Awareness of health warnings and factors predicting awareness and perceived effectiveness of pictorial health warnings on tobacco products among adults in rural Puducherry, India

Abstract

BACKGROUND:Limited information exists in India about the awareness and perception of the people regarding pictorial health warnings (PHWs) and text warnings on tobacco products, more so from rural areas. Objectives were to report the awareness of these warnings, factors predicting awareness and perceived effectiveness of PHWs, and understanding of their content in a rural population.MATERIALS AND METHODS:A community-based cross-sectional study was conducted in two villages (chosen randomly out of total four) in the rural field practice area of a tertiary care teaching hospital in Puducherry. Households were selected by systematic random sampling. All persons ≥18 years and residing in the area for at least 6 months were included. Data regarding awareness and perception of participants was collected through a semi-structured interview schedule.RESULTS:A total of 428 participants were recruited; 197 (46%) were male, and 231 (54%) were female. The mean age of the participants was 38.9 (standard deviation 15.0) years. Awareness of PHWs and text warnings was 39.5% (169/428) and 21% (90/428), respectively. Only 11.2% participants perceived PHWs as effective. Most (45%) of the participants had a vague understanding of the content of PHWs. On multivariate logistic regression, male gender, current tobacco use, and better education emerged as predictors of greater awareness of PHWs. Extended family predicted greater perceived effectiveness of PHWs, whereas, high socioeconomic class and middle school completion predicted lower perceived effectiveness of PHWs.CONCLUSION:Awareness and perceived effectiveness of adults in rural Puducherry regarding PHWs were low. There is a need to create awareness through education and using meaningful, larger pictures.

A Qualitative Study of Pictorial Health Warnings on Malaysian Cigarette Packs: How Do the Adults Understand Them?

“…Importantly, understanding a subject helps shape our thoughts and form judgments about it. Studies have shown that higher perceived impacts were observed among those who understood the pictures and messages conveyed by the PHW, and those who possessed adequate health literacy skills [ 20 , 21 , 22 ]. Hence, these highlights the pivotal role of understanding PHWs towards their perceived effectiveness.…”

“…Hence, these highlights the pivotal role of understanding PHWs towards their perceived effectiveness. Moreover, studies have shown that the understanding of PHWs is contributed and related to individuals: (i) knowledge, experience, and exposure on the smoking effects, (ii) their belief of the impact shown by the PHW, (iii) having adequate health literacy skills, (iv) the way and image plus language used in presenting the PHW, (v) their interpretation of the PHWs, (vi) the roles of mass media, and (vii) the ability to relate any smoking effects anatomically [ 20 , 21 , 22 , 23 , 24 , 25 ]. The vague understanding of the pictorial contents among most study participants in rural India contributed to the low perceptions of the effectiveness of the PHWs used in the country during the study period [ 21 ].…”

“…Moreover, studies have shown that the understanding of PHWs is contributed and related to individuals: (i) knowledge, experience, and exposure on the smoking effects, (ii) their belief of the impact shown by the PHW, (iii) having adequate health literacy skills, (iv) the way and image plus language used in presenting the PHW, (v) their interpretation of the PHWs, (vi) the roles of mass media, and (vii) the ability to relate any smoking effects anatomically [ 20 , 21 , 22 , 23 , 24 , 25 ]. The vague understanding of the pictorial contents among most study participants in rural India contributed to the low perceptions of the effectiveness of the PHWs used in the country during the study period [ 21 ]. Moreover, in India, earlier in 2011, PHW presented using a symbol or icon was not understood and perceived as least effective by the participants compared to PHWs depicting the X-ray of a diseased lung [ 22 ].…”

Awareness and perceptions regarding taxation and health warnings related to sugar-sweetened beverages and the factors associated with these among visitors of a general out-patient clinic in Bhopal, India

“…Increased taxation and warnings on tobacco packaging have already succeeded in spreading awareness about its harmful effects,[ 9 ] although the awareness of health warnings on tobacco packaging still seems to be low in India even after so many years of implementation of the warnings. [ 10 ] Similarly, increased taxation on SSBs has been found to reduce obesity by decreasing consumption. [ 11 ] Mexico and United Arab Emirates have increased taxes on SSBs to decrease consumption.…”

Awareness About Pictorial Warnings on Tobacco Products Among Tobacco Users - A Questionnaire Study

“…India is one among the countries with the highest use of tobacco (T, Thejus and Jayakrishan, 2009). Tobacco packages which are left in public view between users may help in curbing passive smoking as it serves as portable advertisement making nonsmokers aware of deleterious effects of inhaling tobacco smoke (Majumdar, kumar and Selvaraj, 2017).…”