Awareness about pictorial warnings on tobacco products and its impact on tobacco consumers in coastal Karnataka

Background: Tobacco use is a major risk factor for many chronic diseases, including cancer. India revised the pictorial warnings on all tobacco products in 2018, but its impact on tobacco consumers after the revision is less studied. Aim and Objective: To assess the awareness of the revised pictorial warnings on tobacco products and the impact of it on tobacco consumers in a coastal town. Methods: This cross-sectional study was conducted from 1st to 31st March 2021 among 185 adult tobacco consumers in a coastal town in Karnataka after obtaining ethical clearance and informed consent. The data was analysed using SPSS version 16.0 by descriptive statistics, Chi-square, Fisher’s exact test and binary logistic regression analysis. Results: Majority (95.7%) were males and 96.2% had seen the pictorial warning on the tobacco products. The commonly consumed tobacco products were panmasala (44.9%), gutka (38.9%), cigarette (31.4%) and bidi (15.1%). The mean age of initiation of consuming tobacco products was 24.8 years and mean duration of the habit was 17 years. Conclusions: A majority (96.2%) have seen the pictorial warnings on the tobacco products and significant predictors for reducing tobacco consumption were those who inferred the pictorial warnings as tobacco is injurious to health and cancerous

Feedback from vendors on gutka ban in two States of India

Background & objectives: Beginning in 2012, all States in India eventually banned the sale of gutka. This study was conducted to investigate gutka vendors' knowledge on gutka ban, products covered under ban, penalties for non-compliance and action for enforcement by government agencies. Methods: Twenty vendors were interviewed, 10 each in Mumbai (Maharashtra) and Indore (Madhya Pradesh) during May - June, 2013, one year after ban was imposed. Interviewers used a standardized questionnaire to assess vendors' knowledge of gutka ban, their attitude towards it and compliance to it in practice. Results: All 20 vendors were aware that gutka sale was banned. However, despite ban, eight of the 10 vendors in Mumbai perceived sale of pan masala as legal. In Indore, all 10 vendors perceived sale of Indori Tambakoo, a local gutka variant, as legal. No vendor was sure about the quantum of fine applicable on being caught selling the banned product. Two vendors in Mumbai and nine in Indore admitted selling gutka. Five vendors in Mumbai and four in Indore supported an existing ban on gutka. Interpretation & conclusions: All vendors were aware of the ban on gutka and reason for it. Many vendors supported the ban. However, awareness of other products covered under ban and on fines in case of non-compliance was low. Law enforcement system needs to be intensified to implement ban. Notification of ban needs to be further strengthened and made unambiguous to explicitly include all smokeless tobacco products.

Clinical, Cytological and Histopathological Correlation of Oral Mucosal Changes in Gutka Chewers – A Prospective Study

Background: Gutka chewing is the most and popular form of smokeless tobacco use in India. Epidemiological studies showed a strong association between smokeless tobacco use and oral precancerous lesions, carcinoma and other oral mucosal lesions. Aim and objectives: To know the patterns of clinical and pathological manifestations of oral mucosal lesions in Gutka chewers (patients) attending out-patient department of oral Medicine and Radiology at Govt. Dental college/ Hospital, Hyderabad, To assess the efficacy of the oral brush cytology in the detection of precancer and cancerous conditions of the buccal mucosa. Materials and methods: Oral mucosal lesions diagnosed in patients of both sexes with Gutka chewing habit were taken at Dept. of Oral Medicine and Radiology, Govt. Dental College, Hyderabad. Total 800 cases were studied from 2006 to 2017 (10 years study), Oral Brush cytology Procedure with papanicolaou staining procedure was used. Brush cytology results were divided into 3 groups: Negative brush cytology (normal or inflammatory smear), Positive brush cytology (Dysplasia positive smear), Atypical brush biopsy (Suspicious smear). Results: Out of 800 patients, males (80%) outnumbered females. Total no of controls 2246 with 51% were males. 75% were below 30 years of age. Higher percentage of cases (60%) belonged to the P. Ram Mohan, Lakshmi Narayana, G. Sai Sowmya, Tamilarasi. Clinical, Cytological and Histopathological Correlation of Oral Mucosal Changes in Gutka Chewers - A Prospective Study. IAIM, 2018; 5(11): 70-76. Page 71 lower socio economic groups. Clinical diagnosis of sub mucosal fibrosis and carcinoma corresponding to histopathological confirmation is almost 100%. Conclusion: Oral brush cytology is useful in early detection of precancerous and cancerous conditions of the oral cavity lesions in Gutka chewers

Health Hazards of Gutkha: An Update Article.

Gutka or Gutkha is a partial grinded mixture of areca nut (beetle nut or supari), smokeless tobacco, catechu, paraffin and sweet smelling chemicals in limewater. It is popular and mainly manufactured in India and exported to some other countries like Bangladesh, Pakistan, Nepal etc and is used as a mild stimulant and highly addictive. It is consumed like smokeless or chewing tobacco and causes several health hazards. It is a leading cause of oral cancer born deaths in India. It is continuously selling in some parts of India by shopkeepers without any care of imposing a ban for a high profit on the other hand clever manufacturers provide Gutka stuff.

Prevalence of habits and oral mucosal lesions in Jaipur, Rajasthan.

Introduction: Dental health and oral health are used almost synonymously when stating the goals of oral health; such statements are only valid for dental health. This may lead to severe underestimation of the need of total oral health care. When planning measures of oral health care, the lack of data may lead to a risk of overlooking diseases of the soft tissue in, and adjacent to, the oral cavity. Prevalence data of oral mucosal lesions are available from many countries, but the information is usually restricted to very few lesions in each survey. Materials and Methods: The present study is an attempt to assess and compare the various deleterious habits and its associated oral mucosal lesions among patients visiting outpatient department of Jaipur Dental College, Jaipur, Rajasthan. Results: It was found that the prevalence of habits was 51.4% including both the sexes and prevalence of oral mucosal lesions were 9.9%. Discussion: The prevalence of habits and oral mucosal lesions is very high as compared with other studies. The habit of smoking was higher in males as compared to females.

Rising incidence of oral cancer in Ahmedabad city.

CONTEXT: In 1999, an increase in mouth cancer incidence among young men (<50 years) in urban Ahmedabad was reported to be occurring along with decreasing mouth cancer incidence in older age groups and increasing oral submucous fibrosis incidence associated with areca nut consumption among young men in Gujarat. The aim was to investigate whether the increase in the incidence mouth cancer that had started among young men in the 1990s was continuing. SETTINGS AND DESIGN: Ahmedabad urban population, comparison of reported mouth cancer cases in the population across four time period. METHODS: Age‑specific incidence rates of mouth cancer (International Classification of Diseases [ICD]‑9:143–5; ICD‑10:C03–06) in five year age groups among men aged ≥15 years for the city of Ahmedabad for years 1985, 1995, 2007 and 2010 were extracted from published reports. For comparison, lung cancer (ICD‑9:169; ICD‑10:C33–C34) rates were also abstracted. STATISTICAL ANALYSIS USED: A cohort approach was used for further analysis of mouth cancer incidence. Age adjusted incidence rates of mouth and lung cancer for men aged ≥15 years were calculated and compared. RESULTS: The age specific incidence rates of mouth cancer among men increased over the 25‑year period while lung cancer rates showed a net decrease. Using a cohort approach for mouth cancer, a rapid increase in younger age cohorts was found. CONCLUSIONS: Mouth cancer incidence increased markedly among men in urban Ahmedabad between 1985 and 2010, apparently due to increasing consumption of areca nut products, mawa and gutka. Gutka has now been banned all over India, but a more vigorous implementation is necessary.

Compliance to Gutka ban and other provisons of COTPA in Mumbai.

BACKGROUND: Cigarettes and other tobacco products act 2003 (COTPA) is the principal law governing tobacco control in India. Government of Maharashtra in one of its landmark decisions also banned manufacturing, sale and distribution of gutka and pan masala since July 2012. The desired impact and level of enforcement of the COTPA legislation and the gutka and pan masala ban in Maharashtra State, however, needs assessment. Among the many provisions within COTPA, the present study seeks to assess compliance to implementation and enforcement of Section 5 and 6 of COTPA including compliance to gutka and pan masala ban in Mumbai, India. METHODOLOGY: Six educational institutes (EI) within the Mumbai metropolitan region were selected in a two stage random sampling process. Area around each EI was manually mapped and all the tobacco products selling outlets with in the 100 yards distance were listed by trained Field Social Investigators and were observed to determine compliance for Section 5 and Section 6 of the COTPA legislation and for gutka and pan masala ban. The vendors/shop owners manning these outlets were also interviewed for their personal sociodemographic details, self‑tobacco use, awareness and perception about ill‑effects of tobacco and existing tobacco control legislation in the country. RESULTS: A total of 222 tobacco retail outlets were listed within 100 yards of the EI in violation to the provisions of Section 6 of COTPA, of which 72 (32.4%) were selling tobacco products on mobile structures. About 53.2% of the tobacco vendors were also users of some form of tobacco. Whereas, nearly 217 (97.7%) vendors were aware about the gutka and pan masala ban in the State, only 48.2% were aware about the existence of COTPA legislation. None of the EI had a display board prohibiting the sale of tobacco products within a radius of 100 yards of their EI. Only 56.3% tobacco outlets had complied with the mandatory warning display boards indicating tobacco products will not be sold to people below 18 years of age. With regards to point of sale advertisement only 25.2% compliance was noted for display of health warning boards at the point of sale. Nearly 48.6% tobacco outlets exhibited >2 display boards and another 43.2% exhibited hoardings with brand pack photo, brand name in violation to the provision under Section 5. Violation by visible stacking and open display of tobacco products for sale was observed at 51.3% of tobacco outlets. While 41% of tobacco outlets were found displaying gutka and pan masala packets in violation to the ban. CONCLUSIONS: Enacting of the law without robust measures for enforcement has led to widespread noncompliance to the provisions with in the tobacco control legislation in the metropolitan city of Mumbai. Strong and sustainable measures needs to be incorporated both by civic administration and public health departments for its forceful implementation.

Local responses to the Maharashtra gutka and pan masala ban: A report from Mumbai.

Background: The Maharashtra government has banned the production, sale, distribution and storage of gutka, and pan masala in the Maharashtra State due to the increasing burden of cancer and reproductive health problems attributable to the use of these products. In view of this, it is important to understand the way producers', sellers' and users' are adapting to the ban. Objective: During the two months following the ban (July 19 th through Sept 30, 2012), a research team studying smokeless tobacco use and promotion in a low income community of Mumbai conducted rapid surveillance to assess the impact of the ban in the study community. Materials and Methods: Assessment involved documenting new points of sale, informal observations of tobacco use, and interviews with thirteen shop owners and eight gutka users'. Overall changes in accessibility, availability, patterns of use of tobacco products, perception of ban, social norms and surveillance activities were assessed. Results: Tobacco companies were marketing new products that resembled gutka, under similar brand logos. Surveillance, financial and social cost of selling gutka or using it in public have had an immediate effect on reducing local supply, demand and use and increasing stigma associated with its use. There was an increased recognition of ill-effects of gutka on cancer among sellers' but not overall. Conclusions : To reduce the overall consumption of tobacco in the community, it is critical to include programs that create awareness about effects of smokeless tobacco on health and sustain surveillance levels. This would maintain requirements of the ban, and sustain limits on accessibility, availability and use of these products in the community and other similar communities.

Banning smokeless tobacco in India: Policy analysis.

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 product and 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."

Best practices in tobacco control in the South-East Asia Region.

The tobacco epidemic is an increasing threat to public health with the tobacco burden particularly high in WHO's South-East Asia Region (SEAR). The Region has many obstacles to tobacco control, but despite these challenges, significant progress has been made in many countries. Although much work still needs to be done, SEAR countries have nevertheless implemented strong and often innovative tobacco control measures that can be classified as "best practices," with some setting global precedents. The best practice measures implemented in SEAR include bans on gutka, reducing tobacco imagery in movies, and warning about the dangers of tobacco. In a time of scarce resources, countries in SEAR and elsewhere must ensure that the most effective and cost-efficient measures are implemented. It is hoped that countries can learn from these examples and as appropriate, adapt these measures to their own specific cultural, social and political realities.

Oral sub-mucous fibrosis: realities of etiology / Fibrose de submucosa oral: a realidade da etiologia

Oral sub-mucous fibrosis (OSMF) is a well known potentially malignant condition resulting commonly due tothe use of areca nut. Areca nut chewing is a primordial tradition in Asian countries. It is also a psychoactiveessence. With the emergence of commercial pan masala and gutkha, witness of massive growth in the salesof these products, with huge worldwide export market developed. Various components in this quid have itsown mechanism of action resulting in OSMF. Other causes proposed were chillies, misi, nutritional deficiency,genetic predisposition, immunologic aspects, infection and saliva. This review attempts to give an overviewabout the postulated etiologies and its role in causation of OSMF.

Fibrose de submucosa oral (FSMO) é uma condição potencialmente maligna muito conhecida resultante geralmentedo uso da noz de areca ou betel. Mastigar a noz de betel é uma tradição primordial nos países asiáticos.É também uma essência psicoativa. O surgimento comercial da pan masala e da gutkha, aliado ao enorme crescimento nas vendas desses produtos, possibilitou um grande mercado de exportação em todo o mundodesenvolvido. Vários componentes neste material tem seu próprio mecanismo de ação, resultando em FSMO.Outras causas propostas foram pimentões, misi, deficiência nutricional, predisposição genética, aspectos imunológicos,infecção e saliva. Esta revisão procura dar uma visão geral sobre as etiologias postuladas e seu papelna causa da FSMO.

Sociodemographic correlates of male chewable smokeless tobacco users in India: A preliminary report of analysis of national family health survey, 2005-2006.

Objective : To estimate the prevalence, the socioeconomic and demographic correlates of chewable smokeless tobacco consumption among males in India. Design : A cross-sectional, nationally representative population-based household survey. Subjects : 74,369 males aged 15-54 years who were sampled in the National Family Health Survey-3 (2005-2006). Data on tobacco consumption were elicited from male members in households selected for the study. Materials and Methods : The prevalence of various smokeless tobacco use currently was used as outcome measures. Simple and two-way cross tabulations and univariate logistic regression analysis were the main analytical methods. Results : Thirty-four percent of the study population (15 years or older) used chewable smokeless tobacco. Smokeless tobacco consumption was significantly higher in poor, less educated, scheduled castes, and scheduled tribe populations. The prevalence of tobacco consumption showed variation with types. The prevalence of chewing also varied widely between different states and had a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. Failure to do so would most probably result in doubling the burden of diseases-both communicable and noncommunicable-among India's teeming poor. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed.