Health Warnings Research Articles

The Awareness, Perceptions and Attitudes towards health warnings on cigarette packages in Northern Cyprus: a community-based descriptive study

Background: Health warnings displayed on tobacco products are important sources of health information for the community. Aims: The aim of this study was to determine the awareness, perceptions and attitudes towards the impact of health warnings on cigarette packages of a community in Nicosia, where no previous data was available. Methods: The descriptive cross-sectional study was conducted among 629 cafe attendants in Nicosia in October 2019, using a structured questionnaire to determine the impact of pictorial and text-only cigarette pack warnings. Since cigarette packs include only text-only warnings in Northern Cyprus, sample pictorial warnings from Turkey were presented to the participants.The data were analysed by IBM–SPSS-18.0 to compare perceptions regarding sex, age, smoking status with significance level accepted as p<0.05. Results: Of all the participants, 48%were smokers and smokers among men were significantly higher (56.8%) than women (40.6%). The results demonstrated that 71.2% of the participants were aware of the health warnings on packages and 59.4% rated health warnings as effective. Stronger pictorial health warnings were deemed as more effective. However, 65.6% of the “smoker” group were not aware of the warnings.There were significant differences between smokers and non-smokers regarding perceptions of pictorial warnings. Non-smokers, including former smokers adopted positive views more; 54% of ex-smokers declared health warnings had contributed to their quitting process. Conclusion: The perceptions of the non-smokers of this community group displayed more positive attitudes towards health warnings. This study has pointed to the urgent need for the implementation of pictorial warnings for smokers in Northern Cyprus.

Doing more with less: A proposal to advance cigarette packaging regulations in the United States

Cigarette packages are potent marketing tools. Following guidance from the WHO Framework Convention on Tobacco Control, many countries have sought to diminish this marketing power by mandating that (1) large graphic health warnings be affixed to the packages (i.e., text warnings combined with graphic images of the health consequences of smoking) and (2) all packages be fully “plain” in their design (i.e., all packages use the same drab/bland color and font type; no brand logos, other colors, or designs are permitted). Yet, the United States lags other countries in implementing regulations designed to blunt the marketing power of cigarette packages. This is not because of a lack of effort on the part of the Food and Drug Administration, the main governmental body charged with regulating tobacco products in the United States. Rather, it is because the regulatory options that that have been advanced in the country (e.g., graphic health warnings) have not been found - yet - to be legally feasible by its courts. This commentary works through some of the conceptual, practical, and legal issues regarding packaging regulations in the United States. It considers the political and bureaucratic risks involved with issuing new regulations. The overall intent is to prompt our field to think creatively about what is realistic in this regulatory space and to offer a novel perspective that may help move the United States tobacco control community forward in its efforts to reduce the promotional power of cigarette packages.

Pasteurella multocida strains of a novel capsular serotype and lethal to Marmota himalayana on Qinghai-Tibet plateau in China

Pasteurella multocida is a zoonotic pathogen causing serious diseases in humans and animals. Here, we report P. multocida from wildlife on China's Qinghai-Tibet plateau with a novel capsular serotype, forming a single branch on the core-genome phylogenetic tree: four strains isolated from dead Himalayan marmot (Marmota himalayana) and one genome assembled from metagenomic sequencing of a dead Woolly hare (Lepus oiostolus). Four of the strains were identified as subspecies multocida and one was septica. The mouse model showed that the challenge strain killed mice within 24 h at an infectious dose of less than 300 bacteria. The short disease course is comparable to septicemic plague: the host has died before more severe pathological changes could take place. Though pathological changes were relatively mild, cytokine storm was obvious with a significant rise of IL-12p70, IL-6, TNF-αand IL-10 (P < 0.05). Our findings suggested P. multocida is a lethal pathogen for wildlife on Qinghai-Tibet plateau, in addition to Yersinia pestis. Individuals residing within the M. himalayana plague focus are at risk for P. multocida infection, and public health warnings are necessitated.

An observational study of the marketing practice of e-cigarette specialty stores in two large cities in China: Is there potential to normalize the use of e-cigarettes?

Supervision measures in China have designated offline retail as the only legal channel for the sale and advertising of e-cigarettes. Specialty stores, exclusively selling vaping devices and e-liquids, are professionally designed to showcase company images and provide the best examples of e-cigarette marketing strategies. The goal was to analyze the retail marketing practice of e-cigarette specialty stores and provide a scientific reference for future e-cigarette point-of-sale regulation. On-site observations were conducted in specialty stores among the popular business districts of Chengdu and Shanghai, China, from January to May 2021. 'Dianping', known as 'Chinese Yelp', was used to identify 8 business districts in Shanghai and 5 in Chengdu as observation sites. Two trained observers visited each store in the identified business districts. The data were collected with a checklist, which consisted of 5 sections with 37 items, including basic information, marketing practice, age restriction and health warnings. In total, 161 e-cigarette specialty stores, including 82 specialty stores in Shanghai and 79 in Chengdu, were identified. Of these stores, 156 were single-brand retailers and 5 were multi-brand retailers. Each store displayed e-cigarette products, which were visible from outside the store. The most common e-cigarette products were rechargeable kits and nicotine-containing e-liquids, which were available at all specialty stores. Frequent forms of promotion were free e-liquid samples (100%) and slogans (57.8%). Signage stating prohibition of minor use and purchase was presented at 141 (87.6%) specialty stores. Relatively few specialty stores (31.7%) displayed health warnings. E-cigarette specialty stores featured highly visible product displays, varied product selections, abundant marketing materials, free trial services, absent entry restrictions for minors, and a lack of health warnings. Policymakers should move to reduce youth exposure to e-cigarette products and marketing in the retail environment by strengthening regulations on product display and marketing.

Investigating the Microbial Contamination of Hookah Mouth Tips in Bandar Abbas City, Iran

Background: Hookah smoking is now increasing and has become a serious public health warning worldwide. Hookah smoking has led to the transmission of infectious diseases. This study investigates the microbial contamination of hookah mouth tips in Bandar Abbas City, Iran. Materials and Methods: This descriptive study was conducted in Bandar Abbas City, Iran. The hookah mouth tip samples were obtained from various hookah supply centers and the Ultersnap U device measured the microbial load of hookah mouth tips. The microbial load ranks were divided into three categories. Meanwhile, data analysis was done using the SPSS software, version 26. Results: The highest contamination tips were observed in the beach boulevard (Saheli-Blv), where vendors operate. In three parks, namely Park-e-Ghadir, Park-e-Dowlat, and 13-Hektar, one contaminated hookah mouth tip was observed in each station. A significant difference was observed between the stations in both clean and warning levels; however, this difference was not significant in the contaminated level (P˃0.05). The highest level of contamination was observed in the guild of peddlers. A significant difference was also observed between the guilds in both clean and warning levels, but this difference was not significant in the contaminated level (P˃0.05). Conclusion: Our results showed that a significant number of hookah mouth tips were in warning and contaminated levels. The highest number of contaminated hookah mouth tips were observed in the peddlers guild, which is strongly recommended to collect and prevent their inactivity, especially in public places. In addition, health warnings should be posted on all tobacco products and the environment of smoking and or cafes.

Impact of standardized tobacco packaging on smoking-related behaviors and perceptions in Singapore.

Singapore phased in standardized tobacco packaging on 1 July 2020 following a three-month grace period. This pre-post study evaluated its impacts on smoking-related behaviors and perceptions among adults who currently smoke. Baseline and follow-up data were collected in a pre- and post-questionnaire from a cohort of 1873 Singaporean adults who were currently smoking at baseline. Baseline data were collected from December 2019 to May 2020, and follow-up data from July 2021 to September 2021. We used descriptive statistics and bivariate analyses to assess pre-post changes (Bhapkar's test, Wilcoxon signed rank test) and to identify characteristics of participants who had quit or cut down smoking at follow-up (Pearson's chi-squared, Fisher's exact test). At follow-up, 11.7% (n=220) had quit smoking. There was a higher proportion of those smoking non-daily (pre: 13.1%, post: 16.9%; p<0.001), and those intending to quit within the next year (pre: 14.8%, post: 17.5%; p<0.05) or six months (pre: 10.4%, post: 13.2%; p<0.01). Tobacco products were scored more negatively in relation to packaging, quality, satisfaction, value for money and overall appeal (scores pre: 15.9, post: 14.3; p<0.001), harmfulness (scores pre: 0.61, post: 0.54; p<0.05), noticing others smoking the same brand (scores pre: 1.92, post: 1.65; p<0.001), and considering quitting due to health warnings (scores pre: 0.81, post: 0.86, p<0.05). Fewer reported that some cigarette brands have higher prestige (pre: 58.0, post: 54.3%; p<0.01), and more reported using flavored cigarettes (pre: 42.2%, post: 60.1%; p<0.001) and e-cigarettes (pre: 4.2%, post: 6.1%; p<0.01). In Singapore, the changes observed before and after the implementation of standardized packaging suggest that it might be associated with quit-related outcomes, reduced tobacco product appeal, and increased effectiveness of graphic health warnings.

The Effectiveness of Graphic Health Warnings on Cigarette Packs: Examining Smokers’ Attitudes Across Personal Demographics

Innovations in cigarette smoking prevention were internationally recognized by adding Graphic health (GHW) warnings on cigarette packs. This study determines the effect of GHW on smokers in various demographic profiles employing descriptive-correlation in data analysis. Survey questionnaires were distributed to 138 smokers as respondents. Findings show that the urge to smoke begins at most 20 years old during high school. The GHW affects the attitude towards smoking quitting which could be a potential first step towards quitting altogether. However, translating that thought into concrete action remains a challenge. The relevance of the graphics to the health consequences of smoking to be more convincing is highlighted. To effectively deter smoking, graphic health warnings on cigarette packs need to be both attention-grabbing and informative. Bright colors and a variety of shocking images will initially capture smokers’ attention, breaking through complacency. However, to maintain impact, these visuals and messages require regular updates to prevent habituation. Furthermore, using clear pictures that directly depict the harm caused by smoking, like diseased lungs, can create a stronger emotional connection and encourage smokers to think twice about the consequences of their habit. Beyond grabbing attention, clear communication is essential. Large, bold text and concise language ensure everyone understands the message while offering warnings in multiple languages, breaking down language barriers, and empowering diverse populations to make informed health choices. By combining these elements, graphic health warnings become a powerful tool for raising awareness and promoting smoking cessation.

A microfluidic microalgae detection system for cellular physiological response based on an object detection algorithm.

The composition of species and the physiological status of microalgal cells serve as significant indicators for monitoring marine environments. Symbiotic with corals, Symbiodiniaceae are more sensitive to the environmental response. However, current methods for evaluating microalgae tend to be population-based indicators that cannot be focused on single-cell level, ignoring potentially heterogeneous cells as well as cell state transitions. In this study, we proposed a microalgal cell detection method based on computer vision and microfluidics, which combined microscopic image processing, microfluidic chip and convolutional neural network to achieve label-free, sheathless, automated and high-throughput microalgae identification and cell state assessment. By optimizing the data import, training process and model architecture, we solved the problem of identifying tiny objects at the micron scale, and the optimized model was able to perform the tasks of cell multi-classification and physiological state assessment with more than 95% mean average precision. We discovered a novel transition state and explored the thermal sensitivity of three clades of Symbiodiniaceae, and discovered the phenomenon of cellular heat shock at high temperatures. The evolution of the physiological state of Symbiodiniaceae cells is very important for directional cell evolution and early warning of coral ecosystem health.

Graphic Health Warning Compliance Assessment of Vapor Products, Heated Tobacco Products, and Novel Tobacco Products in the Philippines

Graphic Health Warning Compliance Assessment of Vapor Products, Heated Tobacco Products, and Novel Tobacco Products in the Philippines

Health Warnings on Tobacco Packages: A Compliance Assessment Study Around Educational Institutions in Bhubaneswar, India.

Background Graphic health warning labels (HWLs) on tobacco product packaging have been identified by the World Health Organization (WHO) as a cost-effective policy intervention towarnconsumers about the health risks of tobacco. Compliance with HWLs shields young individuals from tobacco marketing influences and exposes users to health warnings. Assessing compliance with health warning labels would provide insights into the state of law implementation. The study assessed health warning labels on tobacco packages as per the Cigarettes and Other Tobacco Products (COTPA) (Packaging and Labelling) Amendment Rules of 2020, specifically assessing their availability around educational institutions in Bhubaneswar, Odisha, India. Materials and methods From August 2022 to January 2023, a protocol was employed to collect information on the sale of tobacco products around educational institutions including packages of cigarettes, beedis, and smokeless tobacco (SLT) from Bhubaneswar City.Using multistage random sampling 18 schools were selected inBhubaneswar City.Areaswithin 100 yards (91.44 meters) of each schoolwere mapped using a map tool. All prospective tobacco vendors within 100 yards of each school were included in the study.The data on compliance with HWLs were summarized using descriptive statistics. The health warnings compliance assessmentof the tobacco products available with the vendors was conducted using three major indicators, including analysis of the font content, size and element of the graphics, and textual health warnings. In addition, the surface area occupied by these warnings was measured using a calibrated ruler. Results Within100 yardsof18 schools in Bhubaneswar city, 57 vendors were found selling tobacco. About 48 distinct brands and 791 unbrandedtobacco productswere identified from 2135 packets collected from 57 vendors.Out of the 48 branded product packets examined, 25 brands were for smoking (cigarettes, bidis), while 23 were for SLTproducts such as khaini, gutkha, and pan masala containing tobacco. Only six brands out of 17 cigarette packs complied with HWL provisions. None of theeightunique bidi packs and 302 unbranded bidi packs were compliant with any HWL compliance indicators. Other compliance-related issues included incomplete health warning labels, out-of-rotation pictorial health warnings, distorted printing (blurry, heavy tint, and faded), and split warnings. Conclusion Tobacco products were sold within 100 yards of educational institutions in clear violation of the COTPA Section 6 provisions. Furthermore, the tobacco products sold were also not in compliance with the health warning label laws under section 7 of COTPA. There is an urgent need for strict enforcement of the provisions relating to the ban on sale within 100 yards of educational institutions and health warning labelrules in Bhubaneshwar.

Concentration, speciation and risk effects of multiple environmentally sensitive trace elements in respirable fine-grained fly ash

Respirable fine-grained fly ash (RFA) is captured very inefficiently by existing air purification devices of power plant, leading to increasing concerns regarding their migration and subsequent interaction with body due to fine particle size and its complex toxic composition. Trace elements of RFA in three groups with five different sizes between 8–13 µm were analyzed in terms of available concentration, speciation and risk effects. The concentration, pollution level and ecological risk level of elements in RFA were related to particle sizes. Chronic non-carcinogenic effect risk (NER) and carcinogenic effect risk (CER) were negatively correlated with particle size. The individual weight of exposed subjects, corresponding trace elements concentration and ingestion rate in RFA were three significant variables influencing CER. NER and CER had a tenfold exaggerated effect when calculated using total element concentration of RFA. In addition to individual differences and exposure conditions, trace element properties, speciation and available concentration were the dominant factor responsible for ecological and environmental effects of trace elements in RFA, following the order As>Ni, Mn>Cr>Pb>Cu>Zn. Results of this work highlight the effects and differences of trace elements in RFA on ecology and health, and provide a basis for further pollution control and human health warning.

Health Warnings on Loose Cigarettes: Lessons for Asian Countries.

Health Warnings on Loose Cigarettes: Lessons for Asian Countries.

Is evoking fear effective? Exploratory findings from a randomised experiment on the impacts of health warning labels on sugar-sweetened beverages.

Health warning labels (HWL) have been suggested to be effective in reducing consumption of sugar-sweetened beverages (SSB). Yet, the efficacy and acceptability of SSB HWL of different formats (textual/pictorial) and severity remain unclear. This exploratory study aims to examine the extent and mechanism through which HWL of different formats and severity may affect responses towards the HWL and SSB consumption. Randomised online experiment. Participants were exposed to images of a hypothetical SSB bearing a HWL of one of three conditions: text-only HWL, moderately severe pictorial HWL and highly severe pictorial HWL. They then responded to theory-based affective, cognitive and behavioural measures. Singapore. One hundred and twenty-seven young adult consumers from a public university. Direct effects were found for fear, avoidance, reactance and acceptability of the HWL, but not attitude, intention or motivation to consume less SSB. Pictorial (moderately severe and highly severe) HWL were associated with greater fear, avoidance, and reactance, and lower acceptability than text-only HWL. There was weak evidence that highly severe pictorial HWL resulted in greater reactance than moderately severe pictorial HWL. Fear mediated the effect of HWL of different severity levels on avoidance, reactance, intention and motivation, but not for attitude or acceptability. Exploratory findings indicate that although pictorial HWL were less acceptable, they may still be effective in influencing intention and motivation to reduce SSB consumption through the psychological mechanism of fear. Hence, graphic HWL should not be dismissed too quickly when considering strategies for reducing SSB consumption.

Cannabis vaporisation: Understanding products, devices and risks.

Vaporisation is a common method of cannabis administration. Inconsistent terminology and jargon regarding vaporisation has led to confusion. The increasing public interest and access to cannabis, combined with possible safety concerns associated with certain cannabis vaping products, warrants improved consumer and public and health care professional knowledge. To improve this knowledge, we conducted a review of the common terminology, regulatory status, products and device types related to cannabis vaporisation. Cannabis vaporisation devices can be separated into nine types. While vaporisation reduces respiratory risks associated with cannabis combustion, not all vaping products and device types carry the same level of safety. Metered dose inhalers and dried product vaporisers present the lowest safety risk due to a lower risk of toxin exposure and the use of lowertetrahydrocannabinol potency products. As both vaping and cannabis use increase in popularity, focusing on accurate health education will help facilitate health promotion to encourage lower risk use. The current lack of understanding on risk differences between types of cannabis vaporisation is a missed opportunity for harm reduction. Increased opportunities for public health and health care professional education on different cannabis vaporisation devices and associated risks are warranted. Improvements to health warning labelling may also be beneficial. Not all cannabis vaporisation devices and products carry the same level of risk. A better understanding of risk differentiation is needed among consumers and health professionals. Continued research, policy development and health education can lead to safer cannabis vaporisation.

Cigarette packaging, warnings, prices, and contraband: A discrete choice experiment among smokers in Ontario, Canada

In Canada, despite substantial decline, tobacco use remains the leading risk factor responsible for mortality and morbidity. There is overwhelming evidence that higher tobacco taxes reduce tobacco use, even if high taxes create an incentive to avoid or evade tobacco taxes. Recently, in addition to taxes, plain and standardized packaging and printing a warning on each cigarette have been lauded to reduce tobacco use. In November 2019, Canada became the country with the most comprehensive cigarette packaging regulations; and in June 2022, Canada proposed to print health warnings on individual cigarettes, the first jurisdiction to ever do so. The regulations came into force on August 1, 2023, and are being implemented through a stepwise approach. Our objective was to examine the effects of plain and standardized packaging, warning on cigarettes, price, and the availability of illicit cigarettes on intention to purchase and risk perceptions. We conducted a discrete choice experiment, and examined heterogeneity in preferences using latent class models among smokers in Ontario, Canada. We found that using latent class analyses was essential in quantifying preferences for attributes of cigarettes and cigarette packs. First, nearly half of smokers stated a preference for cheaper illicit cigarettes in a branded pack without any health warnings, regardless of the licit cigarette alternatives. For about 20% of respondents, plain packaging and especially warning on cigarette sticks decreased the probability of stating a purchasing preference for these alternatives. Third, about a third of respondents chose competing alternatives with mostly one attribute in mind, price. Lastly, none of the products and attributes seem to have significantly influenced risk perception. Our findings attest to the importance of prices and taxes, to the potential of warnings on cigarette sticks to control tobacco use, and indicate that efforts to restrict the availability of illicit cigarettes may yield substantial benefits.

How effective are health messages/warnings in improving knowledge and awareness of alcohol-related harm? The Slovenian case on using a mobile app

BackgroundConsumers generally lack access to information on alcoholic beverages, in spite of it being readily available for food and non-alcoholic beverages. Given the rights of consumers, and as with other products harmful to the population, there have been increasing calls for health warnings to be placed on alcoholic beverages, similar to those implemented on tobacco products. The aim of our research was to assess whether knowledge and awareness of the risks and harms associated with alcohol can be improved with a mobile app.MethodsIntervention was conducted using VKJ mobile app, which enables users to scan the barcode of an alcoholic beverage and receive feedback on its labelled alcohol content and estimated energy value. At each search, eleven different health messages/warnings about the risks and harms of alcohol are also displayed randomly, rotating on the screen. A survey was conducted before and after the intervention, to assess the knowledge and awareness of the risks and harms associated with drinking alcohol.ResultsSignificant differences were found for eight of the twelve tested statements. The improvement was seen to a greater extent in the group of high-risk drinkers. The results also showed that the vast majority of participants (78%) who were exposed to the health messages supported mandatory labelling of alcoholic beverages with information on ingredient listing and energy value, and 72% would like to have health warnings on alcohol products.ConclusionsThe use of a mobile app can be an option to improve knowledge and raise awareness of the risks and harms related to alcohol.

A recent surge of nitrous oxide misuse around London which merits a public health warning.

Use of nitrous oxide (N2O) gas for recreational purposes by young people is increasingly recognized as a public health hazard in the UK. We looked at the hospital records of patients admitted over the last 4years to a single neurological centre in Essex to determine the demographics, presentation, and management of patients presenting with symptoms of N2O toxicity from its recreational use. Of the 17 patients (mean age = 22.9 ± 3years) admitted between September 2018 and October 2022, 70% were admitted between January and October 2022. All patients reported limb paraesthesiae and 16/17 reported (95%) imbalance; 11/17 (65%) showed objective limb weakness. Serum B12 concentration was low in 9/17 (53%). Plasma methylmalonic acid (n = 7) and homocysteine (n = 8) levels were elevated in all patients tested. Spinal cord Magnetic Resonance Imaging (MRI) imaging was abnormal in 10/17 (59%) patients. Nerve conduction studies were abnormal in 10/13 (77%) patients, with evidence of a symmetric, length-dependent, large fibre neuropathy. There has been a recent surge of cases with neurological complications of recreational N2O abuse in the UK, with a relatively greater rate in 2022. Greater awareness of this condition amongst clinicians and health regulators is urgently required to prevent harm from N2O misuse in young people.

Motivations for continued tobacco smoking and reasons for quitting among youths in Wakiso district, Uganda: a qualitative study

BackgroundEfforts have been invested towards cessation of tobacco use among youths aged 18–35 years, however, motivators for continued tobacco smoking and reasons for quitting are limited in Ugandan settings. Therefore, this study aimed to explore motivations for continued tobacco smoking and reasons for quitting in Wakiso district Uganda.MethodsThis study used explanatory sequential method. Data from a Population-based survey collected from October 2019 to September 2020 was used to select participants for this qualitative study. Twenty-three in-depths interviews were conducted from July to October 2021 among youths (18-35years old) who reported continued tobacco use and those who quit. Data were analyzed using a team-based thematic content approach with the help of NVivo.ResultsData was collected from a total of twenty three participants, fourteen were tobacco quitters and nine were current tobacco smokers. Recurrent habit, desire to complement the use of other drugs, peer pressure, using smoking as a replacement for alcohol consumption, low tobacco prices, smoking as a tradition were reported as motivators for continued tobacco smoking. However, reported reasons for quitting smoking by youths included; packaging health warnings, school based prevention programs, fear of associated health risks due to tobacco use, embarrassment from family members.ConclusionTargeted, and tailored tobacco prevention counselling through family support programs, intensified health education on the risks of smoking, and implementing stronger health warnings on tobacco packaging can be employed to reduce or stop tobacco use among urban youth.

Qualitative Analysis of Opinions and Beliefs Associated with the Use of Tobacco Dentifrice among Individuals Attending a Tobacco Counselling Session.

Smokeless tobacco (SLT) use is positively associated with oral, oesophageal, and pancreatic cancers. The tobacco dentifrice is a type of SLT which is applied to the teeth and gums. It is available in different forms which include mishri, gul/gulmanjan, gudhaku, snuff, red tooth powder, and creamy snuff. This qualitative study aims to explore the opinions and beliefs associated with the harmful effects of tobacco dentifrice use. Thirty in-depth interviews were conducted among tobacco dentifrice users visiting a dental hospital. The data were coded and analysed using thematic analysis in ATLAS.ti software 8. A total of 11 codes and six categories were generated which comprised of the reason for the initiation, awareness of health effects, perception of oral tobacco application, perception of quitting, the reason for continued use, and use in society. Family, peers, access to the product, curiosity were important factors to initiate the tobacco dentifrice use. Participants believed in the myth that tobacco dentifrice was beneficial for the teeth, gums, and bowel movements. The participants considered tobacco dentifrice to be less harmful than other forms of tobacco. However, some participants were aware of its adverse effects on health and have tried to quit in the past. None of the participants had taken any professional help for quitting. There were strong beliefs and myths among the participants that tobacco dentifrice was beneficial for oral and general health. There is a need to create awareness and improve the standard of the health warning of such products.

Determinants of awareness on pictorial health warnings on tobacco products in an Eastern state of India.

Pictorial health warnings (PHW) are an effective strategy to deter or reduce tobacco use. This study was conducted to determine the level of awareness of PHWs on tobacco products and their correlates among adults attending the outpatient department (OPD) of a tertiary care facility in Eastern India. This cross-sectional study was conducted over a period of 3 months among 307 patients aged 18 years to 65 years. A pre-tested semi-structured questionnaire was used for the collection of data and inferential statistics were performed using JAMOVI version 2.3.21. About 84% (95% CI, 78.9-87.2) of the participants were aware of PHW on tobacco products, 82.4% (95% CI, 77.8-86.3) for smoked forms and 51.8% (95% CI, 46.2-57.3) for smokeless forms. More than half of the participants felt that the current PHW were ineffective. Male [AOR, 3.13; 95% CI, 1.33-7.37], being educated [AOR, 3.37; 95% CI, 1.29-8.76], employment [AOR, 5.65; 95% CI, 1.21-26.30] and ever-tobacco use [AOR, 3.23; 95% CI, 1.43-7.2] were found to be independent correlates of PHW awareness for smoked tobacco products, whereas as being male [AOR, 2.01; 95% CI, 1.02-3.95] and being young (18-30 years) [AOR, 2.51; 95% CI, 1.08-5.84] were found to be the independent predictors of PHW awareness for smokeless tobacco products (SLT). Four out of every five individuals were aware of pictorial health warnings (PHW) on tobacco products; however, it was much less for SLT compared to smoked tobacco products. Male, being educated, employment and ever-tobacco use were independent correlates of awareness for the smoked form of tobacco products, whereas being young (18-30 years) was an independent predictor of awareness for SLT.