Saturday, 20 December 2014

State-level laws banning gutka are impacting product availability and use: WHO

A study by the World Health Organisation to examine the impact of gutka ban in select states of India has found that state-level laws banning gutka are having a positive impact – reduced product availability and a decrease in consumption of gutka. 

The study, 'Examining the impacts of the gutka bans in selected states in India' revealed that the support for gutka bans is very high (92%) and there was an almost universal agreement (99%) that gutka bans are good for the health of India’s youth.

The study was conducted by the World Health Organization Country Office for India in collaboration with Johns Hopkins Bloomberg School of Public Health in seven states (Assam, Bihar, Gujarat, Karnataka, Madhya Pradesh, Maharashtra and Orissa) and the National Capital Region region.

“These findings have a strong message that regulatory mechanisms are effective and can have a positive impact on the consumption pattern,” said Dr Nata Menabde, WHO Representative to India. 

Surveys were conducted with 1,001 current and former gutka users and 458 tobacco product retailers to gain insight into the e ffect of the bans on consumer use and product availability in seven states and the National Capital Territory. 

Observations of 450 retail environments and 54 in-depth interviews with government officials, enforcement officials and citizens working with civil society groups were also conducted to the same end.

The study has recommended the following measures for better public health impact and saving lives:

  • Government to expand the Gutka ban to all smokeless tobacco products. The ban should also cover products that can be bought separately and mixed to be consumed as Gutka or a product similar to Gutka (by whatever named called).
  • Enforcement mechanisms need to be strengthened to ensure complete compliance of the ban
  • Provision for tobacco cessation services to be scaled up to cater to the unmet need for cessation after the ban
  • Products like pan masala are used as a base for making products akin to Gutka and also are produced and marketed by the same manufacturers under the similar brand names. These pan masala products are blatantly advertised and act as a surrogate advertising medium for smokeless tobacco.
  • Therefore, the Government needs to take urgent action to stop advertisements of pan masala to protect the vulnerable sections of society including the youth.
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Tuesday, 16 December 2014

Kerala, the first Indian state to become tobacco advertisement free

Kerala has become India’s first state to be free of tobacco advertisements after the southern state completely did away with giving publicity to the nicotine-laden material at its points-of-sale.

Tobacco advertisements from 95.3 per cent of points-of-sale across 14 districts were successfully removed in an 18-month-long campaign spearheaded by the Public Health wing of the Kerala Health Services Department. The state police joined forces in this mega effort.

Tobacco control champion and Kerala Home Minister Shri Ramesh Chennithala declared Kerala as tobacco advertisement-free at function held in the presence of State Health Minister Shri VS Sivakumar in the Kerala capital of Thiruvananthapuram on November 14.

Dr AS Pradeep Kumar, Additional Director of Health Services (Public Health) who coordinated this massive effort, said a three-phase activity plan was developed with District Medical Officers at the core. “Sensitisation programmes were conducted with emphasis on Section 5 of COTPA for district officers at the state capital,” he added. “District officers in turn trained and authorised personnel attached to the Primary Health Centre.”

Section 5 of Indian tobacco control law called COTPA, 2003 bans all forms of advertisement, direct or indirect, of tobacco products.

The districts were given the freedom to customise according to their local needs. “This, in turn, raised the level of commitments and ownership taking,” pointed out the medical doctor who has a PhD in tobacco control. “At the state level, we supported the districts by framing guidelines, monitoring and advising course corrections,” said Dr Kumar who is among the few in India to have completed the Global Tobacco Control Leadership Program of the Johns Hopkins Bloomberg School of Public Health, USA.  

The process that started during World No Tobacco Day 2013 saw both integrated and intensive drives that effectively pooled the services of health personnel from district to primary health centre level. In drives integrated with regular activities during the first phase from June to December 2013, over 23,500 notices were issued to shops that violated the provisions of Section 5. 

Intensive weeklong drives in January and May 2014 marked the second leg of the campaign. As many as 32,566 shops and 62,365 eateries were inspected during the period 10 to 17 January 2014. While the January round revealed violations in 48.8 per cent of sites, field assessments conducted by personnel of Primary Health Centres in May showed that 90 per cent of points-of-sale were free of tobacco boards. 

In October 2014, teams led by District Medical Officers at the district level and Programme Officers at the Panchayat and Primary Health Centre level certified that tobacco advertisement boards were surfaced out. 

As many as 22,344 points-of-sale in 84 wards across Kerala were observed during 28 October to 7 November. Dr Pradeep Kumar says, “A civil society group with nearly four-decade-long experience in research and field implementation in Kerala conducted the evaluation study.”

The evaluation reported an overall compliance of 95.3 per cent – 98.5 per cent of points-of-sale are free of any advertisement hoardings and 96.7 per cent of points-of-sale are free from stickers and print advertisements. International standards prescribe that 90 per cent of sites have to be free of advertisements to become eligible for the tag of tobacco advertisement free. 

Noted head and neck cancer surgeon Dr Pankaj Chaturvedi of Mumbai’s Tata Memorial Centre and an internationally acclaimed tobacco control proponent said, “Tobacco is the only consumer product in the world that has not a single beneficial use apart from causing death and disability. Industry spends billions in advertising this killer product to lure youngsters. Ban on advertising will save innocent youths from initiating this habit. I congratulate the Kerala Government.”

The Global Adult Tobacco Survey (2009-10) said 44.2 per cent of adults above 15 years in Kerala had noticed advertisements or promotions on cigarettes and 70.9 percent and 72.3 per cent had noticed advertisements on bidis and smokeless tobacco respectively. 

Bangalore-based senior head and neck cancer surgeon and tobacco control advocate Dr Vishal Rao said, “This is a significant step that Kerala has achieved in its efforts to improve public health of Keralites, especially the youth of Kerala. Youth between the age of 10 and 18 fall prey to the advertisement of tobacco and lured into addiction. Today we are seeing cancers in age group of 20s and 30s, which we earlier saw in the 70s. A healthy society should have less illness, less hospitals and less doctors and this can only be achieved through preventive health.” 

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Monday, 15 December 2014

Oral cancer not the only risk for those who chew tobacco

Contrary to the prevailing notion that chewing tobacco only increases the risk of oral cancer, a study that looked at different researches conducted in India has shown that smokeless tobacco can also cause oesophageal, throat and even stomach cancer.

The findings are critical. While one-third of the country’s population takes tobacco, 21% of them consume smokeless tobacco, such as gutkha and khaini, according to the Global Adult Tobacco Survey released in 2010.

“While reviewing various studies, we found the incidence of oesophagal [foodpipe] cancer was higher in the north-east, while in the south we found pancreatic cancer was prevalent in those who consumed smokeless tobacco,” said Dr Pankaj Chaturvedi, head and neck cancer surgeon at Tata Memorial Centre and co-author of the review study.

He added that researches in Madhya Pradesh have showed that throat cancer is common among smokeless tobacco users.

The study, titled A Review of Indian Literature for the Association of Smokeless Tobacco with Malignant and Pre-malignant Diseases of Head and Neck Region, was published last week in the Indian Journal of Cancer.

Researchers said the review exposed the risk of developing throat, stomach, oesophageal, pancreatic, cervical cancer as a result of chewing tobacco.

“It depends how and where you are consuming tobacco. There is a difference in the incidence of tobacco-related cancer between India and the western world. Those who place the tobacco mixture under the lip are more prone to cancer in that region. Those who also consume areca nuts are increasing their risk of two cancers, as areca nut itself is carcinogenic,” said Dr Chaturvedi.

Researchers said apart from the way tobacco is consumed, the ethnicity of the consumer is also a factor in determining the type of cancer he or she is prone to develop.

Unlike in western countries, smokeless tobacco use is far more common than smoking in India. “Unfortunately, there is nobody regulating the use of smokeless tobacco. It is easy to grow tobacco crop anywhere. It is sold loose and also not taxed. A person who stops consuming smokeless tobacco is at the risk of developing cancer for at least a decade after giving up the habit. This itself shows the impact of the habit,” said Dr Chaturvedi.

Source: Hindustan Times
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Saturday, 6 December 2014

Ban on loose cigarettes: An open letter from a cancer survivor to PM Narendra Modi

After the announcement of amendments of COTPA (such as ban on  sale of loose cigarettes), a cancer survivor has sent an open letter addressed to PM that he as addressed to PM Narendra Modi. He expresses his views about the ban on loose cigarettes and urges Modiji to reconsider its implementing the amendments it with full vigour.

Respected Modi Ji,

It was with great sense of pride and satisfaction that I learnt from the Newspapers reports that Government of India has decided to ban sale of loose cigarettes as it constitutes over seventy percent of its sale. 

However, the joy was short lived as today it has been announced that the amendments of COTPA (such as ban on  sale of loose cigarettes) is going to be deferred. Although I did not believe in the paper published by the Congress party with caption U-Turn, it immediately occurred to me that the decision not to implement ban on sale of loose cigarettes is likely to be dubbed as another U-Turn. 

However, the joy was short lived as today it has been announced that the amendments of COTPA (such as ban on  sale of loose cigarettes) is going to be deferred. Although I did not believe in the paper published by the Congress party with caption U-Turn , it immediately occurred to me that the decision not to implement ban on sale of loose cigarettes is likely to be dubbed as another U-Turn. 

Sir, I am a tobacco victim and cancer survivor. After having smoked cigarettes made attractive by constant  advertising with inciting slogans like, ‘Made for Each Other’ by ITC , I was detected with Throat Cancer in 2008. It resulted in removal of my voice box and now I speak with the help of a prosthesis (machine). Eating and Speaking has become a challenge. As ill lack would have it, I suffered yet another Cancer of the Tongue in 2013 resulting in partial removal of my tongue. It can be thus well imagined that my life has become virtual hell. Please see the attached picture that was taken recently during my discharge from hospital. 

I never wanted any other person to have the same fate which was the reason for my joy on learning that sale of loose cigarettes is going to be banned and loop holes in COTPA are going to be plugged by amendment.

Mr. Prime Minister, the case before Consumer Court filed by me for compensation from ITC could not succeed  as one of the grounds taken in defense was that I could not produce bills for cigarettes purchased by me. 

Can you imagine any person being issued with bills for sale of loose cigarettes by the vendors. Therefore, if at all loose cigarettes are to be sold then issuance of sale bills must be made mandatory for loose as well as packets of cigarettes. The activities of cigarettes manufacturing companies must be curbed as they are nothing but merchants of death. One cannot protect these companies and tobacco growers, vendors etc on the plea that the Revenue of the Government as also employment opportunities of persons shall be affected.

For generation of jobs and revenue at the cost of millions of lives lost due to cigarette smoking and  expenditure on health care cannot be justified on this score. You had tweeted on 31st May (World no tobacco day) for a healthier and Tobacco Free India. You had pledged to reduce tobacco consumption in India. Unfortunately your senior Cabinet Ministers do not support your ideologies and continue to patronage tobacco lobby.

It is, therefore, prayed that the Honourable Prime Minister may kindly reconsider its rethinking on proposed  curbs on sale and consumption of tobacco and implement it with full vigour. Sir, you have evoked high hopes in people of India. It is our cherished desire that the Government shall take decisive steps to make India tobacco free. It would not only save lives but also save enough money spent in health care and loss of economic activity to compensate for the loss of Government Revenue. Surely the Government does not want to earn Revenue by allowing its citizens to be killed by Companies like ITC whose share prices have surged by 6% after the announcement to defer ban on loose cigarettes.

The main beneficiaries of tobacco business aren’t farmers/vendors but few powerful families who run this trade only to make vulgar profits. How can you ignore that these business families are killing one million Indians every year and making the nation lose nearly one lac crore every year on health care expenditure? At the end, it is urged that all the proposed amendments in COPTA and its implementation may kindly be done immediately.

Yours Sincerely,
Deepak Kumar
Commissioner of Customs,Central Excise & Service Tax (Retd)

Courtesy: Healthsite
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Monday, 24 November 2014

Tobacco control measures in Rajasthan: UN mission to visit state

Exemplary work done by the Rajasthan government in tobacco control has attracted the attention of a joint mission of the UN inter-agency task force on prevention and control of non-communicable diseases, which is visiting Rajasthan next month. 

In a letter to state's principal secretary, medical and health, WHO representative to India Dr Nata Menabde mentioned, "The main focus of the visit will be to create a forum for highlighting lessons learned in formulating multi-sectoral coordination for non-communicable diseases (NCDs) and tobacco control and identify challenges in the prevention and control of NCDs at state level." The team of officials will visit the state on December 11. 

The mission members will discuss with the state officials about the distinction of Rajasthan as the first state in India with a mandatory requirement for government job aspirants to file an undertaking for not using tobacco products in any form (smoking or chewing forms), declaration of all educational institutions in the state as tobacco-free institutions as per government of India guidelines and imposition of the highest rate of VAT on all tobacco products.

The team will comprise officials from WHO, UNDP, UNFPA, UNICEF and the World Bank with participants from their headquarters, regional and country office. 

The visit will be coordinated by the WHO country office for India in close collaboration with the ministry of health and family welfare and office of the UN resident coordinator in India. The efforts are being made to intensify fight against NCDs as it is currently leading cause of morbidity and mortality in India. 

Nata pointed out in the letter, "In September 2011, heads of state and government adopted the political declaration of the high-level meeting on prevention and control of NCDs during the general assembly of UN. The declarations called upon WHO, as the lead UN specialized agency for health, and all other UN system agencies and international financial institutions to work together in a coordinated manner to support national efforts to prevent and control NCDs and mitigate their impacts." 

Tobacco control and NCD nodal officer (state) Dr Sunil Singh said, "Rajasthan won two WHO's director general awards in two successive years for its efforts on tobacco control. We have banned gutkha and introduced Pehal, an online counseling for tobacco addict." 

The UN inter agency task force (UNIATF), which will visit the state was established to coordinate the activities of the relevant UN funds, programmes and specialized agencies and other intergovernmental organizations to support realization of the commitments made in the political declaration. In particular, through implementation of the WHO global action plan on NCDs 2013-2020. 

In this regard, a joint mission of the UNIATF is visiting India during December 8-12, 2014. The joint mission is intended to enhance the support of the UN agencies to the government of India to scale up the national multi-sectoral response to NCDs.

Courtesy: Times of India
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Wednesday, 5 November 2014

Living with a smoker equals breathing the air in world's most polluted cities

Living with a smoker can be like breathing the air in the world’s most polluted cities, according to a new study from Scotland.

According to lead author Sene Semple of the of the Scottish Center for Indoor Air at the University of Aberdeen, smoking in  home leads to really poor air quality and results in concentrations of fine particles. 

Tiny particles 2.5 microns in diameter or smaller, known as PM2.5, can penetrate deep into the lungs and even enter the blood. They’ve been linked to heart disease, strokes and cancer.

“Making your home smoke-free is key to reducing your exposure to PM2.5; for non-smokers who live with a smoker the impact of implementing smoke-free house rules would reduce their daily intake of PM2.5 by 70 percent or more,” Semple said. 

Such tiny particles typically result from combustion. Outdoors, the primary sources are vehicle exhaust, power plants and wildfires. Indoors, wood-burning or coal-burning stoves, gas cooking and heating fires and tobacco smoke are the most common sources of PM2.5 in the air.

For outdoor air, the World Health Organization says the safe exposure limit for PM2.5 particles is an average of 25 micrograms, or 25 millionths of a gram, per cubic meter of air over a 24-hour period, or average annual levels of 10 micrograms per cubic meter.

The U.S. Environmental Protection Agency sets the 24-hour limit at an average of 12 micrograms.

Semple and his colleagues wanted to bring together two scientific communities: those involved in tobacco control work and those interested in outdoor air pollution and health. “We think there is a lot that each can learn from the other,” he said.

Many studies have examined outdoor air pollution or indoor air quality in workplaces. But home is where most people spend the majority of their time, particularly small children and homebound elderly people, the researchers write. By comparing indoor air pollution in the homes of smokers and non-smokers, then comparing that to the most polluted cities, they hoped to illustrate the perils of indoor tobacco smoke over a lifetime.

The study team looked at data from four separate studies that measured PM2.5 levels in 93 Scottish homes where people smoked and 17 homes that were smoke free.

On average, PM2.5 levels in smokers' homes were around 31 micrograms per cubic meter – 10 times greater than the average of 3 micrograms in non-smoking homes.

There was a wide range of smoke concentrations in the smokers’ homes, however, and in one quarter of them, the 24-hour averages were 111 micrograms.

Semple pointed out, “A considerable proportion of smokers’ homes had air pollution levels that were the same or higher than the annual average PM2.5 concentration measured in Beijing,” a heavily polluted city.

The study team estimates that over a lifetime, a non-smoker living with a smoker will inhale about 6 grams more particulate matter than a non-smoker living in a smoke-free home.

Semple said that isn’t much, but this amount is likely to "have a substantial effect on the risk of developing diseases of the cardiovascular and respiratory systems.”

Semple said smokers often express the view that outdoor traffic pollution is a bigger problem than second-hand smoke pollution in the home.

“What this work shows is that, for most people living outside of major heavily polluted mega-cities like Beijing or Delhi, outdoor air pollution is much, much lower than what is measured inside homes where someone smokes,” he said.

Source: Reuters

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Wednesday, 15 October 2014

Tobacco packets to devote 85 per cent space to warnings

India has made it mandatory for tobacco companies to devote 85 per cent space on packets of cigarettes and other tobacco products to warnings against the ill effects of tobacco consumption.

"We have issued a notification to ensure that in the next few months cigarette manufacturers have 85 per cent space on packets covered with either pictorial warnings or messages warning against the perils of tobacco use," Union Health Minister Harsh Vardhan announced in New Delhi at a function on the occasion of global hand washing day.

The guidelines would come into effect from April 1, 2015. 

As of now, tobacco companies are required to devote only 40 per cent of the space on packets to pictorial warnings against tobacco use.

Mr Harsh Vardhan said, "In my career as a doctor, I have seen smokers and tobacco users die in front of me. We should do whatever we can to make people aware."

With this, India will join Thailand where 85 percent of space on packs of cigarette and other tobacco products is covered with warnings. 

India will now rank first in the list of 198 countries that warn smokers about the hazards of smoking through graphic pictures on cigarette packets.

In Australia, it is 82.5 per cent and in Uruguay, it 80 per cent. 

India's ranking had dropped down to 136 out of 198 among countries, which include pictorial health warnings on cigarette packets.

According to the notification issued: "The specified health warning shall cover at least 85 per cent of the principal display area of the package, of which 60 percent shall cover pictorial health warning and 25 percent shall cover textual health warning and shall be positioned on the top edge of the package".

For packages containing smoking forms of tobacco, the pictorial warnings would be of throat cancer, and for chewable tobacco products, they would be of mouth cancer.

The notification said the health warnings shall be expressed in English or any Indian language. 

"The specified health warning on tobacco product packages shall be rotated every 24 months from the date of commencement of these rules or before the period of rotation as may be specified by the central government notification," it said.

"The size of all components of the specified health warning shall be increased proportionally according to increase in package size to ensure that the specified health warning covers 85 percent of the principal display area".

Source: NDTV
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Tuesday, 14 October 2014

TFK stall at Clean Campus Trivandrum Regional Meet

TFK's stall set up at the venue of Trivandrum Regional Meet of Clean Campus, Safe Campus on 10 October 2014 evinced enthusiastic participation of students and bureaucrats alike.

Visitors thronged our stall and eagerly wrote their comments in the 'Have Your Say' wall. 

Posters were specially designed wherein key stakeholders could write their views on implementing the ban on sale of tobacco products around schools.

Under Section 6 (b) of Indian tobacco control law, COTPA, 2003, sale of tobacco products is prohibited in an area within a radius of 100 yards of an educational institution. 

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Wednesday, 8 October 2014

Tobacco control: Health custodians congratulate Kerala Police

Senior custodians of health across the state have heaped praises on Kerala Police for their role in preventive health by tightening enforcement of the tobacco control law COTPA, 2003 that is aimed at protecting public from the many harms of tobacco use. COTPA violations check by Kerala Police for the May-July 2014 quarter has gone up by 64 per cent compared to the same period last year.

Dr. Ramdas Pisharody, Principal, Trivandrum Medical College, congratulating the Trivandrum City Police for making the college area smoke-free said,  “This concerted effort by the police force to safeguard the lives of thousands who visit the hospital every day by enforcing COTPA is very laudable. Owing to high literacy levels and penetration of mass media in Kerala, awareness that smoking and tobacco use is harmful to health is very high among our people. Yet, people continue to smoke away causing harm not only to their health but also of others. Tough enforcement of laws together with counselling by doctors is the need of the hour to arrest the preventable damage to public health from tobacco use.”

The Trivandrum City Police, as a part of the collective exercise led by the District Administration to make the district model COTPA compliant, recently declared the Medical College police circle smoke free.

Ernakulam and Kozhikode districts are also in the fray to become model COTPA compliant. Multi-stakeholder efforts in these two districts are led by the District Collectors with active support from the police and other enforcement agencies.  

According to Dr. VP Gangadharan, pioneer medical oncologist and HoD of Medical and Paediatric Oncology, Lakeshore Hospital, Kochi, tobacco induced oral cancers is on the rise in Kerala. “Youngsters are increasingly developing an affinity for tobacco products, which are a definitive causative factor for mouth and throat cancers.”

Complimenting the Kerala Police for their action to curb tobacco use through noble endeavours such as model COTPA compliant districts, he said, “All sections of the society should support the police and other enforcement officials to ensure that no sale of tobacco products happen around any educational institution in Kerala, from primary schools to institutions of higher education.”

Section 6 (b) of COTPA prohibits the sale of tobacco products around 100 yards (91.4 metres) of any educational institution.

Dr MN Krishnan, Prof and Head, Department of Cardiology, Government Medical College, Kozhikode feels that by working to control tobacco use through enforcing the law, police are not just helping to save lives but supporting the state’s economy as well.

“The economic burden to Kerala from tobacco use is very high; a study for the year 2011 found it is the highest for cardiovascular diseases at Rs 226 crores. This is precious resources going down the drain. Police, by acting against tobacco use, are doing a productive service not just to public health but also to our economy’s health.” 

He added that the fine amount collected by the police and other enforcement agencies should be pumped in for tobacco control measures.

From 16,363 challans for COTPA violations during May-July 2013, police have strengthened efforts and have fined/challaned 26,797 persons during May-July 2014, as per Kerala Police website. Fine amount collected from COTPA violators have also increased by 115 per cent in the same period. From Rs 2,270,950 in 2013, it rose to Rs 4,877,550 in 2014. 
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