indian tobacco
TRANSCRIPT
Dr. K.S. ReddyHony Executive Director, HRIDAY
CIGARETTE SMOKE CONTAINS 4000 POISONS
1 tobacco related death 1 tobacco related death every 6 secondsevery 6 seconds
WHAT IS AT STAKE?
= 10 million annual = 10 million annual deaths by 2030 deaths by 2030
1 Billion deaths in 21st Century
Global Tobacco TollTobacco toll rising globally: 5 million in 2002 to 10
million in 2030- WHODeveloping Countries increasingly vulnerable: 7
million deaths in 2030- WHO700 million children worldwide are forced to
passively breathe tobacco smoke1.69 million due to cardiovascular diseases1.47 million due to all tobacco related (0.83 million due to lung cancer)1 million due to chronic obstructive pulmonary
disease.
Health Consequences of Tobacco Use
Tobacco chewing in its various forms is directly responsible for cancers of the oral cavity, oesophagus, pharynx, cervix, penis.
Beedi and cigarette smoking cause oral, pharyngeal, oesophagael, laryngeal, lung, stomach, gallbladder, urinary bladder and penile cancers.
Tobacco use is a major known risk factor for cardiovascular diseases.
Tobacco smoking is responsible for over 82% of chronic obstructive pulmonary disease.
Tuberculosis is a major cause of death in India and it is three times as great among smokers than non smokers.
Men who smoke have a lower sperm count and poorer sperm quality than non smokers
Tobacco use is also associated with oral precancerous lesions such as leucoplakia and other oral mucosal lesions.
TOBACCO AND CANCERSTOBACCO AND CANCERS
Lung Lung Mouth (oral)Mouth (oral) Throat (Pharynx & Throat (Pharynx &
Larynx)Larynx) Food Pipe (Oesophagus)Food Pipe (Oesophagus) Urinary BladderUrinary Bladder Other Sites Other Sites
CARDIOVASCULAR RISKS OF SMOKINGCARDIOVASCULAR RISKS OF SMOKING
100% Increase in Risk
300% Increase in Risk
Stroke; CHD; Impotence
Death from undiagnosed CHD
> 300 % Increase in Risk
Peripheral Arterial Disease
400 % Increase in Risk
Aortic Aneurysm
OTHER DISEASESOTHER DISEASES
Chronic Bronchitis Chronic Bronchitis Emphysema Emphysema AsthmaAsthma CataractCataract Tuberculosis Tuberculosis DiabetesDiabetes Still Birth and Low Birth WeightStill Birth and Low Birth Weight
> 25 Diseases > 25 Diseases
PASSIVE SMOKING (ETS)PASSIVE SMOKING (ETS)
Second Hand Smoke increase risk ofSecond Hand Smoke increase risk of– Cancer by 30%Cancer by 30%– Heart attack by 25%Heart attack by 25%
in spouse of the smokerin spouse of the smoker
Increased risk of asthma and lung Increased risk of asthma and lung disease in children disease in children
Economic Effects of Tobacco Use
The total social costs of tobacco products exceed the direct outlay on them, owing to morbidity, mortality and negative externalities associated with the consumption of tobacco products.
The costs inflicted by tobacco consumption extend much
beyond the direct users to cover secondary smokers as well as non-users.
The recognition of the costs of tobacco has been obfuscated
and made opaque by the unethical tactics and practices by the tobacco lobbies.
Worldwide recognition of the perils of the pandemic of
tobacco have led to the recognition of tobacco as a demerit good, i.e. a public ‘bad’.
Cost of Tobacco related Cancer
ECONOMIC COSTS OF TOBACCOECONOMIC COSTS OF TOBACCO
Health Care: Just for 3 diseasesHealth Care: Just for 3 diseases (Coronary Heart Disease; Cancer; (Coronary Heart Disease; Cancer;
Chronic Lung Disease)Chronic Lung Disease)
Health Care cost in 2002 – 2003 was Rs. Health Care cost in 2002 – 2003 was Rs. 308.33 Billion (USD 7.2 Billion)308.33 Billion (USD 7.2 Billion)
Tobacco also has: Environmental costs Tobacco also has: Environmental costs & Social costs & Social costs
PrevalencePrevalence Of Tobacco Use Among Of Tobacco Use Among The Youth - INDIAThe Youth - INDIA
Global Youth Tobacco Survey (GYTS) conducted among Global Youth Tobacco Survey (GYTS) conducted among
school going youth (aged 13-15) during 2000-2004 in school going youth (aged 13-15) during 2000-2004 in
India:India:
Ever tobacco use :Ever tobacco use : 25.1%25.1%
Current tobacco use:Current tobacco use: 17.5%17.5%
Current smokeless:Current smokeless: 14.6%14.6%
Current smoking:Current smoking: 8.3% 8.3%
Current cigarette smoking: Current cigarette smoking: 4.2%4.2%
Results support the need to prevent youth from initiating tobacco
habit and provide the evidence base for the provisions of Indian
Tobacco Control Act, 2003
Sixth grade Sixth grade
(n=6165)(n=6165)
Eighth gradeEighth grade (n=5477)(n=5477)
Ratio Ratio pp
Ever use to tobacco Ever use to tobacco
Chewing tobacco %Chewing tobacco % 19.019.0 6.86.8 2.8:12.8:1 <0.0001<0.0001
Smoking bidis %Smoking bidis % 11.911.9 3.43.4 3.5:13.5:1 <0.0001<0.0001
Smoking cigarettes %Smoking cigarettes % 12.512.5 4.74.7 2.7:12.7:1 <0.0001<0.0001
Any kind of tobacco Any kind of tobacco 24.824.8 9.39.3 2.7:12.7:1 <0.0001<0.0001
Current use of tobaccoCurrent use of tobacco
Chewing tobacco %Chewing tobacco % 4.54.5 1.61.6 2.8:12.8:1 <0.0001 <0.0001
Smoking bidis %Smoking bidis % 2.02.0 0.90.9 2.2:12.2:1 0.00010.0001
Smoking cigarettes %Smoking cigarettes % 2.02.0 0.90.9 2.2:12.2:1 0.00010.0001
Any kind of tobacco Any kind of tobacco 6.76.7 2.92.9 2.3:12.3:1 <0.0001<0.0001
Differences in prevalence of tobacco use between sixth-grade and eighth-grade students
(n=11642) : MYTRI STUDY
- (The Lancet, 2006; 367: 589-594
Government Initiatives towards Tobacco Control Laws to Curb the
Problem
• Cigarettes Act is passed with first statutory health warning, 1975
• States like Delhi, Goa and a few more had created their own tobacco control laws
• Kerala High Court and Supreme Court had given momentous decisions in favour of tobacco control policies
• Prevention and Control of Pollution Act included smoking in the definition of air pollution, Motor Vehicles Act of 1988 made it illegal to smoke in a public vehicle and Cables Television Network Amendment Act of 2000 prohibited the transmission of tobacco commercials on cable TV across the country.
• The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA), a comprehensive tobacco control legislation, comes into force on 1st May 2004
• India ratified FCTC on 5th February 2004.
The Cigarettes and Other Tobacco Products Act, 2003: Significance to
Public Health
Section 4: Ban on Smoking in Public Places
Secondhand smoke (passive smoking) of smoke causes many diseases like lung cancer, respiratory diseases, heart disease, breast cancer, asthma, bronchitis. In some cases, it can trigger severe, even life-threatening reactions in individuals.
Children are the worst affected. It causes sudden infant death syndrome.
People working, especially in the food service industry are affected.
Ban on smoking in public places would prevent damage to the health of non smokers and smokers
Contd..Section 5: Ban on Advertisements of Tobacco
Products
In India children and the youth have been greatly influenced by tobacco advertisements, especially those for cigarettes and gutka which definitely harms their health.
Advertisements and placing of the product at a low height and next to candies at points of sale is a strategy they use to give undesirable exposure and access to children.
A study found that children who had seen sports events being sponsored by a tobacco company were more likely to start smoking. This was during the period when a cigarette company sponsored cricket matches.
Many tobacco industries are promoting tobacco products to target women.
This provision would prevent women and children from being influenced by glamorized advertisements of tobacco products.
TRENDS IN WEIGHTED CIGARETTE CONSUMPTION PER CAPITA IN COUNTRIES WITH A
COMPREHENSIVE BAN COMPARED WITH NO BAN
1450
1500
1550
1600
1650
1700
1750
1981 1991
Year
An
nu
al
cig
are
tte
co
ns
um
pti
on
p
er
ca
pit
a
BanNo Ban
Source: World Bank Report, 1999
Contd..Section 6: Prohibition of Sale of Tobacco
Products to and by Minors
Many children in India experiment with tobacco at an early age and become addicted thereafter.
Individuals who use tobacco from a young age are more likely to suffer from serious diseases earlier than others and die prematurely
Sale by a minor gives a message to that child, as well as to other children, that it may be all right to use tobacco.
Adolescents out of school are more likely than other youth to sell tobacco.
This would restrict access of tobacco products to youth and children
Contd..Section 7: Specified Health Warning Labels on all
Tobacco Products Images help smokers visualize the nature of tobacco-related
diseases and convey health messages in a clearer way. Pictorial health warnings are intended to serve as visual cues to
prompt smokers to take action to quit. They are designed to shock people into realizing that smoking kills and causes serious illness.
Pictorial warnings also make the health warnings accessible to those who are illiterate.
They are effective tool in conveying health risks to the tobacco users. It also has an impact on intention and ability to quit.
In countries like Brazil, Canada and Thailand many pictorial warnings have helped in decreasing consumption of tobacco products
Contd..Section 7(5): Every tobacco package to have
nicotine and tar contents along with the maximum permissible limits
Nicotine and tar are carcinogensNicotine and tar contents along with permissible
limits should mentioned on the packagesHaving them on the package would help people
making an informed choice
Contd..Increasing Tax and Price of Tobacco Products
Price and tax measures are an effective and important means of reducing tobacco consumption by various segments of the population, in particular young persons.
Implementing tax policies and price policies, on tobacco products would contribute to the health objectives aimed at reducing tobacco consumption.
This measure acts as a demand reduction measure for tobacco products.
IMPACT ON SMOKERS ALIVE IN 1995
Change in Change in
Grouping number of smokers number of deaths
(millions) (millions)
Low/middle -36 -9
Income
High Income -4 -1
World -40 -10
Source: World Bank Report, 1999
PRICE INCREASE OF 10%
POWER OF POLICY FOR CHRONIC DISEASE PREVENTION
TOBACCOTOBACCO
Evidence is available from many Evidence is available from many countries (including LMIC) that countries (including LMIC) that
‾ TaxationTaxation‾ Ad BansAd Bans‾ Smoke Free PoliciesSmoke Free Policies‾ Health Warnings Health Warnings
ARE EFFECTIVEARE EFFECTIVE 48.1% of mortality averted in UK (1981-2000) is attributable to 48.1% of mortality averted in UK (1981-2000) is attributable to
reduced smokingreduced smoking (Unal B et al. Circulation 2004)(Unal B et al. Circulation 2004)
TOBACCO CONTROL POLICIES WORKTOBACCO CONTROL POLICIES WORK
Ban on smoking in bars: 80% reduction in salivary cotinine Ban on smoking in bars: 80% reduction in salivary cotinine levels of bar staff levels of bar staff
(BMJ 2005; 331:1117-22)(BMJ 2005; 331:1117-22)
Graphic warning labels have impact on smoking cessationGraphic warning labels have impact on smoking cessation
(Tobacco Control 2003; 12:391-95)(Tobacco Control 2003; 12:391-95)
Reduced incidence of admissions for myocardial infarction Reduced incidence of admissions for myocardial infarction after public smoking banafter public smoking ban
(BMJ 2004; 328:977-80)(BMJ 2004; 328:977-80)