Do cigarette pictorial warnings really work for Korean smokers?
Department of Journalism and Public
Relations, Jeju National University, Jeju,
Seohyeon Lee, Department of Journalism and
Public Relations, Jeju National University, Jeju,
According to previous research, cigarette pictorial warnings are effective in not only
preventing smoking but also in inducing smoking cessation. In Korea, however, the
smoking rate has not changed much despite implementing pictorial warnings on ciga-
rette packaging. Thus, in this study, I focused on how smokers perceive cigarette pic-
torial warnings. To do this, I conducted in‐depth interviews with cigarette buyers at a
convenience store where real cigarettes were purchased, and I observed their behav-
iors at the same time. Thirty buyers responded to the interview. During the interviews,
respondents said that when they first saw a tobacco warning picture, they were
affected by it at the moment, but it did not help at all to quit smoking. Rather, they jus-
tified smoking by considering the warning picture as a picture or a cigarette company
logo. They also had a positive illusion of, “It will never happen to me”about the
smoking‐related illnesses presented in the warning pictures. Above all, cigarette warn-
ing pictures were not effective in reducing rates of smoking. This means that the
tobacco warning picture policy did not properly influence smokers' perceptions.
Further research on the usefulness of cigarette pictorial warning is needed.
Vivid images make up the cigarette pictorial warnings attached to
packaging of cigarettes currently sold in South Korea: lung cancer,
laryngeal cancer, oral cancer, heart disease, stroke, secondhand smoke,
pregnant women smoking, sexual dysfunction, skin aging, and prema-
ture death (MOHW, 2016a).
Cigarette pictorial warnings designed to inform consumers about
the harms of tobacco use have been widely adopted in recent years
(Kees, Burton, Andrews, & Kozup, 2010). This is a representative
nonprice‐related smoking cessation policy recommended by the World
Health Organization (WHO), and it has been implemented in more
than 101 countries around the world since it was first introduced in
Canada in 2001 (MOHW, 2016a, b). A recent study (Noar et al.,
2011) reported that tobacco warning pictures are more effective than
warning text only and that colored warning pictures are more effective
than black‐and‐white images. Also, larger‐sized pictorial warnings are
more effective (Hammond, 2011). Many countries have implemented
tobacco warning pictures accordingly.
In Korea, after the ratification of the WHO Framework Conven-
tion on Tobacco Control in May 2005, full‐fledged discussions on
cigarette warning pictures began in July of the same year. However,
cigarette warning pictures were not easily implemented because of
the lack of government willingness to help with smoking cessation,
opposition from tobacco growers, and lobbying by tobacco companies.
The tobacco warning picture policy had been pending in the Korea's
National Assembly since 2002 and was introduced in June 2015, after
13 years of legislative efforts. All cigarette packs produced after
December 23, 2016, have been required to include both text and
pictorial warnings accordingly.
The warning picture must be presented on the front and back of
the cigarette pack. There are 10 types of warning pictures, with 5
types of diseases related to smoking and 5 types of nondiseases
related to secondary smoking, as shown in the Figure 1. Also,
according to the enforcement ordinance of the National Health
Promotion Act, warning pictures should be regularly replaced every
According to the Korean Health Promotion Institute cigarette pic-
torial warning labels have a practical effect. A study of 18 countries
implementing graphic warnings showed the smoking rate of those over
the age of 15 has declined by an average of 4.2%. Specifically, the
smoking rate in Brazil has decreased from 35.4% in 2000 to 21.6% in
2008 (MOHW, 2016b). Korea's Ministry of Health and Welfare also
positively evaluated the effectiveness of tobacco warning pictures.
According to the results of the survey on cigarette warning images
published by the National Center for Smoking Cessation of the Korea
Received: 23 February 2018 Accepted: 26 February 2018
J Public Affairs. 2018;18:e1709.
© 2018 John Wiley & Sons, Ltd.wileyonlinelibrary.com/journal/pa 1of9