National Tobacco Control Programme.pptx

According to a Lancet study (2012), in India, tobacco-related cancers represented 42·0% of male and 18·3% of female cancer deaths
India also has one of the highest rates of oral cancer in the world as the consequence of high prevalence of smokeless tobacco use

1. NATIONAL TOBACCO CONTROL PROGRAMME DR.NEELAM AHIRWAR DNBSS RESIDENT (SURGICAL ONCOLOGY) APOLLO CBCC

2. Introduction India is second to China in terms of number of smokers aged 15 or above accounting for 106 million of the world's 1.1 billion smokers 9 million adolescents (13-15 years) used tobacco in South-east Asia- sizeable portion in India According to the Global Adult Tobacco Survey-2 (GATS-2), 2016-17, 28.6% adults use tobacco (smoke or smokeless tobacco)

3. Introduction 19 % of men and 2% of women smoke tobacco. 6% of men and 12.8% women use smokeless tobacco India has the largest number of Smokeless Tobacco users in the world- accounts for 66% of world’s smokeless tobacco users Prevalence of tobacco use decreased by 6% from 2009-10 to 2016-17 Projection: Prevalence to further drop to 8.5% by 2025

4. Issues - Health According to a Lancet study (2012), in India, tobacco-related cancers represented 42·0% of male and 18·3% of female cancer deaths India also has one of the highest rates of oral cancer in the world as the consequence of high prevalence of smokeless tobacco use Tobacco use also leads to cardiovascular diseases and chronic obstructive pulmonary diseases Significant relation is also seen between passive or active exposure to tobacco smoke and tuberculosis infection

5. Issues - Health GATS 2 report shows that 39% of adults in India are exposed to second-hand smoking (SHS). High health Expenditure- Direct medical cost, indirect morbidity cost, productivity loss due to premature mortality

6. Issues Economy Economic burden of tobacco-related diseases in India', tobacco-related disease was over INR 1, 04,500 crores (1.16% of GDP) for the year 2011, just among adults aged between 35 and 69. Environment Tobacco cultivation and the curing process contribute towards deforestation, soil depletion, loss of soil nutrients and pollution due to the heavy use of agrochemicals.

7. Issues Toxic waste Cigarette and bidi butts are non-biodegradable. Cigarette filters are made of cellulose acetate (a form of plastic) which is resistant to biodegradation and can persist in the environment for a very long time. Further, the butts contain toxic substances which contaminate the environment with heavy metals and poisonous chemicals like nitrosamines, polycyclic aromatic hydrocarbons, nicotine

8. Issues Society Affects household welfare Expenses incurred in tobacco use substitute the basic needs of food and education among disadvantaged population-lower socio-economic group Adverse effects on children and adolescents

9. WHO FCTC (The Framework Convention on Tobacco Control) M ost important global initiative for tobacco control GOI ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2004, the first ever international public health treaty focusing on the global public health issue of tobacco control.

10. MPOWER Technical assistance package by WHO six evidence-based tobacco demand reduction measures contained in the FCTC

11. National Tobacco Control Programme (NTCP) The Ministry of Health and Family Welfare launched the pilot phase of the National Tobacco Control Programme in 2007-08 in 9 states of the country covering 18 districts. In 2008, it has been upscaled to 42 districts across 21 states C urrently , the Programme is being implemented in all 36 States/Union Territories covering over 600 districts across the country

12. The National Tobacco Control Cell (NTCC ) R esponsible for overall policy formulation, planning, implementation, monitoring and evaluation of the different activities envisaged under the National Tobacco Control Programme (NTCP). F unctions under the direct guidance and supervision of the programme in-charge from the MoHFW i.e. Joint Secretary

13. Aim To bring greater awareness about the harmful effects of tobacco use and about the Tobacco Control Laws To facilitate effective implementation of the Tobacco Control Laws Reduce the production and supply of tobacco products . Helps the people quit tobacco use through Tobacco Cessation Centers Training of health and social workers, NGOs, school teachers Information, education, and communication (IEC) activities

14. Aim National level mass awareness campaigns Establishment of tobacco product testing labs Monitoring and evaluation, including Adult Tobacco Survey (ATS) Setting up of National Regulatory Authority Coordination with Panchayati Raj Institutions for village level activities

15. Manuals and guides by NTCP Manual on Tobacco Control in Schools National Tobacco Control Programme -Health Worker Guide Training Manual for Doctors Tobacco Dependence Treatment Guidelines E stablishment of Tobacco Cessation Centers in Dental Institutes-An Integrated Approach in India-Operational Guidelines 2018 Operational Guidelines for National Tobacco Testing Laboratories ( NTTL)

16. Structure ( i ) National Tobacco Control Cell (NTCC) at Central level ( ii) State Tobacco Control Cell (STCC) at State level ( iii) District Tobacco Control Cell (DTCC) at District level. There is also a provision of setting up Tobacco Cessation Services at District level

17. National level Public awareness/mass media campaigns for awareness building and behavioural change Establishment of tobacco product testing laboratories. Mainstreaming research and training on alternative crops and livelihood with other nodal Ministries. Monitoring and evaluation including surveillance Integrating NTCP as a part of health-care delivery mechanism under the National Health Mission framework.

18. State Level Dedicated State Tobacco Control Cells Refresher training of the DTCC staff. Training on tobacco cessation for Health care providers. Law enforcers training / sensitization Programme

19. District Level Dedicated District Tobacco Control Cells Training of Key stakeholders: health and social workers, NGOs, school teachers, enforcement officers etc. Information, Education and Communication (IEC) activities. School Programmes Monitoring tobacco control laws.

20. District Level Setting-up and strengthening of cessation facilities including provision of pharmacological treatment facilities at the district level. Co-ordination with Panchayati Raj Institutions for inculcating concept of tobacco control at the grassroots.

21. Tobacco Control in India Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 ( COTPA 2003 ) Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations,1st August 2011 , tobacco and nicotine shall not be used as ingredients in any food products, Gutkha is banned Section-77 of the Juvenile Justice (Care and Protection of Children) Act, 2015

22. Tobacco Control in India The Prohibition of Electronic Cigarettes (production, manufacture, import, export, transport, sale, distribution, storage and advertisement) Ordinance, 2019  Cable Television Networks Amendment Act of 2000 - Prohibited the transmission of advertisements on tobacco and liquor in India Prevention and Control of Pollution Act of 1981- smoking as an air pollutant

23. COTPA 2003 ( MoHFW ) applicable to all products containing tobacco in any form i.e. Cigarettes, Cigars , bidis, gutka , pan masala, khaini , mawa , mishri , snuff

24. Main provisions of the COTPA Prohibition of smoking in public places Prohibition of advertisement, sponsorship and promotion of tobacco products Prohibition on sale to minors section( less than 18 yrs ) Prohibition of sale of tobacco products near educational institutions Regulation of health warning in tobacco products packs Regulation of tar and nicotine contents of tobacco products . Pictorial health warnings also to be included.

25. Health warnings

26. Prohibition of smoking in public places An offence punishable with fine up to Rs . 500 and is compoundable . Display of board in public place

27. P rohibition on sale of tobacco products near educational institutions section 6(b) sale of the same is prohibited in an area within radius of 100 yards of any educational institution

28. An advertisement includes any visible representation (notice , circular, label, wrapper) All forms of audio, visual and print media Both direct & indirect advertisements are prohibited. Total ban on sponsoring of any sport/cultural events by cigarette and other tobacco product companies. Prohibition of advertisement of all tobacco products(section 5)

29. Prohibition of advertisement of all tobacco products(section 5) No trade mark or brand name of cigarettes or any tobacco product can be promoted in exchange for sponsorship, gift,prize or scholarship Offence punishable with maximum of 2 years of imprisonment fine up to Rs . 1000. In subsequent offence, imprisonment up to 5 years and with fine up to Rs . 5000

30. Provisions of the COTPA CREATION OF SMOKING AREAS - hotels having 30 rooms, restaurants having seating capacity of 30 persons and in airports. Board at point of sale of tobacco products- Size of board used for advertisement for tobacco products shall not exceed 90 cms by 60 cms shall contain warning “Tobacco causes cancer ” or “Tobacco kills” occupying 25% of top area of board.

31. mTobacco Cessation program GOI launched mCessation using text messages in 2016 as part of the government’s   Digital India Initiative allows people who want to quit tobacco use to register by giving a missed call to a dedicated national number progress is monitored in real-time  N ational toll-free quit line uses two-way messaging between the individual seeking to quit tobacco use and programme specialists providing them dynamic support.

32. mTobacco Cessation program TO QUIT TOBACCO, CALL 1800 112 356 (TOLL FREE) OR GIVE A MISSED CALL AT 011-22901701

33. mTobacco Cessation program recently released  version-2  of the “mTobaccoCessation” platform, which can deliver content through SMS or interactive voice response in 12 languages . average quitting rate of 7 per cent for both smokers and users of smokeless tobacco six months after enrollment.

34. Tobacco taxation According to WHO Report on the Global Tobacco Epidemic 2017, cigarette taxes in India are amongst the highest in the world Cigarettes are subjected to high and discriminatory rates of taxation , As of 2014-15 Government collected 87% of its total tobacco revenue from legal cigarettes India has banned foreign direct investment in cigarette manufacturing

35. Alternate crop cultivation The main tobacco producing states include Andhra Pradesh, Telangana, Chhattisgarh, Madhya Pradesh, Assam, West Bengal, Bihar, Uttar Pradesh & Gujarat provides employment to around 36 million people Domestic tobacco industry also contributes nearly Rs.8000 crore to government through indirect and direct taxes The union government is actively pursuing with states like Andhra Pradesh and Karnataka, major growers of tobacco, to chalk out plans to help farmers

36. Alternate crop cultivation The Rajahmundry-based Central Tobacco Research Institute suggested alternative crops like black pepper, sugarcane and maize Federation of All-India Farmers’ Association (FAIFA) is working in coordination with government to draft a “well-balanced’’ tobacco control policy.

37. ENDS Battery-operated devices that produce  aerosol by heating a solution containing nicotine , which is the addictive substance in combustible cigarettes. These include  all forms of Electronic Nicotine Delivery Systems, Heat Not Burn Products, e-Hookah and the like devices .  

38. The Prohibition of Electronic Cigarettes (production, manufacture, import, export, transport, sale, distribution, storage and advertisement) Ordinance, 2019 punishable with an imprisonment of up to one year or fine up to Rs . 1 lakh or both for the first offence; and imprisonment of up to three years and fine up to Rs . 5 lakh for a subsequent offence

39. Impact Global Adult Tobacco Survey India (GATS 1) 2009-2010 ,covered 69,296 adults, comprising,33,767 males and 35,529 females . GATS 2- 2016-17 Tata Institute of Social Sciences, Mumbai - agency for carrying out the GATS2 The technical assistance for GATS 2 was provided by the U.S. Centers for Disease Control and Prevention (CDC ), the World Health Organization (WHO)

40. GATS2 28.6 percent(266.8 million) of adults in India aged15 and above currently use tobacco men was 42.4 percent, women it was 14.2 percent Every third adult (32.5%) from rural areas and every fifth adult (21.2%) from urban 64.5 percent in Tripura to 9.7 percent in Goa. khaini - a tobacco, lime mixture- is the most commonly used bidi, smoked by 7.7 percent of adult Indians gutka - a tobacco, lime,areca nut mixture- ranks the third (6.8%)

41. The current levels of tobacco use are still very high across the nation which calls for sustained efforts at all levels. The strict enforcement of COTPA2003, enhanced implementation of National Tobacco Control Programme and WHO FCTC will definitely lead to acceleration of existing efforts for prevention and control of tobacco and achievement of the global targets

42. Thankyou