Introduction: Initially, studies showed that graphic warning signs (GWSs) on cigarette packages encouraged smok- ing cessation. However, there have been recent concerns over the effectiveness of GWSs to change smoker percep- tions and behavior over time. Our goals were to assess the latest perceptions of GWSs among smokers in Kelantan and to determine the factors associated with them. Methods: This cross-sectional study was conducted among re- spondents who attended outpatient clinics in a teaching hospital in Kelantan. Their perceptions were analyzed with a validated Malay questionnaire containing four domains: fear, influence, credibility, and picture content. Results: The average smoking age was 17 (3.04) years old. The mean smoking time was 11 (7.49) years. The average daily cigarettes smoked was 8 (6.26). Most respondents perceived low levels of fear (83%), poor picture content (65.5%), low influence (87.6%), and low levels of credibility (70.1%) in GWSs. Those with low levels of education were significantly associated with poor perceptions of GWSs. Conclusion: Despite vigorous efforts by the government to discourage smoking in Kelantan, smokers still poorly perceive GWSs. More effective health-promotion strategies are essential to influence smokers in this area.