chools and colleges were selected by using simple Random sampling techniques. Of the 120 institutions listed, 18 institutions' were selected for the study and among them 27 students were selected by simple random sampling technique. Inclusion criteria were people who were willing to participate, who were present on the day of examination.
A specially designed questionnaire was administered to assess understanding, credibility and persuasiveness of the pictorial and textual warnings on the reverse panel of smoked and smokeless tobacco. The questionnaire consisted of 6 questions 4 dealing with the comprehension of the warnings and other two dealt with the perceived seriousness of the warnings. The responses were "never," "sometimes," "rarely," "very often" and last two questions responses were dichotomized as "yes" or "no." The questionnaire assessed the salience (noticing, looking closely at warnings), depth of processing (thinking about warnings, discussing them with others), comprehension and credibility (warning comprehensibility, believability, and truthfulness), unaided recall, persuasiveness (warnings as a deterrent to smoking), avoidance techniques (e.g., hiding packs), and a behavioral indicator (forgoing cigarettes due to warnings) of the participants.  A model containing the pictorial and textual warnings on panel of smoked and smokeless tobacco products were shown to the study subjects. This model was displayed in the rooms where the participants were supposed to see them and then complete the questionnaire.
The recorded data were transferred to the computer in Microsoft Excel worksheet and was subjected to statistical analysis by using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Chi-square test was used for intergroup comparisons based on gender and age of the participants. P value was set at < 0.05.
| Results|| |
Majority 251 of the population belonged to the age group of 11-15 years of age in that 197 were males and 54 were females, 249 subjects were in the age group of 16-19 years, in that 176 were males and 73 were females [Table 1]. In the age group of 11-15 years the mean age of the participants was 13 ± 2.8 years and that of age group of 16-19 years 17.5 ± 2.12 years (P < 0.001). The sample consisted of total 373 males and 127 females (P < 0.001).
Only 168 (33.6%, P < 0.05) had often "noticed warnings on tobacco packs in the last month," 137 (27.4%, P > 0.05) had "sometimes" read or looked closely at the warnings on tobacco packs in the last month, 131 (26.2%, P > 0.05) had "rarely" thought about what warnings on the tobacco packs are telling them with the pack in sight/out of sight in the last month, 155 (31%, P > 0.05) had rarely "talked with anyone about these warnings" [Table 2].
|Table 2: Distribution of participants based on the response of the questions |
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In the last month, majority 415 (83%, P > 0.05) found these "pictures were not easy to understand," 421 (84.2%, P > 0.05) found these "images were not believable," 403 (80.6%, P < 0.05) found these "images were not truthful in respect to the health risks associated with tobacco use," 432 (86.4%, P < 0.05) found these "images did not deter them from the likely use of tobacco," 446 (89.2%, P > 0.05) found it "did not stop them from using tobacco" [Table 3].
|Table 3: Distribution of participants based on the response of the questions |
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| Discussion|| |
This study was conducted to assess the adolescent response to pictorial and textual warnings on a reverse panel of tobacco products. In this study, it was observed that very small portion of the study sample hardly ever thought about the warnings or discussed about it. Such a finding points toward the lack of seriousness or lack of sensitization of the adolescents regarding such habits.
Similarly, majority of the study participants found these warnings as unbelievable, not easy to understand or truthful and that these warnings did not deter them from using tobacco. This study is first of its kind to be conducted in India. Most of the studies have been condu