Objective To evaluate the warning effect of different tobacco packaging on teenagers and provide an objective evidence for improving tobacco packaging in China.
Methods A multi-stage cluster sampling method was used to investigate students from two middle schools and two high schools in Huangpu District， Shanghai with a self-filled questionnaire survey， and a total of 1 238 valid questionnaires were collected. Epidata 3.1 was used to input data and SPSS 20.0 was used for data analysis.
Results About 69% of the respondents supported printing pictures of diseases on tobacco packages in China， and 81.58% thought graphic warnings should cover more than 70% of the tobacco package. The effect of graphic health warning labels was better than that of text-only warning labels （P<0.05）， and the effect of real photos was better than abstract pictures. In addition， labels with real graphic warnings had the highest scores in terms of preventing youth smoking and the degree of support， which was significantly different from abstract graphic warning labels and text-only warning labels （P<0.05）.
Conclusion Cigarette packs with graphic health warnings have a stronger effect on teenagers than plain text health warnings. Teenagers support the use of graphic warnings. It is recommended to apply graphic health warnings with real photos of diseases on the cigarette packages to maximize the effect of the health warnings.
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