RiteeshGrandhi/sciclaimeval-shared-task huggingface dataset:
Materials and Methods
A cross-sectional study was conducted in Kuala Lumpur using a self-administered questionnaire. Ethical approval was obtained from the UKM Research Ethics Committee (UKMREC) with reference no: UKM PPI/111/8/JEP-2023-427. A purposive sampling method was used for this study. Respondents were invited to join the study period from October 2023 till January 2024. The sample size was calculated using the Raosoft Sample Size Calculator, and the recommended sample size was 378 for a 95% confidence level, at a 5% margin of error, for an unknown population. The study divided respondents into two groups according to their tobacco usage status. Thus, the sample size for smokers and non-smokers was divided equally into 189, respectively. Participants who fulfilled the inclusion criteria were aged 15 years and above and could understand Malay and English were invited to partake. Exclusion criteria included non-illiterate people. Written consent was obtained from all participants at the time of recruitment.

A self-administered questionnaire consisting of four components in both English and Malay was used as a data collection instrument. The questions were adapted from other studies ( Rekha & Anjum, 2012 ; Hammond et al., 2003 ; Ratneswaran et al., 2016 ). The four components are the socio-demographic details, tobacco use assessment, perception and knowledge of pictorial warnings, and impact of pictorial warnings on participants. The rating scales used in this survey were a 5-point- and 10-point Likert scales.

The questionnaire included six standard cigarette pictorial warning images ( Figure 1 ). The images were mouth cancer, neck cancer, gangrene, lung cancer, miscarriage, and premature birth. Participants were shown the six pictorial warnings ( Figure 1 ). The participants’ emotional reaction to the pictures was observed by asking them to rate their feelings of “fear,” “disgust,” or “avoiding looking at the pictures” using a Likert scale of 1 to 10 after viewing the images.

The statistical analysis of the data collected was analysed using the Statistical Package for the Social Science (SPSS) version 29.0 (IBM, Armonk, New York). Frequencies and percentages were calculated for categorical data. Means and standard deviation were used for continuous data. Non-parametric tests, the Chi-square test and the One-Way ANOVA test were used to calculate the differences between the variables, as the data was not normally distributed. Statistically significant differences were set at p -value < 0.05.

A Dental Public Health specialist assessed the questionnaire’s content validity. Then, a pretest was carried out with a sample of 20 individuals who were not part of the study to assess the questionnaire’s face validity and reliability. Based on the feedback and suggestions for improvement that arose during the pretest phase, final amendments and modifications were made.
Conclusions
This study highlights the differing perceptions and impacts of pictorial warnings on cigarette packaging between smokers and non-smokers in Malaysia. While non-smokers demonstrated greater engagement with and emotional responses to the warnings, smokers showed less frequent interaction and a tendency toward desensitisation. Although pictorial warnings play a vital role in raising awareness of the health risks of smoking, particularly lung and mouth cancer, their effectiveness in encouraging smoking cessation among smokers remains limited. The findings suggest that additional, more aggressive tobacco control policies, such as more significant warnings or plain packaging, may be needed to reduce smoking rates further.

Future research should focus on refining the design and messaging of pictorial warnings, possibly incorporating more graphic or culturally relevant images to increase their impact. Longitudinal studies that track behaviour over time, combined with complementary cessation aids, could offer more insight into how best to move smokers from contemplation to action. Including socioeconomic and psychological factors in future studies would provide a more comprehensive understanding of how to tailor warnings to diverse audiences. By addressing these areas through targeted policies and research, there is significant potential to enhance the overall effectiveness of tobacco control strategies in reducing smoking prevalence and preventing smoking initiation.

In conclusion, smokers generally perceived pictorial warnings on cigarette packaging as less significant and showed limited engagement with the warning labels compared to non-smokers. On the other hand, non-smokers exhibited a greater understanding and interpretation of these warnings. While the implemented pictorial warnings may serve as an initial step towards encouraging smoking cessation, they have limited effectiveness in deterring smokers from continuing the smoking habit. Conversely, non-smokers demonstrated a slight increase in knowledge and awareness regarding the health consequences of tobacco use as compared to non-smokers. This study underscores the gap in awareness and offers valuable insights for policymakers in designing future smoking cessation campaigns, aligning with the World Health Organization’s efforts. MPOWER policies include monitoring tobacco consumption and the effectiveness of preventive measures, protecting people from tobacco smoke, offering help to quit tobacco use, warning about the dangers of tobacco, enforcing bans on tobacco advertising, promotion and sponsorship, and raising taxes on tobacco to combat tobacco usage globally. Hence, future studies should focus on re-evaluating other suitable pictorials on cigarette packaging.
Figure 1: Pictorial warnings on cigarette packaging.
From upper left: (A) Premature birth; (B) Lung cancer; (C) Miscarriage. From lower left: (D) Mouth cancer; (E) Gangrene; (F) Neck cancer.

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DOI: 10.7717/peerj.18713/fig-1
Figure 2: Percentage of known health effects of tobacco use among respondents (n = 378).

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DOI: 10.7717/peerj.18713/fig-2
Figure 3: Impact of pictorial warnings on the initiation to smoking by non-smokers (n = 189).

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DOI: 10.7717/peerj.18713/fig-3
Sociodemographic characteristics of the respondents (n= 378).
Tobacco use assessment of smokers (n= 189).
The perception of the respondents towards pictorial warnings on cigarette packaging.
Emotional Impact of pictorial warnings by respondents (n= 378).
Impact of pictorial warnings on quitting smoking by smokers (n= 189).
Impactful images on cigarette packs among respondents (n= 378).