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.

Impact of 'gutkha and pan masala ban' in the state of Maharashtra on users and vendors.

BACKGROUND: Gutkha and pan masala contain harmful and carcinogenic chemicals. Hence, Maharashtra Government banned their manufacture, storage, distribution and sale on 19th July 2012 for a year. OBJECTIVES: The objective of this study is to determine the impact of the ban on gutkha and pan masala on its users and vendors. MATERIALS AND METHODS: A cross‑ sectional study was conducted among gutkha and/or pan masala users and tobacco vendors in the selected area of Mumbai city, 4‑6 months after the implementation of the ban. The parameters studied included knowledge regarding the ban, usage or discontinuation of use of the banned products, product availability, withdrawal symptoms among quitters, etc., RESULTS: A total of 68 users and five tobacco vendors were enrolled in this study. Although all users were aware about the ban on gutkha, very few knew about the ban on pan masala. Only 5.9% of users knew that currently the ban had been declared for only 1 year. Electronic media was the main source of information regarding the ban as reported by 45.6% users. All users and vendors were in favor of the ban. After the ban, 23.53% gutkha users quit their habit while 55.88% reduced their gutkha consumption. Non‑availability of gutkha was the most important reason stated by the gutkha users for quitting or reducing the consumption. In spite of the ban, gutkha is still available in the market, but at an increased cost or in a different form. CONCLUSION: Nearly 23.53% of gutkha users have quit their habit post‑ban despite its availability through illegal sources.

All in the name of flavour, fragrance & freshness: Commonly used smokeless tobacco preparations in & around a tertiary hospital in India.

Background & objectives: There is a general misconception that smokeless tobacco particularly sweetened and flavoured paan masala and gutkas are safe to use. The present study was undertaken with the objective of highlighting the deceptive and aggressive marketing techniques adopted by the manufacturers of smokeless tobacco preparations exploiting cultural, social and religious values. Another object was to highlight the lack of transparency in terms of content, weight, quality control and warning. Methods: All empty pouches of the used paan masalas, gutka, khaini or surti in and around a tertiary care hospital at east Delhi were collected. Their constituents were studied as per written declaration by the manufacturers on each packet. Information on net weight, cost, presence and type of warning, and quality assurance on each brand provided on side of the packets was noted. Results: A total of 1136 pouches of 33 brands/varieties were collected. Most of the gutka preparations contained tobacco, betel nut, unknown flavouring agents, undeclared spices and heavy metals. Warning regarding the harmful effect of tobacco was written in 90.9 per cent of brands with 81.8 per cent in English language only in minute font. Contents of the products were mentioned in 84.8 per cent of brands and only 27.3 per cent of those mentioned the net weight of the ingredients. Interpretation & conclusions: Seemingly ‘innocuous’ tobacco preparations in the form of paan masalas, gutka, khaini, surti or mouth fresheners contain various harmful substance like tobacco, betel nut, sugar coated fennel, saccharine, heavy metals like silver, unknown flavouring agents and undeclared spices in unknown quantities. Lack of transparency in terms of content, weight, quality control and warning is duping unsuspecting consumers.

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.

Social disparities in tobacco use in India: The roles of occupation, education and gender.

Background: Identifying social disparities in patterns of tobacco use with regard to education, occupation, and gender characteristics can provide valuable insights into the tobacco use patterns of the population. Aim: We assessed social disparities in tobacco use, smoking, and smokeless tobacco use by examining occupation-, education-, and gender-specific patterns. Setting: About 69,030 Indian residents ΃15 years in 29 States and 2 Union Territories (UT). Design: Three-stage sampling in urban areas and two-stage sampling in rural areas for selection of households. Materials and Methods: Data has been derived from GATS 2009-2010, wherein the sample was collected through household interviews. Statistical Analysis: Percentages, proportions, adjusted odds ratios (ORs), and 95% confidence interval (CI) were reported. Results: As a person entered adulthood, the prevalence of ever tobacco use increased by 51.5% among men and 28.8% among women. Prevalence was 2.5 times higher in men (mainly smoking) as compared to women (predominantly smokeless form). ORs for tobacco use were higher among illiterate respondents as compared to the college educated (male OR = 4.23, female OR = 8.15). Unemployed, able to work (male OR = 1.50, female OR = 1.23) showed highest risk, while students (male OR = 0.35, female OR = 0.52) showed the least. The combined effect of occupation and education showed synergistic interaction among females and antagonistic interaction among males. Conclusion: The study clearly underscores the individual and joint effects of education and occupation on tobacco use besides discussing variations based on gender. This can have far-reaching policy implications in addressing disparities in tobacco use.

Smokeless tobacco use in Sri Lanka.

To comprehensively review the issues of smokeless tobacco use in Sri Lanka . This review paper is based on a variety of sources including Medline, WHO documents, Ministry of Health and Nutrition, Colombo and from other sources. Results: The prevalence of smokeless tobacco (SLT) use in Sri Lanka has been reported high, especially among rural and disadvantaged groups. Different smokeless tobacco products were not only widely available but also very affordable. An increasing popularity of SLT use among the youth and adolescents is a cause for concern in Sri Lanka. There were evidences of diverse benign, premalignant, and malignant oral diseases due to smokeless tobacco use in the country. The level of awareness about health risks related to the consumption of smokeless tobacco products was low, particularly among the people with low socio-economic status. In Sri Lanka various forms of smokeless tobacco products, some of them imported, are used. At the national level, 15.8% used smokeless tobacco products and its use is three-fold higher among men compared to women. Betel quid is by far the traditional form in which tobacco is a general component. Other manufactured tobacco products include pan parag/pan masala, Mawa, Red tooth powder, Khaini, tobacco powder, and Zarda. Some 8.6% of the youth are current users of smokeless tobacco. There are studies demonstrating the harmful effects of smokeless tobacco use, especially on the oral mucosa, however, the level of awareness of this aspect is low. The highest mean expenditure on betel quid alone in rural areas for those earning Rs. 5,000/month was Rs. 952. The core issue is the easy availability of these products. To combat the smokeless tobacco problem, public health programs need to be intensified and targeted to vulnerable younger age groups. Another vital approach should be to levy higher taxation.

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."