Since 1980, large reductions in the estimated prevalence of daily smoking were observed
at the global level for both men and women, but because of population growth, the number
of smokers increased significantly [1]. The most important consequence of smoking is
chronic obstructive pulmonary disease (COPD) which is the fourth leading cause of
morbidity and mortality with high direct and indirect medical costs (about 38.6 billion Euros
in Europe) [2]. Approximately 10 to 15% of smokers aged >40 years will acquire COPD
with higher values where smoking is a greater problem [2]. Furthermore, long-term
exposure to tobacco smokes is the most common cause of approximately 80–90% of lung
cancers [3]. Globally, LC is the most widespread cancer in terms of both incidence and
mortality especially in people over 50. In 2008, there were 1.61 million new cases and 1.38
million deaths were due to lung cancer [4]. Therefore, further efforts to prevent initiation
and promote cessation of tobacco use are urgently needed.
Lots of countries (and recently also in Europe) have implemented prominent health
warnings on cigarette packaging including shocking pictures communicating risk [5-7]. In
fact, researches have proved that using pictures and increasing the size of health
warnings, rather than just text-only messages, enhance their effectiveness with respect to
perceptions of risk and cessation-related behaviors as they cause strong emotional fearrelated
reactions [5-7]. Graphic cigarette warning images reduced cravings to smoke (6.20
point decrease) more than neutral images (3.36 point decrease) [8].
Adolescents in particular can be positively influenced by warning pictures. “After viewing
them, they more frequently read, attended to, thought and talked about warning labels at
follow-ups” [9-10]. Unfortunately, although the use of shocking images and warning
messages is a valid tool of smoke dishabituation, millions of people continue/start
smoking.