Pictorial Health Warnings on Cigarette Packs in Iraq: Awareness and Perceptions among One Medical University Staff in Baghdad

Abstract

Background: Pictorial health warnings (PHWs) on cigarette packs communicate the risks of smoking more effectively than text-only warnings. Although Iraqi legislation has required PHWs since 2012, their recognition by the public has not been evaluated.

Objective: To assess the awareness and perceptions of PHWs among the staff of a medical university in Baghdad and to compare ever-smokers with never-smokers.

Materials and Methods: A cross-sectional survey using a self-administered 28-item Arabic questionnaire was conducted in June 2025 among 28 staff members of Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, who were shown example packs bearing PHWs. Groups were compared using Fisher’s exact, Monte Carlo chi-square and Mann–Whitney U tests (SPSS version 22), and handwritten opinions on the campus smoking ban were coded thematically.

Results: Six respondents (21.4%) were ever-smokers. One-third (32.1%), all never-smokers, did not know whether warnings are printed on packs sold in Iraq, and 39.3% did not know what a PHW was. Most agreed that PHWs attract more attention (78.6%) and provide more information (82.1%) than text warnings, and 82.1% supported mandating PHWs on all packs. After viewing the warnings, 86.4% of never-smokers were convinced they would never smoke, whereas only 33.3% of ever-smokers agreed that PHWs would make them quit. Nearly all commenters (96.2%) supported the campus smoking ban, but ever-smokers favored a full ban less often than never-smokers (20.0% vs. 85.7%; P = 0.010).

Conclusion: Awareness of PHWs remains limited despite legislation, although attitudes toward them are favorable. PHWs should be complemented by awareness campaigns, cessation services and enforced smoke-free policies.