In the six countries studied, researchers found that awareness about warning labels was greatest among children in Brazil where graphics often featured extremely gruesome pictures and covered 100 percent of either the front or back of the cigarette packet.

Awareness of health warning labels was lowest among children from India and Nigeria.

The Indian warning label shows an image of a symbolic scorpion and the Nigerian warning label uses only a vague text message.

"Pro-smoking messages are reaching the world's most susceptible audiences. We need to do a better job globally to reach children with anti-smoking messages," said lead author Dina Borzekowski from University of Maryland School of Public Health (UMD).

The study showed that only 38 percent of children had any awareness of warning labels currently being featured on cigarette packages.

Their findings offer data from 2,423 five and six year-old children interviewed in Brazil, India, China, Nigeria, Pakistan and Russia about their awareness and understanding of cigarette health warning labels.

Even after showing warning labels to participating children, around two-thirds (62 percent) of the children were unable to explain what the health warnings were about, noted the study.

"Heath warning labels on cigarette packs are an important medium for communicating about the serious health effects caused by tobacco products," stressed Joanna Cohen from Johns Hopkins Bloomberg School of Public Health.

The messages are most effective when the labels are large and include pictures that evoke an emotional response, said the study published in Journal of Public Health.


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