Insights into pictorial health warnings on tobacco product packages marketed in Uttar Pradesh, India

Background: The Government of India issued an undertaking in the Supreme Court mandating pictorial health warnings (PHWs) on packages of tobacco products from 31^st May, 2009 under "Cigarettes and Other Tobacco Products Act" (COTPA) guidelines. This constitutes a key economic channel for educating people on devastating health impacts of deadly products within in a vivid and memorable way. Few studies have investigated PHWs on tobacco products marketed in India. Objectives: To assess met guidelines for pictorial health warnings under packaging and labeling rules on packages of collected tobacco products specified by COTPA. Materials and Methods: Snowball/network sampling design was followed to obtain samples of 37 different tobacco brands, 18 in smoking form (12 cigarette, 6 bidi brands) and 19 in smokeless form (4 chewing tobacco, 11 Gutkha and 4 Khaini brands) marketed at retail outlets at Muradnagar. They were analyzed for their compliance with guidelines through checklist by one calibrated examiner. Results: PHWs were absent on packages of 5 tobacco brands. Fifteen tobacco brands had PHWs smaller than stipulated 40% of principal display area; 6 brands of bidis had PHWs on deceptive backgrounds, 3 of which were placed on a curved axis. Misleading descriptors and promotional messages were also present. Conclusion: Locally marketed tobacco products were not compliant with packaging and labeling rules specified by COTPA. This highlights the need for more stringent implementation of COTPA guidelines to combat the ever-growing tobacco menace.