Saturday, 25 March 2017

Why smoking is still so widespread

MORE than 50 years after it became clear that smoking kills, the habit remains the leading preventable cause of death, with an annual toll of nearly 6m lives. A study published this week in the Lancet, a medical journal, helps to explain why it is so enduring.

The study examined the link between smoking prevalence and measures to curb it in 126 countries. The authors considered five measures: taxation to raise cigarette prices, smoke-free places, cessation programmes, warning labels on cigarette packs and bans on tobacco advertising. 

They took stock of the countries which, between 2007 and 2014, had introduced these measures at the level of stringency recommended by the World Health Organisation (WHO). It advises, for example, that taxes comprise at least 75% of the retail price of the most popular brands of cigarettes, and that countries ban all forms of advertising, including billboards, promotional discounts and sponsorship of events by tobacco companies.

Countries that introduced more measures had greater declines in smoking between 2005 and 2015. In a country that introduced three such measures, for example, the number of smokers shrunk on average by about a fifth. 

But the vast majority of countries have a long way to go. During the ten years the study considered, the average country saw only a modest reduction in smoking prevalence, from 25% to 22%. In 2014 each measure was in place in its strictest form in only about a quarter of countries or fewer. Turkey was the sole country to have followed the WHO's recommendations on all five measures. A policy of high taxation, the most effective way to reduce smoking quickly (especially in poor countries), is mostly limited to Europe. Few countries in Africa and the Middle East have instituted any of the five measures with the strictness demanded by the WHO. These two regions are home to 22 of the 24 countries in the study where smoking is on the rise.

The battle against smoking is far from being won. The Lancet study makes it clear that the governments of countries where smoking is still popular largely have themselves to blame.

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Friday, 24 March 2017

Let's unite for 100 per cent tobacco smoke-free environments


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Create 100 per cent tobacco smoke-free environments to end TB, say experts

As the world 'unites to end TB' on World TB Day, March 24, like-minded bodies in Kerala have come together to strongly pitch for 100 percent tobacco smoke-free public places.

The Indian Chest Society, South Zone; TB Association of Kerala and Tobacco Free Kerala call for both individual and collective tobacco control measures to wipe out drug-resistant tuberculosis.

The WHO attributes 40 per cent of the TB burden in India to smoking.  Studies have also shown that people who smoke have approximately twice the risk of tuberculosis and thrice the risk of tuberculosis infection.  

Dr. DJ Christopher, Chairperson, Southern Region, Indian Chest Society is vocal in calling for coordinated efforts to achieve 100 per cent tobacco smoke-free public places to protect lung health. 

“Over the years, Kerala has made great strides in curtailing smoking in public places. The next step forward is to work towards public places that are 100 per cent smoke-free as mandated by the WHO. Such a measure would greatly contribute to overcoming the scourge of TB in Kerala. Kerala with is high literacy rate is in the best position to show the way for the rest of the country,” 

“It is not very widely known that tobacco smoking increases risk of developing TB disease and smokers has worse disease and lung damage and respond to treatment poorly when compared to non-smokers. Even after successfully being cured from TB, the risk of the disease recurring in twice as high. It is important to understand and propagate the message about this lethal effect of tobacco as we observe the world TB day,” Dr Christopher, also the Prof & Head, Pulmonary Medicine, Christian Medical College, Vellore said.

“Studies have also shown that second hand smoke may increase susceptibility to the conditions such as cancers and chronic obstructive pulmonary disease (COPD). Children are particularly vulnerable and become more prone to respiratory infections and wheezing,” Dr Christopher added.  

Dr M Sunil Kumar, Honorary Secretary, TB Association of Kerala said, “General symptoms of TB include fever, cough with sputum or blood stained, loss of weight and evening rise of temperature. It goes beyond doubt that smoking aggravates TB symptoms and hence a patient should not smoke. At the individual level, every possible effort should be made to stop smoking to protect oneself from TB.”

According to the latest published figures of the Government of India’s Revised National Tuberculosis Control Programme, as many as 14,147 persons in Kerala were diagnosed with TB, and 22,785 patients registered for treatment in 2015.

Dr AS Pradeep Kumar, former Addl Director of Health Services and Advisor, Tobacco Free Kerala, citing a study conducted in Chennai said, “50 percent of deaths among male TB patients in India were among smokers.”

Explaining the concept of 100 per cent tobacco smoke-free, Dr Pradeep Kumar said, “It involves creating an environment where tobacco smoke cannot be seen, smelled, sensed, or measured. Presence of cigarette/bidi butts or ash would also not make an area 100 per cent smoke-free.”

Smoking aids such as ashtrays, matchboxes or lighters in the public place are in violation of Section 4 of Indian tobacco control law COTPA, 2003. Warning signages prohibiting smoking in a public place should be put up in accordance with size and colour dimensions prescribed by the Act, Dr Pradeep Kumar pointed out. 
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Monday, 20 March 2017

Tobacco use triggers multimorbidity among the elderly, says a study

Tobacco use is responsible for causing more than one health condition or multimorbidity among the elderly, thereby accentuating the burden by non-communicable diseases in Kerala, a new study reveals.
The seven-state study, published in a recent edition of BMJ Open (a leading online, open access journal on medical research), has brought out that Kerala has the highest prevalence of high blood pressure, diabetes and heart disease. 

A high 45.5 per cent of 9,852 adults aged 60 or more were found to be an ‘ever tobacco user’ or those who had used tobacco at least once in their lifetime, found the study conducted using data collected by the United Nations Population Fund.

Hospitalisations within one year due to chronic non-communicable diseases (NCDs) were higher among ever tobacco users as against non-users, the study points out.

The study considered 12 NCDs such as arthritis, high-blood pressure, cataract, diabetes, lung disease, heart disease, paralysis, depression, Alzheimer’s disease, stroke, dementia and cancer.  The study defines multimorbidity as the co-existence of at least two of these 12 selected NCDs in the same person.

Researchers attached to Achutha Menon Centre for Health Science Studies of Sree Chitra Institute of Medical Sciences and Technology here and Centre for Public Health, Amrita Institute of Medical Sciences, Kochi carried out the study. 

Titled ‘Pattern, correlates and implications of non-communicable disease multi-morbidity among older adults in selected Indian states: a cross-sectional study’, its aim was to estimate the proportion of older adults with multi-morbidity, its correlates and implications.

Dr KR Thankappan, Principal investigator of the study and Professor and Head of Achutha Menon Centre, said, “Tobacco-induced morbidity and multimorbidity is preventable through adequate tobacco control interventions. Through tobacco control, the physical and financial burden caused by non-communicable diseases in Kerala can be brought down to a large extent.” 

Citing an earlier study, Dr Thankappan, who is also the Vice Chairman of Tobacco Free Kerala, said, “The economic burden on tobacco-induced diseases is Rs 1514 crore a year in Kerala; this is massive draining away of productive resources. Mainstreaming supply and demand reduction of tobacco in policy discourse and heightened enforcement to prevent youth initiation has become highly imperative.”

Dr GK Mini, Assistant Professor, Centre for Public Health, Amrita Institute, and principal author of the study, said, “Tobacco being a highly addictive substance, the key is to prevent initiation. Our educational institutions have to be made tobacco-free, both in letter and spirit.”

Other than Kerala, Tamil Nadu, Punjab, Himachal Pradesh, Maharasthra, Odisha and West Bengal were included in the study. From each state, 1,280 households with older adults were selected. The sample covered 47 per cent men with a mean age of 68 years. 
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Thursday, 16 March 2017

Provision requiring license to sell tobacco products comes into force in Nepal

The government of Nepal has enforced the provision of acquiring a license to sell tobacco and tobacco products.

The meeting of the Council of Ministers on January 19 took the decision by endorsing a proposal presented by the Ministry of Health informing the government about adverse impact of the consumption of tobacco and tobacco products on people's health.

Article 11(6) of Tobacco Product (Control and Regulatory) Act-2011 provides a legal ground for the government to enforce the provision of a license for selling tobacco products and the January 19 decision had come based on the same ground. The Article 11(6) states that Government of Nepal may, if it deems necessary, make provisions of license for sale and distribution of tobacco products.

Now the provision is in place that the registration of tobacco business shall be done in an authority concerned, a separate license from the Inland Revenue Office shall be obtained to sell tobacco products and there shall be a separate outlet for sale and distribution of tobacco products, Raju Katuwal, legal advisor to the Health Minister, said.

Anyone found violating the provision shall be punished as per the Act, the Ministry said.

Tobacco retailers should place a clearly visible and readable notice in front of the shop to inform the public about the legal provision that no person shall be allowed to sell and distribute tobacco products to a person below the age of 18 and to the pregnant woman, and no person below the age of 18 and pregnant woman shall be made to sell and distribute tobacco products.

With the enforcement of the government decision, sale of tobacco products from grocery stores has been banned and the government has assigned the Assistant Chief District Officer to monitor in this regard in every district. The Ministry was receiving public complaints that an unchecked sale of various forms of tobacco products (Bidi, Tamakhu, Sulfa, Kakkad, Kachha Surti, Khaini and Gutkha), cigarette and cigar stick has caused adverse impact on the public health, mainly of women and children.

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Monday, 13 March 2017

The Global Economic Burden of Tobacco: An Interview with Dr. Mark Parascandola

NCI recently released The Economics of Tobacco and Tobacco Control, the latest in a series of monographs on tobacco use and tobacco control. Produced in collaboration with the World Health Organization, the new report examines the current research surrounding the economics of tobacco control in many countries around the world.
In this interview, Mark Parascandola, Ph.D., of NCI’s Tobacco Control Research Branch, discusses the findings.

How is this report different from others in the series of monographs on tobacco control?
The NCI Tobacco Control Monograph series aims to provide ongoing and timely information about emerging public health issues in smoking and tobacco use control. This particular monograph is the first in the series to focus entirely on tobacco control from an economic perspective. Additionally, while some of our previous monographs focus primarily on data and experience from the United States, this report, completed in collaboration with the World Health Organization (WHO), takes a global perspective.

Economic tools can be applied to tobacco control in a variety of ways. For instance, researchers can assess the impact of tax and price on tobacco use, measure the economic costs of tobacco use, characterize the manufacturing and trade of tobacco products, and consider how information and tobacco control policies influence consumer demand for tobacco products.

What are the economic costs of tobacco use around the world?
The report found that the use of tobacco burdens economies with more than US$1 trillion annually in health care costs and lost productivity. In addition to early death, tobacco users are more likely to suffer from debilitating diseases that may prevent them from working, as well as burdening family members and other caregivers. We also found that among poor households, tobacco use can exacerbate poverty by increasing health care costs, reducing incomes, and decreasing productivity, as well as by diverting limited family resources away from basic needs.

Are there any negative economic effects from reducing tobacco use, such as reduced income for tobacco farmers?
The report found that, overall, tobacco control does not harm economies. The number of jobs dependent on tobacco has already been falling in most countries, largely due to technological innovation, and for most countries tobacco control measures will have only a modest impact on employment. Additionally, there is now a large body of evidence from many countries demonstrating that smokefree policies do not adversely affect hospitality businesses, such as bars and restaurants.

Where do most of the world’s current smokers live?
There are an estimated 1.1 billion tobacco smokers aged 15 years or older worldwide, and 80% of them live in low- and middle-income countries‎. Due to its large population and smoking prevalence, China accounts for 40% of the world’s cigarette consumption. But Russia, the United States, and Indonesia are also relatively high tobacco consumers.

Has there been progress in reducing tobacco use globally over the past decade?
One of the major conclusions of this report is that progress is being made in controlling the global tobacco epidemic. In high-income countries like the United States, this progress has been going on over several decades. But in recent years, following the WHO Framework Convention on Tobacco ControlExit Disclaimer, many low- and middle-income countries have also been implementing effective tobacco control measures.

Are there effective interventions available now to reduce tobacco use and the harmful effects of tobacco use?
Yes. Research from around the world has demonstrated the effectiveness of evidence-based interventions to reduce tobacco use, including significant tobacco tax and price increases, comprehensive bans on tobacco industry marketing, prominent pictorial health-warning labels, smokefree policies, and cessation programs. Additionally, research demonstrates that these interventions are highly cost effective.

However, these interventions remain underutilized. Global tobacco excise taxes generated nearly US$269 billion in government revenues in 2013-2014, yet governments spent less than US$1 billion during that period on tobacco control.

What did you learn by including data on low- and middle-income countries in this report?
One of the major contributions of this report was to analyze recent data‎ from low- and middle-income countries in addition to data from high-income countries. Interestingly, we found that certain tobacco-control tools, such as raising taxes on tobacco products, can be just as effective in low- and middle-income countries as they are in high-income countries.

What areas of new research are needed?
While there are effective interventions to reduce tobacco use, ongoing research is needed to further understand the economics of tobacco control, particularly in low- and middle-income countries. Key priorities include further research on the effects of tobacco taxation and pricing, on interrelationships between tobacco use and poverty, on illicit trade, on economically viable alternatives to tobacco growing and manufacturing, and on the implementation and evaluation of the WHO Framework Convention on Tobacco Control.

Is there a take-home message from this report?
Above all, the research summarized in this monograph confirms that evidence-based tobacco control interventions make sense from an economic as well as a public health standpoint. Concerns that tobacco control will have adverse economic effects are not supported by the evidence. Given the enormous health and economic consequences of tobacco use and the rapidly evolving global market for tobacco, these interventions are needed now more urgently than ever.

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Tuesday, 7 March 2017

Call for a separate head of account for tobacco control fines

As fines collected for violations of Indian tobacco control law COTPA, 2003 exceed Rs four crore in 2016; strong voices have emerged in favour of creating a dedicated head of account to deposit the amounts in the Government Treasury to strengthen measures for dealing with the worrisome health menace. 

Currently, COTPA fine amounts are deposited in the miscellaneous account of the State Government Treasury. 

Advocates of public health are also vocal in asking for allocating a portion of the fine amounts for strengthening tobacco control in the wake of increasing and worrying incidence of tobacco use among youngsters in the state. 

COTPA fines for the period January-December 2016, according to the official website of Kerala Police, amounted to Rs 4.38 crores, representing a 31 per cent increase over the corresponding period in 2015, during which the fine for violation of tobacco control laws was Rs 3.33 crore. 

The Excise and Health Departments are also very active in safeguarding public health through strict enforcement of the COTPA, 2003. 

Dr Sunil Mani, Professor and Director, Centre for Development Studies, Trivandrum, said, “A separate head of account will create administrative ease for enforcement officials to deposit COTPA fine amounts and enable the government to keep track of the amounts collected under this head. Such a system will also facilitate mechanisms wherein these funds can be used to reduce the economic burden of tobacco-related diseases and enhance public health in the state.” 

Dr AS Pradeep Kumar, former Addl Director of Health Services and former Tobacco Control Nodal Officer who has been making a sustained campaign in this regard, said, “Recent accounts of tobacco use initiation at the young age of 15 are startling and disturbing. Utilising a major portion of the fine amounts collected will be beneficial in strengthening various tobacco control efforts in the state.”

Along with law implementation and enforcement, widespread and targeted mass media efforts and cessation clinics are needed to rein in the tobacco epidemic in Kerala, he noted. 

Details of persons fined, and fine amounts collected by the Kerala Police under COTPA from October 2012 to December 2016, are available at http://www.keralapolice.gov.in/public-information/crime-statistics/cotpa-violations.
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Tuesday, 28 February 2017

Smoking Ban In Public Places May Help Improve Health

Researchers have found evidence that a ban on smoking in public places could be an effective measure to reduce exposure to second-hand smoke which has long been associated with negative health effects.

"The study findings highlight the impact of smoke-free policies, which contradict the hypothesis driven by the tobacco industry that smoke-free legislation merely displace smoking from public to private places," said lead author Esteve Fernandez of the Catalan Institute of Oncology in Spain.

The study of second-hand smoke exposure after two smoking bans in Spain showed that overall exposure can be decreased across all settings by comprehensive legislative efforts.

The researchers reviewed approximately 2,500 adult non-smokers' self-reported rates of tobacco smoke exposure in several public and private settings following smoking bans in 2006 and 2011.

While the 2006 smoking ban prohibited smoking in enclosed public places and workplaces (except in hospitality venues), in 2011, it was extended to all hospitality venues and selected outdoor areas (hospital campuses, educational centres, and playgrounds).

The survey results, published in the journal Nicotine & Tobacco Research, showed significantly lower exposure following the second legislation, with participants reporting their overall exposure falling from 72 per cent in 2006 to 45 per cent in 2011.

Exposure decreased across all locations surveyed, beyond the workplaces and hospitality settings covered by the 2011 legislation.

For example, exposure also decreased in residences from 29 per cent to 13 per cent and in transportation spaces from 41 per cent to 13 per cent.

"Exposure to second-hand smoke in selected outdoor settings may be further reduced by extending smoke-free legislation," said senior author Maria J. Lopez of the Public Health Agency of Barcelona, Spain.

Source: News18
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Thursday, 23 February 2017

This 70-Year-Old Lost Her Voice Box to Throat Cancer, but Continues to Inspire Hundreds

Diagnosed with vocal chord cancer in early 2010, Nalini Satyanarayan underwent a surgery successfully in April 2010 and took radiation therapy subsequently. But due to the location of the cancer, they had to remove her voice box, and she was fitted with a provox prosthesis during surgery. The prosthesis is a valve between the food pipe and the wind pipe. It helps one to speak by modulation of air. The international varieties of the prosthesis cost anywhere between ₹20,000 – 30,000. Currently Nalini uses the AUM prosthesis developed by an Indian oncologist, costing only ₹50.

Nalini’s husband was a heavy smoker (making her an inadvertent passive smoker) who passed away due to cardiac ailments before her cancer was diagnosed. Despite the harrowing experience of conquering cancer, she very soon bounced back to a new normal life with confidence and determination.

Fortunately enough, her son, daughter, and grandchildren stood by her in this difficult time and are supportive till date, encouraging her each step of the way.

Tobacco use kills around 6 million people globally each year, of which almost 1 million people are from our country alone. In India, the economic burden of tobacco-related diseases was ₹1,40,500 crore for the year 2011-12, which is about 1.16 % of our GDP, and 12 % more than the combined State and Central Government expenditure on health in the same year.

It is unfortunate that innocent family members are subjected to the harms of tobacco apart from the user, who might or might not make an informed choice. Second-hand smoke is the combined mix of the smoke that comes from burning tobacco products such as cigarettes, beedis, cigars etc., and the smoke exhaled by the smoker. Studies have found this second-hand to contain more than 7,000 chemicals, of which 250 are harmful, and at least 69 are carcinogenic. Globally, about 6,00,000 deaths are due to exposure to second-hand smoke.

This smoke leads to a variety of ailments including cancers, heart and respiratory diseases, strokes, etc.

The above statistics do not convey the emotional suffering caused by tobacco use. Apart from the economic and financial impacts, tobacco cultivation also has significant environmental impacts, leading to large amounts of deforestation. Curing a kilogram of tobacco leaves requires 7-8 kg. of wood, and causes nutrient depletion in the soil.

Since her recovery, Nalini has reached out to as many individuals as possible, spreading the word on cancer prevention. She volunteers for trainings conducted on tobacco control for children, law enforcers, and other relevant audiences. She also counsels patients recovering from surgeries similar to hers who have lost voices and are learning to speak again.

Nalini helps them navigate this crucial time by instilling confidence in them and being a true role model.

Nalini is a proud member of the Voice of Tobacco Victims, and the Pink Hope Support Group in HCG Global. Able to reach out to fellow survivors, she helps cancer patients lead a life of hope after the treatment. She is also a member of the University Women’s Association. She runs two hostels for girls and women from rural areas who come to the city to study or work.

Very few victims of tobacco-related illnesses come back to mainstream society after undergoing disfiguring surgeries. Life has given Nalini a second chance, and she has grabbed it with both hands, becoming an inspiration for many. The Institute of Public Health is proud to associate with volunteers like her. These volunteers lend themselves to the cause of cancer prevention, protecting lakhs of young productive lives from this deadly addiction.

Cooking, cleaning, gardening, using public transport, inspiring children, sensitizing officials, or addressing the media—Nalini does it all with flair. She truly lives up to her motto, “Learn from yesterday, live for today, and hope for tomorrow!”

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