Best Practices in Smokeless Tobacco Control

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1 ICMR- NATIONAL INSTITUTE OF CANCER PREVENTION & RESEARCH Best Practices in Smokeless Tobacco Control Workshop on Priorities in Smokeless Tobacco Control Research and Training needs November, 2017 Dr Amit Yadav Senior Consultant WHO FCTC Global Knowledge Hub on Smokeless Tobacco National Institute of Cancer Prevention and Research, Noida

2 Background SLT use coupled with areca nut use present a complex challenge to public health. Good practices in SLT control: Apply all provisions of FCTC and the Protocol to Eliminate the Illicit Trade in Tobacco Products Complete ban on manufacture, sale, import etc. of SLT Prohibition on spitting/use in public places Several Parties to the WHO FCTC have implemented complete and partial ban on manufacture, sale and import etc. of SLT products. There is historical precedence of spitting ban to curb the epidemic of tuberculosis from late 19 th Century and Early 20 th Century. 2

3 Best Practice in implementing FCTC Article 6: Republic of Korea have highest taxes on SLT products. Article 11: Larger 85% mouth cancer warnings in India. Article 12: Mukesh and Sunita mass media campaigns in India and betel nut campaign in Myanmar. Article 13: complete ban on direct and indirect advertisement Article 14: cessation services Article 15: governmental licensing including of retail sale Article 16: Age of sale increased to 21 years Article 20: collect data on SLT under GTSS and other national and international surveillance systems 3

4 Efforts by Parties Governmental sale licenses: 26 countries require license for sale of SLT products Several countries regulate the production, distribution, and sale of cottage industry manufactured SLT products as well. Age restrictions: Several countries have raised age of access to 21 years. Reduce the appeal of SLT products by banning or regulating sweeteners and flavouring substances. 4

5 Complete Prohibition on SLT Australia, Bhutan, Sri Lanka and Singapore have complete ban on sale, manufacture and import of SLT products. 45 other Parties have full or partial ban on sale of SLT products, 11 have banned manufacture and 6 have banned import. SLT Control measure 5

6 SLT Ban In India First started in but Supreme Court of India reversed decisions by states on technical grounds. Said power rests with the Central Government Goa amends Public Health Act in 2005 to continue the ban Supreme Court of India prohibits sale of certain smokeless tobacco products in plastic sachets from March 2011 Food Safety and Standards Authority notifies prohibition on sale of food items containing tobacco or nicotine as ingredients. Madhya Pradesh became first state to ban gutkha, Maharashtra bans gutkha and pan-masala while Mizoram bans gutkha, pan masala and Zarda as well Several states now ban sale of all kinds of SLT 6

7 Ban on Spitting Prohibition on spitting in public places have been imposed for: Controlling communicable diseases; Maintaining public cleanliness and hygiene; and Preventing/reducing SLT use. 7

8 Ban on spitting in high resource Parties United Kingdom: To maintain clean pavements, the London Borough of Brent, in 2010, classified spitting paan/khilli paan juice as criminal damage attracting a fixed-penalty. Australia: The Sydney suburb of Fairfield implemented a regulation against spitting in Violation attracted fines ranging from AUD110 to AUD1100. Singapore: Spitting is prohibited in coffee shops and markets, public roads, sideways and any other place that s open to the public. Any violation of the law attracts a fine of up to SGD1,000. 8

9 Ban on spitting in developing countries Nepal is the only country which has banned use of any kind of tobacco products in public places (2011). In Bhutan, a 2012 regulation prohibits smearing lime and spitting doma in public area. Hangzhou, a province in China, spitting and littering in public places was banned in In Myanmar, there is a ban on spitting red betel juice in the streets and public places In Papua New Guinea (PNG), since 2013, chewing betel nuts and spitting betel nut juices has been banned from the streets. 9

10 Ban on spitting in India Indian Railways ban spitting on its premises since 2012 Metro Rail Corporations across India have also prohibited spitting in metro Several states have implemented ban on spitting both for cleanliness and to reduce SLT use. Most recently the Uttar Pradesh Government has banned spitting in public buildings. 10

11 Ban on spitting under local (municipal) laws The Karnataka municipal law prevents spitting in public and violation attracts fine of INR 100 the first time and INR 200 subsequently. The Bombay Police Act, Section 116, prohibits smoking and spitting in government premises in Maharashtra. The Greater Hyderabad municipal law prescribes action against violators under its sanitation bye-laws with fine of INR 500 upwards. The Bihar municipal law makes spitting an offence with a penalty of INR

12 Impact of ban on spitting There is lack of scientific literature on the impact of ban on SLT use and spitting in public places. However, a study conducted in Jodhpur, Rajasthan, India revealed that the most frequent cited reason for quitting tobacco usage was spitting and ash dropping which was embarrassing in-front of others. There is need for undertaking further research on the effects of ban on SLT use and spitting in public places on various SLT prevention and control measures. 12

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