Smokeless Tobacco dependence and cessation measures in India (original) (raw)
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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.
Tobacco Induced Diseases, 2019
INTRODUCTION Cessation attempts for smokeless tobacco (SLT) have been studied in the countries that provide comprehensive cessation services, but there is no evidence about SLT cessation in Ethiopia, where there are no comprehensive tobacco cessation services. The objective of this study was to determine cessation attempts and related factors among daily SLT users. METHODS We analyzed the data obtained from a cross-sectional survey of SLT users in Borena zone, Ethiopia, focusing on a subset of 600 daily SLT users. Participants were adult SLT users aged ≥18 years. The dependent variable was SLT cessation attempt. Multivariable logistic regression was performed to identify association between cessation attempts and explanatory variables. Analyses were performed using SPSS version 20. RESULTS Overall, 18.5% reported having tried to quit SLT in the past 12 months. In multivariable analyses, SLT cessation attempts were significantly associated with being male (AOR=1.96, 95% CI: 1.13-3.40), current dual-product user (AOR=2.11, 95% CI: 1.31-3.38), being advised by α health professional (AOR=1.82, 95% CI: 1.13-2.92), current knowledge (AOR=1.20, 95% CI: 1.00-1.44), and risk perception (AOR=1.06, 95% CI: 1.02-1.10). CONCLUSIONS A low cessation attempt rate among daily SLT users calls for comprehensive cessation intervention. More attention to factors such as knowledge of the health consequences of SLT use, risk perception and health workers advice will be required to encourage cessation attempts.
Determinants of Smokeless Tobacco Consumption and its Cessation among its Current Users in India
Journal of clinical and diagnostic research : JCDR, 2016
Global Smokeless Tobacco (SLT) consumption is on the rise and constitutes a major Public Health problem. Controlling SLT intake is central to containing the increasing tobacco menace. The present study was undertaken to comprehensively explore various factors involved in SLT consumption and its cessation among current SLT users. Present study was conducted among current SLT users visiting Department of Oral Medicine and Radiology, Manipal College of Dental Sciences (MCODS), Manipal University, Mangalore, Karnataka, India. A structured, pretested and self-administered questionnaire was employed for the present study. Knowledge, attitude, behaviour, worksite practices of respondents towards SLT consumption and its cessation, barriers to SLT cessation were explored. Information about socio-demographic variables was also collected. Overall, 170 current SLT users participated in the present study. Results revealed that the mean knowledge, attitude, worksite related practices and barrier ...
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...
TOBACCO CONTROL POLICIES AND THEIR IMPLEMENTATION GLOBAL SMOKELESS
WHO FCTC Global Knowledge Hub on Smokeless Tobacco ICMR - National Institute of Cancer Prevention and Research, Noida, 2018
Since the effort to include SLT in tobacco control policies under the WHO FCTC started, there has been considerable progress in its compliance, especially with Article 1(f) in defining SLT by the Parties and in surveillance of SLT use (Article 20). More participation is needed from the parties to initiate implementing these articles. Fortherestofthearticlesverylittleprogresshasbeenmade. SLTpreventionhas received much less attention than smoking prevention. Where there are policies on SLT, all provisions of the relevant FCTC articles have not been covered. Since there is evidence that partial policies are not very effective, more attention needs to be given to make them comprehensive. Even where there are policies on SLT, often they have not yet been implemented effectively.
Facing the challenges of smokeless tobacco epidemic in Bangladesh
Lifestyle Medicine, 2022
Background Smokeless tobacco (SLT) use in Bangladesh is one of the highest in the world. Despite having a tobacco control programme, the use of SLTs has increased in recent years. The objective of this paper is to report on the prevalence of SLTs and challenges faced during control measures in Bangladesh. Methods A wide range of published reports on tobacco in general and SLT were reviewed. Websites of relevant organizations and national survey reports including PubMed were visited to identify national- or subnational-level data. Legislations, policies and their implementation and programmes are reviewed. Additional data were captured by active surveys on SLT products, especially on graphic health warning. The authors’ perspectives on SLT control in Bangladesh were captured through a series of brainstorming sessions. Findings The reported prevalence of SLTs ranged from 21% to 26% among adults. SLT control measures are not adequately addressed despite the existence of several policies and programmes. It is based to the definition of Tobacco Control ACT in 2013. We propose inadequate prioritization and weak policy directives; unregulated industry leading to high production, marketing, violation of package warning and tax evasion; high level of cultural acceptance; and poor awareness of the people as challenges to the control efforts. In addition, a lenient attitude of the government towards the so-called “cottage” industry made SLTs unabated. We propose prioritization of SLT control, strengthening industry monitoring and tax measures, countering cultural acceptability and public ignorance and cessation support engaging government and civil society organizations as the way forward. Conclusion The control measures should be evidence-based warranting operational research. Government and non-government organizations’ collaborative efforts on an immediate, short-and long-term basis are recommended to meet the challenges of SLTs. These primarily include policy support for prioritization, enforcement of legislation, industry and marketing regulation, stringent tax measures, denormalizing societal acceptability and cessation support.
Tobacco Control, 2024
Background Smokeless tobacco (SLT) packaging in India had a single symbolic (a scorpion) health warning label (HWL) in 2009 covering 40% of the front surface. In 2011, it was replaced with four pictorial images. In 2016, HWLs were enlarged to 85% on the front and back. This study aimed to assess the effectiveness of the old (symbolic and smaller images) and larger HWLs. Methods Data were from the Tobacco Control Project India Survey and included respondents who used SLT in Wave 1 (2010-2011, n=5911), Wave 2 (2012-2013, n=5613) and Wave 3 (2018-2019, n=5636). Using a repeated-measures design, weighted logistic regression models assessed whether there were changes in seven HWL effectiveness measures within the domains of awareness, salience, cognitive and behavioural responses. A cohort design was employed to test whether HWL effectiveness in Waves 1 and 2 was associated with quitting SLT in Waves 2 and 3, respectively. Results The 2011 HWL revision did not result in any significant changes in HWL effectiveness. There was no significant change in HWL awareness and salience after larger HWLs were introduced in 2016, but respondents were more likely to consider SLT health risks (Wave 2=17.9%, Wave 3=33.6%, p<0.001) and quitting SLT (Wave 2=18.9%, Wave 3=36.5, p<0.001). There was no change in HWLs stopping SLT use (Wave 2=36.6%, Wave 3=35.2%, p=0.829); however, respondents were more likely to avoid looking at HWLs (Wave 2=10.1%, Wave 3=40.2%, p<0.001). Effectiveness of older, symbolic and smaller pictorial HWLs was not associated with quitting SLT. Discussion There was no significant change in HWL effectiveness following the revision from a symbolic to a pictorial image, but enlarging pictorial images resulted in some improved cognitive and behavioural effects. Results suggested wear-out of HWL salience and that the effectiveness of warnings depends on both their design and time since implementation.
Tobacco control measures in India: A Scoping Review Protocol
Objective: The goal of this scoping review is to identify tobacco control interventions and to cover all aspects of tobacco control strategies in the Indian context. Introduction: Tobacco use and its dependence are now treated as global epidemics and are a significant public health problem in India. Tobacco control is a top priority, both in terms of public health and poverty alleviation. Despite tobacco control policies, various tobacco products are still used in India. Previous studies lacked data on aspects of bidi smoking and smokeless tobacco (SLT) use that are more relevant in the Indian context. Inclusion criteria: This review will consider all peer-reviewed articles and grey literature published in English language across all age groups, any form of tobacco use, and intervention related tobacco control focused on India. Methods: The JBI methodology for scoping reviews will be used for this scoping review. Cochrane Central (Wiley), MEDLINE (PubMed), SCOPUS (Elsevier), Embase ...
Asian Pacific journal of cancer prevention, 2024
Smokeless tobacco (SLT) use is more common than smoking in India. Nationally representative data from the Global Adult Tobacco Survey (GATS) in 2016-17 found that three-fourths of tobacco users used at least one type of smokeless tobacco [1]. Only 5.8% of everdaily smokeless tobacco users reported quitting the use of smokeless tobacco. The ever-daily smokers had a relatively better quit ratio (16.8%). Nearly one-third of the smokeless tobacco users had attempted quitting in the previous 12 months, but most of them had relapsed. These data underline minimal tobacco cessation among smokeless tobacco users in India. Knowledge, attitudes and behavioural intentions are mediators of quit attempts and sustenance of cessation. Mass media messaging, warning labels, and advice by healthcare providers have been three chief interventions under the national tobacco control program (NTCP). A significant change in the warning labels on smokeless
Why smokeless tobacco control needs to be strengthened?
Cancer Control
Tobacco menace is responsible for significant mortality and morbidity worldwide. Smokeless tobacco (SLT) is consumed in more than 140 countries, thus is emerging as a global problem. Several adverse health outcomes like oropharyngeal, oesophageal, and pancreatic cancers; oral potentially malignant lesions; diabetes mellitus; cardiovascular diseases; mental illness; osteopenia; low birth weight; preterm births; small for gestation age babies; and stillbirths are attributed to SLT usage. Smokeless tobacco products vary greatly in types, constituents, packaging, forms, addiction, and harm potential, and thus are challenging to study and control. Involvement of both formal and informal sector in SLT production and sales further add to the complexities. The problem of SLT is usually understated and less researched upon. This paper summarizes the existing knowledge and provides evidence to strengthen the case against the SLT, stressing on the need to enhance the SLT control across the globe.