Tuesday, 24 February 2015

Tobacco kills two in three smokers: Australian Study

A large Australian study of more than 200,000 people has provided independent confirmation that up to two in every three smokers will die from their habit if they continue to smoke.

The research, published today in the international journal BMC Medicine, is the first evidence from a broad cross-section of the population to show the smoking-related death toll is as high as two thirds.

“We knew smoking was bad but we now have direct independent evidence that confirms the disturbing findings that have been emerging internationally, said lead author Professor Emily Banks, Scientific Director of the Sax Institute’s 45 and Up Study and a researcher at the Australian National University.

“Even with the very low rates of smoking that we have in Australia we found that smokers have around three-fold the risk of premature death of those who have never smoked. We also found smokers will die an estimated 10 years earlier than non-smokers.”

Until relatively recently it was thought that about half of smokers would die of a smoking-related illness, but newer studies in UK women, British doctors and Amercian Cancer Society volunteers have put the figure much higher, at up to 67%.

“We have been able to show exactly the same result in a very large population-wide sample,” Professor Banks said.

The research is the result of a four-year analysis of health outcomes from more than 200,000 men and women participating in the Sax Institute’s 45 and Up Study ? the largest longitudinal study of healthy ageing in the Southern Hemisphere.

Australia has one of the lowest smoking rates in the world – at 13% of the population and is an international leader on plain cigarette packaging. “But our findings are an important reminder that the war on tobacco is not yet won, and tobacco control efforts must go on,” Professor Banks said.

The research was supported by the National Heart Foundation of Australia in collaboration with major 45 and Up Study partner Cancer Council NSW and was conducted by a national and international team. It also found that compared with non-smokers, smoking just 10 cigarettes a day doubles the risk of dying and smoking a pack a day increases the risk four- to five-fold.

The NSW Heart Foundation’s CEO, Kerry Doyle, said the Australian Government was on the right path in driving down smoking rates through initiatives like tax increases and plain packaging.

“Higher tobacco prices have been shown to be the most effective intervention available to governments to reduce demand for tobacco. With smoking being a major cause of cardiovascular disease, including heart attack, stroke and peripheral vascular disease the more deterrents people have between them and smoking, the better,” Ms Doyle said.

Scott Walsberger, Tobacco Control Manager at Cancer Council NSW, said the research results highlighted an important message for smokers: “It’s never too late to quit ? no matter what your age, or how much you smoke.”

Source: ScienceBlog
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Saturday, 21 February 2015

Smokefree workplaces linked to smokefree homes in India

Adults in India are substantially more likely to abstain from smoking at home if they are prohibited from smoking at work, according to a study published in Tobacco Control - an international peer-reviewed journal for health professionals and others in tobacco control.

The percentage of respondents employed indoors (outside the home) working in smoke-free environments who lived in a smoke-free home was 64.0% compared with 41.7% of those who worked where smoking occurred. Indian states with higher proportions of smoke-free workplaces had higher proportions of smoke-free homes. In the individual-level analysis, working in a smoke-free workplace was associated with a significantly higher likelihood of living in a smoke-free home.

The authors of the study, from Imperial College London and the Public Health Foundation of India (PHFI), say the findings suggest that the implementation of smokefree legislation in India may have resulted in substantial health benefits for the population, particularly for women and children.

“This study suggests that, in India, there is good evidence that smokefree laws in workplaces are associated with a reduction in second-hand smoke at home,” said Dr John Tayu Lee, from the School of Public Health at Imperial College London, who led the study.

“The results support the idea of ‘norm spreading’, whereby restrictions on smoking in public places make it seem less acceptable to expose others to second-hand smoke more generally, including at home,” said Dr Christopher Millett, from the School of Public Health at Imperial. “They highlight the importance of accelerating the implementation of smokefree legislation more widely in India.” Dr Millett is also a Visiting Senior Research Fellow at PHFI.

"Achieving sustained and equitable reductions in SHS exposure is a high public health priority for India. Our findings highlight the importance of accelerating the implementation of existing national tobacco control legislation on smoke-free public places (Section 4 of the Cigarettes and Other Tobacco Products Act 2003) building on earlier successes in achieving smoke-free environments," the study notes. 

The study can be downloaded here
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Tuesday, 10 February 2015

Call for bigger health warnings on tobacco product packs

Concerned over the growing tobacco menace in India, health organisations from across the world have asked the Indian Government to oversee new warning labels on tobacco packets.

Tobacco products like cigarettes and gutkas will have more prominent health risk warnings from April 1 this year. 

“Similar health warnings were first proposed in 2006 and they were vigorously opposed in and out of courts by the tobacco industry.

"The Government of India persevered until announcing the new measures last year. The tobacco industry will certainly object to the warnings, just as it does in other countries. 

"We recommend that the tobacco industry simply be ignored and that priority be given to the health of the Indian population,” wrote Laurent Huber, director of Framework Convention Alliance (FCA), Switzerland. 

“If countries such as Nepal, Thailand, Australia and Uruguay can implement similar size warnings (80-90 per cent), there is no reason why India cannot. 

"The FCA also notes that in India, the new warnings will apply to tobacco products generally and not just cigarettes. This is essential, given the diversity of tobacco products in Indian market,” he added. 

Various international public health organisations working on tobacco control and cancer have individually written letters to Prime Minister Narendra Modi and Union Health Minister J.P. Nadda on the new tobacco package issue. 

“The large and improved warnings on tobacco packs serve as a no-cost and proven mass education tool that can protect the health of our people... The best evidence of their efficacy lies in the tobacco industry’s opposition to the warnings. 

"The Government needs to prioritise the nation’s health over narrow commercial interests,” said Shoba John, Health Bridge programme director. 

Former Union Health Minister Dr Harsh Vardhan had on October 15, 2014, issued a notification requiring tobacco manufacturing firms to devote at least 85 per cent of the surface areas of all tobacco products on both sides to graphically and literally represent the statutory warning. 

“Awareness has increased gradually regarding the harmful effects of tobacco. This decision will further help,” said Dr Jagdish Kaur, Chief Medical Officer at the Union health ministry, adding: “Industries have been given enough time to prepare new stocks.” 

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Thursday, 22 January 2015

Higher cigarette taxes bring down sales

Higher excise duty on cigarettes announced in the Union Budget last year and increases in value-added tax by Tamil Nadu, Kerala and Assam has resulted in a below-par performance in the quarter ending December 2014, tobacco giant ITC has said. 

"The cigarette segment revenue, as a consequence, remained flattish during the quarter," ITC said.

ITC reported a net profit growth of 10.4 per cent at Rs 2,635 crore in the December quarter against Rs 2,385 crore in the year-ago period, according to a story in the Business Standard on 22 January 2015

The below-par performance was a consequence of slow growth in the cigarette business. Revenue in ITC's cigarette segment grew 0.6 per cent year-on-year to Rs 4,142 crore. 

The Union Government in the 2014-15 Budget raised specific excise duty on cigarettes in the range of 11 to 72 per cent.

Kerala Government raised taxes of cigarettes by fifty per cent during the fiscal year 2014-15. From 20 per cent in 2013-14, cigarette taxes were raised to 22 per cent in the Kerala Budget 2014-15. In a mid-term post Budget revision, cigarette taxes were raised from 22 to 30 per cent in September 2014. 

Tobacco kills one million Indians every year and drains away Rs 104,500 crores as direct and indirect costs of treatment. 

The World Health Organisation has stated that increasing tobacco taxes is the most effective way to reduce consumption and save lives. It can also bring in much-needed resources to cash-starved economies. 
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Tuesday, 20 January 2015

COTPA (Amendment) Bill 2015: Slew of affirmative tobacco control measures

The war against tobacco has gained further vigour and momentum with the Ministry of Health and Family Welfare recently placing in the public domain a draft Bill that seeks to amend the provisions of the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003. 

Among the changes proposed, the one that will have an immediate and lasting impact on reducing tobacco consumption is the prohibition on using a “name or brand of tobacco products for marketing, promoting or advertising other goods, services and events”.

Falling within the ambit of indirect advertising, the use of a brand name of a tobacco product to market and advertise a non-tobacco product is a clear case of brand-sharing, which the WHO Framework Convention on Tobacco Control (FCTC) prohibits. 

Using the brand name of a tobacco product to market a non-tobacco product is a ploy that is routinely resorted to by companies to get round the ban on tobacco product advertising, which has been singularly responsible for the dramatic reduction in tobacco consumption in India and across the world. It is one of the changes that the government can easily implement and effectively enforce.

The draft Bill removes the ambiguity around point-of-sale display by banning the showcasing of tobacco products at the entrance to or inside a shop; it is in line with the FCTC recommendation to keep these products “out of public view”.

Displaying tobacco products prominently inside a shop is a “key means” to promote them. Besides effectively bypassing the ban on tobacco product advertising, it fuels impulse buying. While the prohibition can further reduce tobacco consumption, putting it into effect will be a major problem as tobacco products are sold predominantly at small shops. 

For the same reason, banning the sale of these products to anyone under the age of 21 can hardly be enforced. The very fact that 15- to 24-year-olds account for over 27 per cent of tobacco consumption in India clearly indicates that sale to those below 18 years, which is currently not allowed, is a reality. 

The outcome will be no different in the case of a ban on the sale of cigarettes or bidis in the loose. Since ensuring that users are forced to notice the pictorial warning and message on the packets is one of the main reasons for banning the sale of tobacco products except as a whole packet, the amendment, on paper, will have a significant impact, particularly on bidi-smokers.

Bidis constitute nearly 85 per cent of all tobacco smoked in India, involving mainly those in the lower economic stratum, on whom pictorial warnings could be expected to have the maximum impact.

Courtesy: The Hindu
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Friday, 9 January 2015

Governor sets agenda to monitor tobacco control measures in educational centres

His Excellency Governor of Kerala with Dr Paul Sebastian
Shri Justice (Retd) P. Sathasivam, Hon’ble Governor of Kerala, said that Tobacco control in campuses of higher learning will be made an item in the agenda at Vice Chancellors’ Meet held every quarter.

He said this during an interaction at Kerala Raj Bhavan with the activists of ‘Tobacco Free Kerala’ led by Dr Paul Sebastian, Director, Regional Cancer Centre and Vice Chairman of the Organisation.

Expressing concern at the growing affinity for tobacco products among youngsters and the increasing number of tobacco-induced cancers in Kerala, the Governor said that he will also direct the inclusion of tobacco control measures in campuses in Vice Chancellor’s monthly reports.

“Every month, Vice Chancellors send reports to me on any instances of sexual harassment, ragging and the like in campuses, action taken and steps planned for the future. Tobacco control measures in campuses too will be included in the monthly reports,” the Governor said. 

Dr Sebastian briefed the Governor about the extent of tobacco use and the harms it causes in Kerala. “An alarming 21.4 per cent of Kerala’s adults above 15 years use tobacco products in any form. Around 50,000 new cancer cases are detected every year, of which more than 40 per cent of cancers in males are tobacco-induced. The economic burden of tobacco use in Kerala is over Rs 1500 crore a year.”

Tobacco-induced cancer victims also shared their experiences with the Governor. Fisherman Saju K, a 34-year-old tobacco-induced oral cancer victim from Kollam recounted how he started smoking in his early 20s as a means to fight chill while fishing.

“Gradually, I was drawn to smoking and I would smoke cigarettes in addition to using smokeless tobacco products. Tobacco use made me an oral cancer patient that changed the course of my life forever,” Saju said.

The group requested the Hon’ble Governor’s intervention for strengthening tobacco control in educational institutions, particularly in centres of higher learning, and in mentoring and directing to sustainable completion the plan to make three districts of Kerala models in tobacco control by adhering to the provisions of the Indian tobacco control law COTPA, 2003.

With a view to creating replicable benchmarks in tobacco control for the rest of the state and the country to emulate, District Collectors of Trivandrum, Ernakulam and Kozhikode are driving efforts to make these model tobacco free COTPA compliant districts. Police, Health and Education Departments are supporting the District Collectors in this endeavour to improve Kerala’s public health through effective tobacco control. 

Shri S Jayaraj, State Coordinator, Tobacco Free Kerala was also present during the interaction. 
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Monday, 5 January 2015

Smoke-free regulations: Study finds crucial role of Government workers

Government workers play important roles in formulating, implementing and enforcing smoke-free regulations, reports a cross-sectional study conducted to assess factors associated with support for smoke-free policies among government workers in six Chinese cities.

The study called 'Factors associated with support for smoke-free policies among government workers in Six Chinese cities: a cross-sectional study' is the first to examine support for smoke-free settings among government workers, an important set of opinion leaders and a large segment of the working population in China.

Data were from an evaluation of the Tobacco Free Cities initiative of Emory University''s Global Health Institute - China Tobacco Control Partnership. As many as 6,646 workers in 160 government agencies in six Chinese cities completed self-administered surveys.

Over 90% felt that smoking should not be permitted in hospitals, elementary and middle schools, colleges, public transportation, religious sites, worksites or restaurants, found the study conducted to examine support for smoke-free settings among government workers from 160 agencies in six Chinese cities. 

Nine settings were examined, including colleges, hotels and religious sites which have not been examined in prior studies.

Levels of support for smoke-free public places typically vary by smoking status, knowledge about the harmfulness of SHS, and demographics. Levels of support also vary by the type of restriction. Knowledge about SHS was associated with increased support.

Data from the 2010 Global Adult Tobacco Survey documented that 52.5% of adult non-smokers were exposed to SHS daily in China and 72.4% were exposed in a typical week.


The study and the important role it assigns to Government workers has a bearing in Kerala where 41.8 per cent and 18.7 per cent of adults were exposed to second-hand smoke at home and in public places respectively, as per GATS. 

Around 92.6% of Kerala’s adults believe that exposure to smoke causes serious illness in non-smokers.

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Tuesday, 30 December 2014

Tobacco litter a challenge to a clean India: Environmental experts

Even as the Clean India campaign is making waves with both standalone and coordinated efforts in Kerala as across the country, acclaimed environmental experts  have called for no-holds-barred implementation of the ban on public smoking as a means to keep our cities, towns and villages clean and litter-free.

They contend that callously discarded cigarette stubs found abundantly in public places in violation of the smoking ban poses a challenge to dream of a clean India besides bringing the need for stricter implementation of laws to the fore.

Prof MK Prasad, noted environmental expert and educationist said, “While there are public discourses on the health impacts of tobacco use, its effect on the environment have come up for scant discussion in Kerala and India. Developed countries have woken up to this fact and have undertaken steps to identify the enormity of the problem. According to one estimate, the overall littering rate for cigarette butts in America is 65 per cent.”

“The non-biodegradable nature of cigarette butts, a hazardous solid waste, makes it a challenging area to address. The butts also contain dangerous chemicals such as cadmium, arsenic and lead. Stricter implementation of laws on public smoking will not only improve public health but also restrict the environmental damage caused from cigarette use,” Prof Prasad added.

A paper published in the International Journal of Environmental Research and Public Health cites that an estimated 1.69 billion pounds of butts are littered worldwide a year.

Adv. Harish Vasudevan, environmental law expert said, “Studies point out that tobacco refuse is a major source of litter on the planet. Filtered cigarettes offered as an alternative to reduce the amounts of nicotine and tar consumed are a mainstay with smokers now. Cigarette filters are made of cellulose acetate, a plastic slow to degrade.”

“Presence of cigarette stubs in public places provides cues for smoking. This major environmental and public health issue can be effectively controlled by implementing laws that prohibit smoking in public places. If sufficient multi-stakeholder efforts are not taken on time, it can pose a challenge to having a clean India,” Adv. Vasudevan added.

Indian tobacco control law COTPA, 2003 vide Section 4 prohibits smoking in all public places including public offices, educational institutions, public conveyances, restaurants, hotels, health institutions and all workplaces.

Highlighting how in-flight smoking has been effectively prohibited, Dr CN Mohanan, Retd., Scientist and Head, Environmental Sciences Division, Centre for Earth Science Studies here said that education, awareness generation and enforcement all have equal roles to play while addressing the cigarette litter issue.

“Policy backing, repetitive communication, and punishment for violators have made it possible to curb smoking during air travel. Similar measures will have to be taken to tackle cigarette littering in public places by enforcing laws against public smoking. Having a clean India is a collective dream; cigarette butt littering is something we cannot afford to ignore,” Dr Mohanan noted.

The Centre-State Rs 62,000 crore Clean India campaign launched by the Indian Prime Minister Shri Narendra Modi aims to accomplish the vision of a ‘Clean India’ by October 2, 2019. Among others, the campaign envisages cent per cent collection and scientific processing, disposal, reuse and recycling of solid waste.

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Thursday, 25 December 2014

Koolimadu: India's first tobacco free area

Even as dedicated efforts are on to make three districts of Kerala, viz., Trivandrum, Ernakulam and Kozhikode models in tobacco control by following the provisions laid out in Indian tobacco  control law, COTPA, 2003, here's an engaging story of Koolimadu in Kozhikode.

Reproducing the story carried by the India Today on 15 December 1996 that recounts how locals of Koolimadu turned their village into India's first tobacco free area.

While acknowledging that the current status of Koolimadu with regard to tobacco control has not been checked, the story is being carried here for the sheer energy it provides to Kerala's tobacco control efforts.

Weeding out tobacco
Inspired locals turn their village into India's first tobacco-free area

For most smokers, the statutory warning on cigarette packs means only puff and nonsense. But the 2,200 villagers of Koolimadu, 25 km from Kozhikode town, have taken it very seriously.

With the Kozhikode district administration declaring it tobacco-free, smoking has not just been banned in this tiny hamlet, you run the risk of being excommunicated for a day if you flout the ban.

At village gatherings now, tendrils of smoke curl up only from tea glasses. Wizened women no longer chew away at pukayila (tobacco leaves). And the village shops no longer stock the cigarettes or beedis that used to make them richer by about Rs.2,000 every day.

It was a death that sparked the campaign. In 1994, chain smoker Ahmed Kutty, 58, a regular at the popular village reading room, Akshara, died of cancer. And the founders of the reading room, E.A. Moideen and Kader, all smokers in arms, who learnt how cancer is linked to heavy smoking, decided to launch an anti-smoking movement in the village.

Says Kader, a smoker for 30 years: "Kutty's death came as a shock. His sudden demise, caused by smoking, was enough of a deterrent."

It wasn't easy. Die-hard smokers were initially not interested in a fresh lease of life just because it came smoke-free. And a lot of women - like Kader's compulsively pukayila-chewing mother, Ameena - felt they would much rather die than kick their addiction.

But the village elders, whose diktat runs in the 250-odd houses here, ensured that the campaign was a success. Explains Moideen: "We printed no-tobacco pledge cards and went to every house in the village and asked everyone to sign or put their thumb impression on them." Persuasion finally worked. As did Kutty's death.

The promise of a long, healthy life rather than a rasping early death was not enough to wean away smokers from their addiction for good. The supply had to be cut off at source. The campaigners approached the two village stores which sold about 300 packs of cigarettes and beedis every day and asked them not to replenish their stocks.

Says a shop owner, M. Khalil: "They bought whatever was there in the shop for Rs.300 and made a public bonfire. We thought we lost some good business but later realised that a healthy, smoke-free life is much more rewarding in the long run."

Next, the campaigners got in touch with the Kozhikode branch of the Nehru Yuva Kendra (NYK) - established by the Centre in November 1972, to mobilise rural youth for development work in villages - for guidelines on how to systematically eradicate tobacco from the villages.

Placards, festoons and banners ("Stop smoking, save family" and "Koolimadu is tobacco-free zone"), were put up. Banners at the village bus stop entreated travellers not to smoke while they were in the village.

Koolimadu residents who can't help lighting up risk being excommunicated for a day. But this punishment has not had to be enforced yet. 

The inveterate smoker, of course, has only to walk about a kilometre to either Nairkuzhi village in the north, Mavoor village in the south or the banks of the river Chaliyar in the south and east to enjoy a smoke.

This also means that the anti-tobacco campaign has not caught on in any of the other villages. Neither does the district administration have any plans to mobilise such campaigns elsewhere in the area.

But inside Koolimadu, smoking remains strictly a no-no. Says local civil engineer K. Abdullah, 29: "We have groups of youth to monitor the ban." Fortunately, according to Kozhikode NYK coordinator M. Anil Kumar, the punishment of being excommunicated for a day for defying the ban has not had to be enforced as yet.

Ultimately, the effort to banish tobacco may turn out to be the healthiest investment Koolimadu residents have made till now.

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