At least 23 countries now use picture warnings, including images of diseased lungs, a dying smoker¹ and a fetus²
China must use graphic³ picture warnings and expand health messages on cigarette packs to alert more people to the dangers of smoking, according to health experts.

The country is scheduled to introduce new cigarette pack designs next year with "bigger, clearer warnings", according to the World Health Organization Framework Convention on Tobacco Control.

A recent State Tobacco Monopoly Administration regulation requires written warnings to cover 30 percent of the pack.

"Compared with the previous packages, the warnings were printed in smaller characters, and the use of colors made the warnings less distinguished," Yang Jie, deputy director of the tobacco-control office under the Chinese Center for Disease Control and Prevention, said at a recent seminar.

But all designs comply with the minimum requirement of the Convention, he said.

"The written messages are vague and inexplicit about the harm of smoking, and it is time to introduce hard-hitting images on cigarette packets," Professor Wu Yiqun, director of the Beijing-based thinktank Research Center for Health Development, said.

The regulation also requires tobacco producers to print warnings in English on the back of cigarette packs sold domestically.

"It is ridiculous, because many Chinese cannot read English, and such warnings are useless," Professor Wu said.

Health lobbies are now trying to urge the tobacco administration to put picture warnings on cigarette packs.

Evidence from Canada, Brazil and elsewhere shows the images have a greater impact than written health warnings, they said.

At least 23 countries now use picture warnings, including images of diseased lungs, a dying smoker and a fetus.

A dozen countries require the picture warnings to cover half the pack.

"But the point is the country's health administration now has no say on the matter of cigarette package design and implementations," Wu said.

The good news is a majority of people support large picture warnings.

A website survey that began on Wednesday shows 67 percent of the 2,700 people who had voted by Thursday evening agreed "large picture warnings were helpful to motivate smokers⁴ to quit".

Only one-fifth of those surveyed said the images' impact was limited, while another 12 percent said they were useless.

"The image warnings look really scary. It might have less impact on long-time smokers, but it can certainly scare off those who have just begun to smoke," Wang Zhiping, an IT engineer in Shanghai who quit smoking three years ago, said.

China has the largest number of smokers in the world.

Official statistics showed China had 300 million smokers in 2007, with an additional 540 million people forced to inhale⁵ passively.

Each year, about 1 million Chinese die from smoking-related illnesses.