Introduction:
The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 11 recommends provisions on packaging and labeling for tobacco products, including health warning labels (HWLs), constituents and emissions information, removal of misleading information, and plain packaging to reduce tobacco consumption. The objective of this study was to assess the adoption of tobacco products packaging and labeling policies based on the FCTC’s Article 11 guidelines in the WHO Region of the Americas (AMRO).

Material and Methods:
We reviewed data on the regulatory environment of tobacco packaging and labeling in AMRO. Data was extracted from Tobacco Control Laws (www.tobaccocontrollaws.org), a database developed and maintained by legal advisors at the International Legal Consortium from the Campaign for Tobacco-Free Kids in collaboration with in-country lawyers, wherever possible. We analyzed four sub-policy areas for smoked and smokeless tobacco products: 1) HWLs (e.g., size), 2) constituents and emissions (e.g., message content), 3) misleading information (e.g., brand descriptors), and 4) other requirements (e.g., standardized/plain packaging).

Results:
Of 35 countries in AMRO, 31 have tobacco packaging and labeling laws. Twenty-six countries require pictorial HWLs, 24 require warnings printed on at least 50% of the front and back of the packs, and 24 rotate a single or multiple (from 2 to 16) warnings within a specified period (from 5 up to 24 months). Only 21 countries require descriptive messages on toxic constituents and emissions information. Twenty-seven countries ban brand descriptors with references to implied harm reduction (e.g., “light”), 24 ban figures, colors, and other signs, but only 13 prohibit emission yields printed on the packs. Only Canada and Uruguay have adopted standardized tobacco packaging while Uruguay also requires a single presentation (one brand variant) per brand family.

Conclusions:
Many countries in AMRO have made good progress in adopting multiple, rotating, large pictorial HWLs and banning misleading brand descriptors. However, there needs to be greater attention on other tobacco packaging and labeling provisions with a focus on implementing standardized tobacco packaging.