Tobacco Control in India K R Thankappan MD, MPH Professor Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India kavumpurathu@yahoo.com
Learning Objectives To understand different forms of tobacco use in India Prevalence and trends of tobacco use Government of India initiatives for tobacco control and some challenges Quit Tobacco India Project and its role in tobacco control in India
Smoking Chewing Snuff Application Cigarettes Pan Masala Fine Powder Powder Beedi Zarda Paste Hookah Gutkha Dhumti Khaini Chutta Paan Hookli Cigars
Trends of Smoking among men in India 50 45 42.5 43.7 45.8 45.2 40 35 30 29.1 36.3 (%) 25 20 19.2 1998 2005 15 10 8.6 5 0 15-24 year 25-34 year 35-44 year 45-54 year Age Range Thankappan KR, Mini GK. New Engl J Med 2008;358:2842-43
% Trends of Smokeless Tobacco Use in India 45 40 35 30 30.0 42.6 29.9 39.9 35.4 35.135.8 25 20 15 14.3 1998 2005 Prevalence ratio 10 5 2.09 1.42 1.12 1.01 0 15-24 year 25-34 year 35-44 year 45-54 year Age Range
12 10 8 TOBACCO USE BY WOMEN W Rural WUrban WTotal15-49 9.8 8.4 % 6 5.5 4 2 0 1.8 0.5 1.4 Smokes cig or bidi 0.2 0.0 0.2 Smokes cigars or pipe USES OF TOBACCO National Family Health Survey -3, 2005-06 Chews paan masala, gutkha,or other tobacco 0.9 0.5 0.8 Uses snuff
Awareness on harmful Effects of Tobacco in Kerala, India Mostly on linkages with Cancer (46%) Only 22 % knew that smoking is associated with cardiovascular diseases Very few (7.3%) knew the association between smoking and Tuberculosis Sixty four percent of diabetes patients reported that smoking will not affect Diabetes. Thankappan K R et al. Indian J Med Res 2007; 126: 300-08
Implications for the Poor in India Tobacco Use is significantly higher among the poor Tobacco related diseases such as cancer, cardiovascular diseases, chronic lung diseases including tuberculosis are likely to increase poverty Any poverty alleviation program cannot ignore the potential impoverishment associated with tobacco use.
Government of India Initiatives 1970-2008 1975:The Cigarettes Act 1975 made mandatory health warnings on cigarette packets 1980: Imposed restrictions on tobacco trade 1990: Directive for prohibiting smoking in public places, banned tobacco advertising on radio and TV and made statutory warnings on chewing tobacco products 1991: Directive to Central board of Film certificate to comply with the Cinematography act 1952 1995: An expert committee on the economics of tobacco 1999: Railways banned sale of cigarettes and bidis on railway platforms and inside trains
2008: Smoke free Rules came into effect, prohibiting smoking in public and workplaces from October 2, 2008 Government of India Initiatives 1970-2008 2000: Govt. of India banned tobacco advertisements on cable TVs 2001: Imposed ban on sale of Gutka at railway stations 2001-03 Several states banned production and sale of Gutka and pan masala under the prevention of Food Adulteration act 2003: Cigarettes and other Tobacco products Act (COTPA) applicable to all tobacco products 2004: Govt. of India was among the first 8 countries to ratify the FCTC on February 05, 2004. Report on Tobacco Control in India 2007-08: National Tobacco Control Program
National Tobacco Control Program 2007-08 Setting up of State Tobacco Control Cells District Tobacco Control Program Training and capacity building of enforcement officials Monitoring and implementation of tobacco control laws Launching an IEC campaign Cessation Centres at District level School health and awareness program National level mass awareness campaign Establishment of tobacco product testing labs Research and training Monitoring and evaluation including Adult Tobacco Surveys Setting up of National Regulatory Authority
Landmark Government Report Released 2004 Provides roadmap for action Documents health consequences Advocates public health measures Strongly encourages cessation
Awareness about tobacco related health problems and COTPA Tobacco related health problems and COTPA Percent Awareness on any tobacco related health problem 97.3 Cancer 53.0 Respiratory Diseases 36.7 Heart Problem 28.3 Tuberculosis 22.0 Hypertension 11.0 Diabetes 01.3 Awareness of the harmful effects of secondhand smoke 78.7 Awareness on COTPA 45.7 Sharma I et al. Indian J Cancer 2010; 47: (S1) 63-68
Barriers in implementation of COTPA Lack of knowledge on Specifications Most of the People did not know whom to complain if there is violation of COTPA Most Implementers did not receive the official notification Public Opposition for implementation Sharma I et al. Indian J Cancer 2010; 47: (S1) 63-68
Quit Tobacco India is part of the Quit Tobacco International project supported by the Fogarty International Centre of the US National Institutes of Health by a grant (RO1TW005969-01). Quit tobacco India -2 Project Components QTI-2 Project Medical Curriculum Implementation And Evaluation Clinic-based Cessation Community Outreach For Cessation Tobacco Cessation Research Network
According to the International Union Against Cancer Health care professionals have a duty to treat tobacco use as they would any other disease or addiction
Prevalence (%) of Smoking among Male Medical Students in Kerala & Karnataka Medical College Ever smokers Current Smokers Kerala Private 15.4 2.1 Kerala Cooperative 27.6 8.0 Kerala Govt. 24.7 17.2 Karnataka Private 31.6 21.0 Karnataka Govt. 19.3 8.9 Total 24.2 12.4 Quit Tobacco India project data 2009 (Unpublished)
Implementation sites of the QTI -2 Project Five medical colleges in south India: Three in Kerala 1. Govt. Medical College Alappuzha 2. Amrita Institute of Medical Sciences, Kochi 3. Academy of Medical Sciences Kannur Two in Karnataka 1. Kasturba Medical College Mangalore 2. Bangalore Medical College, Bangalore
QTI modules being implemented in the selected medical colleges 1. Basic Medical Practice 2. Cardiovascular 3. Respiratory 4. Reproductive 5. Neoplasia 6. Mental & Behavioral Health 7. Musculoskeletal 8. Nervous System 9. Special Sense Organs 10. Endocrine 11. Gastrointestinal 12. Community Medicine
Street play against tobacco use developed jointly by students with help of teachers and performed by school students in intervention schools The impact of art forms for communicating anti-tobacco messages was found to be very effective.
Release of the media Kit on tobacco control Recognizing the huge role of media in effective communication we developed this kit and was released by the health secretary, the highest health official in the state.
Tobacco Smoke free households inaugurated by Honorable Minister for Health and Social Welfare Smt. P K Sreemathi March 25, 2010 The objective of this initiative is to protect women and children from the effects of second hand smoking from their male family members Director, SCTIMST, State leader of the women s organization, professor from the regional cancer centre are also seen
Make Tobacco A women and Children Issue: Women participants from Nellanad Panchayat (village), Kerala. About 200 women living with a smoking male member in the household participated from the intervention village.
Supply of tobacco free campus policy documents for enforcing tobacco control law These documents were developed and distributed to all the intervention institutions (schools, health centres, workplaces and local self government Institutions) and placed in key offices
Thank you.