Adnan-Final Year Project Report

The Effects of Graphical Health Warning
Labels towards Smoking Behavior

Submitted by
Adnan Saleh Bhutto
(07-0261)
Supervised by:
Mr. Hasan Javid
Program
Bachelors of Business Administration (BBA)
SPRING 2011
FAST- School of Business
National University of Computer & Emerging Science
Karachi Campus
FAST SCHOOL OF BUSINESS, KARACHI

1
Recommendation for External Examination
This final year project, hereto attached, titled, Effects of graphical health warning labels toward
smoking Behavior, prepared and submitted by Adnan Saleh Bhutto, in partial fulfillment of the
requirements for the degree of Bachelors of Business Administration (BBA), is hereby forwarded for
appropriate action .
Mr. Hasan Javid

Advisor
FAST SCHOOL OF BUSINESS, KARACHI
Certificate of Completion
This final year project titled, Effects of graphical health warning labels toward smoking
Behavior, prepared and submitted by Adnan Saleh Bhutto, in partial fulfillment of the
requirements for the degree of Bachelors of Business Administration (BBA), has been accepted
and approved.
Mr. Hasan Javid

Advisor
Dr. Nadeem A Syed

Head of Management Science Department
ACKNOWLEDGEMENTS
3
Behind every task is a vision and in order to complete a successful task we

must have a determination to complete that vision. I would like to thanks my
Almighty Allah who gave me enough strength to work on this research
project. I would like to say the words of appreciation to my advisor Mr. Hasan
Javid for his kind guidance and support throughout the research.
This report could not have been accomplished without the splendid support
and cooperation of Dr. Nadeem A Syed (HOD) and my respected facility
members, who throughout my research helped me in guiding and sharing
their knowledge.
It has been really knowledge seeking experience to do this research. And
finally, I offer my regards and blessings to all of those who supported me in
any respect during the completion of the research report.
Table of Contents
(i) Title
page
..i
(ii)
Certificates
.ii
(ii)
Acknowledgement
iv
(iii) Table of
contents
.v
(iv) Executive
Summary
...vii
1.
INTRODUCTION..................................................................................................................8
1. 1
BACKGROUND AND JUSTIFICATION.......................................................................................8
1.1.1 Overview of the area under study:...............................................................................................................8
1.1.1.1 Role of Government...................................................................................................................................9
1.2
1.3
1.4
1.5
1.6
1.7
2.
TYPES OF SMOKERS UNDER STUDY (BY CIGARETTE CONSUMPTION).............................................10

TYPES OF CIGARETTE BRANDS UNDER STUDY.......................................................................11
PROBLEM.................................................................................................................... 12
RESEARCH OBJECTIVE.................................................................................................... 12
LIMITATIONS................................................................................................................ 12
SCOPE........................................................................................................................ 13
LITERATURE REVIEW....................................................................................................14
2.1
PACKAGING AND LABELING OF TOBACCO PRODUCTS...............................................................14
2.2.
HEALTH RISK ASSOCIATED WITH SMOKING...........................................................................15
2.3.
HEALTH MESSAGES ON PACKAGING....................................................................................16
2.3.1. Purpose of health warning labeling......................................................................................................17
2.3.2 Importance of health warnings...................................................................................................................18
2.4 THE ROLE OF WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL (FCTC)........................18
2.5. EFFECTIVENESS OF GRAPHIC HEALTH WARNINGS................................................................19
2.6.
EFFECTIVENESS OF GRAPHICAL HEALTH WARNINGS IN RELATION TO AWARENESS AND BELIEVABILITY..20
2.6.1 Change in Behavior....................................................................................................................................21
3.
RESEARCH METHODOLOGY........................................................................................22
3.1.
3.2.
3.3.
3.4.
3.5.
3.6
3.7.
4.
RESEARCH DESIGN........................................................................................................ 23
POPULATION................................................................................................................ 23
SAMPLE AND SAMPLING METHOD.....................................................................................23
MEASUREMENT/INSTRUMENT SELECTION............................................................................23
VARIABLES................................................................................................................. 23
MODEL..................................................................................................................... 23
HYPOTHESIS................................................................................................................ 24
EMPIRICAL DATA.............................................................................................................25
5. ANALYSIS................................................................................................................................43
5.1 HEALTH WARNING LABEL:.............................................................................................. 43
5.2 BELIEVABILITY:.................................................................................................................. 51
5.3 CHANGES IN SMOKING BEHAVIOR:.......................................................................................... 54
5.4 AWARENESS OF HEALTH RISK AND CHANGE IN SMOKING BEHAVIOR:.................................................58
5.5 TYPE OF BRAND AND CHANGE IN SMOKING BEHAVIOR:.................................................................60
5.6 SMOKERS CONSUMPTION LEVEL AND CHANGE IN SMOKING BEHAVIOR:.............................................63
5.4 EFFECTIVENESS OF GRAPHICAL HEALTH WARNING (PICTURE OF MOUTH CANCER)..............................66
6. ANALYSIS OF HYPOTHESIS:..........................................................................................69
7.
FINDINGS:...........................................................................................................................81
7.1 HEALTH WARNING LABEL:.............................................................................................. 81
7.2 CHANGES IN SMOKING BEHAVIOR:.......................................................................................... 81
7.2.1 Awareness of Health risk and change in smoking behavior:......................................................................82
7.2.2 Type of Brand and change in smoking behavior:.......................................................................................82
7.2.3 Smokers consumption level and change in smoking behavior:.................................................................82
7.3 BELIEVABILITY:.................................................................................................................. 82
FOLLOWING IS THE RESULTS OF HYPOTHESIS:...............................................................................84
8. CONCLUSION......................................................................................................................85
8. RECOMMENDATIONS........................................................................................................86
REFERENCES............................................................................................................................87
APPENDIX:.................................................................................................................................89
EXECUTIVE SUMMARY:
The following report details the findings of effectiveness of the graphical health warning labels
on cigarette packs towards smoking behavior. In more specific terms, the aim is to examine
smoker reaction to the graphical health warnings with relation to their age, consumption,
awareness and preferences level. Further study focuses on the extent to which health warnings
convey believable information about the health risk to smokers and the extent to which the health
warning is effective in relation to the type of brand the smoker is using. Quantitative techniques
are been used to make inferences.
Smokers are characterized by the amount of cigarettes they smoke and the type of brands,
premium, middle, and lower class they use. The main variable of investigation is the
smokers change in behavior i.e. leading to reduce or quit smoking. In this research the
independent variables is health warning labels that is been moderate by four variables that might
bring change in smoker behavior (awareness of health risk, believability of health risk, types of
smokers (heavy, moderate, light & casual), types of brands (premium class, middle class & lower
class). Noticeability of graphical health warning, awareness and believability of health risk
associated to smoking are critical determinants of overall effectiveness of health warning in
changing consumer behavior. Latest work done on the effectiveness of health warnings in
Australia, Canada, America and China exhibits the importance in increasing awareness and
knowledge of health risk associated with smoking. Taking into account the current Pakistani
graphical health warning labels can be an important finding in this regard.
1. Introduction
1. 1 Background and Justification
For most consumer products, packaging in one of the most important component of overall
marketing strategies. The importance of packaging is seen as it performs many sales tasks,
such as gaining attention, describing the product, and helping to make the sale and is an
important factor for consumer impulse buying. Infact we can say that in current competitive
marketing environment packaging sells first. It establishes the brand identity and serves as
an effective form of promotion both at the point of purchase and while the product is being
used. Although in all consumer products the manufacturers freely uses creativity, art and
design to shape their product packaging in a manner that would communicate and attract
consumers at first sight, but in cigarette packaging there is an involvement of health
authorities to considerable extent. The manufacturer is directed to print health warnings on
packets, which might be a cause of drastic change in design of cigarette packaging, but with
producing a design to attract consumers to buy cigarettes, packaging stands as an equally
important medium for communication of public health messages.
This research focus on the effectiveness of health messages printed on cigarette packs on
smokers behavior (quitting intentions).
1.1.1 Overview of the area under study:

In the case of cigarettes, which do have a high degree of social visibility, packaging is
particularly important. The nature of the product tends to make smokers use the packaging
slightly different from many other products. Usually packaging is discarded after opening,
but in the case of cigarette smokers generally retain the cigarette pack until the cigarettes are
used and keep the pack with them or close by. Thus, cigarette packs are constantly being
taken out and opened, as well as being left on public display during use.
As a fact smoking is a proven killer and has been identified by the World Health Organization
as the leading cause of death and disability in the world. If we talk about Pakistan, the
tobacco related mortality is increasing rapidly; an estimated 100,000 people die every year
8
from Tobacco related diseases (AKU report, January 31, 2008 by ismailimail, [online]
Available
http://ismailimail.wordpress.com/2008/01/31/smoking-trends-in-pakistan-aku-
report/). Smoking can rapidly produce serious medical conditions and health consequences; it
has numerous immediate health effects on the brain and on the respiratory, cardiovascular
system and cause heart disease, lung cancer, other cancers, and strokes. The use of cigarettes
which kills millions worldwide annually, is perfectly legal and the risk that is associated with
smoking completely lie on smoker. Now the question arises that to what extent smokers
understand the magnitude of these health risks? Probably this might leads to know their
smoking behavior.
1.1.1.1 Role of Government

The government actions in discouraging tobacco intake and informing the public about health
risk plays very important role. The Ministry of Health take steps in order to reduce health
risk, like implementation of activities for tobacco control and to provide strategic guidelines
to the provincial governments for implementation of the National Tobacco Control Program
that enable to achieve obligations stipulated in the Framework Convention for Tobacco
Control
(World
health
Organization
2003,
2004,
2005,
[online]
http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf). The health warnings on

cigarette packs are one the most important regulation of the government. They have been
implemented in an effort to improve the public awareness of the harmful effects of smoking.
The World Health Organizations Framework Convention on Tobacco Control (FCTC) also
states as its first guiding principle that every person should be informed of the health
consequences, addictive nature and mortal threat posed by tobacco consumption and
exposure to tobacco smoke (Article 4.1). So Cigarette health warning labels are the primary
and widespread policy initiatives purely implemented to educate smokers. Now here the
question arise that to what extent do these health warnings effect public behavior specially
smokers behavior? Are they more likely to quit smoking or do they just ignoring the health
warning after being educated?
In Pakistan both in English and Urdu language the text warnings are being displayed
occupying 30% of both the front and back and located at the top portions of the face (in
Urdu) and back (in English) of the packet (Statutory Order 1219(I)/2008 dated 25 September
9
2008, published in the Gazette of Pakistan dated 24 November 2008). The size, color and the
placement of health warning does matter a lot. It plays a key role in noticeability. Recently on
May 31, 2010 Pakistan government introduced legislation that requires the implementation of
regulations for picture-based health warnings. Cigarette packs covering 40% of warning
labels on both the front and back. 30% is covered by the picture and 10% by the warning text.
This means 40% of the overall package space is appropriated to health warnings (RCT, 2010,
Pakistan gets mouth cancer picture on cigarette packs. [press release], 07 September, 2010).
This step of Government for implementing pictorial warning may meet the criteria for
maximum effectiveness. Now almost all brands manufactured and sold in Pakistan have text
and graphical health warning showing mouth cancer. Now the question arise that does the
graphical warnings conveys message more effectively than text-only warning? And does the
exposure of graphical warnings results in increase awareness of the risk of smoking? And
does it result in stronger behavioral response and increase interest in quit smoking?
Graphical health warnings are already been implemented globally and particularly by those
that are signatories to the FCTC (Framework Convention on Tobacco Control). Many
countries have introduced larger, hard-hitting health warning taking into account the risk of
smoking.
1.2
Types of smokers under study (by cigarette consumption)
Smokers are generally characterized by the amount of cigarettes they smoke. Depending on
the society the standard for classifying smokers based on consumption may differ. The
standard used for the research study is given blow:
Heavy Smoker/Chain Smoker non-stop smoker who lights his next cigarette with
the cigarette he is presently smoking (quantity estimated is more than 3 packs per day)
Moderate Smoker smokes between 1-2 packs per day
Light Smoker smokes 1/2 to 1 pack per day
10
1.3
Types of Cigarette Brands under study
Cigarette may be classified by tobacco, by flavor or by length. In Pakistan Cigarettes are

classified according to taste quality and length which are as follows:
Premium Class
It is the Cigarette produced by the best available tobacco. Following study will consider:
Gold Leaf
Benson & Hedges
Marlboro
Middle Class
The tobacco of these cigarettes is little hard and in this class following brand will be
considered:
Red & White

Morven Gold
Capston
Gold Flake
Lower Class
The taste of these Cigarette is very hard and in this class following brand will be considered:
K-2
Embassy
Lords
Royal Filter
1.4
Problem
11
Health warnings with death threat and diseases will capture peoples attention but how they
impact behavior is much more complicated question. Considering the risk associated with
cigarette smoking government take steps to reduce health risk and one of the major efforts to
effectively communicate the health risk associated with smoking is of placing text-only and
graphical health warning labels on cigarette packs. Moreover to insure the maximum
effectiveness of communication the government of Pakistan recently on May 31, 2010
introduced legislation that requires the implementation of regulations for picture-based health
warnings. Cigarette packs covering 40% of warning labels on both the front and back. 30% is
covered by the picture and 10% by the warning text (Tobacco Labeling resource centre,
[online], available,
http://www.tobaccolabels.ca/healthwarningimages/country/pakistan
Now the evaluation of the effectiveness of these health warnings on consumer behavior can
lead us to know the quitting intention of smoker.
1.5
Research Objective
The objective of the study is to determine:
The extent to which the graphical health warning is effective that may change
smokers behavior leading to reduced or quit smoking.
The extent to which the graphical health warning is effective in relation to
The awareness of health risk
Believability of health risk
Smokers consumption level
The type of brand the smoker is using.
1.6
Limitations
Few limitations that will hinder this study are:

less available time
Availability of types of smoker defined might not be convenient.
It will be only applicable in Pakistani environment.
12
1.7
Scope
This study will focus on:
Government efforts for communicating health risk associated with smoking
Providing information of smokers behavior leading to reduce or quit smoking that

will help government to change or modify different type of effective health warnings.
Research will be conducted only in Karachi.
The study will be done on the smokers classified as

Heavy Smoker/Chain Smoker
Moderate Smoker
Light Smoker
Casual Smoker
The study will be done on the brands classified as

Premium Class
Middle Class
Lower Class
2. Literature review
2.1
Packaging and labeling of tobacco products
13
Marketing literature usually highlights the critical role played by pack design in the overall
marketing mix, emphasizing that the product package is the communication life-blood of
the firm, the silent salesman that reaches out to customers(Underwood RL, Ozanne J, J
Marketing Communication 1998:207-20) and that packaging act as a promotional tool in
its own right (Palmer A. The Product. Principles of Marketing. Oxford: Oxford University
Press/Books 2000:215-38)
The importance of packaging, especially of tobacco product cant be denied, as according to

(Beguinot E, 2008) Packaging is a central marketing tool for tobacco products, is an effective
form of advertising, and is in the judgment of marketing experts and courts. Tobacco
companies monitor and alter packaging on a regular basis to ensure its continuous and
increasing appeal to target audiences.
The markings placed on tobacco product packaging may have many functions. To the
manufacturer this is an important space for branding and reinforcing the identity of the
product. It may also be used to communicate claims about the product. For the government
authorities, the packaging is an important space for mandatory health warnings, consumer
information and antismuggling marks. There is an obvious conflict over space on the pack
between the authorities and the tobacco companies i.e. the latter wanting the official markings
to be small and unobtrusive, with no restrictions on branding. As cigarette advertising is
steadily banned and restricted around the world, the pack is becoming an important
promotional space (A briefing for the Government of Malaysia, WHO Framework
Convention on Tobacco Control Key issues for the INB-4, ASEAN inter-sectional meeting 47 March 2002).
Cigarette packaging is highly visible

Cigarette packs displays are everywhere in retail stores and outdoor cabin worldwide.
Cigarette packaging is not removed and discarded but is used until the
cigarettes have been consumed; it thus remains highly visible and is
frequently exposed to users (and others).
14
According to Marketing Backgrounder, Brown & Williamson

(1985):
...if you smoke, a cigarette pack is one of the few things you use regularly that makes a
statement about you. A cigarette pack is the only thing you take out of your pocket 20 times a
day and lay out for everyone to see.
Cigarette packaging as an important promotional tool
Cigarettes packaging becomes more important when other form of promotional possibilities
are restricted or eliminated by law. The displays and shelving are highly prevalent and
effective form of promotion. The cigarette packs when displayed behind the checkout counter
at retail outlet tends to focus consumers and are highly effective.
Slade (1997) wrote: As advertising restrictions loom or become a reality, the surfaces of
the pack itself remain available for communication to customers and potential customers (p.
169).
2.2. Health risk associated with smoking
There are serious health risks associated with smoking (ASH Scotland, 2004). The only
leading preventable cause of ill health and premature death around the world is the use of
tobacco. Around 13000 people die every year from tobacco related diseases in Scotland,
which include heart and cancer diseases (Callum, 1998). Everyday about 2500 Indians die
due to diseases occurred from tobacco intake (Reddy & Gupta, 2004, Report on Tobacco
Control in India). According to a report of the (Surgeon General; 2004) smoking is the
leading preventable cause of death in the United States, and cigarettes is only cause of an
ever expanding number of diseases and health conditions. Smoking occurrence is
considerably higher among people with mental health problems than among the general
population (McNeill, 2001). Study reveal constantly higher smoking rates among people with
all categories of mental health problems than in the general population, with highest rates
found in people with a diagnosis of psychosis (Meltzer et al, 1995). Surveys on residents in
15
British psychiatric institutions found that over 70% of patients were current smokers (Meltzer
et al, 1996). In a study of 8000 UK population found that, people with neurotic disorders (e.g.
depressive episodes, phobias, obsessive compulsive disorder) were twice as likely to smoke
as those with no neurotic disorder. Containing neurotic disorder was associated with heavy
smoking (Coultard et al, 2000). So the major cause of mental illness is associated with higher
rate of smoking
According to (Smoking and Health: Report of the Advisory Committee to the Surgeon
General of the Public Health Service) cigarette smoking is highly related to lung cancer in
men. The degree of the effect of cigarette smoking is higher. In comparison with nonsmokers, moderate and heavy smokers are likely to have lung cancer that shows the degree of
risk is high. Furthermore the (Advisory Committee) concluded that the cigarette smoking is
the most important causes of chronic bronchitis in the United States, and increases the risk of
dying from chronic bronchitis and emphysema (U.S. Public Health Service, 32)
Furthermore, smoking also cause tooth loss (Hanioka T, Ojima M, Tanaka K et al.2007).
Among 789 men followed for up to 35 years in the VA Dental Longitudinal Study (VA DLS),
an ongoing closed panel longitudinal study of men in the Greater Boston area (USA), rates of
tooth loss among current cigarette smokers were approximately twice those of never smokers
(Krall EA, Dietrich T, Nunn ME et al.,2006). Smoking has been reported to cause
brown/black discoloration of teeth (Eriksen HM, Nordbo H,. 1978), alteration of taste and
smell (Asmussen E, Hansen EK, 1986), to be associated with a coated tongue (black hairy
tongue) (Pasquali B. Menstrual phase,.1997).
2.3. Health messages on packaging

Being as a marketing tool for the tobacco industry, cigarette packages also provide
government an effective means of communicating with smokers. Health warnings are placed
in an effort to improve the public awareness of the harmful effects of smoking.
Tobacco companies claim that they have sufficiently warned about the risk of tobacco use
and assume that everyone knows that smoking is bad. But according to Health Canada
(Health warning testing: report. Prepared by Environics Research Group, 1999) this is not the
16
case. In legal system the manufactures are forced to warn smokers about health consequences
that might possibly occur. It is there duty to provide information like:
The magnitude of risk

Consequences of smoking
Specific harmful disease etc.( Mahood G. Warnings that tell the truth, Tob Control,
1999)
2.3.1.
Purpose of health warning labeling
There are two main reasons for the inclusion of health warnings on cigarette packs:
It increases awareness among the public of the negative health effects of tobacco use.
The necessity to bring about further attitudinal and behavioral change in smokers with the
prospect of decreasing the number of smokers (Centre for Behavioral Research in Cancer,
1992).
The health warnings are used to inform and alert smokers about the health hazards of
smoking and as stated by the Centre for Behavioral Research in Cancer (1992), there are two
recognizable groups most likely to be affected by health warnings on tobacco packages:
Those thinking of quitting
Those thinking of taking up the habit, experimenting with smoking or considering trying
smoking.
The National Tobacco Strategy (1999-2003) believes there is no safe level of tobacco
consumption, therefore health warning labels are imperative to reducing the prevalence of
smoking in Australia (MCDS, 1999).
2.3.2 Importance of health warnings

According to (Centers for Disease Control and Prevention, Morbidity and Mortality Weekly
Report, 2009) the imposition of effective health warning messages can be vital tool to
educate smokers and nonsmokers about the health risks of smoking and passive smoking. The
17
effective warning means that the display of warning must be prominent and the message
should be graphical and in words, so that it can be more likely to be noticed by consumers.
Health warnings stimulate reactions that are predictable antecedents of quitting attempts
(Borland R, Yong H-H, Wilson N, Fong GT, Hammond D, Cummings KM, et al). Effective
and stronger warnings stimulate more of these reactions, including thinking about the harms,
thinking about quitting as a result of the warnings, and the relationship between these
reactions and quitting appears to be independent of warning strength, suggesting they are
consistent predictors of quitting (Borland R et al)
2.4 The role of WHO Framework Convention on

Tobacco Control (FCTC)
(Adopted by the Conference of the Parties to the WHO FCTC, WHO Framework Convention
on Tobacco Control, 2003, updated reprint 2004, 2005)
Health warnings are the focus of Article 11 of the Framework Convention on Tobacco
Control (FCTC), the worlds first health treaty. More than 160 countries inhabited by over
80% of the worlds population are parties to the FCTC and are required to implement
effective policies on health warnings. Article 11 of the FCTC states that health warnings on
cigarette packages should cover at least 50 percent of the principal display areas (both the
front and back) of the tobacco package, but at a minimum must cover at least 30 percent of
the principal display areas. It also requires that warnings be rotated; large, clear, visible and
legible; and approved by the competent national authority.
Canada was the first country (2001) to implement graphical health warning labels that are
compliant with the FCTC Article 11 Guidelines. As of May 2009, more than 20 countries
have passed legislation requiring large pictorial health warnings on cigarette packages. Other
countries are currently preparing strong warning label policies in response to the new FCTC
Guidelines.
The introduction of new graphical health warnings instead of text only warnings tends to
stand as more effective in informing smokers about the risks of smoking compared to smaller,
less comprehensive text warnings. In Pakistan on May 31, 2010 the implementation of
18
regulation for picture-based health warning took place. Cigarette packs covering 40% of
warning labels on both the front and back. 30% is covered by the picture and 10% by the
warning text. This means 40% of the overall package space is appropriated to health warnings
(RCT, 2010, Pakistan gets mouth cancer picture on cigarette packs. [press release], 07
September, 2010).
2.5.
Effectiveness of Graphic Health Warnings
Research (Hammond, D., Fong, G.T., Borland, R., Cummings, M., McNeill, A. & Driezen, P.
(2007) Text and graphic warnings on cigarette packages) indicates that pictorial warnings are
more effective than text-only warnings. The International Tobacco Control (ITC) Project
shows that graphical health warning was very much effective to Canadian smokers in helping
them inform about health risk and they think it is good source of information. They were
more aware of a series of adverse health effects of smoking compared to that of their
counterparts in countries where there are text-only health warnings (Hammond et al, 2007).
For influencing particular smoker groups, graphical health warnings have varying effects:
Generally older age group and middle age group have greater effect by Graphical health
warning (Willemsen, 2002; Omar et al, 2006). Research indicates that graphical health
warning may be more effective in changing behavior of younger smokers than text-only
warning (Datafolha Institute, 2002, cited in Agencia Saude, 2003; Environics Research
Group, 2005a; Environics Research Group, 2005b; OHegarty et al, 2006; Golmier et al,
2007);
According to (Omar et al, 2006) moderate income consumers are generally most likely to be
influenced by health warnings and Health warnings are likely to have a greater impact on
males
Another studies indicates, that females respond more strongly than males to health warnings,
particularly those featuring graphics (Koval et al, 2005; OHegarty et al, 2006; Thrasher,
Rousu et al, 2007)
19
According to Hammond, the lighter or moderate smoker is more likely change behavior i.e.
reduce or quit smoking, when they see graphical health warning (Hammond et al, 2004a;
Environics Research Group 2005).
2.6. Effectiveness of Graphical health warnings in relation to

awareness and believability
According to research conducted by (Dr David Hammond, findings from the International
Tobacco Control (ITC) Four Country Survey, 2005)
Warnings that are understandable, graphical, larger, and more comprehensive in content are
more effective in communicating the health risks of smoking. Although the information of
health risk might not be that much prominent in the mind of smoker but the health warning
having effective information, larger text, and relevant content can increase the knowledge of
smoker about the health risk. The following research also concluded that the smokers from
different countries showed significant gaps in their knowledge of risk of smoking . Smokers
who noticed the warnings were considerably more likely to support health risks, including
lung cancer and heart disease. In each instance where labeling policies differed between
countries, smokers living in countries with government mandated warnings reported greater
health knowledge.
Smokers have greater knowledge about particular health effects in countries where those
health effects are the subject of warnings than in countries where they are not (Environics
Research Group Limited, survey, Ottawa: Health Canada, 2005). National surveys
conducted on behalf of Health Canada indicate that approximately 95% of youth
smokers and 75% of adult smokers report that the Canadian graphical health warnings
have been effective in providing them with important health information (Institute of
Medicine of the National Academies, 2007). The 2001 survey conducted by the Canadian
Cancer Society found that, recently introduced graphical health warnings resulted in 58
percent of smokers reporting that they thought about the health effects of smoking more
frequently than previously (Canadian Cancer Society, survey, Prepared by Environics, Focus
Canada 2001-3, 2001). In Ontario 51 percent of the respondents among adult smokers
20
reported that the warning labels made them think about health risk associated with smoking
(Hammond, D., Fong, G.T., et al., 2004). According to Canadian smokers cigarette packages
were as a source of information about health risk than smokers in the United States
(Hammond, D, McNeill et al., 2006).
In an Internet-based study of current and former young adult smokers in the United States,
the Canadian graphic warnings were rated as significantly more effective than the current
U.S. warnings on cigarette packs for conveying concerns about the health risks of smoking
(O'Hegarty, M., Pederson, L.L., et al. 2006). According to study by Hammond we can see that
graphical warnings are effective in enhancing knowledge about the risks of smoking for e.g.
in Canada, the graphical warning shows risks of impotence, smokers were 2.68 (2.412.97)
times more likely to agree that smoking causes inability compared to smokers from the other
three countries (Hammond et al., 2006, Tob. Control). Further in Canada, smokers also
reported negative emotions such as bad feelings, fear and disgust after observing the
graphical warnings. Respondents who reported greater negative emotions were more likely to
have quit, attempted to quit or reduced smoking after 3 months (Hammond et al., 2004, Am J
Public Health)
According to a report published in 2008 in comparison of 2000 (Shanahan, P. and Elliott, D.,
2009, Evaluation of the Effectiveness of the Graphic Health Warnings on Tobacco Product
Packaging 2008, Australian Government Department of Health and Ageing, Canberra)
unaided awareness is still very high among smokers, with 91% recalling health messages on
the front of pack. The decline in unaided awareness of side of pack information is offset by a
significant increase in unaided recall of back of pack health information. Design of pictures
labels appear to have played a greater role in noticeability and recall of health warnings
(Shanahan, P. and Elliott, D., 2009).
2.6.1 Change in Behavior

According to research findings:
21
The effect of health warnings on smoker behavior is more associated with their attempt
towards quit smoking when warning messages appear on Australian and Canadian package
(Hammond et al., 2004). This is because Canadian packaging evokes negative emotions that
lead to change in smokers behavior (Hammond et al., 2004).
In one of the clinical study done to compare the awareness of smoking risks and the impact of
graphic health warning labels on cigarette packs in discouraging smoking among adults in
Singapore and Scotland, by (D H L Ng, S T D Roxburgh, S Sanjay and K G Au Eong., may
2010) concluded that: Graphic health warning labels reading Smoking causes blindness
printed on cigarette packs may be useful in raising public awareness of blindness as a
smoking-related condition and discouraging the habit of smoking in Singapore and Scotland
(D H L Ng, S T D Roxburgh, S Sanjay and K G Au Eong., May 2010)
According to a survey by the Canadian Cancer Society, 44 percent of adult smokers stated
that the graphical health warnings increased their motivation to quit smoking (Environics,
Focus Canada 2001-3, 2001). In another study of Canadian young adults (ages 20 to 24),
37% of male participants and 48% of female participants reported that the warnings on
cigarette packs led them to think about quitting smoking (Koval, J.J., Aubut, J.A., et al.,
2005). In this same study, 36% of male participants and 34% of female participants also
indicated that the health warnings might make young people less likely to start smoking
(Koval, J.J., Aubut, J.A., et al., 2005).
3.
Research Methodology
3.1. Research Design

The research design of study will be quantitative descriptive research.
22
3.2. Population
The population for the research study will be cigarettes smokers irrespective of age in
Karachi market.
3.3.
Sample and Sampling Method
Convenient sampling method will be adopted to collect the data from smokers classified as
heavy, moderate, light and casual. The sample size will be 384 respondents for questionnaire.
3.4. Measurement/Instrument Selection

Both primary and secondary data will be collected. Primary data will be collected through
questionnaires. While, secondary data will be collected through internet, research papers,
magazines, journals and articles.
3.5. Variables
My main variable of investigation is the smokers change in behavior. In this research the
independent variables is health warning labels that is been moderate by four variables that
might bring change in smoker behavior. Those four moderating variable are:
3.6
Awareness of health risk

Believability of health Risk
Types of Smokers (heavy, moderate, light & casual)
Types of Brands (premium class, middle class & lower class)
MODEL
CHANGE IN
BEHAVIOR
HEALTH
WARNING
AWARNESS OF
HEALTH RISK
23
BELIEVEABLITY OF
HEALTH RISK
TYPE OF
SMOKERS
TYPE OF BRAND
3.7. Hypothesis
1) Ho = Graphical health warning does not change smokers behavior leading to reduced or
quit
smoking.
Ha = Graphical health warning change smokers behavior leading to reduced or quit

smoking.
2) Ho = Graphical health warning labels does not lead to change in behavior, if smoker have
awareness of health risk.
24
Ha = Graphical health warning labels will leads to change in behavior, if smoker have
3) Ho = Graphical health warning labels does not lead to change in behavior, if consumer use
premium class brand.
Ha = Graphical health warning labels will lead to change in behavior, if consumer use
4) Ho = Graphical health warning labels does not lead to change in behavior, if consumer are
light smokers
Ha = Graphical health warning labels will lead to change in behavior, if consumer are light
smokers
5) Ho = Health warning labels does not lead to change in behavior, if smokers believe in
health
risk.
Ha = Health warning labels will lead to change in behavior, if smokers believe in health
risk.
4.
Empirical Data
AGE:
25
Age
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
18-25
186
48.4
48.4
48.4
26-35
143
37.2
37.2
85.7
55
14.3
14.3
100.0
384
100.0
100.0
more than 35
Total
age
more than 35; 14%
18-25
26-35
more than 35
18-25; 48%
26-35; 37%
Interpretation:
Above table shows the percentage of smokers respondents according to age wise. 18-25 age
group is among the highest respondents.
CURRENT STATUS:
26
Current status
Frequency
Valid
student
Percent
Valid Percent
Cumulative Percent
185
48.2
48.2
48.2
58
15.1
15.1
63.3
103
26.8
26.8
90.1
other
38
9.9
9.9
100.0
Total
384
100.0
100.0
businessman
in fulltime employment
current status
other; 10%
Student
Businessman
In fulltime employment
In fulltime employment; 27%

Student; 48%
Businessman; 15%
The frequency of student respondents is high i.e. 185 out of 384 respondents
Question 1: Smokers current use of cigarettes?
27
other
Consumption
Frequency
Valid
heavy smoker
Percent
Valid Percent
Cumulative Percent
108
28.1
28.1
28.1
87
22.7
22.7
50.8
light smoker
189
49.2
49.2
100.0
Total
384
100.0
100.0
moderate smoker
consumption
Heavy smoker
Heavy smoker; 28%

Moderate smoker
Light smoker
Light smoker; 49%
Moderate smoker; 23%
Above chart shows that percentage of smokers current use of cigarettes i.e. light smokers are
in higher percentage (49.2%) who smokes upto one pack per day.
Question 2: What brand of cigarette do you smoke?

28
BRAND:
Brand
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
premium class
228
59.4
59.4
59.4
middle class
128
33.3
33.3
92.7
lower class
28
7.3
7.3
100.0
384
100.0
100.0
Total
brand
Lower class; 7%
Premium class
Middle class
Middle class; 33%
Lower class
Premium class; 59%
Above chart shows the percentage of smokers who smokes Premium, Middle and Lower
class brands. The highest percentage is of Premium brand smokers i.e. 59.4% premium brand
include (Gold Leaf, Benson & Hedges and Marlboro).
29
Question 3: Are you aware of any picture health warning printed on the cigarette pack you
use?
Awareness of picture of health warning on pack

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
342
89.1
89.1
89.1
no
42
10.9
10.9
100.0
384
100.0
100.0
Total
Awarness of picture health warning on pack
No; 11%
Yes
No
Yes; 89%
89.10% smokers are aware of the picture health warning printed on cigarettes pack only 11 %
smokers are not aware of the warning label
30
Question 4: Could you recall any health message given below? You can tick one or more
choice
RECALL OF HEALTH MESSAGE
Smoking cause mouth cancer
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
210
54.7
54.7
54.7
no
174
45.3
45.3
100.0
Total
384
100.0
100.0

Yes No; 45%
Yes; 55%
No
Smoking cause lungs cancer

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
140
36.5
36.5
36.5
no
242
63.0
63.0
99.5
.3
.3
99.7
.3
.3
100.0
384
100.0
100.0
Total
Smoking cause Lung cancer

Yes; 37%
Yes
No; 63%
31
No
smoking kills
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
224
58.3
58.3
58.3
no
160
41.7
41.7
100.0
Total
384
100.0
100.0
Smoking Kills
YesNo; 42%
No
Yes; 58%
Smoking is injurious to health

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
284
74.0
74.0
74.0
no
100
26.0
26.0
100.0
Total
384
100.0
100.0

No
26%
Yes
Yes
74%
No
Above tables and charts shows that smokers can recall the health warnings but among these
four the percentage of warning Smoking is injurious to health is higher than others. While
recall of other warnings are at average.
32
Question 5: How important is it that the government imposes to place picture health warning
on the packets of cigarettes?
Importance of warning labels

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
very important
139
36.2
36.2
36.2
quite important
102
26.6
26.6
62.8
quite unimportant
102
26.6
26.6
89.3
very unimportant
41
10.7
10.7
100.0
384
100.0
100.0
Total
Importance of picture health warning
Very unimportant
11%
Very important
Quite important
Quite unimportant
27%
Very important
Quite
36%unimportant
Very unimportant
Quite important
27%
Above table shows that most of the smokers feel that placement of Health warning Label is
very important.
33
Question 6: Do you believe that the brand you smoke is harmful to your health?
Believe in brand
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
247
64.3
64.3
64.3
no
137
35.7
35.7
100.0
Total
384
100.0
100.0
Believe in brand
Yes
No
36%
No
Yes
64%
Above table shows that 64.3% smokers believe that the brand they smoke is harmful to their
health.
34
Question 7: Are you aware of the health consequences caused by cigarette smoking?
awareness of health consequences

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
331
86.2
86.2
86.2
no
53
13.8
13.8
100.0
384
100.0
100.0
Total
Awareness of health consequences
No
14%
Yes
No
Yes
86%
86.2% smokers are aware of health consequences caused by smoking.
35
Question 8: To what extent, if at all, does the picture health warning make you think about
the health risk (health dangers) of smoking?
Think of health risk

Frequency
Valid
not at all
Percent
Valid Percent
Cumulative Percent
62
16.1
16.1
16.1
122
31.8
31.8
47.9
98
25.5
25.5
73.4
a lot
102
26.6
26.6
100.0
Total
384
100.0
100.0
a little
somewhat
Think of health risk
Not at all
Not at all
16%
A lot
27%
A little
Somewhat
Somewhat
26%
A lot
A little
32%
According to the table above 31.8% smokers are those say that picture health warning
somewhat make them think of health risk. While 26.6% smokers feel that picture health
warning make them think a lot about health risk of smoking.
36
Question 9: Do you think the picture health warning printed on cigarette pack is easily
noticeable?
Noticeability of warning label

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
Yes
315
82.0
82.0
82.0
No
69
18.0
18.0
100.0
384
100.0
100.0
Total
Noticeability of warning label
No
18%
Yes
No
Yes
82%
There is a high noticeability of picture warning labels as 82% smokers say yes picture
health warning printed on cigarette pack is easily noticeable.
37
Question 10: Would you say the inclusion of picture health warning and health information
on cigarette pack has improved your knowledge of health effects of tobacco
consumption?
knowledge of health effects

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
Not at all
149
38.8
38.8
38.8
A little
130
33.9
33.9
72.7
Somewhat
67
17.4
17.4
90.1
A lot
38
9.9
9.9
100.0
Total
384
100.0
100.0
Knowledge of health effects
A lot
10%
Not at all
Somewhat
A little
17%
Not
at all
Somewhat
39%
A lot
A little
34%
Above table shows that higher percentage of smokers i.e. 38.8% thinks that inclusion of
picture health warning and health information on cigarette pack has not at all improved their
knowledge of health effects of tobacco consumption. While 33.9% smokers think that it had
improved their knowledge. We can see a less deviation in percentages.
38
Question 11: In terms of the way you feel about your own smoking behavior would you say
the health warning on packs of cigarette have helped you smoke less?
change in smoking behavior

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
not at all
129
33.6
33.6
33.6
a little
173
45.1
45.1
78.6
somewhat
69
18.0
18.0
96.6
a lot
13
3.4
3.4
100.0
Total
384
100.0
100.0
A lot
3%
Not at all
Not at all
34%
Somewhat
Somewhat
18%A little
A lot
A little
45%
Above table shows that 45.10% smokers feel that the health warning on packs of cigarette
have helped them a little to smoke less. While 33.6% smokers feel that there is no effect of
health warning on their smoking behavior.
39
Question 12: What is your reaction after looking the picture of mouth cancer on cigarette
pack?
Reaction after looking at picture health warning

Frequenc
y
Valid
it makes you feel bad
Percent
Valid
Cumulative
Percent
Percent
140
36.5
36.5
36.5
95
24.7
24.7
61.2
37
9.6
9.6
70.8
108
28.1
28.1
99.0
other
1.0
1.0
100.0
Total
384
100.0
100.0
I am more likely to
quit smoking
because of the picture
you use separate
cigarette box
no reaction

It makes me feel bad
I am more likely to quit smoking

28%
37%
Because of the picture you use separate cigrette box

10%
No reaction
25%
36.5% respondents said that smoking makes them feel bad while 24.70% respondents feel
they are more likely to quit smoking.
40
Question 13: Do you think printing picture of mouth cancer on cigarette packs is an effective
way to reduce smoking?
Effectiveness of warning label
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes very effective
142
37.0
37.0
37.0
yes less effective
168
43.8
43.8
80.7
74
19.3
19.3
100.0
384
100.0
100.0
not effective
Total
Effectiveness of warning label
19%
Yes very effective
Yes less effective

37%
Not effective
44%
Above table shows that almost 80% of smokers think that there is an effect of printed picture
of mouth cancer on cigarettes pack in reducing smoking.
41
Question 14: What do you think smoking gives you?
Feelings towards smoking

Frequency
Valid
pleasure
Percent
Valid Percent
Cumulative Percent
213
55.5
55.5
55.5
recognition
32
8.3
8.3
63.8
status
28
7.3
7.3
71.1
harm
52
13.5
13.5
84.6
nothing
59
15.4
15.4
100.0
384
100.0
100.0
Total
What smoking gives you?
Nothing
15%
Pleasure
Recognition
Harm
Status
14%
Status
7%
Harm
Nothing
Pleasure
56%
Recognition
8%
Above table shows about 55.5% smokers tends to get pleasure out of smoking, while only
13.5% think that smoking is harmful
42
Question 15: Do you think smoking causes cancer and other harmful diseases?
Believe (Cause of cancer and other harmful diseases)

Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
230
59.9
59.9
59.9
to some extent
141
36.7
36.7
96.6
13
3.4
3.4
100.0
384
100.0
100.0
no
Total
Cause of cancer and other harmful diseases
3%
Yes
37%
To some ex tent
No
60%
Above table shows that mostly smokers (59.9%) think that smoking is dangerous and cause
cancer and other harmful diseases. While 36.7% smoker also think smoking cause cancer to
some extent.
43
5. ANALYSIS
5.1 HEALTH WARNING LABEL:
Awareness of picture of health warning on pack
Frequency
Valid
Percent
Valid Percent
Cumulative Percent
yes
342
89.1
89.1
89.1
no
42
10.9
10.9
100.0
384
100.0
100.0
Total
Descriptive Statistics
N
awareness of picture of health
warning on pack
Valid N (listwise)
Minimum
384
Maximum
1
Mean
2
1.11
Std. Deviation
.313
384
Around 89.1% respondents are aware of health warning label on cigarette packs and that is
the reason why the mean square is near to 1 which is option Yes. This means that majority
of people knew about health warning label but the question arises about the effectiveness of
these labels, to make smokers quit smoking. So this research will focus on identifying and
understanding the affect of such labels with respect to believability, awareness of health risk,
type of smoker and type of brand.
44
Awareness of picture health warning on pack * age Cross tabulation

Count
age
18-25
warning on pack
50.00%
Total
162
134
46
342
no
24
42
186
143
55
384
57.10%
47.40%
39.20%
40.00%
30.00%
more than 35
yes
Total
60.00%
26-35
yes
no
21.40%
21.40%
20.00%
13.50%
10.00%
0.00%
18-25
26-35
more than 35
Among those who have seen health warning majority of them were 18-25 age group (162
respondents) while 134 respondents were 26-35 age group smokers. If we compare
percentage of those who said yes, majority of them were 18-25 age group (47.40%) while
interestingly 18-25 age group were among the highest respondent who selected No were 1825 age group (57.1% of 42 respondents). While both more than 35 age group have not seen
health warning label (21.40%). Now the question arises what brand they use.
45
Awareness of picture of health warning on pack * consumption Cross tabulation

Consumption
moderate
heavy smoker
awareness of picture of yes
health warning on pack
Count
smoker
light smoker
Total
89
81
172
342
26.0%
23.7%
50.3%
100.0%
% within consumption
82.4%
93.1%
91.0%
89.1%
% of Total
23.2%
21.1%
44.8%
89.1%
19
17
42
45.2%
14.3%
40.5%
100.0%
17.6%
6.9%
9.0%
10.9%
4.9%
1.6%
4.4%
10.9%
108
87
189
384
28.1%
22.7%
49.2%
100.0%
100.0%
100.0%
100.0%
100.0%
28.1%
22.7%
49.2%
100.0%
% within awareness of
picture of health warning
on pack
no
Count
on pack
% of Total
Total
Count
on pack
% of Total
This table shows that of those who selected Yes regarding awareness of health warning label
majority were light smokers (50.3%) while others were heavy smoker (26%).This is
interesting as 18-25 age group were mostly light smokers.
46
Age * consumption Cross tabulation

Count
Consumption
heavy smoker
age
Total
moderate smoker
light smoker
Total
18-25
17
33
136
186
26-35
66
40
37
143
more than 35
25
14
16
55
108
87
189
384
Above table shows that majority of 18-25 age group smoker are light smokers and 26-35 age
group smokers are mostly heavy smokers.
47
Awareness of picture of health warning on pack * brand Cross tabulation

Brand
Total
premium class middle class

awareness of picture of
yes
Count
lower class
211
114
17
342
61.7%
33.3%
5.0%
100.0%
% within brand
92.5%
89.1%
60.7%
89.1%
% of Total
54.9%
29.7%
4.4%
89.1%
17
14
11
42
40.5%
33.3%
26.2%
100.0%
% within brand
7.5%
10.9%
39.3%
10.9%
% of Total
4.4%
3.6%
2.9%
10.9%
228
128
28
384
59.4%
33.3%
7.3%
100.0%
100.0%
100.0%
100.0%
100.0%
59.4%
33.3%
7.3%
100.0%
on pack
no
Count
on pack
Total
Count
on pack
% within brand
% of Total
Chi-Square Tests
Value
Pearson Chi-Square
Likelihood Ratio
Linear-by-Linear Association
N of Valid Cases
df
Asymp. Sig. (2-sided)
33.215a
.000
33.772
.000
1.780
.182
384
a. 1 cells (11.1%) have expected count less than 5. The minimum expected count is 4.01.
48
Those who were aware of health warning majority of them used premium class (61.7% of
342). As P-value (0.000) is less than 0.05 significant level so the relation between awareness
of health warning label is statistically significant.
This implies that 18-25 age group has more knowledge of health warning, use premium
brand and are light smokers.
49
consumption * change in smoking behavior Cross tabulation

not at all
consumption heavy smoker
Count
% within smoking
behavior
% of Total
moderate
smoker
Count
% within smoking
behavior
% of Total
light smoker
Count
% within smoking
behavior
% of Total
Total
Count
% within smoking
behavior
% of Total
a little
Somewhat
a lot
Total
43
57
108
39.8%
52.8%
6.5%
.9%
100.0%
33.3%
32.9%
10.1%
7.7%
28.1%
11.2%
14.8%
1.8%
.3%
28.1%
34
29
20
87
39.1%
33.3%
23.0%
4.6%
100.0%
26.4%
16.8%
29.0%
30.8%
22.7%
8.9%
7.6%
5.2%
1.0%
22.7%
52
87
42
189
27.5%
46.0%
22.2%
4.2%
100.0%
40.3%
50.3%
60.9%
61.5%
49.2%
13.5%
22.7%
10.9%
2.1%
49.2%
129
173
69
13
384
33.6%
45.1%
18.0%
3.4%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
33.6%
45.1%
18.0%
3.4%
100.0%
Those who are light smokers they have higher percentage (46.0% of 189) which shows that
they feel health warnings helped them a little to smoke less, which shows that they are
leading to reduce smoking.
50
consumption * reaction Cross tabulation

Reaction
Total
Because of
the picture
consumptio heavy smoker Count
It makes
quit
cigarette
No
you feel bad
smoking
box
reaction
Other
37
40.7%
12.0%
12.0%
34.3%
% within reaction
31.4%
13.7%
35.1%
34.3%
25.0%
28.1%
% of Total
11.5%
3.4%
3.4%
9.6%
.3%
28.1%
31
21
27
87
35.6%
24.1%
9.2%
31.0%
.0% 100.0%
22.1%
22.1%
21.6%
25.0%
.0%
22.7%
8.1%
5.5%
2.1%
7.0%
.0%
22.7%
65
61
16
44
189
34.4%
32.3%
8.5%
23.3%
% within reaction
46.4%
64.2%
43.2%
40.7%
75.0%
49.2%
% of Total
16.9%
15.9%
4.2%
11.5%
.8%
49.2%
140
95
37
108
384
36.5%
24.7%
9.6%
28.1%
100.0%
100.0%
100.0%
36.5%
24.7%
9.6%
Count
% within
consumption
% within reaction
% of Total
Count
% within
consumption
Total
separate
13
consumption
light smoker
likely to
13
% within
smoker
you use
44
moderate
I am more
Count
% within
consumption
% within reaction
% of Total
51
108
.9% 100.0%
1.6% 100.0%
1.0% 100.0%
100.0% 100.0% 100.0%

28.1%
1.0% 100.0%
Now let us focus on one factor likely to quit smoking we can see
Consumption
Likely to quit smoking
Heavy smoker
13.7% from 95
Moderate smoker
22.1% from 95
Light smoker
64.2% from 95
This implies that 18-25 age group has more knowledge of health
warning, use premium brand are light smokers and are likely to reduce
or quit smoking due to picture health warning.
5.2 Believability:
52
Crosstab
consumption
Total
moderate
heavy smoker
believe
yes
Count
63
105
230
% within Cause of diseases
27.0%
27.4%
45.7%
100.0%
57.4%
72.4%
55.6%
59.9%
% of Total
16.1%
16.4%
27.3%
59.9%
40
22
79
141
28.4%
15.6%
56.0%
100.0%
37.0%
25.3%
41.8%
36.7%
% of Total
10.4%
5.7%
20.6%
36.7%
13
46.2%
15.4%
38.5%
100.0%
5.6%
2.3%
2.6%
3.4%
% of Total
1.6%
.5%
1.3%
3.4%
108
87
189
384
28.1%
22.7%
49.2%
100.0%
100.0%
100.0%
100.0%
100.0%
28.1%
22.7%
49.2%
100.0%
Count
Total
light smoker
62
to some extent Count
no
smoker
Count
% of Total
Chi-Square Tests
Value
df
9.521a
.049
9.538
.049
.036
.850
N of Valid Cases
384
Pearson Chi-Square
Likelihood Ratio
53
Chi-Square Tests
Value
Pearson Chi-Square
Likelihood Ratio
a.
df
9.521a
.049
9.538
.049
.036
.850
2 cells (22.2%) have expected count less than 5. The minimum expected count is 2.95.
Around 45.7% of those who believe in health risk of smoking are light smokers. P-value
0.049 is less than 0.05 but it is very close to 0.05 which shows that the relation between
believability and consumption is somewhat statistically significant.
54
Cause of diseases * reaction Cross tabulation

reaction
Total
Because of
the picture
you use
Believe
(cause of
disease)
yes
separate
you feel
likely to quit
cigarette
No
bad
smoking
box
reaction
71
23
31
44.3%
30.9%
10.0%
13.5%
% within reaction
72.9%
74.7%
62.2%
28.7%
75.0%
59.9%
% of Total
26.6%
18.5%
6.0%
8.1%
.8%
59.9%
38
23
13
66
141
27.0%
16.3%
9.2%
46.8%
27.1%
24.2%
35.1%
61.1%
25.0%
36.7%
9.9%
6.0%
3.4%
17.2%
.3%
36.7%
11
13
.0%
7.7%
7.7%
84.6%
.0% 100.0%
% within reaction
.0%
1.1%
2.7%
10.2%
.0%
3.4%
% of Total
.0%
.3%
.3%
2.9%
.0%
3.4%
Count
140
95
37
108
384
36.5%
24.7%
9.6%
28.1%
100.0%
100.0%
100.0%
36.5%
24.7%
9.6%
Count
% within Cause of
diseases
% within reaction
% of Total
no
Count
% within Cause of
diseases
Total
Other
102
diseases
extent
I am more
Count
% within Cause of
to some
It makes
% within Cause of
diseases
% within reaction
% of Total
1.3% 100.0%
.7% 100.0%
1.0% 100.0%
100.0% 100.0% 100.0%

28.1%
1.0% 100.0%
Believe
It makes you feel bad
Yes
74.7%
72.7%
To some extent
24.1%
27.1%
No
1.1%
0%
55
230
Around 74.7% of 95 respondents who are likely to quit smoking believe that yes smoking
cause cancer and other diseases while interestingly around 72.7% out of 140 respondents who
said that picture health warning make them feel bad also believe that smoking cause cancer.
This shows that believability is increasing among smokers.
Chi-Square Tests
Value
df
71.570a
.000
Likelihood Ratio
73.496
.000
54.391
.000
Pearson Chi-Square
N of Valid Cases
384
7 cells (46.7%) have expected count less than 5. The minimum expected count is .14.
P-value 0.000 is less than 0.05 which proves that the association between believability and
reaction toward behavior is statically significant.
5.3 Changes In Smoking Behavior:

Descriptive Statistics
N
Minimum
smoking behavior
384
Valid N (listwise)
384
Maximum
1
56
Mean
4
Std. Deviation
1.91
.803
change in smoking behavior * Cause of diseases Cross tabulation

Believe(Cause of diseases)
yes
change in
not at all
smoking behavior
a little
somewhat
a lot
Total
Count
to some extent
no
Total
50
70
129
% within smoking behavior
38.8%
54.3%
7.0%
100.0%
21.7%
49.6%
69.2%
33.6%
% of Total
13.0%
18.2%
2.3%
33.6%
108
61
173
62.4%
35.3%
2.3%
100.0%
47.0%
43.3%
30.8%
45.1%
% of Total
28.1%
15.9%
1.0%
45.1%
62
69
89.9%
10.1%
.0%
100.0%
27.0%
5.0%
.0%
18.0%
% of Total
16.1%
1.8%
.0%
18.0%
10
13
76.9%
23.1%
.0%
100.0%
4.3%
2.1%
.0%
3.4%
% of Total
2.6%
.8%
.0%
3.4%
230
141
13
384
59.9%
36.7%
3.4%
100.0%
100.0%
100.0%
100.0%
100.0%
59.9%
36.7%
3.4%
100.0%
Count
Count
Count
Count
% of Total
Chi-Square Tests
Asymp. Sig. (2Value
df
sided)
53.898a
.000
Likelihood Ratio
59.622
.000
46.707
.000
Pearson Chi-Square
N of Valid Cases
384
a. 4 cells (33.3%) have expected count less than 5. The minimum expected count is .44.
Of those who selected yes smoking cause cancer 47% of 230 respondent said that health
warning label have cause them to smoke less i-e a little. While interestingly who to some
57
extent believe that smoking cause cancer 49.6% of 141 said that graphical health warning
label not at all effected there smoking behavior.
Believe (Cause of diseases) * brand Cross tabulation
Count
Brand
premium class
believe
Total
middle class
lower class
yes
108
101
21
230
to some extent
113
24
141
13
228
128
28
384
no
Total
Smokers who smoke premium class to some extent believe that cigarette smoking cause
cancer and other harmful diseases
Chi-Square Tests
Value
df
45.017a
.000
Likelihood Ratio
45.751
.000
18.886
.000
Pearson Chi-Square
N of Valid Cases
384
The relation between believability and brand is significant.
58
brand * change in smoking behavior Cross tabulation

Count
Change in smoking behavior
not at all
brand
a little
Total
somewhat
a lot
premium class
94
96
35
228
middle class
23
67
29
128
lower class
12
10
28
129
173
69
13
384
Total
The result of this table is interesting as premium brand users responses are distributed in two
categories. One are those who use premium brand but they are not likely to quit smoking (94
respondents) ,while other are those who use premium brand and they are likely to quit
smoking i-e a little (96 respondent).
59
Chi-Square Tests
Value
Pearson Chi-Square
Likelihood Ratio
26.813a
.000
27.982
.000
9.371
.002
N of Valid Cases
a.
df
384
The relation between brand and change in smoking behavior is statistically significant.
consumption * change in smoking behavior Cross tabulation

Count
not at all
somewhat
a lot
Total
43
57
108
moderate smoker
34
29
20
87
light smoker
52
87
42
189
129
173
69
13
384
Total
100
90
80
70
60
50
40
30
20
10
0
a little
87
57
Not at all
52
43
34
A little
42
Somewhat
29
A lot
20
7
heavy smoker
4
moderate smoker
8
light smoker
Above results show that there is a highest percentage of light smoker that they have little
chance in change in behavior
60
5.4 Awareness of Health risk and change in smoking behavior:

awareness of health consequences * smoking behavior Cross tabulation
not at all
awareness of health
yes
consequences
Count
health consequences
% within smoking
behavior
% of Total
no
health consequences
% within smoking
behavior
% of Total
Total
Count
health consequences
% within smoking
behavior
% of Total
somewhat
a lot
Total
97
157
65
12
331
29.3%
47.4%
19.6%
3.6%
100.0%
75.2%
90.8%
94.2%
92.3%
86.2%
25.3%
40.9%
16.9%
3.1%
86.2%
32
16
53
60.4%
30.2%
7.5%
1.9%
100.0%
24.8%
9.2%
5.8%
7.7%
13.8%
8.3%
4.2%
1.0%
.3%
13.8%
129
173
69
13
384
33.6%
45.1%
18.0%
3.4%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
33.6%
45.1%
18.0%
3.4%
100.0%
Count
a little
Chi-Square Tests
Value
df
20.269a
.000
Likelihood Ratio
19.458
.000
15.410
.000
Pearson Chi-Square
N of Valid Cases
a.
384
P-value is below 0.05 which shows that result is statistically significant. Mostly those
respondent who said that they are aware of health consequences 90.8% of 173 said that health
warning label have cause them to smoke less
61
Crosstab
Count
Because of
awareness of health
consequences
I am more
the picture you
It makes you
likely to quit
use separate
feel bad
smoking
cigarette box
yes
no
Total
no reaction
other
Total
137
86
26
79
331
11
29
53
140
95
37
108
384
Awareness of health consequences

137
140
120
100
80
60
40
I am86
more likely to quit smoking
79
Because of the picture you use separate cigarette box
20
0
29
26
no reaction
3
11
other
Yes
No
Chi-Square Tests
Value
df
41.263a
.000
Likelihood Ratio
44.512
.000
37.149
.000
Pearson Chi-Square
N of Valid Cases
384
The relation between awareness of health consequences and reaction after looking at picture
health warning is statically significant. The smokers, 137 out of 337 who are aware of the
health consequences of smoking, believe that smoking makes them feel bad. While 86 out of
311 smokers who are aware of health consequences feel that they are more likely to quit
smoking
62
5.5 Type of Brand and change in smoking behavior:

Crosstab
Count
Change in Smoking behavior
not at all
Brand
somewhat
a lot
Total
premium class
94
96
35
228
middle class
23
67
29
128
lower class
12
10
28
129
173
69
13
384
Total
100
a little
94
96
90
80
67
70
60
50
40
Not at all
A little
35
10
A lot
29
23
30
20
Somewhat
12
10
0
Premium Class
Middle Class
Lower Class
Above table shows that smokers who use premium brand, they are either less likely to quit
smoking (96 respondent selected a little) while others are not likely to quit smoking (94
respondent). This shows that deviation is less in those who use premium brand. While
middle class brand smokers also likely to have change in behavior.
63
Chi-Square Tests
Value
Pearson Chi-Square
Likelihood Ratio
df
26.813a
.000
27.982
.000
9.371
.002
N of Valid Cases
384
The p value (0.000) is less than 0.05 which shows that the association between brand and
change in behavior is statistically significant.
Crosstab
Count
Total
Because of the
picture you use
Brand premium class
Total
It makes you
I am more likely
separate
feel bad
to quit smoking
cigarette box
No reaction
Other
75
55
18
77
228
middle class
61
37
16
13
128
lower class
18
28
140
95
37
108
384
64
80
77
75

61
55
70
60
50
37
40
30
20
18
No reaction
10
16
Premium class
Other
18
13
Middle class
Lower class
Above table shows that smoker who use premium brand mostly tends to have no reaction after
looking at picture health warning, while many of them feel that smoking makes them feel bad.
Only 55 out of 228 smokers feel that they are more likely to quit smoking after looking at
picture health warning.
Chi-Square Tests
Value
df
44.810a
.000
47.548
.000
.145
.703
N of Valid Cases
384
Pearson Chi-Square
Likelihood Ratio
The P-value (0.000) is less than 0.05 which shows that the association between brand and
reaction to warning labels is statistically significant.
65
5.6 Smokers consumption level and change in smoking behavior:
Crosstab
Count
Smoking behavior (smoke less)
not at all
Total
a little
somewhat
Total
a lot
43
57
108
moderate smoker
34
29
20
87
light smoker
52
87
42
189
129
173
69
13
384
Above table shows that light smokers are more likely to change behavior and its percentage
of deviation is high then heavy and moderate smokers. While the percentage of change in
behavior (quit smoking) is very low in smokers.
66
87
90
80
70
57
52
60
50
40
43
42
Not at all
A little
34
Somewhat
29
30
A lot
20
20
10
0
Heavy smoker
Moderate smoker
Light smoker
Chi-Square Tests
Value
df
21.989a
.001
Likelihood Ratio
25.301
.000
12.327
.000
Pearson Chi-Square
N of Valid Cases
384
The p value (0.001) is less than 0.05 which shows that the association between consumption
and change in behavior is statistically significant.
67
Crosstab
Count

Because of the

moderate
smoker
light smoker
Total
I am more
picture you
It makes you
likely to quit
use separate
feel bad
smoking
cigarette box
No reaction
Total
44
13
13
37
108
31
21
27
87
65
61
16
44
189
140
95
37
108
384
65
70
Other
61
60
50
44
40
30
20
44
37
31
Because of the picture you use27separate cigarette box
21
16
13 13
No reaction
8
10
Other
Heavy smoker
Moderate smoker
Light smoker
Chi-Square Tests
Value
Pearson Chi-Square
Likelihood Ratio
N of Valid Cases
df
17.852a
.022
19.907
.011
1.344
.246
384
Here light smoker 65 out of 189 feels bad after looking at health warning, while 61 out of 189
says that they a more likely to quit smoking after looking at picture health warning. This
shows that light smokers are more likely to reduces smoking or quit it when they are exposed
of picture health warnings
68
5.4 Effectiveness of Graphical Health Warning (Picture Of Mouth Cancer)
69
Age * Effectiveness of warning label Cross tabulation

effectiveness of warning label
age
18-25
yes very
yes less
effective
effective
not effective
Total
Count
53
94
39
186
% within age
28.5%
50.5%
21.0%
100.0%
37.3%
56.0%
52.7%
48.4%
% of Total
13.8%
24.5%
10.2%
48.4%
Count
74
49
20
143
% within age
51.7%
34.3%
14.0%
100.0%
52.1%
29.2%
27.0%
37.2%
% of Total
19.3%
12.8%
5.2%
37.2%
Count
15
25
15
55
% within age
27.3%
45.5%
27.3%
100.0%
10.6%
14.9%
20.3%
14.3%
% of Total
3.9%
6.5%
3.9%
14.3%
Count
142
168
74
384
% within age
37.0%
43.8%
19.3%
100.0%
100.0%
100.0%
100.0%
100.0%
37.0%
43.8%
19.3%
100.0%
% within effectiveness of
warning label
26-35
warning label
more than 35
warning label
Total
warning label
% of Total
70
94
100
90
74
80
70
53
60
50
49
Yes very effective

39
Yes less effective
Not effective
40
30
25
20
15
20
15
10
0
18-25
26-35
more than 35
Smokers who are of 18-25 of age think that printing picture of mouth cancer on cigarette
pack is an effective way to reduce smoking. While interestingly smoker of age 26-35 also
think that printing pictorial warning is very effective.
consumption * effectiveness of warning label Cross tabulation

Count
effectiveness of warning label
yes very effective
consumption
yes less effective
not effective
Total
heavy smoker
53
33
22
108
moderate smoker
35
37
15
87
light smoker
54
98
37
189
142
168
74
384
Total
71
98
100
90
80
70
60
50
40
30
54
53
Yes very effective
33
Yes less effective

37
35
Not effective
37
22
15
20
10
0
Heavy smoker
Moderate smoker
Light smoker
Above table shows that mostly light smoker (98 out of 189) think that printing picture of
mouth cancer on cigarette pack is an effective way to reduce smoking. While heavy and
moderate smoker also think that pictorial warning is effective to some extent.
72
6. ANALYSIS OF HYPOTHESIS:
Ho = Graphical health warning does not change smokers behavior leading to reduced or quit
smoking.
Ha = Graphical health warning change smokers behavior leading to reduced or quit
smoking.
Awareness of picture of health warning on pack * Change in smoking behavior Cross tabulation
not at all
Awareness of picture of yes
Count
a little
somewhat
Total
a lot
115
148
66
13
342
33.6%
43.3%
19.3%
3.8%
100.0%
89.1%
85.5%
95.7%
100.0%
89.1%
29.9%
38.5%
17.2%
3.4%
89.1%
14
25
42
33.3%
59.5%
7.1%
.0%
100.0%
10.9%
14.5%
4.3%
.0%
10.9%
3.6%
6.5%
.8%
.0%
10.9%
129
173
69
13
384
33.6%
45.1%
18.0%
3.4%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
33.6%
45.1%
18.0%
3.4%
100.0%
on pack
% within change in
smoking behavior
% of Total
no
Count
on pack
% within change in
smoking behavior
% of Total
Total
Count
on pack
% within change in
smoking behavior
% of Total
73
148
160
140
115
120
100
80
Not at all
66 A little
Somewhat
A lot
60
25
40
14
13
20
0
Yes
No
Above table shows that the smokers who are aware of graphical health warning have little
chance that they will change their behavior in reduce smoking or quit it.
While the correlation shows:
Correlations
awareness of picture
of health warning on
pack
warning on pack
Pearson Correlation
Sig. (2-tailed)
-.076
.138
N
smoking behavior
smoking behavior
Pearson Correlation
384
384
-.076
Sig. (2-tailed)
.138
384
384
The p-value (0.138) is more than significance level 0.05 which means that the relation
between graphical health warning and change in behavior is not statistically significance.
While the correlation value -0.076 reflect moderate negative relation. There is a weak relation
between variables so this implies that if smoker have seen graphical health warning, it is
less likely that they will quit smoking. (Ho accepted)
2) Ho = Graphical health warning labels does not lead to change in behavior, if smoker have
74
Ha = Graphical health warning labels will leads to change in behavior, if smoker have
Awareness of health consequences * Change in smoking behavior Cross tabulation
Count
Change in Smoking behavior
not at all
Awareness of health
a little
somewhat
a lot
Total
yes
97
157
65
12
331
no
32
16
53
129
173
69
13
384
consequences
Total
157
160
140
120
97
100
80
65 A little
Not at all
60
Somewhat
A lot
32
40
16
12
20
0
Yes
No
Above table shows that there is a little chance of change in behavior if smokers are aware of
health consequences.
75
Chi-Square Tests
Value
df
6.865a
.076
Likelihood Ratio
8.914
.030
2.198
.138
Pearson Chi-Square
N of Valid Cases
384
As per above result we conclude that as P-value exceeds 0.05 i.e. 0.076 so we assume that the
relation between change in behavior and awareness of health consequences is not statistically
significant. And when the P-value is greater than o.o5 then we cannot reject Ho so we
conclude that Graphical health warning labels does not lead to change in behavior, if
smoker have awareness of health risk. (Ho accepted)
76
3) Ho = Graphical health warning labels does not lead to change in behavior, if consumer use
Ha = Graphical health warning labels will lead to change in behavior, if consumer use

not at all
brand
premium class
Count
% within brand
% within change in smoking
behavior
% of Total
middle class
Count
% within brand
behavior
% of Total
lower class
Count
% within brand
behavior
% of Total
Total
Count
% within brand
behavior
% of Total
77
a little
somewhat
a lot
Total
94
96
35
228
41.2%
42.1%
15.4%
1.3%
100.0%
72.9%
55.5%
50.7%
23.1%
59.4%
24.5%
25.0%
9.1%
.8%
59.4%
23
67
29
128
18.0%
52.3%
22.7%
7.0%
100.0%
17.8%
38.7%
42.0%
69.2%
33.3%
6.0%
17.4%
7.6%
2.3%
33.3%
12
10
28
42.9%
35.7%
17.9%
3.6%
100.0%
9.3%
5.8%
7.2%
7.7%
7.3%
3.1%
2.6%
1.3%
.3%
7.3%
129
173
69
13
384
33.6%
45.1%
18.0%
3.4%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
33.6%
45.1%
18.0%
3.4%
100.0%
100
90
80
70
60
50
40
30
20
10
0
94
96
Change in
behavior
67
Not at all 35
a little
29
23
Smomewhat
3
Premium class
12
Middle class
A lot
10
Lower class
According to this table, those who use premium brand, they are either less likely to quit
respondent). This shows that deviation is less in those who use premium brand. While middle
class are also a little likely to quit smoking. Interestingly those who use lower class brand,
majority of them said that they are not at all likely to quit smoking (12 respondents). Hence
premium brand users are more likely to quit smoking (55.5 % of those who said they
will change their behavior a little as compared to lower and middle class brand users.
Chi-Square Tests
Value
Pearson Chi-Square
Likelihood Ratio
N of Valid Cases
df
26.813a
.000
27.982
.000
9.371
.002
384
The p value (0.000) is less than 0.05 which shows that the association between brand and
change in behavior is statistically significant. Also the value of Pearson chi square (26.8) lies
in rejection region as the value of X with alpha and degree of freedom 6 is 12.59 and that it is
proved that Health warning labels will lead to change in behavior depending on the type of
brand.
This implies that health warning label will lead to change in behavior if consumer use
premium brand. (Ho Rejected).
78
4) Ho = Graphical health warning labels does not lead to change in behavior, if consumer are
light smokers
Ha = Graphical health warning labels will lead to change in behavior, if consumer are light
smokers
Consumption * Change in smoking behavior Cross tabulation

not at all
Count
% within change in
smoking behavior
% of Total
moderate smoker Count

% within change in
smoking behavior
% of Total
light smoker
Count
% within change in
smoking behavior
% of Total
Total
Count
% within change in
smoking behavior
% of Total
79
a little
somewhat
a lot
Total
43
57
108
39.8%
52.8%
6.5%
.9%
100.0%
33.3%
32.9%
10.1%
7.7%
28.1%
11.2%
14.8%
1.8%
.3%
28.1%
34
29
20
87
39.1%
33.3%
23.0%
4.6%
100.0%
26.4%
16.8%
29.0%
30.8%
22.7%
8.9%
7.6%
5.2%
1.0%
22.7%
52
87
42
189
27.5%
46.0%
22.2%
4.2%
100.0%
40.3%
50.3%
60.9%
61.5%
49.2%
13.5%
22.7%
10.9%
2.1%
49.2%
129
173
69
13
384
33.6%
45.1%
18.0%
3.4%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
33.6%
45.1%
18.0%
3.4%
100.0%
87
90
80
70
57
52
60
50
40
43
Not at all
A little
34
42
A lot
Somewhat
29
30
20
20
10
0
Heavy smoker
Moderate smoker
Light smoker
Above table shows that light smokers have little chance to change behavior and its percentage
of deviation is high then heavy and moderate smokers. While the percentage of change in
behavior (quit smoking) is very low in smokers.
Chi-Square Tests
Value
df
21.989a
.001
Likelihood Ratio
25.301
.000
12.327
.000
Pearson Chi-Square
N of Valid Cases
384
The p value (0.001) is less than 0.05 which shows that the association between consumption and
change in behavior is statistically significant. Also the value of Pearson chi square (21.989) lies
in rejection region as the value of X with alpha and degree of freedom 6 is 12.59 and that it is
proved that Health warning labels will lead to change in behavior depending upon
consumption level of smoker. (Ho rejected)
80
5) Ho = Health warning labels does not lead to change in behavior, if smokers believe in
health risk.
Ha = Health warning labels will lead to change in behavior, if smokers believe in health risk.
Believe (Cause of diseases) * change in smoking behavior Cross tabulation

not at all
Believe (Cause of
yes
diseases)
Count
% within Believe
(Cause of diseases)
% within change in
smoking behavior
% of Total
to some
extent
Count
% within Believe
(Cause of diseases)
% within change in
smoking behavior
% of Total
no
Count
% within Believe
(Cause of diseases)
% within change in
smoking behavior
% of Total
Total
Count
% within Believe
(Cause of diseases)
% within change in
smoking behavior
% of Total
81
a little
somewhat
Total
a lot
50
108
62
10
230
21.7%
47.0%
27.0%
4.3%
100.0%
38.8%
62.4%
89.9%
76.9%
59.9%
13.0%
28.1%
16.1%
2.6%
59.9%
70
61
141
49.6%
43.3%
5.0%
2.1%
100.0%
54.3%
35.3%
10.1%
23.1%
36.7%
18.2%
15.9%
1.8%
.8%
36.7%
13
69.2%
30.8%
.0%
.0%
100.0%
7.0%
2.3%
.0%
.0%
3.4%
2.3%
1.0%
.0%
.0%
3.4%
129
173
69
13
384
33.6%
45.1%
18.0%
3.4%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
33.6%
45.1%
18.0%
3.4%
100.0%
120
108
100
80
70
62
60
61
50 at all
Not
A little
Somewhat
A lot
40
20
10
0
Yes
No 0
To some extent
Above table shows that those smokers who believe smoking cause cancer and other harmful
diseases have a little chance that they will reduce or quit smoking. However there is no
maximum chance of change in behavior.
Chi-Square Tests
Value
df
53.898a
.000
Likelihood Ratio
59.622
.000
46.707
.000
Pearson Chi-Square
N of Valid Cases
384
The P-value (0.000) is less than 0.05 which shows that the association between believability
and change in behavior is statistically significant. Also the value of Pearson chi square
(53.898) lies in rejection region as the value of X with alpha and degree of freedom 6 is 12.59
and that it is proved that health warning labels will lead to change in behavior, if
smokers believe in health risk. (Ho Rejected)
Now if we look at the smokers who believe that the specific brand they smoke is harmful to
their health:
82
Believe in brand harmfulness * Change in smoking behavior Cross tabulation

not at all
Believe in brand
yes
harmfulness
Count
% within believe in brand
harmfulness
% within change in
smoking behavior
% of Total
no
Count
harmfulness
% within change in
smoking behavior
% of Total
Total
Count
harmfulness
% within change in
smoking behavior
% of Total
83
a little
somewhat
a lot
Total
64
116
55
12
247
25.9%
47.0%
22.3%
4.9%
100.0%
49.6%
67.1%
79.7% 92.3%
64.3%
16.7%
30.2%
14.3%
3.1%
64.3%
65
57
14
137
47.4%
41.6%
10.2%
.7%
100.0%
50.4%
32.9%
20.3%
7.7%
35.7%
16.9%
14.8%
3.6%
.3%
35.7%
129
173
69
13
384
33.6%
45.1%
18.0%
3.4%
100.0%
100.0%
100.0%
100.0%
33.6%
45.1%
18.0%
100.0
%
3.4%
100.0%
100.0%
116
120
100
80
60
65
64
55
Not at all
57
Smoewhat
A little
A lot
40
14
12
20
0
Yes
No
Above table shows that there is a chance that those smokers who believe that the brand they
smoke is harmful to their health will reduce or quit smoking.
Chi-Square Tests
Value
df
24.281a
.000
Likelihood Ratio
25.601
.000
23.921
.000
Pearson Chi-Square
N of Valid Cases
384
The P-value (0.000) is less than 0.05 which shows that the association between believability
of brand harmfulness and change in behavior is statistically significant. Also the value of
Pearson chi square (24.281) lies in rejection region as the value of X with alpha and degree of
freedom 3 is 7.815 and that it is proved that health warning labels will lead to change in
behavior, if smokers believe that the brand they smoke is harmful to their health.
84
7.
FINDINGS:
After overall analysis the finding are as under

7.1 HEALTH WARNING LABEL:
Around 89.1% respondents are aware of health warning label on cigarette packs, which is
surly a higher percentage. Now Among those who have seen health warning majority of them
were 18-25 age group (162 respondents) while 134 respondents were 26-35 age group
smokers. those who are aware of health warning label majority were light smokers (50.3%)
while others were heavy smoker (26%) and 18-25 age group were mostly light smokers.
Those who were aware of health warning majority of them used premium class (61.7% of
342). Light smokers feel that health warnings helped them a little to smoke less, which shows
that they are leading to reduce smoking.
7.2 Changes in Smoking Behavior:

The result of this variable is quite interesting, Of those who selected yes smoking cause
cancer 47% of 230 respondent said that health warning label have cause them to smoke less ie a little. While interestingly who to some extent believe that smoking cause cancer 49.6%
of 141 said that graphical health warning label not at all affected there smoking behavior.
When comparing believability with type of brand I found that smokers who smoke premium
class to some extent believe that cigarette smoking cause cancer and other harmful diseases.
While relation between type of brand and change in smoker behavior is very interesting.
There is less deviation between smokers. One are those who use premium brand but they are
not likely to quit smoking (94 respondents) ,while other are those who use premium brand
and they are likely to quit smoking i-e a little (96 respondent). But the relation between
brand and change in smoking behavior is statistically significant.
Finally when comparing consumption level and change in behavior I found that there is a
highest percentage of light smoker that they have little chance in change in behavior
85
7.2.1 Awareness of Health risk and change in smoking behavior:

Mostly those respondent who said that they are aware of health consequences 90.8% of 173
said that health warning label have cause them to smoke less. When we compared what
reaction smokers have who are aware of health consequences I found that the smokers, 137
out of 337 who are aware of the health consequences of smoking, believe that smoking makes
them feel bad. While 86 out of 311 smokers who are aware of health consequences feel
that they are more likely to quit smoking
7.2.2 Type of Brand and change in smoking behavior:

Results shows that smokers who use premium brand, they are either less likely to quit
respondent). This shows that deviation is less in those who use premium brand. While
middle class brand smokers also likely to have change in behavior.
7.2.3 Smokers consumption level and change in smoking behavior:

Result shows that light smokers are more likely to change behavior and its percentage of
deviation when comparing smoking behavior and consumption is high then heavy and
moderate smokers.
While when analyzing consumption level and reaction of smoker after looking at warning
lable I found that light smoker 65 out of 189 feels bad after looking at health warning, while
61 out of 189 says that they a more likely to quit smoking after looking at picture health
warning. This shows that light smokers are more likely to reduces smoking or quit it when
they are exposed of picture health warnings.
7.3 Believability:
After analyzing two variables believability and consumption I found that around 45.7% of
those who believe in health risk of smoking are light smokers and 27% are moderate and
heavy smokers. When analyzing other two variables i.e. reaction to health warning label and
believe (cause of disease) I found that around 74.7% of 95 respondents who are likely to quit
smoking believe that yes smoking cause cancer and other diseases while interestingly around
72.7% out of 140 respondents who said that picture health warning make them feel bad also
believe that smoking cause cancer. This shows that believability is increasing among
smokers.
86
Believe
Yes
To some extent
No

74.7%
24.1%
1.1%

72.7%
27.1%
0%
After analyzing we conclude two final points:

1.
Only graphical health warning does not leads to change in smoking behavior, for
changing smoking behavior it is necessary that smokers must notice the health warning that will
leads to awareness of health consequences and after that smoker must believe in health risk
associated with smoking. We can conclude as given in the diagram:
Noticeability of
graphical health
warning labels
Awareness of health
consequences of
smoking
Believability of health
risk associated to
smoking
Change in smoking
behavior (reduce or
quit smoking)
2.
Light smokers normally of age 18-25 who use premium & middle class brand are
more likely to reduce or quit smoking when they are aware of health risk and believe
in health consequences of smoking.
87
Following is the results of Hypothesis:

NO
1
Hypothesis
Ho
Graphical health warning does not change smokers

behavior leading to reduced or quit smoking.
Ho
Graphical health warning labels does not lead to change in

behavior, if smoker have awareness of health risk.
Ho

behavior, if consumer use premium class brand.
Ho

behavior, if consumer are light smokers
Ho
Health warning labels does not lead to change in behavior,

if smokers believe in health risk.
8. Conclusion
88
Outcome
Ho
Accepted
Ho
Accepted
Ho
Rejected
Ho
Rejected
Ho
Rejected
After analyzing the research we can say that the introduction of graphical health warning in
Pakistan have somehow achieved its purpose. The link between exposure to graphical health
warnings and knowledge of the health consequences of smoking has been well established in
the market. The findings of this report suggest that the graphical health warning is more
effective towards light smokers in changing their behavior. They are more likely than
moderate & heavier smokers to consider the warnings effective in communicating health
effects, and they also consider it important that there be warnings on packs and they also are
more likely to find the warnings very believable and be more likely to reduce or quit
smoking.
Analysis proved that the 18-25 age group has more knowledge of health warning, use
premium brand are light smokers and are likely to reduce or quit smoking due to picture
health warning. If we talk specifically about the health warning of mouth cancer used in
Pakistan than it is proved that printing picture of mouth cancer on cigarette pack is an
effective way to reduce smoking.
The hypothesis testing proved that:
Graphical health warning alone will not change smoking behavior
Graphical health warning labels does not lead to change in behavior, if smoker just have
awareness of health risk

Health warning labels will lead to change in behavior, if smokers believe in health risk.
Health warning label will lead to change in behavior if consumer use premium brand
Health warning labels will lead to change in behavior depending upon consumption level.
Light smoker will more likely to change smoking behavior.
8. Recommendations
The graphical health warnings on cigarette packaging have emerged as an important and
effective component of tobacco control in Pakistan. However there are many areas for
improvement in communicating the health risk of smoking to consumers. The step of
89
government to imposing pictorial warning in 2010 should be considered as an initial step

towards implementation of health awareness. There are many areas where government must
focus to make health warnings much effective and knowledgeable, for example:
Design campaigns for the health awareness focusing specially to youngsters and light
smokers
Making changes to design and content of warnings
The introduction of other messages
Much area of the cigarette pack must be covered with warning
Many variety of health messages must be imposed in order to make them relevant for
different consumer groups
In addition, Ministry of health has to focus particularly on public service

messages in order to effectively communicate health consequences of
smoking. They have to take steps in designing appropriate health
awareness campaigns focusing on currently suffering smokers. Yearly
thorough survey must be done nationwide to study the ratio of smokers
(increase/decrease). Particularly government must encourage youngsters
to quit smoking through NO TO SMOKING campaigns as youngster age
18-25 are more likely to get attracted towards smoking.
References
1. ASH Scotland (2004) Briefing on Passive
Smokinghttp://www.ashscotland.org.uk/issues/pass_pass_smok.html
90
2. Dr Ann McNeill, (2001) Smoking and mental health - a review of the literature;
available(http://www.ash.org.uk/files/documents/ASH_202.pdf)
3. U.S. Department of Health and Human Services, The Health Consequences of Smoking, A
Report of the Surgeon General; 2004, available at
http://www.surgeongeneral.gov/library/smokingconsequences/index.html.
4. Coultard M, Farrell M, Singleton N and Meltzer H, (2000) Tobacco, alcohol and drug use
and mental health London: Stationery Office
5. Callum C (1998) The UK Smoking Epidemic: Deaths in 1995 London: The Health Education
Authority.
6. Hammond D, Fong GT, McNeill A, Borland R and Cummings KM. Effectiveness of cigarette
warning labels in informing smokers about the risks of smoking: findings from the
International Tobacco Control (ITC) Four Country Survey. Tobacco Control. 2006;15:iii 19
25. Available from:http://tc.bmjjournals.com/cgi/content/abstract/15/suppl_3/iii19
7. Krall EA, Dietrich T, Nunn ME et al. Risk of tooth loss after cigarette smoking cessation.
Prev Chronic Dis 2006 3 4: A115
8. Eriksen HM, Nordbo H. Extrinsic discoloration of teeth. J Clin Periodontol 1978 5 4: 229236.
9. 116. Asmussen E, Hansen EK. Surface discoloration of restorative resins in relation to
surface softening and oral hygiene. Scand J Dent Res 1986 94 2: 174-177.
10. 117. Pasquali B. Menstrual phase, history of smoking, and taste discrimination in young
women. Percept Mot Skills 1997 84 3 Pt 2: 1243-1246.
11. Centers for Disease Control and Prevention, Health Warnings on Tobacco Products
Worldwide, 2007,Morbidity and Mortality Weekly Report, 58(19); 528-9, May 22, 2009,
available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a3.htm.
12. Borland R, Yong H-H, Wilson N, Fong GT, Hammond D, Cummings KM, et al. How
reactions to cigarette packet health warnings influence quitting: Findings from the ITC Four
Country survey
13. Hammond, D., Fong, G.T., Borland, R., Cummings, M., McNeill, A. & Driezen, P. (2007and
2004) Text and graphic warnings on cigarette packages: Findings from the International
Tobacco Control Four Country Study Am J Prev Med, 32, (3), 210-217.
14. Koval, J.J., Aubut, J.L., Pederson, L.L., OHegarty, M. & Chan, S.S.H. (2005) The potential
effectiveness of warning labels on cigarette packages: the perceptions of young adult
Canadians, Canadian Journal of Public Health, 96, (5), 353-356.
91
15. Createc+ Market Studies (2003) Effectiveness of health Warning Messages on Cigarette
Packages in Informing Less-literate Smokers, Prepared for Communication Canada,
unpublished report.
16. Institute of Medicine of the National Academies, Ending the Tobacco Problem: A Blueprint
for the Nation, 2007, available at http://www.iom.edu/Reports/2007/Ending-the-TobaccoProblem-A-Blueprint-for-the-Nation.aspx.
17. Canadian Cancer Society, Evaluation of New Warnings on Cigarette Packages. Prepared by
Environics, Focus Canada 2001-3, 2001, available at http://www.cancer.ca/Canada-wide/How
%20you%20can%20help/Take%20action/Advocacy%20what%20were%20doing/Tobacco
%20control%20advocacy/Progress%20in%20tobacco%20control/Evaluation%20of%20new
%20warnings%20on%20cigarette%20packages.aspx?sc_lang=en.
18. O'Hegarty, M., Pederson, L.L., et al.,Reactions of Young Adult Smokers to Warning Labels
on Cigarette Packs,American Journal of Preventive Medicine, 30(6); 467-73, 2006.
19.Shanahan, P. and Elliott, D., 2009, Evaluation of the Effectiveness of the Graphic Health
Warnings on Tobacco Product Packaging 2008, Australian Government Department of Health
and Ageing, Canberra) it has been concluded that:
APPENDIX:
CODE BOOK
92
93
The Effects of Graphical Health Warning Labels Toward Smoking Behavior
Age:
18-25
26-35
Are you a.
Student
More than 35
Businessman
In fulltime employment
Other: ________
1. Which of the following statement describes your current use of cigarettes?

Smokes 3 or more packs per day
Smokes between 1-2 packs per day
Smokes upto one pack per day

2. What brand of cigarette do you smoke? Please look up in category and tick your choice
(--Gold Leaf --Benson & Hedges --Marlboro)
(--Red & white --Morven Gold --Capstan --Gold Flake)
(--K-2--Embassy --Lords --Royal Filter)
3. Are you aware of any picture of health warning printed on the cigarette pack you use?
Yes
No
4. Could you recall any health message given below? You can tick one or more choice
Smoking cause lung cancer
Smoking Kills
5. How important is it that the government imposes to place picture health warning on the packets of
cigarettes?
Very Important
Quite Important
Quite unimportant
Very unimportant
6. Do you believe that the brand you smoke is harmful to your health?
Yes
No
7. Are you aware of the health consequences caused by cigarette smoking?

Yes
No
If Yes then can you specify any consequence _________________________________
8. To what extent, if at all, does the picture health warning make you think about the health risk (health
dangers) of smoking?
Not at all
A little
Somewhat
A lot
94
9. Do you think the picture health warning printed on cigarette pack is easily noticeable?
Yes
No
10. Would you say the inclusion of picture health warning and health information on cigarette pack has
improved your knowledge of health effects of tobacco consumption?
Not at all
A little
Somewhat
A lot
11. In terms of the way you feel about your own smoking behavior would you say the health warning on
packs of cigarette have helped you smoke less?
Not at all
A little
Somewhat
A lot
12. What is your reaction after looking the picture of mouth cancer on cigarette pack?
No reaction
Others____________
13. Do you think printing picture of mouth cancer on cigarette packs is an effective way to reduce
smoking?
Yes Very Effective
Yes Less Effective
Not effective
14. What do you think smoking gives you?

Pleasure
Recognition
Status
Harm
Nothing
15. Do you think smoking causes cancer and other harmful diseases?
Yes
To some extent
No
Thank you for helping me with this important research.
95

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The Effects of Graphical Health Warning

Labels towards Smoking Behavior

FAST SCHOOL OF BUSINESS, KARACHI

Recommendation for External Examination

Mr. Hasan Javid

FAST SCHOOL OF BUSINESS, KARACHI

Mr. Hasan Javid

Dr. Nadeem A Syed

Behind every task is a vision and in order to complete a successful task we

TYPES OF SMOKERS UNDER STUDY (BY CIGARETTE CONSUMPTION).............................................10

1.1.1 Overview of the area under study:

1.1.1.1 Role of Government

http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf). The health warnings on

Types of smokers under study (by cigarette consumption)

Types of Cigarette Brands under study

Cigarette may be classified by tobacco, by flavor or by length. In Pakistan Cigarettes are

Red & White

The objective of the study is to determine:

Few limitations that will hinder this study are:

It will be only applicable in Pakistani environment.

This study will focus on:

Government efforts for communicating health risk associated with smoking

Providing information of smokers behavior leading to reduce or quit smoking that

Research will be conducted only in Karachi.

The study will be done on the smokers classified as

The study will be done on the brands classified as

Packaging and labeling of tobacco products

The importance of packaging, especially of tobacco product cant be denied, as according to

Cigarette packaging is highly visible

According to Marketing Backgrounder, Brown & Williamson

2.2. Health risk associated with smoking

2.3. Health messages on packaging

The magnitude of risk

Purpose of health warning labeling

2.3.2 Importance of health warnings

2.4 The role of WHO Framework Convention on

Effectiveness of Graphic Health Warnings

2.6. Effectiveness of Graphical health warnings in relation to

2.6.1 Change in Behavior

3.1. Research Design

Sample and Sampling Method

3.4. Measurement/Instrument Selection

Awareness of health risk

Ha = Graphical health warning change smokers behavior leading to reduced or quit

more than 35; 14%

In fulltime employment; 27%

Question 1: Smokers current use of cigarettes?

Heavy smoker; 28%

Light smoker; 49%

Moderate smoker; 23%

Question 2: What brand of cigarette do you smoke?

Premium class; 59%

Awareness of picture of health warning on pack

Awarness of picture health warning on pack

Smoking cause mouth cancer

Smoking cause lungs cancer

Smoking cause Lung cancer

Smoking is injurious to health

Smoking is injurious to health

Importance of warning labels

Importance of picture health warning

awareness of health consequences

Awareness of health consequences