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The none-too-subtle message was that if the nurse, with all of her expertise and her dedication to helping patients, chose to smoke a particular brand of cigarettes or even recommended a particular brand, then it must be safe

The packs with graphic warning labels had their main effect on those who were least likely to hide their packs prior to the study. Strong concluded: "We found no evidence that graphic warning-labeled packs changed smoking behavior over the year-long study.

"It's great having tobacco control strategies but the enforcement arm of that needs to be in place, and if it's not it completely undermines the wider strategy." Experts say counterfeit cigarettes, in particular, can contain poor quality tobacco, plastic and human or rat faeces

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Engaging the relevant communities to identify, design, and evaluate interventions to protect their communities is critical if these interventions are to be effective and sustained