Standardizing smokeless tobacco packs in India to enhance health warning visibility and harm perceptions

Introduction Approximately 21% of adults in India use smokeless tobacco and over half use khaini, a tobacco-lime mixture. Khaini is available in a variety of pack shapes and sizes, which can affect health warning label (HWL) size and placement. This study explored consumer perceptions of existing kh...

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Main Authors: Hannah E. Barker, Raniyan Zaman, Lauren Czaplicki, Sejal Saraf, Rana J. Singh, Ashish K. Pandey, Joanna E. Cohen
Format: Article
Language:English
Published: European Publishing 2025-06-01
Series:Tobacco Induced Diseases
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Online Access:https://www.tobaccoinduceddiseases.org/Standardizing-smokeless-tobacco-packs-in-India-to-enhance-health-warning-visibility,205097,0,2.html
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author Hannah E. Barker
Raniyan Zaman
Lauren Czaplicki
Sejal Saraf
Rana J. Singh
Ashish K. Pandey
Joanna E. Cohen
author_facet Hannah E. Barker
Raniyan Zaman
Lauren Czaplicki
Sejal Saraf
Rana J. Singh
Ashish K. Pandey
Joanna E. Cohen
author_sort Hannah E. Barker
collection DOAJ
description Introduction Approximately 21% of adults in India use smokeless tobacco and over half use khaini, a tobacco-lime mixture. Khaini is available in a variety of pack shapes and sizes, which can affect health warning label (HWL) size and placement. This study explored consumer perceptions of existing khaini packs and two proposed standard shape/size khaini packs across dimensions of HWL noticeability and harm perceptions. Methods In March 2023, we conducted 24 focus groups (FGs) across India. Groups were equally numbered by residence, gender, and current khaini use. FGs were led by trained facilitators. Each FG discussed six existing khaini packs and two standard packs (paper sachet; tin cylinder). Data were collected in local languages, translated into English, and thematically analyzed. Results All FGs discussed the limited visibility of HWLs on existing packs, noting that HWLs were often small, blurry, or printed too faintly to notice. Most (defined as ≥80%) FGs discussed how the HWLs on both standard packs were large and easy to see. FGs discussed how the standard packs appeared more harmful than existing packs due to the large, clearly printed HWL. Most FGs found that the standard tin cylinder was less harmful than the standard paper sachet due to its comparatively smaller HWL. Conclusions Both standard khaini packs increased HWL noticeability and perceived harm compared to existing packs, and the standard paper sachet was seen as more harmful than the standard tin cylinder. Implementing the standard sachet pack could enhance HWL visibility and increase perceptions of harm among consumers.
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spelling doaj-art-2edc3defc7de4a3c9dc16d3de5643d492025-08-20T03:15:31ZengEuropean PublishingTobacco Induced Diseases1617-96252025-06-0123June11310.18332/tid/205097205097Standardizing smokeless tobacco packs in India to enhance health warning visibility and harm perceptionsHannah E. Barker0https://orcid.org/0000-0002-0405-2209Raniyan Zaman1https://orcid.org/0009-0007-7852-839XLauren Czaplicki2https://orcid.org/0000-0002-7496-0990Sejal Saraf3https://orcid.org/0000-0001-9109-8143Rana J. Singh4https://orcid.org/0009-0000-6459-5873Ashish K. Pandey5https://orcid.org/0009-0002-8234-1628Joanna E. Cohen6https://orcid.org/0000-0002-3869-3637Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United StatesInstitute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United StatesInstitute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United StatesInstitute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United StatesVital Strategies Tobacco Control Division, New Delhi, IndiaVital Strategies Tobacco Control Division, New York, United StatesInstitute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United StatesIntroduction Approximately 21% of adults in India use smokeless tobacco and over half use khaini, a tobacco-lime mixture. Khaini is available in a variety of pack shapes and sizes, which can affect health warning label (HWL) size and placement. This study explored consumer perceptions of existing khaini packs and two proposed standard shape/size khaini packs across dimensions of HWL noticeability and harm perceptions. Methods In March 2023, we conducted 24 focus groups (FGs) across India. Groups were equally numbered by residence, gender, and current khaini use. FGs were led by trained facilitators. Each FG discussed six existing khaini packs and two standard packs (paper sachet; tin cylinder). Data were collected in local languages, translated into English, and thematically analyzed. Results All FGs discussed the limited visibility of HWLs on existing packs, noting that HWLs were often small, blurry, or printed too faintly to notice. Most (defined as ≥80%) FGs discussed how the HWLs on both standard packs were large and easy to see. FGs discussed how the standard packs appeared more harmful than existing packs due to the large, clearly printed HWL. Most FGs found that the standard tin cylinder was less harmful than the standard paper sachet due to its comparatively smaller HWL. Conclusions Both standard khaini packs increased HWL noticeability and perceived harm compared to existing packs, and the standard paper sachet was seen as more harmful than the standard tin cylinder. Implementing the standard sachet pack could enhance HWL visibility and increase perceptions of harm among consumers.https://www.tobaccoinduceddiseases.org/Standardizing-smokeless-tobacco-packs-in-India-to-enhance-health-warning-visibility,205097,0,2.htmlpolicysmokeless tobaccohealth warning labeltobacco packagingindia
spellingShingle Hannah E. Barker
Raniyan Zaman
Lauren Czaplicki
Sejal Saraf
Rana J. Singh
Ashish K. Pandey
Joanna E. Cohen
Standardizing smokeless tobacco packs in India to enhance health warning visibility and harm perceptions
Tobacco Induced Diseases
policy
smokeless tobacco
health warning label
tobacco packaging
india
title Standardizing smokeless tobacco packs in India to enhance health warning visibility and harm perceptions
title_full Standardizing smokeless tobacco packs in India to enhance health warning visibility and harm perceptions
title_fullStr Standardizing smokeless tobacco packs in India to enhance health warning visibility and harm perceptions
title_full_unstemmed Standardizing smokeless tobacco packs in India to enhance health warning visibility and harm perceptions
title_short Standardizing smokeless tobacco packs in India to enhance health warning visibility and harm perceptions
title_sort standardizing smokeless tobacco packs in india to enhance health warning visibility and harm perceptions
topic policy
smokeless tobacco
health warning label
tobacco packaging
india
url https://www.tobaccoinduceddiseases.org/Standardizing-smokeless-tobacco-packs-in-India-to-enhance-health-warning-visibility,205097,0,2.html
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