Global Tobacco Control Updates

Effectiveness of graphic health warnings in Africa: The experience of Mauritius
12 Aug 2015
Research Alert

In 2009, Mauritius became the first country in the World Health Organization (WHO) African Region to implement graphic health warnings (GHWs) on tobacco product packages, with 60% coverage on the front and 70% coverage on the back of packs. A study published in Nicotine & Tobacco Research finds that the implementation of GHWs in Mauritius significantly enhanced the effectiveness of the warnings, but effectiveness decreased over time. The study is based on data from the International Tobacco Control Mauritius Survey. Data on 668 adult smokers (ages 18 and older) were collected before and after GHWs implementation in three waves: 6 months prior to implementation (Wave 1), and 10-12 months (Wave 2) and 20-21 months (Wave 3) post implementation.


  • All indicators of warning label effectiveness increased significantly between Waves 1 and 2:
    • Smokers were almost four times more likely to report noticing warnings.
    • Smokers were almost three times more likely to report reading warnings closely.
    • Smokers were more than twice as likely to report thinking about smoking-related health risks.
    • Smokers were almost three times more likely to report considering quitting because of the warnings.
    • Smokers were almost four times more likely to report avoiding looking at the warnings.
    • Smokers were more likely to report forgoing a cigarette at least once because of the warnings.
  • Between Waves 2 and 3, the indicators of warning effectiveness either remained unchanged or, in the case of avoiding looking at the warnings, significantly decreased.
  • The findings indicate that the GHWs lost effectiveness over time as smokers became overexposed to the same images.

Key Messages

  • Graphic health warnings represent a high-priority public health tool with no cost and broad reach.
  • Graphic health warnings are more effective than text-only health warnings for communicating the harms of tobacco use to smokers.
  • Countries considering graphic health warnings should not delay in implementation strong graphic health warning policy.
  • Rotating multiple graphic health warnings every 12 to 24 months prevents overexposure to warning images and reduced effectiveness among smokers.

The WHO Framework Convention on Tobacco Control’s Guidelines for Article 11 recommend that graphic health warnings cover 50% or more of tobacco product packaging and that governments establish a rotation system for revising the content of health warnings every 12–36 months.

Full Citation: Green AC, Kaai SC, Fong GT, Driezen P, Quah ACK, Burhoo PB. Investigating the Effectiveness of Pictorial Health Warnings in Mauritius: Findings From the ITC Mauritius Survey. Nicotine & Tobacco Research. 2014 September;16(9):1240-1247.

Full text [English only] available from:

Additional Resources: For additional information about the effectiveness of pictorial health warnings [Arabic, Chinese, English, French, Portuguese, Russia, Spanish], visit:

Nicotine & Tobacco Researchis a peer reviewed journal sponsored by the Society for Research on Nicotine and Tobacco.

If you have questions about the study or how you may use it in your advocacy efforts, please contact


africa, graphic warning labels, mauritius, who, world health organization