Context: Studies have shown that adolescent’s tobacco use habits are influenced by peers, sibling, teacher or parent’s behaviour. Various strategies are put into force to control the use of tobacco in India. Pictorial warnings labels (PWLs) on cigarette packets are one among them. Aim: To assess the levels of knowledge, attitude and perception of student’s about the pictorial health warnings on cigarette packets in Coastal Karnataka. Settings and Design: The study was conducted in Schools (Students and Teachers) and Hospitals (Doctors) in Udupi Taluk of Karnataka state. Methods: A cross-sectional quantitative study was conducted among 600 college students aged 18- 21 years in 2016to understand awareness of PWLs on tobacco use, knowledge, attitude and perception towards PWLs. In-depth interviews were conducted among teachers and physicians to understand their opinion on need and strategies for tobacco control. Statistical analysis used: Descriptive statistics and significance of associations were calculated using SPSS16.Manual thematic analysis was performed on qualitative data. Results: The majority (97%) of the students were aware of PWLs and more than 70% knew about adverse health effects of smoking. Almost 60% could not remember thecontents ofPWLs. Physicians and teachers suggested that PWLs should be red coloured and cover both sides of the cigarette pack for better visibility and greater impact. Conclusion: Pictorial warnings on cigarette packets play an important role in tobacco control, that could be improvised further by other parallel control strategies. Education about tobacco effects at the school level, lectures by experts, attaching an emotional component to the PWLs and strict implementation of tobacco-related laws will result in greater impact.
