Say Yes To Life: Say No To Tobacco

World No Tobacco Day is on 31 May 2010
The theme of this year's World No Tobacco Day (WNTD) is "Gender and tobacco with an emphasis on marketing to women." It is designed to draw particular attention to the harmful effects of tobacco marketing towards women and girls. Controlling the epidemic of tobacco among women is an important part of any comprehensive tobacco control strategy. Professor Judith Longstaff Mackay, Senior Adviser, World Lung Foundation, spoke to CNS in Hong Kong. She lamented that for decades women and adolescents have been a major target of opportunity for the tobacco industry, and more so now, when this industry needs to recruit new users to replace the nearly half of current users who will die prematurely from tobacco-related diseases. So it is an ongoing battle – longer than the 100 years war. Prof Judith Mackay has been conferred the prestigious BMJ Lifetime Achievement award for her contribution to the fight against tobacco across the world, and is also a recipient of the American Cancer Society's Luther Terry award for Outstanding Individual Leadership. As a leader in the battle to control tobacco, she was once described by the tobacco industry as "one of the three most dangerous people in the world" (Time magazine). Read more



Women comprise about 20% of the world's more than 1 billion smokers. Especially troubling is the rising prevalence of tobacco use among girls. The new WHO report, ‘Women and health: today's evidence, tomorrow's agenda’, points to evidence that tobacco advertising increasingly targets girls. In fact, women, minorities, blue-collar workers, adolescents, and even children are bombarded by clever and often insidious marketing and advertising gimmicks of the tobacco industry. There is a strong correlation between smoking rates among adolescents and sales promotion expenditures by tobacco companies.

Recently, I had the opportunity to talk to Professor Judith Longstaff Mackay in Hong Kong. According to Judith, this year’s theme of World No Tobacco Day is very relevant, as women need to be an integral part of all health schemes.

She said that the number of women smokers in the Western Pacific Region is relatively low at 5%, as compared to 60% of men smokers. Twenty five years ago it was predicted that smoking in Asian women would inevitably increase, thanks to the women centric aggressive advertising/marketing tactics of the tobacco industry, increase in the purchasing power of women as a result of economic independence, and the diminishing role of parents/teachers/elders in determining their behavioural patterns. But interestingly, this has not happened. Yet we have to be cautiously optimistic about this current low level of smoking in women of this region, and remain ‘terribly vigilant’.

Some of the recent surveys point at a worrying indication that young girls are likely to take to smoking. In fact, according to a new WHO report, data from 151 countries show that about 7% of adolescent girls smoke cigarettes as opposed to 12% of adolescent boys. The report also points to evidence that tobacco advertising is increasingly targeting young girls with their slim, light, nicotine free menthol-cigarette overtures . While in Hong Kong, I saw for the first time, a quick puff of the long and slim cigarettes being enjoyed by young girls on roadsides. This was a common sight, although Hong Kong reportedly has less than 4% of women smokers. It has very strict laws against smoking in public places. It also banned all imports/ manufacture/selling of chewing tobacco way back in 1987. In India, perhaps due to societal pressures, it is still uncommon to find female smokers out in the open, although a lot many smoke in hiding, away from the public gaze. A worse form of tobacco abuse gaining wide spread popularity in India is flavoured chewing tobacco, called gutka/mawa/pan masala, which, though portrayed as a mouth freshener, is highly addictive. It is cheap, socially acceptable even in women (as against smoking), and consumed by millions of Indians (rich and poor alike), including children and adolescents. Gutka chewing is an important factor of the high prevalence of oral cancer in the sub continent. Another latest fad amongst teenage girls and boys in Indian metro cities is smoking the hookah (or the water pipe) in the numerous hookah bars, which are popular joints frequented by the youngsters. Water pipe smokers inhale dangerous levels of carbon monoxide, but users are blissfully unaware of the risks involved.

Dr Judith Mackay feels that women are not only vulnerable to misleading tobacco advertisements, but also to second hand smoke. A conservative society makes it difficult for Asian women to stand up against their smoker husbands/boyfriends. They are thus more prone to the health hazards of second hand smoke, even if they do not smoke themselves.

So it becomes imperative to evolve strategies to reduce, and eventually prevent, smoking and other forms of tobacco consumption by women and girls, with a view to protect and promote their health. Dr Mackay is of the opinion that school based awareness programmes can help only when they are co linked with other community based health programmes. She is emphatic that ‘stand alone’ school programmes do not work. The health knowledge of smokers and non smokers is just the same. So it is actually meaningless to tell adolescents that smoking is a health hazard- that it causes cancer and other life threatening diseases. Not only students, but all adults (be they teachers, parents, visitors) should be prohibited from smoking within school campuses.

Who would know it better than Dr Mackay that such school programmes, and/or a ban on sale of tobacco products to minors are actually supported by the tobacco industry and just do not deliver the desired results. She rightly feels that the tobacco industry is manipulating kids like puppets on strings. So, a more meaningful strategy would be to bring about a change in youth attitudes indirectly -- to make them realize that smoking is not cool, but a horrible habit; that although smoking is sold as freedom by the tobacco industry, it is actually a bondage; that freedom is about making correct and right choices without the fear of losing friends; that courage is about saying NO to smoking and yet remain friends.

According to Judith, only stringent economic measures, coupled with multi component (including social behaviour) school programmes would work. Increasing the price tag on cigarettes to the extent of making it unaffordable to most adolescents is the single most important initiative to restrict access to tobacco among children and adolescents. Along with this, there is a crying need for stricter implementation of anti tobacco legislation. A mere burgeoning of anti tobacco laws (with very little compliance) has a very adverse effect on the children’s psyche, as they grow up thinking that laws are meant to be disregarded. This would breed only lawless citizens. Sale of tobacco products to minors should not only be banned, but any violation of this law should attract the penalty of losing one’s license for ever.

Let more women join the likes of Dr Judith Mackay in this battle against tobacco, by standing up against the fatal attractions of the tobacco industry. We need to become role models for our rudderless adolescents, by practicing and not merely preaching about a cigarette/tobacco free and healthy society.


Shobha Shukla

(The author is the Honorary Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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Media Nest focusses on tobacco control

"Both the use and acceptance of tobacco usage is on the increase. This is indeed a very alarming sign for society. The Indian anti-tobacco law is strong but in reality its implementation is very weak," said Bobby Ramakant, an activist journalist, at the monthly 'Media for Children' session organized at the UP Press Club, by Media Nest (MN), with the support of UNICEF. MN is a Lucknow based pan-global forum of media professionals that works for the welfare of media persons and their families. Read more

Ramakant while giving a run through the various development that have taken place in the tobacco industry said that of late though dedicated individuals have come forward to create awareness about the hazards of tobacco yet a lot still needs to be done because tobacco industry is a cartel of sharks. He said this is why the global tobacco treaty, the WHO Framework Convention on Tobacco Control (FCTC), had adopted the guidelines for Article 5.3 stating clearly that there is a direct and irreconcilable conflict between the tobacco industry and public health. Ramakant informed that from 1st June, 2010 the tame pictorial warnings on the cigarette packs will be replaced by powerful pictures- showing oral cancer that will have an impact on the mind of the smoker and dissuade him from consuming this slow poison.

While briefing journalists at this capacity building programme on how to write hard-hitting stories on tobacco usage Ramakant gave them data and findings to show how they can give a sharpness and focus to their articles against tobacco usage. He said even as a common informed and concerned citizen you can help reduce this menace.

"It is in your power to make your environment smoke-free, please work towards this healthy initiative" he requested.

Present as resource persons at this Media Hour session were members of the Shine Health Association (SHA)- a group of Lucknow-based young dental doctors working towards a tobacco-free India and better oral health.

One of the doctors, Dr Shambivi Singh, a dental surgeon, gave a presentation describing how they are working towards creating awareness in youth, specially children against tobacco usage.

"The benefits of giving up tobacco can be felt in 20 minutes but it takes 10 years of total abstenance for it to show effect. Beware do not believe that smoking or taking any form of narcotics will give you a style statement," said Dr Singh.

Earlier addressing the audience, Dr Satya Gupta, head SHA, said that the alarming statistics that they got during a research which showed that 36.9 % of children initiate smoking before the age of 10 years with boys 55.1% and girls 32.1%.

(i) 4.2% of students currently smoked cigarettes with the rate for boys significantly higher than girls

(ii) 11.9% of students currently used other tobacco products

(iii) Cigarette smoking among youth is high in Central, Southern and Eastern regions (12%) made them decide to take by anti-tobacco awareness campaign in a big manner

"We thought that even if we cannot stop tobacco users we can at least ensure that we help prevent increasing their numbers through motivational drives among children against tobacco," said Dr Gupta. She said that their team is now holding camps at various schools in slums in both rural and urban area.

SHA organizes a oral health check up camp for the members of Media Nest (MN) and their families at UP Press Club.

Conducting the session Mr Durgesh Narain Shukla, senior journalist and member of Media Nest said that it is a happy co-incidence that Media Nest has initiated the health camps from May 8th which is the International Red Cross Day.

Speaking on the occasion the secretary general of Media Nest, Kulsum Talha, said that with the initiative of adding a health camp to the Media for Children, Media Nest has started its work towards working for the health of not just Media persons but also their families.

"Media Nest is like a cocoon for Media persons and their families and we are happy that we are now really working on welfare activities for journalists. With the passage of time we hope to organize more health and utility camps for journalists," said Ms Talha.

She said that for the last one and half years Media Nest has been organizing this session bi-monthly but now it will be held once a month on second Saturday. The fourth Saturday programme will be held at different Press Clubs in the state by rotation.

Kulsum Mustafa
(The author is a senior journalist and secretary of Media Nest)

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World Tuberculosis (TB) Day is on 24 March in Year of the Lung (2010)

The World TB Day is just a week ahead of us. This year 2010 is the year of the lung. In the lead up to the World TB Day, CNS is reproducing an exclusive article written in December 2009 (Cancun, Mexico) where 2010 was announced as year of the Lung. Read more



2010 is Year of the Lung

The Forum of International Respiratory Societies (FIRS) convening at the 40th Union World Conference on Lung Health in Cancun, Mexico, declared the year 2010 as the Year of the Lung. This was done to recognize that hundreds of millions of people around the world suffer each year from treatable and preventable chronic respiratory diseases. This initiative acknowledges that lung health has long been neglected in public discourses, and understands the need to unify different health advocates behind one purpose of lung health, informed Dr Nils Billo, Chair of FIRS. The FIRS partners include the International Union Against Tuberculosis and Lung Disease (The Union), American Thoracic Society (ATS), Asian Pacific Society of Respirology (APSR), Asociacion Latinoamericana de Torax (ALAT), European Respiratory Society (ERS), Pan African Thoracic Society and American College of Chest Physicians (ACCP).

The New York Times carried a series of articles on different parts of human body, but forgot the lungs! It is difficult to remain alive without lungs for more than few seconds!

The Declaration signed by the partners of the Forum of International Respiratory Societies (FIRS) read as following:

[Begin]
WE NOTE WITH GRAVE CONCERN THAT:
Hundreds of millions of people around the world suffer each year from treatable and preventable respiratory diseases, including tuberculosis (TB), asthma, lung cancer, H1N1, pneumonia, chronic obstructive pulmonary disease (COPD).

WE RECOGNIZE THAT:
Despite the magnitude of suffering and death caused by lung disease, lung health has long been neglected in public discourse and in public health decisions.

WE CALL UPON OUR PARTNERS TO:
Enact smoking cessation legislation and programs to reduce the prevalence and stigma of tobacco-related lung diseases.
[Ends]

There are a range of health and environmental factors that affect our lung health. This includes tuberculosis (TB), tobacco smoke, biomass fuel smoke, chronic obstructive pulmonary disease, asthma, pneumonia among other respiratory infections. The evidence of their potentially devastating effects on global public health is increasing and they require a coordinated approach for control. These diseases all occur in predominantly resource-poor countries. They are perpetuated by poverty and inadequate resources and their control and management require coordinated approach among health programmes at all levels.

Statistically, there is 1 TB-related death that takes place every 18 seconds, 1 HIV death every 16 seconds, 1 child dies of pneumonia every 15 seconds and 1 smoking-related death every 13 seconds. The enormous public challenge posed by the combined epidemics of tobacco smoking, HIV, TB and COPD, is undoubtedly alarming.

More than 2 billion people or a third of the world's total population, are infected with mycobacterium tuberculosis. Tuberculosis is now the world's seventh-leading cause of death. It killed 1.8 million people worldwide last year, up from 1.77 million in 2007. It is one of the three primary diseases that are closely linked to poverty, the other two being AIDS and malaria.

Tobacco smoking is unquestionably the primary risk factor for COPD. More than 5 million deaths are attributed to tobacco use every year. Smokers have two fold higher risk of developing active TB disease. Tobacco smokers have 2 times more risk of dieing of TB. Tobacco smoke increases the risk of pneumonia, influenza, menningococcal meningitis, among others. Evidence is accumulating that smoking is a risk factor for TB. However there is no published data on the cellular interactions of tobacco smoke and mycobacterium tuberculosis. The risk to develop active TB disease is higher when tobacco smoking is combined with alcohol.

Dr Donald Enarson stressed that tobacco smoking cessation is an important part of the comprehensive tobacco control programme, and not the only part. So all components of the comprehensive tobacco control measures should be implemented for improving public health outcomes. Dr Enarson was referring to MPOWER report from Tobacco Free Initiative (TFI) of WHO which outlines the MPOWER package, a set of six key tobacco control measures that reflect and build on the WHO Framework Convention on Tobacco Control (FCTC, global tobacco treaty). Another delegates remarked that MPOWER is in line with the global tobacco treaty - FCTC - and we should be demanding implementation of the treaty to which governments have committed to enforce. The WHO FCTC is the first public health and corporate accountability treaty, said a delegate from India. Comprehensive tobacco control programmes can yield major public health outcomes, as 30% of male TB patients die of tobacco smoking.

Asthma is yet another major lung health challenge. It is a chronic disease that affects airways. When people have asthma, the inside walls of their airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that they are allergic to or find irritating. When airways react, they get narrower and lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night. When asthma symptoms become worse than usual, it's called an asthma attack. In a severe asthma attack, the airways can close so much that vital organs do not get enough oxygen. People can die from severe asthma attacks.

More than 300 million people around the world have asthma, and the disease imposes a heavy burden on individuals, families, and societies. The Global Burden of Asthma Report, indicates that asthma control often falls short and there are many barriers to asthma control around the world. Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet in many regions around the world, this goal is often not met. Poor asthma control is also seen in the lifestyle limitations experienced by some people with asthma. For example, in some regions, up to one in four children with asthma is unable to attend school regularly because of poor asthma control. Asthma deaths are the ultimate, tragic evidence of uncontrolled asthma.

According to the Global Burden of Asthma Report, the majority of asthma deaths in some regions of the world are preventable. Effective asthma treatments exist and, with proper diagnosis, education, and treatment, the great majority of asthma patients can achieve and maintain good control of their disease. When asthma is under control, patients can live full and active lives.

Pneumonia claims two million children under five each year, yet no new drug, vaccine or special diagnostic test is needed to save their lives. The answers are at hand, and effective treatment is both inexpensive and widely available.

Host of other conditions that affect the lungs, are preventable, and often treatable.

Let us hope that 2010 Year of The Lung initiative of FIRS puts the spotlight on the long neglected part of human body which New York Times missed, the lungs.

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Globally-acclaimed Surgeon Prof Rama Kant now on SRNT Treatment Committee

Globally-acclaimed Surgeon Prof Rama Kant now on SRNT Treatment Committee

One of the most-credible International agencies for tobacco research – SRNT - has inducted Lucknow-based Internationally-acclaimed Surgeon and tobacco control crusader - Professor (Dr) Rama Kant - in its Treatment Committee. Prof Rama Kant began the first Tobacco Cessation Clinic (TCC) in late 1990s and was also the first Indian General and Cardio-thoracic Surgeon to be conferred upon the World Health Organization (WHO) Director-General's International award in recognition of his lifetime contribution to tobacco control in the year 2005. India is one on the list of (Asia, Africa, Oceana Caribbean and Latin America) AAOLA membership countries. Dr Mira Aghi represents the whole of AAOLA on the SRNT Board of Directors.

Presently Prof Rama Kant heads the Department of Surgery at Chhatrapati Shahuji Maharaj Medical University (CSMMU - upgraded King George's Medical College) and is also the Director of the CSMMU Tobacco Cessation Clinic (TCC).

The Society for Research on Nicotine and Tobacco (SRNT), head-quartered in the United States of America, encourages scientific research on public health efforts for the prevention and treatment of cigarette and tobacco use. Dr Jean-Francois Etter, Faculty of Medicine, University of Geneva, Switzerland, who is the co-chair of SRNT Treatment Committee, welcomed Prof Rama Kant to the SRNT Treatment Committee.

"Scientific evidence has unequivocally established that tobacco consumption and exposure to tobacco smoke causes death, disease and disability. There is clear scientific evidence that prenatal exposure to tobacco smoke causes adverse health and developmental conditions for children. Secondhand smoke exposure causes heart disease and lung cancer in nonsmoking adults. Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%.There is no risk-free level of secondhand smoke exposure. We can use the existing vast healthcare network of our country in tobacco control, simply by better management and utilization of the existing healthcare staff, at no extra cost. Involvement of health care workers in managing tobacco cessation programmes is a major tool in curbing the tobacco epidemic" says Prof Rama Kant.

"About 10 lakh tobacco-related deaths occur in India alone. 2500 Indians lose their lives each day because of tobacco use. India has the highest number of oral cancer cases in the world and 90% of all oral cancers are tobacco related and 40% of all cancers in India are due to tobacco use. Those who use tobacco should quit tobacco use before it is too late" says Prof Rama Kant.

Prof Rama Kant is the President-elect of the Association of Surgeons of India (ASI), UP, and also heads the Lucknow College of Surgeons (LCS). He is also the recepient of the National award from Ministry of Health and Family Welfare of Government of India (1997), Anushansa Puruskar of UP State government of India (for the years 1998 and 2000) and Birbal Sahini Award (1995).

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Globally-acclaimed Surgeon Prof Rama Kant now on SRNT Treatment Committee

Globally-acclaimed Surgeon Prof Rama Kant now on SRNT Treatment Committee

One of the most-credible International agencies for tobacco research – SRNT - has inducted Lucknow-based Internationally-acclaimed Surgeon and tobacco control crusader - Professor (Dr) Rama Kant - in its Treatment Committee. Prof Rama Kant began the first Tobacco Cessation Clinic (TCC) in late 1990s and was also the first Indian General and Cardio-thoracic Surgeon to be conferred upon the World Health Organization (WHO) Director-General's International award in recognition of his lifetime contribution to tobacco control in the year 2005. India is one on the list of (Asia, Africa, Oceana Caribbean and Latin America) AAOLA membership countries. Dr Mira Aghi represents the whole of AAOLA on the SRNT Board of Directors.

Presently Prof Rama Kant heads the Department of Surgery at Chhatrapati Shahuji Maharaj Medical University (CSMMU - upgraded King George's Medical College) and is also the Director of the CSMMU Tobacco Cessation Clinic (TCC).

The Society for Research on Nicotine and Tobacco (SRNT), head-quartered in the United States of America, encourages scientific research on public health efforts for the prevention and treatment of cigarette and tobacco use. Dr Jean-Francois Etter, Faculty of Medicine, University of Geneva, Switzerland, who is the co-chair of SRNT Treatment Committee, welcomed Prof Rama Kant to the SRNT Treatment Committee.

"Scientific evidence has unequivocally established that tobacco consumption and exposure to tobacco smoke causes death, disease and disability. There is clear scientific evidence that prenatal exposure to tobacco smoke causes adverse health and developmental conditions for children. Secondhand smoke exposure causes heart disease and lung cancer in nonsmoking adults. Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%.There is no risk-free level of secondhand smoke exposure. We can use the existing vast healthcare network of our country in tobacco control, simply by better management and utilization of the existing healthcare staff, at no extra cost. Involvement of health care workers in managing tobacco cessation programmes is a major tool in curbing the tobacco epidemic" says Prof Rama Kant.

"About 10 lakh tobacco-related deaths occur in India alone. 2500 Indians lose their lives each day because of tobacco use. India has the highest number of oral cancer cases in the world and 90% of all oral cancers are tobacco related and 40% of all cancers in India are due to tobacco use. Those who use tobacco should quit tobacco use before it is too late" says Prof Rama Kant.

Prof Rama Kant is the President-elect of the Association of Surgeons of India (ASI), UP, and also heads the Lucknow College of Surgeons (LCS). He is also the recepient of the National award from Ministry of Health and Family Welfare of Government of India (1997), Anushansa Puruskar of UP State government of India (for the years 1998 and 2000) and Birbal Sahini Award (1995).

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Strictly enforce smoke-free policies! Quit tobacco before it’s too late

Strictly enforce smoke-free policies! Quit tobacco before it’s too late

There was a growing consensus to strictly enforce smoke-free policies at the public symposium organized by the department of Surgery, Chhatrapati Shahuji Maharaj Medical University to mark the World No Tobacco Day. Vice Chancellor Prof (Dr) Saroj Chooramani Gopal and Justice Shabibul Hasnain were the chief guests, and Superintendent of Police (SP) City Harish Kumar was the guest of honour.

“Scientific evidence has unequivocally established that tobacco consumption and exposure to tobacco smoke causes death, disease and disability. There is clear scientific evidence that prenatal exposure to tobacco smoke causes adverse health and developmental conditions for children. Secondhand smoke exposure causes heart disease and lung cancer in nonsmoking adults. Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%.There is no risk-free level of secondhand smoke exposure. India enforced the ban on smoking in public places on 2 October 2008 and we must join hands to implement it effectively” said Prof (Dr) Saroj Chooramani Gopal.

“Effective pictorial warnings can save lives” said Professor (Dr) Rama Kant, Head of Surgery Department, CSMMU and a World Health Organization (WHO) International Awardee for the year 2005 on tobacco control.

“Pictorial health warnings are most effective way of broadcasting health messages across wide spectrum of population about the adverse health effects of tobacco use. Pictorial warning labels detract from the glamour and appeal of tobacco products and help to create an environment where ‘tobacco-free’ is the norm” said Prof Rama Kant.

“Effective warning labels increase knowledge about risks associated with tobacco use more effectively than text-only warnings. In a country like India where one-third of the population is illiterate, pictorial warnings can communicate health messages effectively and prevent uptake and motivate tobacco user to quit” further added Prof Rama Kant. “Countries with strong and effective pictorial warnings are experiencing major reduction in tobacco use” explained Prof Rama Kant.

However in India the pictorial warnings that are going to be implemented from 31 May 2009 are mild, weak and not field tested, said Professor (Dr) Rama Kant. As per the new rules notified on May 3, 2009, pictorial warnings would be displayed only on the 40% of the principal display area of the front panel of all tobacco packs (only ONE side of tobacco pack).

“Tobacco use is the leading preventable cause of disease and death in the world. According to the World Health Organization, each year 5.4 million lives are lost all over the world because of tobacco use. Out of these 9 lakh deaths occur in India alone. 2500 Indians lose their lives each day because of tobacco use. India has the highest number of oral cancer cases in the world and 90% of all oral cancers are tobacco related and 40% of all cancers in India are due to tobacco use” said Dr Vinod Jain, Assistant Professor in Surgery department, CSMMU, and Vice-President of Indian Medical Association (IMA) Lucknow.

Posters on grow without tobacco theme were also displayed. An elocution engaging school students against tobacco took place as well. Many NGOs including Bharat Vikas Parishad, UP Voluntary Health Association, Abhinav Bharat Foundation, Samadhan, Asha Parivar, Indian Society Against Smoking (ISAS) and others too part.

Strictly enforce smoke-free policies! Quit tobacco before it’s too late

Strictly enforce smoke-free policies! Quit tobacco before it’s too late

There was a growing consensus to strictly enforce smoke-free policies at the public symposium organized by the department of Surgery, Chhatrapati Shahuji Maharaj Medical University to mark the World No Tobacco Day. Vice Chancellor Prof (Dr) Saroj Chooramani Gopal and Justice Shabibul Hasnain were the chief guests, and Superintendent of Police (SP) City Harish Kumar was the guest of honour.

“Scientific evidence has unequivocally established that tobacco consumption and exposure to tobacco smoke causes death, disease and disability. There is clear scientific evidence that prenatal exposure to tobacco smoke causes adverse health and developmental conditions for children. Secondhand smoke exposure causes heart disease and lung cancer in nonsmoking adults. Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%.There is no risk-free level of secondhand smoke exposure. India enforced the ban on smoking in public places on 2 October 2008 and we must join hands to implement it effectively” said Prof (Dr) Saroj Chooramani Gopal.

“Effective pictorial warnings can save lives” said Professor (Dr) Rama Kant, Head of Surgery Department, CSMMU and a World Health Organization (WHO) International Awardee for the year 2005 on tobacco control.

“Pictorial health warnings are most effective way of broadcasting health messages across wide spectrum of population about the adverse health effects of tobacco use. Pictorial warning labels detract from the glamour and appeal of tobacco products and help to create an environment where ‘tobacco-free’ is the norm” said Prof Rama Kant.

“Effective warning labels increase knowledge about risks associated with tobacco use more effectively than text-only warnings. In a country like India where one-third of the population is illiterate, pictorial warnings can communicate health messages effectively and prevent uptake and motivate tobacco user to quit” further added Prof Rama Kant. “Countries with strong and effective pictorial warnings are experiencing major reduction in tobacco use” explained Prof Rama Kant.

However in India the pictorial warnings that are going to be implemented from 31 May 2009 are mild, weak and not field tested, said Professor (Dr) Rama Kant. As per the new rules notified on May 3, 2009, pictorial warnings would be displayed only on the 40% of the principal display area of the front panel of all tobacco packs (only ONE side of tobacco pack).

“Tobacco use is the leading preventable cause of disease and death in the world. According to the World Health Organization, each year 5.4 million lives are lost all over the world because of tobacco use. Out of these 9 lakh deaths occur in India alone. 2500 Indians lose their lives each day because of tobacco use. India has the highest number of oral cancer cases in the world and 90% of all oral cancers are tobacco related and 40% of all cancers in India are due to tobacco use” said Dr Vinod Jain, Assistant Professor in Surgery department, CSMMU, and Vice-President of Indian Medical Association (IMA) Lucknow.

Posters on grow without tobacco theme were also displayed. An elocution engaging school students against tobacco took place as well. Many NGOs including Bharat Vikas Parishad, UP Voluntary Health Association, Abhinav Bharat Foundation, Samadhan, Asha Parivar, Indian Society Against Smoking (ISAS) and others too part.

The Burden of Tobacco

The Burden of Tobacco

(1) Tobacco use is the leading preventable cause of disease and death in the world. According to the World Health Organization, each year 5.4 million lives are lost all over the world because of tobacco use.

(2) Out of these 9 lakh deaths occur in India alone. 2500 Indians lose their lives each day because of tobacco use.

(3) India has the highest number of oral cancer cases in the world and 90% of all oral cancers are tobacco related and 40% of all cancers in India are due to tobacco use.

(4) It is estimated that by 2010, nearly 10 lakh people will die because of smoking in India and it is predicted that by 2020 tobacco will account for 13% of all deaths in India.

(5) According to the Global Youth Tobacco Survey (GYTS), 2006, 5500 Indian youth start smoking every day.

(6) Health cost of tobacco related diseases are greater than the income generated from tobacco. According to a new study the direct medical cost for treating diseases related to smoking cigarettes, bidis etc., in India is 907 million US dollars (4535 crore rupees) and for smokeless tobacco products like gutkha, zarda and khaini, this cost is 285 million US dollars (1425 crore rupees).

Credits: this advocacy card is published and distributed by Indian Society Against Smoking (ISAS), Asha Parivar. We acknowledge the financial contribution received from Bloomberg Initiative to Reduce Tobacco use and technical contribution received from HRIDAY on behalf of Advocacy Forum for Tobacco Control - AFTC (Delhi).

Address: C-2211, C-Block Crossing, Indira Nagar, Lucknow-226016. India. Ph-fax: 2358230
Email: ramakant@ramakant.org, website: http://tambakooKills.blogspot.com

The Burden of Tobacco

The Burden of Tobacco

(1) Tobacco use is the leading preventable cause of disease and death in the world. According to the World Health Organization, each year 5.4 million lives are lost all over the world because of tobacco use.

(2) Out of these 9 lakh deaths occur in India alone. 2500 Indians lose their lives each day because of tobacco use.

(3) India has the highest number of oral cancer cases in the world and 90% of all oral cancers are tobacco related and 40% of all cancers in India are due to tobacco use.

(4) It is estimated that by 2010, nearly 10 lakh people will die because of smoking in India and it is predicted that by 2020 tobacco will account for 13% of all deaths in India.

(5) According to the Global Youth Tobacco Survey (GYTS), 2006, 5500 Indian youth start smoking every day.

(6) Health cost of tobacco related diseases are greater than the income generated from tobacco. According to a new study the direct medical cost for treating diseases related to smoking cigarettes, bidis etc., in India is 907 million US dollars (4535 crore rupees) and for smokeless tobacco products like gutkha, zarda and khaini, this cost is 285 million US dollars (1425 crore rupees).

Credits: this advocacy card is published and distributed by Indian Society Against Smoking (ISAS), Asha Parivar. We acknowledge the financial contribution received from Bloomberg Initiative to Reduce Tobacco use and technical contribution received from HRIDAY on behalf of Advocacy Forum for Tobacco Control - AFTC (Delhi).

Address: C-2211, C-Block Crossing, Indira Nagar, Lucknow-226016. India. Ph-fax: 2358230
Email: ramakant@ramakant.org, website: http://tambakooKills.blogspot.com

Asthma control is appalling in most countries

World Asthma Day (5 May 2009)
Asthma control is appalling in most countries

More than 300 million people around the world have asthma, and the disease imposes a heavy burden on individuals, families, and societies.

The Global Burden of Asthma Report, indicates that asthma control often falls short and there are many barriers to asthma control around the world. Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet in many regions around the world, this goal is often not met.

Poor asthma control is also seen in the lifestyle limitations experienced by some people with asthma. For example, in some regions, up to one in four children with asthma is unable to attend school regularly because of poor asthma control. Asthma deaths are the ultimate, tragic evidence of uncontrolled asthma.

According to the Global Burden of Asthma Report, the majority of asthma deaths in some regions of the world are preventable. The theme of World Asthma Day 2009, an awareness-raising event organized by the Global Initiative for Asthma (GINA), is "You Can Control Your Asthma."

This theme emphasizes that effective asthma treatments exist and, with proper diagnosis, education, and treatment, the great majority of asthma patients can achieve and maintain good control of their disease. When asthma is under control, patients can live full and active lives.

According to the GINA Global Strategy for Asthma Management and Prevention (2007), asthma control means that a person with asthma has:

- No (or minimal) asthma symptoms - No waking at night due to asthma

- No (or minimal) need to use "reliever" medication

- The ability to do normal physical activity and exercise

- Normal (or near-normal) lung function test results

- No (or very infrequent) asthma attacks

Some people with asthma symptoms may never receive a diagnosis of asthma, and thus do not have the opportunity for good asthma treatment and control. Various factors such as poor access to medical care, under-recognition by health professionals, lack of awareness among patients, and overlap of asthma symptoms with those of other diseases contribute to under-diagnosis of asthma.

One of the major barriers to asthma control is the high cost of medicines. For example, the cost of medicines is often higher than average monthly salary of a nurse in developing countries.

Also the Asthma medications are not available in some areas with alarming levels of asthma, such as parts of the Middle East, Southern Asia, Central America, and North, West, and East Africa.

Treatment that is not consistent with evidence-based guidelines may hamper asthma control. There are wide variations in clinical management of asthma in different parts of the world, and even when cost is not a barrier under-treatment may still occur.

The under-use of inhaled gluco-corticosteroids for long-term management of asthma is a common problem. These medications diminish chronic inflammation in the lungs of asthma patients, and are a key to controlling the disease.

In many regions of the world, people with asthma may be exposed to conditions such as outdoor or indoor air pollution, cigarette smoke, or chemicals on the job that make their asthma worse. Avoiding risk factors that cause asthma symptoms is an important strategy for improving control.

- Bobby Ramakant

Published in
The Seoul Times, Seoul, South Korea
Arab News, UAE
The Colombo Times, Colombo, Sri Lanka
Thai Indian News, Bangkok, Thailand
Assam Times, Guwahati, Assam
Citizen News Service (CNS)
Bihar Times, Patna, Bihar
Ghana News, Accra, Ghana
My News, Delhi
Topix
News Trust, USA
American Chronicle, USA
Indian Medicos
Northern Voices, Chandigarh and Himachal Pradesh
Talk Medical News, Australia
Twitter
Two Circles.net
Arusha Times, Tanzania
The Standard Times, Seirra Leone
Pakistan Christian Post, Pakistan
Tambakoo Kills
Media for Freedom, Kathmandu, Nepal
Web News Wire

Asthma control is appalling in most countries

World Asthma Day (5 May 2009)
Asthma control is appalling in most countries

More than 300 million people around the world have asthma, and the disease imposes a heavy burden on individuals, families, and societies.

The Global Burden of Asthma Report, indicates that asthma control often falls short and there are many barriers to asthma control around the world. Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet in many regions around the world, this goal is often not met.

Poor asthma control is also seen in the lifestyle limitations experienced by some people with asthma. For example, in some regions, up to one in four children with asthma is unable to attend school regularly because of poor asthma control. Asthma deaths are the ultimate, tragic evidence of uncontrolled asthma.

According to the Global Burden of Asthma Report, the majority of asthma deaths in some regions of the world are preventable. The theme of World Asthma Day 2009, an awareness-raising event organized by the Global Initiative for Asthma (GINA), is "You Can Control Your Asthma."

This theme emphasizes that effective asthma treatments exist and, with proper diagnosis, education, and treatment, the great majority of asthma patients can achieve and maintain good control of their disease. When asthma is under control, patients can live full and active lives.

According to the GINA Global Strategy for Asthma Management and Prevention (2007), asthma control means that a person with asthma has:

- No (or minimal) asthma symptoms - No waking at night due to asthma

- No (or minimal) need to use "reliever" medication

- The ability to do normal physical activity and exercise

- Normal (or near-normal) lung function test results

- No (or very infrequent) asthma attacks

Some people with asthma symptoms may never receive a diagnosis of asthma, and thus do not have the opportunity for good asthma treatment and control. Various factors such as poor access to medical care, under-recognition by health professionals, lack of awareness among patients, and overlap of asthma symptoms with those of other diseases contribute to under-diagnosis of asthma.

One of the major barriers to asthma control is the high cost of medicines. For example, the cost of medicines is often higher than average monthly salary of a nurse in developing countries.

Also the Asthma medications are not available in some areas with alarming levels of asthma, such as parts of the Middle East, Southern Asia, Central America, and North, West, and East Africa.

Treatment that is not consistent with evidence-based guidelines may hamper asthma control. There are wide variations in clinical management of asthma in different parts of the world, and even when cost is not a barrier under-treatment may still occur.

The under-use of inhaled gluco-corticosteroids for long-term management of asthma is a common problem. These medications diminish chronic inflammation in the lungs of asthma patients, and are a key to controlling the disease.

In many regions of the world, people with asthma may be exposed to conditions such as outdoor or indoor air pollution, cigarette smoke, or chemicals on the job that make their asthma worse. Avoiding risk factors that cause asthma symptoms is an important strategy for improving control.

- Bobby Ramakant

Published in
The Seoul Times, Seoul, South Korea
Arab News, UAE
The Colombo Times, Colombo, Sri Lanka
Thai Indian News, Bangkok, Thailand
Assam Times, Guwahati, Assam
Citizen News Service (CNS)
Bihar Times, Patna, Bihar
Ghana News, Accra, Ghana
My News, Delhi
Topix
News Trust, USA
American Chronicle, USA
Indian Medicos
Northern Voices, Chandigarh and Himachal Pradesh
Talk Medical News, Australia
Twitter
Two Circles.net
Arusha Times, Tanzania
The Standard Times, Seirra Leone
Pakistan Christian Post, Pakistan
Tambakoo Kills
Media for Freedom, Kathmandu, Nepal
Web News Wire

Bloomberg Award for Thailand's pictorial warnings on tobacco products

Bloomberg Award for Thailand's pictorial warnings on tobacco products
Jittima Jantanamalaka

The first Bloomberg Award for Global Tobacco Control (2009) was conferred to Dr Prakit Vathisathokit, Executive Secretary of Action on Smoking and Health (ASH), Thailand.

Dr Prakit was awarded for his leadership to implement the pictorial health warning labels on tobacco products effectively in Thailand.

Talking about his campaign at ASH, he contributed extensively in raising awareness in society about tobacco-related health hazards. Working closely with the Ministry of Health in Thailand, Dr Prakit was part of the team which drafted a number of warnings for tobacco products. Thailand was the fourth country in the world after Canada, Brazil and Singapore, to print effective pictorial health warning labels on tobacco products. Thailand has nine photographs of people with tobacco-related life-threatening diseases which it uses on rotational basis for pictorial health warning labels on tobacco products.

Some other countries took these photographs from Thailand to use it as pictorial health warning labels in their own countries, including: Malaysia, Brunei Darussalam, Singapore, Viet Nam, Philippines and Caribbean countries.

The level of awareness about tobacco-related health hazards has certainly gone up, tobacco users are more inclined to quit and children and young people felt de-motivated to use tobacco as a result of strong and effective pictorial health warning labels on tobacco products, said Dr Prakit.

This wasn't an easy task. Tobacco industry tried to threaten and thwart efforts of Dr Prakit, but unsuccessfully. "At that time there were not many countries that had strong and effective pictorial health warning labels on tobacco products. That is why tobacco industry was trying to threaten us. The tobacco industry said that the pictorial health warning labels were breaking the International Trademark law, and they will take legal action against us" said Dr Prakit. "But there were no legal action, just threats."

"Even if the tobacco industry had gone to the court, they would have lost the case because the World Trade Organization (WTO) marks tobacco and cigarette as a special good, which is dangerous to the consumer" said Dr Prakit.

Thailand has signed and ratified the global tobacco treaty - World Health Organization Framework of Convention Tobacco Control (WHO FCTC) - which is a legally binding instrument. The FCTC strongly supports the pictorial health warning label provision, and Thailand is obligated to follow it. Also the WHO has recommended these warnings as they are cost-effective ways to control tobacco. The tobacco industry would have certainly lost in court, says Dr Prakit.

Presently there are 163 countries that have signed on the FCTC and all of them have to implement pictorial health warning labels on tobacco products within 3 years. "To prepare the photographs is not difficult but to handle the tobacco industry which tries to block and interfere with the health policies is most difficult" says Dr Prakit.

Tobacco is very addictive, as addictive as heroin, says Dr Prakit, which is why even many tobacco users are not easily able to quit even if they want to do so.

Due to strong and consistent tobacco control campaign in Thailand over the past 20 years, the number of smokers and sale of cigarettes are still the same - 10 million. If we didn't have a strong campaign and policy framework, estimated number of tobacco users in Thailand would have reached 14 million.

There is a lot more to be done in Thailand on tobacco control. We need to effectively enforce the smoke-free laws in Thailand, ban cross-border advertising and raise taxes on tobacco products so that tobacco cessation services can be scaled up, feels Dr Prakit.

[Audio podcast is available here]

Jittima Jantanamalaka - Citizen News Service (CNS)

Bloomberg Award for Thailand's pictorial warnings on tobacco products

Bloomberg Award for Thailand's pictorial warnings on tobacco products
Jittima Jantanamalaka

The first Bloomberg Award for Global Tobacco Control (2009) was conferred to Dr Prakit Vathisathokit, Executive Secretary of Action on Smoking and Health (ASH), Thailand.

Dr Prakit was awarded for his leadership to implement the pictorial health warning labels on tobacco products effectively in Thailand.

Talking about his campaign at ASH, he contributed extensively in raising awareness in society about tobacco-related health hazards. Working closely with the Ministry of Health in Thailand, Dr Prakit was part of the team which drafted a number of warnings for tobacco products. Thailand was the fourth country in the world after Canada, Brazil and Singapore, to print effective pictorial health warning labels on tobacco products. Thailand has nine photographs of people with tobacco-related life-threatening diseases which it uses on rotational basis for pictorial health warning labels on tobacco products.

Some other countries took these photographs from Thailand to use it as pictorial health warning labels in their own countries, including: Malaysia, Brunei Darussalam, Singapore, Viet Nam, Philippines and Caribbean countries.

The level of awareness about tobacco-related health hazards has certainly gone up, tobacco users are more inclined to quit and children and young people felt de-motivated to use tobacco as a result of strong and effective pictorial health warning labels on tobacco products, said Dr Prakit.

This wasn't an easy task. Tobacco industry tried to threaten and thwart efforts of Dr Prakit, but unsuccessfully. "At that time there were not many countries that had strong and effective pictorial health warning labels on tobacco products. That is why tobacco industry was trying to threaten us. The tobacco industry said that the pictorial health warning labels were breaking the International Trademark law, and they will take legal action against us" said Dr Prakit. "But there were no legal action, just threats."

"Even if the tobacco industry had gone to the court, they would have lost the case because the World Trade Organization (WTO) marks tobacco and cigarette as a special good, which is dangerous to the consumer" said Dr Prakit.

Thailand has signed and ratified the global tobacco treaty - World Health Organization Framework of Convention Tobacco Control (WHO FCTC) - which is a legally binding instrument. The FCTC strongly supports the pictorial health warning label provision, and Thailand is obligated to follow it. Also the WHO has recommended these warnings as they are cost-effective ways to control tobacco. The tobacco industry would have certainly lost in court, says Dr Prakit.

Presently there are 163 countries that have signed on the FCTC and all of them have to implement pictorial health warning labels on tobacco products within 3 years. "To prepare the photographs is not difficult but to handle the tobacco industry which tries to block and interfere with the health policies is most difficult" says Dr Prakit.

Tobacco is very addictive, as addictive as heroin, says Dr Prakit, which is why even many tobacco users are not easily able to quit even if they want to do so.

Due to strong and consistent tobacco control campaign in Thailand over the past 20 years, the number of smokers and sale of cigarettes are still the same - 10 million. If we didn't have a strong campaign and policy framework, estimated number of tobacco users in Thailand would have reached 14 million.

There is a lot more to be done in Thailand on tobacco control. We need to effectively enforce the smoke-free laws in Thailand, ban cross-border advertising and raise taxes on tobacco products so that tobacco cessation services can be scaled up, feels Dr Prakit.

[Audio podcast is available here]

Jittima Jantanamalaka - Citizen News Service (CNS)

We Shall Overcome the menace of tobacco

We Shall Overcome the menace of tobacco

The recently concluded 14th World Conference on Tobacco or Health (WCTOH), renewed the pledge to battle the scourge of tobacco, till we can boast of a smoke free environment and a healthy society. The conference provided a global platform for sharing of ideas and real life experiences and dissemination of information from across 130 countries of the world for improved tobacco control measures. It was attended by a galaxy of luminaries consisting of proactive government agencies, health experts, scientists, educators and anti tobacco advocates working towards a ‘tobacco free society’.

In the words of 2009 Luther Terry Awardee Dr Srinath Reddy, tobacco was brought to India, 400 years ago by the Portuguese, through its west coast, and this conference, hosted in Mumbai, has sounded the clarion call for its exit through the same point.

Tobacco control is a development issue, and not merely a health issue. The tobacco menace is inextricably linked with other ills plaguing the world society today. In times of a global food crisis, (when the UN Secretary General has called for doubling the food production), can we allow to waste 5.3 million hectares of land for cultivation of a poison called tobacco? In times of severe environmental degradation, does it make any sense to fill the already polluted air with carcinogenic cigarette smoke? In times of an economic meltdown (and even otherwise), can governments afford to increase their economic burden on their national health care systems due to tobacco related diseases and deaths? Hence the anti tobacco movement has to work hand in hand with other global movements for the betterment of civil society.

Smokers may insensitively plead for protecting their right to have a particular life style. But they cannot have the freedom to endanger the health and life of innocents through second hand smoke and they do not have the right to force their families to economic deprivation.

The conference taught us lessons in working towards a tobacco free future by making sincere efforts to -- put a curb on illicit tobacco trade; raise taxes on tobacco products; strictly enforce pictorial warnings; ban all tobacco/cigarette advertising; decline sponsorships from tobacco companies for any youth/ sports/ social responsibility activities; and to create public-private partnerships for effective anti tobacco campaigns.

Each one of us needs to step in, to stub it out, before it is too late. The fearless fighters of tobacco can do it, and will do it, to mark the triumph of the human spirit against all odds.

Shobha Shukla, Citizen News Service (CNS)

(The author is the Editor of Citizen News Service (CNS) and also teaches physics at Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

We Shall Overcome the menace of tobacco

We Shall Overcome the menace of tobacco

The recently concluded 14th World Conference on Tobacco or Health (WCTOH), renewed the pledge to battle the scourge of tobacco, till we can boast of a smoke free environment and a healthy society. The conference provided a global platform for sharing of ideas and real life experiences and dissemination of information from across 130 countries of the world for improved tobacco control measures. It was attended by a galaxy of luminaries consisting of proactive government agencies, health experts, scientists, educators and anti tobacco advocates working towards a ‘tobacco free society’.

In the words of 2009 Luther Terry Awardee Dr Srinath Reddy, tobacco was brought to India, 400 years ago by the Portuguese, through its west coast, and this conference, hosted in Mumbai, has sounded the clarion call for its exit through the same point.

Tobacco control is a development issue, and not merely a health issue. The tobacco menace is inextricably linked with other ills plaguing the world society today. In times of a global food crisis, (when the UN Secretary General has called for doubling the food production), can we allow to waste 5.3 million hectares of land for cultivation of a poison called tobacco? In times of severe environmental degradation, does it make any sense to fill the already polluted air with carcinogenic cigarette smoke? In times of an economic meltdown (and even otherwise), can governments afford to increase their economic burden on their national health care systems due to tobacco related diseases and deaths? Hence the anti tobacco movement has to work hand in hand with other global movements for the betterment of civil society.

Smokers may insensitively plead for protecting their right to have a particular life style. But they cannot have the freedom to endanger the health and life of innocents through second hand smoke and they do not have the right to force their families to economic deprivation.

The conference taught us lessons in working towards a tobacco free future by making sincere efforts to -- put a curb on illicit tobacco trade; raise taxes on tobacco products; strictly enforce pictorial warnings; ban all tobacco/cigarette advertising; decline sponsorships from tobacco companies for any youth/ sports/ social responsibility activities; and to create public-private partnerships for effective anti tobacco campaigns.

Each one of us needs to step in, to stub it out, before it is too late. The fearless fighters of tobacco can do it, and will do it, to mark the triumph of the human spirit against all odds.

Shobha Shukla, Citizen News Service (CNS)

(The author is the Editor of Citizen News Service (CNS) and also teaches physics at Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

Scaling up clinic-based tobacco cessation in India

Scaling up clinic-based tobacco cessation in India

The smoke-free policies in India were enforced since 2 October 2008 and different states are at varying levels of its implementation, yet the tobacco cessation services are still limited to very few clinics in India.

A lead article published in The Economist (7-13 March 2009) says: "tobacco is more addictive than virtually all of them [narcotic drugs]."

With tobacco being highly addictive, it is clear that for a successful implementation of the smoke-free policies, the scaling up of high-quality and reliable tobacco cessation services can no longer be ignored.

"Large areas in central and north-east India have more than 65 per cent tobacco use" said Dr Pratima Murthy, who is the Professor of Psychiatry and Chief, De-addiction centre, National Institute of Mental Health and Neuro-Sciences, Bangalore, Karnataka, India. She was speaking at the 14th World Conference on Tobacco or Health (WCTOH) which recently concluded in Mumbai (India). About 57 per cent men and 19 per cent women in rural areas use tobacco, both these figures are far more than the percentage of men and women who use tobacco in urban areas. Incidentally, most of the tobacco cessation services in India, are confined to urban areas. It is vital to expand tobacco cessation services in rural areas as well.

With support from the World Health Organization (WHO) and Ministry of Health and Family Welfare, Government of India, in the year 2002, thirteen tobacco cessation clinics (TCC) were established across the country in primarily cancer, psychiatry, surgical, cardiology and some non-governmental organization settings. These include the TCCs at the Chhatrapati Shahuji Maharaj Medical University (upgraded King George's Medical College) in Lucknow, Tata Memorial Hospital in Mumbai, and such premier healthcare institutes in India. Five more TCCs were added in the year 2005 at each of the regional cancer centres in India. Apart from delivering high quality and reliable tobacco cessation services, these TCCs were also mandated to develop intervention model for tobacco cessation for both smoking and smokeless tobacco users.

Each of these TCCs was well equipped with regular and uninterrupted drug supply, equipments like the CO monitor, and a well-trained staff in tobacco cessation. Over the past years, step-wise effective strategies for tobacco cessation evolved in these TCCs apart from providing tips to quit, behavioural counseling and pharmacotherapy.

The main sources of referral were other doctors and media. Since the year 2002, 34,741 cases were registered across the eighteen TCCs in India, and baseline details were available for 23,320, said Dr Murthy. 92 per cent of those registered in the TCCs were men, and 8 per cent were women. 65 per cent of those registered used smokeless forms, and 35 per cent used smoking forms or both (smoking and smokeless forms of tobacco). The mean age of those seeking tobacco cessation services was 37 years. About 50 per cent of those registered for seeking tobacco cessation services at the TCCs in India, had the average monthly income of about Rs 3000 per month (about USD 60).

Majority of those seeking help to quit tobacco didn't receive drugs - rather behavioural therapies, education, tips to quit, motivation to change and relapse prevention counseling were deemed most appropriate for 69 per cent tobacco quitters. About 31.1 per cent of those who registered for quitting tobacco, had successfully get rid of the deadly addiction. About 49.5 per cent of them had significantly improved by reducing the tobacco intake by over 50 per cent (compared to their baseline data). Only 8.7 per cent of those registered reported no change of tobacco cessation therapies on their addiction.

Improvement was significantly associated with being male, younger, using smokeless tobacco and receiving combined behavioural counseling and pharmacotherapy, said Dr Murthy. "Women – don't do badly but are unable to come for follow up" further explained Dr Murthy.

Dr Murthy outlines some limitations of the tobacco cessation programme in India. She says, very small number of population is covered by these TCCs in India. Most of these clinics are predominantly urban based and follow-up is variable in different TCCs. She also highlights another limitation that the use of tobacco quitting services is very limited among young people who are in varying stages of initiation.

The learnings are clear: tobacco cessation services need to be provided from a range of diverse clinical settings. The tobacco cessation service model needs to be extended in the community. There is also an urgent need for trained human resources to provide cessation services. Dr Murthy also emphasizes on the need to retain the people who want to quit tobacco use by improving follow-up.

She recommends that tobacco cessation training should be a part of the undergraduate training of medical professionals. Also there is a need to focus on basic training of all health professionals. She suggests a community based model to strengthen tobacco cessation services in India.

Bobby Ramakant

Scaling up clinic-based tobacco cessation in India

Scaling up clinic-based tobacco cessation in India

The smoke-free policies in India were enforced since 2 October 2008 and different states are at varying levels of its implementation, yet the tobacco cessation services are still limited to very few clinics in India.

A lead article published in The Economist (7-13 March 2009) says: "tobacco is more addictive than virtually all of them [narcotic drugs]."

With tobacco being highly addictive, it is clear that for a successful implementation of the smoke-free policies, the scaling up of high-quality and reliable tobacco cessation services can no longer be ignored.

"Large areas in central and north-east India have more than 65 per cent tobacco use" said Dr Pratima Murthy, who is the Professor of Psychiatry and Chief, De-addiction centre, National Institute of Mental Health and Neuro-Sciences, Bangalore, Karnataka, India. She was speaking at the 14th World Conference on Tobacco or Health (WCTOH) which recently concluded in Mumbai (India). About 57 per cent men and 19 per cent women in rural areas use tobacco, both these figures are far more than the percentage of men and women who use tobacco in urban areas. Incidentally, most of the tobacco cessation services in India, are confined to urban areas. It is vital to expand tobacco cessation services in rural areas as well.

With support from the World Health Organization (WHO) and Ministry of Health and Family Welfare, Government of India, in the year 2002, thirteen tobacco cessation clinics (TCC) were established across the country in primarily cancer, psychiatry, surgical, cardiology and some non-governmental organization settings. These include the TCCs at the Chhatrapati Shahuji Maharaj Medical University (upgraded King George's Medical College) in Lucknow, Tata Memorial Hospital in Mumbai, and such premier healthcare institutes in India. Five more TCCs were added in the year 2005 at each of the regional cancer centres in India. Apart from delivering high quality and reliable tobacco cessation services, these TCCs were also mandated to develop intervention model for tobacco cessation for both smoking and smokeless tobacco users.

Each of these TCCs was well equipped with regular and uninterrupted drug supply, equipments like the CO monitor, and a well-trained staff in tobacco cessation. Over the past years, step-wise effective strategies for tobacco cessation evolved in these TCCs apart from providing tips to quit, behavioural counseling and pharmacotherapy.

The main sources of referral were other doctors and media. Since the year 2002, 34,741 cases were registered across the eighteen TCCs in India, and baseline details were available for 23,320, said Dr Murthy. 92 per cent of those registered in the TCCs were men, and 8 per cent were women. 65 per cent of those registered used smokeless forms, and 35 per cent used smoking forms or both (smoking and smokeless forms of tobacco). The mean age of those seeking tobacco cessation services was 37 years. About 50 per cent of those registered for seeking tobacco cessation services at the TCCs in India, had the average monthly income of about Rs 3000 per month (about USD 60).

Majority of those seeking help to quit tobacco didn't receive drugs - rather behavioural therapies, education, tips to quit, motivation to change and relapse prevention counseling were deemed most appropriate for 69 per cent tobacco quitters. About 31.1 per cent of those who registered for quitting tobacco, had successfully get rid of the deadly addiction. About 49.5 per cent of them had significantly improved by reducing the tobacco intake by over 50 per cent (compared to their baseline data). Only 8.7 per cent of those registered reported no change of tobacco cessation therapies on their addiction.

Improvement was significantly associated with being male, younger, using smokeless tobacco and receiving combined behavioural counseling and pharmacotherapy, said Dr Murthy. "Women – don't do badly but are unable to come for follow up" further explained Dr Murthy.

Dr Murthy outlines some limitations of the tobacco cessation programme in India. She says, very small number of population is covered by these TCCs in India. Most of these clinics are predominantly urban based and follow-up is variable in different TCCs. She also highlights another limitation that the use of tobacco quitting services is very limited among young people who are in varying stages of initiation.

The learnings are clear: tobacco cessation services need to be provided from a range of diverse clinical settings. The tobacco cessation service model needs to be extended in the community. There is also an urgent need for trained human resources to provide cessation services. Dr Murthy also emphasizes on the need to retain the people who want to quit tobacco use by improving follow-up.

She recommends that tobacco cessation training should be a part of the undergraduate training of medical professionals. Also there is a need to focus on basic training of all health professionals. She suggests a community based model to strengthen tobacco cessation services in India.

Bobby Ramakant