Health warnings on cigarette packages prompt smokers to think about quitting, according to a 14-nation study. Effective warning labels as a component of comprehensive tobacco control can help save lives by reducing tobacco use, said a report released by CDC.

The study, published in Morbidity and Mortality Weekly Report, finds adult usage of manufactured cigarettes varied widely in the 14 countries surveyed: Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, the Russian Federation, Thailand, Turkey, Ukraine, Uruguay and Vietnam. Among men, prevalence ranged from 9.6 percent (India) to 59.3 percent (Russian Federation). Among women, prevalence was highest in Poland (22.9 percent) and less than 2 percent in Bangladesh, China, Egypt, India, Thailand, and Vietnam.

The Global Adult Tobacco Survey (GATS) was conducted once in each of the 14 countries between 2008-2010 by national governments, ministries of health, survey implementing agencies and international partners through face-to-face personal interviews using electronic data collection.

“Tobacco kills more than 5 million people a year—more than HIV, tuberculosis, and malaria combined—and will kill more than 1 billion people in this century unless urgent action is taken,” said CDC director Thomas R. Frieden, M.D., M.P.H. “Warning labels motivate smokers to quit and discourage nonsmokers from starting, are well accepted by the public, and can be effectively implemented at virtually no cost to governments.”

According to the report, the vast majority of men that use manufactured cigarettes noticed package warning labels—more than 90 percent of men in all countries except India (78.4 percent) and Mexico (83.5 percent). Among women, more than 90 percent in seven of the 14 countries reported noticing package warnings, and at least 75 percent in 12 of 14 countries reported noticing a package warning. Among those who noticed package warnings, data suggest there was substantial interest in quitting because of the warnings.

Prominent, pictorial warnings are most effective in communicating the harms of smoking, and use of such warnings is strongly encouraged by CDC and the World Health Organization (WHO). At the time the surveys were conducted, five of the 14 countries participating in the survey had adopted pictorial warnings already. Since that time, four additional countries have passed legislation requiring pictorial warnings.

The World Health Organization has developed MPOWER, a package of strategies to reduce global tobacco use. Among the six elements outlined in the MPOWER package, the WHO has identified the following strategies as “best buys,” or high impact cost-effective initiatives, due to the impact these strategies can have to prevent tobacco initiation, increase cessation, and reduce public acceptance of tobacco use: price increases; smoke-free policies; bans or comprehensive restrictions on tobacco advertising, promotion, and sponsorship, and provision of tobacco-related health information via mass media campaigns and graphic health warnings to the public.

On May 31, many countries will observe World No Tobacco Day—an annual event sponsored by WHO—to help raise public awareness of the dangers of tobacco use. This year’s theme is “The WHO Framework Convention on Tobacco Control (FCTC).” The FCTC is an international global public health treaty adopted by the World Health Assembly in 2003 to address the global burden of tobacco. Article 11 of the FCTC requires health warnings on tobacco product packages sold in countries that have ratified the treaty.

Launched in February 2007, GATS is a nationally representative household survey of all non-institutionalized, men and women ages 15 years old and older. The GATS is intended to enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. Funding for GATS is provided by the Bloomberg Initiative to Reduce Tobacco Use and is conducted in partnership with the Campaign for Tobacco Free Kids, CDC Foundation, Johns Hopkins Bloomberg School of Public Health, World Health Organization, and the World Lung Foundation.

For an online version of the MMWR report, visit www.cdc.gov/mmwr. For information on World No Tobacco Day, visit www.cdc.gov/tobacco, and for additional information and materials, including posters, visit WHO’s Tobacco Free Initiative at http://www.who.int/tobacco/en/.