Estimating the Effectiveness of Health Warnings on Cigarette Packaging in Nigeria: A Modelling Study

Andrea Alcaraz, Adeniran Adedeji, Andrés Pichón-Riviere, Mma Amara Ekeruche, Agustín Casarini, Federico Rodriguez Cairoli, Natalia Espinola, Javier Roberti, Alfredo Palacios, Ariel Bardach

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Tobacco consumption is associated with nearly 30,000 deaths annually in Nigeria alongside other adverse health and economic effects. Our objective was to estimate the health and economic implications of the current cigarette labelling policies (text-only health warnings (HW)); new HW policies in the country (adding graphic HW with up to 60% coverage), and plain packaging policy as recommended by the World Health Organization.

METHODS: We used a probabilistic state-transition individual microsimulation model, considering natural history, healthcare costs, and quality-of-life losses associated with main tobacco-attributable diseases; and the potential effects of packaging and labelling policies. We used three scenarios: a) text-only HWs covering 50% of the pack, b) introduction of graphic HWs of 50% (and later increasing to 80%) of the pack, c) plain packaging with HWs covering 80% of the pack.

RESULTS: A total of 748 deaths are averted in the current situation; 7,478 and 14,208 deaths can be averted with the new policy and with plain packaging, respectively. The number of cardiac, cerebrovascular, and cancer events that could be averted by adopting text and graphic HWs are 3,093, 5,093, and 1,346, respectively; increasing to 5,876, 9,676, and 2,557, respectively, with plain packaging. Up to 251,794 years were lost due to early deaths and disability, and ₦144.6 billion (USD 469 million) in health costs could be saved with HWs covering 50% to 80% of the pack over 10 years. With plain packaging and graphic HWs covering 80% of the package 478,408 years and ₦274.7 billion (USD 895 million) would be saved.

CONCLUSIONS: The new cigarette labeling policy in Nigeria may yield significant health and economic benefits over 10 years. Moving the current policy to plain packaging can significantly improve these benefits.

IMPLICATIONS: The new cigarette labeling policy that Nigeria is implementing should aim to achieve 100% compliance with its current regulation and the logical next step: plain packaging with large warnings. The present study adds evidence on the potential health effects and cost savings of these levels of implementation, which is valuable for local policymakers.

Original languageEnglish
JournalNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Early online date1 Jun 2023
Publication statusPublished - 2023

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© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].

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