title: Perceived effectiveness of text and pictorial health warnings for smokeless tobacco packages in Navi Mumbai, India, and Dhaka, Bangladesh: findings from an experimental study.
abstract: To examine the perceived effectiveness of text and pictorial smokeless tobacco health warnings in India and Bangladesh, including different types of message content.
  
  
  
  An experimental study was conducted in Navi Mumbai, India (n=1002), and Dhaka, Bangladesh (n=1081). Face-to-face interviews were conducted on tablets with adult (≥19 years) smokeless tobacco users and youth (16-18 years) users and non-users. Respondents viewed warnings depicting five health effects, within one of the four randomly assigned warning label conditions (or message themes): (1) text-only, (2) symbolic pictorial, (3) graphic pictorial or (4) personal testimonial pictorial messages.
  
  
  
  Text-only warnings were perceived as less effective than all of the pictorial styles (p<0.001 for all). Graphic warnings were given higher effectiveness ratings than symbolic or testimonial warnings (p<0.001). No differences were observed in levels of agreement with negative attitudes and beliefs across message themes, after respondents had viewed warnings.
  
  
  
  Pictorial warnings are more effective than text-only messages. Pictorial warnings depicting graphic health effects may have the greatest impact, consistent with research from high-income countries on cigarette warnings.
authors.affiliation: School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Seema
authors.initials: S
authors.lastname: Mutti
authors.affiliation: Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Reid
authors.affiliation: Healis-Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India.
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Gupta
authors.affiliation: Healis-Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India.
authors.forename: Mangesh S
authors.initials: MS
authors.lastname: Pednekar
authors.affiliation: Healis-Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India.
authors.forename: Gauri
authors.initials: G
authors.lastname: Dhumal
authors.affiliation: Department of Economics, University of Dhaka, Dhaka, Bangladesh World Health Organization, Geneva, Switzerland.
authors.forename: Nigar
authors.initials: N
authors.lastname: Nargis
authors.affiliation: Department of Economics, University of Dhaka, Dhaka, Bangladesh.
authors.forename: Akm Ghulam
authors.initials: AG
authors.lastname: Hussain
authors.affiliation: School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hammond
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D005260:Female; D058015:Health Communication / Q000379:methods; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010465:Perception; D011356:Product Labeling / Q000379:methods*; D064424:Tobacco Use / Q000009:adverse effects* / Q000523:psychology; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D055815:Young Adult
keywords: Low/Middle income country; Non-cigarette tobacco products; Packaging and Labelling