Communicating risk: Status of health warning labels on various tobacco products in Indian market.

Background: Owing to the role of tobacco packaging as a strong medium of communication, display of health warnings on tobacco packs effectively impart health risks of tobacco consumption to those currently using or contemplating the use of tobacco.
Methods: This community based cross-sectional analytical study was conducted among 2044 tobacco product packs, each collected from a different PoS, to estimate the non-compliance of section 7, 8 & 9 of COTPA among various tobacco products and its association with the PoS characteristics. Data were collected by observation of PoS by field investigators and then purchase of a unique product from each vendor followed by a brief interview of the tobacco vendor.
Results: The study documented an absence of health warning label on 15.51% [95% CI: 13.99-17.13] of the total 2044 tobacco products collected. The non-compliance to 'quality of health warning picture' was lowest 5.96% [95% CI: 4.91-7.16] among the tobacco products with a health warning label. The multivariate regression model revealed that absence of health warning on tobacco product packs were higher among the PoS in rural area (aPR 1.38; 95% CI: 1.16-1.65; p < 0.001) and among street/mobile vendors (aPR 1.65; 95% CI: 1.22-2.24; p = 0.001). The PoS not displaying tobacco products (aPR 1.36; 95% CI: 1.08-1.72; p = 0.01), selling flavored chewable tobacco (aPR 1.67; 95% CI: 1.24-2.27; p = 0.001), not selling loose cigarettes (aPR 2.93; 95% CI: 1.94-4.43; p < 0.001) and with vendors not enquiring age proof (aPR 10.69; 95% CI: 1.59-72.09; p < 0.001) had higher proportion of tobacco products without health warning labels. A greater proportion of smokeless/local variety tobacco products (aPR 18.06; 95% CI: 12.31-26.51; p < 0.001) had absence of health warning label.
Conclusion: The data provided by us have clear policy implications. We recommend regular enforcement activities to monitor the presence of health warning labels on tobacco product packs along and accurate printing of the same with adherence to the Ministry of Health and Family Welfare templates.
Competing Interests: Conflicts of interest The authors have none to declare.
(Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)