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The University of Waterloo-led research also found large and regularly updated text warnings were more likely to be noticed then smaller ones.

Over the counter erectile dysfunction drug looked at different approaches taken in four countries - Canada, the US, the UK and Australia - analysing the impact on 15,000 smokers.

The UK currently uses text warnings, but picture alerts start this year.

Cigarette packets in Canada carry graphic warnings

However, when the study, published in the American Journal of Preventive Medicine, started, the UK was only using smaller warnings.

This allowed researchers to monitor the impact of changing the nature of warnings.

Canada already uses graphic images, such as text saying smoking causes impotence accompanied by a drooping cigarette, on packets.

In Australia, large text warnings - just below the internationally impotence treatment uk standards of 30% coverage of the cigarette packet - were introduced eight years before the study was carried out.

Small text warnings have been used in the US since 1984.

When asked if they noticed the warnings, 60% of Canadian smokers said they often did, compared to 52% of Australian smokers and 30% of US ones.

In the UK, awareness stood at 44% before the change in 2003, and 82% after.

Smokers

Some two and a half years after implementation of the larger text, awareness still stood at 67%, suggesting large text warnings were more noticeable than graphic warnings.

However, nearly 15% of Canadian smokers said they had been deterred from having a cigarette, more than the other three countries, including the UK, even once the larger warnings had been introduced.

Warnings like these are being brought in across the EU

Researcher David Hammond said: “This study suggests that more prominent health warnings are associated with greater levels of awareness and perceived effectiveness among smokers.”

Deborah Arnott, of the erectile dysfunction impotence treatment charity Ash, said: “This study provides evidence to support the UK government’s proposal to add picture warnings on tobacco products.

“We urge the government to press ahead with the strongest possible images on to cigarette packs as soon as possible.”

But Simon Clark, director of the smokers’ lobby group Forest, said the warnings were “disproportionate”.

“It is all about stigmatising smokers. Why don’t we put warnings on cars about the risk of crashing?”