, 2006; Portillo & Antonanzas, 2002). Collectively, these studies indicate that smokers have increased awareness of warnings, and many report thinking about health risks and quitting smoking as a result of the large text warnings. A wide variety e-book of studies have demonstrated the superiority of using pictures and imagery in health communications rather than text-only messages (Braun, Kline, & Silver, 1995; Leventhal, 1970; Sherman, Cialdini, Schwartzman, & Reynolds, 1985; Strahan et al., 2002). Experimental research on cigarette pack warnings has also found that picture-based warnings are more likely to be rated as effective versus text-only warnings, both as a deterrent for new smokers and as a means to increase cessation among current smokers (Liefeld, 1999; O��Hegarty et al., 2006).

Extensive focus group testing and market research commissioned by government health agencies also underscores the importance of using pictures in package health warnings (BRC Marketing & Social Research, 2004a; Clemenger BBDO, 2004; Corporate Research Associates, 2005; Elliott and Shanahan (E&S) Research, 2003; Environics Research Group, 2000; Les ��tudes de Marche Createc, 2006). This research consistently demonstrates that health warnings with pictures are rated by smokers and nonsmokers as more effective and associated with greater impact and recall for health risks than text-only warnings. A series of population-based surveys have compared the effectiveness of text and pictorial warnings.

These findings are consistent with both the experimental and the government commissioned research: Graphic warnings are more likely to be noticed and read by smokers, are associated with stronger beliefs about the health risks of smoking, as well as increased motivation to quit smoking (Clemenger BBDO, 2004; Corporate Research Associates, 2005; Elliott & Shanahan (E&S) Research, 2003; Environics Research Group, 2000; Hammond, Fong, McDonald, Brown, & Cameron, 2004; Hammond, Fong, McDonald, Cameron, & Brown, 2003; Hammond & Parkinson, 2009; Hammond, Fong, et al., 2006, 2007; Les ��tudes de Marche Createc, 2006; Thrasher, Hammond, Fong, & Arillo-Santillan, 2007; White, Webster, & Wakefield, 2008). Picture warnings appear to be especially effective among youth (Environics Research Group, 1999; Moodie, Mackintosh, & Hammond, 2009; White et al., 2008).

In Canada, more than 90% of youth agreed that picture warnings on Canadian packages have provided them with important information about the health effects of smoking cigarettes, are accurate, and make smoking seem less attractive (Environics Research Group, 2007b). Cilengitide Pictorial warnings may be particularly important in communicating health information to populations with lower literacy rates (CR��ATEC + Market Studies, 2003; Malouff, Gabrillowitz, & Schutte, 1992; Millar, 1996).