- Volume 15 Issue 18
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Evaluation of the Knowledge and Perceptions with Regards to Pictorial Health Warnings on Tobacco Products among Tobacco Users Diagnosed with Head and Neck Carcinoma: a Study from the Kumaon Hills of India
- Pant, Nirdosh Kumar (Department of Radiotherapy, Government Medical College-Haldwani) ;
- Pandey, Kailash Chandra (Department of Radiotherapy, Government Medical College-Haldwani) ;
- Madabhavi, Irappa (Department of Medical Oncology, Gujarat Cancer Research Institute) ;
- Pandey, Vinod (Department of Radiotherapy, Government Medical College-Haldwani) ;
- Revannasiddaiah, Swaroop (Department of Radiotherapy, Government Medical College-Haldwani)
- Published : 2014.10.11
Background: Tobacco products continue to be used in large quantities in India despite the mandatory inclusion of pictorial health warnings (PHWs) on all tobacco packaging. The circumstances as to how people could continue the use of tobacco to the point of developing head and neck cancer despite enhanced awareness about the ill effects of tobacco is the main focus of this study. Materials and Methods: This study concerned patients with least 5-years history of tobacco use, having been diagnosed with histopathologically proven malignancies of the hypopharynx, larynx, oropharynx and oral cavity presenting at the Government Medical College-Haldwani, Nainital, India. A total of 183 patients were eligible for inclusion during July 1 2013 - June 30 2014. Of these, 59 patients used smoked tobacco exclusively, 22 patients used smokeless tobacco exclusively, and 102 patients used both forms of tobacco. Among users of smoked forms, 75.2% (n=121) were beedi users, and 24.8% (n=40) were cigarette users. Patients were asked direct questions as to whether they had noticed the presence of PHWs upon tobacco products. The reasons as to why PHWs were not effective in stopping the patients from tobacco use were investigated. Results: Of the 183 patients, 146 reported being aware about the presence of PHWs, and when they were asked reasons as to why they continued tobacco despite being aware of ill-effects, the commonest reason chosen (by 53.4%) was that patients had not regarded themselves as using tobacco heavy enough to cause cancer. Among the 36 patients who reported as being oblivious to the presence of PHWs on tobacco products, 63.9% reported that the products they used never displayed any PHWs, and 36.1% reported never having paid attention to the packaging. The awareness about PHWs was higher among cigarette smokers in comparison to beedi smokers (100% vs 76.1%, p=0.0002). Conclusions: Locally produced and marketed tobacco products such as beedis and oral tobacco often fail to display PHWs. The presence of PHWs without doubt enhances awareness about the carcinogenic risks of tobacco. However, enhanced awareness alone may not be enough, and as elucidated by this study, some persons continue to use tobacco to the point of developing malignancies. The need of the hour is the implementation of legal and economic sanctions discouraging the use of tobacco products.
- Aruna DS, Rajesh G, Mohanty VR (2010). Insights into pictorial health warnings on tobacco product packages marketed in Uttar Pradesh, India. Asian Pac J Cancer Prev, 11, 539-43.
- Abrams A, Gagnon JH, Levin JJ (1968). Psychosocial aspects of addiction. Am J Public Health Nations Health, 58, 2142-55. https://doi.org/10.2105/AJPH.58.11.2142
- Al-Attas SA, Ibrahim SS, Amer HA, et al (2014). Prevalence of potentially malignant oral mucosal lesions among tobacco users in Jeddah, Saudi Arabia. Asian Pac J Cancer Prev, 15, 757-62. https://doi.org/10.7314/APJCP.2014.15.2.757
- Asplund K (2003). Smokeless tobacco and cardiovascular disease. Prog Cardiovasc Dis, 45, 383-94. https://doi.org/10.1016/S0033-0620(03)80002-6
- Balagopal PG, George NA, Venugopal A, et al (2012). Tobacco related habits among first degree relatives of patients undergoing surgery for advanced head and neck malignancies in India. Asian Pac J Cancer Prev, 13, 217-20. https://doi.org/10.7314/APJCP.2012.13.1.217
- Bansal-Travers M, Hammond D, Smith P, Cummings KM (2011). The impact of cigarette pack design, descriptors, and warning labels on risk perception in the U.S. Am J Prev Med, 40, 674-82. https://doi.org/10.1016/j.amepre.2011.01.021
- Bell RG (1965). Defensive thinking in alcohol addicts. Can Med Assoc J, 92, 228-31.
- Bhawna G (2013). Burden of smoked and smokeless tobacco consumption in India - results from the Global adult Tobacco Survey India (GATS-India)- 2009-2010. Asian Pac J Cancer Prev, 14, 3323-9. https://doi.org/10.7314/APJCP.2013.14.5.3323
- C Ruiter RA, Kok G (2005). Saying is not (always) doing: cigarette warning labels are useless. Eur J Public Health, 15, 329.
- Fong GT, Hammond D, Hitchman SC (2009). The impact of pictures on the effectiveness of tobacco warnings. Bull WHO, 87, 640-3.
- Cantrell J, Vallone DM, Thrasher JF, et al (2013). Impact of tobacco-related health warning labels across socioeconomic, race and ethnic groups: results from a randomized web-based experiment. PLoS One, 8, 52206. https://doi.org/10.1371/journal.pone.0052206
- Collishaw NE (2010). The millennium development goals and tobacco control. Glob Health Promot, 17, 51-9.
- Cunningham R (2009). Gruesome photos on cigarette packages reduce tobacco use. Bull WHO, 87, 569.
- Gigliotti A, Figueiredo VC, Madruga CS, et al (2014). How smokers may react to cigarette taxes and price increases in Brazil: data from a national survey. BMC Public Health, 14, 327 https://doi.org/10.1186/1471-2458-14-327
- Hammond D, Fong GT, McNeill A, (2006). Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control, 15, 19-25. https://doi.org/10.1136/tc.2005.011254
- Henley SJ, Thun MJ, Chao A, Calle EE (2004). Association between exclusive pipe smoking and mortality from cancer and other diseases. J Natl Cancer Inst, 96, 853-61. https://doi.org/10.1093/jnci/djh144
- Hitchman SC, Driezen P, Logel C, et al (2014). Changes in effectiveness of cigarette health warnings over time in Canada and the United States, 2002-2011. Nicotine Tob Res, 16, 536-43. https://doi.org/10.1093/ntr/ntt196
- Kaleta D, Koziel A, Miskiewicz P (2009). MPOWER--strategy for fighting the global tobacco epidemic. Med Pr, 60, 145-9.
- Kessels LT, Ruiter RA, Wouters L, Jansma BM (2014). Neuroscientific evidence for defensive avoidance of fear appeals. Int J Psychol, 49, 80-8. https://doi.org/10.1002/ijop.12036
- Sharma PK, Bansal R (2013). Profile of lung cancer in predominantly Bidi smoking rural population of northern Himachal Pradesh. Indian J Chest Dis Allied Sci, 55, 75-8.
- Mays D, Niaura RS, Evans WD, (2014). Cigarette packaging and health warnings: the impact of plain packaging and message framing on young smokers. Tob Control, doi:10.1136/tobaccocontrol-2013-051234. [Epub ahead of print] https://doi.org/10.1136/tobaccocontrol-2013-051234
- Rani M, Bonu S, Jha P, et al (2003). Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control, 12, 4. https://doi.org/10.1136/tc.12.4.e4
- Sharma MK, Gour N, Pandey A, Wallia D (2011). Epidemiological study of risk factors for oral, laryngeal and esophageal cancers at a tertiary care hospital in India. Asian Pac J Cancer Prev, 12, 1215-8.
- Sherman DAK, Nelson LD, Steele CM (2000). Do messages about health risks threaten the self? Increasing the acceptance of threatening health messages via self-affirmation. Pers Soc Psychol Bull, 26, 1046-58. https://doi.org/10.1177/01461672002611003
- Spires M, Rutkow L, Feldhaus I, Cohen JE (2014). The World Health Organization's MPOWER framework and international human rights treaties: an opportunity to promote global tobacco control. Public Health, 128, 665-7. https://doi.org/10.1016/j.puhe.2014.04.010
- Sussenbach P, Niemeier S, Glock S (2013). Effects of and attention to graphic warning labels on cigarette packages. Psychol Health, 28, 1192-206. https://doi.org/10.1080/08870446.2013.799161
- Talikka M, Sierro N, Ivanov NV, et al (2012). Genomic impact of cigarette smoke, with application to three smoking-related diseases. Crit Rev Toxicol, 42, 877-89. https://doi.org/10.3109/10408444.2012.725244
- Tripathy JP, Goel S, Patro BK (2013). Compliance monitoring of prohibition of smoking (under section-4 of COTPA) at a tertiary health-care institution in a smoke-free city of India. Lung India, 30, 312-5. https://doi.org/10.4103/0970-2113.120607
- World Health Organization (1997). Tobacco or health : a global status report. World Health Organization, Geneva.
- Ullrich A, Miller A (2014). Global response to the burden of cancer: the WHO approach. Am Soc Clin Oncol Educ Book. 2014, 311-5.
- Volchan E, David IA, Tavares G, et al (2013). Implicit motivational impact of pictorial health warning on cigarette packs. PLoS One, 8, 72117. https://doi.org/10.1371/journal.pone.0072117
- WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2003. World Health Organization. Wilson TD (2002). Strangers to ourselves: Discovering the adaptive unconscious. Cambridge, MA: The Belknap Press of Harvard University Press.
- World Health Organization (2008). WHO report on the Global Tobacco Epidemic, 2008. Available at HYPERLINK "http://whqlibdoc.who.int/publications/2008/9789241596282_eng.pdf"
- Yen KL, Hechavarria E, Bostwick SB (2000). Bidi cigarettes: An emerging threat to adolescent health. Arch Pediatr Adolesc Med, 154, 1187-9. https://doi.org/10.1001/archpedi.154.12.1187
- Zarocostas J (2011). WHO lists "best buys" for cutting deaths from non-communicable disease. BMJ, 342, 2648 https://doi.org/10.1136/bmj.d2648
- An examination of the effectiveness of health warning labels on smokeless tobacco products in four states in India: findings from the TCP India cohort survey vol.16, pp.1, 2016, https://doi.org/10.1186/s12889-016-3899-7
- Tobacco – Whose friend and who is friend with it? vol.6, pp.2, 2015, https://doi.org/10.1016/j.injms.2015.05.004