1. Nepal Landlocked Situated in the South-East Asia Region
bounded by India and China 30 million people with a growth rate of
2.2% > 80% of the people living in rural areas Adult literacy
rate: 2001- 53.7 % During 2007-2011-60% LE at birth (years) 2011-69
years (UNICEF) 25.2% of population living below the poverty line
(2011) 75 districts, 3 regions
2. Tobacco use is widely prevalent in different forms in Nepal
3. Betel-quid Khaini- DriedTobacco leaves Zarda-flavoured tobacco
available in small packets or tins Pan masala-mixing areca nut,
slaked lime, catechu and condiments Snuff Smokeless tobacco
(SLT)-Chewed, sniffed, inhaled 4. Smoke Form tobacco Cigarettes
Smoking NDHS 2006- one third of males (32.5%) in Nepal and 15.2% of
females smoke cigarettes Daily Male smokers 85% and Female 46% 5.
Gender difference in Prevalence of various tobacco 32.5 1.7 38.2
56.5 15.2 2 5 19.6 0 10 20 30 40 50 60 Cigarettes pipes Other
tobacco products Any tobacco prodcuts Male Female 6. Tobacco Use in
Nepal The proportion of deaths due to non-communicable diseases
(NCD)->50% Nepal cancer society 2008-15,000 tobacco related
death/year The prevalence of smoking among adult females in Nepal
is one of the highest in the SEAR-WHO A hospital-based study among
(2003-05)- 48% of all cancers among males and 28% among females
were related to tobacco use. 7. WHO FCTC was developed in response
to the globalization of the tobacco epidemic and is an
evidence-based treaty for the promotion of public health and
provides new legal dimensions for international health cooperation.
Set global rules to tobacco control 8. The Framework Convention
onTobacco Control (FCTC)- enforced in 2005- requires nations that
have ratified the convention to ban all tobacco advertising,
promotion and sponsorship various time-bound commitments including
smoke-free spaces tobacco package warnings 9. Tobacco packaging
tobacco packaging - key promotional vehicle for the tobacco control
Plain tobacco packaging first appeared in 1980s reduce the allure
of tobacco packaging Branded packagingVs plain packaging- PP
associated with negative perceptions and feelings PP may help
reduce cigarette consumption and encourage cessation in the short
term. 10. Plain Packaging A recent systematic review of the PP with
37 studies, suggests that PP has number of potential public health
benefits 1) reducing the appeal of the pack, product and user 2)
increasing the salience of the health warnings 3) increasing
perceptions of harm 11. Nepal signed the WHO Framework Convention
on Tobacco Control (WHO FCTC) on 3 December 2003. Nepal ratified
theWHO Framework Convention on 7 November2006. The Framework
Convention onTobacco Control (FCTC) requires nations that have
ratified the convention to ban all tobacco advertising and
promotion 12. Tobacco Intervention In Nepal TheTobacco Control and
Regulation Act (2011)- enforced in Aug2011 The act prohibits- 1.
use of any tobacco products in all public places 2. any kind of
promotion, advertisement and sponsorship to promote both smokeless
and smoking forms of tobacco. 3. sale of any form of tobacco to
children under 18 years and pregnant women 4. mandates the use of
pictorial graphics and textual warnings covering 75% of the total
area of tobacco packets. 13. Objective It intends to understand the
perception of adult smokers, adult non- smokers and youth; testing
pictorial health warnings; particularly to recommend the most
effective pictures with messages. Specific objectives are to: in
motivating smokers to quit in convincing youth not to start smoking
and chewing tobacco in helping ex-smokers to stay quitting tobacco
use in informing public on danger of tobacco use. 14. Methodology
Methods Quantitative Qualitative Tools Issue centered discussion
Self administered questionnaire Sample size Issue centered
discussion : 54 (6 groups) Self administered questionnaires: 221
school children 15. Included Picture with Messages w'd|kfg tyf
;'lt{;]jgn] d'vsf] SofG;/ x'G5 1 w'd|kfg tyf ;'lt{;]jgn] d'vsf]
SofG;/ x'G5 w'd|kfg tyf ;'lt{;]jgn] d'v tyf 3f6Lsf] SofG;/ x'G5 2 3
w'd|kfg t yf ; 'lt {; ]j gn] kmf]S; f]sf]SofG; / x'G5 4 w'd|kfg t
yf ; 'lt {; ]j gn] kmf]S; f]sf]SofG; / x'G5 5
w'd|kfg/;"lt{;]jgn]sdtf}n, ckf+ujf d/]sf]aRrfhGdG5 w'd|kfg t yf ;
'lt {; ]j gn] kmf]S; f]sf]SofG; / x'G5 tkfO{n] u/]sf] w'd|kfgn]
qRrfnfO{ lgdf]lgo, bd, vf]sL e} aRrfsf] crfgs d[To' x'g ;S5
w'd|kfgtyf ;"lt{;]jgn]dl:tissf]/Qm>fj x'G5 76 8 9 16. Findings-
top Five in Each Category Motivating users to quit Convincing youth
not to start Informing public about the harms Re-convincing
ex-smoker to stay on quit 32.5 (P7) 22.9(P7) 30.2(P7) 26.5(P7) 14.2
(P9) 20.0(P9) 16.0(P9) 15.6(P9)) 13.8 (P2) 12.0 (P2)) 10.5(P3)
14.5(P3) 11.6 (P3) 10.9 (P3) 8.4(P5) 12.4(P5) 9.1 (P5) 9.8(P5)
8.4(P4) 9.8(P2 17. Effect of Smoking in Health I am a wife of a
chain smoker;I know how it is like to stay with a smoker,who gives
no love and affection to family..a non smoker-Dharmasthali 1 Due to
smoking I have heard that your nose can bleed severely..a non
smoker I am a ex-smoker,I left smoking for some time but then
started to have it again,I feel like vomiting and nauseaa
smoker,dharmasthali-1 I dont believe the picture in which the baby
is dying, although I have been smoking for many years,I have two
healthy baby.I think that may be the most less effective picture
would be of neck cancer.a chain smoker, dharmasthali ward 1 When I
first saw the month in the first picture,I felt like it is the
teeth of ghost.I cant believe what I saw,the picture is really
dangerous,I can never think of smoking,if the result is so
thrilling..a non smoker, dharmasthali-1 18. Effectiveness of the
picture and health message in informing public on harmful effect of
smoke (n=275) Picture Effectiveness level in informing public on
harmful effect of smoke Total The most effective extremely
effective very effective somewhat effective a little bit effective
not at all effective 1 45.5 32.0 13.8 6.2 2.5 100% 5.1 2 45.5 33.1
15.6 4.0 1.8 100% 7.3 3 52.0 27.6 14.5 4.4 1.5 100% 10.5 4 56.7
24.0 13.8 3.6 1.8 100% 8.4 5 52.7 26.9 12.0 4.7 3.6 100% 8.4 6 44.0
34.9 14.2 4.0 2.9 100% 8.0 7 67.6 20.7 6.9 3.6 1.1 100% 30.2 8 45.1
29.8 13.8 8.7 2.5 100% 6.2 9 63.6 21.5 9.8 2.9 2.2 100% 16.0 Total
100% 19. Recommendation Based On highest % Picture & Health
Message Motivating users to quit P7 Convincing youth not to start
P9 Informing the public about the harms P3 Re-convincing the
ex-smoker to stay on quit P2 P5 20. Challenges of implementing the
Act and regulations There is a low level of awareness among people
regarding the Act and regulations. The monitoring mechanism and
roles of responsible institutions have not been clearly defined in
theAct Physical barriers- Geographical barrier for promotion
tobacco industry In a recent confrence (2013) among SEAR
highlighted smokeless tobacco (SLT) as a measure challenge to
implementation of FCTC. Its high prevalence, variety of products
and poor knowledge of its harms make it a unique threat to the
region. 21. Australia Sets an Example 22. ThankYou
