Noticing health warning labels and intentions to quit smokeless tobacco products: results from two Global Adult Tobacco Survey rounds, India.

Introduction: Health warning labels (HWLs) are one of the key strategies for tobacco control. The current study assessed the individual characteristics affecting the noticeability of HWLs and the thought of quitting smokeless tobacco (SLT) on noticing HWLs. We further estimated the temporal changes in noticeability and thought of quitting after noticing HWLs over time in India.

Methods: Data from two rounds (2009-2010 and 2016-2017) of GATS (Global Adult Tobacco Survey) from India were analysed to understand the pattern of SLT usage and estimate the relative changes in the noticeability of HWLs and the thought of quitting SLT among those who noticed HWLs. Sampling weights were used during the analysis. Multivariate binary logistic regression was used to explore the determinants for the noticeability of HWLs and encourage the intention to quit SLT after noticing the HWLs.

Results: About 25.9% and 20.6% of participants consumed SLT daily or non-daily in two rounds of GATS. Overall, there was a 14% relative increase in noticing the HWLs and a 20% increase in the thought of quitting in GATS-2 compared with GATS-1. The adjusted odds ratio of observing HWLs among SLT users was 1.51 times (95% confidence interval (CI), 1.44-1.58) in round 2 compared with round 1, while the odds ratio concerning the thought of quitting SLT after noticing HWLs was 1.95 times (95% CI, 1.84-2.06) in round 2 compared with round 1.

Conclusions: We observe a consistent increase in the noticeability of HWLs and intentions to quit in SLT users, with significant variations across socio-demographic characteristics calling for concerted efforts. SLT being the major form of tobacco usage in India and Asian countries, HWLs alone cannot bring down the consumption rates, and it needs to be supported by strict implementation of SLT legislation for long-lasting impact.