Word Count: 247 Type of presentation: Oral

Transcription

1 ABSTRACT Background In India, at least 1 million deaths every year are related to tobacco use, yet the people including tobacco users have little awareness about the possible consequences of tobacco use. One way to increase awareness is to place more information on tobacco products in the form of pictorial health warnings. However, the implementation of pictorial health warnings in India experienced constant delay and deferral. Objectives To understand people s attitudes towards current pictorial warnings, identify the range of messages conveyed through the warnings and how people associate these pictures with the consequences of tobacco use in India. Methods First, a qualitative study was carried out through four focus group discussions (FGDs) using a prepared moderator guide. Based on these findings, a close-ended questionnaire was designed and administered on 615 individuals in Mumbai in a quantitative field survey. Results In FGDs it was found that most people had seen warnings. The picture of scorpion gets associated with the product in a non-scientific manner. Pictures of diseased lung and x-ray of lung were hardly understood by anybody. Among 615 respondents, 72.5% opined that current warnings definitely do not stop any user from using tobacco products and 89.9% selected the two earlier proposed warnings as the most informative about the ill effects of tobacco on health. Conclusions The findings from FGDs demonstrate that current mandated pictorial warnings were ineffective, while earlier proposed pictorial warnings were more informative than current warnings. These findings were further strengthened by the quantitative field survey. Word Count: 247 Type of presentation: Oral

2 Are the Current Pictorial Health Warnings Effective? Qualitative and Quantitative Study Findings from India AUTHORS NAME Lalit J Raute 1, Mangesh S Pednekar 1, Prakash C Gupta 1 1 Healis Sekhsaria Institute for Public Health, Navi Mumbai, India Presented By Dr. Lalit J Raute Research Fellow September 25, nd National Conference on Tobacco or Health, Mumbai

3 INTRODUCTION In India, at least 1 million deaths every year are related to tobacco use, yet the people including tobacco users have little awareness about the possible consequences of tobacco use. One way to increase awareness is to place more information on tobacco products in the form of pictorial health warnings. However, the implementation of pictorial health warnings in India experienced constant delay and deferral.

4 Pack warnings are effective mode of health communication because Message reaches every tobacco user, every he/she uses tobacco It is one of the most cost effective ways to educate people about the harms of tobacco It is a well proven method of health communication in many countries It tides over the aggressive marketing strategy of the industry and reduces the attractiveness of the packs. thus pack warnings protect non users from taking up tobacco and the user to quit

5 OBJECTIVES To understand people s attitudes towards current pictorial warnings. Identify the range of messages conveyed through the warnings. How people associate these pictures with the consequences of tobacco use in India.

6 METHODOLOGY I. Qualitative Study -- Focus Group Discussions II. Quantitative study -- Field Survey First, a qualitative study was carried out through four focus group discussions (FGDs) using a prepared moderator guide. Based on these findings, a close-ended questionnaire was designed and administered on 615 individuals in Mumbai in a quantitative field survey.

7 I. FOCUS GROUP DISCUSSIONS Research Methodology Focus group discussions were conducted from July 2009 to August Participants were from different parts of Mumbai city. There were series of question prepared in the moderators manual which were utilized during the focus group discussion for interviewing the participants. (Acknowledgment: Harvard School of Public Health for Moderators Manual) A verbal consent was obtained from the participants. The focus group discussions were carried out in house (Healis) and the discussions were audio recorded for future reference. Extensive notes were taken.

8 Information about the participants in the focus group discussion Type of Focus group Tobacco User Male (n) Never Tobacco User Tobacco User Female (n) Never Tobacco User Total (n) Focus group 1 Low socio-income group Focus group 2 Professionals and high educational group Focus group 3 Youth (College students) Focus group 4 Exclusively women group Total

9 Findings The discussions were based on following discussion points: Have you ever seen any health warning on tobacco products? Findings: Majority of the participants had seen the health warning. They had seen the following warning labels 1. Smoking is injurious to health 2. Using tobacco causes cancer.

10 Is it mandatory to have text warning? Findings: Yes, it is mandatory to have text warning. It serves as an educational tool for the children and youth. Non users mentioned that their close associates who use tobacco can be educated about the harm of tobacco use and the amount of harm that is done to them because of their habit.

11 What does this picture communicate? (Scorpion) Findings: Following were the respondent replies A new brand of tobacco product. Tobacco product causing cancer and represents cancer Company s logo. It s a zodiac sign Decorative purpose of tobacco pack. It is a slow poison which the scorpion bite represents. There is scorpion in the packet and it will come in your mouth.

12 Cont.. Do you think this image should be there as a warning label? Findings: Could not understand the relationship between tobacco and scorpion. The image of Scorpion is unable to represent the harms of tobacco use. Illiterate would not find it useful as it was hard for them to relate it text with picture.

13 What does this picture communicate? (x-ray of lung) Findings: Following are their thoughts on this picture Waterfall between two mountains Looks like a butterfly Hazy shadow of two persons talking to each other Represents some body part with cancerous growth Small intestine of the body

14 Cont.. Do you think this image should be there as a warning label? Findings: It is not at all understood. None could relate the image with tobacco. The image was dull, hazy, unclear and not colored. Based on text warning, only literate could find some relationship between tobacco and cancer.

15 What does this picture communicate? (Diseased lung) Findings: Following are the responses Not a single respondent had seen this pictorial warning on any tobacco product. It is a liver which is red A burned leaf A butterfly One respondent identified it as a lung cancer

16 Cont.. Do you think this image should be there as a warning label? Findings: Majority were of the feeling that this image was more effective than the previous two. The image is clear and colored. It does not look dull and hazy like the previous image of X ray lung.

17 Is there anything else that could be done to make these warning labels more effective? Findings: Human body picture should be placed which is easy to understand for a layperson. Picture showing mouth cancer, human face with half side normal and other half diseased. Body part with text written on it stating the body part and the diseases condition. Local language is a must with English or at least Hindi. Combination of text and picture is a must. Text should always be in red as red represents danger. Outline of the human body should be demarcated while showing any internal body part.

18 II. Field Research Study Research Methodology We conducted field research study in September A close ended questionnaire was designed based on focus group discussion findings. The sample size was 615 individuals (18 years and above), selected from different parts of Mumbai i.e. main city, central and western suburb. Field investigators were trained to administer the questionnaire. Pictures (Fig. 1) of three mandated pictorial health warnings and two warnings proposed earlier by the government were shown to the respondents at time of data collection.

19 Figure 1 Figure A, B and C : Mandated Pictorial Health Warnings Figure D and E : Warnings Earlier Proposed by the Government

20 Demographic of the subjects VARIABLE MEN Number (%) WOMEN Number (%) TOTAL Number (%) Gender 459 (74.6) 156 (25.4) 615 (100) smokeless tobacco users Tobacco users Categories Smoke tobacco users Mixed tobacco users Never tobacco users

21 Results: About health warnings on tobacco products 53.2% male and 23.1% female had read text or statutory warnings on smokeless tobacco products. 62.7% male and 32.6% female had read text or statutory warnings on smoked tobacco products. 61.7% male but only 23.7% female think that, text message on smoked tobacco products trying to convey that Cigarettes smoking is injurious to health.

22 Results: Interpretation about scorpion picture on smokeless tobacco products Interpretations Frequency Percent It represents a zodiac sign It represents a brand image of smokeless tobacco product It is used for decorative purpose of the tobacco product Scorpion may be inside the tobacco packet Tobacco is poisonous like scorpion Tobacco is harmful to health and causes disease like cancer Cannot understand what message this image conveys

23 Results: Interpretation about X - Ray of lung picture on smokeless tobacco products Interpretations Frequency Percent It represents a waterfall between two mountains It looks like a butterfly 12 2 It represents hazy shadow of two person talking to each 43 7 other It represents some part of the body It represents X ray of diseased lungs It conveys the ill-effects of smoking Cannot understand what message this image conveys

24 Results: Interpretation about diseased lung picture on smokeless tobacco products Interpretations Frequency Percent It represents a burned leaf It looks like a butterfly It represents foodstuff It represents some part of the body It represents diseased lungs It conveys the ill-effects of smoking 6 1 Cannot understand what message this image conveys

25 Results: Opinion of the people for mandated pictorial warnings 78.2% males and 80.8% females opined that the image of scorpion (fig 1-A) was showing the ill effect of smokeless tobacco use. 56.4% males and 51.3% females felt that image of X-ray of lung (fig. 1-B) was not showing any ill-effects of smoking. 63% males and 54.5% females felt that image of Diseased Lung (fig. 1-C) was not showing any ill-effect of smoking. 75% smoked tobacco users also have the same opinion about this picture.

26 Cont 41.1% people said that these pictorial health warnings may be helpful to stop any user from using tobacco products. 25.2% said that these pictorial warnings definitely did not stop any user from using tobacco products. 93% of people were of the opinion that these images should be on both side of tobacco products. 94.8% of people felt that these images should be of larger size than present size of pictures on tobacco products.

27 Cont After the images shown (figure 1) to the participants, % said that figure D % said that figure E were most informative in conveying the ill effects of tobacco on health. For the current mandated health warnings, for scorpion (5%), for x ray of lung (2.4%), for diseased lung (2.6%) of people opined as most informative figure about the ill effects of tobacco on health. Figure D Figure E

28 CONCLUSIONS The results of both the focus group discussions and field survey indicate that most of the people have seen text and pictorial warnings on smokeless and smoking tobacco products. Mandated pictorial warnings do not serve the desired purpose since they are not properly understood. Scorpion gets associated with the product in a non-scientific manner. X-ray lung was hardly understood by anybody. People would like to see the warnings mainly in Hindi and Marathi (local language) and want it to be placed on top or middle of both side of tobacco packet. People opinioned that, pictorial warnings proposed by the government earlier were the more informative about the ill effects of tobacco use.

29 Acknowledgement We would like to acknowledge the World Health Organization (WHO) for funding support. Contact Us Add: Healis Sekhsaria Institute for Public Health, 601/B Great Eastern Chambers, Plot no. 28, Sector 11, CBD Belapur, Navi Mumbai , INDIA. Tel: Lalit J Raute rautel@healis.org

30 THANK YOU