Saturday, 30 July 2016

India to host international summit on tobacco-control

India will host a crucial global summit in November to eliminate the illicit trade of tobacco products in which delegates from 180 countries will take part. 

"India is hosting the 7th session of the Conference of the Parties (COP7) to the WHO Framework Convention on Tobacco Control (WHO-FCTC)," Minister of State for Health Anupriya Patel said in a written reply to a question in the Lok Sabha.

She said the summit scheduled from November 7-12 at the Indian Exposition Mart in Noida will aim "to eliminate illicit trade of tobacco products." 

About 1,000-1,500 delegates from 180 countries along with observers in official relations with the WHO FCTC are expected to participate in the summit, Patel said. 

"India has ratified FCTC in 2004 and is a party to it." 

Patel, however, said that no decision has been taken yet on the composition of the Indian delegation for the event. 

Replying to another question, she said according to the Indian Council of Medical Research - National Cancer Registry data, the estimated number of cancer cases in the country stood at 14.5 lakh in 2016. 

Based on this report, the percentage of tobacco-related cancers is 43.8 among males, 16.0 among females and 30.1 of the population as a whole, she said. 

Patel said generating awareness on harmful effects of tobacco use is the key national and state-level activity under the National Tobacco Control Programme.

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Saturday, 23 July 2016

Teens switching to bidis: Report

Nineteen per cent boys and eight per cent girls in the age group of 13-15 have used tobacco products in recent months, mostly in the form of non-commercially produced cigarettes such as bidis, hand-rolled cigarettes made of unprocessed tobacco wrapped in leaves, said a report.

According to the report by the Population Reference Bureau, the usage of such products has prevailed because they are relatively affordable, poorly regulated and easily obtained from street vendors and kiosks.

"Smokeless tobacco products and snuff are commonly used in some places are used more than cigarettes.The rising popularity of e-cigarettes is another concern, as these do not produce tobacco smoke but may still contain nicotine and other harmful substances. These devices are marketed to youth and are easily available online," said the report.

"Myriad varieties in which tobacco is available in Asia, makes tobacco a very versatile product for adolescent and young people. Easy access to unregulated products like e-cigarettes and hukkah further exacerbates their vulnerability, said Monika Arora, Director, Health Promotion Division and Associate Professor, Public Health Foundation of India (PHFI).

According to Arora, India needs to step up enforcement of tobacco control policies to provide full protection to young people and introduce innovative prevention and cessation solutions to meet one of the NCD targets of 30 per cent reduction in tobacco use prevalence by 2025 that the country has adopted.

The report named "Addressing Non Communicable Disease Risk Factors Among Young People: Asia's Window of Opportunity to Curb a Growing Epidemic" also poured light on the four main Non Communicable Diseases- cardiovascular diseases (CVDs), chronic respiratory diseases, diabetes, and cancers -- are caused primarily by exposure to tobacco, harmful use of alcohol, unhealthy diet, and too little exercise.

These behaviours often begin in adolescence or young adulthood and set the stage for NCDs later in life.

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Saturday, 9 July 2016

Pictorial warnings more effective, says study

A study published in a medical journal finds that pictorial warnings are more effective than text-only messages in tobacco products. The study, which had more than 2,000 respondents, was done to gauge the perceived effectiveness of text and pictorial health warnings for smokeless tobacco packages and was conducted in Navi Mumbai and Dhaka.

The experimental study by Tobacco Control, an international peer-reviewed journal for health professionals and others, involved adult smokeless tobacco users aged over 19 and non-users. During the study, the respondents viewed warnings depicting five health effects in text-only, symbolic pictorial, graphical pictorial and personal testimonials formats.

"We have found that text-only warning were perceived as less effective than the pictorial styles. Graphic warnings were given higher effectiveness ratings than symbolic or testimonial warnings," said PC Gupta, Healis-Sekhsaria Institute for Public Health, one of the co-authors.

Interestingly, WHO has been advocating countries to adopt plain packaging with pictorial warnings to reduce tobacco consumption across the world. It had taken it up as a theme for 'World No Tobacco Day'.

This idea was successfully implemented by Australia in 2012 and, according to WHO, it has shown positive results. Presently, in India, pictorial warning is compulsory on 85% of the packet.

"Tobacco is the only consumer product that has no good use whatsoever apart of killing every third consumer. Tobacco is attributable cause of 50% cancers in India and majority of lung or heart diseases. Pictorial warnings is very effective and plain packaging is the need of the hour," said Dr Pankaj Chaturvedi, professor, head and neck surgeon, Tata Memorial Hospital.

According to WHO, the plain packaging is an important demand reduction measure that lessens the attractiveness of tobacco products, restricts the use of packaging as a form of tobacco advertising and promotion, limits misleading packaging and labelling, and increases the effectiveness of health warnings.

India is ranked at 136 among 198 countries in terms of prominence of pictorial health warnings on tobacco packaging and is ranked much below countries like Pakistan, Bangladesh, Nepal, Thailand etc., having higher proportion of pack warnings on the principal display areas of the tobacco packs.

Health experts also say that apart from emphasising on plain packaging with pictorial warnings on tobacco products, there should also be a robust tobacco cessation programmes. "90% of the people are aware that tobacco is harmful but they do not know how to quit it. We need a robust tobacco cessation programs in our government hospitals. In abroad, many countries like South Korea and Japan have started tobacco cessation programs to help their citizens quit tobacco," said Dr Lancelot Pinto, consultant respirologist at Hinduja Hospital.

What is plain packaging?
A generic, standardised or homogeneous packaging, refers to packaging that requires the removal of all branding (colour, imagery, corporate logo and trademarks). Permitting manufacturers to print only the brand name in a mandated size, font and place on the pack, in addition to the health warnings and any other legally mandated information such as toxic constituents and tax-paid stamp.

Source: DNA
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Friday, 24 June 2016

Smoking May Have Negative Effects On Sperm Quality: Study

Men, take note! Cigarette smoking may significantly damage the DNA of your sperm and affect fertility as compared to non-smokers, a new study has warned.

Researchers also assessed 422 proteins in participants' sperm. One protein was absent, 27 proteins were under-represented, and 6 proteins were over-represented in smokers.

Analyses of these proteins suggest that cigarette smoking may promote an inflammatory response in the male reproductive tract.

The study published in the journal BJU International included 20 non-smoking men and 20 men who smoked.

"More and more studies are demonstrating a harmful effect of smoking on male fertility," said Dr Ricardo Pimenta Bertolla, senior author of the study.

"Our results point in the direction of important semen alterations: semen of smokers presents an inflammatory nature, associated with decreased capacity of sperm to achieve fertilisation and generate a healthy pregnancy," said Mr Bertolla.

"It is especially noteworthy that, in our study, sperm DNA fragmentation was increased. Other studies have proposed this to be a potentially promutagenic effect, which is to say that sperm with altered DNA may lead to health problems in the offspring," Mr Bertolla said.

Source: NDTV

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Tuesday, 14 June 2016

From a smoker to a smokeless tobacco user: Study

Even as the state and the country is preparing for the next round of the Global Adult Tobacco Survey (GATS), a recent study based on the current edition of this globally followed survey has found that switching to equally harmful smokeless tobacco use is the most common smoking cessation method.

The study by Achutha Menon Centre for Health Science Studies of Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum shows that more than a third of the former smokers in India reported switching to smokeless tobacco for quitting smoking. The study has been published in a recent edition of the international peer-reviewed journal ‘Public Health’.

GATS 2009-10 posed a question to all 2035 successful quitters on the method they used for cessation. Among the options given to the respondents were smoking cessation clinic; nicotine replacement therapy; a quit line or a smoking telephone support line; and switching to smokeless tobacco. The majority 44.4 per cent of total successful quitters including 50.8 per cent men and 8.7 women reported switching to smokeless tobacco use. 

The GATS was conducted covering all the 29 states and two union territories in the country. This nationally representative household survey covered 69,296 individuals aged 15 years and above using a standardised methodology.

Highlighting the policy implications, Dr KR Thankappan, Prof and Head, Achutha Menon Centre and principal researcher of the study said, “Switching to smokeless tobacco is not a safer option as it is equally harmful as smoking. Coordinated measures including high levels of taxation on all tobacco products, strict enforcement of 85 per cent graphic warnings, and concerted awareness generation on harms of smokeless tobacco products is very important.”

Specifically for Kerala, he called for strict enforcement of the ban on pan masala and gutkha containing tobacco or nicotine, steps to combat smuggling of these products and targeted awareness building for the migrant population who are among the prime users of smokeless tobacco products.

Senior Project Fellow, Achutha Menon Centre and co-author of the study Dr GK Mini said, “Across the country, smokeless tobacco use surpasses smoking. If switching over is also added, the disease burden from smokeless tobacco use will be compounded. Studies have shown that smokeless tobacco users have a more than three-fold higher risk for cancer.”

As per GATS 2009-10, the number of adult current users of smokeless tobacco in India is 206.0 million, much higher than the number of current tobacco smokers of 111.2 million.

GATS is conducted once in five years; the next round is slated for 2016-17. In India, it is conducted under the coordination of the Union Ministry of Health & Family Welfare with technical assistance from the World Health Organisation.
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Wednesday, 1 June 2016

Government for stringent action against substances harming humans: Kerala Health Minister

The Government will take strong action against substances such as tobacco, alcohol or other drugs that cause harm to the human body. Concerted action will be taken up against tobacco and drug use, said Hon’ble Minister for Health and Family Welfare Smt KK Shyalaja while inaugurating the World No Tobacco Day observance event here today.

The Health Minister, formerly a teacher, expressed concerns over the increasing availability of pan masala and other drugs in the form of candies near educational institutions. She called upon all enforcement agencies to identify the availability of these products and initiate stringent action.

In his presidential address, Hon’ble Minister for Electricity & Devaswom Shri Kadakampally Surendran said that schools and colleges are continuing to be centres of easy availability of pan masala, tobacco products and other drugs. “Continued efforts are needed with the support of civil society to achieve success in reining tobacco use in our state,” he added.

Director, Subhodham, Government of Kerala Dr K Ambady who delivered the keynote address said that collective and coordinated action that hinges on a three-pronged approach including supply, demand and harm reduction strategies are required for bringing down use of tobacco, alcohol and other drugs.

Dr Paul Sebastian, Director, Regional Cancer Centre (RCC), while delivering the welcome address said there is a need for generating awareness against tobacco harms in youngsters between the ages of 10 and 20 years. “Youngsters should be made ambassadors for propagating tobacco harms leading to the creation of a tobacco free society,” he added.

The Health Minister also gave away the media award for best article on cancer instituted to Regional Cancer Association (RCA) to Shri Santhosh Sisupalan, Senior Sub Editor, ‘Manorama Arogyam’. TKM Arts and Science College, Kollam won the award for the best cancer detection camp held in association with NSS volunteers.

Dr R Ramesh, Director of Health Services (DHS); Dr KR Thankappan, Prof and Head, Achutha Menon Centre for Health Science Studies of SCTIMST; Shri Johnson J Edayaranmula, Director, ADIC-India and Hon.Advisor, Subhodham and Dr Babu Mathew, Hon.Secretary, RCA also spoke in the inaugural session.

The importance of advocacy for tobacco control came to the fore as Dr Babu Mathew spoke on the topic "Battle against tobacco - the RCC experience”. Dr KR Thankappan while speaking on the “Relevance of tobacco cessation programmes in India” said both prevention and control are needed to address tobacco, a silent killer.

Dr. AS Pradeep Kumar, Former Addl.DHS & Senior Research Officer, Achutha Menon Centre for Health Sciences Studies apprised participants on “Legal aspects of tobacco control” by highlighting various sections of Indian tobacco control law COTPA, 2003.

A panel discussion on the topic “Towards Tobacco Free Educational Institutions in Kerala – Experiences, Challenges & Plans Ahead” and ensuing discussions witnessed thoughts on the need for self-control, role of students and peers in curbing tobacco use in schools, counseling students with love and care and migrants as suppliers of these products.

Dr Bipin Gopal, Assistant Director of Health Services and State Nodal Officer, NTCP and NCD; Dr Binoy S Babu, Junior Administrative Officer, DHS; Smt Anila George, Joint Director (Academic), DPI; Shri Saju Itty, Executive Director, Kerala Voluntary Health Services and Shri S Jayaraj, State Coordinator, Tobacco Free Kerala spoke. Shri Surendran Chunakara, PRO, RCC moderated the discussion.

Dr R Jayakrishnan, RCC made the closing remarks in the function in which School Health Nurses, Student Police Cadets, NCC cadets and NSS volunteers were present. 
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Monday, 30 May 2016

Get ready for plain packaging of tobacco products

Following Australia’s example, for this year's World No Tobacco Day on May 31 the World Health Organisation is calling on countries to “get ready for plain packaging of tobacco products”. Plain packaging refers to “measures to restrict or prohibit the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and font style (plain packaging)”.

Against all odds, Australia was the first country to successfully introduce plain packaging in 2012 and has since seen a decline in smoking.

The WHO’s call for action comes at a time when the tide is firmly turning against the tobacco companies. For instance, during the first week of May this year, the tobacco companies lost a long-run legal challenge against the European Union rules that force them to print graphic images on both sides that cover two-thirds of a cigarette packet.

It didn’t stop there. The Court said that the 28 member states can go beyond the requirements of the European directive and introduce plain packaging. According to a May 28 editorial in The Lancet, the European Court of Justice said last month that the new EU law on plain packaging was legal.

France, Ireland, and the U.K. have passed legislation that makes plain packaging mandatory from May 20 this year. All cigarette packets manufactured in these countries will have to be plain, standardised in the same drab green colour with the product name on the pack in a standard font.

Encouraging results
A little more than three years after Australia introduced plain packaging, and on the eve of the introduction of plain packaging in the U.K., Australia has reported that its plain packaging experiment is working well.

A post-implementation report published in February this year by Australia said: “The measure has begun to achieve its public health objectives of reducing smoking and exposure to tobacco smoke in Australia and it is expected to continue to do so into the future.”

Between December 2012 and September 2015, plain packaging together with enlarged graphic warnings and 25 per cent tax increase since 2010 reduced average smoking prevalence among Australians aged 14 years and over by 0.55 percentage points. This reduction is would result in at least 118,000 fewer smokers.

Also, experimental studies, surveys and focus group studies have also found that plain packaging achieves its objectives — deter young people from taking up smoking in the first place than making smokers to quit.

“Tobacco packaging is a mobile billboard promoting consumption of tobacco products. Tobacco packaging makes products more attractive, advertises and promotes tobacco consumption, distracts from health warnings and deceives people into thinking that some products are less harmful than others,” notes the WHO in a recently published report.

“If you strip back the decoration, gloss and misleading elements of tobacco packaging, you are left with little more than a box of deadly and addictive products that kills approximately 6 million people a year and harms the health of many more. Plain packaging helps reveal the grim reality of tobacco products,” the WHO report adds.

Uneven success
Although some countries have successfully taken on the Big Tobacco by introducing plain packaging, globally tobacco control has been very uneven. The “least compliant countries are often the ones with the highest rates of tobacco use,” notes the editorial. Hence it wants the global community to “remain vigilant to ensure a robust and even implementation of strategy across all countries”.

For instance, in the case of India, small and locally produced bidis are being displaced by cheap manufactured cigarettes, says a March 14, 2015 paper in The Lancet.

Despite tremendous pressure from tobacco companies India stood its ground by introducing pictorial warning covering 85 per cent of the front and back sides of all tobacco products. The next step for India should be to go in for plain packaging.

There is every reason for India to introduce plain packaging as nearly 1 million people die each year due to tobacco-related diseases. And like Australia, the taxes should be raised steeply to deter young people from smoking and chewing tobacco products.

Australia has reported that its plain packaging experiment is working well.

Source: The Hindu

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Tuesday, 24 May 2016

States told to withdraw tobacco packs without 85 per cent pictorial warning

The Centre has set May 31 deadline for the States and Union Territories to withdraw from the market tobacco products whose 85 per cent packaging space is not covered with pictorial warning.

A communiqué from the Tobacco Control Division of Union Ministry of Health and Family Welfare, New Delhi, dated May 20, 2015, has requested the Chief Secretaries of all States and Union Territories to take steps for strict enforcement of the new rules on pictorial warnings.

The Pictorial Warning Rules under Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA) 2003 had come into force from April 1, 2016. The communiqué said that packages not compliant with the new rules be allowed for sale “only by printing, pasting or affixing the new warnings thereon covering 85 per cent of the principal display area.”

Referring to continued sale of cigarette packets bearing a pictorial warning only on 40 per cent of the display area, U.S. Vishal Rao, member of Karnataka Government’s High Power Committee on Tobacco Control, told The Hindu that cigarette manufacturers were “misleading the public”.

Though the Union Health Ministry’s notification on the larger size of pictorial warning was issued in September last year to come into force from April 1, the cigarette manufacturers continued to mislead the public by restricting the warning to 40 per cent of the display space on one side. “The rest of the space, 60 per cent on one side and 100 per cent on the other, continues to be an advertisement,” he said.

Dr. Rao also said the stores had been directed to display the product in such a manner that the side of the cigarette packet without warning faces the public.

Meanwhile, most cigarettes packs available in Mysuru not only bore a pictorial warning that was restricted to just 40 per cent of the display area on one side, but also a packaging date that was prior to April 1, 2016, when the law on larger pictorial warning came into force.

Though wholesale cigarette dealers, speaking on condition of anonymity, said they did not possess any pack packaged prior to April 1, they did not rule out the possibility of retail shops and stores continuing to sell old stock.

Source: The Hindu
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Monday, 9 May 2016

The bumpy road to 85%: How tobacco packs came to have bigger warnings

A Supreme Court directive last week that tobacco packs would have to adhere to the 85% pictorial warning norm may have finally brought the curtains down on a long and bitter battle that had been raging in the country for about 19 months. Here’s all you need to know about the battle that has been as much about public health as it has been about politics and business. 

When was the decision taken to increase the size of pictorial warnings on tobacco packs to 85% of the principal display area instead of the original 40%?
The Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules 2014 were notified in October 2014 under which the size of the pictorial warning was to be increased, the intention being to reach out to people who may be illiterate, or may not notice small warnings. The larger warnings were to come into effect from April 1, 2015. Many believed the move was powered by then Health Minister Dr Harshvardhan’s firm commitment to the anti-tobacco cause — his sudden removal from the Health Ministry less than a month after the notification was issued, likewise led to frenzied speculation about the hand of the “tobacco lobby”.

How did the Committee on Subordinate Legislation come into the picture?
The Committee, among whose members is Allahabad MP Shyama Charan Gupta, the owner of a self-declared bidi empire that has an annual turnover of Rs 200-250 crore, suo motu decided to examine the notification soon after the first reshuffle of the Cabinet. It tabled an interim report in Parliament in March 2015, asking the Health Ministry to postpone the implementation of the warnings until it had managed to examine various aspects in greater detail. The report made a strong pitch for exempting bidis, saying: “Bidis are natural product and are very small as compared to cigarettes. As such, bidis should not be compared with cigarettes as far as rules are concerned… There is no alternative crops for bidi/tobacco farmers… The new rule that 85% of the bidi wrapper should contain horrific warnings etc. will cause the bidi industry to collapse.” Outside of Parliament, Committee chairman Dilip Gandhi got into another major controversy after he claimed that there was no Indian study to prove that tobacco actually causes cancer.

What was the response of the government? 
Immediately after the report of the Committee on Subordinate Legislation came in, the Health Ministry decided to put on hold the five-month-old notification, five days before it was to have come into effect. This, despite the fact that the report of the Committee was not binding on the government. There have been numerous instances of governments having gone ahead with decisions despite objections from Parliamentary panels — a recent example being the Juvenile Justice (Care and Protection) Act, 2015 that mandated that children aged between 16 and 18 years, who are accused of heinous crimes, may be tried under adult laws if certain conditions are fulfilled. Health Minister J P Nadda defended the decision saying he believed in stakeholder consultation. 

Did the government share the Committee’s concerns about the loss of livelihood for tobacco farmers etc.?
In its written reply to the Committee, the Agriculture Ministry said that alternative crops had been mapped out in regions engaged in tobacco production, so there would be no great implications for farmers’ livelihood. The crops thus identified were onion, chilli, maize and sunflower in Tamil Nadu; sugarcane, soyabean, groundnut and sorghum in Karnataka; potato, maize, wheat and mustard in West Bengal; and maize, sunflower, black gram and chickpea in Andhra Pradesh. 

So what forced the Health Ministry to move on the pictorial warnings? 
In August last year, the Rajasthan High Court, responding to a PIL, ordered the Centre and the state government to immediately implement the 2014 rules under the anti-tobacco law. “After hearing the learned counsel appearing for the petitioner and considering the research as well as orders passed by various High Courts and the Supreme Court, we find it imperative, and in larger public interest, to stay the operation of the corrigendum. The rules of 2014 will come into force immediately, and will be enforced by the Centre and the Government of Rajasthan,” stated the order, passed by a two-judge bench of the High Court on July 3, 2015. The Centre was forced to make a commitment that the rules would come into effect from April 1, 2016, exactly one year after its original date of implementation. 

And did the Committee on Subordinate Legislation too come round to the idea that 85% warnings on tobacco packets is a public health requirement? 
It did not. In its final report submitted in the Budget Session of Parliament this year, it said: “The Committee are of considered view that in order to have a balanced approach, the warning on the cigarette packets should be 50% on both sides of the principal display area instead of 85% of the principal display area as it will be too harsh and… will result in flooding of illicit cigarettes in the country.” On bidis, it held: “The Committee strongly feel that the Government need to re-consider their decision to cover bidi industry under the amended rules and recommend that a practical approach in the matter may be adopted by increasing the size of warning up to 50% on one side of the bidi pack, chewing tobacco and other tobacco, products namely zarda, khaini, misri etc. which will be feasible to follow and which would also ensure that a large number of people in the trade will be saved from being rendered unemployed.” 

Who went to the Supreme Court? 
The Karnataka Bidi Association had approached the apex court against the notification on the bigger pictorial warnings. “Tobacco manufacturers have a duty towards the society. Bigger pictorial warnings on tobacco products are necessary to educate people. They should know about its effect on health,” observed a Bench of Justice P C Ghose and Justice Amitava Roy.

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