A recent national survey conducted by Healis – Sekhsaria Institute for Public Health, an anti-tobacco advocacy group, found that the current pictorial health warnings used on Indian tobacco products are ineffective compared to the pictorial warnings mandated in 2006 and the current international health warnings. The primary objective of this survey was to assess awareness of the current health warning labels in India and their effectiveness in communicating health hazards of tobacco use.

Nationally representative survey of 1,700 rural and urban adults (users and non users of tobacco) aged >= 18years from eight states of four regions (North, East, South, and West) across India was performed. Using a structured questionnaire face-to-face interviewer administered survey was performed to investigate the effectiveness of the current pictorial health warnings on all tobacco products. The survey used aided recall research technique by showing 11 pictorial warnings (in a flip chart) to the respondents to assess the effectiveness of the pictorial warnings.

A study sample includes 680 non tobacco users and 1020 tobacco users (—cigarette smokers, — bidi smokers, — smokeless tobacco users). Among the different types of tobacco users the percentage of tobacco users who either read or looked at the warning labels was low compared to other countries. In this study, it was found that only 20.6 % of cigarette smokers, 15 % of bidi smokers and 13.2 % of smokeless tobacco users either read or looked at the warning labels while this was reported as 91 % in Canada from a survey conducted in the year 2000.

Underscoring the need for the government to replace the current pictorial warning, Dr. Gupta says, “Strong pictorial warnings on tobacco products were an evidence-based measure to warn the users and thus empower the consumer. The pictorial warnings on tobacco products in other countries were very explicit and really sent the desired message to the smoker. Smoking rates have significantly reduced in countries such as Brazil and Mauritius, which printed gory images of mouth cancer on cigarette packs. After their introduction, the tobacco companies in those countries had reported a decline in sales.”

During the study, three sets of pictorial health warnings – current, mandated in 2006 and international pictorial warnings were used. Around 68% of respondents were very alarmed when it showed graphic image of surgeons operating a heart with a text message ‘smoking clogs the arteries and causes heart attacks and strokes’, and 53.3% of the respondents wanted to quit after seeing this image.

The survey also found that 65% of the respondents were alarmed when they were shown the graphic image mandated in 2006 depicting a grotesque picture of oral cancer with a message ‘Tobacco causes mouth cancer’ and 48.6 % of the respondents wanted to quit after seeing this image.  Further, a study found that 58.4 % of the respondents were alarmed when they were shown an explicit pictorial warning mandated in 2006 that depicted pictures of a patient with post surgical cheek with a text message ‘Tobacco causes slow and painful death’ and 47.8% respondents wanted to quit after seeing this image.

When the currently mandated pictorial warnings depicting graphic image of X-ray lung were shown, only 36.7 of respondents were alarmed and 40% of the respondents wanted to quit after seeing the image. After showing the pictorial warning depicting a scorpion, only 36.7% were alarmed and a mere 30.8% wanted to quit after seeing this graphic image.  When the graphic image depicting a diseased lung with the warning ‘Tobacco causes cancer’ was showed, only 41.4% of the respondents were alarmed and 30% were motivated to quit after seeing the image.

“The pictorial warnings on tobacco products in other countries were very explicit and really sent the desired message to the smoker. All tobacco companies in Thailand are required to carry nine graphic warnings, while in Brazil and Uruguay the tobacco manufacturers are mandated to carry 10 and nine pictorial warnings respectively.  Smoking rates have significantly reduced in countries such as Brazil and Mauritius, which printed gory images of mouth cancer on cigarette packs. After their introduction, the tobacco companies in those countries had reported a decline in sales,” said Associate Professor of Head and Neck Surgery at Tata Memorial Hospital, Mumbai, Dr Pankaj Chaturvedi.