{
  "abstract": "Introduction\n\nUse of smokeless tobacco (SLT) is a serious public health problem in India. Health warning labels (HWLs) play a vital role in imparting information regarding the adverse health effects of tobacco use. Despite the statutory requirement under the Cigarettes and Other Tobacco Products Act (COTPA), there are reports of non-compliance with HWLs in terms of size, position, language, and presentation. The present study aimed to assess compliance with HWLs of SLT products sold by retail shops in Bhubaneswar, India.Methods\n\nA quantitative observational cross-sectional study was conducted using multistage cluster random sampling in 30 wards of Bhubaneswar Municipal Corporation from August 2025 to July 2026. A total of 515 SLT packs collected from retail outlets were assessed for HWL compliance using an observational checklist. Proportions are reported with 95% confidence intervals (CIs); zone differences were tested using design-based methods (Rao-Scott chi-square test and survey regression) accounting for clustering within wards.Results\n\nNone of the packages assessed fulfilled all HWL requirements, while 496 (96.3%; 95% CI: 93.9-98.0) packages had at least one type of HWL violation. Only 101 (19.6%; 95% CI: 17.2-22.3) packages had a warning at the prescribed top position, while 271 (52.6%; 95% CI: 47.5-57.7) had a warning in the English language, as compared to 14 (2.7%; 95% CI: 1.5-4.5) packages that had a warning in English and Odia languages. Only 5.8% (95% CI: 4.0-8.1) of the packages complied with the requirement of coverage of HWL of ≥85% of the principal display area, while 88.0% of the packages failed to meet the same. Three HWL violations were most frequently observed, occurring in 197 of 515 packs (38.3%; 95% CI: 34.3-42.3), while ≥4 violations occurred in 149 (30.0%; 95% CI: 26.6-33.7) of 496 non-compliant packs. No significant variation was found in compliance across the geographic zones after accounting for clustering within wards (Rao-Scott p = 0.825).Conclusion\n\nThe study found that HWLs of SLT products in Bhubaneswar were largely non-compliant with statutory requirements, with multiple violations in terms of coverage, position, and language. There is a need for strict regulatory and surveillance measures to ensure HWL compliance by SLT manufacturers.",
  "abstract_shown": true,
  "affiliations": [
    "Public Health, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, IND.",
    "Health Care Management, Swiss School of Business and Management Geneva, Geneva, CHE.",
    "Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sulagna Pattajoshi"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Pratap K Jena"
    },
    {
      "affs": [
        2
      ],
      "name": "Ipsa Mohapatra"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2nj6yafb6zs68.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.116986",
  "fulltext_url": "https://europepmc.org/articles/PMC13711045",
  "id": "2nj6yafb6zs68",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42948327",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Health Policy"
    ],
    [
      "heading",
      "Public Health"
    ],
    [
      "heading",
      "Substance Use and Addiction"
    ],
    [
      "openalex",
      "2737|Smoking Behavior and Cessation"
    ]
  ],
  "openalex": "W7214528707",
  "pdf_url": "https://europepmc.org/articles/PMC13711045?pdf=render",
  "pmcid": "PMC13711045",
  "pmid": "42948327",
  "published": "2026-09-27",
  "publisher": "Cureus Inc.",
  "ris": "https://research.draconitic.com/paper/2nj6yafb6zs68.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:35Z",
      "native_id": "MED:42948327",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42948327"
    },
    {
      "first_seen": "2026-10-31T12:21:53Z",
      "native_id": "PMC13711045",
      "source": "pmc",
      "url": "https://doi.org/10.7759/cureus.116986"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "heading:Public Health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Assessment of Health Warning Label Compliance on Smokeless Tobacco Products in Bhubaneswar, India.",
  "title_text": "Assessment of Health Warning Label Compliance on Smokeless Tobacco Products in Bhubaneswar, India.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:21:53Z",
  "url": "https://research.draconitic.com/paper/2nj6yafb6zs68",
  "venue": "Cureus",
  "versions": []
}