Gender & tobaccoGender & tobacco

Dr Sheelu SrinivasDr Sheelu SrinivasConsultant ENT Surgeon & Dept co ordinaterConsultant ENT Surgeon & Dept co ordinater

Fortis Hospital, Bannerghetta roadFortis Hospital, Bannerghetta road

History of TobaccoHistory of Tobacco

Tobacco cultivation has a history of Tobacco cultivation has a history of about 8000 years.about 8000 years.

Europeans were introduced to tobacco Europeans were introduced to tobacco when Columbus landed in America in when Columbus landed in America in 1492.1492.

Portuguese traders introduced tobacco Portuguese traders introduced tobacco in India during 1600. Tobacco became a in India during 1600. Tobacco became a valuable commodity in barter trade and valuable commodity in barter trade and its use spread rapidly.its use spread rapidly.

Gradually tobacco got assimilated into Gradually tobacco got assimilated into the cultural rituals and social fabric due the cultural rituals and social fabric due to presumed medicinal and actually to presumed medicinal and actually addictive properties attributed to it.addictive properties attributed to it.

Facts about nicotineFacts about nicotine

plant nicotiana tabacumplant nicotiana tabacum When tobacco is smoked, nicotine is When tobacco is smoked, nicotine is

absorbed by the lungs and quickly moved absorbed by the lungs and quickly moved into the bloodstream, where it is circulated into the bloodstream, where it is circulated throughout the brain throughout the brain

In fact, nicotine reaches the brain within 8 In fact, nicotine reaches the brain within 8 seconds after someone inhales tobacco seconds after someone inhales tobacco smoke. Nicotine can also enter the smoke. Nicotine can also enter the bloodstream through the mucous bloodstream through the mucous membranes that line the mouth (if tobacco membranes that line the mouth (if tobacco is chewed) or nose (if snuff is used), and is chewed) or nose (if snuff is used), and even through the skin. even through the skin.

Effects on various organsEffects on various organs HeartHeart Lung Lung BrainBrainnicotine gets into the brain, it attaches to nicotine gets into the brain, it attaches to

acetylcholine receptors and mimics the actions of acetylcholine receptors and mimics the actions of acetylcholine. acetylcholine.

Acetylcholine and its receptors are involved in many Acetylcholine and its receptors are involved in many functions, including muscle movement, breathing, functions, including muscle movement, breathing, heart rate, learning, and memory. heart rate, learning, and memory.

nicotine raises the levels of a neurotransmitter nicotine raises the levels of a neurotransmitter called dopamine in the parts of the brain that called dopamine in the parts of the brain that produce feelings of pleasure and reward produce feelings of pleasure and reward

How cancer?How cancer?

Tobacco smoke contains chemicals Tobacco smoke contains chemicals that are harmful to both smokers and that are harmful to both smokers and nonsmokers nonsmokers

Over 4000 chemicals ,250 have been Over 4000 chemicals ,250 have been found to be harmfulfound to be harmful

Toxic chemicals found in tobacco Toxic chemicals found in tobacco smokesmoke

hydrogen cyanide (used in chemical hydrogen cyanide (used in chemical weapons), carbon monoxide (found weapons), carbon monoxide (found in car exhaust), in car exhaust), formaldehydeformaldehyde (used (used as an embalming fluid), ammonia as an embalming fluid), ammonia (used in household cleaners), and (used in household cleaners), and toluene (found in paint thinners). toluene (found in paint thinners).

Cancer causing chemicals in Cancer causing chemicals in tobaccotobacco

arsenicarsenic (a heavy metal (a heavy metal toxintoxin) ) benzenebenzene (a chemical found in gasoline) (a chemical found in gasoline) beryllium (a toxic metal) beryllium (a toxic metal) cadmiumcadmium (a metal used in batteries) (a metal used in batteries) chromium (a metallic element) chromium (a metallic element) ethylene oxide (a chemical used to sterilize ethylene oxide (a chemical used to sterilize

medical devices) medical devices) nickel (a metallic element) nickel (a metallic element) polonium-210 (a chemical element that gives off polonium-210 (a chemical element that gives off

radiationradiation) ) vinyl chloridevinyl chloride (a toxic substance used in plastics (a toxic substance used in plastics

manufacture) manufacture)

The Health Effects of Smoking The Health Effects of Smoking Airway irritabilityAirway irritability Increased phlegm productionIncreased phlegm production Persistent coughPersistent cough Decreased physical performanceDecreased physical performance Increase in LDLs or “bad fat”Increase in LDLs or “bad fat” Plaque on the artery wallPlaque on the artery wall Thrombosis, or clot, inside a blood vesselThrombosis, or clot, inside a blood vessel Constriction of blood vesselsConstriction of blood vessels Increased heart rateIncreased heart rate Increased blood pressureIncreased blood pressure Heartburn and reflux diseaseHeartburn and reflux disease Peptic ulcers Peptic ulcers Periodontal diseases Periodontal diseases Halitosis, or bad breathHalitosis, or bad breath Inflammation of the middle earInflammation of the middle ear SinusitisSinusitis Congestion Congestion Pneumonia Pneumonia Scurvy and other micronutrient disorders Scurvy and other micronutrient disorders Oxidative damageOxidative damage Drug interactionsDrug interactions

LONG TERM EFFECTSLONG TERM EFFECTS Earlier menopauseEarlier menopause Increased risk of having stillborn or premature infants or infants with low birth weight Increased risk of having stillborn or premature infants or infants with low birth weight

and children with conduct disordersand children with conduct disorders Increased probability that female children will smoke and will persist in smokingIncreased probability that female children will smoke and will persist in smoking Decreased physical performanceDecreased physical performance ImpotenceImpotence Premature hair lossPremature hair loss Increased wrinkles and crow’s feetIncreased wrinkles and crow’s feet Chronic coughingChronic coughing Hearing lossHearing loss Vision problems and lossVision problems and loss Gum diseaseGum disease OsteoporosisOsteoporosis Delayed healing process Delayed healing process Susceptibility to coldsSusceptibility to colds

and fluand flu Increased headachesIncreased headaches Increased stressIncreased stress

Why women?Why women? World over there is some decrease in World over there is some decrease in

menmen Tobacco companies need new Tobacco companies need new

customers & targeting womencustomers & targeting women Because of reproductive roleBecause of reproductive role Role in family :secondary smoke or Role in family :secondary smoke or

educating childreneducating children

Women & tobaccoWomen & tobacco

Female addiction may be reinforced more by the Female addiction may be reinforced more by the sensory and social context of smoking, rather than sensory and social context of smoking, rather than by nicotine, suggesting that patches may not be so by nicotine, suggesting that patches may not be so effective an aid.effective an aid.

Women quit less easily than men due to their Women quit less easily than men due to their different responses to nicotine as well as a lack of different responses to nicotine as well as a lack of social support, fear of weight gain, depression and social support, fear of weight gain, depression and hormones.hormones.

Relapse rates in women are higher, and it may take Relapse rates in women are higher, and it may take a number of attempts before the achieve success.a number of attempts before the achieve success.

““You’ve Come a Long Way, Baby!” You’ve Come a Long Way, Baby!”

Smoking is portrayed as a manly habit linked to Smoking is portrayed as a manly habit linked to happiness, fitness, wealth, power and sexual happiness, fitness, wealth, power and sexual success, success,

The tobacco industry deliberately targets women The tobacco industry deliberately targets women with new products and glamorous, sexy, and with new products and glamorous, sexy, and independent themed advertising.independent themed advertising.

Tobacco is promoted to women as a buffer for Tobacco is promoted to women as a buffer for negative feelings, a time-out from stress, and as negative feelings, a time-out from stress, and as way to control weight.way to control weight.

Tobacco use among women in Tobacco use among women in IndiaIndia

Smokeless & Smokeless & SmokingSmoking

TobaccoTobacco Toll in IndiaToll in India

700, 000 deaths per year due to smoking700, 000 deaths per year due to smoking

800, 000 to 900, 000 per year due to all 800, 000 to 900, 000 per year due to all

forms of tobacco use/ exposureforms of tobacco use/ exposure

Fastest trajectory of rise in tobacco related Fastest trajectory of rise in tobacco related

deaths forecast for the next 20 yearsdeaths forecast for the next 20 years

Many of the deaths (>50%) occur below 70 Many of the deaths (>50%) occur below 70

years of ageyears of age

Prevalence of Tobacco UsePrevalence of Tobacco Use

Tobacco use prevalence : 46.5% males and 13.8% females (1998 -Tobacco use prevalence : 46.5% males and 13.8% females (1998 -1999)1999) National Family Health Survey-2 National Family Health Survey-2

55.8% of males currently use tobacco (12 - 60 years of age) National55.8% of males currently use tobacco (12 - 60 years of age) National Household Survey of Drug and Alcohol Abuse, 2002Household Survey of Drug and Alcohol Abuse, 2002

Tobacco use prevalence Tobacco use prevalence among males is higher compared to among males is higher compared to femalesfemales and among older age groups compared to the younger age and among older age groups compared to the younger age groups.groups.

The prevalence of The prevalence of tobacco use tobacco use is higher in rural populationis higher in rural population compared to that in urban areas.compared to that in urban areas.

India has a huge problem of India has a huge problem of widespread widespread smokeless tobacco use smokeless tobacco use among womenamong women, particularly among disadvantaged women., particularly among disadvantaged women.

The prevalence of tobacco use in pregnant women is similar to that in The prevalence of tobacco use in pregnant women is similar to that in non-pregnant women of the same age.non-pregnant women of the same age.

Tobacco related risks higher in womenTobacco related risks higher in women

In a study in the three centers of Bangalore, Chennai and In a study in the three centers of Bangalore, Chennai and

Thiruvanthapuram Thiruvanthapuram

women who chewed pan-tobacco, has a 46 times higher risk than those women who had never chewed women who chewed pan-tobacco, has a 46 times higher risk than those women who had never chewed

it (RR = 45.9)it (RR = 45.9)

- Men in this study had a 6 fold greater risk of oral cancer if they were pan-tobacco users than Men in this study had a 6 fold greater risk of oral cancer if they were pan-tobacco users than

never users (risk adjusted for smoking)never users (risk adjusted for smoking)

Balaram P, et al. International Journal of Cancer, Balaram P, et al. International Journal of Cancer, 20022002

World over incidences of lung cancer in women is on raise. has already World over incidences of lung cancer in women is on raise. has already surpassed breast cancersurpassed breast cancer

Easy to Start, Hard to Quit Easy to Start, Hard to Quit

withdrawal symptoms :restlessness, withdrawal symptoms :restlessness, hunger, depression, headaches, and hunger, depression, headaches, and other uncomfortable feelings. other uncomfortable feelings.

Indian Law- At a GlanceIndian Law- At a Glance

Key Provision of cigarettes and other tobacco product Key Provision of cigarettes and other tobacco product Act, 2003Act, 2003

Ban on smoking in public placesBan on smoking in public places Ban on direct and indirect advertising of tobacco Ban on direct and indirect advertising of tobacco

productsproducts- Point-of-sale advertising is permittedPoint-of-sale advertising is permitted

Ban on sales to minorsBan on sales to minors- Tobacco products cannot be sold to children <18 yearsTobacco products cannot be sold to children <18 years

- Tobacco products cannot be sold within a radius of 100 yards of Tobacco products cannot be sold within a radius of 100 yards of educational institutionseducational institutions

Pictorial health warningsPictorial health warnings English and one or more other Indian languages to be English and one or more other Indian languages to be

used for health warnings on tobacco packsused for health warnings on tobacco packs Testing and Regulation: Ingredients to be declared on Testing and Regulation: Ingredients to be declared on

tobacco product packages (Tar and Nicotine)tobacco product packages (Tar and Nicotine)

Several legislations have been enacted to protect the beedi workers as Several legislations have been enacted to protect the beedi workers as

they belong to the vulnerable section of society and work in adverse they belong to the vulnerable section of society and work in adverse

work and health conditionswork and health conditions Bonded labour system (Abolition) Act, 1976:Bonded labour system (Abolition) Act, 1976: aims to abolish the bonded labor aims to abolish the bonded labor

system to protect children and other workers to become forced labor in case of system to protect children and other workers to become forced labor in case of

inability to repay a loan.inability to repay a loan.

The child labour (Prohibition and Regulation) Act, 1986:The child labour (Prohibition and Regulation) Act, 1986: aims to stop the aims to stop the

exploitation of children involved in beedi rolling. exploitation of children involved in beedi rolling.

Minimum Wages Act, 1948:Minimum Wages Act, 1948: aims to fix minimum rates of wages in industry and aims to fix minimum rates of wages in industry and

trade where labour organizations are non-existent or ineffective.trade where labour organizations are non-existent or ineffective.

The beedi and cigar workers (Condition of Employment) Act, 1966:The beedi and cigar workers (Condition of Employment) Act, 1966: aims to aims to

regulate the conditions of service of the beedi workers.regulate the conditions of service of the beedi workers.

Beedi workers welfare fund Act, 1976:Beedi workers welfare fund Act, 1976: aims to provide for welfare schemes for aims to provide for welfare schemes for

the beedi workers and their families, related to health, education, maternity benefits, the beedi workers and their families, related to health, education, maternity benefits,

group insurance, recreation, housing assistance etc.group insurance, recreation, housing assistance etc.

The beedi workers welfare cess (Amendment) Act, 1976:The beedi workers welfare cess (Amendment) Act, 1976: aims to improve aims to improve

living conditions and provide welfare measures to beedi workers. This cess collected living conditions and provide welfare measures to beedi workers. This cess collected

by way of excise duty on manufactured beedis contributes to BWWF.by way of excise duty on manufactured beedis contributes to BWWF.

Policies Related to Protection of Policies Related to Protection of LabourLabour

Implementation : Barriers to be OvercomeImplementation : Barriers to be Overcome

Untrained and uncoordinated Untrained and uncoordinated

enforcement machineryenforcement machinery

Inadequately educated communityInadequately educated community

Lack of awareness of rules among Lack of awareness of rules among

relevant group (e.g., restaurant relevant group (e.g., restaurant

managers) managers)

Tobacco industry tacticsTobacco industry tactics

FCTC Ratification in IndiaFCTC Ratification in India India signed FCTC : India signed FCTC : 1010thth Sep 2003 Sep 2003 India ratified FCTC: India ratified FCTC: 55thth Feb 2004 Feb 2004 India was the India was the 88thth country to ratify the FCTC country to ratify the FCTC Central ( Union) Government is the authority to enter Central ( Union) Government is the authority to enter

into international treaties and subsequently ensure their into international treaties and subsequently ensure their implementation.implementation.

FCTC was ratified by India after Cabinet approval. FCTC was ratified by India after Cabinet approval.

Each Party (ratifying country) of FCTC to ensure that its Each Party (ratifying country) of FCTC to ensure that its

national law is in conformity with its treaty obligationsnational law is in conformity with its treaty obligations

Indian Tobacco Control Act (2003) enacted in April- May Indian Tobacco Control Act (2003) enacted in April- May

20032003

Most of the provisions in this Act are very similar to the Most of the provisions in this Act are very similar to the

FCTC’s articlesFCTC’s articles

FCTC Implementation in IndiaFCTC Implementation in India

The Indian Act enactment preceded the adoption and enforcement of The Indian Act enactment preceded the adoption and enforcement of

the FCTCthe FCTC

Indian Legislation needs to be upscaled to comply with the provisions Indian Legislation needs to be upscaled to comply with the provisions

of FCTCof FCTC

- Tax and price measures to be implemented to reduce tobacco consumptionTax and price measures to be implemented to reduce tobacco consumption

- Duty free sales to be tackled by Ministry of FinanceDuty free sales to be tackled by Ministry of Finance

- Prohibiting use of misleading terms to label tobacco productsProhibiting use of misleading terms to label tobacco products

- Mobilize stakeholders, engage civil society to promote and strengthen Mobilize stakeholders, engage civil society to promote and strengthen

education, communication, training and public awareness on tobacco education, communication, training and public awareness on tobacco

control issuescontrol issues

- Promote effective measure for tobacco use cessationPromote effective measure for tobacco use cessation

- Elimination of all forms of illicit trade in tobacco products including Elimination of all forms of illicit trade in tobacco products including

smuggling, illicit manufacturing and counterfeitingsmuggling, illicit manufacturing and counterfeiting

- Sale to and Sale to and byby minors minors

- Curb cross-border advertisingCurb cross-border advertising

- Promote economically viable alternatives for tobacco workers, growers and Promote economically viable alternatives for tobacco workers, growers and

individual sellers (as appropriate)individual sellers (as appropriate)

A Report on Tobacco Control in A Report on Tobacco Control in IndiaIndia

India’s first comprehensive scientific India’s first comprehensive scientific

and advocacy tool on tobacco control and advocacy tool on tobacco control

Government of India commissioned Government of India commissioned

HRIDAY (Dr. K. Srinath Reddy) and HRIDAY (Dr. K. Srinath Reddy) and

Tata Memorial Hospital/ Healis - Tata Memorial Hospital/ Healis -

Sekhsaria Institute of Public Health Sekhsaria Institute of Public Health

(Dr. P.C. Gupta) to jointly produce (Dr. P.C. Gupta) to jointly produce

and edit this report.and edit this report.

The Report explicitly discussed FCTC The Report explicitly discussed FCTC

and delineated its implications for and delineated its implications for

India. India.

The Report was released on The Report was released on

November 25, 2004 in DelhiNovember 25, 2004 in Delhi

Proposed Indian Health Warning on Gutkha Packs

Packaging and Labelling of Tobacco Products

Proposed Indian Health Warning on Cigarette and Bidi

Packs

Proposed Indian Health Warning on Cigarette Pack

Core Programme ClustersCore Programme Clusters

Non-communicable Diseases and Mental Health Non-communicable Diseases and Mental Health Tobacco Free InitiativeTobacco Free Initiative

  

Tobacco Cessation Centre, NIMHANS, BangaloreTobacco Cessation Centre, NIMHANS, Bangalore

Manual for General Public – Manual for General Public – “Do You Know…”“Do You Know…”          EnglishEnglish

          KannadaKannada  

Patient's Manual – Patient's Manual – Tobacco Use: A Smart GuideTobacco Use: A Smart Guide          EnglishEnglish

          KannadaKannada  

  

  

                                                                                        

DE ADDICTIONDE ADDICTION

NICOTINE REPLACEMENT THERAPYNICOTINE REPLACEMENT THERAPY BUPROPIONBUPROPION COUNCELLINGCOUNCELLING

Tobacco is the only legal Tobacco is the only legal consumer product that kills consumer product that kills

when used exactly aswhen used exactly asindicated by the manufacturer.indicated by the manufacturer.

THANK YOUTHANK YOU