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Year : 2010  |  Volume : 47  |  Issue : 5  |  Page : 101-104

Tobacco industry interference for pictorial warnings

Healis-Sekhsaria Institue for Public Health, 601/B Great Eastern Chambers, Plot no. 28, Sector 11, CBD Belapur, Navi Mumbai 400 614, India

Date of Web Publication9-Jul-2010

Correspondence Address:
K C Oswal
Healis-Sekhsaria Institue for Public Health, 601/B Great Eastern Chambers, Plot no. 28, Sector 11, CBD Belapur, Navi Mumbai 400 614
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Source of Support: Funding of the Project – International Union Against Tuberculosis and Lung Diseases under the Bloomberg Grant Initiative (U-INDIA-1-9A), Conflict of Interest: None

DOI: 10.4103/0019-509X.65318

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 » Abstract 

Aim : A study was carried out to understand the process of interference by the tobacco industry, to measure the compliance of the industry for displaying pictorial warnings on a tobacco product as per the packaging and labeling rules post 31 st May, 2009, and to understand the public opinion on the messages conveyed through such warnings. Materials and Methods : A total of 60 samples of tobacco products were purchased after 31 May, 2009, from the retail vendors of tobacco sellers across the country. Results : The government of India has from time to time, taken measures, including legislations, to control tobacco consumption. The actual implementation of these rules has been postponed repeatedly, apparently because of constant pressure exerted by the tobacco industry. The skull and bone sign hurting religious sentiments as stated by the group of ministers proved to be misleading. Later the Group of Ministers (GOM) proposed three very weak and poorly communicative pictorial health warnings to replace those recommended by the Union Health Ministry based on the inputs of the Department of Audio Visual Publicity (DAVP). The industry tried to use strategic means by displaying a dull, diluted, and watered down pictorial warning. The focus group study conducted showed that a scorpion gets associated with the product in a non-scientific manner. X-ray of the lung was hardly understood by anybody. Conclusion : Overall the tobacco industry has constantly flouted with the law right from the policy level to its implementation by displaying dull, diluted, and poorly informed pictorial warnings.

Keywords: Delay and dilution of pictorial warnings, pictorial warning

How to cite this article:
Oswal K C, Pednekar M S, Gupta P C. Tobacco industry interference for pictorial warnings. Indian J Cancer 2010;47, Suppl S1:101-4

How to cite this URL:
Oswal K C, Pednekar M S, Gupta P C. Tobacco industry interference for pictorial warnings. Indian J Cancer [serial online] 2010 [cited 2022 Dec 7];47, Suppl S1:101-4. Available from:

Publication of the supplement was supported by the funds from the 14th World Conference on Tobacco or Health, March 8-12, 2009, Mumbai. The Guest Editors, Editors, Authors and others involved with the journal did not get any financial or non-financial benefit from the sponsors.

 » Introduction Top

Every year 31 st May is celebrated as the 'World No Tobacco Day,' and in 2009, the theme was "Tobacco Health Warnings", [1] with an emphasis on pictorial warnings. Canada was the first country to introduce pictorial warnings in 2001. [2],[3] Graphic pictures of diseased lungs, a brain damaged from a stroke and other disturbing images that appeared on cigarette packs in Canada were effective in informing people about the harms of smoking and motivating smokers to quit. [4] Other countries like Brazil, Thailand, and New Zealand also implemented pictorial warnings on tobacco products and had reported an effective tool for smokers to quit. [5],[6],[7]

India has signed and ratified the World Health Organization-Framework Convention on Tobacco Control (WHO-FCTC), which enlists key strategies for reduction in the demand and supply of tobacco products. Article 11 of the WHO-FCTC mandates that all countries that are parties to FCTC should display pictorial health warnings on the packs of tobacco product. [8] The [Table 1] represents the process in the implementation of pictorial warnings in India.

Hence from the [Table 1], it is clear that the packaging and labeling rules were constantly diluted, delayed, and deferred. A study was carried out across the country to understand the process of policy making, the implementation of packaging and labeling rules, to understand the public opinion about the warning, and the range of messages conveyed by the mandated warnings.

 » Materials and Methods Top

A total of 60 samples of tobacco products were purchased from the retail vendors of tobacco sellers across the country. The samples consisted of both smokeless (n = 30) and smoked (n = 30) tobacco products. The products included were cigarettes both Indian (= 12) and imported (= 4), bidi (= 10), gutka (= 20), plain tobacco (= 4), khaini (= 3), jarda (= 2), and mishri (= 1). The practices of consuming tobacco in these forms are very much prevalent in India. The types of violations that were assessed were the display area of the warnings, appearance of misleading descriptors, and promotional messages, the language used in the warnings, and the placement of the warning. Focus group discussions were also carried out in Mumbai among four different groups. (Youth, professional, women, and laborer groups). Eight to ten participants were selected for each focus group discussion.

 » Results Top

The constant delay in the implementation of pictorial warnings by the group of ministers was a result of the strong lobbying efforts by the tobacco industry. The initial pictorial warning, which had skull and bone did not appear on the tobacco products, because the skull and bone hurt religious sentiments, as stated by a group of ministers at the meeting. [Figure 1] and [Figure 2] A survey was carried out asking the general population about their opinion on whether it hurt the religious sensibility. The sample size selected for the study was 1000 and the study was carried out in Mumbai by the Healis- Sekhsaria Institute for Public Health. The results demonstrated that about 80% of the general population agreed that the placement of the skull and bone on the pictorial warning sign warns them against the danger of its use. About 90% of Hindus, Muslims, and other religions agreed that the sign of the skull and bone did not hurt their religious sensibilities. Even though these results were widely disseminated and publicized through media, yet the tobacco industries were successful in getting the skull and bone deleted from the proposed pictorial warnings. Later the GOM, as per the suggestion of the DAVP, revised the health warnings, which were a scorpion on a smokeless tobacco product and an X-ray of the chest and an image of diseased lungs on the smoked form of tobacco. Due to the constant delay in the implementation of the health warnings, the Supreme Court issued a notification that the tobacco products, after 31 st May, 2009, should have a pictorial warning displayed as per the COTPA packaging and labeling rules. [Figure 3].

The following violations were observed while implementing the pictorial warnings.

While measuring the size of the pictorial warning, which was calculated by (length x breadth of pictorial warning / length x breadth of the total surface) we observed that out of the 30 smokeless tobacco products, 66% of the smokeless products carried smaller warnings, 14% of the smokeless products carried warning over 35% of the surface area, and the remaining 20% did not have any warnings displayed. Out of the 30 smoked tobacco products, 60% of the Indian manufactured cigarettes and bidis had warning covering between 31 - 40% and the remaining 40% of the smoked tobacco products did not have any pictorial warnings displayed.

The promotional messages on the pack were evident on both the smokeless as well smoked form of tobacco; 53% of the smokeless tobacco product and 9% of the smoked tobacco products had messages promoting tobacco products, such as, kesar yukt, saffron blended, silver, premium, sugandhit, and super slims, on their surface.

The misleading descriptors were mainly observed on cigarette packets; 40% of the smoked tobacco brands had misleading descriptors such as balanced taste, honey dew, premium blended; filter, regular, light, clove mix, and chocolate, which appeared on the packs to mask the harm associated with its use. About 4% of the smokeless tobacco products did not display the warnings in the regional language in which the brand name was mentioned, as mandated by the law. As required by the law, the warnings had to be placed on the front panel of the pack and had to be positioned parallel to the top edge and in the same direction as the information on the principal display area. For conical packs the widest end had to be considered as the top edge of the pack. Eight percent of the smokeless product had warnings placed on the back surface to avoid consumers to directly view the pictorial warning, and 8% had it on the crimp of the packet so it got torn while giving it to the consumers. Ninety-four percent of the warnings on smoked tobacco packets were placed on the front surface, but on the lower half of the packets.

The results of the focus group discussions indicated that most of the people had seen the text and pictorial warnings on smokeless and smoking tobacco products. Mandated pictorial warnings did not serve the desired purpose, as they were not properly understood. The scorpion was associated with a zodiac sign, a new brand of the company, company's logo or that tobacco was poisonous, like the scorpion. The x-ray of the lung was understood by only a few participants, while others said that it represented a waterfall between two mountains, shadow of two persons talking to each other. The picture of diseased lung was interpreted as a burned leaf, butterfly, and some part of body or a diseased lung.

 » Discussion Top

Unfortunately, the interference by the tobacco industry in health policy continues to be one of the greatest threats to the global tobacco treaty's implementation and enforcement. Philip Morris / Altria, British American Tobacco (BAT), Japan Tobacco (JT), and Indian Tobacco Company (ITC), continue to use their political influence to weaken, delay, and dilute tobacco control legislation around the world and in India. [9] While the industry claims to have changed its ways, it continues to use strategic methods to undermine meaningful legislation. In India the industry either uses the economic meltdown or claims that the future of thousands of bidi workers and tobacco farmers will be at stake, and as a result, constantly flouts with the law. The bidi industry, which speaks of lost jobs for its workers if pictorial warnings are implemented is the same which does not pay minimum wages, exploits women and children, constantly exposes its workers to hazardous substances, flouts labor laws, and spreads serious illnesses and death.

It was stated that the pictorial warning bearing skull and bone hurts religious sentiments and was replaced with revised warnings. In fact, the research study showed that the skull and bone sign signifies danger and it does not hurt any religious sentiments. Later GOM in India shifted to DAVP from the Ministry of Health and Family Welfare (MOHFW) for a revised pictorial warning on tobacco products. The result was three very weak and poorly communicative pictorial health warnings were given to replace those recommended by the Union Health Ministry [Figure 3]. [9] The results of the focus group discussion showed that such mandated pictorial warnings on the tobacco product did not serve the desired purpose as they were very dull, diluted, and poorly understood by the people.

Overall, extensive research in Canada suggests that larger (> 50% of the surface of principal display area) and strongly worded health warnings, supported by emotionally strong graphics, are highly effective in tobacco control. [10],[11],[12] Evidence from countries like Canada, (58%), Brazil (67%) Thailand (44%), and New Zealand (67%) has shown that placement of pictorial warnings has motivated smokers to quit the habit, in these countries. [4],[5],[6],[7],[10] Therefore, there is a need for stronger and more informative graphic health warnings in India.

 » Conclusion Top

India had ratified the WHO - FCTC, but its implementation remains a challenging task. Taking a cue from the government's lack of firmness on the issue of tobacco warnings (these were greatly diluted as against the originally proposed warnings); tobacco companies have simply chosen to ignore a primary requirement of the new tobacco packaging law. A compliance check on the tobacco industry would be a necessary part of the implementation of FCTC. A political will, along with a determined and strong enforcement agency, and a mass civil society voice will convert this dream into a reality.

 » Acknowledgment Top

I would like to acknowledge Ms Arpita Singh for legal inputs. Funding of the Project - International Union Against Tuberculosis and Lung Diseases under the Bloomberg Grant Initiative (U-INDIA-1-9A)

 » References Top

1.World Health Organization, Call for pictorial warnings on tobacco packs, Geneva. Available from: [last accessed on 2009].  Back to cited text no. 1      
2.Health Canada. The health effects of tobacco and health warning messages on cigarette packages-Survey of adults and adult smoker: Wave 9 surveys. Prepared by Environics Research Group; 2005.  Back to cited text no. 2      
3.Hammond D, Fong GT, McDonald PW, Brown KS, Cameron R. Graphic Canadian cigarette warning labels and adverse outcomes: Evidence from Canadian smokers. Am J Public Health 2004;94:1442-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Fong G, Hammond D, Hitchman S. The impact of pictures on the effectiveness of tobacco warnings. Bull World Health Organ 2009;87:640-3.  Back to cited text no. 4      
5.Cavalcante TM. Labelling and packaging in Brazil. Brazil: National Cancer Institute, Health Ministry of Brazil and WHO 2003.  Back to cited text no. 5      
6.ITC Project. ITC Thailand survey summary. University of Waterloo, Ontario, Canada, Institute of Populations and Social Research, Mahidol University Salaya and Thai Health Promotion Foundation. Thailand 2009.  Back to cited text no. 6      
7.Waa A, Gillespie J, Afzal R. Influence on smoking behavior and perceptions of cigarette packaging in New Zealand: Preliminary findings. New Zealand: The Ministry of Health 2004  Back to cited text no. 7      
8.World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO. Available from: [last accessed on 2003].  Back to cited text no. 8      
9.Reddy SK and Arora M. Pictorial health warnings are a must for effective tobacco control. Indian J Med Res 2009;129: 468-71.  Back to cited text no. 9      
10.Environics Research Group. Qualitative (focus group) report regarding health warning labels and images on cigarette packages. Ottawa: Health Canada, Office of Tobacco Control 1999.  Back to cited text no. 10      
11.Shanahan P and Elliott. Evaluation of the health warnings and explanatory health messages on tobacco products. Department of Health and Aged Care, Canberra: Commonwealth of Australia 2000.  Back to cited text no. 11      
12.Cunningham R. Package warnings: Overview of international developments. Ottawa: Canadian Cancer Society 2007  Back to cited text no. 12      


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]

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