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Table 1 Textual health warnings and efficacy messages from the first and second Tobacco Products Directive (TPD) on the packet of tobacco products

From: Differences in smokers’ awareness of the health risks of smoking before and after introducing pictorial tobacco health warnings: findings from the 2012–2017 international tobacco control (ITC) Netherlands surveys

Textual health warning (THW) in first TPDComparable THW in second TPD
Smoking causes blockage of the blood vessels, heart attacks, and strokesSmoking clogs your arteries
Smoking causes heart attacks
Smoking causes strokes and disability
Smoking causes deadly lung cancerSmoking causes 9 out of 10 lung cancers
Smoking damages your lungs
Tobacco smoke contains more than 70 substances that cause cancerb
Quitting smoking reduces the risk of fatal heart and lung diseasesSmoking causes heart attacks
Smoking causes 9 out of 10 lung cancers
Smoking damages your lungs
Smoking during pregnancy is unhealthy for your babySmoking can kill your unborn child
Protect children: do not let them breathe your smoke
Smoking causes serious harm to you and others around youa
Your smoke harms your children, family and friends
Smoking can reduce blood circulation and cause impotenceSmoking increases the risk of impotence
Smoking can damage the sperm and reduces fertilitySmoking reduces fertility
Smoking is deadlyaSmoking is deadly – quit nowb
Smokers die younger-
Tobacco smoke contains benzene, nitrosamines, formaldehyde and hydrogen cyanide-
Smoking ages the skin-
Your doctor or pharmacist can help you quit smoking-
Smoking is very addictive; do not start-
Smoking can lead to a slow, painful death-
-Smoking causes mouth and throat cancer
-Smoking damages your teeth and gums
-Smoking increases the risk of blindness
-Smokers’ children are more likely to start smoking
-Quit smoking – Stay alive for those close to you
Efficacy message
 Find help to stop smoking: DEFACTO 0900–9390 (€ 0.10 / min) or www.stoppen-met-roken.nl or consult your doctor or pharmacistQuit now! Go to www.ikstopnu.nl. Or call the quit line 0800–1995 (free)
  1. aOne of two general warnings that were placed on each packet on 30% of the front of the packet. The other warnings were placed on 40% of the back of the packet
  2. bOne of two general warnings that were placed on each packet on 50% of the lateral sides
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