Awareness of health warnings and factors predicting awareness and perceived effectiveness of pictorial health warnings on tobacco products among adults in rural Puducherry, India

BACKGROUND: Limited information exists in India about the awareness and perception of the people regarding pictorial health warnings (PHWs) and text warnings on tobacco products, more so from rural areas. Objectives were to report the awareness of these warnings, factors predicting awareness and perceived effectiveness of PHWs, and understanding of their content in a rural population. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in two villages (chosen randomly out of total four) in the rural field practice area of a tertiary care teaching hospital in Puducherry. Households were selected by systematic random sampling. All persons ≥18 years and residing in the area for at least 6 months were included. Data regarding awareness and perception of participants was collected through a semi-structured interview schedule. RESULTS: A total of 428 participants were recruited; 197 (46%) were male, and 231 (54%) were female. The mean age of the participants was 38.9 (standard deviation 15.0) years. Awareness of PHWs and text warnings was 39.5% (169/428) and 21% (90/428), respectively. Only 11.2% participants perceived PHWs as effective. Most (45%) of the participants had a vague understanding of the content of PHWs. On multivariate logistic regression, male gender, current tobacco use, and better education emerged as predictors of greater awareness of PHWs. Extended family predicted greater perceived effectiveness of PHWs, whereas, high socioeconomic class and middle school completion predicted lower perceived effectiveness of PHWs. CONCLUSION: Awareness and perceived effectiveness of adults in rural Puducherry regarding PHWs were low. There is a need to create awareness through education and using meaningful, larger pictures.