The painless way to stop smoking

Context:

• The U.S. Food and Drug has announced a comprehensive proposal to reduce the amount of nicotine in cigarettes to non-addictive levels which created havoc among tobacco companies.

Introduction:

• The proposal is aimed at striking at the root of the problem of smokers getting addicted, and being unable to quit the habit.
• Nicotine does not directly cause cancers and other diseases that kill people, but is extremely addictive. By keeping smokers addicted for the long term, nicotine exposes them to nearly 7,000 chemicals, many of them deadly, every time they smoke.
• Reducing nicotine in cigarettes to non-addictive levels would therefore have multiple benefits. Such as:
• Reduce the likelihood of new users (those in the 15-24 age group) getting hooked to cigarettes, increase the chances of habitual smokers being able to quit, and cut smoking-related disease and death burden overall.

Smoking in India:

• Tobacco was introduced in India by Portuguese barely 400 years ago during the Mughal era.
• With due course of time, India is the second largest producer of tobacco in the world after China.
• India is also the second largest consumer of tobacco in the world, second only to China.
• The prevalence of tobacco use among adults (15 years and above) is 35%. The prevalence of overall tobacco use among males is 48 percent and that among females is 20 percent. Nearly two in five (38%) adults in rural areas and one in four (25%) adults in urban areas use tobacco in some form.
• Over 11 per cent of 6.4 million deaths worldwide was caused by smoking in 2015 and 52.2 per cent of them took place in China, India, USA, and Russia, according to the latest estimates in the Global Burden of Disease (GBD) study.

Government initiatives: in chronological order:

With the growing evidence of harmful and hazardous effects of tobacco, the Government of India enacted various legislations and comprehensive tobacco control measures. 

• The Government enacted the Cigarettes Act (Regulation of Production, Supply and Distribution) in 1975.
• The statutory warning “cigarette smoking is injurious to health” was mandatorily displayed on all cigarette packages, cartons and advertisements of cigarettes.
• Tobacco smoking was prohibited in all health care establishments, educational institutions, and domestic flights, air-conditioned coaches in trains, suburban trains and air-conditioned buses, through a Memorandum issued by the Cabinet Secretariat in 1990.
• Under the Chairmanship of Shri Amal Datta, the 22^ndCommittee on Subordinate Legislation in November 1995 recommended to the Ministry of Health to enact legislation to protect non-smokers from second hand smoke.
• In addition, the committee recommended stronger warnings for tobacco users, stricter regulation of the electronic media and creating mass awareness programmes to warn people about the harms of tobacco.
• In a way, this Committee’s recommendation laid the foundation of developing the existing tobacco control legislation in the country.
• The Cable Television Networks (Amendment) Act 2000 prohibited tobacco advertising in state controlled electronic media and publications including cable television.
• The Government enacted the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA), in 2003.
• The provisions under the act included prohibition of smoking in public places, prohibition of advertisements of tobacco products, prohibition on sale of tobacco products to and by minors (persons below 18 years), ban on sale of tobacco products within 100 yards of all educational institutions and mandatory display of pictorial health warnings on tobacco products packages.
• In 2004, the Government ratified the WHO Framework Convention on Tobacco Control (WHO FCTC), which enlists key strategies for reduction in demand and reduction in supply of tobacco.
• There were many legal challenges which the Government had to face in view of the tobacco industry countering most of these Rules in the court of law. Thus, after a long legal battle and interventions by the civil society, Revised Smoke-free Rules came into effect from 2^ndOctober, 2008.
• Subsequently the law pertaining to pictorial warnings on tobacco products packages was implemented with effect from 31^stMay 2009.
• With effect from 2 October 2012, the government began screening two anti-tobacco advertisements, in movie theatres and on television.
• It is also mandatory for theatres to display a disclaimer on-screen whenever smoking scenes are depicted in the movie.

National Tobacco Control Programme (NTCP)^:

To strengthen implementation of the tobacco control provisions under Cigarettes and Other Tobacco Products Act (COTPA) and policies of tobacco control mandated under the WHO Framework Convention on Tobacco Control (FCTC), the Government of the India piloted National Tobacco Control Programme (NTCP) in 2007-2008.

• The programme is under implementation in 21 out of 35 States/Union territories in the country.
• In total, 42 districts are covered by NTCP at present.

Objectives:

• Creating public awareness/mass media campaigns for awareness building and behavior change.
• Establishment of tobacco product testing laboratories, to build regulatory capacity, as mandated under Cigarettes and Other Tobacco Products Act COTPA, 2003.
• Mainstreaming the program components as part of the health care delivery mechanism under the National Rural Health Mission framework.
• Mainstreaming Research and Training on alternate crops and livelihoods in collaboration with other nodal Ministries.
• Monitoring and Evaluation including surveillance e.g. Global Adult Tobacco Survey (GATS) India.
• Building Tobacco control cells with dedicated manpower for effective implementation and monitoring of anti tobacco laws and initiatives.

E-cigarettes Law:

• E-cigarettes do not contain tobacco, nor is there any form of combustion. It involves heated vapor.
• Import of e-cigarettes and e-liquid is permitted in India, but involves varying permissions.
• This product is not a drug as per the Drugs & Cosmetics Act, 1940, and neither does it come under the jurisdiction of the tobacco department as it does not contain tobacco.

Hookah Law:

• The nationwide smoking ban did not prohibit consumption of hookah.
• However, several cities in India have banned consumption of hookah in hookah bars.
• It is still legal to purchase hookahs at shops and consume them at home.
• Authorities Section 144(Unlawful assembly) of CRPC to shut down hookah bars. Governments also use the COTPA.

Challenges in implementation of laws:

• Implementation remains a challenge due to lack of trained enforcement squad.
• Involvement of police force still not uniformly possible as COTPA violations remains low priority.
• Local municipal bodies are not motivated equally across the States to take up relevant actions.
• Tobbacco sales violations continue in major parts of India due to low implementation drive and the tobacco industry interference.
• Civic agencies, transport corporations are not uniformly implementing COTPA.

Suggestions:

• One of the areas needing attention is tobacco taxation. Globally raising the tobacco taxes on tobacco products will be effective in reducing the prevalence of tobacco use.
• Smoking should be strictly prohibited in all closed workplaces either privately or publicly owned.
• Effective tobacco control is dependent on balanced implementation of demand and supply reduction strategies by the Government and inter-sectoral coordination involving stakeholder departments and ministries.
• It is necessary to craft health laws in every state to meet the peculiar challenges that every state faces in the context of smoking.
• Traditionally, health laws in India have worked more efficaciously when they have been enacted at the state level as opposed to the national level.
• This is because every state faces a unique set of health risks and the causes for those health risks also significantly differ from state to state.
• A complete ban on smoking in public places by law. If not, then designated smoking areas should be separated from non-smoking areas through specified engineering guidelines.
• Mobilizing the common mass through mass education and community empowerment makes huge differences.
• The state governments should progressively reduce the area of land under tobacco cultivation in India.