Background: In 2011, the courts ruled in favor of tobacco companies in preventing the implementation of graphic warning labels (GWLs) in the US, stating that FDA had not established the effectiveness of GWLs in reducing smoking. Methods: Data came from various sources: the WHO MPOWER package (GWLs, MPOWER policy measures, cigarette prices), Euromonitor International (smoking prevalence, cigarette consumption), and the World Bank database (countries’ demographic characteristics). The datasets were aggregated and linked using country and year identifiers. Fractional logit regressions and OLS regressions were applied to examine the associations between GWLs and smoking prevalence and cigarette consumption, controlling for MPOWER policy scores, cigarette prices, GDP per capita, unemployment, population aged 15–64 (%), aged 65 and over (%), year indicators, and country fixed effects. Results: GWLs were associated with a 0.9–3 percentage point decrease in adult smoking prevalence and were significantly associated with a reduction of 230–287 sticks in per capita cigarette consumption, compared to countries without GWLs. However, the association between GWLs and cigarette consumption became statistically insignificant once country indicators were included in the models. Conclusions: The implementation of GWLs may be associated with reduced cigarette smoking.

Background This study examines the association between the Tobacconomics cigarette tax scores and cigarette consumption in 97 countries during the period of 2014–2020. Methods Data on countries’ retail cigarette sales and overall cigarette tax scores from 2014 to 2020 are drawn from the proprietary Euromonitor International database and the Tobacconomics Cigarette Tax Scorecard (second edition). Information on countries’ tobacco control environments and demographic characteristics is from the relevant years’ WHO Report on the Global Tobacco Epidemic, and the World Bank’s World Development Indicators database. Ordinary least squares regressions are employed to examine the link between countries’ overall cigarette tax scores and cigarette consumption. All regressions control for countries’ tobacco control environments, countries’ demographic characteristics, year indicators and country fixed effects. Results Each unit increase in the overall cigarette tax scores is significantly associated with a reduction of 9% in countries’ per-capita cigarette consumption during 2014–2020. The reduction is more pronounced in low and middle-income countries (9%) than in high-income countries (6%). The modest improvement in scores from 2014 to 2020 is associated with a reduction of 3.27% in consumption, while consumption could have been reduced by 20.74% had countries implemented optimal tax policies that would earn the highest score of 5. Conclusions Our results provide evidence on the association between higher cigarette tax scores and lower cigarette consumption. To reduce tobacco consumption, governments must strive to implement all four components in the Cigarette Tax Scorecard at the highest level.