Do the pictorial warnings on cigarette/tobacco products actually work?

From 1 December, 2022, tobacco product packets will have a new set of health warnings and pictures. And a survey suggests they work.

BySumit Jha

Published Aug 01, 2022 | 3:17 PMUpdatedAug 02, 2022 | 11:48 AM

Smoking brain shrinkage

The Union Ministry of Health and Family Welfare has notified new set of specified health warnings for all tobacco product packs. The old image on the tobacco products packet will be changed to a new image with a warning message. South First asked experts and smokers themselves if these images have any impact on helping people quit smoking.

The new set of specified health warnings will be valid for a period of twelve months following its commencement from 1 December, 2022. The present warning on the Cigarette pack says ‘Tobacco Causes Painful Death’ and after a year the warning will be ‘Tobacco Users Die Younger’.


New pictorial warnings on tobacco products pack (Creative Commons)

Does the pictorial warning on tobacco products really work?

“Absolutely,” says Dr Rijo M John, a health economist, whose research focuses on evidence-based public policies on regulation of tobacco. Speaking to South First he said a national survey had clearly demonstrated that the use of pictorial representation of tobacco products was helpful.

“The Global Adult Tobacco Survey (GATS) was conducted by the government of India to collect information and people’s feedback at the national level to check if these pictorial warnings were effective. The effectiveness has been proved,” he said.

What did the survey find?

According to GATS-2016-17 survey, among current cigarette smokers, 83 percent noticed health warnings on cigarette packets. Among beedi smokers, 78.4 percent noticed health warnings. A majority of cigarette (61.9 percent) and beedi (53.8 percent) smokers who noticed health warnings on packages thought of quitting smoking.

In the southern states, 95.5 percent of cigarette smokers in Kerala noticed the health warning and out of that 62.6 percent thought of quitting because of the warning labels on the packets.

In Tamil Nadu, 94 percent of cigarette smokers noticed the health warning; out of that, 80.9 percent thought of quitting. For Karnataka the figures were 83.3 percent 88.6 percent.

In Andhra Pradesh, 75 percent of cigarette smokers noticed the health warning and out of that 91.8 percent thought of quitting. The figures for Telangana were 66 percent and 87.2 percent.

Also, in a 2018 study, smokers who had given up the habit said that the pictorial warning was one of the reasons they quit smoking tobacco.

“The nonsmokers claimed that the textual warning created fear in them, according to the participants. The pictorial warning was more effective than the textual warning,” the study found.

Losing the purpose due to sale of loose tobacco product

However, Dr John said, the survey also showed that most participants claimed to have bought single cigarettes instead of full packets, defeating the purpose of such pictorial warnings.

In India, only few states have properly implemented the Cigarettes and Other Tobacco Products Act (COTPA) of 2003. The act required the state to ban the sale of loose cigarettes and tobacco products. In southern India, only Karnataka has banned the sale of loose cigarettes.

“Sale of loose cigarette and beedis is illegal. The government has to implement it strictly. Just because there are people consuming loose cigarettes or beedis, it is not a reason to stop pictorial warnings on these packets. Efforts to enforce the law should also go hand in hand to see the impact of these pictorial warning,” said Dr John.

What do smokers think?

When South First spoke to few smokers, a majority of them said they did not bother to even see what was on the packets. However, some of them did agree that it made them think about quitting as the pictures and warnings scared them to some extent.

“I am not going to quit smoking cigarettes even after a new warning level comes. Even 85 percent of cigarette packets are covered with images and till now I have not quit; how can I quit after the new warning?” Kuldeep Singh, a chain-smoker from Hyderabad, told South First.

“To my understanding, I have more reasons to smoke cigarettes. And the warning on these packets have little effect. Until you forcefully ban the selling of tobacco products in the country, I am not going to quit,” says Shantanu Sagar.

However, Vamsi Krishna from Hyderabad said, “Addiction doesn’t work in this way. Merely by warning a person, he will not quit smoking or chewing tobacco.”

Don't go by anecdotal data, research has proved it

However, Dr John said that people should not for an opinion with anecdotal data.

“When we ask random people, these are anecdotal. At the national level, through numbers, through representative samples, papers published in international journals, the surveys have clearly shown that they (the pictorial warnings) are actually effective,” he said.

“The large pictorial health warnings need to be continued; images and messages need to be changed periodically to ensure sustained impact. Efforts should be made to make the warning labels more impactful by providing information about diseases caused by tobacco, including cancer, stroke, heart disease, lung disease, etc,” said the GATS 2016-17 survey.