Background:
Plain packaging has been demonstrated to be effective in Australia, where it led to increased quit attempts among adult smokers. Graphic Health Warnings (GHWs) on tobacco packs in India have increased from 40% to 85%. This qualitative study assesses perceptions of Indian adults and children about impact of larger GHWs and plain packaging of tobacco products.

Methods:
Focus Group Discussions (FGDs), conducted with children aged 13-17 years and adults aged 17+ years in the community settings. Separate FGDs were conducted with adults (male and female) and children (boys and girls) in selected urban and rural communities in Delhi and Telangana in 2016. Four dummy tobacco packs categories [A-40% old GHWs, B-40% new GHWs, C-85% new GHWs; D-85% new GHWs with plain pack] were shown. Data was coded and thematic analysis undertaken with using Atlas.ti 6.2.

Results:
In total, fourteen (six in Delhi and eight in Telangana) FGDs were conducted. Participants highlighted the importance of larger GHWs on tobacco products in demonstrating the consequences of tobacco use and limit the pack's appeal. Participants opined, category C and D warnings were most effective to curb tobacco use. Category D was considered the most unattractive pack due to larger GHW, dull color and brand name not being prominent.

Conclusions:
Larger GHWs and PP were perceived to be effective in reducing tobacco use. Plain packaging was further perceived to reduce the attractiveness of pack, enhance noticeability of the GHW, deter new users, and improve quitting among users.