e other side of the scenario of tobacco free initiative. In our study, Satara district was chosen as the study area as Maharashtra is one of the leading states in tobacco consumption and it has been observed on a national and state level survey that age of initiation of tobacco habits is quite young in these state inhabitants. Hence, this study was conducted with the aim to assess the understanding, credibility and persuasiveness of the adolescents regarding the pictorial and textual warnings on reverse panel of smoked and chewable tobacco packages.
| Materials and methods|| |
A cross-sectional study was conducted among adolescents group of Satara district from May to June 2014. The study population was the adolescents belonging to the age group of 11-19 years attending the educational institutions of Satara district in Western Maharashtra. It is inhabited by 74,335 people with an average literacy rate of 76%, which is higher than the national average.  An Ethical Clearance was obtained from the Institutional Ethics Committee to initiate the study. Informed consent was obtained from all the study participants. All necessary permissions were obtained from the concerned authorities.
A pilot study was conducted among 30 adolescents to assess the feasibility of the study. As per the results of the pilot study, the sample size was determined 500 study subjects with the probability of 90% and error of 5%. The questionnaire used for this study was translated to Marathi which is the local language and back translated to English by a bilingual expert and the face and content validity was assessed. The reliability of the questionnaire was assessed in pilot study by measuring Cronbach's alpha and inter-item correlations. The internal consistency reliability coefficient (Cronbach's alpha) for the questionnaire was 0.71. The item-scale correlations of all the items of questionnaire ranged from 0.52 to 0.60, in which none was less than the minimum acceptable level of 0.4.
A list of institutions was obtained and from them the schools 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 