Why do graphic health warnings fail: An explanatory case study on the persistence of smoking behavior among male adult smokers in a rural and low-income setting in the Philippines

BACKGROUND@#The Philippines enacted in 2014 Republic Act No. 10643 that mandated the printing of Graphic Health Warnings on tobacco packages. However, smoking behavior among male smokers in the country, particularly in rural and low-income areas, persists even if the Graphic Health Warnings are according to the guidelines set by the World Health Organization. Hence, this explanatory case study aims to examine why and how most male adult smokers in a rural and low-income setting in the Philippines fail to quit smoking despite the presence of Graphic Health Warnings on tobacco packages.@*METHODS@#Forty-four male adult smokers from Barangay Urdaneta in Magallanes, Cavite, were recruited to participate in this study through snowball sampling. They underwent semi-structured interviews about their history of smoking, experiences as a smoker, and perspectives on Graphic Health Warnings. Thematic analysis of verbatim transcripts was then carried out to identify emerging themes.@*RESULTS@#Findings showed Graphic Health Warnings fail to persuade against smoking because fear was not aroused enough for smoking cessation. Specifically, the perception of risk from smoking was low due to lack of literacy on its harmful effects, and self-efficacy needed for smoking cessation was low because of self-doubt and denial. Other factors, such as the subjective and social benefits of smoking, were likewise contributory to the persistence of smoking behavior.@*CONCLUSION@#All these concerns must be considered for an effective campaign against tobacco use and consumption since Graphic Health Warnings on tobacco packages is only one strategy to address the burden of tobacco smoking.

Use of eye care services among type 2 diabetic patients in Laguna

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The aim of the study was to determine the prevalence of diabetic patients seeking an ophthalmic evaluation for diabetic retinopathy. Specific objectives were to describe the prevalence and risk factors for diabetic retinopathy (DR) in a group of diabetic patients referred for retinal evaluation from different internists in Laguna by screening using digital retinal photography.</p> <p style="text-align: justify;"><strong>METHODS:</strong> The study was a hospital-based mixed method study involving two portions: quantitative (cross-sectional) and qualitative. The cross-sectional portion involved patients diagnosed with type 2 diabetes by internists from San Pablo Colleges Medical Center referred for retinal evaluation using a non-mydriatic retinal camera. Retinal photographs were categorised for the presence and severity of diabetic retinopathy according to the international clinical DR severity scales recommended by the Global Diabetic Retinopathy Project Group. The qualitative portion involved a focus group discussion among diabetic patients and a short key informant interview with the referring internists.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> Sixty-seven (67) diabetic patients were evaluated for diabetic retinopathy (DR) using digital retinal photography. The overall prevalence of any DR was 26% (n=18): 55% mild NDPR, 33% moderate NDPR, 6% severe NPDR and 6% PDR. Diabetic macular edema (DME) was present in 22% of patients with any form of DR. The focus group discussion reported the following reasons for consulting an ophthalmologist: presence of blurring of vision, availability of budget, knowledge of the need for ophthalmic evaluation, and order for evaluation by the internist. Interviews among the referring internists revealed three primary reasons for referring: history of visual disturbances, uncontrolled diabetes and finances of the patient.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> This study presented a lower prevalence rate of diabetic retinopathy among patients who underwent digital retinal photography compared to that of other studies published in the Philippines. Nevertheless, it is important to continue patient education with regards to diabetic complications in the eye, and improve the referral system among medical practitioners.</p>