Are current tobacco pictorial warnings in India effective?

BACKGROUND Warning labels on tobacco products provide an effective way of communicating the consequences of tobacco use. Research has shown that larger and colorful warnings placed on packaging are more effective for informing consumers and general public. However, primarily due to powerful lobbying by the industry, pictorial health warnings in India experienced constant delay in introduction and dilution of content. The current warnings appearing on tobacco products consist of drawing of a scorpion on smokeless forms of tobacco and pictures and X- rays of diseased lungs for smoking forms. METHODOLOGY To understand people's attitude towards the pictorial warning and their understanding of the pictures, a study was planned in two phases. The first phase was qualitative with focus group discussion and second, a population based survey for validating the findings. RESULTS The findings of the study suggested that the mandated pictorial warnings do not serve the desired purpose since they are not properly understood. The scorpion becomes associated with the product in a non-scientific manner. X-rays of lung are hardly understood by anybody and pictures of diseased lungs are not used by tobacco manufacturers. CONCLUSION The results of both the focus group discussions and the field survey indicate that most people have seen text and pictorial warnings on smokeless and smoking tobacco products, but that they lack relevance to the text messages. Irrespective of education the early proposed pictorial warnings by the government were more effective than the currently implemented warnings. People would like to see the warnings mainly in Hindi and Marathi (local language) and want them to be placed on the top or middle of both sides of tobacco packaging.