Improvement of Cigarette Warning Labels in the Philippines

PERCEPTIONS OF PAULINIAN STUDENTS IN THE IMPROVEMENT OF CIGARETTE WARNING LABELS IN THE PHILIPPINES A Thesis Presented to the Faculty of Nursing St. Paul University Quezon City In Partial Fulfillment of the Requirements for the Degree of Bachelor of Science in Nursing FILART, THERESA MARIE D. A. BRINGUELO, RIO LAINE J. ASUNCION, MICHELLE ANN A. September 2011 Table of Contents I. The Problem and Review of Related Literature A. Introduction................................................................................................... 1 B.

Review of Related Literature........................................................................ 3 C. Conceptual Framework............................................................................... 31 D. Statement of the Problem............................................................................ 33 E. Significance of the Study............................................................................ 33 F. Scope and Limitations................................................................................. 34 G.

Definition of Terms..................................................................................... 35 II. Methodology A. Research Design....................................................................... ................... 36 B. Participants.................................................................................................. 36 C. Instrument.................................................................................................... 39 D. Data Gathering Procedures......................................................................... 9 E. Data Analysis.............................................................................................. 40 III. Results and Discussion A. Results......................................................................................................... 43 B. Discussion................................................................................................... 55 IV. Summary, Conclusions, and Recommendations A. Summary..................................................................................................... 1 B. Conclusions................................................................................................. 62 C. Recommendations....................................................................................... 63 References Appendices A. Letter to the Registrar.................................................................................. 73 B. Validation Letters........................................................................................ 74 C.

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Letter to the Deans...................................................................................... 78 D. Questionnaire.............................................................................................. 81 E. Curriculum Vitae......................................................................................... 87 Acknowledgements This study would not have been possible without the help and guidance of several individuals who, in one way or another, contributed and extended their valuable assistance in the completion of this thesis.

We would like to extend our deepest gratitude to our thesis adviser, Dr. Adrian Lawrence Carvajal, for his unfailing guidance in directing our study. To Mrs. Cristina Price, our statistician, for her expertise. She has guided us in computing and analyzing our gathered data. To Mrs. Maricar Tan, Mrs. Jennifer Lualhati, and Mr. Marlon Lofredo who gave their time in validating our questionnaire. They shared valuable insights for the improvement of this study. To the deans of the three college departments of St. Paul University Quezon City, Sr.

Sahlee Palijo, SPC, Dr. Clarissa Deliarte, and Dr. Helen Rigor, for allowing us to distribute our questionnaires and conduct our survey. To Ms. Rosemarie Bautista, head of Registrar’s Office, who provided us with information that are pivotal for the completion of this study. To Mr. Robin Robert Nunez for giving his generous time and support, and for his assistance on how to use the software needed for the study. To our families and friends who have been supportive, understanding, and patient throughout our thesis making.

And most importantly, to our Almighty God who blessed us with his wisdom and knowledge in order for us to accomplish this study. Abstract The purpose of this study was to provide recommendations to improve cigarette warning labels here in the Philippines. The respondents’ perceived susceptibility to smoke-related illnesses, the severity of the effects of smoking, and their perceived ways in improving cigarette warning labels were examined. A quantitative study approach was done by the researchers, and a self-constructed survey questionnaire was used to obtain the data needed for the study.

Frequency and percentage, as well as weighted mean, were used to analyze the gathered data. The results revealed that most of the respondents are 18 years old and below, are female, and are non-smokers. They believe that smoking makes one highly susceptible to lung cancer, respiratory infections, and chronic obstructive pulmonary disease. Respondents who are smokers also believe that smoking could harm their health, while non-smokers believe that second hand smoking has negative effects on their wellbeing.

The greater part of the respondents wants to improve cigarette warning labels in the Philippines. When asked how, they prefer to put pictures on both front and back cover, and occupy 50% of the cigarette package. If these suggested improvements are to be implemented, most of them would then be more aware of the dangers posed by smoking; smokers would be motivated to quit, while non-smokers would be discouraged to engage in smoking. Lastly, majority of the respondents would have a change in perception regarding smoking. Chapter 1

THE PROBLEM AND REVIEW OF RELATED LITERATURE INTRODUCTION Smoking is one of the biggest threats to the public health, contributing largely to the morbidity and mortality rate among individuals. Among all the types of tobacco, cigarettes are one of the most popular and commonly consumed products nationwide. In today’s time, tobacco consumption and exposure greatly influence the perception of the public towards smoking, especially when cigarettes are widely advertised, cheap, and easily accessible (Mackay & Eriksen, 2002).

Contrary to popular belief that smoking relieves stress, it actually does nothing good in one’s physiological, emotional, and mental health; in fact, it only causes our body harm. Smoking poses a great risk on one’s health. It predisposes numerous illnesses such as lung cancer, emphysema, tuberculosis, and cardio vascular diseases to both smokers and non-smokers. “Global data show that 1 out of 5 people use tobacco. WHO estimates about 5 million tobacco-related deaths annually.

This means that in the 20th century, more than 100 million deaths can be attributed to tobacco use,” stated Tetch Torres (2011) on her article “Ex-health secretaries want graphic warnings on cigarette packs” last January 17, 2011 in the Philippine Daily Inquirer. The public is being informed of the harmful effects that smoking cause. Some anti-smoking campaigns include posters depicting an image of an altered body caused by the destructive habit, conducting seminars, and putting ads on cigarette packaging labels saying, “Government Warning: Cigarette smoking is dangerous to your health. But despite these, it seems that there are still a lot of people who indulge in smoking. They say a picture speaks a thousand words, but could it save lives? Neighboring countries like Singapore, Malaysia, and Thailand have already put graphic health warnings on their cigarette packages so as to motivate consumers to quit smoking. The article of Torres (2011) reveals that based on international studies of the WHO, picture warnings are more easily seen and effective than those of only texts. Also, when it was implemented in Brazil, 7 out of 10 (67 percent) smokers were motivated to quit.

Like how restaurants improve their quality of service and food based from the consumers’ suggestions, the opinion of the people also hold an importance in the improvement of cigarette packaging labels in the Philippines. The voice of the people is an excellent tool in assessing what is missing or lacking so as to make a better product, or in this study, an advocacy. The purpose of this study is to provide recommendations to improve cigarette warning labels here in the Philippines based from the perceptions of the respondents. REVIEW OF RELATED LITERATURE A. Local Sources The first order under Section 13 of Republic Act No. 211, An Act Regulating the Packaging, Use, Sale Distribution, and Advertisements of Tobacco Products and for Other Purposes, is “all packages in which tobacco products are provided to consumers withdrawn from the manufacturing facility of all manufacturers or imported into the Philippines intended for sale to the market starting January 1, 2004 shall be printed in either English or Filipino, on a rotating basis or separately and simultaneously, the following health warnings: “GOVERNMENT WARNING: Cigarette Smoking is Dangerous to Your Health”; “GOVERNMENT WARNING: Cigarettes are Addictive”; GOVERNMENT WARNING: Tobacco Can Harm Your Children”; or “GOVERNMENT WARNING: Smoking Kills. ”” (Republic Act No. 9211, 2003) Second, “upon effectivity of this Act until June 30, 2006, the health warning shall be located on one side panel of every tobacco product package and occupy not less than fifty percent (50%) of such panel including any border of frame. ” (Republic Act No. 9211, 2003) Third, “beginning July 1, 2006, the health warning shall be on the bottom portion of one (1) front panel or every tobacco product package and occupy not less than thirty percent (30%) of such panel including any border frame.

The text of the warning shall appear in clearly legible type in black text on a white background with a black border and in contrast by typography, layout, or color to the other printer materials on the package. The health warning shall occupy a total area of not less than fifty percent (50%) of the total warning frame. ” (Republic Act No. 9211, 2003) Fourth, “the warning shall be rotated periodically or separately and simultaneously printed so that within any twenty four (24) month period, the four (4) variations of the warnings shall appear with proportionate frequency. (Republic Act No. 9211, 2003) Fifth, “the warning shall not be hidden or obscured by other printed information or images, or printed in a location where tax or fiscal stamps are likely to be applied to the package or placed in a location where it will be damaged when the package is open. If the warning to be printed on the package is likely to be obscured or obliterated by a wrapper on the package, the warning must be printed on both the wrapper and the package. ” (Republic Act No. 211, 2003) Sixth, “in addition to the health warning, all packages of tobacco products that are provided to the consumers shall contain, on one (1) side panel, the following statement in a clear, legible, and conspicuous manner; “NO SALE TO MINORS,” or “NOT FOR SALE TO MINORS. ” The statement shall occupy an area of not less than ten percent 10% of such side panel and in appear in contrast by color, typography, or layout with other printed material on the side panel. ” (Republic Act No. 9211, 2003) Lastly, “no other printed warnings except the health warning and the message required in the 6th paragraph shall be placed on cigarette packages. (Republic Act No. 9211, 2003) Unfortunately, despite these warnings, there has been an increase in cigarette consumption, especially by students who are mostly teenagers. Health experts should warn students never to try smoking and all efforts should be made to prevent teenagers from trying smoking. They must be informed about the harmful effects of smoking. (Students advised not to try smoking at all, 2010) Valmero (2010) reveals that “about 17. 3 million Filipinos aged 15 years old and above are tobacco smokers with at least 13. 8 million smoking daily, the Philippine Global Adult Tobacco Survey (GATS) showed”.

Almost 94 percent of the surveyed smokers admitted that serious illnesses such as lung cancer, heart attack, and stroke could happen to them. Smoking is a hard habit to break because tobacco contains nicotine, which is highly addictive. Like addictive drugs, the body and mind quickly become used to the nicotine in cigarettes that a smoker needs to have it just to feel normal. President Benigno S. Aquino III, who is himself a confessed smoker, advised the students in impromptu speech at a recent launching of a book entitled “12 Little Things Our Filipino Youth Can Do For Your Country” not to smoke, especially if one is not into it yet. Students advised not to try smoking at all, 2010). According to the announcement of Department of Health, Over 240 Filipinos, or 10 every hour, die every day due to these smoking-related illnesses (Gorospe,2011). Smoking increases the risk of developing heart diseases, lung ailments, and various types of cancer. It also has a damaging effect on the skin, nails, hair, taste, and appetite. In the United States, about one out of five deaths are caused by smoking. One-third of the people who start smoking when they are teenagers will die prematurely from the effects of smoking.

Recent statistics show that about nine out of ten smokers start before they are 18 years old. Most adults who started smoking in their teens never expected to become addicted. Therefore, it is best for people to not try smoking at all (Students advised not to try smoking at all, 2010). On May 12, 2010, the Department of Health (DoH) issued Administrative Order (AO) No. 2010-0013. The AO requires putting graphic health information on all tobacco packages that are “noticeable, relevant and memorable in order to be effective,” and adopting ways to make certain that tobacco product packaging and labeling do not promote tobacco use by any means.

This AO is one of the government’s attempts to curb tobacco use (DoH Issues Administrative Order Requiring Graphic Health Information on Tobacco Packaging, 2010). Apart from the above-mentioned reason why AO No. 2010-0013 was issued, it was also done to reduce smoking’s enormous socio-economic costs. The country tolls an estimated P200 billion due to the health costs and productivity losses caused by smoking, a highly substantial amount in comparison to the P30 billion profit gain from the taxes paid by the tobacco industry.

If tobacco consumption is to be reduced, most gains are estimated to come from the youth sector who will be likely discouraged from smoking because of the graphic health warnings. According to the Philippines’ 2007 Global Youth Tobacco Survey, the smoking prevalence among young Filipinos aged 13-15 has increased by approximately 30% over the past two years, and thus making this order very relevant (DOH Issues Administrative Order Requiring Graphic Health Information on Tobacco Packaging, 2010). At least 38 countries and territories are already implementing picture-based warnings on tobacco packaging. These include Canada, Brazil, Singapore, Thailand, Venezuela, Jordan, Australia, Uruguay, Panama, Belgium, Chile, Hong Kong, New Zealand, Romania, United Kingdom, Egypt, Brunei, India, Taiwan, Malaysia, Peru, Djibouti, Switzerland, Cook Islands, Niue, Papua New Guinea, Samoa, Mongolia and Iran. ” (DoH Issues Administrative Order Requiring Graphic Health Information on Tobacco Packaging, 2010).

The DOH had already filed a bill to both the Senate (SB 2377) and the House of Representatives (HB3364). It wished to consent the use of “picture-based warnings instead of mere text warnings on no less than 50% of both the front and back sides of the tobacco packages. ” These legislative initials, however, were met by strong opposition from the tobacco industry (DoH Issues Administrative Order Requiring Graphic Health Information on Tobacco Packaging, 2010). The Philippine Tobacco Industry (PTI), an association of leading tobacco companies, used R. A. 9211 against the DoH’s order. R. A. 211 is a law which only asks to place text warnings on cigarette packaging labels and PTI said that the AP violates this regulation. With this, the petition of the DoH to put graphic warning in cigarette packages went back to square one (Balane, 2010). B. Foreign Studies Biraghi and Tortorano (2009) reveal that tobacco smoking is a serious public health threat worldwide and they are said to be addictive and lethal. For years, numerous scientific researches have been conducted regarding the effects of tobacco smoke, proving time and time again that its consumption poses a great risk in one’s health.

Despite this, the number of people worldwide who are smoking are increasing, and smokers are smoking more cigarette (Mackay & Eriksen, 2002). Anderson (2006) explains that when a cigarette is lit, the tobacco breaks down into ash and smoke, and then this smoke is inhaled by the smoker through the filter and into the lungs. “Tobacco smoke contains over 4000 chemicals, some of which have marked irritant properties and some 60 are known or suspected carcinogens.

Tobacco smoke includes acetone, ammonia, arsenic, butane, cadmium, carbon monoxide, hydrogen cyanide, methanol, naphthalene, toluene, vinyl chloride, as found in paint stripper, floor cleaner, ant poison, lighter fuel, car batteries, car exhaust, fume, insecticide, gas chambers, rocket fuel, moth balls, and industrial solvent plastics. ” (Mackay & Eriksen, 2002). 250 of these contents were known to be harmful and more than 50 of the toxic chemicals in secondhand tobacco smoke cause cancer. There is absolutely no safe level of exposure to secondhand smoke (Woods, 2010).

So what happens when we smoke? According to Anderson (2006), when we inhale or breathe in lighted cigarette, the burning tobacco reaches the temperature of up to 1290°F (700°C) at the tip. This causes a number of chemical reactions to take place, including the formation of gases such as carbon monoxide and of tiny droplets of sticky solids, known as tar. When we draw tobacco smoke into our lungs, it irritates the delicate lining of the air passages, which may make us cough or experience a burning sensation. The brown, syrupy tar condenses and sticks to the wall of our bronchioles and alveoli.

This interferes with the lungs’ ability to fight infection and makes us more prone to colds, flu, bronchitis, and pneumonia. It also makes it more difficult for oxygen to pass from the lungs and into the bloodstream. Also, Anderson (2006) stated that once the chemicals from the tobacco smoke gets into our bloodstream, they are rapidly transported through the body. Carbon monoxide reduces the amount of oxygen in the blood because it binds with hemoglobin in red blood cells more easily than oxygen does. This makes our heart and lungs work harder. It can also reduce our ability to think quickly.

Nicotine takes between 8 to 15 seconds to reach the brain. It stimulates the receptors in the brain which increases our heart rate and blood pressure and generates feelings of pleasure. This is the dizzy sensation of smoking “high” that new smokers experience. “Nicotine is a stimulant, and just like cocaine, amphetamines, and methamphetamines, it works by speeding up the processing rate of the central nervous system (CNS). Nicotine is highly addictive, and smokers can quickly become dependent on cigarettes and suffer serious symptoms of withdrawal when they try to quit.

Nicotine travels through the body and the brain quickly, affecting the CNS, hypothalamus, and pituitary glands, and then accumulates in the brain. But just as rapidly as it came, its effects also disappear quickly--only a few minutes--meaning that you need to smoke more and more often to maintain the feeling that you get from smoking. ” (Wagner, 2003). Mackay and Eriksen (2002) stated that cigarette smoking affects most of the organ in the body. Smoking-related disorders include lung, esophageal, stomach, colon, pancreatic, cervical, kidney, bladder, liver, oral, pharyngeal, and laryngeal cancer.

It also causes chronic obstructive pulmonary disease (COPD), emphysema, bronchitis, pneumonia, asthma, strokes (CVA), anxiety, poor circulation, discolored and loose teeth, gingivitis, reduced sense of taste, deformity, loss of motility, reduced number of sperm, infertility and impotence, longer time of wound healing, non-insulin dependent diabetes mellitus (Type 2, adult-onset), increased leg pain, gangrene, peripheral vascular disease, cataracts, premature aging of skin, stomach and duodenal ulcers, aortic aneurysm, osteoporosis, earlier menopause for females, infertility and delayed conception, leukemia, and weakened immune system.

Smokers have increased risks of multiple cancers. In addition to that, they are also at greater risk of having heart disease, stroke, emphysema, and other diseases (Mackay & Eriksen, 2002). Research reveals that smoking reduces life expectancy by seven to eight years. Each cigarette, on an average, shortens a smoker’s life by around 11 minutes. The National Cancer Institute reports that mere exposure to secondhand smoke causes roughly 38,000 deaths annually (Does smoking increase the risk of early death). We are all influenced by what other people think and do.

There is nothing wrong with this, but it can become a problem if we are under too much pressure to behave in a certain way. The tobacco industry argues that smoking among young people is a societal problem. It insists that most smokers take up the habit as a result of family or peer pressure. Anderson (2006) learned that children are more likely to smoke if their parents smoke, and numerous studies have shown that most young smokers are influenced by their friends’ and older siblings’ smoking habits (Anderson, 2006).

Also, Anderson (2006) believes that media plays a big part in influencing smoking in teenagers. Films, television, music, and magazines are good in creating the image of a lifestyle we would like to have. When a film star or a famous model lights a cigarette, it looks glamorous. A recent World Health Organization survey has examined the Indian film industry and found that young people who watch their favorite actors smoke are three times more likely to do so themselves. The survey also found that these young people are sixteen times more likely to think positively about smoking.

People start smoking for many different reasons, but most continue to smoke for one reason only – they are addicted to nicotine. Addiction occurs when we take a drug that changes the way we feel and we become increasingly dependent, both in order to continue to experience its effects and to avoid the discomforts of its absence. For many, the desire comes from an addiction that is both mental and physical. Physical addiction occurs when our bodies are used to having a certain amount of nicotine in the blood.

Without further doses of nicotine, smokers start to experience discomfort in the form of withdrawal symptoms such as irritability, restlessness, anxiety, and even depression (Anderson, 2006). In the article “What are the Effects of Smoking on Productivity at Work? ”, Fornis (2007) wrote that due to the temporary stimulating effects of nicotine, smokers often think they are performing well on their job. Smoking however, is a dilemma that is related with decreased job performance, reduced productivity, increased absenteeism, and taking long work breaks too often.

Studies, which were done in Sweden and United States, showed that workers who smoked continued to have poor performance, demotion, and other non-honorable discharges. Nordqvist (2009) stated that according to WHO (World Health Organization), mental health is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". WHO stresses that mental health "is not just the absence of mental disorder". Moreover, Anderson (2006) declared that many smokers believe that smoking helps them concentrate, but research suggests that the only thing cigarettes do is temporarily suppress the symptoms of withdrawal caused by not smoking. Researchers said that smoking can also affect one’s mental health as nicotine causes the immune cells of the brain to attack not only the unhealthy cells, but the healthy ones as well. This event could induce depression, social isolation, insomnia, and lowered IQ. Furthermore, not only is this effect common in smokers, but also those who are victims of assive smoking. (Smoking degrades the status of your life – physically and mentally, n. d. ). Cassan (2007), a British woman who studies at University for Political Science and Environment, said, “As an ex-smoker I was curious about the environmental impact of smoking so I decided to investigate. These days everyone knows what smoking cigarettes does to our bodies, but the knowledge of what smoking does to the Earth is not as common. There are some things that every smoker who has any concern for environmental issues should know. She mentioned that it is not only the nonsmokers who are affected by smokers, but the environment as well. Cassan alao atated that, “It is obvious that smoking pollutes the air. It makes it unsafe for the present citizen and future children of the next generation. ” She knows for sure that quitting is hard especially when one is addicted to it, but she advised that for smokers to help lessen the negative effects of smoking, they should always think twice before engaging themselves to it. WHO Director-General Dr.

Margaret Chan stated that, “the cure for this devastating epidemic is dependent not on medicines or vaccines, but on the concerted actions of government and civil society”. She mentions that in order to cease smoking, the government should apply measures within their reach, regardless of income level. She mentions of banning tobacco advertising, which was already done, protecting people from second-hand smoke, warning people about the hazards of tobacco, helping those who want to quit, and monitoring the use to understand and reverse the said epidemic (UN: 'Tobacco epidemic' could kill 1 billion in 21st century, 2008).

Szabo (2010) reported that due to the increase in numbers of active smokers every day, the number of their victims also rises. Second-hand smoking kills the rights of people to live in a safe environment. Moreover, an estimated 21% of all american adults (45 million people) who smoke cigarette everyday affects millions of people through passive smoking (Tobacco Use Among Adults—United States, 2005). Over 126 million non-smoking Americans continue to be exposed and most of the time, they are prevalent in homes, vehicles, workplaces, and public places (US Department of Health and Human Services, 2006).

The Food & Drug Administration and the Department of Health and Human Services propose a new aid to reduce tobacco use. They have reported 443,000 deaths per yer due to cigarette smoking. FDA Commissioner Margaret Hamburg said in an interview that this is a very serious problem with a very serious medical consequences. The FDA now uses their authority to regulate tobacco which includes selling guidelines for marketing and labelling, banning certain products, and limiting nicotine. However, nicotine or tobacco are not totally banned. They proposed 36 label comments like “Smoking can kill you. and “Cigarettes cause cancer. ” with added graphic image such as a cartoon of a mother blowing smoke to her baby’s face, rotting teeth and diseased gums, as well as cigarettes being flushed down the toilet to sgnify quitting. These convey the dangers of tobacco and remind smokers about diseases they are exposed to everytime they smoke (Felberbaun, 2009). Based on research, about 46 million adults are hooked with this health concern and though the average cost per pack has gone from 38 cents to $5. 33, the increase in usage still cannot be prevented (Felberbaun, 2009).

The amount one is paying to buy cigarette could almost help one in expenses in extra medical cost, lost pay, food expense, etc. The tobacco companies derive income at the expense of health, wealth, happiness, efficency, and resources of the addicted smoker. (Smoking Facts: The Facts About Smoking - How And Why To Quit n. d). Felberbaum (2009) also stated that though these may not totally cease smoking, it could at least lessen it. On the other hand, Stanton Glanz, a tobacco researcher at the University of California in San Francisco, sees these graphic labels “tremendously effective. Craige (2009) identified that Article 11 of the Framework Convention on Tobacco Control (FCTC) is the world’s first health treaty, which focuses on health warnings. This report was created to provide policymakers with evidence from world’s most wide-ranging research devoted to assessing the impact of policies of the FCTC, the International Tobacco Control (ITC) Policy Evaluation Project. Cigarette packages in most countries include health warning labels but the size, number, and the way the health information is presented vary among countries.

The use of standardized methods and measures across all ITC surveys ensures that the effectiveness of health warning labels can be compared among countries in order to provide guidance in the designing warning labels. The findings of the said research provide an evidence base that outlines the components of effective warning labels and strongly supports the implementation of graphic warnings. In short, it offers evidence-based answers to the question: “What is effective and what is not effective for policies on health warnings? Health warnings on cigarette packages are one of the most noticeable sources of information about the dangers of smoking and tobacco use. Aside from television, a lot of smokers state that they learn about the risks of smoking from the packages of cigarettes and tobaccos. Compared to other smoking prevention efforts, health warnings are farthermost cost-effective. For example, smokers who smoke 20 cigarettes a day are potentially exposed to the warnings at least 7300 times a year. Non-smokers, including youth, also stated the same thing.

Research conducted by the ITC Project has proven that warning labels are an effective tool for educating/informing smokers and non-smokers about the many negative health consequences of smoking, motivating and encouraging smokers to quit and non-smokers not to start smoking, and providing information to enhance efficacy for quitting (Craige, 2009). Craige (2009) stated that another significant reason for implementing strong health warning in smoking packages is that it can counteract misleading messages and convey the health risks of smoking and exposure to second hand smoke.

Herman (2010) explained that according to the American Cancer Society, secondhand smoke causes breathing problems in nonsmokers, including coughing, mucus, chest discomfort and reduced lung function. FCTC Article 11 guidelines for health warnings states that health warnings on cigarette packages should cover at least 50% of the principal display areas (both the front and back), but at a minimum must cover at least 30% of the principal display areas.

It also requires that warnings be rotated; large, clear, visible, and legible; and approved by the competent national authority. Strong international guidelines for Article 11 adopted in November 2008 during the Third Conference of the Parties recognize the evidence that effectiveness of health warnings increases with their size and that graphic warnings have a greater impact than text-only warnings. The guidelines recommend pictorial warnings on at least 50% of the package and call for key requirements for the content, position, and size of warnings.

Furthermore, labels should be at the top of the package, include full color pictures, rotate multiple messages, include a range of warnings and messages, include information on harms of tobacco smoke, provide advice about cessation, and list constituents without numbers (Craige, 2009). Canada was the first country (2001) to implement pictorial warning labels that are compliant with the FCTC Article 11 Guidelines. As of May 2009, more than 24 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 (Craige, 2009). Craige (2009) also mentioned that the International Tobacco Control (ITC) Four Country Survey (ITC-4), a cohort survey of approximately 9000 adult smokers in Canada, Australia, the United Kingdom, and the United States was conducted and provided major evidence to support policymakers in implementing larger warning labels, including images.

Conducted between 2002 and 2006 (ongoing to 2014), the ITC Project has examined labeling policies of over 4 countries and has studied what happens when countries implement changes in text and size only, compared to when graphic warnings were introduced. The following findings provide convincing evidence of the effectiveness of graphic warnings in Canada and Australia and improved UK text warnings, establishing the case for strong implementation of the Article 11 Guidelines. In 2001, Canadian graphic warning labels were most effective in informing smokers about the risks of smoking.

Australia’s text warnings, which were slightly below the FCTC minimum requirement, were more effective in providing the range of health risks than the United States’ side-of-pack text warning and the UK warning, both of which were well below the minimum FCTC standard (Craige, 2009). On the other hand, in 2003, when the UK implemented larger text warnings in compliance to the FCTC guideline, more smokers reported that they read and notice these warnings and were more likely to report that the health warnings had discouraged them from having a cigarette.

Furthermore, Canadian smokers continued to report higher levels of impact than smokers in the other three countries (Craige, 2009). Figure 1. Front of Cigarette box Figure 2. Back of a Cigarette Box Craige (2009) also revealed that in 2006, the introduction of graphic warnings in Australia (as shown in figure 1 and 2) resulted in an increase in noticing and reading of warning labels, thinking about the health risks and quitting, reporting that the labels had made them withhold a cigarette they were about to smoke, and avoiding warning labels among Australian mokers. These are all positive outcomes because they are associated with increases in quitting. An enormous body of health communication research has shown that the use of pictures results in messages that are easily noticed and remembered. Understanding both the health risks and severity of smoking are important factors in motivating smokers to quit. ITC Four Country Survey showed that larger graphic warnings are likely the most effective means of conveying the severity of health risks to smokers.

After Canada introduced large graphic warning labels in 2001, 91% of smokers in Canada said they had read the warnings and 84% of smokers saw health warning labels as a source of health information, compared with 47% of US smokers, where only text-only labels are required. Graphic warning labels increased awareness of the connection between smoking and specific health hazards (Craige, 2009). An ITC study regarding the knowledge and warning labels in Canada, Australia, the US, and the UK in 2002 showed that a large proportion of smokers have insufficient knowledge about the dangers of smoking.

Smokers in Canada, the only country that had pictorial warnings on 50% of the front and 50% of the back of the pack, are most knowledgeable of the effects of smoking. US smokers, where text warnings appear only on the side of the pack, are less knowledgeable of the effects of smoking. From this, it can be concluded that enhanced health warnings increase knowledge of the risks of smoking (Craige, 2009). Furthermore, Craige (2009) reported that in early 2003, the size of text warning in the UK increased from 6% of the front and back to 30% of the front and 40% of the back and is surrounded by a border of 3-4mm.

The number of warnings increased from 6 to 16. These changes made the smokers state that their awareness regarding health risks greatly improved. Also, unlike Mexican smokers, Canadian smokers are aware that smoking causes stroke, impotence, and mouth cancer, as these illnesses are included in warning labels in Canada but not in warning labels in Mexico. As stated by Craige (2009), the size, as well as the location of the warning labels, matter.

This was one of the aspects that Australia considered in their graphic warnings when it was introduced in 2006. The warning was put on 30% of the front and 90% of the back. It seemed like the better choice because it is likely that people look at the front far more than the back of a package. In an observational study by Borland and Lal (2004), observers recorded which side was facing up of packs lying on restaurant tables in Melbourne. More than 90% of 160 observed that packs were facing front-side up.

This implies that the proper way to evaluate different size options is to take into consideration how often people are exposed to the front or the back of cigarette packs. If the average is weighted for exposure, then the 50-50 option render a higher average exposure to the warnings when the person is exposed to the front of the pack at least twice as often as to the back. In addition, many countries require warnings in multiple languages and allocate each side to a different language. This makes it even more important that the size on both sides of the pack be as large as possible.

According to Craige (2009), “graphic, fear arousing images do not have negative effects. ” Although people have a general knowledge on the harms caused by smoking, picture warning labels, however, present these effects in a more vivid manner that would be more easily noticed and better remembered by the mass. Fear, after decades of research studies, has been shown to be effective in motivating behaviour change (i. e. quitting), especially if coupled with information on how to avoid these fearful consequences.

ITC research had also found out that fear of or negative emotional reactions to these picture warning labels elicit avoidant behaviors (e. g. covering the pack, keeping it out of view, or avoiding specific labels) that can motivate quitting. Craige (2009) argued that larger and more comprehensive health warnings are more effective. In the analyses of the first wave of the ITC Four Country Survey done in 2002, FCTC found out that larger (50%) and more comprehensive warning labels were more likely to be effective. 0% of Canadian smokers agreed that they have noticed the warnings “often” and “very often” since they use larger and more comprehensive warning labels compared to those of Australia, UK and US smokers, who have only rated 52%, 44 %, and 30% respectively. In 2003, UK enhanced their health warning labels in order to meet the minimum FCTC standard, and a significant increase in warning label salience and self-reported impact were noticed following the improvement of the cigarette package.

From 44% of UK smokers who noticed health warnings “often” and “very often,” it increased to 82% -- the highest rank among the four countries. Compared to the US and Australian smokers who had yet to enhance their warning labels, UK smokers were more likely to report that these new health warnings have dissuaded them from having a cigarette (Craige, 2009). Craige (2009) unraveled there is a common phenomenon termed “message wear-out” in health communication. Over time, warnings may lose their impact with repeated exposure on health warnings.

The results showed after the ITC-4 Country Survey suggests that “pictorial warnings sustain their effects longer than text warning. ” While a decrease in salience and impact has been reported in the UK two and a half years following the introduction of new warning labels, wear-outs were more prominent in Australia, where the warning has been in place for almost eight years and only a little bit smaller than that of UK’s, and in the US, where labels are printed small and only on the side of the pack.

Canada, on the other hand, kept a high level of salience and impact even after four years of following the implementation of large, picture warning labels. Evidence from the ITC surveys also suggest that larger pictorial warning labels are more effective in promoting smoking cessation. Large pictorial warnings stimulate more cognitive responses by means of increasing the knowledge of the harms posed by smoking, thoughts about the health risks, and behaviours like avoiding the warnings.

These responses can then lead to motivate intentions to quit and then finally, quitting attempts (Craige, 2009). Figure 3. Countries that implement warning labels Craige (2009) showed “smokers in low and middle income countries such as Thailand, China, and Malaysia, are more likely to notice warning labels “often” or “very often” compared to smoker in high income countries such as Canada, US, Australia and UK. These may be due to the lack of information sources available to convey the harms of smoking. Since warning labels are so prominent in these low and middle-income countries, they have the potential to influence smokers’ behaviours more than in high-income countries. ” See figure 3. Figure 4. Effectivity of Warning labels ITC research conducted in the three Asian countries found that noticing level is high, thus suggesting that they have a strong impact on smokers.

Compared to the extent that the warning labels in Thailand make the smokers think about the health risks of smoking, the potential for effective warning labels is not fulfilled in Malaysia and China, where warning labels are small and less comprehensive. Health warnings are more likely to assume greater importance in low and middle-income countries as they have fewer other sources of information about the harms of smoking, given that the labels are adequately prominent so as to fulfill their potential (Craige, 2009) See figure 4.

Figure 4. Effect of Warning labels in Thailand and Malaysia Evidence from the ITC Thailand survey shows that enhancing warning labels beyond FCTC minimum standard increases effectiveness. This was evaluated by comparing the change in Thailand from when they used 30% text-only warning labels to the enhanced 50% pictorial, to the change in Malaysia at the same time where the label warnings did not change. The survey found that the bigger the label size and putting graphic images to warning labels also increase its effectiveness.

After the implementation of these new warnings in Thailand, “the percentage of smokers stating that the labels made them think about the health risks “a lot” increased from 34% to 53% and those stating that the labels made them “a lot” more likely to quit increased from 31% to 44%. Meanwhile, the survey conducted in Malaysia showed no such increase in effectiveness, as their labels did not change during that time. (Craige, 2009) Figure 5. Warning labels in China Figure 6. Actual Warning labels in China Figure 7. Effectiveness Rating Table

China, on the other hand, also enhanced their cigarette warning labels on 2008 by replacing the text warnings on the side of the pack to text warning on 30% of the front and 30% of the back – meeting only the minimum label size of the FCTC standard. The actual Chinese warnings – text-only and 30% of front and back – had the lowest rating among the 10 warnings in terms of motivating smokers to quit. See figures 5 and 6. Also, consistent with the ITC-4 findings, graphic warnings had a higher rating compared to their corresponding text warnings in terms of label effectiveness (Craige, 2009).

See Figure 7. Craige (2009) observed that the warning labels that were created on Chinese cigarette packages using graphic and text warnings from Canada, Singapore, Hong Kong, and The European Union, were ranked and rated in terms of perceived effectiveness in motivating smokers to quit and convincing youth not to start smoking. The results are as follows: graphic and text warnings were ranked highest; text-only warnings were ranked middle; and 30% of front and back, the newly enhanced Chinese text warnings, were rated the lowest. “There is a strong public support for large picture warnings. In the research done by the ITC, it shows that smokers desire to see more health information on cigarette packages, even in countries where graphic warning labels are already implemented (Craige, 2009). Figure 9. Warning Cigarette Label in Brazil In FCTC Article 11 Tobacco Warning Labels of Craig (2009), some of the most vivid and emotionally stirring pictorial warning label graphics can be found in Brazil. Their approach is based on research in the neurobiology of emotions stating that avoidant responses are motivated by very negative and highly arousing stimuli.

Figure 9 shows some of Brazil’s pictorial warning labels CONCEPTUAL FRAMEWORK Administration of survey questionnaire Data Analysis Profile of the respondents a. Age b. Gender c. Category of respondents as to smoking Perceived susceptibility to smoking-related illnesses Perceived severity of the effects of smoking Perceived ways on how to improve selected cigarette warning labels Recommendations to improve cigarette warning labels in the Philippines based on the respondents’ perceptions InputProcess Output

Figure 1: Paradigm of the Study Figure 1: Paradigm of the Study shows the four components of the input of the study which are as follows: the profile of the respondents in terms of age, gender, and category as to smoking, the respondents’ perceptions on their susceptibility to smoke-related illnesses, the respondents’ perceptions on the severity of the effects smoking, the respondents’ perceived ways in improving cigarette warning labels. The process was through the administration of survey questionnaire and data analysis.

The output of the study was the recommended ways on how to improve selected cigarette warning labels in the Philippines. STATEMENT OF THE PROBLEM The main purpose of the study is to recommend ways to improve cigarette warning labels in the Philippines based on the perception of the respondents. Specifically, it sought to answer the following: 1. What was the profile of the respondents in terms of: a. Age b. Gender c. Category as to smoking? 2. What were the respondents’ perceptions on their susceptibility to smoke-related illnesses? 3.

What were the respondents’ perceptions on the severity of the effects of smoking? 4. What were the respondents’ perceived ways in improving cigarette warning labels in the Philippines? SIGNIFICANCE OF THE STUDY This study aims to recommend ways on how to improve cigarette warning labels in the Philippines. The researchers analyzed the perceptions of the respondents and from this, created new designs for cigarette boxes. For the students, this study will aid create awareness about the dangers posed by smoking. It aims to help motivate the smokers to quit, and for nonsmokers to not engage in smoking at all.

For the school, this study will help in its advocacy of health promotion and its attempt to curb smoking amongst its students. The school could use this study as basis for identifying the perceptions and knowledge of Paulinian students regarding smoking and its effects. For the future researchers, this study can be used as a reference material and basis for prospective studies about cigarette warning labels. Lastly, this is another contribution to literature as the researchers provided added information regarding the possible improvement of cigarette warning labels.

Lastly, this study wishes to strongly encourage the government and its legislators to pass the Department of Health’s Administrative Order (AO) No. 2010-0013 in lieu of improving cigarette warning labels in the Philippines. SCOPE AND LIMITATIONS The study was delimited to the respondents’ perception regarding their perceived ways on how to improve cigarette warning labels in the Philippines. The respondents’ susceptibility to smoke-related illnesses, and the severity of the effects of smoking were also studied.

The respondents of the study were the 334 enrolled college students of SPUQC under SY 2010-2011, 2nd semester. DEFINITION OF TERMS The following words were defined operationally and arranged by significance: Cigarette warning labels. In this study, it referred to the information found in cigarette packages. Perceived susceptibility. In this study, it referred to the respondents’ beliefs about the chances of contracting a health condition. Perceived severity. In this study, it referred to the respondents’ beliefs about the seriousness of the effects brought about by smoking.

Smoking-related illnesses. In this study, it referred to the illnesses that can be acquired through smoking such as lung cancer, ischemic heart disease, chronic obstructive pulmonary disease (COPD ), stroke, asthma, respiratory infections, emphysema, bronchitis, coronary artery disease, peripheral artery disease, colorectal cancer, liver cancer, prostate cancer, erectile dysfunction in men, stomach cancer, bladder cancer, abdominal aortic aneurysm, leukemia, cataract, cervical cancer, kidney cancer, pancreatic cancer, periodontitis, and pneumonia. Chapter 2 METHODOLOGY RESEARCH DESIGN

The tool that helped define the respondents’ perceived susceptibility to the health-hazards posed by smoking, the severity of the effects of smoking, and their perceived ways on how to improve selected cigarette warning labels in the Philippines was a survey questionnaire. The study made use of the descriptive research design where it described the data and characteristics about the population or phenomenon that was being studied. It answered the questions who, what, where, when, and how. PARTICIPANTS The respondents of this study were the random 334 students which are sample representatives for the three Colleges of St.

Paul University Quezon City, 2nd semester, SY 2010-2011. The total number of enrollees in the college department as of February 2011 was 2009, 1313 of which were from the College of Business and Technology (CBT), 167 from the College of Health and Sciences (CHS), and 529 from the College of Arts, Sciences, and Education (CASE). 218 students from the CBT, 28 from the CHS, and 88 from the CASE were taken. Slovin’s Formula and stratified random sampling were used to determine the researchers’ sample size. The computations were as follows: Where: n = sample size N = population e = margin of error; 5% or . 05 ^2 = 0. 0025 n = 2009 1 + 2009 (0. 0025) = 2009 1 + 5. 0225 = 334 334 = 0. 166 2009 CBT1313*0. 166=218 CHS167*0. 166=28 CASE529*0. 166=88 | Total Population| Respondents| College of Business and Technology| 1313| 218| College of Health and Sciences| 167| 28| College of Arts, Sciences and Education| 529| 88| TOTAL| 2009| 334| INSTRUMENT The primary instrument for this study was the self-constructed questionnaire of the researchers, printed in English. The survey was divided into four parts, and first of which determined the profile of the respondents in terms of age, gender, and category as to smoking.

The second and third parts made use of the Likert scale to assess the respondents’ perception regarding their susceptibility to smoke-related illnesses and the severity of the effects of smoking. The last part of the questionnaire assessed the perceived ways of the respondents on how to improve selected cigarette warning labels in the Philippines. DATA GATHERING PROCEDURES In order for the researchers to get an accurate sample size, they went to the Registrar’s office to request and asked for a permission to get the population of the students enrolled in the college department as of the 2nd semester, SY 2010-2011.

Prior to distribution, the questionnaires were handed to three professors for validation. After it was checked, consent letters for distribution were given to the College Deans of St. Paul University Quezon City; namely, College of Business and Technology, College of Arts, Sciences and Education and College of Health and Education. Upon approval, the survey was conducted to the students of St. Paul University Quezon City before the summer class of SY 2010-2011. Each respondent was given a questionnaire wherein instructions and content were briefly explained and discussed.

With regards to medical terms, the researchers attached a piece of paper where information and definitions of the latter can be found. Also, in areas where the respondents felt like they needed more explanation, they were encouraged to raise questions or queries for clarifications. These, according to the respondents, helped comprehend the material better -- making it possible to answer the questions as honest as possible. As for researchers, this made the questionnaires more accurate and valid since respondents were well informed.

After all the survey questionnaires were submitted, the papers were tallied and studied. Based on their answers, researchers formulated ways on how to improve selected cigarette warning labels in the Philippines based on the Paulinian’s point of view. DATA ANALYSIS The profile of the respondents and their perceived ways on how to improve selected cigarette packaging labels in the Philippines were measured by means of frequency and percentage. The formula, Percentage = f x 100 % n shall be used, where: f = frequency/number of responses n = sample size/number of respondents

The perceived severity of the effects of smoking was measured by means of weighted mean. The weighted mean has a verbal interpretation of: WeightMean valueVerbal Interpretation 43. 25-4. 0Strongly Agree 32. 50-3. 24Agree 21. 75-2. 49Disagree 11. 0-1. 74Strongly Disagree The perceived susceptibility of the effects of smoking was measured by means of weighted mean. The weighted mean has a verbal interpretation of: WeightMean valueVerbal Interpretation 43. 25-4. 0Highly susceptible 32. 50-3. 24Susceptible 21. 75-2. 49Less susceptible 11. 0-1. 74Not susceptible at all and make use of the formula:

Weighted Mean = ? fw n Where: ? = summation f = frequency w = weight per scalen = sample size CHAPTER III RESULTS AND DISCUSSION RESULTS I. Profile of the respondents Table 1 Respondents’ Age Age| CBT| CHS| CASE| Total| %| Rank| 18 years old below| 123| 0| 59| 182| 54| 1| 19-21 years old| 93| 27| 26| 146| 44| 2| 22-24 years old| 2| 1| 2| 5| 1| 3| 25 years old and above| 0| 0| 1| 1| 0| 4| Total| 218| 28| 88| 334| 100| | Table 1 shows that out of 334 respondents in the college department, 182 belong to the age bracket of 18 years old and below, thus comprising 54 % of the total population.

There are 146 out of 334 respondents who belong to the age bracket of 19-21 years old, and comprising 44% of the population. 5 respondents belong to the age bracket of 22-24 years old, comprising 1% of the total population. One respondent belongs to the age group of 25 years old and above. Table 2 Respondents’ Gender Gender| CBT| CHS| CASE| Total| %| Rank| Femaile| 164| 9| 79| 252| 75| 1| Male| 54| 19| 9| 82| 25| 2| Total| 218| 28| 88| 334| 100| | Table 2 shows that 252 out of 334 respondents are female and comprising 75 percent of the total population.

Meanwhile, the remaining 82 respondents are male, involving the 25 percent of the population. Table 3 Respondents’ Category as to Smoking Category of respondents as to Smoking| CBT| CHS| CASE| Total| %| Rank| Smokers| 67| 11| 30| 108| 32| 2| Non-Smokers| 151| 17| 58| 226| 68| 1| Total| 218| 28| 88| 334| 100| | Table 3 shows that 108 out of 334 respondents, or 32% of the population, are smokers. On the other hand, 226 respondents are non-smokers, thus making up 68% percent of the total population. Table 4

Respondents’ Perceived Susceptibility to Smoking Related Illnesses | CBT| CHS| CASE| Grand Weighted Mean| Verbal Interpretation| Lung Cancer| 3. 56| 3. 86| 3. 49| 3. 63| Highly Susceptible| Ischemic Heart Disease| 3. 28| 3. 57| 3. 20| 3. 35| Highly Susceptible| Chronic Obstructive Pulmonary Disease| 3. 32| 3. 71| 3. 16| 3. 40| Highly Susceptible| Stroke| 3. 04| 3. 64| 2. 94| 3. 21| Susceptible| Asthma| 3. 41| 3. 39| 3. 24| 3. 35| Highly Susceptible| Respiratory Infections| 3. 44| 3. 82| 3. 26| 3. 51| Highly Susceptible| Emphysema| 3. 16| 3. 79| 2. 86| 3. 27| Highly Susceptible| Bronchitis| 3. 9| 3. 71| 3. 08| 3. 36| Highly Susceptible| Coronary artery disease| 3. 11| 3. 71| 2. 91| 3. 25| Susceptible| Peripheral artery disease| 3. 12| 3. 43| 2. 88| 3. 14| Susceptible| Colorectal cancer| 3. 09| 3. 25| 3. 00| 3. 11| Susceptible| Liver cancer| 3. 17| 3. 39| 2. 90| 3. 15| Susceptible| Prostate cancer| 0. 00| 3. 29| 2. 75| 2. 01| Susceptible| Erectile dysfunction in men| 3. 01| 3. 25| 2. 74| 3. 00| Susceptible| Stomach cancer| 2. 92| 2. 96| 2. 67| 2. 85| Susceptible| Bladder cancer| 2. 94| 2. 93| 2. 58| 2. 82| Susceptible| Abdominal aortic aneurysm| 2. 96| 3. 25| 2. 69| 2. 7| Susceptible| Leukemia| 2. 89| 2. 86| 2. 48| 2. 74| Susceptible| Cataract| 2. 82| 2. 71| 2. 51| 2. 68| Susceptible| Cervical cancer| 2. 85| 2. 93| 2. 52| 2. 77| Susceptible| Kidney cancer| 2. 98| 3. 04| 2. 59| 2. 87| Susceptible| Pancreatic cancer| 2. 96| 2. 96| 2. 60| 2. 84| Susceptible| Periodontitis| 2. 92| 2. 96| 2. 50| 2. 80| Susceptible| Pneumonia| 3. 08| 3. 57| 2. 73| 3. 13| Susceptible| OTHERS: none| --| --| --| --| --| ------------------------------------------------- GRAND MEAN3. 05 Susceptible WeightMean valueVerbal Interpretation 43. 25-4. 0Highly susceptible 2. 50-3. 24Susceptible 21. 75-2. 49less susceptible 11. 0-1. 74Not susceptible at all Table 4 shows that the respondents perceive that they are highly susceptible to: lung cancer, ischemic heart disease, COPD, stroke, asthma, and respiratory infections, emphysema, and bronchitis; susceptible to: stroke, coronary artery disease, peripheral artery disease, colorectal cancer, liver cancer, erectile dysfunction in men, stomach cancer, bladder cancer, abdominal aortic aneurysm, leukemia, cataract, cervical cancer, kidney cancer, pancreatic cancer, and pneumonia, and prostate cancer.

Table 5 Respondents’ Perceived Severity of the Smoking Related Illnesses Table 5. 1: Smokers | CBT| CHS| CASE| Grand Weighted Mean| Verbal Interpretation| 1. Smoking could harm my health. | 3. 43| 3. 45| 3. 30| 3. 40| Strongly Agree| 2. Smoking can be addictive and I might have a hard time quitting. | 3. 13| 3. 18| 3. 03| 3. 12| Agree| 3. I will get diseases from smoking. | 3. 28| 3. 36| 3. 17| 3. 27| Strongly Agree| 4. These diseases that I might encounter could affect my job in the future. | 3. 06| 2. 82| 2. 83| 2. 0| Agree| 5. Smoking could affect my income/savings in the future. | 2. 87| 2. 73| 2. 53| 2. 71| Agree| 6. Smoking could affect my mental health. | 2. 60| 2. 82| 2. 47| 2. 63| Agree| 7. I will die at an early age because of smoking. | 3. 06| 2. 73| 2. 67| 2. 82| Agree| 8. OTHERS: none | --| --| --| --| --| GRAND MEAN2. 98Agree | Table 5. 2: Non smokers | CBT| CHS| CASE| Grand Weighted Mean| Verbal Interpretation| 1. Second hand smoking has negative effects on the health of individuals. | 3. 71| 3. 94| 3. 74| 3. 0| Strongly Agree| 2. I am also susceptible to diseases that active smokers could get. | 3. 61| 3. 82| 3. 62| 3. 68| Strongly Agree| 3. I am most likely to smoke if the people around me smoke. | 2. 11| 2. 59| 2. 05| 2. 25| Disagree| 4. Smoking causes an unsafe environment. | 3. 72| 3. 82| 3. 62| 3. 72| Strongly Agree| 5. OTHERS: none| --| --| --| --| --| GRAND MEAN3. 39Strongly agree | Table 5 shows that the smokers strongly agree that smoking could harm their health and that they will get diseases from smoking.

Furthermore, they agree that a) smoking can be addictive, b) the diseases they might encounter could affect their job in the future, c) smoking could affect their income and/or savings in the future, d) smoking could affect their mental health, and e) that they will die at an early age because of smoking. On the other hand, non-smokers strongly agree that second hand smoking has negative effects on the health of individuals, that they are also susceptible to diseases that active smokers could get, and that smoking causes an unsafe environment. Nonsmokers disagree that they are most likely to smoke if the people around them smoke.

Table 6 Respondents’ Perceived Ways in Improving Selected Cigarette Warning Labels Do you want to improve cigarette warning labels in the Philippines? | CBT| CHS| CASE| Total| %| Rank| Yes| 194| 21| 76| 291| 87| 1| No| 24| 7| 12| 43| 13| 2| Total| 218| 28| 88| 334| 100| | Table 6 shows that 291 out of 334 respondents, or 87% of the population, said that they want to improve cigarette warning labels in the Philippines. The remaining 43 respondents that encompass 13% of the population said that they do not want to improve cigarette warning labels in the Philippines. Table 6. 1

Respondents’ Preferred Details to be Included in Cigarette Packaging If I were to improve cigarette packaging label, I would include:| CBT| CHS| CASE| Total| %| Rank| Pictures of smoking-related illnesses| 137| 16| 53| 206| 71| 1| Details about the smoke-related diseases| 129| 14| 36| 179| 62| 4| Slogans about the negative effects of smoking| 123| 13| 48| 184| 63| 3| Statistics on deaths or sicknesses caused by smoking| 11

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