Role of Tobacco Warning Labels in Informing Smokers about Risks of Smoking among Bus Drivers in Mangalore, India

  • Mallikarjun, Sajjanshetty (Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University) ;
  • Rao, Ashwini (Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University) ;
  • Rajesh, Gururaghavendran (Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University) ;
  • Shenoy, Ramya (Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University) ;
  • Mithun, Pai B.H. (Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University)
  • Published : 2014.10.23


Background: Smoking tobacco is considered as a leading cause of preventable death, mostly in developing countries like India. One of the primary goals of international tobacco control is to educate smokers about the risks associated with tobacco consumption. Tobacco warning labels (TWLs) on cigarette packages are one of the most common statutory means to communicate health risks of smoking to smokers, with the hope that once educated, they will be more likely to quit the habit. Materials and Methods: The present survey was conducted to assess the effectiveness of TWLs in communicating health risks of tobacco usage among 263 adult smokers working as bus drivers in Karnataka State Road Transport Corporation (KSRTC), Mangalore, India. Information was collected on demographic details, exposure and response to health warnings on tobacco products, intention to quit and nicotine dependency. Results: The majority (79.5%) of the respondents revealed negative intentions towards quitting smoking. Nearly half of the participants had a 'low' nicotine dependency (47.5%) and 98.1% of the respondents had often noticed warning labels on tobacco packages. These health warnings made 71.5% of the respondents think about quitting smoking. Respondents who noticed advertisement or pictures about dangers of smoking had better knowledge, with respect to lung cancer and impotence as a consequence of tobacco. A higher exposure to warning labels was significantly associated with lower nicotine dependency levels of smokers among the present study population. A significantly higher number of respondents who noticed advertisement or pictures about the dangers of smoking thought about the risks of smoking and were more inclined to think about quitting smoking. As exposure increased, an increase in the knowledge and response of participants was also observed. Conclusions: Exposure to tobacco warning labels helps to educate smokers about health risks of tobacco smoking. It may be possible to promote oral health among bus drivers by developing strategies to educate them about these risk factors.


  1. Ajzen I (1991). The theory of planned behavior. Organ Behav Hum Decis Process, 50,179-211.
  2. 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.
  3. Ayanian JZ, Cleary PD (1999). Perceived risks of heart diseases and cancers among cigarette smokers. JAMA, 281, 1019-21.
  4. Bathija G V, Bant DD, Itagimath SR, et al., (2014). A study on stress among government city bus drivers in Hubli. Int J Biomed Res, 5, 102-4
  5. Bhan N, Srivastava S, Agrawal S, et al (2012). Are socioeconomic disparities in tobacco consumption increasing in India? A repeated cross-sectional multilevel analysis. BMJ Open, 2, 1348.
  6. Binnal A, Rajesh G, Ahmed J, Denny C, Nayak SU (2013). Insights into smoking and its cessation among current smokers in India. Asian Pac J Cancer Prev, 14, 2811-8.
  7. Borland R (1997). Tobacco health warnings and smoking-related cognitions and behaviours. Addiction, 92, 1427-35.
  8. Brownson CR, Thompson JJ, Wilkerson JC, et al (1992). Demographic and socioeconomic differences in beliefs about the health effects of smoking. Am J Public Health, 82, 99-103.
  9. CDC (2004). Centers for disease control and prevention. the health consequences of smoking: a report of the Surgeon General. Atlanta, Georgia: Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, DC.
  10. CDC (2007). Centers for Disease Control and Prevention. Best practices for comprehensive tobacco control programs-October 2007. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington DC.
  11. Crawford TV, McGrowder DA, Barnett JD, et al (2012). Tobacco-related chronic illnesses: a public health concern for Jamaica. Asian Pac J Cancer Prev, 13, 4733-8
  12. Cummings KM, Hyland A, Giovino GA, et al (2004). Are smokers adequately informed about the health risks of smoking and medicinal nicotine? Nicotine Tob Res, 6, 333-40.
  13. Frank E, Denniston M, Pederson L (2002). Declines in smokers understanding of tobacco hazards between 1986 and 1998: a report from North Georgia. South Med J, 95, 675-80.
  14. Goon S, Bipasha MS (2014). Prevalence and pattern of smoking among bus drivers of Dhaka, Bangladesh. Tobacco Use Insights, 7, 21-5.
  15. Gupta B, Kumar N (2014). A cross-country comparison of knowledge, attitudes and practices about tobacco use: findings from the Global Adult Tobacco Survey. Asian Pac J Cancer Prev, 15, 5035-42.
  16. Hammond D, Fong GT, McDonald PW, Cameron R, Brown KS (2003). The impact of the graphic Canadian warning labels on adult smoking. Tob Control, 12, 391-5.
  17. Hammond D, McDonald PW, Fong GT, Brown KS, Cameron R (2004a). The impact of cigarette warning labels and smokefree bylaws on smoking cessation: evidence from former smokers. Can J Public Health, 95, 201-4.
  18. Hammond D, Fong GT, McDonald PW, Brown KS, Cameron R (2004b). Graphic cigarette package warning labels and adverse outcomes: evidence from Canadian smokers. Am J Public Health, 94, 1442-5.
  19. Hammond D, Fong GT, McNeill A, Borland R, Cummings KM (2006). Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the international tobacco control (ITC) Four Country Survey. Tobacco Control, 15, 19-25.
  20. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO (1991). The fagerstrom test for nicotine dependence: a revision of the fagerstrom tolerance questionnaire. Br J Addict, 86, 1119-27.
  21. Holme I, Helgeland A, Hjermann I, Leren P, Lund-Larsen PG (1977). Coronary risk factors in various occupational groups: The Oslo study. Br J Prev Soc Med, 31, 96-100.
  22. Hu KK, Woodall ED, Do HH, et al (2006). Tobacco knowledge and beliefs in Chinese-american men. Asian Pac J Cancer Prev, 7, 434-8.
  23. Hyland A, Li Q, Bauer JE, et al (2004). Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res, 6, 363-9.
  24. Janz NK, Becker HM (1984). The health belief model: a decade later. Health Educ Q, 11, 1-47.
  25. Jayakirshnan R, Uutela A, Mathew A, et al (2013) Smoking cessation intervention in rural Kerala, India; findings of a randomised controlled trial. Asian Pac J Cancer Prev, 14, 6797-802.
  26. Jena PK, Bandyopadhyay C, Mathur M, Das S (2012). Extending the application of 'hardcore' definition to the smokeless tobacco use: estimates from a nationally representative population in India and its implication. Asian Pac J Cancer Prev, 13, 5959-63.
  27. Jha P, Jacob B, Gajalakshmi V, et al, (2008). A nationally representative case-control study of smoking and death in India. N Engl J Med, 358, 1137-47.
  28. Kerr S, Watson H, Tolson D, Lough M, Brown M (2006). Smoking after the age of 65 years: a qualitative exploration of older current and former smokers' views on smoking, stopping smoking, and smoking cessation resources and services. Health Soc Care Community, 14, 572-82.
  29. Kishore J, Jena PK, Bandyopadhyay C, et al (2013). Hardcore smoking in three south-east asian countries: results from the global adult tobacco survey. Asian Pac J Cancer Prev, 14, 625-30.
  30. Lin M, Huang S, Shih W, et al (2013). Effects of an anti-smoking program to prevent lung cancer among urban aboriginals in Taiwan. Asian Pac J Cancer Prev, 14, 6451-7.
  31. Luqman M, Javed MM, Daud S, et al (2014). Risk factors for lung cancer in the Pakistani population. Asian Pac J Cancer Prev, 15, 3035-9.
  32. Ministry of Health & Family Welfare, Government of India (2003). Cigarettes and other tobacco products Act (COTPA) 2003. Available from (Accessed on 28-09-2013).
  33. Murray CJL, Lopez AD (1997). Alternative projections of mortality and disability by cause 1990-2020: global burden of disease study. Lancet, 349, 1498-504.
  34. Panda B, Rout A, Pati1 S, et al, (2012). Tobacco control law enforcement and compliance in Odisha, India - implications for tobacco control policy and practice. Asian Pac J Cancer Prev, 13, 4631-7.
  35. Rao SVK, Mejia G, Thomson KR, Logan R (2013). Epidemiology of oral cancer in Asia in the past decade-an update (2000-2012). Asian Pac J Cancer Prev, 14, 5567-77.
  36. Raute LJ, Pednekar MS, Gupta PC (2009). Pictorial health warnings on cigarette packs: a population based study findings from India. Tobacco Use Insights, 2, 11-6.
  37. Reddy P, Weitz AM, Yach D (1996). Smoking status, knowledge of health effects and attitudes towards tobacco control in South Africa. S Afr Med J, 86, 1389-93.
  38. Roychowdhury S, Roychowdhury G, Sen U (2005). Assessment of awareness level on tobacco and smoking habits as risk factors for cancer among lung and laryngeal cancer patients in kolkata -a case control study. Asian Pac J Cancer Prev, 6, 332-6.
  39. Sansone GC, Raute LJ, Fong GT, et al (2012). Knowledge of health effects and intentions to quit among smokers in india: findings from the tobacco control policy (TCP) India pilot survey. Int J Environ Res Public Health, 9, 564-78.
  40. Udayar SE, Konduru RK, Kumar PKB, Shivachandiran V, Srinivas T (2014). Study of cardiovascular risk factors among transport drivers in rural area of andhra pradesh. Int J Res Health Sci, 2, 420-6.
  41. Wardle H, Pickup D, Lee L, et al (2010). Evaluating the impact of picture health warnings on cigarette packets. Public health research consortium short report, Department of Health Policy Research programme, London, UK.
  42. Weinstein ND (1999). Accuracy of smokers' risk perceptions. Nicotine Tob Res, 1, 123-30.
  43. World Health Organization (2010). Ukraine Global Adult Tobacco Survey (GATS). (WWW) Available from: (Accessed on 28-09-2013).
  44. World Health Organization (2011). WHO report on the global tobacco epidemic, 2011, warning about the dangers of tobacco. Geneva, Switzerland, WHO press, 2011.
  45. World Health Organization (2013). WHO management of substance abuse. (WWW) Available from: on 24-03-2013).
  46. Yang J, Hammond D, Driezen P, Fong GT, Jiang Y (2010). Health knowledge and perception of risks among Chinese smokers and non-smokers: findings from the Wave 1 ITC China Survey. Tob Control, 19, 18-23.

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