THE LEVEL OF IMPLEMENTATION AND EFFECTIVENESS

OF THE GRAPHIC HEALTH WARNING LAW OF 2014 (RA 10643) IN SAN CARLOS
CITY, PANGASINAN (CY 2021-2022)

A Thesis
Submitted to Faculty of
St. Therese College Foundation
College of Criminology
San Carlos City, Pangasinan

In Partial Fulfillment
Of the Requirements for the Degree
Bachelor of Science in Criminology

Submitted by:

ALVIN MACARAEG
JERRYME DE LEON
ELDER DELOS SANTOS
MA . ELYSA ALICAWAY
IANMAN CORNEL
RJHAY WAYNE GABAY
COLUMBUS BAGUIO

December 2021
 Chapter 1

INTRODUCTION

Background of the Study

The Graphic Health Warning Law or RA 10643 took effect. It had the aim of
discouraging smoking through the use of images of adverse health effects of smoking
printed on tobacco product packaging. Months have passed since then. Did it bring
about the desired effect? The researchers attempt to answer this question in a very
specific population. Investigations show that smoking incidence was directly
proportional to the rise in the number of BPO workers, especially those with graveyard
shifts. Hence, the decision to focus on call center agents in Cebu City. General
Objective: To know the effect of the graphic health warnings on cigarette packs among
smokers in the Business Process Outsourcing industry. Study Design: This is a
descriptive cross-sectional study to identify a reduction of the incidence of smoking
within the business process outsourcing industry upon the introduction of the Graphic
Health Warning Law. Study Setting: The study was performed at Asia town I.T. Park,
Lahug, Cebu City where the targeted companies are located on March 2016. Study
Population: The study included call center agents regardless of age, gender and date of
employment working within the research setting who are Current smokers smoking at
least 1 stick per day or Ex-smokers who used to smoke at least 1 stick per day but had
quit after March 3, 2016. Maneuvers: Questionnaires were handed to known smokers
within the study population. After their participation, they were asked for referrals of
other subjects that fit the study's inclusion criteria. Those respondents, in turn, were
asked for other referrals, and so on. After the data collecting period, the data were
tabulated and summarized. Outcome Measures: A Two-tailed Paired-Difference t-Test
was used to analyze the data. It was determined whether there is a significant
difference between their smoking habits prior to March 3, 2016 and the present.
Furthermore, it was computed if the graphic health warning law has had significant
impact on this change. Conclusion: There was no significant difference between the
smoking habits of call center agents before and after the Graphic Health Warning Law
was implemented. Of those whose smoking habits have declined, 51.85% claimed that
the new law had an effect on them. Furthermore, 10.96% of all respondents claimed not
to notice the new graphic warnings at all. Lastly, 39.73% of all respondents believed on
the effectiveness of the program.

Tobacco addiction in the Philippines

The Philippines became a party to the WHO Framework Convention on Tobacco

Control (FCTC) in 2005. There are two main pieces of tobacco control legislation: the
Tobacco Regulation Act of 2003 (Republic Act No. 9211), an omnibus tobacco control
law, and the Inter-Agency Tobacco-Committee issued Implementing Rules and
Regulations of the Tobacco Regulation Act of 2003. These national laws:

Prohibit smoking in enumerated indoor places and work places, such as

healthcare and educational institutions. Smoking is permitted in designated areas of
other public places and workplaces, including bars and nightclubs. Public land
transportation vehicles and terminals are smokefree. Bans some advertising and
promotional activity, but allows points of sale promotion and free distribution of tobacco
products, as well as other promotional activities.
Require a rotating text-only health warning covering 30% of the front of the
package. Starting in late 2015, 50% graphic health warnings are required on the front
and back of packaging; a ban on misleading descriptors will also come into effect. Allow
sub-national regulations that are stricter than the national law(https://theunion.org/our-
work/tobacco-control/

Tobacco addiction in Pangasinan

The Pangasinan provincial government has turned over two tobacco curing barns to
San Manuel and Balungao towns that were funded from the tobacco excise tax in 2016.

In an interview on Friday, provincial agriculturist Dalisay Moya clarified the tobacco

curing barns are not for the exclusive use of tobacco farmers.

“Hindi lang tobacco farms ang makikinabang dito, pati na rin ang iba pang agricultural
sector tulad ng mga nagtatanim ng palay at mais, rural-based organizations, and even
the municipal agriculture offices (Aside from tobacco farmers, other agricultural sectors
like the rice and corn farmers, rural-based organizations, and even municipal agriculture
offices would benefit from these structures),” Moya said.

The curing barn is a facility intended for preparing tobacco leaves for consumption.

The funding for the construction of the curing barns worth PHP10 million, was taken
from the PHP27.6 million tobacco excise tax in 2016. The provincial government also
utilized the Tobacco Excise Tax to distribute hand tractors and water pumps to farmers
in the province.

Moya assured more projects to benefit Pangasinense farmers are underway.

“Patuloy po ang pamimili ng provincial government ng palay sa small farmers, habang

ang mga irrigation projects, post-harvest development projects, at technology transfer
ay nagpapatuloy din (The provincial government is continuously buying palay from small
farmers, while irrigation projects, post-harvest development projects, and technology
transfer are also continuing), she said.

Governor Amado Espino III, in his speech during the turn-over on Thursday, said the
project is to support farmers in Pangasinan and ease their economic woes.

Prior to the construction of the barns, the Sangguniang Panlalawigan approved

Resolutions No. 2013-2021 and 2014-2021 respectively, authorizing governor Espino to
enter into a memorandum of agreement (MOA) with the municipalities of Balungao and
San Manuel for the construction of said barns.

A pact regarding the turnover of the facilities was also signed by Espino and San
Manuel Mayor Kenneth Marco Perez, Vice Mayor Alain Jerico Perez, and Vice Mayor
Philipp Peralta of Balungao town.

Statement of the Problem

This study was undertaken to determine the level of implementation and

effectiveness of The Graphic Health Warnings Law of 2014 (RA 10643) in San Carlos
City, Pangasinan for the Calendar Year 2021-2022.
Specifically, it sought to answer the following questions:
1. What are the essential provisions of The Graphic Health Warnings Law of
2014 in the Philippines?
 What is the level of implementation of the provisions of The Graphic Health
Warnings Law of 2014 in San Carlos City, Pangasinan for the Calendar Year
2021-2022?
2. What is the level of effectiveness of The Graphic Health Warnings Law of
2014 in San Carlos City, Pangasinan?
3. What is the degree of seriousness of some problems which prevented the
implementation and effectiveness of The Graphic Health Warnings Law of
2014in San Carlos City, Pangasinan?
4. What is the level of urgency of some recommendations to strengthen the
implementation and effectiveness of the The Graphic Health Warnings Law of
2014 in San Carlos City, Pangasinan?

Significance of the Study

Pursuing this study was considered significant as the findings provided some
insights and information on anti-red tape program to the following:
Victims – The result of this study could provide the people necessary information about
disadvantages of cigarette smoking through graphic health warning
Community – it is the community who will be benefitted by this study since they will
understand better the negative effects of cigarette smoking
Retailer – Ideas gained from the study could help the consumers to sell only a legitimate
cigarette products by looking at the packages
Researchers – This study could provide us a knowledge that can be used to help the
local government in the better implementation of the Graphic Health Warning
Future Researchers – This study could provide future researchers insights and valuable
data for further studies like surveys regarding the graphic health warning.
Scope and Delimitation of the Study

This study was undertaken to determine the level of implementation and

effectiveness of the The Graphic Health Warnings Law of 2014 in San Carlos City for
the Calendar Year 2021-2022. Respondents would be all from San Carlos City,
Pangasinan consisting of 25 City Hall Employee, 25 Retailer and 50 Consumer.

Definition of terms

Insert - means any communication inside an individual package and/or carton

purchased at either wholesale or retail by consumers, such as a leaflet or brochure.

Onsert - means any communication affixed to the outside of an individual package

and/or carton purchased at either wholesale or retail by consumers, such as a brochure
beneath the outer cellophane wrapping or glued to the outside of the cigarette package.

Graphic Health Warnings - refer to the photographic image printed on the tobacco
product package which accurately depicts the hazards of tobacco use and is
accompanied by textual warning related to the picture.

Principal Display Surface means:

(1) In the case of a package and carton that has at least two (2) equal sized sides or
surfaces, other than the top and bottom, that may be displayed or visible under normal
or customary conditions of sale or use, the areas of each of the two (2) largest surfaces;

(2) In the case of a spherical, cylindrical or conical container of tobacco products, the
two (2) largest surfaces that are predominantly displayed; and
(3) In the case of a package and carton that do not have a particular side or surface that
is predominantly displayed or visible under normal or customary conditions of sale or
use or those that are not described under subsections 1 and 2, fifty percent (50%) of
the three (3) dominant sides or the total surface thereof, whichever is bigger, which will
ensure that the Graphic Health Warnings are visibly shown.

Tobacco Product Package - means the packet and package of tobacco products and
any outside packaging and labelling of tobacco products for sale and distribution in the
domestic market, importation, trade, exchange, or for exhibition, such as, but not limited
to, packs, tins, boxes, pouches, flip-tops, slide and shell packages, cartons, packages
containing one (1) product unit, or other containers of tobacco products containing the
logo or trademark of the tobacco companies, primarily intended for consumers or for
retail sale: Provided, That for mastercases that contain the logo or trademark of tobacco
brands, such mastercases shall contain the textual health warning "SMOKING KILLS"
which shall be printed in the same single color and in bold print as the trademark logo:
Provided, further, That textual health warnings shall be of equal prominence and
visibility as the logo or trademark of tobacco companies. Such textual warnings on the
mastercase shall occupy not more than fifty percent (50%) of each principal display
panel of the mastercase.

Tobacco Products - means products entirely or partly made of leaf tobacco as raw
material, which are manufactured to be used for smoking, sucking, chewing or snuffing,
or by any other means of consumption.
 Chapter 2

REVIEW OF RELATED LITERATURE

This chapter would present a summary of some related literature and studies that
have direct bearing with the present study.

I. BOOKS

A. Foreign

Smoking is prohibited in enumerated indoor public places and workplaces such

as government facilities, healthcare and educational institutions, and facilities
frequented by minors, while designated smoking areas are allowed in other public
places and workplaces, including bars and nightclubs. Smoking is prohibited in public
land transport, aircraft, and public transport terminals. Public watercraft may have
designated smoking areas. (Dillard JP, Weber KM, Vail RG. 2002).

Many forms of tobacco advertising and promotion are prohibited, though tobacco
advertising and promotion at points of sale and free distribution of tobacco products,
among other promotional activities, are allowed. There are some restrictions on tobacco
sponsorship and the publicity of such sponsorship(Davis KC, Nonnemaker J, Duke J,
et al.,2006).

Rotating and combined picture and text health warnings are required to be
placed on 50 percent of each of the principal display areas of tobacco product
packaging. Misleading terms such as “light” and “low” are prohibited on tobacco product
packaging, but other misleading packaging (e.g., colors, numbers, and symbols) are not
prohibited (Hammond D, Reid JL, Driezen P, et al, 2007).

B. Local

The law prohibits the sale of small packets of cigarettes and the sale of tobacco
products within 100 meters of schools, playgrounds, and other facilities frequented by
minors. In addition, the law restricts sales via vending machines. There are no
restrictions on internet sales or the sale of single cigarettes. The sale of tobacco
products is prohibited to persons under the age of 21. (Aquino,2002).

The law allows the retail sale of e-cigarettes. The use of e-cigarettes is prohibited
where smoking is prohibited, which includes public conveyances and enumerated
indoor public places and workplaces. There are several restrictions on e-cigarette
advertising and promotion and sales in specified locations. Sales are prohibited to
persons under the age of 21. Beginning in May 2022, flavors other than “plain menthol”
and “plain tobacco” will be prohibited. In addition, combined picture and text health
warnings will be required to cover 50 percent of the front and back of e-cigarette
packaging. (Bagtas,2000).
 The Department of Justice would be interested in your relations with your
competitors. Should you want to raise capital by the sale of stock or bonds, you would
fall under the Securities and Exchange Commission. You would need export licenses
from the Department of Commerce to sell your product in some areas of the world.
Federal prohibitions against race, age, and sex discrimination in hiring and promotion
would apply to you. If you were to extend credit to your customers , you might fall under
truth-in-lending laws(Salonga,2008).

The cigarette package is a critical communication device for creating and

reinforcing brand imagery, and is the link between other forms of tobacco advertising
and the uptake of the addictive drug nicotine from a cigarette. (Aquino,2008 Using
striking colors, distinctive fonts and carefully crafted materials, cigarette packaging is
defined to be highly attractive, especially among young people. (De Leon,2000).

On the other hand, cigarette pack warnings are able to disrupt brand imagery, an
important factor for tobacco trial and use. This reality is acknowledged by the tobacco
industry, which vigorously opposes such measures.1,3 Package warnings are unique
among tobacco control initiatives implemented to educate smokers and prevent
smoking initiation as they cost little to produce and can be integrated with larger
interventions such mass media campaigns. Reminders from health providers to their
patients about the hazards of smoking and the benefits of quitting have been found to
reduce smoking, and cigarette pack warnings can work in a similar way, even among
populations in which language is a barrier. (Diego, 2005). Large comprehensive graphic
warnings—that combine a picture embedded with a text message relevant to the
depicted picture—are effective in increasing adult awareness of the dangers of
smoking, aiding smoking cessation and are more likely to be noticed and rated as
effective by adult smokers in comparison to plain text-only messages, while their size
and emotional impact also play a vital role in their effectiveness. (Viscocio,2002).
II. MAGAZINES, STUDIES, JOURNALS, NEWSPAPERS

A. Foreign

Graphic health warning labels on cigarette packages display gruesome images

(e.g. autopsy photos, disfiguring body scars) that, in combination with text warnings, are
designed to invoke fear, educate about the health risks of smoking, and motivate
smoking cessation
Article 11 of the World Health Organization’s Framework Convention on Tobacco
Control proposed a set of guidelines for implementing graphic health warning labels,
and as of this date more than 100 countries have passed regulations mandating that
some type of graphic health warning label appears on cigarette packages. (Nicotine
Tobscience journal,2012).

Narrative reviews and meta-analyses of many qualitative, correlational,

observational and experimental studies from around the globe have indicated that
compared with text-only labels, graphic health warning labels are recalled more readily
and generate more attention compared with text-only warnings; are associated with
more negative cognitions about smoking; and are perceived as having greater
effectiveness for preventing smoking and helping smokers quit [1–4]. Results from a
large randomized clinical trial from the US demonstrated that adult smokers who carried
cigarette packs with graphic health warning labels had more quit attempts and were
more likely to quit during a 1-month follow-up period than those who carried typical (for
the United States: text-only warning) packages (Health Commun, 2013).

One question that has yet to be answered is whether the presence of graphic
health warning labels on cigarette packages has any effect on cigarette product
purchases at point-of-sale (POS) retail locations. (Health Psychol, 1996).

B. Local

Graphic health warnings are effective in prompting smokers who buy on per-stick basis
to think about the dangers of smoking, which in turn, is associated with increased intention to
quit smoking. This is among the findings of a study conducted by research students of the
University of the Philippines in Diliman.

The researchers surveyed 402 Quezon City smokers and conducted two focus group
discussions from October to November 2016 to find out how the graphic health warnings on
cigarette packs had affected smoking behavior of Filipinos, given the fact that buying tingi, or on
a per-stick basis, is prevalent in the Philippines.

The results suggest that thinking about the dangers of smoking is the strongest factor correlated
with the intention to change cigarette consumption, especially among tingi buyers. In other
words, the more smokers think about the dangers of cigarette smoking, the more likely they are
to think about quitting. This is where the graphic health warnings show their strongest impact:
Smokers who are more afraid of the graphic health warnings think more about the dangers of
smoking(philstar magazine,2007).

Statistical analysis from the study suggests that newspapers and the internet were the
biggest contributors to knowledge of dangers of smoking among pack-buyers. Even if the
smokers watched programs about smoking on television more often, they got more information
from the things they had read on newspapers and saw on the internet.

Studies about mass media consumption suggest that reading is an active way of media
consumption that induces higher engagement from people. Highest engagement is expected to
increase recall of the information read. So those who read about smoking-related health risks
from media, such as newspapers and the internet, are expected to remember more information.
(business inquirer journal,2005).

III.INTERNET SOURCE

A. Foreign

The bureaucratic arena refers to all state organizations engaged in implementing policy
as well as in regulating and delivering services. Governance issues in the bureaucratic arena
take on special significance given the massive pressures that have been placed on public
agencies in recent years to become leaner, more efficient and bring services closer to the
people. As part of a project to undertake comprehensive governance assessments, we focus
here on the nature of the rules (formal and informal) that affect the bureaucracy. While issues of
bureaucratic governance are not constitutive of development per se, they are seen as crucial
determinants of the degree to which a country makes social and economic progress - or fails to
do so. The rules that determine procedures in the bureaucracy, whether formal or informal, are
especially important for public perceptions of how the state operates(Large, picture-based
health warning labels on tobacco packages are an essential component of a national strategy to
reduce tobacco use.
 Tobacco companies depend on package design to build brand recognition and promote
sales. Packaging establishes brand imagery that is often completely opposite to the realities and
dangers associated with tobacco product use. Control over tobacco packaging is critical to
tobacco control efforts. Tobacco packs can effectively broadcast messages about the harmful
impact of tobacco use.

Research shows that effective warning labels increase knowledge about risks
associated with smoking and can influence future decisions about smoking. Large and pictorial
health warning labels can motivate smokers to quit, discourage nonsmokers from starting, and
keep ex-smokers from starting again.

Studies have also found that warning labels are most effective at communicating the
health risks of tobacco use when they contain both pictures and words and are large and in
color. Warning labels also must be rotated periodically to avoid over
exposure(https://www.tobaccofreekids.org/what-we-do/global/warning-labels)

Graphics exceeding 50% of packs were the most common ratio for GHWs, and
identified an ongoing reliance on negatively framed messages and limited source
attribution. Perceived harms and quit intentions were increased by GHWs. However,
wear-out effects were observed regardless of GHW format indicating the length of time
warnings are present in market warrants ongoing research attention to identify wear out
points. Quit intentions and perceived harm were also combined into a cognitive
response measure, limiting the evaluation of the effects of each GHW format variables
in those cases. In addition, alternative GHW package inserts were found to be a
complimentary approach to traditional GHWs.
(https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10810-z).

B. Local
 The use of tobacco is responsible for many chronic and severe conditions such as lung
cancer, heart and respiratory diseases. With an average of 240 Filipinos dying every day from
smoking related diseases, the law will be able to raise awareness about the risks of smoking.

WHOs priorities in tobacco control are to prevent young people from starting to use tobacco,
and to help people reduce their use of tobacco or stop completely. Research has shown that
picture-based warnings are effective in motivating smokers to quit and in reducing the appeal of
tobacco use for people who are not yet addicted.

Dr Julie Hall, WHO Representative in the Philippines said, “Having these visible pictures so that
people really understand the fact that smoking kills is very important and incredibly powerful.
Stopping people from taking up smoking and encouraging smokers to quit saves lives and
saves money that can be spent tackling other health challenges. We continue to work closely
with the Government of the Philippines and strongly support their pioneering work in the country
to end tobacco use.” (https://www.who.int/philippines/news/detail/22-06-2014-philippines-
signs-into-law-graphic-health-warnings).

Warning labels on tobacco packaging are a cost-effective way of warning citizens

about the dangers of tobacco and of discouraging smoking. Warning labels on
packages impose minimal costs on public health budgets, and ensure a maximum
exposure of the target group to the warnings. Smokers and at-risk individuals frequently
interact with tobacco packaging—a heavy smoker sees warning labels on cigarette
packets an estimated 7300 times per year.
(https://tobaccocontrol.bmj.com/content/28/e1/e71).

Health warnings on cigarette packs and cartons can serve as an important

source of information for smokers and non-smokers alike. Smokers are exposed to
cigarette packs multiple times per day, which translates into potentially thousands of
exposures to a health warning each year. These exposures happen at the time the
smoker smokes a cigarette (https://businessmirror.com.ph/2019/05/29/red-tape-a-bane-
1-year-after-eodb-laws-ok/).

The Family Smoking Prevention and Tobacco Control Act (Public Law 111-31) enacted
in 2009 granted the Food and Drug Administration (FDA) important new authority to regulate the
manufacture, marketing and distribution of tobacco products to protect the public health
generally and to reduce tobacco use by minors. Section 201 of the Act amends the Federal
Cigarette Labeling and Advertising Act (FCLAA) (15 USC 1333) and requires the FDA to issue
‘regulations that require color graphics depicting the negative health consequences of smoking
to accompany’ nine warning statements (see Supplementary Appendix Table AI for a list of all
warning statements). The nine new graphic warning labels selected by the FDA must appear on
at least 50% of the front and back of all cigarette packs and cartons sold in the United States. In
addition, the new graphic warnings must cover at least 20% of the area of all cigarette
advertisements. The new warning labels were scheduled to be implemented on packs and
advertisements in September 2012. However, because of legal challenges to the warning labels
by tobacco companies, the implementation of warning labels is uncertain.
(https://academic.oup.com/her/article/30/1/46/685373).
 Chapter 3

RESEARCH AND METHODOLOGY

In this chapter, the researcher would present the description of the research
method used, a profile of respondents, the instruments used to gather data, the data-
gathering and the statistical treatment of data.

The Research Design

The descriptive survey-method was used in this investigation with the primary
purpose of ascertaining conditions, which were common among the population of the
study. The researcher made use of the questionnaire-checklist and simple interview as
the instrument gathering the data needed for the study.

The Respondents

There are 100 persons who acted as a respondents for this study, namely:
 Table 1
Distribution of the Respondents of the study
Respondents Number of Respondents
Consumer 50
Retailer 25
City Hall Employee 25
Sub-Total 100

The Research Instrument

The researchers formulated a questionnaire-checklist / simple interview under

the guidance and assistance of City Hall Employee. They put into use the information
and ideas that they provided about the construction of data-gathering instrument. Expert
opinions of knowledgeable persons were also solicited.

Administration and Retrieval of the Questionnaire

To validate their questionnaire, the researchers sought advice of their College

Dean and key officials of the city who had extensive knowledge on the Anti-Red Tape
Act of 2007 in San Carlos City. The researchers made a Questionnaire to perform such
survey gathering-data for the 100 respondent to answer in San Carlos City since the
City Hall has no questionnaire available for this particular survey.

The questionnaire was administered during operation hours of City Hall in San
Carlos City on December 2021.
 Retrieval of the questionnaire from the respondents was 100 percent since the
researchers administered the data-gathering instrument personally.

Statistical Treatment of Data

The data gathered through the questionnaire-checklist/ simple interview; and

their answers were then tabulated, consolidated and collated for easy interpretation in
the form of tables and textual presentation. In the statistical presentation of data,
percentage, ranking and weighted average used.

Percentage was used to denote proportion between the numbers of respondents

giving a response to a particular item to the population of the study.

Ranking was used specifically to denote the hierarchieal importance of the data
based on the number of responses or respondents.

Paradigm of the Study

I
INPUT PROCESS OUTPUT
Questionnaire and Tabulation Profile of the
preparation of Analysis and Respondents
interview guide Interpretation of
Data Contributing
Distribution of Factors
questionnaires and
interview of key Proposed strategies
personalities to continuously
prevent the red-tape

Figure 1: Schematic diagram showing the different variables of the study.