Dr. Pragya Khanna
As established by health experts around the world tobacco use remains the second leading cause of death in the world causing nearly six million deaths each year. Accordingly, cigarette packages in almost every jurisdiction in the world carry health warnings to inform consumers about the risks of smoking. Health warnings on packages are engaging both because of their low cost to regulators and their unequalled reach among smokers. However, the efficacy of package warnings depends on their size, position, and design: whereas ambiguous warnings have been shown to have relatively little impact, more comprehensive warnings, including picture-based warnings, have been associated with greater recall, increased motivation to quit smoking, and greater attempts to quit. Some research also indicates that health warnings are subject to ‘wear-out’, such that newly implemented warnings are most likely to be noticed and rated as effective by smokers.
India has about 110 million smokers and the government says smoking kills nearly a million people a year. In recent years, India has come up with stringent rules to curb the use of tobacco. Tobacco-related advertisements are banned and the sale of tobacco products to minors is also an offence.
A countrywide ban on smoking in public places came into effect in 2008, although correspondents say it is blatantly flouted and poorly enforced.
Now the government has made it mandatory for tobacco companies to carry health warnings covering at least 85% of the surface of cigarette packets, making India the world leader in implementing plain packaging of tobacco products, as advocated by the World Health Organisation.
The health ministry amended the rules under the Cigarettes and Other Tobacco Products Act (COTPA) through a gazette notification, fixing April 1, 2015, as the deadline and leaving cigarette makers with less than six months for compliance. The development has come in the wake of an international report by the Canadian Cancer Society, which ranked India at 136 out of 198 countries with regard to the size of health warnings on cigarette packets. Thailand (85%), Australia (82.5%) and Uruguay (80%) were the top three countries, as per the report.
As per earlier rules, pictorial warnings covered 40% of just the front surface of the cigarette packs in India. With the drastic revision in rules, India will share the top spot with Thailand.
According to a survey a pack-a-day smoker potentially sees a cigarette pack an estimated 7300 times per year (20 views/day×365 days/year). It is believed that messages on these packs would generate exposure far outweighing exposure from other anti-tobacco communications, such as mass media campaigns.
However, changing a person’s health behavior is a difficult and complex process. According to the Health Belief Model, to change behavior individuals must: 1) feel personally susceptible to the health problem, 2) feel the problem can cause them serious harm, and 3) know what actions can be taken to avoid the harm, and know the cost or benefits of the actions. If the costs outweigh the benefits, the action to avoid a health risk is unlikely to be taken.
The first steps of the Health Belief Model, that of conveying personal susceptibility and harm, are particularly difficult with young people. According to experts, youth often engage in magical thinking, perceiving themselves as immortal and that illness, accidents, and negative events only happen to others. Findings of studies with youth, particularly in the area of drugs or sexuality, have shown minimal effectiveness in changing behavior even when the focus concerned information of risks or serious harm resulting from the behavior among high-risk groups.
According to a study, smokers who are continually confronted with warnings that cigarettes kill actually develop coping mechanisms to justify continuing their habit.
Comparatively, if smokers are shown warnings suggesting the habit could make them unattractive, they are more likely to give up. Teenagers who took up the habit to impress or fit in with their peers were more likely to be influenced by warnings about their appearance, the study found.
“In general, when smokers are faced with death-related anti-smoking messages on cigarette packs, they produce active coping attempts as reflected in their willingness to continue the risky smoking behaviour,” the study said.
“To succeed with anti-smoking messages on cigarette packs one has to take into account that considering their death may make people smoke.”
The study from the United States, Switzerland and Germany, led by Jochim Hansen of New York University and the University of Basel, asked 39 psychology students who said they were smokers, aged between 17 -41.
Research in 2012 from the University of South Carolina suggested that health warning labels containing pictures have proven to be effective in causing awareness in adult smokers.
Other research from Susquehanna University in Selinsgrove suggested that graphic cigarette packet warning labels could significantly reduce demand.
Most educators would probably agree that even problem of alcohol consumption represents a complex social issue fraught with cultural mores, opinions, and values. Messages received from warning labels may or may not increase consumers’ awareness of a health risk or influence their behaviour to reduce the risk.
Due to conflicting findings, investigators are unable to determine whether or not consumers even read health and safety warnings. And even if a warning is read, the caution may not be followed and the warning may not be read again. In one study in which students were asked to wear safety goggles while hammering a nail, students neglected to wear the goggles despite a warning label on the hammer and the presence of goggles near the hammer. Teachers are aware of many students and adults who, after a few days, do not notice a health or safety message posted on a bulletin board. When traffic safety notices are given such as, “buckle your seat belt: it’s the law,” how frequently do unbuckled drivers read the sign and then buckle up? Regardless of state law or seat belt warning signals, less than 15% of all drivers use seat belts. How many drivers speeding faster than 65 miles per hour slow down when they see a freeway speed limit sign?
Therefore, considering all the above issues it becomes quite uncertain whether such efforts are fruitful or create a false sense of security that something is being done to thwart the abuse? Can such legislated public policy solve complex social problems, or is this policy primarily a symbolic effort in support of reducing tobacco abuse in the country? |
