| Summary: | Introduction
We studied adolescent and adult perceptions of the effects of larger
size, 85% versus 40%, Graphic Health Warnings (GHWs) on conventional and
plain tobacco packs, in India.
Methods
A cross-sectional survey was conducted with 2121 participants (aged ≥13
years), during the period 2015–16, in Delhi and Telangana, India. Four categories
of GHWs on tobacco packs were shown: A – 40% existing (April 2013–April
2016), B – 40% new (April 2016–present), C – 85% new, and D – plain packs (85%
new). Regression models tested percentage differences in choice of categories
for eight outcomes, adjusted for gender, area of residence, socioeconomic status,
age, and tobacco use.
Results
Of the total 2121 participants, 1120 were from Delhi, 1001 from Telangana,
50% were males, 62% were urban residents, 12% were adolescents, and 72% had
never used tobacco. Among packs shown, the majority of participants perceived
the 85% size GHWs more effective than the 40% size GHWs across all outcomes.
The perceived increase in noticeability of GHWs was 45% for category C (p<0.05)
and 43.5% for category D (p<0.05) versus category B. In Delhi, participants
perceived plain packs to be most effective in motivating quitting, preventing
initiation and conveying the health message. In Telangana, adolescents believed
GHWs on plain packs were most noticeable, most effective for quitting and
preventing initiation.
Conclusions
The larger size 85% GHWs were perceived to be more effective in
increasing noticeability of warnings, motivating cessation, preventing initiation,
and conveying the intended health message. Support for plain packaging was
higher in Delhi and among adolescents in Telangana.
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