Tobacco_public health_India PKC.pptx dep

Tud,dependance

1. Tobacco: A Public Health Challenge in India Prabhat Chand MD,DNB Professor of Psychiatry NIMHANS

2. Learning Objectives Epidemiology of Tobacco use Challenges Opportunities

3. Tobacco use In India India is the third largest tobacco producing nation and second largest consumer of tobacco world-wide. Mortality due to tobacco in India is estimated at upwards of 1.3 million (Out of these, one million are attributed to tobacco smoking and the rest to smokeless tobacco use). One feature of tobacco related mortality in India is the high incidence of oral cancer India has the highest burden of both tuberculosis (TB) and Multi- Drug Resistant (MDR) TB based on estimates reported in Global TB Report 2016

4. Global Adult Tobacco Survey: India 2016-17 Of all adults (>15yrs) 28.6% (266.8 million) currently use tobacco (smoked and/or smokeless tobacco) : 42.4% of men, 14.2% of women 10.7% (99.5 million) of all adults currently smoke tobacco : 19.0% of men, 2.0% of women 21.4% (199.4 million) of all adults currently use smokeless tobacco: 29.6% of men, 12.8% of women

5. In last 8years: From GATS-1 (2009-10) to GATS-2 (2016-17) >15 years The number of tobacco users has reduced by about 81 lakh.

6. DISTRIBUTION OF TOBACCO USE IN INDIA GATS 2

7. Most common form of Tobacco K haini is the most commonly used tobacco product and is used by every ninth adult (11.2%). The next most commonly used tobacco product is bidi, smoked by 7.7 percent adult Indians. Gutka ranks third (6.8%) in use and betel quid with tobacco ranks fourth (5.8%).

8. Most common form tobacco Man Khaini: 8.5 crore Bidi: 6.7 crore Gutka: 5.1 crore Woman Betel quid with tobacco: 2.0 crore Tobacco for oral application: 2 crore Khaini: 1.9 crore

9. DISTRIBUTION RURAL VERSUS URBAN

10. ACROSS STATES

11. PREVALENCE OF CURRENT TOBACCO USE (SMOKING AND/OR SMOKELESS) AMONG STATES/UTS

12. PREVALENCE OF CURRENT TOBACCO SMOKING AMONG STATES/UTS, GATS INDIA 2016-17

13. PREVALENCE OF CURRENT TOBACCO SMOKELESS AMONG STATES/UTS, GATS INDIA 2016-17

14. CHALLENGES

15. CHALLENGE 1 : LARGE NUMBER OF USERS

16. Between GATS 1 and GATS 2 There has been a decrease in prevalence of tobacco Prevalence of each of the tobacco products has decreased significantly. Average age of initiation of tobacco use has increased rising from 17.9 years to 18.9 years for smoking and from 17.9 years to 18.8 years for use of smokeless tobacco. One in five daily tobacco users (18%) resort to tobacco use immediately or within five minutes after waking up.

17. CHALLENGE 2: DISCONNECT BETWEEN BELIEF AND PRACTICE

18. QUIT ATTEMPTS AMONG SMOKERS IN PAST 12 MONTH BY AGE GROUP, GATS INDIA, 2009-10 AND 2016-17 

19. Challenge continues When it comes to the impact of tobacco use on one’s own body, the majority of tobacco smokers and smokeless tobacco users feel harm has not been done The lack of obvious symptoms attributable to tobacco does not mean that there are no ill effects on the body One of the challenges of health communication in the coming years is to change this perception

20. CHALLENGE 3- MORE PEOPLE WANT TO QUIT….BUT

21. Most users who are attempting to quit are usually unsuccessful Cigarette smokers (47.4%), bidi smokers (48.7%) and smokeless tobacco users (49.5%) who made a quit attempt in the preceding 12 months were unable to sustain the quit status for even a month. The proportion of smokers and smokeless tobacco users who attempted to quit has remained stagnant and decreased significantly. Significant decrease in the proportion of urban smokers and smokers in the 15-24 year age group who attempted to quit

22. CHALLENGE 4 : PARTICIPATION BY THE HEALTH PROVIDERS STILL SUBOPTIMAL

23. Challenge 5– Variation in tobacco and nicotine content in commonly used tobacco products creates challenges for cessation support

24. Challenge 6 - Larger forces at play Threats from within communities Normalisation of tobacco use Reduction in age of initiation Inadequate attention to the factors responsible for initiation External threats Tobacco as cash Political patronage Circumventing the law (e.g. Gutka ban) Lack of of strong social messaging Lack of alternatives to vulnerable populations Lack of opportunities to quit

25. OTHER ISSUES

26. SECOND HAND SMOKE: EXPOSURE TO SECOND HAND SMOKE AMONG ALL ADULTS IN PAST 30 DAYS AT VARIOUS PLACES, GATS INDIA (09-10 AND 16-17)

27. WARNING ON TOBACCO PRODUCT EFFECTIVE?

28. Opportunities - Mpower Approach Monitor use and prevention policies Monitor Protect people from tobacco smoke Protect Offer help to quit tobacco use Offer Warn about the dangers of tobacco Warn about Enforce bans on tobacco advertising promotion and sponsorship Enforce Raise taxes on tobacco Raise

29. Take home Inclusion in teaching curriculum Wide menu of resources to quit Expanding services in group and community settings Training a range of health professionals in brief counselling Increasing accessibility to medication Extend reach to completely unserviced areas- like prison Tobacco cessation experience will have important lessons for policy and programming for other addictions

30. Further readings Singh A, Ladusingh L. Prevalence and determinants of tobacco use in India: evidence from recent Global Adult Tobacco Survey data. PloS one. 2014 Dec 4;9(12):e114073. Grover S, Anand T, Kishore J, Tripathy JP, Sinha DN. Tobacco use among the youth in india: evidence from global adult tobacco survey-2 (2016-2017). Tobacco Use Insights. 2020 Jun;13:1179173X20927397. World Health Organization. WHO framework convention on tobacco control. WHO Regional Office for South-East Asia; 2004.