WHO FCTC significantly accelerated implementation of health warning labels in low and middle income countries

Heikki Hiilamo and I just published "Implementation of effective cigarette health warning labels among low and middle income countries: State capacity, path-dependency and tobacco industry activity" in Social Science and Medicine.  This paper adds to the empirical case that the WHO Framework Convention on Tobacco Control significantly accelerated implementation of health warning labels, including graphic warning labels, in low and middle income countries.
 
We also found that:
 

• Lower capacity states were less likely to implement warning labels, reinforcing the need to build state capacity.
• Countries that implemented voluntary agreements with the tobacco industry (back in the early 1990s) were less likely to implement FCTC-compliant warning labels
• Higher levels of tobacco industry activity (measured as the number of industry documents that mentioned the country) was associated with greater likelihood of FCTC-compliant warning labels, suggesting that the industry was responding to progress by health advocates.

 
The finding on the long-term inhibitory effects of voluntary agreements is a cautionary message for those working in other areas of public health, such as obesity prevention.
 
Here is the abstract:
 
We investigates the effects of ratifying the WHO Framework Convention of Tobacco Control (FTCT), state capacity, path-dependency and tobacco industry activity on the implementation of effective health warning labels (HWL) on cigarette packs among low and middle income countries (LMIC). Using logistic regression in separate analyses for FCTC Article 11 compliant HWLs and graphic HWLs (GHWL), we found that the odds of FCTC compliance increased by a factor of 1.31 for each year after FCTC entered into force in the country (p p p p   
The full paper is available here and via PubMed.