Assessment of Health Warning Label Compliance on Smokeless Tobacco Products in Bhubaneswar, India.
- 1Public Health, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, IND.
- 2Health Care Management, Swiss School of Business and Management Geneva, Geneva, CHE.
- 3Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Abstract
Introduction
Use 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
A 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
None 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
The 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.
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BibTeX
@article{pattajoshi2026assessment,
title = {{Assessment of Health Warning Label Compliance on Smokeless Tobacco Products in Bhubaneswar, India.}},
author = {Sulagna Pattajoshi and Pratap K Jena and Ipsa Mohapatra},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116986},
url = {https://europepmc.org/article/MED/42948327},
note = {CC BY},
}
RIS
TY - JOUR
TI - Assessment of Health Warning Label Compliance on Smokeless Tobacco Products in Bhubaneswar, India.
AU - Sulagna Pattajoshi
AU - Pratap K Jena
AU - Ipsa Mohapatra
PY - 2026
DA - 2026/09/27
JO - Cureus
DO - 10.7759/cureus.116986
UR - https://europepmc.org/article/MED/42948327
AB - Introduction Use 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 A 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 None 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 The 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.
SN - 2168-8184
ER -