Perceived effectiveness of text and pictorial health warnings for smokeless tobacco packages in Navi Mumbai, India, and Dhaka, Bangladesh: findings from an experimental study

Tob Control. 2016 Jul;25(4):437-43. doi: 10.1136/tobaccocontrol-2015-052315. Epub 2015 Jul 22.


Objective: To examine the perceived effectiveness of text and pictorial smokeless tobacco health warnings in India and Bangladesh, including different types of message content.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Low/Middle income country; Non-cigarette tobacco products; Packaging and Labelling.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Bangladesh
  • Female
  • Health Communication / methods
  • Humans
  • India
  • Interviews as Topic
  • Male
  • Middle Aged
  • Perception
  • Product Labeling / methods*
  • Tobacco Use / adverse effects*
  • Tobacco Use / psychology
  • Tobacco, Smokeless / adverse effects*
  • Young Adult