Get the true picture: Pack Warnings

Dr. Mira Aghi

What a wonderful concept!

This day marks the need for global attention to the tobacco epidemic and highlights the loss on account of preventable death and disease.

Why is tobacco a health threat?

Did you know? Tobacco claims nearly 1 million lives each year in India

The National Family Health Survey, in its third round, found that tobacco use among males was 57% and 10.8% among females aged 15 years and above. In India, tobacco use prevalence is higher among older age groups as compared to the younger age groups and also higher in rural population in comparison with urban areas.

The younger population is however, increasingly vulnerable and at great risk. The threat across all age groups is evident from recent studies on prevalence and projections for future. The need for more effective action is therefore very clear.

• The Indian component of the Global Youth Tobacco Survey (GYTS) conducted among school going youth (aged 13-15) in 2006 estimated that 12% students had smoked cigarettes at least once; 4.2% currently smoked cigarettes and 11.9% used other tobacco products (GYTS, 2006).
• A study conducted by HRIDAY (Health Related Information Dissemination Amongst Youth) in two large cities of India: Delhi and Chennai, concluded that students in sixth grade were using two to four times more tobacco than those in eighth grade ( Reddy KS et al, The Lancet, 2006).

About World No Tobacco Day

In 1987, the World Health Assembly passed a landmark resolution (WHA40.38), calling for April 7, 1988 to be “a world no-smoking day.” Thereafter, in 1988, Resolution WHA42.19 was passed, calling for the celebration of World No Tobacco Day, every year on May 31.

Ever since then, each year, World No Tobacco Day has been observed around the world on May 31. It is a reminder to one and all that tobacco use bodes nothing but disaster.

Each year, the World Health Organization (WHO) selects a theme for the World No Tobacco Day. This year the theme is "Tobacco Health Warnings."

Tobacco health warnings are meant to appear on all tobacco products and are viewed as among the strongest defenses against the global epidemic of tobacco.

In India all tobacco products are meant to have these warnings from 1 June of this year.

Why are tobacco pack warnings important?

Every eight seconds, someone somewhere in the world is killed as a result of tobacco use. Such a big loss! Is one day in a whole year enough to turn the havoc around? Most definitely not! We need a continuous reminder, if not every eight seconds, at least often enough to keep the momentum going.

Are health warnings on packages effective?

Health warnings on cigarette packages are among the most prominent sources of health information: more smokers report getting information about the risks of smoking from packages than any other source except television. Health warnings are an extremely cost-effective public health intervention and have tremendous reach. (Hammond D et al. 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 2006; 15(Suppl. III: iii19–iii25.)

WHO particularly approves of warnings that contain both pictures and words, because they are the most effective at convincing people to quit using tobacco. Using gory pictures to remind people of the ugly truth has been observed to work very well.

Cigarette packs in India may soon display graphic health warnings, like the ones below:

An image illustrating the effects of smokeless tobacco products

Reaching out to communities

There are examples far and wide where behavioral scientists have successfully modified people’s thinking, attitudes, and behavior by involving them in creating stories, dramas, and role plays that entertain and educate people at the same time. They have also been able to communicate clearly the risks that they are likely to suffer from, in case they do not change. Tobacco pack warnings are a step in that direction, by providing a clear picture of the negative effects on one’s health, body and those of our loved ones.

For over 30 years entertainment Education (E-E) has been a tool for changing health behavior. E-E uses drama, music, or other communication formats that engage the emotions to inform audiences and change attitudes, behavior, and social norms. Worldwide, several hundred major projects have used E-E to improve health. Entertainment-education has encouraged people to live healthier lives. For example, E-E projects for family planning and reproductive health have helped motivate people to use contraception, to prevent HIV infection.

To improve public health, E-E has encouraged people to exercise, eat more fruits and vegetables, and stop smoking as well as to adopt family planning and avoid HIV infection.

In South Asia animated cartoons and comic books from the Meena initiative portray the dangers of early marriage and early pregnancy and the advantages of allowing girls to finish school through the life of a dynamic little girl, her pet parrot, her brother and friends.

In India the Community Media Initiative used a video van to show episodes of Jasoos Vijay, a TV detective drama with a theme of HIV prevention. Thanks to the video van, people in 1,200 towns in Uttar Pradesh saw the episodes and participated in discussions and interactive games that accompanied the shows. (Entertainment-Education for Better Health, INFO Reports, No. 17. Baltimore, INFO Project, Johns Hopkins Bloomberg School of Public Health, January 2008. Available online at: http://www.infoforhealth.org/inforeports)

It might be very rewarding to attempt something along these lines. One story each day or one episode in a serial to show what it takes for people to introspect about their behavior. A simple way of doing it would be to have someone come up with a problem and show how drama can be created to bring about a solution. It would be worthwhile to try this as an experiment. It might prove to be the beginning of the end of tobacco use!