Increased taxes and regulation of Indian cigarillos (bidi) industry: Effects on revenue and years of life lost.

INTRODUCTION: Indian cigarillos (bidi) are low-cost alternatives to cigarettes with only 22% imposed taxes, and turnover of upto INR 4 million per annum exempted from taxation. This paper estimates revenue implications and potential loss of life years (YLLs) averted, if bidi industry is subjected to increased regulations and taxation. METHODS: Revenue estimated at 10% increased regulation and 100% regulation were calculated, followed by estimates at taxes equivalent to cigarettes and World Health Organization - Framework Convention on Tobacco Control (WHO-FCTC) recommendation. Price elasticity was considered to assess demand. Price change in separate fractions (previously regulated and unregulated) were calculated to obtain potential YLLs averted. RESULTS: Current revenue of USD 59.25 million is projected to increase to USD 179.25 million with 695,159 averted YLLs at cigarette equivalent taxes and 10% increased regulation; USD 639.38 million with 4,527,597 averted YLLs with 100% regulation; USD 54.75 million, at WHO recommended taxes with 2,233,740 YLLs averted at 10% increased regulation, and 10,486,192 YLLs at 100% regulation. CONCLUSION: Proposed estimates are inline with WHO recommendations as they consider price elasticity and suggest substantial increase in revenue, while averting YLLs. A national action is needed to drive the policy decisions towards increased regulation and taxation and revision of India's tobacco control legislation. IMPLICATIONS: Our study presented empirical evidence of how the currently underutilized tool of taxation, as proposed in the WHO-FCTC, can be utilized to decrease bidi smoking prevalence and save measurable life years while generating government revenue simultaneously. While the revenue statistics counter the misleading tobacco industry narratives, the projected reduction in mortality will be seen as an irrefutable driving force for policy reforms, targeted at strategic increase in regulation and taxation of the traditional Indian cigarillos industry.

Prioritizing tobacco control & its cessation under sustainable development goals with a focus on India.

Sustainable development goals (SDGs) were meant to put each and everywhere 'at par'. The tobacco epidemic globally is one major deterrent to their achievement. While it gets addressed under SDG 3 through the Framework Convention on Tobacco Control (FCTC) - the World Health Organization (WHO) global treaty (the target 3.a of SDG 3), the progress made globally and by India is slow. As a result, many countries may fall short of achieving the target of reducing tobacco usage (taking 2016 as base year) by 30 per cent by the year 2030. India with its high burden of tobacco use and abysmally low quitting along with soaring economic costs of tobacco related diseases and deaths can do better with the engagement of multisectoral stakeholders to strengthen tobacco control under SDGs. Moreover, there is a need to emphasize that the goal of O - Offer to Quit of WHO MPOWER can be achieved through increasing 'onus' on policy makers, and strategists, and opportunities for masses, tobacco users, healthcare professionals (HCPs) and enforcers to have tobacco cessation delivered optimally. By doing so, the United Nations can significantly facilitate a reduction in tobacco use and the resultant economic costs. Furthermore, it will assist the WHO to fulfil the targets set for 2030 under SDG 3.a by the FCTC member countries. In addition, it will fulfil the vision and mission defined in the Chandigarh declaration of the 5th National Conference on Tobacco or Health for India to be tobacco free by 2030.

Compliance to Online Retail of Electronic Nicotine Delivery Systems (ENDS) in India before and after the 2018 Ban Order of the Government of India.

Since their launch globally in 2012, electronic nicotine delivery systems (ENDS) were positioned as a harm reduction strategy and cessation device but it is yet to be proven to have clinical safety or public health benefits. Instead, recent reports suggest that the tobacco industry targeted youth and sponsored research whose evidence was used to mislead policymaking. On August 28, 2018, Ministry of Health & Family Welfare's advisory banned the sale, purchase, and trade of ENDS. A survey was done in two waves. The first survey was done between August 10 and 25 2018 all websites which sold ENDS product were mapped and documented. The survey was repeated (November 30, 2018) were after the restriction to trade on ENDS was proposed by the Department of Customs. The two waves of survey found that no website, whether comprehensive e-commerce portals or dedicated ENDS marketing platforms fully complied with government orders. National and states government enforcement agencies are currently unaware of internet-based sale of ENDS. Although some states have given specific directions to stop the sale and delivery of ENDS within the state through e-commerce, there is limited monitoring and legal compliance by seller. Public health advocates need to stay vigilant and monitor the online sale and point of sale retail of ENDS to ensure strict compliance of national and state regulations.

Pricing of tobacco products: Pre and post GST implementation.

There is ample evidence stating that any taxation policy that effectively increases the real price of tobacco products reduces its use. In the past, several countries have documented instances; wherein the intended effects of tobacco taxation were undermined by aggressive pricing strategies of the industry. However, there is a dearth of such evidence in Indian context. Hence, the current study was conducted to ascertain the changes in the retail price of locally available tobacco products during pre and post GST period in India. This cross-sectional analytical study was conducted among all available tobacco products in the states of Meghalaya, Odisha, Puducherry and Telangana. The information on maximum retail price (MRP) pre and post GST implementation on tobacco products was gathered from the owners of Point of Sale (PoS), vendors and retailers of various tobacco products. The results showed that of the total 154 brands observed pre and post GST implementation, 33.12% [95%CI 25.75-41.15] did not exhibit any increase in their price. The proportion of tobacco product brands with decrease/no change in price was a higher in Meghalaya (PR = 44; 95%CI: 6.32-306.3), Odisha (PR = 23; 95%CI: 3.25-162.7) and Puducherry (PR = 1.48; 95%CI: 0.1-22.84) as compared to Telangana. As compared to cigarettes, smokeless tobacco (PR = 1.84; 95%CI 1.16-2.89) and bidi (PR = 1.74; 95%CI: 0.78-3.9) had more number of brands with a decrease/no change in price post GST implementation. Moreover, four new brands of smokeless tobacco were introduced into the market following GST implementation. The study clearly suggests a departure from the outcomes envisaged by taxation policy on tobacco products in the country. Given the importance of price as a determinant in tobacco use especially among youth, there is an urgent need for strengthening our tax regime for tobacco products.

National level E-Resource Centre for Tobacco Control (E-RCTC): One stop solution to information on tobacco control in India.

The existing information on tobacco control, though highly valuable, is lying scattered at different sources. Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh in collaboration and technical support of International Union against TB and Lung Diseases (The Union) undertook an initiative to start a national level E-Resource Centre for Tobacco Control (E-RCTC) with an aim to provide relevant information on tobacco control under one roof thereby countering the misleading facts on tobacco control which exist on various web engines. The national level E-Resource Centre for Tobacco Control was developed in three stages. In the span of less than 3 years, the portal is open in public domain with over 2,36,019 visitors from around 80+ countries (as on 23rd July 2020), and growing. The portal showcases an array of valuable and vital information related to tobacco control initiatives under various heads like: Policies and Legislations, Circulars and Orders, National Tobacco Control Programme (NTCP), Publications and IEC Materials. India's first national level Resource Centre for Tobacco Control has proved to be a much-needed step in the country for facilitating speedy implementation of World Health Organization- Framework Convention on Tobacco Control (WHO-FCTC), MPOWER and other tobacco control interventions. Even with its limitations like absence of an interactive mechanism among a few others, the Resource Centre is nothing less than a storehouse of knowledge as it showcases content that are immensely helpful for the tobacco control community. Constant efforts are being made to improve the national level E-Resource Centre for Tobacco Control website and minimize the drawbacks.

Tobacco retailer density and tobacco retailers near schools in two cities of East India, Ranchi and Siliguri.

BACKGROUND: Passive and active exposure to tobacco smoke is associated with tuberculosis infection and tuberculosis disease. Addressing tobacco use is a critical strategy to address tuberculosis (TB). Studies conducted globally demonstrate that the physical presence and density of tobacco vendors can increase tobacco use in both youth and adults. Little is known about the number and density of tobacco vendors in India, where there are approximately 267 million tobacco users. In India, a national tobacco control law (COTPA, 2003) prohibits the sale of tobacco within 100-yards of an educational institution. Little is known about the number of tobacco vendors operating within 100-yards of schools. This study assesses the number and density of tobacco vendors in the cities of Ranchi (Jharkhand) and Siliguri (West Bengal), and the number of retailers selling tobacco near schools. Both of these jurisdictions have passed local tobacco vendor licensing laws. METHODS: Data collectors conducted a census of tobacco vendors within select wards in each city. Each tobacco vendor was classified as either an independent store, permanent kiosk, temporary kiosk, or street vendor. The location of each tobacco vendor was recorded. Data collectors also noted the location of any school/educational institution. Spatial analysis was conducted using GIS software (QGIS 10.5). 100-yard buffers were mapped around school premises. Tobacco vendor density was calculated by area, by road distance, and by population. Tobacco vendors within 100-yards of school properties were counted. RESULTS: The study identified 559 tobacco vendors in Ranchi, across three wards, and 367 tobacco vendors in Siliguri, across five wards. When considering the three wards in Ranchi, tobacco vendor density was 68 vendors/km2, 06 vendors/km road, and 08 vendors/1000 population. In Siliguri, the tobacco vendor density was 99 vendors/km2, 05 vendors/km road, and 07 vendors/1000 population. The study found that 19% (n = 105) of vendors observed in Ranchi and 23% (n = 84) of vendors in Siliguri were located within 100-yards of one or more schools. The most common vendor-type in Ranchi was an independent store (58%) and in Siliguri was a permanent kiosk (52%). CONCLUSION: Tobacco vendor density was remarkably high in each of the surveyed wards. The study identified tobacco vendors operating within 100-yards of schools. Fully implementing COTPA, 2003 could reduce vendor density in Ranchi and Siliguri. Each city's tobacco vendor licensing laws could further reduce tobacco vendor density. Other strategies should be considered to further reduce density, including setting limits on tobacco vendor type, area or population. The data from this study can be used to inform future tobacco control strategies for these cities and others in the region.

Depiction of tobacco in Indian mass media: A content analysis.

BACKGROUND: Although exposure to tobacco content on mass media is a well-grounded source for early initiation, less is known on how tobacco is portrayed in mass media. OBJECTIVES: To determine the proportion of tobacco appearances and the percentage of pro or anti-tobacco messages in the selected print, electronic and internet based Indian mass media. METHODS: The content analysis was conducted among selected categories of: top two daily newspapers in terms of readership, topmost Television channel in terms of viewership and top five trending videos on YouTube. The tobacco appearances in newspaper, television (five minute interval) and YouTube (one minute interval) were recorded and coded as pro or anti-tobacco messages. RESULTS: Tobacco appearances were present in 0.3% of 9373 [95% CI: 0.2-0.5] advertisements reviewed in Newspapers; all of which were pro-tobacco messages. Among the total 1512 intervals watched on Television, 18.1% [95% CI: 16.2-20.1] had tobacco appearance. There were a total of 289 tobacco incidents in television of which 92.4% were pro-tobacco messages. Out of the total 900 videos watched on YouTube, 11.44% [95% CI: 9.49-13.65] had tobacco appearance. Among the 206 tobacco incidents present in YouTube, 98.5% were pro-tobacco messages. CONCLUSIONS: The study documented considerable extent of pro-tobacco depictions in Indian mass media.

Prevalence and factors associated with the sale of loose cigarettes at Point of Sale: A cross-sectional analytical study from four Indian states.

BACKGROUND: The Framework Convention on Tobacco Control (FCTC) has established that sale of loose cigarettes increases the affordability and accessibility of tobacco for minors. Acknowledging this threat to public health, the Department of Consumer Affairs, Government of India amended the Legal Metrology Act to prohibit sale of loose cigarettes. Regardless, over 70% of the total cigarette sale in the country is in the form of loose cigarettes majority of which is being sold at unrecognized, unrecorded and unregulated informal sector of economy. However, there is a paucity of studies examining the factors associated with sale of loose cigarettes and further research is warranted in the country to know the dynamics of this issue. OBJECTIVE: To determine the prevalence and the factors associated with the sale of loose cigarettes at Point of Sale (PoS) in the selected four Indian states. METHODS: A community based cross-sectional analytical study was conducted among a total of 2044 PoS in the project states of Meghalaya, Odisha, Puducherry and Telangana using purposive sampling technique. The characteristics of tobacco vendors and the status of loose cigarettes sale were collected using a structured and pre-tested checklist. Proportion for prevalence estimate, bivariate and multivariable log binomial regression analysis were done. RESULTS: The prevalence of loose cigarette sale was 93.05% [95% CI: 91.89-94.1]. Sale of loose cigarette showed a significant association with area (aPR 1.03; 95% CI: 1-1.06; p = 0.025), sale of tobacco products to minors (aPR 1.07; 95% CI: 1.04-1.11; p < 0.001), sale of smoking aids to customers (aPR 1.05; 95% CI: 1.01-1.09; p = 0.02), sale of flavored chewable tobacco (aPR 1.08; 95% CI: 1.03-1.12; p = 0.001) and presence of pack warning (aPR 1.18; 95% CI: 1.11-1.25; p < 0.001). CONCLUSION: Our findings infer an open disregard for the laws specific to sale of loose cigarettes at PoS. The factors associated with the sale of loose cigarette needs to be addressed through prompt implementation of the tobacco control laws and suitable policy formulation.

Communicating risk: Status of health warning labels on various tobacco products in Indian market.

BACKGROUND: Owing to the role of tobacco packaging as a strong medium of communication, display of health warnings on tobacco packs effectively impart health risks of tobacco consumption to those currently using or contemplating the use of tobacco. METHODS: This community based cross-sectional analytical study was conducted among 2044 tobacco product packs, each collected from a different PoS, to estimate the non-compliance of section 7, 8 & 9 of COTPA among various tobacco products and its association with the PoS characteristics. Data were collected by observation of PoS by field investigators and then purchase of a unique product from each vendor followed by a brief interview of the tobacco vendor. RESULTS: The study documented an absence of health warning label on 15.51% [95% CI: 13.99-17.13] of the total 2044 tobacco products collected. The non-compliance to 'quality of health warning picture' was lowest 5.96% [95% CI: 4.91-7.16] among the tobacco products with a health warning label. The multivariate regression model revealed that absence of health warning on tobacco product packs were higher among the PoS in rural area (aPR 1.38; 95% CI: 1.16-1.65; p < 0.001) and among street/mobile vendors (aPR 1.65; 95% CI: 1.22-2.24; p = 0.001). The PoS not displaying tobacco products (aPR 1.36; 95% CI: 1.08-1.72; p = 0.01), selling flavored chewable tobacco (aPR 1.67; 95% CI: 1.24-2.27; p = 0.001), not selling loose cigarettes (aPR 2.93; 95% CI: 1.94-4.43; p < 0.001) and with vendors not enquiring age proof (aPR 10.69; 95% CI: 1.59-72.09; p < 0.001) had higher proportion of tobacco products without health warning labels. A greater proportion of smokeless/local variety tobacco products (aPR 18.06; 95% CI: 12.31-26.51; p < 0.001) had absence of health warning label. CONCLUSION: The data provided by us have clear policy implications. We recommend regular enforcement activities to monitor the presence of health warning labels on tobacco product packs along and accurate printing of the same with adherence to the Ministry of Health and Family Welfare templates.