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Background Following to insertion of pictorial health warning on cigarette packages in 2009, in order to know the effects of this policy, a qualitative - quantitative study has been performed in Tehran City. Methods Focus group discussions (FGD) with six groups of smokers and nonsmokers aggregated by sex, educational level and smoking status totaling 46 people as well as random dialing method in Tehran citizens totaling 850 individuals was performed. Results FGDs showed that using a still image and not changing it over time caused in lowering effects of health messages. Most people think that the quality of the image has an impact on non-smokers as a barrier to start smoking. Telephone interview showed that these images could prevent from starting smoking (57.2%) and 36.8% were stated that these images are ineffective in preventing the onset of smoking.67.6% stated that these images led them to discuss about the hazards of smoking, 71.3% encouraged their families and friends to quit smoking and 63.9% announced that these images caused in preventing their associates from being smoker. In total, about 84 percent of people was supported the insertion of pictorial health warnings on tobacco packages (83.9%) and 10% (85 individuals) were against this policy. More than half of smokers following to see these images, decreased their cigarette consumption, and less than half of smokers reported no change in their smoking rates (55.1% against 43.3%). Considering the effect of these pictures on the cessation, about 38 percent claimed that made them think about quit smoking, 63.8% of smokers said it caused their associates to ask them for quitting and 12% claimed that it made them quit. Conclusions This policy applies to a positive change in the attitude and behavior of the smokers and people around them and necessary steps to increase the efficiency of these images are required.