Communicating risk: Status of health warning labels on various tobacco products in Indian market

Joseph, Neema; Goel, Sonu; Singh, Rana J; Patro, Binod Kumar; Pala, Star; Kumar, Rajeev; Purohit, Bishwaranjan; Medini, Shravan Kumar; Kharbangar, Ory Nica; Kar, Sitanshu Sekhar

doi:10.1016/j.ijtb.2021.07.009

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…A similar study reported that nearly 81 per cent of tobacco products displayed a health warning 23 . Inserts of promotion messages were also absent in more than 70 per cent of the cases, and in Telangana, it was 100 per cent at both time points; findings similar to other studies 22 .…”

Section: Discussionsupporting

confidence: 87%

“…All the UT/States showed a decrease in percentage from baseline to endline regarding compliance with sections 7, 8 and 9 of COTPA. The presence of a health warning was noted in more than 70 per cent of all tobacco products in project UT/States, and similar results were obtained in a study conducted by Joseph et al 22 where the absence of a health warning was noted on 15 per cent of the products. A similar study reported that nearly 81 per cent of tobacco products displayed a health warning 23 .…”

Section: Discussionsupporting

confidence: 86%

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Comparative assessment of implementation of Cigarette and Other Tobacco Products Act in three States of India: A pre-post study

Goel,

Anjali,

Kar

et al. 2023

Indian Journal of Medical Research

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Background & objectives: The Cigarette and Other Tobacco Products Act (COTPA) limits the sale of tobacco products, promotion and advertising and packaging of tobacco products in India. Periodic monitoring of the level of compliance with all sections of COTPA is obligatory to assess the effectiveness of the act. Methods: This pre-post study aimed to assess the change in the level of compliance with different sections of COTPA in selected States. A total of 3849 and 2176 samples were assessed during the study in November 2020 and October 2021, respectively; using the EpiData Software. Results: Average compliance with section 4 of COTPA was highest in Puducherry during baseline [51.88%, prevalence ratio (PR)=0.72, 95% confidence interval (CI): 0.51-1.02] and in Telangana during endline assessment (66.1%, PR=0.6, 95% CI: 0.48-0.74). A visible change with section 5 of COTPA was observed in Telangana (40.08 to 93.12%, PR=0.04, 95% CI: 0.02-0.07). Compliance with section 6a of COTPA decreased in Puducherry (81.34 to 71.83%, PR=1.84, 95% CI: 1.14-2.95) and increased for Meghalaya and Telangana. The average compliance with sections 7, 8 and 9 (for Puducherry 51.09 vs. 48.8%, Meghalaya 54.94 vs. 46.18% and Telangana 73 vs. 51.91%, respectively) decreased in all States. An increase in average compliance was observed with sections 4 and 5 (P=0.19 and 0.11, respectively) and a decrease with sections 7, 8 and 9 (P=0.02) of COTPA in all three States. For sections 6a (P=0.06) and 6b (P=0.01), a mixed response was noted. Interpretation & conclusions: The findings of this study suggest that the level of compliance with sections 4 and 5 of COTPA increased because they are strictly monitored compared to sections 7-9, which are less enforced by the States. There is a need to monitor sections 7-9 (pack warning) to fulfill the objectives related to the World Health Organization (WHO) Framework Convention on Tobacco Control.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 86%

Comparative assessment of implementation of Cigarette and Other Tobacco Products Act in three States of India: A pre-post study

Goel,

Anjali,

Kar

et al. 2023

Indian Journal of Medical Research

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“…These results confirm those of other studies in India whereby HWLs have low levels of HWL awareness. 16 33 Lack of change in awareness may be attributed to factors that prevent individuals from encountering HWLs, for example, limited manufacturer compliance with the regulations, [34][35][36] illicit SLT and the purchase of loose rather than packaged SLT products. 24 A study that collected SLT packages following increased HWL size requirements reported that while 97.5% of Indian SLT products had an HWL, compliance with all regulations was poor.…”

Section: Original Researchmentioning

confidence: 99%

Evaluation of the effectiveness of the Indian government’s policies to strengthen health warning labels on smokeless tobacco products: findings from the 2010–2019 Tobacco Control Project India Surveys

Holdroyd,

Puntambekar,

Driezen

et al. 2024

Tob Control

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BackgroundSmokeless tobacco (SLT) packaging in India had a single symbolic (a scorpion) health warning label (HWL) in 2009 covering 40% of the front surface. In 2011, it was replaced with four pictorial images. In 2016, HWLs were enlarged to 85% on the front and back. This study aimed to assess the effectiveness of the old (symbolic and smaller images) and larger HWLs.MethodsData were from the Tobacco Control Project India Survey and included respondents who used SLT in Wave 1 (2010–2011, n=5911), Wave 2 (2012–2013, n=5613) and Wave 3 (2018–2019, n=5636). Using a repeated-measures design, weighted logistic regression models assessed whether there were changes in seven HWL effectiveness measures within the domains of awareness, salience, cognitive and behavioural responses. A cohort design was employed to test whether HWL effectiveness in Waves 1 and 2 was associated with quitting SLT in Waves 2 and 3, respectively.ResultsThe 2011 HWL revision did not result in any significant changes in HWL effectiveness. There was no significant change in HWL awareness and salience after larger HWLs were introduced in 2016, but respondents were more likely to consider SLT health risks (Wave 2=17.9%, Wave 3=33.6%, p<0.001) and quitting SLT (Wave 2=18.9%, Wave 3=36.5, p<0.001). There was no change in HWLs stopping SLT use (Wave 2=36.6%, Wave 3=35.2%, p=0.829); however, respondents were more likely to avoid looking at HWLs (Wave 2=10.1%, Wave 3=40.2%, p<0.001). Effectiveness of older, symbolic and smaller pictorial HWLs was not associated with quitting SLT.DiscussionThere was no significant change in HWL effectiveness following the revision from a symbolic to a pictorial image, but enlarging pictorial images resulted in some improved cognitive and behavioural effects. Results suggested wear-out of HWL salience and that the effectiveness of warnings depends on both their design and time since implementation.

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“…A scoping review study conducted by Mudey et al (2023) evaluates the impact of graphic health warnings on tobacco packaging in India and suggests the need for more visible and comprehensible images to effectively discourage tobacco use [17]. A comprehensive community-based cross-sectional analytical research study by Joseph et al (2021) using 2044 tobacco product packs gathered from various points of sale discovered that a higher proportion of smokeless/local variety tobacco products lacked a health warning label [18].…”

Section: Introductionmentioning

confidence: 99%

Health Warnings on Tobacco Packages: A Compliance Assessment Study Around Educational Institutions in Bhubaneswar, India

Satpathy,

Jena,

Epari

et al. 2023

Cureus

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BackgroundGraphic health warning labels (HWLs) on tobacco product packaging have been identified by the World Health Organization (WHO) as a cost-effective policy intervention to warn consumers about the health risks of tobacco. Compliance with HWLs shields young individuals from tobacco marketing influences and exposes users to health warnings. Assessing compliance with health warning labels would provide insights into the state of law implementation. The study assessed health warning labels on tobacco packages as per the Cigarettes and Other Tobacco Products (COTPA) (Packaging and Labelling) Amendment Rules of 2020, specifically assessing their availability around educational institutions in Bhubaneswar, Odisha, India. Materials and methodsFrom August 2022 to January 2023, a protocol was employed to collect information on the sale of tobacco products around educational institutions including packages of cigarettes, beedis, and smokeless tobacco (SLT) from Bhubaneswar City. Using multistage random sampling 18 schools were selected in Bhubaneswar City. Areas within 100 yards (91.44 meters) of each school were mapped using a map tool. All prospective tobacco vendors within 100 yards of each school were included in the study. The data on compliance with HWLs were summarized using descriptive statistics. The health warnings compliance assessment of the tobacco products available with the vendors was conducted using three major indicators, including analysis of the font content, size and element of the graphics, and textual health warnings. In addition, the surface area occupied by these warnings was measured using a calibrated ruler. ResultsWithin 100 yards of 18 schools in Bhubaneswar city, 57 vendors were found selling tobacco. About 48 distinct brands and 791 unbranded tobacco products were identified from 2135 packets collected from 57 vendors. Out of the 48 branded product packets examined, 25 brands were for smoking (cigarettes, bidis), while 23 were for SLT products such as khaini, gutkha, and pan masala containing tobacco. Only six brands out of 17 cigarette packs complied with HWL provisions. None of the eight unique bidi packs and 302 unbranded bidi packs were compliant with any HWL compliance indicators. Other compliance-related issues included incomplete health warning labels, out-of-rotation pictorial health warnings, distorted printing (blurry, heavy tint, and faded), and split warnings. ConclusionTobacco products were sold within 100 yards of educational institutions in clear violation of the COTPA Section 6 provisions. Furthermore, the tobacco products sold were also not in compliance with the health warning label laws under section 7 of COTPA. There is an urgent need for strict enforcement of the provisions relating to the ban on sale within 100 yards of educational institutions and health warning label rules in Bhubaneshwar.

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Communicating risk: Status of health warning labels on various tobacco products in Indian market

Cited by 5 publications

References 18 publications

Comparative assessment of implementation of Cigarette and Other Tobacco Products Act in three States of India: A pre-post study

Comparative assessment of implementation of Cigarette and Other Tobacco Products Act in three States of India: A pre-post study

Evaluation of the effectiveness of the Indian government’s policies to strengthen health warning labels on smokeless tobacco products: findings from the 2010–2019 Tobacco Control Project India Surveys

Health Warnings on Tobacco Packages: A Compliance Assessment Study Around Educational Institutions in Bhubaneswar, India

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