Smokeless tobacco control in India: policy review and lessons for high-burden countries

Abstract

We examined the magnitude of smokeless tobacco (SLT) use in India and identified policy gaps to ascertain the priorities for SLT control in India and other high SLT burden countries in the Southeast Asia region. We reviewed and analysed the legal and policy framework to identify policy gaps, options and priority areas to address the SLT burden in India and lessons thereof. In India, 21.4% adults, including 29.6% of men, 12.8% of women, use SLT while more than 0.35 million Indians die every year due to SLT use. SLT use remains a huge public health concern for other countries in the region as well. Priority areas for SLT control should include: constant monitoring, increasing taxes and price of SLT products, strengthening and strict enforcement of existing laws, integration of SLT cessation with all health and development programmes, banning of advertisement and promotion of SLT, increasing age of access to tobacco up to 21 years, introducing licensing for the sale of SLT, standardising of SLT packaging and preventing SLT industry interference in the implementation of SLT control policies besides a committed multistakeholder approach for effective policy formulation and enforcement. SLT control in India and the other high SLT burden countries, especially in the Southeast Asia region, should focus on strengthening and implementing the above policy priorities.

Policy priorities for strengthening smokeless tobacco control in Bangladesh: A mixed-methods analysis

“…However, efforts to control ST use, in general, remain suboptimal compared to cigarette consumption 26 . The policy priorities identified in our analysis are consistent with global priorities for ST control 3 , 27 . Further research is needed to assess the impact of these policies and interventions on health.…”

Evidence on article 5.3 of FCTC (tobacco industry interference in tobacco control activities) in India- a qualitative scoping study

“…On the same lines, most of the stakeholders observed interference with implementing tobacco control laws and activities; which is regarded as another common form of TII tactics. One of the vital tools for improving tobacco control is litigation and judicial interpretations, which have played a beneficial role by institutionalizing laws for tobacco control in many jurisdictions across the globe [ 45 ]. However, it also remains one of the most significant challenges for the governments to protect tobacco control efforts from litigation by the TI [ 46 ].…”

Prevalence of Smokeless Tobacco Use in India and Its Association With Occupations: A LASI Study

“…There has always been an effort by the state and central Governments at various policy levels to reduce tobacco use. Laws like, Products Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution Act, 2003 Cigarettes and other tobacco products act COTPA [4,6,17,18] are enforced. Taxation or increasing the price of SLT products is one of the leading steps [13,19].…”

“…As for the first time, the LASI was conducted in India as a part of the global study, with one of the components to understand tobacco use which is an essential aspect for many policy levels changes and health care facilities [17]. Though occupation plays a pivotal role in initiation and continuation of SLT, there is limited evidence available from India.…”