India moots 'sin tax' on tobacco

India has mooted the introduction of a designated "sin tax" to finance a part of the health budget during the 12th five year plan (2012-2017).

The 12th plan document, to be submitted to the National Development Council (NDC) presided over by Prime Minister Manmohan Singh, says "a sin tax can lead to reduced consumption of harmful items such as tobacco and alcohol and could be considered".

The move is part of the health ministry's larger plan to combat non-communicable diseases like cardiovascular diseases, diabetes, cancers and chronic respiratory diseases which are emerging as major killers.

The document for NDC says a package of policy interventions would be taken up which includes raising taxes on tobacco, enforcing ban on tobacco advertising in electronic media, counselling for quitting tobacco, early detection and effective control of high blood pressure  and diabetes, screening for common and treatable cancers and salt reduction in processed foods.

Around 275 million Indians consume tobacco which has 3,095 chemical components of which 28 are proven carcinogens that can cause cancer. Around 2,500 people die every day due to tobacco related diseases in India.

Source: Times of India

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The Rajani Effect!

That popular Tamil actor Rajinikanth has an unparalleled influence on his fans is no news. Every word that he utters both on-screen and off screen is widely followed and even adhered to by his fans who run into several lakhs. 

A recent instance of Rajinikanth asking his fans to quit smoking has met brought a favourable response from his fans. 

In response to his call, fans have vowed to stop smoking. Fans across Tamil Nadu burnt cigarette cartons. A Rajini fan speaking to a news website is quoted to have said, "Our Thalaivar’s word is sacrosanct for us. We will do anything for him. From now on, we will never touch a cigarette in our life.” 

In his birthday message, the actor had urged fans not to learn from him and give up the habit completely. Admitting his inability of stop smoking completely, he said that his illness involving the kidneys was as a result of the habit.

Tobacco, which is fast turning to a public health menace, needs more such celebrity icons!


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Supreme Court issues notice to Centre on gutkha ban

The Supreme Court on Wednesday issued notice to the Union of India on an application from the Centre for Public Interest Litigation alleging that though 14 States had banned gutkha, the ban was not being effectively implemented.

A Bench of Justices G.S. Singhvi and S.J. Mukhopadaya issued notice; seeking the government's reply on the plea by the NGO.

Appearing for the NGO, counsel Prashant Bhushan said that only gutkha (mixture of pan masala and tobacco) was banned by 14 States. Neither pure tobacco nor pan masala (without tobacco) was banned and as a result manufacture was still going on.

The application said the court imposed a complete prohibition on the use of plastic material for packing of tobacco products, gutkha and pan masala.

“If gutkha and chewing tobacco is banned, leaving pan masala alone, then the implementation of such a ban is rendered impossible as manufacturers will pass on their tobacco-laden pan masala as ‘sada’ pan masala or tobacco-free pan masala. Pan masala consumption too is linked to high rates of oral cancer,” Shri Bhushan noted.

The counsel alleged that the order passed by the apex court on December 7, 2010 for prohibition of such products were “wilfully and brazenly” violated by some manufacturers who sold them under other “misleading” nomenclature and some others dumped their products under the “for export” tag. 

The application said that the Food Safety and Standards Authority of India, a statutory body set-up under Food Safety and Standards Act, 2006 had on August 5 last year banned gutka and other chewing tobacco products. 

It sought direction from the bench that disobeying their order would make the manufacturer liable under the Environment Protection Act, 1986, Food Safety And Standards Act, 2006, and for contempt of court.

Source: The Hindu and Deccan Herald

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Kerala CM puts foot down on tobacco industry

Kerala Chief Minister Oommen Chandy Thursday informed the state assembly that, barring the tobacco industry, his government has taken steps to support the coir, handloom, cashew and other traditional sectors of industry.

"Barring the beedi (tobacco) sector, my government has done a lot for all other traditional industries. Since we have taken an anti-smoking stand, the employment in that sector is dwindling," said Chandy in response to an adjournment motion moved by the Left opposition.

Ever since Chandy assumed office, he has maintained a strong stance against tobacco and went on to the extent of banning gutka (a tobacco-laced chewing mix) in the state a few months back.

Earlier this month, Chandy wrote to the prime minister for a nationwide ban on tobacco.

The sale of tobacco has dropped from Rs 1.30 crore annually to a few thousands only in the state over the last one decade. 

Source: SMETimes

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Tobacco keeps the death clock ticking

As this post is begun, 63,371,796 human lives have been lost due to tobacco-related diseases since the opening of the first FCTC working group on 28 October 1999, as the Death Clock on the website of FCTC reveals.

It is heart-wrenching to see the clock adding to the death tally in quick succession. Every few seconds, the tally on the clock is revised, showing that someone somewhere in the world has lost his or her life due to this addictive substance called tobacco.

Each death ruins years of productive capability, hope and aspirations and snatches away precious moments from near and dear ones. The pain is all the more compounded when the cause of the death is man-made affliction.

While keep the death clock from ticking completely may be a tall order, yet collective efforts can definitely bring down the updates to the tally.

To view the death clock, click here

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Country-wide gutkha ban: Tobacco Free Kerala welcomes Kerala CM's letter to PM

Tobacco Free Kerala, a coalition of like-minded organisations for tobacco control, welcomes the Kerala Chief Minister’s intervention of writing to the Prime Minister for a country-wide gutkha ban.

Shri Oommen Chandy has requested the Prime Minister Dr Manmohan Singh “ban gutkha products containing tobacco and nicotine in all states of the country. By doing so, India will not only be able to save millions of children and youth - our productive resources of the future  - but also send a clear signal of our commitment to public health.”  

This move is especially commendable for Kerala, which in spite of a total ban, has had to confront problems of smuggled-in tobacco products from neighbouring states that have not banned these products. 

Dr Paul Sebastian, Vice Chairman, Tobacco Free Kerala, welcoming the Kerala Chief Minister’s whole-hearted efforts for tobacco control in the state said, “Kerala is really fortunate to have a leader like Shri Oommen Chandy who is fully awake to the issues confronting the health of our people, especially the menace caused by tobacco use.”

“Every day I come across scores of patients who are afflicted with various types of cancers due to tobacco use. It pains me much to see young people suffer so. The silver lining for us is the high level of consciousness of our Chief Minister and Health Minister Shri V S Sivakumar; with their support we are sure of bringing about a positive change in tobacco-induced morbidity and mortality,” Dr Sebastian, who is also the Director of Regional Cancer Centre here, added. 

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E Chandrasekharan Nair shows the way!

Where there's a will, there's a way, goes a time-honoured adage. With determination, it is possible to find a recourse for the most difficult of situations, including the addictive tobacco smoking, which to many users seems impossible to give up. 

Tobacco users who are on the lookout for a role model can find a worthy example in Shri E.Chandrasekharan Nair, former Kerala Minister for Food, Tourism and Law. This veteran politician completely quit smoking in 1987, and continues to be a non-user even after three decades now.

He reflects, “I have been through the harsh effects of smoking. The principal reason behind my heart attack was chain smoking. I suffered a heart attack while travelling from Delhi to Trivandrum by air. My doctors convinced me that smoking brought me this hardship, and then I quit smoking.”

Reacting to recent reports that pictorial warnings in packets of tobacco products in India do not comply with international guidelines, Shri Nair said, "Cigarette manufacturers in India are not completely complying with the international guidelines on health warnings, this is intentional. Concerned authorities have to ensure that these guidelines are compulsorily met.”

A report called ‘Cigarette Package Health Warnings: International Status Report’ released in the Conference of Parties to the WHO Framework Convention of Tobacco Control (FCTC) that concluded in Seoul, South Korea on November 17, shows that health warnings in cigarette packets in India only cover 40% of the front face of the packet. This is despite two rounds of revisions of warnings, in 2009 and 2011.

Article 11 of World Health Organisation’s FCTC, which India ratified in 2004, requires that health warnings “should be 50% or more of the principal display areas but shall be no less than 30% of the display areas” – the principal display areas being front and back of the package. 

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Smoking killed 100 million in 100 years

Nearly 45 trillion bidis and cigarettes manufactured over the past 100 years in the country are expected to be responsible for nearly 100 million deaths of adult Indians, a recent study has found.

"Our calculations are derived from using the most conservative estimates and yet present mortality estimates which are significant and alarming," researchers Pranay G Lal, Nevin C Wilson and Prakash C Gupta said in a study published in Current Science.

The study concluded that of the estimated 100 million deaths due to tobacco use, smoking bidis alone contribute to 77 million deaths.

The researchers have pressed for an urgent review of tobacco control interventions and re-examination of policies that promote the tobacco industry in India.

They said since it takes three to four decades for a smoker to die after he starts smoking, the current tobacco use was expected cause deaths only in the coming decades.

"For consumption in the last four decades, the mortality may be partially realised and some of the deaths will occur in near future", they said.

"Since the bulk of manufacturing and consumption occurred in the latter part of the last century, the early deaths of these smokers will happen in the first half of this century."

The study has estimated that there were about 190 million and 41 million lifetime bidi and cigarette smokers, respectively, in the country from 1910-2010.

"So in effect, if we were to cease all production and consumption in 2010, deaths would continue to take place. Less than one-fourth of the deaths from 100 year of smoking (from 1910-2010) have already taken place, and the three-fourths of the deaths will take place in the next 40 years", the study said.

The reseachers have reviewed 23 data sources including industry reports, trade and academic journals, paid internet databases, repositories and reports prepared by market research firms from 1920 to arrive at the estimated number of cigarettes manufactured over the last 100 years.

To derive total bidis produced, they used total bidi tobacco produced in India using data from the Ministry of Agriculture and divided it by the average tobacco contained in each bidi. These estimates were compared with 14 other sources.

While Lal and Wilson are associated with the South-east Asia office of the International Union Against Tuberculosis and Lung Disease, Gupta is with the Healis-Sekhsaria Institute for Public Health, Navi Mumbai.

Original story published in the Indian Express

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India falls short of FCTC guidelines on tobacco products’ packaging

A new report has revealed that pictorial warnings in tobacco products in India do not meet the internationally stipulated size parameters, at a time when health warnings on tobacco products have come to be recognised as a cost-effective means of communication.

Called ‘Cigarette Package Health Warnings: International Status Report’, it points out that pictorial warnings in packets of tobacco products in India fall short of the stipulated 50% of the display area, even after two rounds of revisions of warnings in 2009 and 2011. 

The report released in the Conference of Parties to the WHO Framework Convention of Tobacco Control (FCTC) that concluded in Seoul, South Korea on November 17, shows that health warnings in cigarette packets in India only cover 40% of the front face of the packet. 

Brought out by leading Canadian non-government organisation, Canadian Cancer Society in October 2012, it also brings out that India has fallen 23 places in the ranking of countries on depiction of health from 100 in 2010 to 123 in 2012.

Article 11 of World Health Organisation’s FCTC, which India ratified in 2004, requires that health warnings “should be 50% or more of the principal display areas but shall be no less than 30% of the display areas” – the principal display areas being front and back of the package. It further stipulates that such warnings should be applied to all categories of tobacco products.

India’s current pictorial warnings, notified by the Union Government in 2011 under Section 7 of the country’s tobacco control legislation – COTPA 2003, have designated picture and text warnings for smoking and smokeless tobacco products. In September, India brought out a revised set of warnings that will take effect from 1 April 2013.  

On the relevance of pictorial warnings, the report that provides a ranking of 198 countries notes, “A picture really does say a thousand words. Pictures are especially important for individuals who are illiterate or who have low literacy. Pictures are also important to immigrants, temporary workers as well as individuals from minority language groups who may not yet be able to read the national language(s).”

The International Status Report also has that Australia leads the pack with pictorial warnings occupying an impressive 82.5% of the principal display area. India’s neighbour in the Asian region, Sri Lanka has notched up the second rank, with pictorial warnings covering 80% of the front and back covers of the packet. Thailand sells tobacco products with warnings spread over 55% on its front and the back faces. 

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Poor more susceptible to smoking in India

The poor in India are more susceptible to smoking, as a recent study reveals. Called ‘Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey’, the study was conducted to assess the socio-economic inequality in smoking in low and middle income countries.

The study based on data from the World Health Survey (WHS) of the World Health Organisation (WHO) found that 46.7 per cent of the poorest men smoke in India as against 21.8 per cent of the richest men.

Though the findings are in line with common knowledge regarding smoking prevalence, what is distressing that well over a quarter of India’s population are under the addictive spell of tobacco. According to figures of the Planning Commission, GoI, there are as many as 3546.8 lakhs people below the poverty line in India, which is nearly 29 per cent of the total population.

A total of 213,807 men and women of 48 low and middle income countries were covered in this study that was initiated in the context of the fact that the risk of dying from smoking is significantly higher in the lowest socio-economic groups as compared to higher socio-economic groups. 

Commenting on the study, Dr R Jayakrishnan, Assistant Professor, Community Oncology Division, Regional Cancer Centre said, “The findings reinforce the trend seen during clinical practice. Majority of tobacco-induced cancer patients who visit the Centre are from the lower income strata of the society. The need of the hour is to develop prevention strategies that specifically focus on the more vulnerable sections.”

Outlining some possible prevention strategies, Dr M A Oommen, renowned economist said, “While linking high incidence of smoking with poverty is a simplistic correlation, the issue has to be tackled in a multi-pronged manner such as incentivising the poor to get out of the habit, moral suasion, higher incidence of excise duty on tobacco products, expanding capability building of the poor and structural reforms through better employment opportunities.”

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Prime Minister, Sonia on tobacco use in India

India is the second largest consumer of tobacco products in the world. 

This post excerpts what our national leaders have said on tobacco use in India.

Dr Manmohan Singh, Hon'ble Prime Minister of India said, "It is clear that we need to heighten our concern about tobacco usage being a leading cause of death and debilitating disease in our country. The increasing prevalence of tobacco consumption among high risk groups, including women and children, and the exposure to second hand smoke, either in homes or in public places, is a matter of serious concern."   

Smt Sonia Gandhi, Chairperson, United Progressive Alliance (UPA) notes, "The consumption of tobacco in various forms is a threat to public health. There is strong evidence to link tobacco use with the incidence of cancer. A massive public awareness campaign has to be sustained at various levels to deal with this malaise."

Shri Ghulam Nabi Azad, Hon'ble Union Minister for Health and Family Welfare states, "As one of the lagest consumers of tobacco in the world, India is faced by human costs, including cancers, cardiovascular and chronic respiratory diseases, which require the urgent attention and intervention of the Government on both regional and state levels." 

"We must also consider the economic burdens that the usage of tobacco imposes on our country's health care systems. As may as one million deaths annually can be attributed to tobacco consumption forcing health facilities to spend an even greater share of their precious resources on treating largely preventable diseases."

According to Global Adult Tobacco Survey (GATS) India 2009-10 Report, India has nearly 274.9 million tobacco users, age 15 and above, making the country the second largest consumer of tobacco products in the world. 

Among them, 197.0 million are males and 77.9 million are females; and 216.0 million tobacco users from rural areas and 58.8 million from urban areas. 

Compiled from Messages in from GATS India Report 2009-10, available here

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Knock the Cigarette Out, says Dr Siddhartha Mukherjee

"If cancer is the quintessential product of modernity, then so, too, is its principal preventable cause: tobacco," writes Siddhartha Mukherjee in his 'The Emperor of all Maladies'.

This book, which won the Indian American cancer researcher and physician the Pulitzer Prize for Non-Fiction for the year 2011, is a profound biography of cancer - a disease humans have lived with - and perished from - for more than five thousand years.

A staunch advocate of anti-tobacco movement, Dr Mukherjee goes to write, "The classification of tobacco smoke as a potent carcinogen - and the slow avalanche of forces unleashed to regulate cigarettes in the 1980s - is rightfully counted as one of cancer prevention's seminal victories."

In this embedded video, Dr Mukherjee says the first five things of preventing cancer are "Don't smoke, Don't smoke, Don't smoke, Don't smoke, Don't Smoke."

He adds, "There's a new study that makes the argument that if you take people who are high risk -- smokers that are high risk -- and you perform CAT scans, you can detect cancers. The problem is that for dollar for dollar, it's much better to knock the cigarette out of the person you see smoking outside... than to perform a 6000 dollar CAT scan."

Image courtesy http://stanmed.stanford.edu

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Fight transitory withdrawal symptoms for health

The findings of Global Adult Tobacco Survey (GATS) conducted in Kerala brings out that a significant 70.6 per cent of male smokers in Kerala are planning or thinking about quitting.

As successful quitters will testify, breaking free from this addictive habit is not impossible. Experts say that the withdrawal symptoms can be easily managed with will and are only transitory. Mild discomfort for approximately two weeks after quitting is nothing compared to the benefits it can bring to one's health. 

Nicotine's chemical properties are addictive. If nicotine is kept away from the body, it may manifest as the following physical and mental withdrawal symptoms. 

Knowledge of the symptoms will make management of the symptoms more comfortable and help with the quitting process. 

Physical withdrawal

Nicotine obstructs the flow of oxygen and nutrients to various parts of the body. 

• Bowel discomfort: It's time to change your diet and fitness once you quit smoking. Quitting smoking can cause cramps, nausea, flatulence and constipation, therefore it is important to increase roughage and exercise your body.

• Nasal and throat problems: When you stop smoking, your nose and throat will try to clear the mucous that has accumulated over the years. You may experience coughing, dry throat and mouth. Fluids are the key to clearing this process.

• Increase in appetite: Craving for cigarettes can be confused with hunger cravings. The best way to stay healthy is to consume fluids and low calorie snacks.

• Headaches: Lack of nicotine can lead to headaches, the way out of it is with massages, plenty of water and rest. Gently massage your temple, drink water, take a hot shower and take a deep breathe.

• Lack of sleep: You may experience insomnia after you quit smoking. Take a hot shower before you hit the sack, do breathing exercises too and most importantly avoid coffee closer to bed-time.
  
• Restlessness/lack of concentration: You feel like there is energy bursting in you, transfer this energy into something constructive. In these situations smokes would calm your nerves, but now switch off that thought and cultivate a new habit. You may feel you can't concentrate too; try listening to music or take a break from your routine life.

• Weight gain: Increase in craving can lead to weight gain, especially if you indulge in unhealthy food. But don't be dejected, you can cut it out with exercise and the right diet.

• Sweating and shaky hands and feet: You will feel that your hands and feet tremble. It is a passing phase that will stop. If you experience these withdrawals you know your body is simply shedding an addiction and leading you to a much healthier life.

• Skin trouble: While quitting smoking is associated with healthier skin, the period of withdrawal will cause some skin trouble. Some people with sensitive skin might break out into a fresh acne case or suffer from some ulcers in the inner-cheeks, tongue and mouth. The reason is simply that your body is letting go of the toxins and levelling up.

Emotional withdrawal

Some of the most common symptoms are ...

• Depression: You may feel low, sad and hopeless. Hence it is important to surround yourself with people, preferably non smokers and friends who will support your decision to quit smoking.

• Angry: Emotional upheaval can make you angry. Others may not be aware of it, but you know what's happening to your body. The age-old remedy of counting till 10 isn't such a bad idea. Stop, think, regain your calm and composure before losing your cool.

• Bored: You may have noticed that when you were bored, tired or depressed you tend to smoke. Now that you are on your way to a smoke free life replace these voids with hobbies or get involved with people around you. Pay more attention to your loved ones.

• Lonely: Withdrawal of smoking can make you feel lonely, impatient and irritable. If your friends are busy, take up a dance class or cooking class. It is important to expect these feelings of loneliness, so stay prepared.

• Mood swing: Tempers will flare and tantrums will increase. These are not exactly PMS symptoms. Nicotine was once your evil friend but now you have to bear with the loss of the addiction. This will throw your emotional reactions to daily happenings into a tizzy. Most quitters will need help with these mood swings. Replace the smoking placebo with something else. Invest in some great music and strong coffee, maybe?

Instead of losing motivation, after reading these withdrawal symptoms, the one thought any quitter must focus on is this: The fact that your body is changing so much when quitting, simply showcases how much it is continuously changed and affected while you still smoke. 

Avoid poor health and dangerous diseases - and call it quits today!

Source: www.healthmeup.com

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Keralites spend 9 per cent of their income on smoking

Smokers in the state spend nearly 9 per cent of their income on smoking tobacco products, point out the Kerala findings of the pioneering Global Adult Tobacco Survey (GATS). 

Shri Oommen Chandy, Hon’ble Chief Minister of Kerala formally released the Kerala report of GATS by handing over the first copy to Dr Paul Sebastian, Director, Regional Cancer Centre and Vice Chairman of Tobacco Free Kerala – a coalition of like-minded organisations formed to fight tobacco use in the state. 

The GAT Survey, conducted under the coordination of the Union Ministry of Health and Family Welfare in 2009-10, points out that the monthly expenditure by a smoker on cigarettes is Rs. 484 and on bidis is Rs.139. 

According to the latest figures of the Government of India, Kerala’s per capita income at current prices for the year 2011-12 is Rs 83,725. The per capita income of Kerala for the year 2009-10 was Rs. 59,179.

GATS is the global standard for systematically monitoring adult tobacco use and includes information on patterns of tobacco use (smoking and smokeless), cessation, second-hand smoke, economics and perceptions towards tobacco use, among others. 

Mumbai-based International Institute for Population Sciences (IIPS) conducted the household survey on persons 15 years of age and older using hand-held devices. The findings on Kerala are based on 1,825 completed interviews of males and females. 

The Survey also throws light on the fact that 58.6 per cent of daily tobacco users consume tobacco within half-an-hour of waking up. In Kerala, 21.4 per cent of adults including 35.5 per cent of males and 8.5 per cent of females use tobacco in any form. 

It further reveals that there is no escaping the deleterious impact of tobacco even at home. As high as 41.8 per cent of adults - 47.2 per cent of males and 36.8 per cent of females – are exposed to tobacco smoke at home. 

In spite of COTPA, 2003 – the comprehensive Indian tobacco control legislation – banning smoking in public places, GATS shows that 18.7 per cent of adults in Kerala are exposed to second-hand smoke in public places. At the workplace, 21.5 per cent of males and 3.7 per cent of females have to put up with toxins smoked by others. 

The Global Adult Tobacco Survey - conducted using a consistent and standard protocol across countries - is a critical tool to help our nation fulfil one of its obligations of generating comparable data under the Framework Convention on Tobacco Control (FCTC) of the World Health Organisation (WHO).

The Kerala Fact Sheet can be viewed here

Malayala Manorama, 14 October 2012

The Hindu, 12 October 2012

The New Indian Express, 12 October 2012

Mathrubhumi, 11 October 2012

Times of India, 11 October 2012

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FAQs on pan masala/gutkha ban

Kerala has banned pan masala and gutkha containing tobacco and nicotine under the Food Safety and Standards Act, 2006 with effect from 22 May 2012. The Hon'ble Kerala High Court has also upheld the ban.

But still doubts linger. 

Given below are some FAQs and answers compiled by Dr Pankaj Chaturvedi, Head and Neck Cancer Surgeon, Tata Memorial Hospital, Mumbai. Dr Chaturvedi has also been honoured with World Health Organisation Director’s Recognition Award (South-East Asia region) for initiating a campaign to ban tobacco products in India.


Why is gutka Banned and bidi/cigarette are still there?

As per law (FSSAI regulation 2.3.4), gutkha is a prohibited FOOD substance and state governments have no option but to enforce that. Bidi and cigarette are tobacco products but there is no constitutional provision to prohibit them. Bidi and cigarettes are regulated under COTPA with intention to remove tobacco from society.

Is the ban necessary?

Under section 2.3.4, Manufacture/Storage/Sale of gutkha and Pan Masala is prohibited. In case of violation, arrest is the punishment. This basically turns a profitable industry into an illegal industry! Eventually people will lose interest in gutka/Pan Masala business. It will also decrease free and cheap availability especially for kids. In states with ban, the consumption has gone down dramatically in matter of few months.

Which other states have done it?
Apart from Maharashtra, Madhya Pradesh, Bihar, Kerala, Himachal Pradesh, Rajasthan, Chhattisgarh, Jharkhand, Chandigarh, Haryana, Punjab, Sikkim, Delhi. Public Interest Litigations (PILs) have been filed in UP, West Bengal, Andhra Pradesh and Karnataka urging the state governments to ban it.

Has the ban in these sates been challenged in respective high courts?
Gutka/Pan Masala Industry filed writ petitions in the High Courts of Maharashtra, Rajasthan, MP, Bihar and Kerala for stay on the ban. All the High Courts have upheld the ban and declared it constitutionally valid . Delhi high court ordered the Delhi government to enforce ban in two weeks.

Why is Pan Masala banned in Maharashtra even though it does not contain tobacco?

a. It contains supari that causes cancer and several illnesses.
b. Supari is addictive
c. Gutkha Industry sells gutka under the name of pan masala
d. Pan masala glamorises supari as a mouth freshener.

What about smuggled Gutkha?
It is a genuine problem as long as gutka ban isn't enforced all over India. It is sad that all state governments are failing to enforce a central law. Smuggled gutka is only available to hard core addicts and not to kids/youth or first time users.

What about black market availability?

This pushes the cost of Gutka/Pan Masala 5-6 times its retail price. This increase in price causes -

• decrease in consumption among addicts
• no free availability for kids and youth who are not addicted.
• reduced over all availability in the market that adversely the profitability of this business.

Do we have infrastructure to enforce ban? Why Maharashtra is better?
Maharashtra is one of the states that has engaged to Police to enforce the ban. It seems it will be an additional support to FDA.

 What happens after one year?
 The ban on gutkha is permanent (section 2.3.4).

What are the health effects of smokeless tobacco?

• Highly addictive with dismal quit rates of 5%.
• International Agency for research on Cancer, World Health Organization has classified  Smokeless tobacco as confirmed cancer causing substances.
• Contains 3095 chemicals and 28 well proven carcinogens
• Causes severe impairment of the oral and dental health
• Strongly associated with precancerous lesions and cancer of mouth that is a leading cancer in India.
• Apart from mouth cancers, smokeless tobacco usage is associated with cancers of oesophagus, stomach, pancreas, larynx, pharynx and lung. 
• It is associated with hypertension and Ischaemic heart disease.
• Its use is associated with increased risk of Stroke.
• It adversely affects reproductive health in women and also seriously affects the foetus.

What are the adverse effects of Areca Nut/Supari/Pan Masala?

• Highly addictive
• Usually taken along with smokeless tobacco
• International Agency for research on Cancer, World Health Organization has classified Arecanut as confirmed cancer causing substances.
• It contains several polyphenols and nitrosamines that are confirmed carcinogenic. 
• It causes impairment of oral and dental health.
• Its usage is strongly associated with precancerous lesions and cancer of mouth that is a leading cancer in India.
• Studies have shown association between Supari chewing and cancers of the Liver, oesophagus,  stomach and lung.
• Supari use is associated with hypertension and ischemic heart disease.
• Usage of Supari adversely affects reproductive health in women and also affects foetus.
• Supari chewing is associated with diabetes, obesity and several metabolic disorders.
• Supari chewing is associated with causation of certain psychological disorders.

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Make educational campuses tobacco free, says Padma Shri Dr G Vijayaraghavan

Educational campuses and offices should be made tobacco-free to prevent the increasing incidence of tobacco-induced heart diseases in Kerala, said renowned cardiologist Padma Shri Dr G Vijayaraghavan, Vice Chairman and Director Medical Services of KIMS Hospital, on the occasion of World Heart Day.

“Nearly 60 per cent of the patients in Intensive Cardiac Care Unit of KIMS are current or old smokers. More than 30 per cent have smoked over 2 packs a day for more than 10 years,” said Dr Vijayaraghavan referring to high linkage between smoking and heart diseases. 

Dr Vijayaraghavan said he had one of his most shocking experiences when he walked into a smoke-filled room at the college where his son was studying. “The staff room was stuffy with the smell of smoke and I felt compelled to walk out of the room.”

The Indian tobacco control legislation – COTPA, 2003 has spelt out the guidelines for tobacco-free educational institutions. Under Section 4 of the Act, it is mandated that educational institutions set up a board of 60 cm x 30 cm at the entrance and other conspicuous places. It should read, “No Smoking Area – Smoking Here is an Offence,” in the local language. 

Also Section 6 of the Act requires that a board specifying that “sale of tobacco products in an area within a radius of 100 yards of educational institutions is strictly prohibited” be displayed at a conspicuous place outside the premises. 

“In USA today, it is difficult to find a seat in the non-smoking area of a restaurant, as they always remain crowded. The smoking areas on the contrary remain empty,” said the physician who holds Fellowships of the American Heart Association and the Royal College of Physicians, UK, among others. “Stoppage of smoking has been the main factor in the decrease of deaths due to heart attack in major countries, especially USA,” he added.  

“When one smokes, the heart rate jumps up and the blood pressure rises. Continuous smoke to the lungs make the smoker feels warm, but that is due to high penetration of carbon dioxide in the blood. When you shake hands with a person and if it feels too warm, you can know that he is a smoker. Smoking makes one a little alert, but that is short-lived,” said Dr Vijayaraghavan.
  
On the role of the media, Dr Vijayaraghavan said, “Many youngsters have been tempted to take up this addictive habit following depictions in the media. One always sees a Churchill with a cigar, Sherlock Holmes with a pipe, and a Dev Anand or a Raj Kapoor with cigarettes. Thankfully, media has reversed its gear in the last 20 years.”

“Chewing, smoking, snuffing or any form of tobacco use is harmful not only to heart but also to the lungs and intestines. Educational campuses and offices should be made tobacco-free along with strong pressure from wives to make husbands quit use at home. Public awareness is a key to this,” he said.

Malayala Manorama, 2 October 2012

Janmabhoomi, 30 September 2012

Thejas, 30 September 2012

The Hindu, 29 September 2012

Kerala Bhooshanam, 29 September 2012

Mangalam, 29 September 2012

Metro Vaartha, 29 September 2012

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Smoking can cause Alzheimer's Disease, says study

Cigarette smoking can lead to cognitive impairment and even Alzheimer's Disease shows recent research studies , even as the world observed World Alzheimer’s Day on September 21 to wipe away the stigma associated with the disease and provide relief to sufferers and their families. 

Alzheimer’s disease (AD), the most common form of dementia, is characterised by progressive deterioration in intellect including memory, thinking, learning, orientation, language, comprehension and judgement. The impact of the disease could be so harsh that patients are even unable to carry out everyday chores.

With no effective treatments available currently, the medical and scientific community has turned its attention to identifying modifying effects of lifestyle, including smoking.

In the backdrop of epidemiological studies that have shown cigarette smoking, including second-hand smoking to be an important risk factor of cognitive decline and Alzheimer’s disease, researchers, in a recent study named “Cigarette Smoking Accelerated Brain Aging and Induced Pre-Alzheimer-Like Neuropathology in Rats” sought to identify cigarette-smoke induced pathological changes in brains.

The study conducted on Sprague-Dawley rats (a multipurpose breed used in medical research) demonstrated that exposure to cigarette smoke induces pathological changes in the brain and increases susceptibility to the development of cognitive impairment or even Alzheimer’s Disease later in life.

The rats were exposed to either sham air or four per cent cigarette smoke for an hour per day for 8 weeks in a ventilated smoking chamber to simulate the situation of chronic passive smoking.

Dr Jacob Roy Kuriakose, Chairman, Alzheimer’s Disease International said, “Kerala is going through a situation of emerging and re-emerging communicable and non-communicable diseases. In this context, the social costs in managing diseases such as Alzheimer’s disease will challenge health systems. What we need is to set in place an effective preventive measure strategy including phasing out of tobacco products.”

“One way of doing this would be strict implementation of the provisions of Indian tobacco control legislation and initiate penal action to dissuade use,” added Dr Kuriakose who is also the National Chairman of Alzheimer’s and Related Disorders Society of India (ARDSI). 

According to Alzheimer’s Disease International – an umbrella organisation working to improve the quality of life of people with dementia and their families - 35.6 million people across the world were estimated to be living with dementia in 2010 - there are 7.7 million new cases of dementia each year, implying that there is a new case of dementia somewhere in the world every four seconds.

In Kerala, the projected prevalence of dementia in elderly aged 65 years and over 80 was 0.15 million in 2011 according to the Dementia India Report 2010 of Alzheimer’s and Related Disorders Society of India. The prevalence is estimated to be 0.18 million by 2016 and 0.21 million by 2021.

Image courtesy: TopNews

Deccan Chroncile, 21 September 2012

Chandrika, 22 September 2012

Madhyamam, 22 September 2012

Metro Vaartha, 22 September 2012

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Chairman of Indian Cricket Selection Committee regrets smoking

"I should not have smoked on television during a press interaction on the eve of the Pakistan tour during my stint as the captain of Indian team," said Krishnamachari Srikkanth, Chairman of Indian Cricket Selection Committee.

In a widely-read interview, the former cricketer described this act as his "biggest regret". 

This admission of regret is a great turnaround, coming from someone who was quoted as saying, "My best moment was when I smoked in the Lords' balcony".

Known for his entertaining, innovative and explosive batting style, Srikkanth played 43 Tests for India scoring 2,062 runs. He represented the country in 146 One Day Internationals, notching up a total of 4,091 runs. 

Let us hope that his public denunciation of smoking will cascade down to his countless fans across the world and help spread the message of abstinence from smoking for better health. 

Image courtesy: Zee News

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Tobacco Free Emerging Kerala

The Emerging Kerala Summit that concluded at Kochi on 14 September 2012 made news for various things - from participation from 51 countries to a presence of globally acclaimed thought-leaders who could  articulate and give specific recommendations on Kerala's development agenda. 

The meet which saw participation of over 4500 delegates also brought cheer to public health and tobacco control activities in the state, for stringently following the COTPA's provisions on prohibition of smoking in public places. 

The Prohibition of Smoking in Public Places Rules, 2008 under Section 4 of COTPA has comprehensively laid out the various aspects of the prohibition on public places.

The Act defines ‘public place’ as any place to which the public has access whether as of right or not and includes all places visited by general public and includes hotels, restaurants, auditoriums, health institutions, hospital buildings, bus stops and amusement centres.

In keeping with the Kerala Government's proactive stance on tobacco control, the Emerging Kerala meet had specially hired trained detectives from Bangalore to keep an eye over smokers and drug addicts at the venue.

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