Impact of COVID-19 Lockdown and E-cigarette Ban on Tobacco and Nicotine Use in India (original) (raw)
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Tobacco Prevention & Cessation
INTRODUCTION Tobacco use is detrimental at any time. However, it is proving to be more dangerous during the COVID-19 pandemic. Tobacco use may increase the risk of being infected, increases the chances of complications, and also increases the probability of its spread. We assessed the awareness about this association and the impact of the lockdown on tobacco use among tobacco users registered before the lockdown for LifeFirst, a tobacco dependence treatment program. METHODS 1016 tobacco users were under active follow-up in their course of the 6-month counselling program. From 14 to 28 May 2020, 650 (64%) of these registered users were contacted by counsellors for follow-up sessions over the telephone. Semi-structured questionnaires were filled in during the calls. RESULTS Two-thirds (67%) of tobacco users were unaware of the association between tobacco and COVID-19. Only 30% of the users felt that the current situation had affected their tobacco use, the commonest impacts being unavailability and increased prices of tobacco products. While this was seen as an opportunity to quit by some users, some reported increased tobacco use due to increased stress. Of the 219 (34%) tobacco users who quit tobacco during the lockdown, 51% quit because of the lockdown and their concern over COVID-19. Abstinence among those who were aware of the association between the coronavirus and tobacco was twice that among those who were not aware. CONCLUSIONS Awareness activities about the harmful effects of tobacco during the coronavirus pandemic have to be strengthened. Measures to motivate and support tobacco users to quit have to be provided through cessation services.
Harm Reduction Journal
Background Tobacco smoking is one of the biggest and avoidable public health threats in the world, especially in low- and middle-income countries. India represents a highly complex public health environment due to the large number of smokers and complexities arising from tobacco use in different forms, including a variety of smokeless tobacco (SLT) products. Electronic cigarettes, an alternative nicotine delivery system with significantly less harmful emissions than smoke, could be an option for those who are unable to achieve smoking abstinence using other available means. This study, which we believe is the first of this kind in India, was conducted to obtain data on the characteristics and tobacco use profile of e-cigarette users (vapers) in India. Methods An interview-based survey was performed in the 8 largest metropolitan cities in India using a convenience sampling approach involving a total of 3000 subjects. Inclusion criteria were being a current e-cigarette user and aged 1...
Does India's Ban on Electronic Cigarettes Improve Public Health Outcomes?
2023
In 2019, India banned Electronic Nicotine Delivery Systems (ENDS)-a broad category that includes electronic cigarettes, vaping devices, and Heat Not Burn (HNB) devices-because of concerns about health impacts, youth vulnerability, and their potential to undermine tobacco control efforts. This is a missed public health opportunity to reduce tobacco consumption, if ENDS actually help reduce and wean users off nicotine dependency in less harmful ways. This paper applies a risk analysis framework to examine whether India's ban on ENDS improves public health outcomes, or whether an alternative approach such as regulation would be more effective. It studies global responses and compares how public health goals are served in the United States of America and the United Kingdom, based on four key parameters of concern-health impacts, normalisation of ENDS usage among non-smokers, appeal among youth, and device safety. This comparison demonstrates that the United Kingdom's regulation-focused approach delivers superior outcomes across all four parameters. Thus, the evidence-based recommendation for India would be to regulate at least HNB devices under the Cigarettes and Other Tobacco Products Act (as they utilise tobacco), as this can help reduce harm and promote innovation in devices that can wean users off nicotine dependence.
Clinical Epidemiology and Global Health, 2021
Introduction: COVID-19 and subsequent country-wide lockdown has impacted smokeless tobacco (SLT) product availability in India. We aimed to examine SLT quitting during COVID-19 lockdown among SLT users who consented to be enrolled in a cessation programme. Methods: Between January-March 2020, we screened 227 exclusive SLT users to be enrolled in a randomizedcontrolled feasibility study on SLT cessation. However, all activities were suspended due to national lockdown in response to the COVID-19 pandemic. To examine the quitting intention and behaviour during COVID-19 lockdown, we re-contacted these individuals telephonically; during September-October 2020. Results: Of 227 participants, 87 (38.3%) could not be contacted on phone. We conducted telephonic qualitative interviews and assessed the SLT use status, willingness to quit and participate in the SLT cessation trial among the remaining 140 participants. Among these, 12.1% (17/140) showed no willingness to participate in the study due to migration. Since COVID-19 lockdown, 32.1% (45/140) participants reported quitting SLT due to nonavailability, increased cost of products, shifts in community norms and family pressures. Conclusions: COVID-19 pandemic presented an opportunity for tobacco cessation as stringent bans and isolation from social circles enabled tobacco cessation. It also triggered improvement in dissemination of public health information at an unprecedented scale, particularly related to the vulnerability of tobacco users to co-morbidities and harm from SARS CoV-2 infection. Implementation of strict bans on sale and consumption of SLT and strengthening of cessation support may lead to sustainable tobacco control. This study provides insight into effective policy strategies to reduce SLT use; which need to be substantiated with adequate cessation support.
Banning Loose Cigarettes and Other Tobacco Products in India: A Policy Analysis
Asian Pacific Journal of Cancer Prevention
Survey (2009-2010), 57% of smokers purchased loose cigarettes. This situation has worsened since then with two-thirds of cigarette smokers, one-sixth of bidi smokers and one-fourth of smokeless tobacco users found to purchase tobacco in an unpackaged form (GATS-2, 2016-2017). This is because singles make smoking habit accessible and affordable for smokers in India who might not be able to afford a complete pack of cigarettes (Lal et al., 2015). Multiple studies across the globe have suggested that poor education and income status have been consistently associated with the purchase behaviour of loose cigarettes highlighting the inducement to tobacco use by ease of
Clinical Epidemiology and Global Health, 2021
Background: Healthcare professionals (HCPs) have a definite role in tobacco control and can help immensely by setting examples. The current study aimed to study the tobacco use pattern and quitting behaviour among HCPs of India during the COVID-19 pandemic. Methods: We addressed the research objective using a cross-sectional, anonymous online survey using 'google form" among 687 HCPs of India during December 2020. Descriptive and inferential statistics were performed using SPSS. Results: Overall, 32.6% of the HCPs were ever tobacco user while 23.4% and 16.9% were current and daily tobacco user. During the COVID-19 pandemic, 51.7% and 43.1% of HCPs cut down the frequency and amount of tobacco use respectively while for 24.1% COVID-19 pandemic exerted no effect on their tobacco use. Presence of vulnerable population at home [ adjusted odds ratio (AOR): 17.5 (95% confidence interval (CI): 3.3-92.2)], ever tobacco quit attempt [AOR: 13.5 (95% CI:2.7-67.7)] and history of COVID-19 disease [AOR: 5.1 (95% CI:1.3-20.7)] significantly determined reduced tobacco use (60.3%) during the pandemic. Similarly, reduced tobacco use during the pandemic [AOR: 4.8 (95% CI:1.7-13.5)] and perception of both smoking and smokeless tobacco form to be harmful for COVID-19 [AOR: 4.8 (95% CI:1.7-13.5)] were the independent correlates of tobacco quit attempt (50.0%) during the pandemic. Conclusion: Tobacco use was quite rampant among the HCPs with every fourth and sixth being a current and daily tobacco user respectively. During the COVID-19 pandemic three in every five HCPs surveyed reduced tobacco use while every second HCP made a quit attempt.
International Journal of Public Health, 2019
Objectives We describe national and subnational trends in tobacco use over three decades in India, assess the impact of the World Health Organization's Framework Convention on Tobacco Control (FCTC) on them and draw inferences for regional tobacco control policy. Methods Data from nine cross-sectional surveys conducted between 1987 and 2016 were analysed. Time trends in genderand state-wise prevalence were derived for different forms of tobacco. To assess Framework Convention's impact, relative changes in tobacco prevalence before and after its implementation were estimated. Progress towards global noncommunicable diseases target was also measured. Results Post-implementation of the FCTC, smoking and smokeless tobacco use declined by 52.9% and 17.6%, respectively. The tobacco product mix (exclusive smokeless/exclusive smoked/dual) underwent a reversal from 37:52:11 in 1987 to 65:22:13 in 2016. Having achieved 20.5% relative reduction since 2009, India is en route to achieving the global noncommunicable diseases target. Conclusions Steep declines in tobacco use have followed the implementation of FCTC in India. However, the impact has been unequal on smokeless and smoked forms. Tobacco-control policies in high smokeless burden countries should take cognizance of this pattern and design comprehensive and flexible policies. Keywords Framework Convention on Tobacco Control Á Smokeless tobacco Á Tobacco smoking Á Trends Á Tobacco control Á India Electronic supplementary material The online version of this article (
PLoS ONE, 2014
Background: Tobacco use in India is characterized by a high prevalence of smoking and smokeless tobacco use, with dual use also contributing a noticeable proportion. In the context of such a high burden of tobacco use, this study examines the regional variations, and socioeconomic, demographic and other correlates of smoking, smokeless tobacco and dual use of tobacco in India. Methods and Findings: We analyzed a cross sectional, nationally representative sample of individuals from the Global Adult Tobacco Survey in India (2009-10), which covered 69,296 individuals aged 15 years and above. The current tobacco use in three forms, namely, smoking only, smokeless tobacco use only, and both smoking and smokeless tobacco use were considered as outcomes in this study. Descriptive statistics, cross tabulations and multinomial logistic regression analysis were adopted as analytical tools. Smokeless tobacco use was the major form of tobacco use in India followed by smoking and dual tobacco use. Tobacco use was higher among males, the less educated, the poor, and the rural population in India. Respondents lacking knowledge of health hazards of tobacco had higher prevalence of tobacco use in each form. The prevalence of different forms of tobacco use varies significantly by states. The prevalence of tobacco use increases concomitantly with age among females. Middleaged adult males had higher prevalence of tobacco use. Age, education and region were found to be significant determinants of all forms of tobacco use. Adults from the poor household had significantly higher risk of consuming smokeless tobacco. Lack of awareness about the selected hazards of tobacco significantly affects tobacco use. Conclusions: There is an urgent need to curb the use of tobacco among the subgroups of population with higher prevalence. Tobacco control policies in India should adopt a targeted, population-based approach to control and reduce tobacco consumption in the country.
Clinical Epidemiology and Global Health
Since 2011, sale of commercially available smokeless tobacco products for chewing such as gutkha has been prohibited in many states in India. The current study attempts to understand the effectiveness and perception towards ban on gutkha sales in West Bengal and Kerala. Methods: Total six districts from both the states (three districts from each state). From each district, 1 Municipality and 2 Community Development Blocks were selected randomly, representing each cluster. From each cluster, line transect survey was used to identify Point of Sale (POS) of tobacco products. Tobacco consumers and vendors were interviewed from POS. Results: 865 tobacco users (West Bengal = 450, Kerala = 415) and 173 vendors (West Bengal = 90, Kerala = 83) were interviewed for the study. 16.1% of the total users from Kerala were using gutkha alone or in combination with other tobacco chewing products while in West Bengal the corresponding figure was 17.3%. Knowledge on ban was high among the consumers (95.7%) and vendors (100%) in Kerala while in West Bengal it was 64% and 62.2% respectively. Gutkha was available in 68% of the shops in West Bengal, while in Kerala no sale was reported in shops, though half of the vendors interviewed, admitted its sales in black market. Conclusion: The ban had little impact in West Bengal in the open market, while it had moderate impact in Kerala. However, the black market sales in Kerala are a matter of concern. Strict legislative measures are essential to cut the supply route for effective implementation of the ban.
Smokeless tobacco control in India: policy review and lessons for high-burden countries
BMJ Global Health, 2020
We examined the magnitude of smokeless tobacco (SLT) use in India and identified policy gaps to ascertain the priorities for SLT control in India and other high SLT burden countries in the Southeast Asia region. We reviewed and analysed the legal and policy framework to identify policy gaps, options and priority areas to address the SLT burden in India and lessons thereof. In India, 21.4% adults, including 29.6% of men, 12.8% of women, use SLT while more than 0.35 million Indians die every year due to SLT use. SLT use remains a huge public health concern for other countries in the region as well. Priority areas for SLT control should include: constant monitoring, increasing taxes and price of SLT products, strengthening and strict enforcement of existing laws, integration of SLT cessation with all health and development programmes, banning of advertisement and promotion of SLT, increasing age of access to tobacco up to 21 years, introducing licensing for the sale of SLT, standardisi...