Methods: Review of legislation on tobacco products packaging and labeling, analysis of internal tobacco industry documents from the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) and British American Tobacco Documents Archive (http://bat.library.ucsf.edu), and assessment of tobacco products packages according to a detailed rubric.

Results: Most countries of the Americas only require a weak, unspecific, small, and text-only warning label (i.e., “Smoking is harmful to health”). Specific legends with references to cancer, stroke, cardiovascular disease, emphysema, and sexual impotence are required to appear on a rotating basis in a few countries. In addition, only few countries communicate information on the consequences of secondhand tobacco smoke, addictiveness of nicotine, benefits of quitting smoking, and a quit line telephone number. Since 2001, Canada, Brazil, Venezuela, Uruguay, and Chile have introduced pictorial-based health warning labels. Few countries disclose toxic constituents and emissions, including tar, nicotine, carbon monoxide and arsenic. Misleading descriptors (e.g., “light”) are rarely banned in the region. Tobacco companies voluntary print warnings of adult product (e.g., “Only for adults,” “Underage sale prohibited”) as part of their “youth smoking prevention” programs and warnings of harm reduction (e.g., “There is no safe cigarettes,” “100% additive-free”).

Conclusions: Twenty-one out of 35 countries of the Americas have ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC). However, very few of them have implemented the FCTC's recommendations on packaging and labeling as indicated in Article 11.