IntroductionFor the past 20 years, there have been no changes to the text-only cigarette warning labels in the United States. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of this study was to investigate the reactions of U.S. young adult smokers and nonsmokers aged 18 to 24 years to Canadian cigarette label text and graphic warnings. The study focused on determining their perceptions and the potential impact of Canadian labels on smoking, and study participants were asked for suggestions for modifications of U.S. cigarette warning labels so they would be effective for smoking deterrence and cessation.Methods During January and February 2002, 11 focus groups consisting of 54 smokers and 41 nonsmokers were conducted in the Detroit metropolitan area. Current smokers were defined as those who had smoked a cigarette within the past 30 days. Participants were asked about their knowledge and perceptions of current U.S. cigarette warning labels and their impressions of Canadian cigarette warning labels.AnalysisA content analysis and a word index were applied to the transcripts of all focus groups to identify and clarify themes and domains that appeared in group discussions and to compare results across different groups.ResultsFocus group participants reported that Canadian cigarette warning labels were more visible and informative than U.S. cigarette warning labels. Messages perceived to be relevant to smokers were considered effective. Education level did not appear related to how participants responded to warning labels. There were some differences for warning labels that had sex-specific messages.DiscussionWarning labels are one component of comprehensive tobacco control and smoking cessation efforts. Stronger warnings on cigarette packages need to be part of a larger U.S. public health educational effort.