Impact of Health Warning Labels on Cigarette Packs in India: Findings from the Global Adult Tobacco Survey 2016-17.

Two rounds of Global Adult Tobacco Survey (GATS) were conducted in 2009-10 and 2016-17 in India. These two surveys provide national comparable data on tobacco usage and its related aspects in India. This study used the data from GATS 2016-17 to examine the salience and impact of cigarette pack pictorial health warnings (PHWs) on quit intention among current cigarette smokers in India. The nationally representative survey interviewed 74, 037 respondents aged ≥15 years with an overall response rate of 92.9% using a multi-stage sampling method. Results of multivariate analysis showed that the strongest predictor for quit intention because of health warnings was "ever made a quit attempt in the past 12 months" and buying cigarette packs instead of loose cigarettes. Compared to GATS 2009-10, GATS 2016-17 observed an increase in salience of cigarette health warnings by 16% and increase in the impact of PHWs on quit intention by 50%. PHWs have a significant impact on intention to quit among cigarette smokers in India with a rising trend. The efforts of Government of India in terms of periodic introduction of new PHWs and increase in the size of warning labels to 85% of the cigarette packs is laudable. The study results support ban on loose cigarettes and warrants stricter implementation of the act prohibiting sale of loose cigarettes.