Let's Quit Tobacco Today

Q. What are the current hurdles related to tobacco control in India?

India’s Government has implemented tobacco control interventions, including the National Tobacco Control Program (NTCP), which have reduced tobacco consumption and increased intention to quit, according to the recent Global Adult Tobacco Survey 2 (GATS)1. However, over 103 million adults (aged 15+) and 625,000 children (aged 10-14 years) still use tobacco each day, according to The Tobacco Atlas.

Current barriers to progress include the continued availability, affordability and marketing of tobacco products. Proven strategies like stronger smoke-free laws, comprehensive bans on tobacco advertising, promotion and sponsorships, higher tobacco taxes and sustained public education campaigns would help reduce India’s tobacco epidemic. 

Q. The Union Health Ministry issued a notice on enhanced pictorial warnings to be printed on packets of cigarette and other tobacco products. Will this help in behavior change?

The World Health Organization Framework Convention on Tobacco Control (FCTC) requires governments to implement and rotate warning images to ensure their effectiveness. The Ministry has mandated 85% pictorial health warnings on both sides of all tobacco products including cigarettes, bidis, and smokeless/chewing tobacco, and recently notified new warnings and the national quitline number. These warnings work: in the recent GATS survey, 62% of cigarette smokers and 54% of bidi smokers said that they had prompted thoughts about quitting. They also deter youth initiation and encourage smokers to use the quitline. 

Q. Can you comment on the anti-tobacco messages played before movies in theatres and television whenever there is a smoking scene, how effective is that?

Section 5 of Cigarettes and Other Tobacco Products Act (COTPA) prohibits the advertisement, promotion, and sponsorship of tobacco products, including the depiction of tobacco products or their use in films and television programmes. To promulgate this provision, the Ministry of Health and Family Welfare, Government of India issued amendments (2011, 2012) under the COTPA, also known as the ‘Film Rules,’ which mandate the broadcast of anti-tobacco health spots, audiovisual disclaimers and static health warning messages when tobacco products, branding or use are shown in films and television programmes. The Rules came into effect on October 2, 2012 and are applicable to all Indian and foreign films and television programmes broadcast in India. 

This is a commendable initiative by the government, that helps to deter the incorporation of scenes of tobacco use in films and TV programmes and encourages behavior change among current and potential tobacco users - including preventing tobacco initiation among youth. The static warning messages and anti-tobacco health spots are especially strong elements of the Film Rules, helping to deliver these objectives.

Vital Strategies and World Health Organization India conducted an evaluation which highlighted the challenges in ensuring effective implementation of the tobacco-free television and film policy. The study observed that in cinemas, all elements of the Film Rules were appropriately implemented in 27% of films that depicted tobacco use. An analysis of randomly selected TV programming found that only 4% of programmes depicting tobacco use included at least two or three elements of the Film Rules. More robust enforcement and monitoring of all elements of the Film Rules and the use of evidence-based, pre-tested anti-tobacco health spots are strongly recommended to ensure this policy is implemented more effectively and delivers the desired impacts on behavior and health.

Q. As per the recent WHO 2018 Global TB report, among the 10 million people who developed the disease in 2017, two-thirds were from eight countries with India leading the pack. Could you elaborate on the connection between TB and tobacco use?

India has the world’s highest number of TB patients and a second-largest population of tobacco users, after China. Approximately 7.9 percent of TB deaths in India are related to tobacco use. Smoke from bidis and cigarettes damages vital immune cells in the lungs and smoking increases the risk of TB by more than two and a half times. It increases the risk of developing active TB, more severe and longer duration of TB, and reduced effectiveness of TB treatment – increasing the risk of death. These risks also increase among non-smokers exposed to secondhand smoke (SHS), including children.

In May 2017, India became the first country to implement a national mass media campaign, “TB Cough,” showing the link between smoking, exposure to SHS and increased risk of TB. It was broadcast again in March 2018 during the End-TB Summit. “TB Cough” was developed and implemented with technical support from Vital Strategies. 

Q. What is the efficacy of tobacco control mass media campaigns, and how are they helpful in reducing the number of smokers?  

Under Article 12 of the WHO FCTC and WHO’s MPOWER policy package, we know it’s best to run sustained, population-level mass media campaigns using a mix of channels - social and digital media are fast emerging as effective options.

According to the Tobacco Atlas, sustained campaigns that highlight tobacco’s deadly harms promote healthy behaviors, prompt quit attempts, prevent youth initiation, and create a supportive environment for policy change. The life-saving potential of these campaigns is confirmed in a recent paper3 co-authored with Dr. David Levy of Georgetown University.

In India, campaigns are rigorously pretested and refined to ensure maximum effectiveness. A research study found that a smokeless tobacco campaign in India (Dr. Nandita Murkutla Et al.) was highly cost-effective, costing just INR 4.5 (USD 0.06) per quit attempt, INR 189 (USD 2.6) per permanent quit and INR 667 (USD 9.2) per death averted.