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

ABSTRACT

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.