India home to a high proportion of young smokers

Data from the Global Tobacco Atlas released recently indicates that despite lowering tobacco use in recent years, India is home to an estimated 625,000 child smokers in the age group of 10 to 14 years. More than 932,600 Indian lives are lost to tobacco-related diseases every year. Further, the economic burden of smoking is very high in India and this includes both direct cost of healthcare and the indirect cost of lost productivity.

Use of tobacco is one of the leading causes of cardiovascular diseases, stroke, pulmonary diseases and certain types of cancers.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “One of the major causes for continued tobacco consumption in India is the fact that it is a part of the country’s social culture. Kids start smoking even before they’re old enough to think about the risks; after starting they rapidly become addicted to smoking and then regret it later. Smoking aggravates bone loss and is a risk factor for hip fracture. It is responsible for more than 10% of heart blockage diseases all over the world and 33% of all cardiac deaths. Any form of tobacco like snuff, chewing, and dipping varieties which are not burnt can be termed as smokeless, another variant that is harmful to health. Smokeless forms also contain sugar and prolonged usage can adversely affect control of blood sugar levels in patients with diabetes.”

It is a common practice in India to use SLT mixed with areca nut. Areca nut itself is classified as a class one carcinogenic and also causes other adverse health effects.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Quite often, we may rebuke a patient for failing in his efforts to quit smoking and say, ‘If you do not quit, you may die’. A statement worded as this may inadvertently sound discouraging to the patient. While it is important that people know the dangers of smoking or using tobacco products, a positive communication approach may have a more fruitful impact than a critical approach.”

HCFI tips to quit this habit.

· Try short-acting nicotine replacement therapies such as nicotine gum, lozenges, nasal sprays, or inhalers. These can help overcome intense cravings.

· Identify the trigger situation, which makes you smoke. Have a plan in place to avoid these or get through them alternatively.

· Chew on sugarless gum or hard candy, or munch raw carrots, celery, nuts or sunflower seeds instead of tobacco.

· Get physically active. Short bursts of physical activity such as running up and down the stairs a few times can make a tobacco craving go away.

One approach to smoking cessation is the five-step algorithm called the “5 A’s” (Ask, Advise, Assess, Assist, Arrange)

All smokers should be advised to quit smoking.

Even brief advice to quit has been shown to increase quit rates.

Smokers be managed with a combination of behavioral support and pharmacologic therapy

Combination therapy is superior to either behavioral intervention or pharmacologic therapy alone.

Courtesy:The Health Site

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Campaign launched to warn of dangerous link between tobacco and TB

The Ministry of Health and Family Welfare (MoHFW), during the End-TB Summit here, has re-launched 'Cough,' a national mass media campaign to warn citizens about the links between TB and tobacco use.

'Cough' shows that tobacco consumption and exposure to secondhand tobacco smoke increases the risk of TB and of dying from the disease. A key barrier to timely diagnosis and treatment among smokers is the assumption that a cough is related to their smoking. This campaign encourages smokers to visit their doctor to confirm whether a persistent cough is a sign of TB.

TB killed 432,000 Indians in 2016 - more than 1,183 every day. The government aims to eradicate TB from India by 2025, five years ahead of the global TB elimination target of 2030. The campaign, which is designed to create support for TB eradication, encourage smokers to quit, and increase timely diagnosis and treatment of TB, was developed and implemented with technical support from Vital Strategies.

"Most TB deaths in India occur among young, economically productive adults and the disease is one of the top five causes of death among people aged 30-69 years," said Jose Luis Castro, President and Chief Executive Officer, Vital Strategies.

"India's tobacco epidemic is contributing to this burden. 'Cough' will support progress towards the target of eliminating TB by 2025 by encouraging smokers to quit and ensuring that smokers and those exposed to secondhand smoke visit the doctor about a persistent cough. This is a life-saving message and we congratulate MoHFW on the re-launch of this important campaign," added Castro.

When 'Cough' first launched on World No Tobacco Day in 2017, India became the first country in the world to run a national tobacco control campaign that highlights the increased risk of TB and dying from TB linked to smoking tobacco (cigarettes or bidis) or exposure to second hand smoke.

The public service announcement (PSA) graphically shows that while a smoker's cough tells the smoker they have a health problem, a persistent cough over two weeks or more could indicate that problem is TB. The PSA shows a father smoking and coughing beside his daughter, noting that exposure to second-hand smoke brings the same risks. It ends with the stark warning that "Every bidi cigarette brings you and those around you closer to TB."

Courtesy :Deccan Chronicle

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Detrimental Tobacco

Let me start by saying that I don't want to sound like a fanatic, for I don't suggest anything that I can't do myself. I quit smoking recently. And that's no small feat. Tobacco is the most common form of addiction and one of the most harmful as well, much more than the dreaded cannabis or for that matter Ecstasy, let alone alcohol.

If, and I know it's a big if, alcohol is consumed in moderation at a decent pace, half an hour for a peg, it's actually medicinal. But there's no safe amount of consumption of tobacco products. And for a young country like India, where half of the population is below 25 years of age, tobacco is doom. The greatest challenge before India, as a nation, is to exploit the incredible demographic potential—and inculcating a sports culture is the most effective way of doing it. Tobacco is the surest and easiest way of squandering it.

Simply put, tobacco is a significant public health hazard, and something urgently needs to be done to discourage people from tobacco consumption. Just to give an idea of the enormity of the problem, globally, tobacco kills more people than tuberculosis, HIV/AIDS, and malaria combined. Remember, smoking a cigarette is just one of many ways of consuming tobacco. The consumption of smokeless tobacco in the form of snuff, chewing tobacco, tobacco leaf and gutkha is widespread amongst all age groups in India. There's no escape, every second Indian is hooked on to one or the other form of tobacco consumption, and more often than not, it contributes to oral submucosal fibrosis or OSF.

More Indians chew tobacco than they smoke cigarettes or beedis, the figures are 26 per cent and 14 per cent, respectively, according to the Indian government and the World Health Organisation's Global Adult Tobacco Survey of 2009-2010. Not surprisingly, nearly 80 per cent of oral cancer patients are tobacco users.

Recently, the Indian Journal of Medical of Pediatrics published a study by Gauravi Mishra, Sharmila A Pimple and Surendra S Shastri that pointed to the fact that India is the second-largest consumer of tobacco globally, and accounts for approximately one-sixth of the world's tobacco-related deaths. The Global Youth Tobacco Survey paints a grim picture of India. It was carried out amongst students of classes VIII, IX and X, or roughly of the 13-16 age group. It was found that 15 per cent of students used tobacco products, mostly chewing tobacco (nearly 80 per cent).

Despite this, not much has been done to curtail tobacco consumption. One of the main reasons is that the tobacco industry is fairly influential. It has been boasting about its contribution to the Indian economy at large by generating employment in the agriculture and manufacturing sectors along with revenues in the form of exports and taxes, as a justification to be allowed to play with the health of our country's people. But one doesn't need rocket science to understand that the public health hazard caused by tobacco outweighs all economic benefits many times over.

In the past, many states have tried to ban chewing tobacco but with little success. Take the case of gutka, a concoction of raw betel nut mixed with tobacco, which has been banned for some years now. To circumvent this, many tobacco companies started selling gutka discreetly, by selling pan masala paired with a separate sachet of tobacco. Though this may seem harmless, tobacco sold in small portions in a sachet actually facilitates its use primarily amongst teenagers. Many celebrities, from the film industry to sports, campaign for tobacco products, in spite of the repeated persuasion against doing so. Tobacco, sadly, has become an integral part of life in cities and villages.

I specialise in youth outreach programmes by the way of sports. And tobacco consumption is a great impediment to the objective of creating a healthy society that is committed to playing sports. Children and the unemployed youth are hard-pressed for money, and their consumption of tobacco products is highly susceptible to strong fiscal measures.The availability of tobacco products in smaller quantities, in sachets and cigarettes sold by individual sticks, make it accessible to all, even children. Ideally, the government should ban the consumption of tobacco. But, till the time it's done, at least the government should ensure two things. One, those that are 18 years and below are not to be sold any tobacco product. And two, the sale of tobacco products in small quantities, especially sachets which cost merely Rs 5 to 10, should be banned at the earliest. This will effectively curtail the access of tobacco products to sub-adults. No half measures will suffice in the fight against tobacco. Ban tobacco. 

Courtesy: Millennium Post

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WHO wants developing countries to hasten implementation of tobacco control conventions

The World Health Organisation has reiterated the need for countries to focus on accelerating implementation of the Framework Convention on Tobacco Control (FCTC), especially in developing countries.

The WHO FCTC remains one of the most swiftly embraced United Nations treaties, gaining 181 Parties in just over ten years.

These 181 countries are legally obliged to adopt and implement its evidence-based measures for reducing tobacco use.

Since it came into force in 2005 high impact policies have been increasingly introduced by some countries around the world.

But officials believe it is high time more countries especially developing countries to live up to their commitments by accelerating the implementation of the Convention.

For some countries, this means ensuring that they comply with their obligations, such as tightening existing laws to eliminate smoking rooms and point-of-sale advertising.

It has been identified that tobacco not only wrecks health and health systems it is also a drain on economies and the environment.

Every year, according to the WHO, tobacco use kills about 7 million people, and many more people develop serious illnesses such as cancers, chronic respiratory diseases and heart disease.

Tobacco costs the global economy more than 1 trillion US Dollars annually in health spending and lost productivity.

“This is unacceptable”, said the Director-General of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus during his opening speech at the 17th World Conference on Tobacco or Health, in Cape Town, South Africa.

Raising Taxes

He is optimistic this cost can be offset if all governments raised excise taxes by about 80 U.S. cents per pack of cigarettes.

This, according to him, would increase revenues by 47 percent, or 140 billion US Dollars, which could provide much-needed funding for health systems.

It would also increase cigarette prices by an average of 42 percent leading to a 9 percent decline in smoking rates and at least 66 million fewer smokers.

Effects of tobacco production on the environment

In a report published in 2017, the WHO showed that tobacco production is extremely water-intensive.

Large amounts of water are used in areas where tobacco farms and factories are located, which can put severe stress on local water reserves.

In addition, countless trees must be cut down to cure tobacco leaves, and the waste from tobacco also contains over 7000 toxic chemicals, including some that cause cancer.

Emissions from tobacco products contribute thousands of tonnes of human carcinogens, toxicants and greenhouse gases to the environment.

“All of this can be prevented if countries take action to implement the convention. Our message is implement, implement, implement the Convention. It is comprehensive,” Dr Adhanom Ghebreyesus

Call to eliminate the illicit trade in tobacco products

The “legal” cigarette market is bad enough. But the illicit trade of tobacco products creates a shadowy market that not only destroys health, it fuels organised crime and deprives governments of tax revenues.

The Protocol to Eliminate the Illicit Trade of Tobacco Products will help countries put a stop to the situation.

To come into force, the WHO needs six more countries to ratify by July, 2, because so far, only 34 countries have ratified the protocol.

“I urge countries in this room that have not ratified the protocol to do so. I am writing to all Parties to the Convention, encouraging them to ratify the Protocol and bring it into force,” he pleaded.

It is therefore critical for countries to strengthen their efforts and scale up their actions while facing increasing interference from the tobacco industry.

Today, 6 in 10 people globally are protected by at least one of the six tobacco control best practices in the demand reduction tobacco control policies, collectively known as MPOWER.

That’s four times more people than in 2007 when WHO first introduced MPOWER to help countries implement the Convention.

Africa is at the heart of the Sustainable Development agenda but is also seen as a growth market for the tobacco industry.

Africa has made great strides on some health issues, such as HIV/AIDS, but the tobacco problem is in its early stages and is not being given sufficient attention.

But there are many reasons for hope since countries like Ghana, Ethiopia, Gabon, the Gambia have recently increased tobacco taxes.

Kenya is fighting the illicit tobacco trade through an advanced track and trace system;

Senegal implemented four tobacco control measures at the same time, including large graphic health warnings and a comprehensive ban on tobacco advertising, promotion and sponsorship.

Uganda has passed a comprehensive tobacco control law, and 13 of the 34 countries that have ratified the illicit trade protocol are in Africa.

But there is more work to be done.

"We need to ensure that developing countries, some of which have the highest rates of tobacco consumption, take steps to implement the WHO Framework Convention on Tobacco Control. We need more countries to increase tobacco taxes to drive down smoking rates and generate revenues to fund health systems. We need to stop the illicit trade in tobacco products by bringing the WHO FCTC Illicit Trade Protocol into force,” the WHO Director said.

Head of the Secretariat of the WHO FCTC, Dr Vera Luiza da Costa e Silva, told delegates that tobacco control was at the heart of the new Sustainable Development Agenda.

“By accelerating the implementation of the WHO FCTC, the global tobacco control treaty, and becoming Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products, countries can facilitate the achievement of their goals by 2030 and save tens of millions of lives,” said da Costa e Silva.

Meanwhile, President of the 17th WCTOH, Dr Flavia Senkubunge, is optimistic the high quality of science being presented in Cape Town comes at a pivotal moment in tobacco control.

“This confirms that we know what works in tobacco control,” said Dr Flavia Senkubunge.
 

Courtesy: myjoyonline.com

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9.9% school kids suffer from bronchial asthma

The students residing in rural area who are exposed to smoke along with a family history of bronchial asthma are at greater risk of getting the chronic inflammatory disease compared with those staying in urban area, shows a study conducted by Amrita Institute of Medical Sciences among the higher secondary school students in Ernakulam district.

A total of 629 students participated in this study and the prevalence of bronchial asthma was estimated to be 9.9%. Besides family history, one of the main causes for asthma as per the study is active and passive smoking. Almost 15.3 % of those who had asthma reported that their friends used to smoke in their presence, when compared to 8.6% of those who reported not being exposed to friend's smoke. In the study, 18.6% who had asthma reported a family history of asthma, as per the study published in the Journal of Family Medicine and Primary Care.

"One of the main cause of chronic respiratory disease is active and passive smoking, besides family history. This shows that despite the tobacco control programs in place, school students in Ernakulam reportedly smoke," one of the author of the study PS Rakesh, department of community medicine, AIMS.

The study shows that while 5.4% of those having bronchial asthma were told by a doctor that they had asthma, 4.1% were currently receiving treatment for asthma. Majority of those studied (56.1%) were males, with 54.8% residing at a rural location and 93.9% living in pucca houses. Incidentally, of those residing in rural area (12.2%) had asthma while it was 7.1% for those belonging to urban areas.

In India, there are currently more than 15 million people living with asthma. Kerala government that has implemented a pilot project of the World Health Organization (WHO) recommended practical approach to lung health strategy, with an intention to further strengthen the health system and to improve the quality of diagnosis, treatment and management of common chronic respiratory illnesses in primary healthcare settings.

The state government has a plan to scale up public health programmes for chronic respiratory disease management. As per the plan, they have started a programme to address the problem of asthma and chronic obstructive pulmonary disease, a major cause of morbidity and mortality in India, affecting nearly 9% of the population above 35 years.

Courtesy:Times of India

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Doctors Appeal for Tobacco Control in Manifestos

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Call for bigger health warnings on tobacco product packs

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

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

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

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

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

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

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

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

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

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

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

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

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Higher cigarette taxes bring down sales

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Courtesy: The Hindu

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Governor sets agenda to monitor tobacco control measures in educational centres

His Excellency Governor of Kerala with Dr Paul Sebastian

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Tobacco litter a challenge to a clean India: Environmental experts

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

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

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

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

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

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

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

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

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

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

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

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Economic costs of tobacco use: Kerala surpasses neighbours

Kerala has emerged as a leader of sorts in South India with the huge economic burden it shoulders on account of tobacco use. God’s Own Country has left behind its tobacco cultivating neighbours – Karnataka and Tamil Nadu, reveals the findings of a major recent national study conducted to estimate the economic dimensions of tobacco use.

The study supported by the Union Ministry of Health & Family Welfare and the World Health Organisation brings out that the economic resources lost in treating and managing four major tobacco-induced diseases is nearly 75 per cent more than Karnataka. While Kerala burns out Rs 545.4 crores, it is Rs 314.7 crores in Karnataka.

Monetary resources lost due to tobacco use in Tamil Nadu is nearly 17 per cent lesser than Kerala, at Rs 467 crores.

The report following the study called ‘Economic Burden of Tobacco Related Diseases in India’ developed by the Public Health Foundation of India has estimated the economic costs on persons aged 35 – 69 in the year 2011. It has estimated both direct medical costs and indirect morbidity costs in two categories – all tobacco-induced diseases, and four specific diseases – cardiovascular diseases (CVDs); cancer, tuberculosis and respiratory disease.

Direct medical costs include direct healthcare expenditure for inpatient hospitalisation or outpatient visits such as medicines, diagnostic tests, bed charges and surgeon’s fees. Indirect costs accrue from expenses incurred on transportation and lodging charges for caregivers, loss of household income due to inpatient hospitalisation, besides costs from premature death. 

A similar pattern prevails with regard to economic burden of tobacco use from all diseases, with Kerala facing a greater pinch than Karnataka and Tamil Nadu. The economic cost in Kerala on all diseases is Rs 1513.7 crores, as against Rs 983.1 crores in Karnataka and Rs 1171.3 crores in Tamil Nadu.

In line with consumption patterns, tobacco-induced costs are higher among Kerala males as compared to females. Among males, higher costs – both direct and indirect – accrue from smoking tobacco products as against smokeless tobacco products.

On four diseases specifically, tobacco use among Kerala males causes a loss of Rs 518.9 crores, which is nearly 90 per cent more than in Karnataka and 40 per cent more than in Tamil Nadu. Tobacco induced economic costs among Kerala females is Rs 26.4 crores.

Kerala’s saving grace is Andhra Pradesh, a major tobacco producing state in India, which leads with the highest economic burden due to tobacco use among southern states.

The study, among others, recommends prioritisation of tobacco control measures such as strengthening implementation of Indian tobacco control law, COTPA, 2003; uniform taxes on all tobacco products such as cigarettes and bidis; prohibition on sale and manufacture of all forms of smokeless tobacco products/chewing tobacco and high visibility public awareness campaigns to consistently reach different target audiences.

The Value Added Tax on cigarettes in Kerala is 22 per cent and bidis are not taxed at all.

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Tobacco displays, an effective channel for promoting brands among the young

A study conducted in England on the association of tobacco display and brand communications at the point-of-sale (PoS) and adolescent smoking behaviour has found a positive relation between the two. 

Exposure to and awareness of PoS displays and brands in displays were associated with smoking susceptibility in the study that covered more than 5,000 students between the ages of 11 and 15 years. 

The odds of ever-smoking doubled for those visiting shops almost daily relative to less than once a week, and susceptibility increased by around 60%. Noticing tobacco on display every time during store visits increased the odds of susceptibility more than threefold compared with never noticing tobacco. 

For each additional tobacco brand recognised at the PoS, the adjusted odds of being an ever-smoker increased by 5% and of susceptibility by 4%. The association between frequency of visiting stores and susceptibility was predominantly due to exposure in small shops.

This study shows that tobacco displays are a potentially effective channel for promoting cigarette brands to young people, linking such promotion with ever-smoking and susceptibility to future smoking. The association between exposure to tobacco displays and susceptibility to smoke is predominantly explained by exposure in small shops and therefore the tobacco ban in supermarkets in England fails to safeguard young people from exposure associated with smoking initiation.

In England, point-of-sale (PoS) displays in larger shops were prohibited in April 2012, with an exemption for smaller retailers until 2015.

Source: Tobacco Control journal

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Tripling tobacco tax worldwide could cut smokers by a third

Aggressive taxation is the key to achieving a World Health Organization goal of reducing the global prevalence of smoking by one-third, new research led by a Toronto scientist shows.

A study headed by St. Michael’s Hospital’s Centre for Global Health Research, published in the New England Journal of Medicine, found that tripling tobacco taxes around the world could reduce the number of smokers by 433.3 million people and prevent 200 million premature deaths from lung cancer and other smoking-related diseases.

“We hope this will spur governments to (recognize) it’s a no-brainer. There is more revenue, fewer deaths and all sorts of benefits for the population,” said Dr. Prabhat Jha, director of the centre and professor in the Dalla Lana School of Public Health at the University of Toronto.

He launched the study to determine how the worldwide prevalence of smoking could be chopped by a third by 2025, a goal set at the World Health Organization’s 2013 Assembly.

While the proposal to hike tobacco taxes is a global one, it is particularly targeted at 10 regions representing two-thirds of the world’s 1.3 billion smokers. In descending order, they are: China, India, the European Union, Indonesia, the United States, Russia, Japan, Brazil, Bangladesh and Pakistan.

Strong lobbying by the tobacco industry has helped keep taxes lower in those countries, Jha explained.

Residents of China consume a staggering two trillion cigarettes annually, out of a world total of about six trillion.

Jha pointed out that the study is not just theoretical and that some countries have experienced great success in reducing smoking rates by sharply upping taxes.

For example, France tripled cigarette prices by raising taxes at least 5 per cent higher than the inflation rate every year between 1990 and 2005. At the same time, the country managed to halve cigarette consumption and double tobacco revenues.

The number of smokers in Canada has also dropped by half, but the decline has taken three decades and is largely due to tax increases, Jha said.

About 4 million Canadians smoke today, and that number could continue to be reduced — again by a third — if tobacco taxes were tripled, he said.

Jha noted that non-price interventions — including advertising bans, warning labels and smoke-free laws — also help to reduce smoking, but hiking taxes is the “single most effective” tool.

About $300 billion (U.S.) is collected annually in tobacco taxes around the world. Even though higher taxes would lower consumption, tax revenues would continue to rise by another $100 billion, bringing the annual total to $400 billion, the analysis showed.

Source: The Star

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Kerala Budget's tobacco taxes dismays activists

The Kerala Budget 2013-14 has raised cigarettes by a token, from 15 per cent to 20 per cent, while it has left bidis taxes untouched. Bidis, which among the most harmful smoking products, continue to be zero VAT slab.

Tobacco control activists share their thoughts:

Justice K Narayana Kurup, Former Judge of Kerala High Court and the legal luminary behind the legendary smoking ban in Kerala in 1999 said, “It pains me to see that the Government has given low priority to an-all important public health issue when it comes to taxing tobacco products. Exempting bidi from taxes to safeguard the interest of the poor does not hold merit, as poor bidi smokers could lead a healthy and longer productive life if they can reduce consumption, brought out through tax-induced price hikes.”

“Our neighbouring Tamil Nadu is taxing bidis at 14.5 per cent, why can’t Kerala do the same?” Justice Kurup, also founder, Anti Tobacco Foundation, Kochi asks. “The tax increase on cigarette is also disappointing in a state which prides itself for its public health initiatives,” he added.

Adv A Sampath MP said, “Tobacco use is high in Kerala and controlling it is vital for prevention of non-communicable diseases. The use of tobacco reflects in the growing health risks among our people. I hope that the Government of Kerala will wake up to this worrisome factor and initiate measures to curb its use by levying higher taxes on all tobacco products.”

Dr Tiny Nair, Head, Department of Cardiology, PRS Hospital said, “Taxing tobacco products is a proven way to reduce consumption, as WHO studies have shown. There are 1.6 million bidi smokers in Kerala, who mostly belong to poorest socio-economic backgrounds. Taxing bidis, which are among the world’s most harmful smoking products, will contribute to bringing down use among bidi smokers. Irreplaceable lives can be safeguarded from untimely morbidity and mortality.” 

Dr Nair adds that any reduced consumption brought out through increased tobacco taxes will also save non-smokers from the negative effects of passive smoking. “Passive smoking is not some third person singular number anymore; it affects each one of us. The particles in the unfiltered smoke that drifts from burning cigarette are finer and more concentrated, thus increasing their capacity to penetrate deeper and stay longer in the lungs of a passive smoker than the actual smoker. Revenues raised from higher taxes on tobacco products can finance large-scale tobacco cessation measures.” 

Magician Gopinath Muthukkad who spreads anti-tobacco messages through magic said, “A man smoking in his house is in fact passing on unseen hardships to his family members including children. WHO figures show that worldwide 165,000 children have lost their lives to passive smoking. 

Even though Indian tobacco control legislation COTPA has banned smoking in public places, it is poorly implemented. What we need to do is to make cigarettes and bidis unaffordable to the poor who bear the higher brunt of diseases that cripple their life and make them unproductive to eke out a living. This can be possible only by raising taxes on these products.”

“The courage shown by the Government to ban gutkha and pan masala in the state was praiseworthy. A similar people-oriented commitment is found missing in this Budget when it comes to taxing bidis and cigarettes,” Shri Muthukkad added.

Image courtesy various sites

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Expensive cigarettes equals more revenue and less health risks

Announcing an increase of excise duty on cigarettes, Finance Minister
Shri P Chidambaram during his Budget speech on Thursday said, “What does a Finance Minister turn to when he requires resources? The answer is cigarettes.”

The FM could well have rephrased his comment to what should government do to force people to quit smoking? The answer is, impose higher tax on cigarettes.

Rajasthan has shown the way. Consumption of cigarettes, bidis and zarda (chewing tobacco) has declined drastically in the state since the last three years after the state government increased tax rate on tobacco products from 20 per cent to 50 per cent.

While in terms of value, cigarette sale was Rs 413.55 crore in 2010-11, it came down to Rs 349.67 crore in the following year while in the first six months of current financial year the total sale of cigarettes was just Rs 160.28 crore.

Similarly, bidi industry registered a decline in sale by more than 50% in last two years from Rs 73.45 crore to Rs 25.10 crore and chewing tobacco sale dropped from Rs 31.54 crore to Rs 14.56 crore.

Buoyed by this trend the state government is contemplating a 50 per cent hike in the tax rate on tobacco products in the upcoming Budget. The state government while presenting a paper on strategy to reduce tobacco consumption in the National Consultation on Economics of Tobacco in December last year proposed to increase tax rate on tobacco products from existing 50 per cent to 75 per cent in line with WHO norms.

Experts say that raising taxes on cigarettes and bidis would have twin impact on health and revenue. Dr Virender Singh, Medical Superintendent of SMS Hospital said, “Cost escalation in tobacco products would not only reduce their consumption but also increase revenue for the government.” If the trend continues actual health benefits would be witnessed in a decade, he added.

As per WHO, in developing countries every 10% increase in price of tobacco will result in 8% reduction in tobacco use or consumption.

A recent study titled ‘Economics of Tobacco and Tobacco Taxation in India’ also highlights the crucial role that the government can play in reducing tobacco-related deaths by raising taxes on tobacco products.

Quoting a study by John’s Hopkins University (USA), Dharamveer Katawa, secretary Indian Asthma Care Society said, “The state government saved four lakh young lives when it raised tax rate on tobacco products from 20 per cent to 40 per cent.” At the same time, the state government’s earnings from tax on tobacco products have increased almost three folds. From Rs 288.16 crore in 2009-10, it went up to Rs 627.82 crore in the last financial year.

Courtesy: Daily Bhaskar

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Tobacco Control Sensitisation for Education Officials

A Shajahan

Tobacco Free Kerala organised a tobacco control sensitisation programme for education officials of Kerala at Al-Saj Convention Centre, Kazhoottam, Trivandrum on February 7, 2013.

The sensitization programme was done during a capacity-building exercise for Education Department Officials conducted by the National University of Educational Planning and Administration. 

In his opening remarks, Director of Public Instruction Shri A Shajahan said that the State Government gives great thrust to the tobacco free campaign. The objective of the Government is to create tobacco free.

Dr AS Pradeep Kumar, Addl. Director of Health Services, Government of Kerala gave a detailed presentation on COTPA Act, 2003 and its implementation in schools. He dealt at length about Sec 4 and Sec 6 (b) and the statutory boards to be insalled in schools as mandated under the law. 

Dr Paul Sebastian

Dr Paul Sebastian, Director RCC and Vice Chairman, TFK talked about the health hazards caused by the use of tobacco products. He used images of patients affected with cancers of oral cavity to drive home the harmful impacts of tobacco use. 

Dr Sebastian also showed videos of two tobacco victims – one an elderly man and another a young man – both of whom had lost out on precious productive years and had to face the trauma of cancers.

Irinjalakuda DEO Shri CC Jacob described the efforts taken to make Irinijalakuda educational district tobacco free. He pointed out that this was possible due to collective efforts by all including school administrations, police, parents and public.

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TFK observes World Cancer Day

Tobacco Free Kerala, a coalition led by Regional Cancer Centre, joined hands with Swasthi Charitable Foundation to to initiate a state-wide school based cancer awareness programme on World Cancer Day. 

His Excellency Governor of Mizoram Shri Vakkom B Purushothaman inaugurated the programme held at St Mary's Higher Secondary School - the school with the highest student strength in Kerala with nearly 9,000 boys and girls in its rolls. 

Shri Purushothaman said that fear is a major cause of death due to cancer. “When my mother was 80 years, she underwent an operation for breast cancer. On the advice of her doctor, we did not tell our mother about her condition though she was on medications. She lived without any complications for three years. A chance remark made by a relative about her disease however took here through a phase of fear, and she passed away within two months of that knowledge,” he recounted.

Organising Secretary, Santhigiri Ashram Swami Gururetnam Jnana Thapaswi who presided over the function said that similar cancer awareness programmes would be conducted in educational institutions across Kerala. 

Director of Public Instruction Shri A Shajahan exhorted students to keep away from tobacco products as they are proven to be a major cancer-causing factor. “Smoking and tobacco chewing might seem heroic to students, but they result in endless misery. Around 45 per cent of cancers are attributed to tobacco use.”

Shri Shajahan also told students about the efforts taken by the Government and his department for tobacco control efforts. Committees have been formed at the state, district and school level for implementing the Government’s intent of strict monitoring of tobacco use among students. “The Committees at the school level, which also has representation from the police and PTA has been authorised to ensure that no tobacco products are sold around schools,” he added. 

Shri Palode Ravi MLA; Shri Pirappancode Murali Ex MLA; Principal Secretary IT Shri PH Kurien; well-known novelist Dr George Onakoor; noted film actor Shri Jagadish, playback singer Shri G Venugopal and a host of other dignitaries were present. Shri Jagadish and Shri Venugopal enthralled the school children with their lilting melodies. 

Prof. & Head, Community Oncology Dr Remani Wesley; Addl Prof., Surgical Oncology, RCC Dr Paul Augustin and Asst Prof., Community Oncology Dr R Jayakrishnan collectively answered student queries on cancer.

General Secretary of Swasthi Charitable Foundation Shri Aby George delivered the welcome address and Principal of St.Mary’s School Rev. Dr. Varkey Attuparuthu proposed thanks.

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Kerala High Court's decision to uphold pan masala ban welcome

The Kerala High Court, in a welcome ruling, has upheld the ban on pan masala and gutkha containing tobacco or nicotine in Kerala, imposed by the Government under the provisions of the Food Safety and Standards Act, 2006.


Responding to the petition of the All Kerala Tobacco Dealers' Association to stay the ban, the Court declined to interfere with the Government's decision. The judgement bears significance as it has direct link in safeguarding and protecting the health of nearly 4.9 lakh users of pan masala and gutkha in Kerala. 


Countless studies have proven the toxic impacts of smokeless tobacco (ST) products, also known as non-combusted tobacco. A recent study on smokeless tobacco called 'Toxicology of smokeless tobacco: implications for immune, reproductive, and cardiovascular systems,' draws light on the adverse health outcomes owing to ST use.


The researchers Willis D, Popovech M, Gany F and Zelikoff J. surmise that there exists evidence of  reproductive outcomes, such as perinatal mortality, preterm birth, and reduced sperm viability, in conjunction with ST use. Cardiovascular health may also be impacted by ST use, resulting in increased blood pressure and endothelial dysfunction, both of which may potentially lead to cardiovascular diseases, they point out. 


Tobacco Free Kerala joins thousands of crusaders of public health across the world in hailing the Kerala High Court's verdict.


Image courtesy: http://media03.viva-images.com

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