Document Type : Original Article
Authors
- . Firas Farisi Alkaff
- . William Putera Sukmajaya 1
- . Amelya Armadani 2
- . Reynaldy Cliftianto Moksidy 2
- . Rina Syarifah Salma 2
- . Kafin Rifqi 2
- . Gesti Wira Nugrayekti 2
1 Department of Orthopedics and Traumatology, Faculty of Medicine Universitas Brawijaya, Malang
2 Medical Student, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
Abstract
INTRODUCTION: Smoking is a significant health problem among Indonesian adolescents and adults.
The Indonesian government had issued several policies to alleviate this problem, including placement
of pictorial health warning (PHW) on cigarette package. There had been several evaluation studies
regarding the effectivity of PHW in urban areas but none in rural areas. This study aims to evaluate
the effectivity of PHW in motivating smoking cessation in a rural area in Indonesia.
MATERIALS AND METHODS: This was a descriptive cross‑sectional study conducted in August
2017 in Losari village, Indonesia. Respondents of this study were villagers aged 18–60 years who
were active smokers and purchased cigarette with PHW on the package. The research instruments
for this study were questionnaire and printout pictures of each PHW approved by the Indonesian
government.
RESULTS: There were 94 respondents recruited in this study. Among them, only 26 (27.7%) stated
that PHW motivated them to stop smoking. From the five figures of PHW, a picture of lung cancer
was the most effective PHW to motivate smoking cessation. Eighty‑one of 94 respondents affirm
that there are other factors besides PHW that might motivate them to stop smoking. Most of them
agreed that an increase in cigarette price will force them to stop smoking.
CONCLUSIONS: Current PHW used on cigarette package might be ineffective in motivating smoking
cessation at Losari village. Further study with larger samples needs to be done to confirm this finding.
Keywords
Ramasundarahettige C, Palipudi K, et al. Global hazards of
tobacco and the benefits of smoking cessation and tobacco taxes.
In: Gelband H, Jha P, Sankaranarayanan R, Horton S, editors.
Cancer: Disease Control Priorities. 3rd ed., Vol. 3. Washington,
DC: World Bank; 2015.
2. Kementerian Kesehatan Republik Indonesia. Basic
Health Research (RISKESDAS). Jakarta: Badan Penelitian
dan Pengembangan Kesehatan Kementerian Kesehatan
Republik Indonesia; 2013.
3. Aditama TJ. Smoking problem in Indonesia. Med J Indones
2002;11:56‑65.
4. West R. Tobacco smoking: Health impact, prevalence, correlates
and interventions. Psychol Health 2017;32:1018‑36.
5. Gilbert A, Cornuz J. Which are the Most Effective and
Cost‑effective Interventions for Tobacco Control? Copenhagen:
World Health Organization Regional Office for Europe’s Health
Evidence Network; 2003.
6. Bekki K, Inaba Y, Kunugita N. WHO framework convention on
tobacco control (FCTC) article 11: Packaging and labelling of
tobacco products. Nihon Eiseigaku Zasshi 2015;70:24‑32.
7. Indonesian Minister of Health Regulation Number 28, 2013 on
Health Warning Message and Health Information on Tobacco
Packaging; 2013.
8. Jung M. Implications of graphic cigarette warning labels on
smoking behavior: An international perspective. J Cancer Prev
2016;21:21‑5.
9. Hamdan SR. Effect of pictorial health warning against intention
to stop smoking (article in Indonesia). MIMBAR 2015;31:241‑50.
10. Sandra C. Effectiveness analysis of the pictorial health warning
policy on cigarette packs in lowering the smoking behavior
students of SMK in Jember district (Article in Indonesia).
J Kebijakan Kesehatan Indone 2016;5:163‑7.
11. Dean AG, Arner TG, Sunki GG, Friedman R, Lantinga M,
Sangam S, et al. Epi Info™, a Database and Statistics Program
for Public Health Professionals. Atlanta, GA: Centers for Disease
Control and Prevention; 2011.
12. Arora M, Tewari A, Nazar GP, Gupta VK, ShrivastavR. Ineffective
pictorial health warnings on tobacco products: Lessons learnt
from India. Indian J Public Health 2012;56:61‑4.
13. Rahman MM, Arif MT, Abd RM, Suhaili MR, Tambi Z, Akoi C,
et al. Effectiveness of pictorial health warning on cigarette
packages: A cross‑sectional study in Sarawak, Malaysia. Malays
Fam Physician 2015;10:19‑26.
14. Mayerl H, Stolz E, Freidl W. Responses to textual and pictorial
cigarette pack health warnings: Findings from an exploratory
cross‑sectional survey study in Austria. BMC Public Health
2018;18:442.
15. Bhardwaj V, Fotedar S, Abbot S, Jhingta P, Sharma D, Negi N.
Awareness of pictorial warning on cigarette packets and
its impact on smoking cessation among smokers in Shimla,
Himachal Pradesh: A cross‑sectional study. Int J Health Allied
Sci 2016;5:148‑53.
16. Majumdar A, Kumar SG, Selvaraj R. Awareness of health
warnings and factors predicting awareness and perceived
effectiveness of pictorial health warnings on tobacco products
among adults in Rural Puducherry, India. J Educ Health Promot
2017;6:23.
17. Durazzo TC, Meyerhoff DJ, Nixon SJ. Chronic cigarette smoking:
Implications for neurocognition and brain neurobiology. Int J
Environ Res Public Health 2010;7:3760‑91.
18. Cantrell J, Vallone DM, Thrasher JF, Nagler RH, Feirman SP,
Muenz LR, et al. Impact of tobacco‑related health warning labels
across socioeconomic, race and ethnic groups: Results from a
randomized web‑based experiment. PLoS One 2013;8:e52206.
19. Bittencourt L, Person SD, Cruz RC, Scarinci IC. Pictorial health
warnings on cigarette packs and the impact on women. Rev Saude
Publica 2013;47:1123‑9.
20. World Health Organization. Systematic Review of the Link
Between Tobacco and the Poverty. Geneva: WHO; 2011.
21. Lopez AD, Collinshaw NE, Piha T. A descriptive model of the
cigarette epidemic in developed countries. Tobacco Control
1994;3:242‑7.
22. Hammond D. Health warning messages on tobacco products:
A review. Tob Control 2011;20:327‑37.
23. Rekha B, Anjum S. Effectiveness of pictorial warnings on tobacco packs: Hospital‑based study findings from Vikarabad. J Int Soc
Prev Community Dent 2012;2:13‑9.
24. Raute LJ, Pednekar MS, Gupta PC. Pictorial health warnings on
cigarette packs: A population based study findings from India.
Tobacco Use Insights 2009;2:TUI.S2751.
25. RahmanMM, ArifMT, SuhailiMR, RazakMF, AkoiC, AzihanN, et al.
Knowledge, attitude, pictorial health warnings and quitting attempt to
smoking in Sarawak, Malaysia. Bangladesh J Med Sci 2017;16:266‑73.
26. Ratih SP, Susanna D. Perceived effectiveness of pictorial health
warnings on changes in smoking behaviour in Asia: A literature
review. BMC Public Health 2018;18:1165.
27. Ross H, Blecher E, Yan L, Hyland A. Do cigarette prices motivate
smokers to quit? New evidence from the ITC survey. Addiction
2011;106:609‑19.
28. Park EJ, Park S, Cho SI, Kim Y, Seo HG, Driezen P, et al. What
cigarette price is required for smokers to attempt to quit smoking?
Findings from the ITC Korea waves 2 and 3 survey. Tob Control
2015;24 Suppl 3:iii48‑55.
29. Levy DT, Cummings KM, Hyland A. Increasing taxes as a strategy
to reduce cigarette use and deaths: Results of a simulation model.
Prev Med 2000;31:279‑86.
30. Chaloupka FJ, Straif K, Leon ME; Working Group, International
Agency for Research on Cancer. Effectiveness of tax and price
policies in tobacco control. Tob Control 2011;20:235‑8.