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Pre testing of pictorial health warning

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Pre testing of pictorial health warning

  1. 1. Nepal  Landlocked Situated in the South-East Asia Region  bounded by India and China  30 million people with a growth rate of 2.2%  > 80% of the people living in rural areas  Adult literacy rate:  2001- 53.7 %  During 2007-2011-60%  LE at birth (years) 2011-69 years (UNICEF)  25.2% of population living below the poverty line (2011)  75 districts, 3 regions
  2. 2. Tobacco use is widely prevalent in different forms in Nepal
  3. 3. Betel-quid Khaini- DriedTobacco leaves Zarda-flavoured tobacco available in small packets or tins Pan masala-mixing areca nut, slaked lime, catechu and condiments Snuff Smokeless tobacco (SLT)-Chewed, sniffed, inhaled
  4. 4. Smoke Form tobacco Cigarettes Smoking  NDHS 2006- one third of males (32.5%) in Nepal and 15.2% of females smoke cigarettes  Daily Male smokers 85% and Female 46%
  5. 5. Gender difference in Prevalence of various tobacco 32.5 1.7 38.2 56.5 15.2 2 5 19.6 0 10 20 30 40 50 60 Cigarettes pipes Other tobacco products Any tobacco prodcuts Male Female
  6. 6. Tobacco Use in Nepal  The proportion of deaths due to non-communicable diseases (NCD)->50%  Nepal cancer society 2008-15,000 tobacco related death/year  The prevalence of smoking among adult females in Nepal is one of the highest in the SEAR-WHO  A hospital-based study among (2003-05)- 48% of all cancers among males and 28% among females were related to tobacco use.
  7. 7.  WHO FCTC was developed in response to the globalization of the tobacco epidemic and is an evidence-based treaty  for the promotion of public health and provides new legal dimensions for international health cooperation.  Set global rules to tobacco control
  8. 8.  The Framework Convention onTobacco Control (FCTC)- enforced in 2005- requires nations that have ratified the convention to  ban all tobacco advertising, promotion and sponsorship  various time-bound commitments  including smoke-free spaces  tobacco package warnings
  9. 9. Tobacco packaging  tobacco packaging ¨- key promotional vehicle for the tobacco control  Plain tobacco packaging first appeared in 1980s reduce the allure of tobacco packaging  Branded packagingVs plain packaging- PP associated with negative perceptions and feelings  PP may help reduce cigarette consumption and encourage cessation in the short term.
  10. 10. Plain Packaging  A recent systematic review of the PP with 37 studies, suggests that PP has number of potential public health benefits  1) reducing the appeal of the pack, product and user  2) increasing the salience of the health warnings  3) increasing perceptions of harm
  11. 11.  Nepal signed the WHO Framework Convention on Tobacco Control (WHO FCTC) on 3 December 2003.  Nepal ratified theWHO Framework Convention on 7 November2006.  The Framework Convention onTobacco Control (FCTC) requires nations that have ratified the convention to ban all tobacco advertising and promotion
  12. 12. Tobacco Intervention In Nepal  TheTobacco Control and Regulation Act (2011)- enforced in Aug2011  The act prohibits- 1. use of any tobacco products in all public places 2. any kind of promotion, advertisement and sponsorship to promote both smokeless and smoking forms of tobacco. 3. sale of any form of tobacco to children under 18 years and pregnant women 4. mandates the use of pictorial graphics and textual warnings covering 75% of the total area of tobacco packets.
  13. 13. Objective It intends to understand the perception of adult smokers, adult non- smokers and youth; testing pictorial health warnings; particularly to recommend the most effective pictures with messages. Specific objectives are to:  in motivating smokers to quit  in convincing youth not to start smoking and chewing tobacco  in helping ex-smokers to stay quitting tobacco use  in informing public on danger of tobacco use.
  14. 14. Methodology  Methods  Quantitative  Qualitative  Tools  Issue centered discussion  Self administered questionnaire  Sample size  Issue centered discussion : 54 (6 groups)  Self administered questionnaires: 221 school children
  15. 15. Included Picture with Messages w'd|kfg tyf ;'lt{;]jgn] d'vsf] SofG;/ x'G5 1 w'd|kfg tyf ;'lt{;]jgn] d'vsf] SofG;/ x'G5 w'd|kfg tyf ;'lt{;]jgn] d'v tyf 3f6Lsf] SofG;/ x'G5 2 3 w'd|kfg t yf ; 'lt {; ]j gn] kmf]S; f]sf]SofG; / x'G5 4 w'd|kfg t yf ; 'lt {; ]j gn] kmf]S; f]sf]SofG; / x'G5 5 w'd|kfg/;"lt{;]jgn]sdtf}n, ckf+ujf d/]sf]aRrfhGdG5 w'd|kfg t yf ; 'lt {; ]j gn] kmf]S; f]sf]SofG; / x'G5 tkfO{n] u/]sf] w'd|kfgn] qRrfnfO{ lgdf]lgo, bd, vf]sL e} aRrfsf] crfgs d[To' x'g ;S5 w'd|kfgtyf ;"lt{;]jgn]dl:tissf]/Qm>fj x'G5 76 8 9
  16. 16. Findings- top Five in Each Category Motivating users to quit Convincing youth not to start Informing public about the harms Re-convincing ex-smoker to stay on quit 32.5 (P7) 22.9(P7) 30.2(P7) 26.5(P7) 14.2 (P9) 20.0(P9) 16.0(P9) 15.6(P9)) 13.8 (P2) 12.0 (P2)) 10.5(P3) 14.5(P3) 11.6 (P3) 10.9 (P3) 8.4(P5) 12.4(P5) 9.1 (P5) 9.8(P5) 8.4(P4) 9.8(P2
  17. 17. Effect of Smoking in Health I am a wife of a chain smoker;I know how it is like to stay with a smoker,who gives no love and affection to family…..a non smoker-Dharmasthali 1 Due to smoking I have heard that your nose can bleed severely…..a non smoker I am a ex-smoker,I left smoking for some time but then started to have it again,I feel like vomiting and nausea…………a smoker,dharmasthali-1 I don’t believe the picture in which the baby is dying, although I have been smoking for many years,I have two healthy baby….I think that may be the most less effective picture would be of neck cancer…….a chain smoker, dharmasthali ward 1 When I first saw the month in the first picture,I felt like it is the teeth of ghost.I can’t believe what I saw,the picture is really dangerous,I can never think of smoking,if the result is so thrilling…………..a non smoker, dharmasthali-1
  18. 18. Effectiveness of the picture and health message in informing public on harmful effect of smoke (n=275) Picture Effectiveness level in informing public on harmful effect of smoke Total The most effective extremely effective very effective somewhat effective a little bit effective not at all effective 1 45.5 32.0 13.8 6.2 2.5 100% 5.1 2 45.5 33.1 15.6 4.0 1.8 100% 7.3 3 52.0 27.6 14.5 4.4 1.5 100% 10.5 4 56.7 24.0 13.8 3.6 1.8 100% 8.4 5 52.7 26.9 12.0 4.7 3.6 100% 8.4 6 44.0 34.9 14.2 4.0 2.9 100% 8.0 7 67.6 20.7 6.9 3.6 1.1 100% 30.2 8 45.1 29.8 13.8 8.7 2.5 100% 6.2 9 63.6 21.5 9.8 2.9 2.2 100% 16.0 Total 100%
  19. 19. Recommendation Based On highest % Picture & Health Message Motivating users to quit P7 Convincing youth not to start P9 Informing the public about the harms P3 Re-convincing the ex-smoker to stay on quit P2 P5
  20. 20. Challenges of implementing the Act and regulations  There is a low level of awareness among people regarding the Act and regulations.  The monitoring mechanism and roles of responsible institutions have not been clearly defined in theAct  Physical barriers- Geographical barrier for promotion  tobacco industry  In a recent confrence (2013) among SEAR highlighted smokeless tobacco (SLT) as a measure challenge to implementation of FCTC. Its high prevalence, variety of products and poor knowledge of its harms make it a unique threat to the region.
  21. 21. Australia Sets an Example
  22. 22. ThankYou

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