Industry manipulation of pictorial health warning labels in Pakistan

Crespi, Elizabeth; Iacobelli, Michael; Welding, Kevin; Saraf, Sejal; Smith, Katherine Clegg; Cohen, Joanna E.

doi:10.1136/tobaccocontrol-2020-056433

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…Over decades, the tobacco industry has undermined warnings in many ways, including by having a voluntary warning to deter stronger regulation; having voluntary warnings in a foreign language (English); using weak message content; minimising warning size, prominence and visibility including through the choice of colours and package location; having deficient print quality for colour images; having warnings stretch over bevelled edges; and marketing ‘slims’ packages and various novel package formats, which impair warnings 3 8 96–99…”

Section: Industry Undermining Of Warningsmentioning

confidence: 99%

Tobacco package health warnings: a global success story

Cunningham

2022

Tob Control

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Section: Industry Undermining Of Warningsmentioning

confidence: 99%

Tobacco package health warnings: a global success story

Cunningham

2022

Tob Control

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“…For example, improving the image's quality was a general recommendation to improve HWLs' effectiveness. The tobacco firms seem to be aware of image quality for the effectiveness of HWLs since they have manipulated (by tinting, darkening, and fading) HWLs' image quality on cigarette packs in Pakistan [52]. Concerning the text message, focus group participants suggested using statements that are more assertive (e.g., "WP use causes") rather than "may lead to" or "can cause."…”

Section: Discussionmentioning

confidence: 99%

Adapting waterpipe-specific pictorial health warning labels to the Tunisian context using a mixed method approach

et al. 2023

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Background Waterpipe (WP) use is rapidly increasing among young people worldwide due to the widespread misperception that it is safer than cigarette smoking. Health warning labels (HWLs) can effectively communicate tobacco-related health risks but have yet to be developed for WP. This study aimed to optimize and adapt a set of 16 pictorial WP-specific HWLs, developed by an international Delphi study, to the Tunisian context. HWLs were grouped into four themes: WP health risks, WP harm to others, WP-specific harms, and WP harm compared to cigarettes. Methods Using a mixed method approach, we conducted ten focus groups combined with a survey among young WP users and nonusers (N = 63; age 18–34 years). In the survey, participants rated the HWLs on several communication outcomes (e.g., reaction, harm perception, effectiveness) and were then instructed to view all HWLs in each theme and rank them in the order of overall perceived effectiveness, from the most to the least effective. Afterward, participants provided in-depth feedback on HWLs and avenues for improvement. Mean effectiveness rating scores and percentages of participants’ top-ranked HWLs were calculated. Discussions were audio-taped, transcribed verbatim, and analyzed thematically. Results The top-ranked HWLs were those showing oral cancers, orally transmitted diseases, and a sick child. Focus group discussion illustrated that these selections were based on participants’ reactions to the direct impact of WP on a person’s physical appearance and evoking guilt over children’s exposure to WP smoke. Suggestions for improvement highlighted the need to use the local dialect and more affirmative statements (e.g., avoiding "may" or "can"). Conclusions This study is the first in North Africa to attempt to advance HWLs policy as the World Health Organization recommended. The results of this study can be used as a basis for implementing WP-specific health messages in the Eastern Mediterranean Region.

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“…There is also evidence of explicit manipulation of HWLs on smokeless tobacco packs purchased in rural India in 2017, with HWLs being blurred in parts, stretched and tinted 6. Further, HWLs on cigarette packs purchased in Pakistan, a lower middle-income country, in 2019 and 2020 were manipulated such that they were tinted, faded, blurred, the background colour was changed and the size of throat cancer included in the HWL image was reduced 7…”

Section: Manipulation Of Hwlsmentioning

confidence: 99%