Assessment of compliance with tobacco packaging and labeling policies across 14 low and middle income countries

Article 11 of the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) requires that Parties to the Convention implement effective tobacco packaging and labeling measures  to increase public awareness of the negative health impacts of tobacco products.  We present findings on compliance with required health warnings on tobacco packages for the 14 low- and middle-income countries with the greatest number of smokers.

In 2013 we established a global tobacco packaging surveillance system by systematically purchasing packs of cigarettes, kretek and bidis in Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Pakistan, the Philippines, the Russian Federation, Thailand, Turkey, Ukraine and Viet Nam. In each country, data collection was conducted with vendors in low, middle, and high socioeconomic areas of three cities. We purposively selected cities based on population size and cultural, geographic, and linguistic diversity.

We collected 3,335 unique tobacco packs in total and assessed policy compliance on a number of country-specific factors including warning label size and layout, type of warning, language, presence of misleading descriptors, placement of warnings, and obstruction or distortion of health warnings. Preliminary findings reveal color distortion and image distortion on pictorial health warnings, the presence of expired health warning labels, and imported or smuggled packs. Findings provide valuable compliance information and help identify patterns regarding issues of non-compliance across brands and between countries. Findings may inform advocacy efforts for packaging requirements that are compliant with the FCTC as well as improved implementation of current laws.