Preschool children in India and Nigeria have the lowest awareness and understanding of health warning labels on cigarette packages, according to an international study of over 2,000 kids in six countries.
Children in countries where larger, graphic cigarette warning labels are used (such as Brazil) were more likely to be aware of and understand the health risks of tobacco products, researchers said.
The study, led by Dina Borzekowski, in the University of Maryland School of Public Health (UMD SPH), and Joanna Cohen, Johns Hopkins Bloomberg School of Public Health (JHSPH), interviewed 2,423 five and six year-old children in Brazil, China, India, Nigeria, Pakistan, and Russia in 2012.
Preschool children were presented with two separate images of current health warning labels (from their own countries), with the words 'smoking' or 'tobacco' blanked out.
Only 38 per cent of children had any awareness of warning labels currently being featured on cigarette packages.
Even after showing warning labels to participating children, around two-thirds (62 per cent) of the children were unable to explain what the health warnings were about.
In India, where children were shown a warning label featuring a scorpion, 87.2 per cent children had no understanding of the warning label message, 11.3 per cent had a weak understanding and only 1.6 per cent had a solid understanding.
The data collection location in India was around and near New Delhi.
In India, a policy for health warnings was drafted in 2006; two warnings were released in 2008 and started appearing on packages in 2009. The warnings in India are required to cover 40 per cent of the front of cigarette packages, researchers said.
Among the six countries studied, awareness and understanding of health warning labels was greatest among children in Brazil, where graphic warning labels, often featuring extremely gruesome pictures, have been featured since 2002 and cover 100 per cent of either the front or back of the cigarette package.
Only 32.4 per cent children in Brazil had no understanding of health warning labels on cigarette packages, while in Nigeria 90 per cent children did not understand the warning labels.
In Pakistan, 67.2 per cent kids had no understanding of health warning labels, the figures were 54 per cent in China and 45.1 per cent in Russia.
"Pro-smoking messages are reaching the world's most susceptible audiences. We need to do a better job globally to reach children with anti-smoking messages," said Borzekowski.
"To do this, health warning messages should be big and clear, especially for low-literacy populations, children and young people," said Borzekowski.
The study was published in the Journal of Public Health.
