Interview: Anti-tobacco cell and the fight against tobacco use.

DTSA:Dr.Jagannath ,what is the role of anti-tobacco branch in tobacco control and cessation?
Dr.Jagannath: State Anti Tobacco Cell, Department of Health & Family Welfare, Government of Karnataka was established in the year 2004 with a goal to reduce tobacco use by the people of our State and eventually reducing morbidity and mortality rates due to tobacco related diseases.
The role of State Anti Tobacco Cell is to implement National Tobacco Control Programme which was launched during the year 2007-08. The key activities of this Programme are as follows:
• Training of key stakeholders.
• School tobacco control programmes.
• Enforcing Tobacco control laws.
• Information Education Communication (IEC)
• Establishment of Tobacco Cessation Centres.

Tobacco Cessation Centres (TCC) will be established in all the District Hospitals of the State (in a phased manner) run by the Health department. The key activities of the TCC is to identify and register tobacco users at the TCC and provide assistance to quit tobacco use by providing professional counseling and prescription of nicotine replacement therapy for the needy patients. The TCC will have a psychologist on a full time basis to provide counseling services.

What according to you is the current status of this tobacco menace in our country?
India is the third largest producer and second largest consumer of tobacco in the World. Every year, nearly 10 lakh people die due to tobacco related diseases which is more than the deaths due to tuberculosis, HIV/AIDS and malaria combined together. India is home to more than 90% of the World’s oral cancer cases. According to Global Adult Tobacco Survey 2009-10, nearly 35% of the adults aged 15 years and above use tobacco in one or the other form in India. Of this 48% are males and 20% are females. About 26% of Indian adults use smokeless form and 14% use smoking forms of tobacco.
The total economic costs attributable to tobacco use from all diseases in India in the year 2011 for persons aged 35-69 amounted to nearly Rs 1,04,500 crores of which 16 % s direct cost and 84% was indirect cost.

What challenges do you face in implementing tobacco cessation protocols?
Tobacco Cessation is a novel concept in India unlike drug and alcohol deaddiction services. The challenges faced by the Health Systems in implementing Tobacco cessation services is low level of awareness among health professionals regarding the tobacco cessation protocol. Owing to the less number of tobacco cessation centres in India, there is a huge gap between demand and supply chain. Further to this, the quit rates are very low (just about 5-10%) among the cessation users by means of counseling and may increase up to 30% when counseling is coupled with Nicotine Replacement Therapy (NRT). NRT is time-consuming and is largely unaffordable by most of the Indian population. As a result, drop-out rates are high in tobacco cessation. Due to the availability of myriad varieties of tobacco products in India, chewing tobacco users are more likely to get accustomed to nicotine chewing gums than tobacco smokers due to the consumption patterns. All the above factors have made tobacco cessation services a challenge in implementation of the programme.

The world no tobacco day is observed on the 31st of May every year. What is the theme this year?
Every year, World No Tobacco Day is observed on 31st of May. The theme for this year is “Get ready for plain packaging”. Plain tobacco packaging, also known as generic, standardised or homogeneous packaging, refers to packaging that requires the removal of all branding (colours, imagery, corporate logos and trademarks), permitting manufacturers to print only the brand name in a mandated size, font and place on the pack, in addition to the health warnings and any other legally mandated information such as toxic constituents and tax-paid stamps. The appearance of all tobacco packs is standardised, including the colour of the pack.

The tobacco industry in India was quite vocal in displaying their displeasure over pictures on packaging. In what way do pictures on packaging help your cause?
Plain packaging is a demand reduction measure that serves several purposes, including:

a.Reducing the attractiveness of tobacco products.

b.Eliminating the effects of tobacco packaging as a form of advertising and promotion.

c,Addressing package design techniques that may suggest that some products are less harmful than others.

d.Increasing the noticeability and effectiveness of health warnings?

What is the scenario in other countries?
In 1989, the New Zealand Department of Health’s Toxic Substances Board first recommended that cigarettes be sold only in white packs with black text and no colours or logos. Public health officials in Canada developed proposals for plain packaging of tobacco products in the 1990s. A parliamentary committee reviewed the evidence and concluded that plain packaging could be a “reasonable step in the overall strategy to reduce tobacco consumption”.The committee recommended that legislation be implemented pending the outcome of government-sponsored research on the likely effectiveness of plain packs. However following tobacco industry lobbying and changes in government ministers the proposal was dropped. Australia, with the enactment of the Tobacco Plain Packaging Act in 2011, became the first country in the world to require tobacco products to be sold in plain packaging. Products manufactured since October 2012, and all on sale since 1 December 2012 must be plain packaged. In June 2014 Ireland announced it was proposing legislation that would make it the first country in the European Union and the second in the world to introduce plain packaging.

Do you counsel people on tobacco cessation? What is the one advice you wish to give to all smokers?
We know quitting isn’t easy. Truth is, the average smoker attempts to quit smoking between 8 and 11 times before ultimately quitting for good. Many are left feeling like smoking is an addiction they cannot overcome. But with the right help, resources, and the support to keep you going, you will have the best chance to quit smoking for good.
Having a quit plan ready is key to quitting successfully. While the road to becoming tobacco-free is not always smooth, being prepared for the bumps along the way will help you stay on course, avoid triggers and overcome nicotine cravings.
And while quitting is hard, it is possible. Here are some quick quit tips to help you become one of them:
• Drink lots of water. Make sure your fridge is always stacked and that you take water with you when you’re on-the-go.
• Have gum or mints handy for when cravings kick in.
• Get your teeth cleaned and/or whitened.
• Avoid caffeinated beverages like coffee and soda, and avoid alcoholic drinks.
• Enjoy healthy snacks like carrots and celery, fruits, and sugar-free snacks.
• Keep your hands and mouth occupied with cinnamon sticks, toothpicks or straws.
• Wash or dry-clean your clothes and have your car cleaned inside and out to get rid of the smell of cigarettes.
• Have the carpet, draperies, bed sheets and other fabrics inside your home cleaned and deodorized to remove the lingering smell of cigarette smoke.
• For some time, try to stay away from places where there will be smoking: like bars, nightclubs and the outdoor areas of restaurants that allow smoking.
• Become physically active, whether it’s at a gym, with friends or on your own. Something as simple and easy as walking will help.
• Decide to quit tobacco- Set a quit date (within 2 weeks)- Consult a dentist/physician.

Tobacco consumption and oral health. How grim is the situation in India?
Tobacco use is a primary cause of many oral diseases and adverse oral conditions. Tobacco-induced diseases include particularly cancer of the oral cavity (mostly of the tongue, but also lips), periodontal disease, tooth loss and congenital defects. These oral diseases contribute significantly to the global disease burden. Oral cancer is the eleventh most common cancer worldwide and tobacco use is estimated to account for about 41% of oral/pharyngeal cancer cases in men, and 11% in women. Severe periodontitis which may result in tooth loss is found in 10-15% of adult populations worldwide. Oral cancer is the most common cancer in India; as 4 in 10 of all cancers are oral cancers. Annually 130,000 people succumb to oral cancer in India which translates into approximately 14 deaths per hour. The reason for high prevalence of oral cancer in India is primarily because tobacco is consumed in the form of gutka, quid, snuff or misri. Rising tobacco use in India, where 40 per cent of the world's smokers live has contributed to this trend. India is home to more than 90% of the World’s oral cancer cases.

What activities has the Anti tobacco cell planned for this year?
State Anti Tobacco Cell is expanding in 16 Districts of Karnataka under the aegis of National Health Mission. Resources in terms of manpower, funding, tobacco cessation services, enforcement, training, etc will be strengthened predominantly in the North Karnataka Districts where prevalence of tobacco use is comparatively higher than other Districts.