Lancet lauds India’s bid to curb smokeless tobacco, calls it ‘exemplary’

India’s efforts to curb smokeless tobacco use is “exemplary”,according to the latest Lancet Global Health Research Review.

India’s efforts to curb smokeless tobacco use is “exemplary”,according to the latest Lancet Global Health Research Review on Global Impact of Tobacco Control Policies on Smokeless Tobacco Use.

Scientists have found non-smoking adolescents who use e-cigarettes, smokeless tobacco or tobacco water pipes are more likely to start smoking conventional cigarettes within a year. (Shutterstock)

“India, in particular, has taken a comprehensive approach to tackle the use of smokeless tobacco products. These measures align with the WHO FCTC (Framework Convention on Tobacco Control) and include taxation, regulation of contents, labelling and packaging, education campaigns, cessation services, restrictions on sale to and by minors, and a ban on sale and manufacture of smokeless tobacco products such as gutkha. India’s efforts, including the mandatory depiction of harmful ingredients on packaging, pictorial health warnings, and mass media campaigns against smokeless tobacco, stand out as exemplary,” the review said.

According to the Global Adult Tobacco Survey (GATS) 2, conducted in 2016–17, the overall prevalence of tobacco users was 28.6% and smokeless tobacco users was 21.38% in India. The numbers have come down as compared to the earlier survey— GATS 1— that found 34.6% overall tobacco users and 25.9% smokeless tobacco users.

“Additionally, India has implemented policies such as bans on advertisements, prohibition of the use of plastic sachets for packaging, and tobacco use in public places to further discourage consumption, raise awareness, and protect public health from the harmful effects of smokeless tobacco. Notably, some states including Maharashtra, Haryana, Uttar Pradesh, Bihar, Jharkhand, Uttarakhand, Telangana, Nagaland and Assam, in India, have issued orders on the ban of use of smokeless tobacco products and spitting in public places in view of the COVID-19 pandemic,” it added.

Experts, however, have been pointing out that bans related to use of tobacco in the country need to be implement in a more stringent manner as many states are lax in their implementation.

At least 300 million people use smokeless tobacco globally, resulting in significant contribution towards developing tobacco-related diseases and death. For smokeless tobacco control, many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control, which has been instrumental in reducing smoking prevalence.

The use of smokeless tobacco products, which includes pan masala, gutkha and khaini, has been a serious public health concern in India and the region. According to earlier estimates, nearly 80% of the smokeless tobacco products users live in south-east Asia and at least 60% in India.

On the occasion of World Tobacco Day on Wednesday, Poonam Khetrapal Singh, WHO regional director for South-East Asia, said, “…we have success stories from Bangladesh, India, Indonesia, and Sri Lanka, where tobacco growing farmers have successfully shifted over to economically viable alternative crops… I call upon all partners to work collectively to support governments of tobacco growing countries to develop and implement suitable policies and strategies for tobacco farmers to shift to growing food crops that would provide them and their families with a better life culminating in supporting national economies and ensuring food security.”

The Lancet review is the first ever systematic review assessing the global impact of tobacco control policies on smokeless tobacco use. The researchers meticulously examined 11 electronic databases and literature spanning from January 1, 2005, to September 20, 2021. The findings revealed that 57 countries have implemented policies specifically targeting smokeless tobacco, with 17 of them having policies beyond the scope of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC).

The review demonstrates that policy initiatives based on the WHO FCTC have led to reductions in smokeless tobacco prevalence, ranging from 4.4% to 30.3% for taxation and 22.2% to 70.9% for multifaceted policies. Moreover, the implementation of Article 11 (Pictorial health warnings) and Article 13 (Tobacco advertisement, promotion, and sponsorship ban) of the WHO FCTC was found to be widespread.

Experts also emphasized on the need for scaling up tobacco related research.

“Given that 300 million people use it worldwide, emphasis on increasing taxation and better implementation of the existing laws is of paramount importance. While policies on smokeless tobacco prevention and control exist in various countries, there is a lack of comprehensive research and assessment of their impacts, with limited publication in prominent tobacco reports or scientific literature,” said Ravi Mehrotra, co-author, and member, ICMR’s India Cancer Research Consortium.

“The review emphasized the need for continuous updating of guidelines and frameworks to incorporate new evidence on effective smokeless tobacco control measures.”