A pilot study to assess compliance and impact of health warnings on tobacco products in the Udupi district of Karnataka State, India

Abstract

INTRODUCTION The Government of India has taken several steps to reduce tobacco use, including legislation in the Cigarettes and Other Tobacco Products Act (COTPA) requiring health warnings on tobacco products. This study assessed compliance with the legislation on warnings, and awareness of these warnings and their perceived impact in preventing tobacco uptake among college students in a district of Karnataka, India. METHODS This study consisted of two components, pack collection and a survey. For the first, tobacco packs were obtained from all tobacco selling shops in an urban and a rural locality in the Karkala block of Udupi district. Empty cigarette packs were collected from shops, and full packs were purchased if empty packs were not available . The packs were collected to measure their dimensions, as per the Tobacco Pack Surveillance System guidelines, and assessed for compliance, as per COTPA. For the second component of the study, a questionnaire was distributed to each college student to fill in; this was done to assess awareness of the new warnings at the time of the pilot survey, knowledge of harms, and perceptions of the warnings in reducing tobacco uptake. RESULTS We collected 26 tobacco packs. Two (8%) packs had warnings that were the correct size (85% of the main display areas), 15 (58%) packs had clear and legible warnings, and 18 (69%) packs had warning messages in the appropriate language. In the student survey, 60% of males and 52% of females indicated that they would not start using any tobacco products on seeing the new warnings. CONCLUSIONS Only a few studies other than our pilot study have assessed compliance with legislation on health warnings in low- or middle-income countries. Although health warnings were perceived as a deterrent to tobacco use among students, compliance with national legislation in this pilot study was found to be low.

Exploring the Determinants of Intention to Quit and Awareness Regarding Ill Effects and Control Policies of Tobacco among Health Workers of a Tertiary Care Hospital in North India

“…There should be visibility of the antitobacco campaigns at work site and health professionals must be actively involved in promoting tobacco cessation and be trained according to focussed strategies as there is low demand for assistance to quit (Mohan, Lando and Panneer, 2018;Murthy et al, 2018). It is also found that communication on the health effects of smokeless tobacco use within the populations addresses the false beliefs and has a positive impact (Rahman et al, 2015) Increase in the size of pictorial warning can make the message more visible, and it is also a costeffective way of communication which can lead to behavioural changes as there are previous studies stating that pictorial warning depicted did not refrain people from using tobacco (Yaddanapalli et al, 2019;Mullapudi et al, 2019).…”

Does the Graphic Health Warning on Tobacco Products Have an Influence on Tobacco Consumers in India? A Scoping Review

“…On May 27, 2009, the government released a series of graphic health warnings that required different levels of implementation. After numerous modifications, these warnings were required to cover 85% of the front and back of tobacco product packages, with separate warnings for products people smoke and those they do not, as of April 1, 2015 [ 14 , 18 ]. As of 2018, more than 100 countries have implemented graphic warnings on cigarette packages [ 14 , 19 ].…”

“…and "How do you feel when you read the text warning?" Answers to these questions are typically given using words such as "worried," "not to start," "like limiting," "like giving up smoking," and "nothing" [ 5 , 18 , 27 ]. The study found that people who had seen the graphic health warnings were more likely to have a positive attitude toward not smoking.…”

Non-compliant packaging and illicit smokeless tobacco in Bangladesh, India and Pakistan: findings of a pack analysis

“…12 14-28 Illicit trade of ST products has seldom been a focus despite documented ST use in at least 127 countries across the world with over 350 million users. 29 Apart from a handful of single-country reports on packaging compliance, advertising and promotion, [30][31][32][33][34][35] multicountry studies comparing the nature and share of illicit ST sales are non-existent. The absence of any trace and track system or even tax stamps on ST products makes it impossible to estimate the share of illicit ST trade accurately.…”