Perceived Effectiveness of Pictorial Health Warning Labels of Tobacco Products and Associated Factors among Smokers and Quitters in Kaski District, Nepal

Abstract

Introduction: Globally, tobacco kills more than seven million people per year. In Nepal, more than fifty different types of tobacco products, both in smoke and smokeless forms, are available. Pictorial health warning labels (PHWLs) on tobacco products provide an effective way to aware both literates and illiterates about the health effects of tobacco use. This study aimed to assess the perceived effectiveness of pictorial health warning labels of tobacco products and associated factors among smokers and quitters.
 Methods: The study design was community-based cross-sectional analytical with the quantitative method. We interviewed 389 adults (111 Quitters and 278 Smokers) of Kaski district. The sample was taken from both rural and urban areas based on existing household proportion. Ethical approval was taken from NHRC. We entered data in EpiData and analyzed in SPSS softwares. The perceived effectiveness scores of PHWLs were calculated (alpha ranges from 0.91 to 0.96) and compared among different groups using the Wilcoxon rank-sum test and Kruskal-Wallis test with the Dunn’s multiple comparisons. The perceived effectiveness score of PHWLs were correlated with discrete covariates using Spearman rank correlation.
 Results: Nearly one-third of the participants (32.7%) had bought a single piece of tobacco product, which is not allowed in Nepal. Nearly sixteen percentage of the participants were moderate to high level of nicotine dependent. Only twelve percent of participants wanted to quit or already quitted as s/he saw the PHWLs. Scores of Premature birth was statistically significant (p=0.031) on smoking status. Martial status, ethnicity, any family member use tobacco, age at first exposure psychological response, behavioral response and message credibility were statistically significant for the perceived effectiveness of PHWLs among smokers. Whereas place of resident, education status, age, psychological response, behavioral response, self efficacy and message credibility were statistically significant at p<0.05 for the perceived effectiveness of PHWLs among quitters.
 Conclusions: This study concluded that premature type of PHWL was more effective than other type of PHWLs. The interventional program along with social and behavior change communication should be focused on the psychological, behavioral related and geographical setting. Further research is suggested to carryout the interventional study addressing behavioral and psychological factors.