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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Perceptions and acceptability of pictorial health warning labels vs text only - a cross-sectional study in Lao PDR

BMC Public Health > Ausgabe 1/2015
Vanphanom Sychareun, Visanou Hansana, Alongkone Phengsavanh, Kongmany Chaleunvong, Tanja Tomson
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2415-9) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

VS was involved in conceptualizing and designing the study, conducting the statistical analyses, and drafting the manuscript. HV, SP, AP, KC, TT, were involved in data collection, data analysis and revising the manuscript. All authors read and approved the final manuscript.



In Lao PDR, health warnings were first introduced with printed warning messages on the side of the cigarette package in 1993 and again in 2004. Lao PDR same year ratified the Framework Convention on Tobacco Control (WHO FCTC) but has not yet implemented pictorial health warnings. This paper aims to examine the perception and opinion of policymakers on “text-only” and “pictorial” health warnings and to understand lay people’s perceptions on current health warnings and their opinions on the recommended types of health warnings.


A combination of quantitative and qualitative methods were used in this cross-sectional study conducted in 2008. A purposive sample of 15 policymakers, and a representative sample of 1360 smokers and non-smokers were recruited. A range of different areas were covered including consumer attitudes towards current and proposed cigarette package design, views on health warning messages on the flip/slide and inserts, and views on the relative importance of the size, content and pictures of health warning messages. Descriptive statistics and content analysis were used.


Policy makers and survey respondents said that the current health warning messages were inappropriate, ineffective, and too small in size. All respondents perceived pictorial health warnings as a potentially powerful element that could be added to the messages that can communicate quickly, and dramatically. The majority of policymakers and survey respondents strongly supported the implementation of pictorial health warnings.
The non-smokers agreed that the graphic pictorial health warnings were generally more likely than written health warnings to stimulate thinking about the health risks of smoking, by conveying potential health effects, increasing and reinforcing awareness of the negative health effect of smoking, aiding memorability of the health effects and arousing fear of smoking among smokers.


The study suggested that current warnings are too small and that content is inadequate and designed to be hidden on the side pack. These findings are in line with FCTC’s requirements and provide strong support for introducing pictorial warning labels also in Lao PDR. Furthermore, the awareness of Members of Parliament about tobacco control measures holds promise at the highest political level.
Additional file 1: Survey Questionnaire for Perception of Cigarette Health Warnings in the Lao PDR. (DOCX 75 kb)
Additional file 2: Table S1: Multiple logistic regression in awareness of health warnings on side and back of packs between smokers and non-smokers. Table S2: Multiple logistic regression in Perceived effect of current text-only health warnings on thoughts and knowledge about smoking harms between smokers and non-smokers. Table 3: Multiple logistic regression in Perceived effectiveness of pictorial health warnings as compared to text-only warnings between smokers and non-smokers. (DOCX 22 kb)
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