Introduction:
Tobacco pack health warnings are an effective channel to inform smokers of the dangers they face. The FCTC (Article 11, item 2b) requires the rotation of health warnings. Since October 2012, 10 large (50% of the pack surface area) graphic health warnings on tobacco packaging have been introduced in Ukraine. This study aims to analyze the distribution of these 10 health warnings on cigarette packs purchased by Ukrainian smokers.

Material and Methods:
In three nationally representative cross-sectional surveys conducted in Ukraine in 2013, 2014 and 2015 and covering not less than 2000 respondents each year, during face-to-face interviews all participating smokers were asked to demonstrate a cigarette pack. The kinds of health warnings were recorded.

Results:
The distribution of 10 pictorial health warnings was uneven in all three surveys but consistent over time. The most frequently printed warnings were those related to lung cancer (30-37% of all current warnings on Ukrainian cigarette packs) and early death of smokers (18-21%). All other warnings were only seen on 2-13% of packs. The least seen were those related to benefits of quitting (2-6%), skin aging (3-6%) and intrauterine tobacco-related harm (3-5%).

Conclusions:
Tobacco industry consistently overproduces packs with certain health warnings on tobacco packs to minimize the presentation of others. This might be caused by the industry's estimates of comparative potential impact various health warnings might have on users. To properly inform smokers of various aspect of tobacco-related harm, national legislation needs to require each health warning should appear on an equal number of packages.