title: Reactions of nepali adults to warning labels on cigarette packages: a survey with employee and medical students of a tertiary care medical college of Western region of Nepal.
abstract: BACKGROUND
  For the past 30 years, there have been no changes in the text-only cigarette warning labels in Nepal. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of the current study was primarily to compare the differences in reactions to different types of warning labels on cigarette packages, with a specific focus on whether the new warning label adopted by WHO FCTC was better than the text only label used by Nepal.
  
  
  METHODS
  This study was conducted in Gandaki Medical College Teaching Hospital (GMCTH) in 2012, in a tertiary care hospital located in the western region of Nepal. Eligible study participants included in this survey were those aged 18 years and over and those who are studying MBBS/Nursing or who were employees of GMCTH. 500 participants finished the survey. Participants were shown nine types of warning labels found on cigarette packages.They comprised one text only warning label used within Nepalese market and eight foreign brand labels. Participants were asked about the impact of the warning labels on: their knowledge of harm from smoking, giving cigarettes as a gift, and quitting smoking.
  
  
  RESULTS
  On comparing the Nepalese warning label with other foreign labels with regards to providing knowledge of harm warning, impact of quitting smoking and giving cigarettes as a gift, the overseas labels were found to be more effective. Both smokers and non-smokers thought that warning labels with text plus graphics were substantially more of a deterrent than text-only labels.
  
  
  CONCLUSIONS
  The findings from this study support previous research that has found that text-plus graphic warning labels were more salient and potentially more effective than text-only labels.Warning labels are one of the component of comprehensive tobacco control and smoking cessation efforts. Stronger warnings on cigarette packages need to be part of a larger Nepalese public health educational efforts.
authors.affiliation: Associate Professor, Department of Medicine, Gandaki Medicial College Teaching Hospital , Pokhara, Nepal .
authors.forename: Badri
authors.initials: B
authors.lastname: Paudel
authors.forename: Klara
authors.initials: K
authors.lastname: Paudel
authors.forename: Deepa
authors.initials: D
authors.lastname: Timilsina
keywords: Cigarette package; Nepali adults; Reaction; Warning labels