International Classification of Diseases (ICD-10) has notified tobacco dependence as a disease. The International Agency for Research on Cancer of the World Health Organization has categorized tobacco as a category I carcinogen (confirmed human carcinogen). Tobacco usage is strongly associated with several lethal diseases and numerous chronic disabilities. Tobacco, as per an ICMR study conducted in 1996, was responsible for 42 lakh cases of coronary artery disease and 37 lakh cases of chronic obstructive lung disease as well as about 1.5 lakh new cancers! Most Indians use smokeless tobacco therefore we are furnishing the information here.

To know about various tobacco products in India – http://www.aftcindia.org/tob_pro_india.htm

Smokeless Tobacco

Predominant form of Smokeless tobacco in India is Gutka, Pan Masala and other such products that are posing serious health problems in India. While Pan Masala is a predominantly Areca Nut (Supari) product, Gutka is a combination of the Smokeless tobacco and Areca nut (Supari). Both Pan Masala and Gutka contain several other additives such as menthol, perfume, spices, sugar, preservatives etc. to package it into a mouth freshening product.

Analysis of various market preparations of Gutka and Pan masala in India have shown very high levels of heavy metals viz. Lead, Cadmium, Chromium, Arsenic, Copper and Nickel in such products. These heavy metals can cause serious human disease, as they are toxic even at ultra-small levels. FDAs in several states have raided and seized several gutka products in the past especially in Maharashtra and Gujarat due to very high levels of Magnesium Carbonate.

Summary of health effects of the Smokeless tobacco are as follows

• Highly addictive with dismal Quit rates of 5%..
• International Agency for research on Cancer, World Health Organization has classified Smokeless tobacco as confirmed cancer-causing substances.
• Contains 3095 chemicals and 28 well proven carcinogens.
• Causes severe impairment of the oral and dental health.
• Strongly associated with precancerous lesions and cancer of mouth that is a leading cancer in India.
• Apart from mouth cancers, smokeless tobacco usage is associated with cancers of oesophagus, stomach, pancreas, larynx, pharynx and lung.
• It is associated with hypertension and Ischemic heart disease.
• Its use is associated with increased risk of Stroke.
• It adversely affects reproductive health in women and seriously affects the fetus.

Tobacco Related Diseases

Areca Nut/ Supari has been declared as a cancer-causing substance by International Agency for Research On Cancer, World Health Organization. Supari is one of the main ingredient of Gutka and Pan Masala that are posing serious health problems in India. While Pan Masala is a predominantly Areca Nut (Supari) product, Gutka is a combination of the Smokeless tobacco and Areca nut (Supari). Both Pan Masala and Gutka contain several other additives such as menthol, perfume, spices, sugar, preservatives etc to package it into a mouth freshening product. Analysis of various market preparations of Gutka and Pan masala in India have shown very high levels of heavy metals viz. Lead, Cadmium, Chromium, Arsenic, Copper and Nickel in such products. These heavy metals are capable of causing serious human disease, as they are toxic even at ultra-small levels. FDAs in several states have raided and seized several gutka products in the past especially in Maharashtra and Gujarat due to very high levels of Magnesium Carbonate.

Summary of Health Effect of the Areca Nut or Supari

• Highly addictive
• Usually taken along with smokeless tobacco
• International Agency for research on Cancer, World Health Organization has classified Areca Nut as confirmed cancer-causing substances.
• It contains several polyphenols and nitrosamines that are confirmed carcinogenic.
• It causes impairment of oral and dental health.
• Its usage is strongly associated with precancerous lesions and cancer of mouth that is a leading cancer in India.
• Studies have shown association between Supari chewing and cancers of the Liver, oesophagus, stomach and lung.
• Supari use is associated with hypertension and ischemic heart disease.
• Usage of Supari adversely affects reproductive health in women and affects fetus.
• Supari chewing is associated with diabetes, obesity and several metabolic disorders.
• Supari chewing is associated with causation of certain psychological disorders.

For more information on Areca Nut or Supari: https://sites.google.com/site/quitnut/Home

The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 or COTPA, 2003 is an Act of Parliament of India enacted in 2003 to prohibit advertisement of, and to provide for the regulation of trade and commerce in, and production, supply and distribution of cigarettes and other tobacco products in India. This Act was enacted by the Parliament to give effect to the Resolution passed by the 39th World Health Assembly, urging the member states to implement measures to provide non-smokers protection from involuntary exposure to tobacco smoke

Provisions:

The Act prohibits smoking of tobacco in public places, except in special smoking zones in hotels, restaurants and airports and open spaces. Places where smoking is restricted include auditoriums, movie theatres, hospitals, public transport (aircraft, buses, trains, metros, monorails, taxis,) and their related facilities (airports, bus stands/stations, railway stations), restaurants, hotels, bars, pubs, amusement centres, offices (government and private), libraries, courts, post offices, markets, shopping malls, canteens, refreshment rooms, banquet halls, discothèques, coffee houses, educational institutions and parks.Smoking is allowed on roads, inside one's home or vehicle. The meaning of open space has been extended to mean such spaces which is visited by public, and includes open auditorium, stadium, bus stand.

Advertisement of tobacco products including cigarettes is prohibited. No person shall participate in advertisement of tobacco product, or allow a medium of publication to be used for advertisement of tobacco products. No person shall sell video-film of such advertisement, distribute leaflets, documents, or give space for erection of advertisement of tobacco products. However, restricted advertisement is allowed on packages of tobacco products, entrances of places where tobacco products are sold.[4] Surrogate advertisement is prohibited as well under the Act.

Tobacco products cannot be sold to person below the age of 18 years, and in places within 100 metres radius from the outer boundary of an institution of education, which includes school colleges and institutions of higher learning established or recognized by an appropriate authority.

Tobacco products must be sold, supplied or distributed in a package which shall contain an appropriate pictorial warning, its nicotine and tar contents.[6] Cigarette packets are required to carry pictorial warnings of a skull or scorpion or certain prescribed pictorial warnings along with the text SMOKING KILLS and TOBACCO CAUSES MOUTH CANCER in both Hindi and English.

For more information on COTPA: https://www.tobaccocontrollaws.org/files/live/India/India%20-%20COTPA.pdf

The Act also gives power to any police officer, not below the rank of a sub-inspector or any officer of State Food or Drug Administration or any other officer, holding the equivalent rank being not below the rank of Sub-Inspector of Police for search and seizure of premises where tobacco products are produced, stored or sold, if he suspects that the provision of the Act has been violated.

A person who manufactures tobacco products fails to adhere to the norm related to warnings on packages on first conviction shall be punished with up to 2 years in imprisonment or with fine which can extend to Rs. 5000, in case of subsequent conviction shall be punished with up to 5 years in imprisonment or with fine which can extend to Rs. 10000.

A fine up to Rs. 200 can be imposed for smoking in public place, selling tobacco products to minors, or selling tobacco products within a radius of 100 metres from any educational institution.

A person who advertises tobacco products shall on first conviction shall be punished with up to 2 years in imprisonment or with fine which can extend to Rs. 1000, in case of subsequent conviction shall be punished with up to 5 years in imprisonment or with fine which can extend to Rs. 5000.

The Act repealed The Cigarettes (Regulation of Production, Supply and Distribution) Act, 1975

The owner/manager/in-charge of a public place must display a board containing the warning "No Smoking Area - Smoking here is an offence " in appropriate manner at the entrance and inside the premises.[12] In place where tobacco products are sold must display appropriate messages like "Tobacco Causes Cancer" and "Sales of tobacco products to a person under the age of eighteen years is a punishable offence".

For more information on COTPA: https://www.tobaccocontrollaws.org/files/live/India/India%20-%20COTPA.pdf

Enforcement of tobacco control policies: http://www.aftcindia.org/enforcement.pdf
Tobacco control policies: http://www.aftcindia.org/TCL_MANUAL.pdf

Global Adult Tobacco Survey (GATS) Fact Sheet India

Link: http://www.searo.who.int/india/mediacentre/events/2017/gats2_india.pdf?ua=1 

List of Factsheets.

1. India Fact Sheet

2. GAT_2 Highlight, Key Indicator, Comparision G1-G2 & Prevelance in States

3. Arunachal Pradesh

4. Assam

5. Maharashtra

6. Manipur

7. Meghalaya

8. Mizoram

9. Nagaland

10. Rajasthan

11. Sikkim

12. Tripura

13. Gujrat

14. Jharkhand

15. Karnataka

16. Madhya Pradesh

17. Orissa

18. Uttar Pradesh

19. Uttarakhand