Does Pictorial Health Warnings on Tobacco Products Promote its Cessation? A Cross-Sectional Study from a Rural Health Centre in Trichy, Tamil Nadu

Background: Under the National Tobacco Control Programme several measures have be taken to reduce its consumptions. Annual change in pictorial warning on cigarette packs is one such measure. The study aims to assess effectiveness of warning messages on tobacco products in promoting smoking cessation. Methods: A cross-sectional study was conducted among 178 smokers visiting a rural health centre attached to teaching hospital in Tamil Nadu either as patient or their attendee. A structured questionnaire was used to collect data on sociodemographic details, smoking habits, factors influencing to smoke, awareness on pictorial warning and its impact towards smoking cessation. Pictorial warning motivating to quit smoking was expressed in proportion with 95% confidence interval (CI). Results: Mean age of participants were 45.25 ± 15.7 years. Majority smoked daily (43.8%) and consumed more than 20 cigarettes in past one week (44.4%). Factors influencing to smoke were self-interest/pleasure (81.5%), job stress (65.7%), family stress (50.6%) and peer pressure (48.3%). The study found that 132 (71.4%) smokers had seen the pictorial warning on tobacco products of which 81 were motivated to quit smoking i.e. 45.5% (95% CI: 38.04-53.12). Intention to quit smoking in next one month was reported only by 6.2%. Conclusion: A significant proportion of smokers were not motivated to quit smoking based on the pictorial warning. Since many purchased cigarettes in singles rather than whole pack, their probability of viewing the pictorial representation of harmful effects could have been missed. There is need to explore factors that can initiate tobacco cessation among smokers. Keywords: Tobacco, Pictorial Warning, Awareness, COTPA, Smoking