A comparative perception and impact of pictorial warnings on cigarette packaging among Malaysian smokers and non-smokers

Introduction In 2003, the World Health Organization (WHO) recommended that pictorial warnings on tobacco products be used to educate consumers on the negative health impacts associated with tobacco use. This study aimed to assess the effectiveness of pictorial warnings on cigarette packaging among smokers and non-smokers. Methods A cross-sectional study using a self-administered questionnaire was conducted in Kuala Lumpur. Four components assessed the respondents’ socio-demographics, smoking status, perceptions, and impact of pictorial warnings. Six standard cigarette pictorial warning images were included in the questionnaire. Data collected were analysed using SPSS version 29.0. Frequencies and percentages were used for categorical data, while means and standard deviations were used for continuous data. Statistically significant results were set at p-value < 0.05. Non-parametric tests, the Chi-square test and the One-Way ANOVA test were used to calculate the differences between the variables, as the data was not normally distributed. Results Three hundred seventy-eight respondents participated in this study, with smokers and non-smokers divided equally, 189. Most respondents were 20–29 years old (n = 223, 59.0%) and had tertiary education (n = 207, 54.8%). Most smokers were male (n = 172, 91.0%), and most non-smokers were female (n = 119, 63.0%). Most respondents (n = 364, 96.3%, p = 0.276) noticed the pictorial warnings on cigarette packs. Nevertheless, significantly (p < 0.001) more smokers (n = 73, 38.6%) seldomly read the content compared to non-smokers (n = 57, 30.2%). Most smokers (n = 48, 12.7%) sometimes consider quitting smoking upon exposure to pictorial warnings on cigarette packs. However, most non-smokers (n = 161, 42.6%) never had the urge to smoke upon looking at the pictorial warnings. The most impactful image on cigarette packs among smokers was ‘Lung cancer’ (n = 74, 39.2%), while for non-smokers was ‘Mouth cancer’ (n = 59, 31.2%) with p < 0.001. Conclusion While non-smokers demonstrated greater engagement with and emotional responses to the warnings, smokers showed less frequent interaction and a tendency toward desensitisation. Although pictorial warnings play a vital role in raising awareness of the health risks of smoking, particularly lung and mouth cancer, their effectiveness in encouraging smoking cessation among smokers remains limited.