text-only warning covering at least 30% of the front, and a warning accompanied by an image covering at least 40% of the back.

In November 2011, Australia became the first country in the world to pass plain packaging regulations. As of December 1, 2012, all tobacco products in Australia were required to be sold in dull, brown packages, with no company logos and the same font for all brands. Australia prohibits the terms “light” and “mild” from appearing on packages. As well, Australia requires one descriptive message on emissions and constituents on the side of packages.

Bolivia issued regulations on May 25, 2011, requiring pictorial health warnings on all tobacco packages as of December 1, 2011. Cigarette, cigar, and loose tobacco packages are required to have a health warning cover 50% of the front and 50% of the back of the package. Bolivia also requires a descriptive toxic emission message for the side panel.^[29]Canada. Tobacco Labelling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/

In June 2011, the FDA published a final rule requiring that color graphics depicting the negative health consequences of smoking should accompany new textual warning statements. The health warnings were originally scheduled to appear on packages by September 2012. However, the final rule was challenged in court by several tobacco companies. The United States Court of Appeals vacated the rule and denied the government’s petition for a rehearing. The government decided not to seek further review of the Court’s ruling.

Russia finalized regulations requiring pictorial health warnings for tobacco products in 2012. Russian law requires 30% of the front of tobacco packs to have text warnings, and 50% of the back to have text and pictorial warnings. Twelve versions of the warnings are being produced.^[30]Would you smoke these? Bloomberg Philanthropies. (n.d.). Retrieved June 9, 2022, from https://www.bloomberg.org/blog/would-you-smoke-these/

A new set of 16 health warnings were implemented in 2012. The new warnings are larger and must cover 75% of the front and back of cigarette and little cigar packages. As of March 1, 2012, manufacturers and importers were prohibited from distributing products without the new health warnings. Retailers were given 3 months (until June 19, 2012) to transition to packages displaying the new warnings. Canada prohibits the terms “light” and “mild” from appearing on packages.^[31]Canada. Tobacco Labelling Regulations. (n.d.). Retrieved June 7, 2022, from https://tobaccolabels.ca/countries/canada/^[32]TobaccoFreeKids.org. (n.d.). Australia Post Implementation Evidence: Plain Packaging of Tobacco Products Toolkit. Home – Campaign for Tobacco-Free Kids. Retrieved June 7, 2022, from … Continue reading

^[33]Moodie C, Hoek J, Scheffels J, et al. Plain packaging: legislative differences in Australia, France, the UK, New Zealand and Norway, and options for strengthening regulations. Tobacco Control … Continue reading

The New Zealand Parliament passed plain packaging legislation on September 8, 2016, and released final regulations in June 2017. Plain packaging regulations will come into force at the manufacturer level on March 14, 2018. All tobacco products in New Zealand will be sold in dark brown/green colored packaging, with no company logos/imagery and the same font for all brands. The packages will have new, larger warnings that cover at least 75% of the front of the package, and 100% of the back.^[34]Who framework convention on tobacco control. Campaign for Tobacco-Free Kids. (2021, September 27). Retrieved June 7, 2022, from https://www.tobaccofreekids.org/what-we-do/global/fctc.

In March 2020, FDA finalized the “Required Warnings for Cigarette Packages and Advertisements” rule, establishing 11 new cigarette health warnings, consisting of textual warning statements accompanied by color graphics, in the form of concordant photo-realistic images, depicting the negative health consequences of cigarette smoking. These new required warnings depict some of the lesser-known, but serious health risks of smoking.^[35]Products, C. for T. (n.d.). Cigarette Health Warnings. U.S. Food and Drug Administration. Retrieved June 9, 2022, from … Continue reading

On May 10, 2022, the U.S. District Court for the Eastern District of Texas issued an order in the case of R.J. Reynolds Tobacco Co. et al. v. United States Food and Drug Administration et al., No. 6:20-cv-00176, to postpone the effective date of the “Required Warnings for Cigarette Packages and Advertisements” final rule. The new effective date of the final rule is July 8, 2023.^[36]Products, C. for T. (n.d.). Cigarette Health Warnings. U.S. Food and Drug Administration. Retrieved June 9, 2022, from … Continue reading

The U.S. Food and Drug Administration (FDA) proposed to ban menthol as a characterizing flavor in cigarettes and ban all characterizing flavors (including menthol) that flavor cigars.