Prevent tobacco use initiation

This anecdotal narrative beautifully drives home why efforts should be on preventing initiation of smoking or tobacco use.

- He used to smoke around thirty beedis a day; began smoking since the age of fifteen
- The big toe of his right foot turned blue, which graduated into pain and burning sensation in both        legs
- The pain became nearly constant; he stopped going to work

- His five toes were amputated, the family's strained financial condition was further strained
- His wife was frantic about the future of their two daughters

He was dark and swarthy, around five foot four. His posture was slightly stooped and the muscles of his upper arm and torso were becoming flabby. His hair was unkempt and he had stubble on his face and neck. He was around thirty-five but looked older and had streaks of white in his hair. Three toes on his left foot and two in his right were missing. The ring finger of his left hand had darkened and was ischemic. He had severe pain in his arms and legs for which he was hospitalized. 

We were third year medical students and had to present his condition to our professor for discussion. Raveendran (not his real name) used to work as a manual laborer in the Thrissur district of Kerala. He was a hard worker and used to make enough to maintain his family (wife and two daughters). Manual labor is relatively well paid in Kerala and he had built a small house on a plot of land. They were originally from South Kerala but had settled down in Thrissur (central Kerala). Raveendran was a heavy drinker and used to smoke around thirty ‘beedis’ (a thin Indian cigarette filled with tobacco flake and wrapped in a leaf tied with a string at one end) daily. He had been smoking since the age of fifteen. 

About two years ago he noticed the big toe of his right foot turning blue. Soon he began having pain and a burning sensation in both legs. He found working in the fields difficult. Initially the pain came infrequently and ceased when he sat down. Gradually the distance he could walk before he had pain decreased. 

He was diagnosed as suffering from thromboangitis obliterans (Buerger disease) at the medical college hospital and warned to strictly stop smoking. It was a sad story. Raveendran tried to quit smoking but never succeeded. His condition got worse. The pain became nearly constant. He stopped going to work. The family’s economic condition got worse. His house and land were mortgaged to pay off the accumulated debts. He developed gangrene in his toes and five toes were amputated at the hospital. The family started selling off their assets. The neighbors were supportive at first but eventually stopped providing support considering Raveendran’s stubborn refusal to quit smoking. His wife started going to work but could not work the entire day due to her husband’s condition. He was often hospitalized and had to undergo amputations, further straining the family’s resources. 

When we met her the lady was in tears. She had two daughters and was frantic with worry about the family’s future. We tried counseling Raveendran to quit smoking. He was apologetic and aware about the damage smoking was doing to him and his family. But he could not quit. We met the family off and on as we progressed through medical school and then they stopped visiting. 

What had happened to them? We lacked a system of tracking families in their homes. A few of us visited his village but the neighbors told us the family had suddenly left one morning. Where were they and what had happened to them? I often wonder.

The author Dr P Ravi Shankar is Professor of Medical Education and Chair of the Curriculum Committee at the Xavier University School of Medicine, Aruba, Kingdom of the Netherlands.  

Courtesy: Hektoen International

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​High tobacco use behind worrisome​ ​incidence of lung cancers in North Kerala districts

Tobacco use once again is proven as the villain, and a cause behind the high incidence of lung cancers in north Kerala districts of Kozhikode, Kannur and Kasargod, notes a recent study brought out by the Malabar Cancer Centre (MCC), a tertiary cancer centre in Kannur.

As much as 36 per cent of overall patients across these districts had the habit of smoking.  Patients from Kasargod were the most prone to smoking at 40 per cent; followed by Kannur at 34 per cent and Kozhikode at 33 per cent. The extent of smoking among Kerala adults, as per latest benchmark figures of Global Adult Tobacco Survey of Union Health Ministry, is 13.4 per cent.

Lung and breast cancer rank high among the various cancers across the three study districts. The distribution of lung and breast cancers in Kannur is 15 per cent. Lung cancers contribute to 11 percent and breast cancers are at 13 per cent in Kozhikode. In Kasargod, lung and breast cancers are 13 and 15 per cents respectively. 

The retrospective study ‘Geographical Distribution of Cancer in Northern Kerala, India: A Retrospective Analysis’ was conducted based on data of the hospital based cancer registry (HBCR) for the year 2011 in MCC and published in the Indian Journal of Applied Research. A total of 2,366 cancer patients – 1,259 males and 1,107 females – had registered at the MCC in 2011 from the districts of Kozhikode (457), Kannur (1670) and Kasargod (239). A semi-structured questionnaire was used to collect the information from patient’s medical records to understand the demographic factors, personal habits, and tumour staging.

The study also refers to harms of second-hand smoke or passive smoke as it found that 10 per cent of female registered patients were passive smokers. Citing scientific literature, it adds that second-hand smoke is linked to lung cancer and also lymphoma, leukaemia, brain tumours in children, cancers of breast, stomach and the brain, among others.

Dr Satheesan B, Director, Malabar Cancer Centre and the study’s principal investigator and co-author said, “The study findings yet again brings out the role of tobacco in cancers and underlines that tobacco control is the best way to prevent cancers. Things can no longer be left to chance as the combined burden that tobacco use causes on morbidity and mortality at micro and macro levels is enormous. Regular monitoring and consolidation of tobacco control measures taken at the district level should happen through monthly reviews of enforcement and awareness activities.” 

The high availability and consumption of tobacco both in smoking and chewing forms in north Kerala may also be attributed as a reason for high rate of tobacco related cancers in the area. “Provision of health-friendly alternative livelihoods to beedi workers which has been adopted by leading groups in the field is expected to change the scenario. But increasing the beedi prices to dissuade users would be welcome,” Dr Satheesan added.

Pan chewing among patients from Kannur, Kasargod and Kozhikode stands at 14, 19 and 16 per cents respectively.  The International Agency for Cancer Research (IARC) of the World Health Organisation, after scientific evaluations, has pronounced that chewing betel quid with and without tobacco is carcinogenic to humans.

Dr Saina Sunilkumar, Lecturer, Department of Cancer Registry and Epidemiology; Shri Ratheesan.K and Shri Subhradev Sen, Lecturers in Biostatistics collaborated for the study.

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റോഡ് സുരക്ഷാവാരം: വാഹനങ്ങള്‍ക്കുള്ളിലെ പുകവലി അപകടകരമെന്നു വിദഗ്ധര്‍

വാഹനങ്ങളിലിരുന്നു പുകവലിക്കുന്നത് ആരോഗ്യത്തിനു മാത്രമല്ല, റോഡപകടങ്ങള്‍ വഴി ജീവനും ഹാനികരമാകുന്ന ശീലമാണെന്ന് വിദഗ്ധരുടെ മുന്നറിയിപ്പ്. റോഡ് സുരക്ഷാവാരം 2017 ആചരണത്തോടനുബന്ധിച്ച് വാഹനങ്ങള്‍ക്കുള്ളിലെ പുകവലി ക്ഷണിച്ചുവരുത്തുന്ന അപകടങ്ങളെക്കുറിച്ച് ഓര്‍മപ്പെടുത്തുകയാണ് വിദഗ്ധര്‍. വാഹനങ്ങള്‍ക്കുള്ളിലെ പുകവലി ഡ്രൈവറുടെ ശ്രദ്ധ പാളുന്നതിനുള്ള മുഖ്യ കാരണങ്ങളിലൊന്നായി ലോകാരോഗ്യ സംഘടന ചൂണ്ടിക്കാട്ടുന്നു.    

ലോകാരോഗ്യ സംഘടനയുടെ നിര്‍വചനപ്രകാരം ഡ്രൈവിങ്ങിലെ ജാഗ്രതക്കുറവെന്നാല്‍ സുരക്ഷിതമായ ഡ്രൈവിങ്ങില്‍ പാലിക്കേണ്ട കാര്യങ്ങളില്‍നിന്നു ശ്രദ്ധ വ്യതിചലിക്കലാണ്. വാഹനമോടിക്കുന്നതിനിടെ, സിഗരറ്റ് തപ്പുന്നതും തീ കൊളുത്തുന്നതുമുള്‍പ്പെടെയുള്ള പ്രവൃത്തികള്‍ ശരീരത്തിന്റെയും മനസ്സിന്റെയും ജാഗ്രത നഷ്ടപ്പെടുത്തുന്നതിലൂടെ അപകടങ്ങള്‍ ക്ഷണിച്ചുവരുത്തുമെന്നു പഠനങ്ങളും ചൂണ്ടിക്കാട്ടുന്നു. സമ്പൂര്‍ണ ശ്രദ്ധ ആവശ്യമായ ഡ്രൈവിങ്ങില്‍ നിമിഷനേരത്തെ അശ്രദ്ധ പോലും വന്‍ ദുരന്തങ്ങള്‍ക്കു കാരണമാകുന്നുണ്ട്. 

വാഹനങ്ങള്‍ക്കുള്ളിലെ പുകവലി യാത്രക്കാരുടെ സുരക്ഷയ്ക്കും ആരോഗ്യത്തിനും ഹാനികരമായതിനാല്‍ ഈ വിഷയത്തില്‍ ഗവേഷണ പഠനങ്ങള്‍ക്കു നടപടി തുടങ്ങിയതായി നാറ്റ്പാക് ഡയറക്ടര്‍ ഡോ. ബി.ജി ശ്രീദേവി വ്യക്തമാക്കി. നിര്‍ദിഷ്ട പഠനത്തില്‍നിന്നുള്ള കണ്ടെത്തലുകള്‍ ആരോഗ്യ, റോഡ് സുരക്ഷാ നയരൂപീകരണങ്ങളില്‍ ഫലപ്രദമായി ഉപയോഗിക്കാനാവുമെന്നും അതിലൂടെ പുകയില നിയന്ത്രണ നടപടികള്‍ ശക്തിപ്പെടുത്താനാകുമെന്നു പ്രതീക്ഷിക്കുന്നതായി ഡോ. ശ്രീദേവി പറഞ്ഞു.

റോഡ് സുരക്ഷയും പുകയില നിയന്ത്രണവുമുള്‍പ്പെടെയുള്ള പൊതുജനാരോഗ്യ വിഷയങ്ങളില്‍ സമഗ്രമായ ബോധവല്‍ക്കരണ പരിപാടികളെപ്പറ്റി ചിന്തിക്കേണ്ട സമയമാണിതെന്ന് ഐഎല്‍ ആന്‍ഡ് എഫ്എസ് ട്രാന്‍സ്‌പോര്‍ട്ടേഷന്‍ നെറ്റ്‌വര്‍ക്‌സ് ലിമിറ്റഡിന്റെ അസോസിയേറ്റ് വൈസ് പ്രസിഡന്റും ഗതാഗത മേഖലയില്‍ അനുഭവസമ്പന്നനുമായ ശ്രീ. അനില്‍കുമാര്‍ പണ്ടാല പറഞ്ഞു. പുകവലി ഡ്രൈവറുടെ ജാഗ്രത നഷ്ടപ്പെടുത്തുന്നു. സിഗരറ്റ് പുക കാഴ്ച മറയ്ക്കുന്നതും സീറ്റീലോ മടിയിലോ സിഗരറ്റ് വീണുപോകുന്നതുമൊക്കെ ഡ്രൈവിങ്ങിനിടെ അപകടങ്ങള്‍ക്കു വഴി തെളിക്കും. വാഹനങ്ങള്‍ക്കുള്ളിലെ പുകവലി ശീലത്തിനെതിരെയുള്ള നടപടികള്‍ റോഡ് സുരക്ഷയും ആരോഗ്യസുരക്ഷയും ഉറപ്പാക്കാന്‍ അത്യാവശ്യമാണെന്നും അദ്ദേഹം ചൂണ്ടിക്കാട്ടി.

പൊതു വാഹനങ്ങളിലും ബസ് ഡിപ്പോകളും ബസ് സ്റ്റാന്‍ഡുകളിലും പുകവലിക്കെതിരെ നടപടി സ്വീകരിക്കണമെന്ന് 2015ല്‍ ആര്‍ടിഒമാര്‍ക്കും ജോയിന്റ് ആര്‍ടിഒമാര്‍ക്കും ട്രാന്‍സ്‌പോര്‍ട്ട് കമ്മിഷണര്‍ രേഖാമൂലം നിര്‍ദേശം നല്‍കിയിരുന്നു. കോട്പ നിയമപ്രകാരം പുകവലിക്കുന്നവരില്‍നിന്ന് പിഴയീടാക്കാനുള്ള അധികാരം കണ്ടക്ടര്‍ തൊട്ടു മുകളിലോട്ടുള്ളവര്‍ക്കുണ്ട്. നിയമലംഘനം കണ്ടെത്തിയാല്‍ 200 രൂപയാണ് പിഴ. 

പുകവലി പാടില്ല എന്ന  സചിത്ര സൂചനാബോര്‍ഡ് എല്ലാ പൊതു വാഹനങ്ങളിലും പതിപ്പിച്ചിരിക്കണമെന്നും കോട്പ നിയമം അനുശാസിക്കുന്നുണ്ട്. രജിസ്‌ട്രേഷന്‍ വേളയിലും ഫിറ്റ്‌നസ് സര്‍ട്ടിഫിക്കറ്റ് അനുവദിക്കുമ്പോഴും ഇത്തരം സൂചകങ്ങള്‍ വാഹനങ്ങളില്‍ പതിപ്പിച്ചിട്ടുണ്ടെന്ന് ഉറപ്പാക്കുകയും വേണം. പൊതുവാഹനങ്ങളില്‍ വിലക്കിയിട്ടുള്ള, പുകയില ഉല്‍പ്പന്നങ്ങളുടെ പ്രത്യക്ഷമായോ പരോക്ഷമായോ ഉള്ള പരസ്യങ്ങള്‍  പ്രത്യക്ഷപ്പെടുന്നില്ലെന്ന് ഉറപ്പുവരുത്താനും നിര്‍ദേശമുണ്ട്. 

കോട്പ നിയമ ലംഘനങ്ങള്‍ നടന്നിട്ടുണ്ടെങ്കില്‍ പ്രതിമാസ പരിശോധനാ റിപ്പോര്‍ട്ടുകളില്‍ അതു പരാമര്‍ശിക്കേണ്ടതുണ്ട്. ഓട്ടോറിക്ഷ, ടാക്‌സി, പ്രൈവറ്റ് ബസുകള്‍ എന്നിവയുള്‍പ്പെടെയുള്ള പൊതുവാഹനങ്ങള്‍ക്ക് ഇതു ബാധകമാണ്. 1989ലെ കേന്ദ്ര മോട്ടോര്‍ വാഹന നിയമപ്രകാരവും പൊതുവാഹനങ്ങള്‍ ഓടിക്കുന്നതിനിടെയുള്ള പുകവലി, ഡ്രൈവറെ അയോഗ്യനാക്കാനും ലൈസന്‍സ് റദ്ദു ചെയ്യാനും പര്യാപ്തമായ കുറ്റമാണ്.

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NCI-WHO Report: Tobacco Use Costs Countries Over $1 Trillion Annually

A landmark global report released today provides another powerful reason why the fight against tobacco must be a priority for countries around the world: It not only saves lives, but also reduces the enormous economic toll of tobacco use. 

The report finds that tobacco use does not contribute to economic development. In fact, tobacco use burdens countries with more than $1 trillion a year in health care costs and lost productivity, while measures to reduce tobacco use are highly cost-effective and do not harm economies, according to the report issued by the U.S. National Cancer Institute and the World Health Organization.

The report, The Economics of Tobacco and Tobacco Control, is the first comprehensive review of the economic impact of tobacco use and global tobacco control efforts in nearly 20 years.

The report underscores that tobacco use disproportionally harms the world’s most vulnerable populations. In the United States and around the world, tobacco use is increasingly concentrated among the poor and other vulnerable groups and accounts for a significant share of health disparities between rich and poor, the report notes. 

These disparities are exacerbated by a lack of access to health care, diversion of household spending from basic needs such as food and shelter to tobacco, and increased health care spending and reduced income stemming from tobacco-related diseases.  Importantly, the report finds that higher tobacco taxes and prices reduce health disparities because they lead to greater reductions in tobacco use among the poor. Contrary to the claims of the tobacco industry, it is tobacco use – and not tobacco taxes – that disproportionately harms poor people.

The report assesses the impact of tobacco control measures being implemented around the world, including significant tobacco tax and price increases, bans on tobacco marketing, pictorial warnings on tobacco products, smoke-free policies and population-wide tobacco cessation programs. 

These measures are called for by the world’s first public health treaty, the WHO Framework Convention on Tobacco Control, which obligates 180 countries to implement these proven policies to reduce tobacco use. The report finds that these policies and programs are highly cost-effective, with significant tobacco tax and price increases being the most cost-effective of these interventions.

The tobacco industry’s deep pockets and deadly tactics remain the greatest obstacle to progress in addressing the devastating global toll of tobacco use. The report notes that in addition to continued implementation of evidence-based tobacco control strategies, vigilant monitoring of the tobacco industry’s ongoing efforts to promote tobacco use and undermine tobacco control is crucial. 

This report reminds us that while tremendous progress has been made in reducing tobacco use, urgent and sustained global action is needed to prevent tobacco use from killing one billion people worldwide this century.

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Tobacco Use is High Among Boys in Much of Asia

Source: https://www.researchgate.net/publication/12476172_World's_best_practice_in_tobacco_control

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Trying to quit smoking? This smartphone game may help

A new smartphone game that may help smokers stick to their New Year's resolution to kick the butt has been developed by researchers. 

The game - Cigbreak Free - developed by researchers from Kingston University and Queen Mary University of London (QMUL) in the UK works like a regular smartphone game, with players having to complete tasks to progress through levels and gain rewards. 

However, it also incorporates a combination of some 37 behavioural change techniques theory-based methods for changing behaviour selected by psychologists to help smokers quit.

"People think games are frivolous but we learn a lot through play. The good thing about a smartphone gaming app is that you can play it anywhere," said Hope Caton, from Kingston University.

"Craving is a short-term thing, so if you get a craving at 11am, you can play the game in the warm until it passes, rather than going out into the cold for a cigarette," Caton said.

"You have also got something to do with your hands other than smoke," she added.

In the game, players have to swipe a certain number of cigarettes to break them within a time limit.

In the game, players have to swipe a certain number of cigarettes to break them within a time limit.

As well as progressing through levels, the app includes a quit journal where users can calculate how much money they are saving.

There are also mini-games where players have to clear smoke from a room to reveal a health message.

The study analysed the use of behaviour change techniques and game-like elements in health apps currently on the market.

Researchers found that very few of the health apps they looked at were using games to help people make positive health changes.

The development of the app was inspired by a desire to exploit the latest trends in gaming to help improve people's health, according to Professor Robert Walton from QMUL.

"Some of the health messages and behaviour change techniques we have used in the game are based on our previous research and include showing players the health consequences of a behaviour, gaining points for grabbing healthy items, or providing virtual financial incentives," said Walton.

"We are essentially trying to 'gamify' these messages and techniques as a way of embedding them in a person's mind, in the hope that they will then be able to quit smoking," said Walton.

Rewards in the game were a way of giving smokers instant positive feedback, Caton added.

"When you are trying to quit smoking you do not get much instant feedback except desire. Your health is better but somehow it doesn't have the same effect as being told you're winning or getting a gold star," she said.

The study was published in the British Medical Journal. 

Source: Economic Times

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Note ban brings tobacco smuggling to halt

Flow of banned products to State hit due to fall in domestic demand

Nothing, even a series of raids, could check the steady flow of banned hazardous products to the State through the rail route. But demonetisation appears to have done the trick.

According to the Railway police, a spin-off of the ban on high-value currency notes is the drastic fall in smuggling of pan masala products and cheap quality ganja by trains that directly connect the eastern part of the country to Kerala. They attribute the trend to the decline in arrival of migrant labourers coupled with a fall in domestic demand as several of them have returned to their home States post-demonetisation.

“Seizure of tobacco products and ganja in small quantities were regularly being reported after the arrival of weekly trains like Shalimar Express, Guwahati Express, and Dhanbad Express. Now, the number of cases registered under COTPA (Cigarettes and Other Tobacco Products Act) has fallen by at least 80 per cent,” a senior Railway police officer said.

Welcoming the Centre’s demonetisation drive, which they believe has put the brakes on the illegal business, the Railway police are now heaving a sigh of relief.

Despite routine checks on board and on railway station premises, the steady flow of banned products through the rail route had been a major headache for enforcement agencies. For instance, the Railway police in Ernakulam seized close to 150 kg of tobacco in 25 separate cases in 2014, while in the following year, it registered as many as 18 cases. The number of cases, however, came down to 13 this year.

Similarly, they also seized around 25 kg of ganja in 2015 and another 40 kg of the contraband this year.

Rackets from West Bengal

Enforcement agencies have specific information on the operation of rackets in States like West Bengal.

The rackets are engaged in transporting banned tobacco products, cheap quality ganja, and psychotropic drugs to Kerala. These products are supplied mainly to migrant labourers in towns like Perumbavoor, which has the greatest concentration of migrant workers in the State.

Those who transport the contraband exit the station premises clandestinely to evade police surveillance.

Source: The Hindu

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