BACKGROUND: The aim of this study was to assess the effectiveness of 90% Pictorial Health Warnings (PHW) on tobacco products in Nepal.
METHODS: A cross-sectional study was conducted between July 2024 to October 2024 in 11 cities of Nepal. The sample size was calculated using SurveyMonkey. A population of 29.16 million is taken into account while calculating a sample size with a margin error of 1.8% at a 95% confidence level. The respondents were randomly selected and interviewed face to face using a semi-structured questionnaire. The effectiveness of PHWs were measured as perceived: i) scariness; ii) quit motivation iii) convincing youth not to start smoking; iv) encouraging ex-smokers to remain as quitters; and v) building public awareness. Logistic regression analysis was used to determine the factors associated with the effectiveness of PHWs using IBM SPSS version 24.
RESULTS: Of the 3002 general public participants, 94.7% believed that smoking was addictive. 83% participants said to have noticed PHWs in tobacco packs. PHWs made 81.1% of respondents concerned about the danger of consuming tobacco and motivated 80.3% to either think about quitting tobacco or never start it. PHWs made 60% of current smokers reduce their cigarettes intake. In case of retailers, 85.8% said to have knowledge about 90% PHW and 80.3% supported it to increase public awareness. 23% of the retailers stated decline in sale of tobacco products as a result of PHWs.
CONCLUSIONS: PHWs were found important to prevent people from starting smoking or consuming tobacco products, motivate smokers to quit, reduce consumption of cigarettes and prevent relapse in ex-smokers. Evidence from the study suggests that the PHWs are required to be increased to 100% and images to be improved for it to become more effective