It is estimated that more than 10,00,000 people die each year due to tobacco use in India
world over 60,00,000 people die annually due to tobacco use
Opinion Poll
Scientific papers
Prohibiting tobacco advertising, promotions & sponsorships: Tobacco control best buy
- Category: Scientific papers
By: Monika Arora & Gaurang P.Nazar
In the 1990s tobacco smoking and exposure to second hand smoke (SHS) ranked among the top three risk factors contributing to the global burden of disease along with childhood underweight and household air pollution. Today, after two decades, tobacco smoking and exposure to SHS still rank among the top three risk factors despite the other risk factors being replaced by high blood pressure and alcohol use, which are essentially risk factors contributing to non-communicable diseases (NCDs). Tobacco control has been identified as a high priority, cost-effective intervention along with reduction of dietary salt intake and treatment of people at high risk for cardiovascular disease, which can aid in achieving the global target of 25 per cent reduction in NCD related mortality by 2025.
Determinants of Tobacco Cessation Behaviour among Smokers and Smokeless Tobacco Users in the States of Gujarat and Andhra Pradesh, India
- Category: Scientific papers
By: Bidyut K Sarkar, Monika Arora, Vinay K Gupta, K Srinath Reddy
Abstract
Background: This study was undertaken to identify the socio-demographic determinants of quit attempts among smokers and smokeless tobacco users to identify correlates of tobacco cessation behaviour in India. Materials and Methods: This was a cross-sectional study for the outcome of quit attempts made by current tobacco users in last 12 months in twelve districts in two states. Simple and multivariable logistic regression analysis was used to obtain the odds ratios (ORs) of socio-demographic variables (age, gender, education, occupation, socioeconomic status, community, area, type of family) and tobacco user status (smoker/smokeless). Results: In the combined analysis, a smoker had higher predicted probability of attempting quitting (OR- 1.41,CI 1.14 -1.90),in comparison to a smokeless tobacco user and a tobacco user in the state of Gujarat was less likely to attempt quitting than a user in Andhra Pradesh (OR-0.60, CI 0.47-0.78). The probability of making a quit attempt was higher among tobacco users who were more educated (OR-1.40, CI 1.04-1.94), having a higher socio-economic status (SES) (OR-2.39, CI 1.54-3.69), and belonging to non-agricultural labourer occupational group (OR-1.90, CI 1.29-2.78). The effects were maintained even after adjusting for all other variables. In disaggregated analysis, findings were similar except in smokeless as a separate group, education level was not significantly associated with quit attempts and with lower odds (OR-0.91, CI 0.58-1.42). Conclusions: This is one of the first studies to provide useful insight into potential determinants for quit attempts of tobacco users in India including smokeless tobacco users, exploring the socio-demographic patterning of correlates of quit attempts.
Banning smokeless tobacco in India: Policy analysis
- Category: Scientific papers
By: Monika Arora, Raghavendra Madhu
India is the second largest producer and third largest consumer of tobacco. According to GATS India Report (2009-10), the users of only smokeless tobacco (SLT) are more than double than that of smokers. SLT use is an imminent public health problem, which is contributing to high disease burden in India. It is a “unique” tobacco product due to its availability in myriad varieties, easy access, and affordability especially for adolescents. It has been studied to be a gateway productand facilitates initiation. Currently, the Food Safety and Standards Authority of India (FSSAI) have prohibited the use of tobacco and nicotine in any food products; yet, the implementation of a permanent ban on SLT across India is still pending. This paper examines how multiple legislations have failed to effectively control or regulate SLT in India and regionally;
thus, there is need to strengthen SLT control efforts as “no ordinary product.”
Priorities for tobacco control research in India
- Category: Scientific papers
By: K Srinath Reddy, Bidyut K. Sarkar
The enormity of the tobacco epidemic in India, which has a population greater than the United States and Europe combined, merits a huge scaling-up of research efforts that can inform, support and evaluate tobacco control. Research is needed to underpin all the World Health Organization’s MPOWER recommendations. Prioritization and coordination of the research efforts are critical to success and ensuring value for money. Apart from the sheer size of the country and its population, its cultural and regional diversity present particular challenges.
Integrating tobacco control into health and development agendas
- Category: Scientific papers
By: K Srinath Reddy, Amit Yadav, Monika Arora, Gaurang P Nazar
Tobacco use is one of the major risk factors for non-communicable diseases, with a profound impact on resource-poor low-income and middle-income countries such as India, where tobacco use is high and where socioeconomic as well as health inequalities are rampant. Effective implementation of the Framework Convention on Tobacco Control requires multisectoral efforts that can fructify through integration of tobacco control into broader health and development agendas such as food and water security, environment, the right to education and human rights.The global tobacco control community will need to explore innovative partnerships beyond its traditional confines and build a global coalition that supportstobacco control by partnering with others having convergent concerns on common determinants. A firm political commitment and intersectoral coordination between government and non-government agencies is paramount in order to implement effective tobacco control programmes. Integration of tobacco control into other health and development agendas as described in this paper has the potential to contribute to the achievement of all the eight United Nations Millennium Development Goals. This paper explores why the whole of government should accord a high priority to tobacco control, and how this integration could be achieved.
Impact of tobacco advertisements on tobacco use among urban adolescents in India: results from a longitudinal study
- Category: Scientific papers
By: Monika Arora, Vinay K Gupta, Gaurang P Nazar, Melissa H Stigler, Chery L Perry, K Srinath Reddy
Tobacco use among Indian adolescents, particularly younger cohorts, poses an enormous public health challenge with the prevalence of ever tobacco use being 14.7% as determined from the project Mobilizing Youth for Tobacco Related Initiatives (MYTRI), a randomised intervention trial conducted among school going adolescents in India.1 Results from the Global Youth Tobacco Survey (GYTS) in India suggest that there has been an increase of 0.9% in the prevalence of any tobacco use and 0.6% in the prevalence of smoking as well as other forms of tobacco use for over 3 years among youth between the ages of 13 and 15 years, with the prevalence of all forms of tobacco consumption being higher among boys than girls.
Community-based model for preventing tobacco use among disadvantaged adolescents in urban slums of India
- Category: Scientific papers
By: Monika Arora, Abha Tewari, Vikal Tripathy, Gaurang P.Nazar, Neeru S.Juneja, Lakshmy Ramakrishan, K.Srinath Reddy
Tobacco consumption in multiple forms presents an emerging, significant and growing threat to the health of Indian adolescents, especially those from low socio-economic communities. Research in two phases was undertaken among economically disadvantaged adolescents in two urban slums of Delhi. In phase I,qualitative research methods such as focus group discussions and in-depth interviews were used to explore and understand the determinants influencing tobacco use among these adolescents.Prevalence of tobacco use was higher among boys than girls. Adolescents reported using tobacco in multiple forms, chewing tobacco being the most popular. Peer pressure, easy availability and affordability were important reasons associated with tobacco initiation and continued use. Though they had some knowledge about the harmful effects of tobacco, this was not sufficient to motivate them to abstain or quit. The community-based intervention model developed on the basis of the results of phase I was evaluated in phase II in a demonstratio study with two slum communities. One was treated as the intervention and the other as control. A significant difference in current use of tobacco was observed between the study groups (p ¼ 0.048), with the intervention group showing a reduction in use, compared with an increase in use among the control group. Post-intervention, the intervention group reported significantly lower fresh uptake (0.3%) of tobacco use compared with the control group (1.7%). No significant change was found for quit rate (p ¼ 0.282) in the two groups. Community-based interventions can be effective in preventing adolescents from initiating tobacco use in a low-resource setting such as
India.
A Framework to Prevent and Control Tobacco among Adolescents and Children: Introducing the IMPACT Model
- Category: Scientific papers
By: Monika Arora, Manu Raj Mathur, Neha Singh
The objective of this paper is to provide a comprehensive evidence based model aimed at addressing multi-level risk factors influencing tobacco use among children and adolescents with multi-level policy and programmatic approaches in India. Evidences around effectiveness of policy and program interventions from developed and developing countries were reviewed using Pubmed, Scopus, Google Scholar and Ovid databases. This evidence was then categorized under three broad approaches: Policy level approaches (increased taxation on tobacco products, smoke-free laws in public places and work places, effective health warnings, prohibiting tobacco advertising, promotions and sponsorships, and restricting access to minors); Community level approaches (school health programs, mass media campaigns, community based interventions,promoting tobacco free norms) and Individual level approaches (promoting cessation in various settings).This review of literature around determinants and interventions was organized into developing the IMPACT framework. The paper further presents a comparative analysis of tobacco control interventions in India vis a vis the proposed approaches. Mixed results were found for prevention and control efforts targeting youth. However, this article suggests a number of intervention strategies that have shown to be effective. Implementing these interventions in a coordinated way will provide potential synergies across interventions. Pediatricians have prominent role in advocating and implementing the IMPACT framework in countries aiming to prevent and control tobacco use among adolescents and children.
Ineffective Pictorial Health Warnings on Tobacco Products: Lessons Learnt from India
- Category: Scientific papers
By: Dr. Monika Arora, Abha Tewari, Gaurang P.Nazar, Vinay Gupta, Radhika Shrivastav
Pictorial warnings are effective in promoting smoking cessation as shown by research in the developed countries. This study aims to determine perceptions of Indians about the effectiveness of pictorial health warnings on tobacco packs which existed from May 31, 2009, to December 1, 2011. A cross-sectional survey was undertaken in five states of India with 1897 participants (56% males; 54% tobacco users). More tobacco users expressed that the pictorial warnings are inadequate to convey the health impact of tobacco use when compared with nonusers (71.50% vs. 62.75%;P < 0.001). More illiterates when compared with literates expressed their concern that the current pictorial warningswill not motivate them to quit (61.17% vs. 51.01%; P < 0.001). The new warnings implemented from December 1,2011, in India are also not fi eld-tested. Field testing and assessment of effectiveness of health warnings should be a mandatory requirement for Parties reporting on Article 11 of Framework Convention on Tobacco Control (FCTC).
A Model for Making Dental Institutions and Clinics (Workplaces) Tobacco-free
- Category: Scientific papers
By: Rakesh Gupta, Deepak Bhargava, Bhupendra Singh, Catherine Jo
Countries in South Asia and South East Asia, such as India, experience a significant burden of Oral Precancer (specifically OPMDs- Oral Premalignant disorders) and Cancer, largely due to the use of smokeless tobacco. The objective of this paper is to describe a model along with a case study from India for implemention of tobacco-free workplaces. Dentists can be leaders in this effort by making their institutions and clinics tobacco-free.