Alternate Forms of Tobacco Use

8/8/2019 Alternate Forms of Tobacco Use

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Alternate Forms ofTobacco Use

Monika Arora

Director

HRIDAY-SHAN


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Tobacco Use Practices

Many kinds of tobacco are grown in the world, with a variety of uses.

In developed countries, cigarette smoking accounts for most of the

tobacco use.

In South East Asian countries other forms of smoking and smokeless

tobacco is commonly used.

Types of Tobacco Products used in SEAR countries:

- Smoked Forms: Regular cigarettes, Kreteks, klobots, cherrots, beedis and

cigars, kakkad/chillum/sulfa/hookli (smoking in clay pipes), hukka (hubble-

bubble) and hand rolled tobacco.- Smokeless Forms: Pan Masala with tobacco, gutkha, khaini, chewing tobacco

with areca nuts.


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Tobacco Use in India: Practices and Prevalence

India has myriad varieties of

tobacco use (smoking, inhaling

and chewing forms).

Only about 14% of total tobaccoconsumption is in the form of

cigarettes in India.

Beedis account for the largest

proportion of tobacco

consumption in India (about 40%).


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Tobacco Toll in India

700, 000 deaths per year due to smoking

800, 000 to 900, 000 per year due to all forms of tobacco

use/ exposure

Fastest trajectory of rise in tobacco related deaths

forecast for the next 20 years

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


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Types of Tobacco

Smoking Tobacco

Smokeless Tobacco

- Oral Use (through the mouth)

- Nasal Use (through the nose)


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Alternative Forms of Smoking Tobacco

CHEROOT

A cherootis a roll made from tobacco leaves.

KRETEKS

Indigenous cheroots containing tobacco, cloves and cocoa.

They contain a wide range of exotic flavourings whichhas an anaesthetising effect.

Kreteks are used commonly inIndonesia.

CHUTTAS

Chuttas are coarsely prepared cheroots.

Nearly 9% of the tobacco produced inIndia is used for making chuttas.

300 million pieces produced every year inIndia

Chutta smoki

ng is widespread i

nthe coastal areas of A

ndhra Prades

h,T

amilN

adu and Orissa.

REVERSE CHUTTA SMOKING

Term describes smoking while keeping the glowing end of the tobacco product inside the mouth.

Practiced extensively by women in rural areas ofIndia like Vishakhapatnam and Srikakulam district of

Andhra Pradesh.


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Alternative Forms of Smoking Tobacco DHUMTI

Dhumti is a kind of a conical cigar made by rolling tobacco leaf in the leaf of another

plant.

It may be occasionally smoked with the lighted end inside the mouth (Reverse Dhumti

Smoking).

It is used in parts ofIndia like Goa.

BEEDI

A beediis an indigenous cigarette in which tobacco is wrapped in a tendu ortemburini

leaf and tied with cotton thread at one end.

They are potent because they do not have a filter and are wrapped innonporous leaves.

The tar and carbon monoxide content is higher than a regular cigarette

Popular in Bangladesh, Pakistan, Afghanistan, Sri Lanka, Cambodia and India because

of its low price as compared to cigarettes. Beedis are becoming popular outside of South

East Asia, where they have been marketed in a variety of flavours (cherry, chocolate etc.)

About 40% of the tobacco produced inIndia is used for making beedis.

Beedi smokers run the risk of developing oral cancers, lung cancers and otherhealth

problems.


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Smoking Tobacco HUKKA (Hubble- Bubble)

It is a traditional Middle Eastern or Asian device for smoking and

considered smoother and more flavourful as compared to other methods

of smoking tobacco .

The tobacco is burnt directly by a piece of charcoal and the smoke

passes through the water before being inhaled through a long tube or

pipe attached to the bottle.

HOOKLIS

Hooklis are clay pipes commonly used in westernIndia.

CHILLUM

Chillum is a straight, conical pipe traditionally made from fired clay, 10-14

cm long and held vertically.

Chillum smoking is a very social form of smoking and is an exclusivelymale practice. It is limited to the northern states ofIndia, predominantly in

rural areas.

Chillum probably predates the introduction of tobacco to India and was

used for smoking opium and othernarcotics.


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Health Effects of Tobacco Smoking

Relative Risk for all-cause mortality for ever-smokers compared

to never-smokers was 1.6 in men and 1.3 in women.

Prevalence of Tuberculosis (TB) is about 3 times as great among

ever-smokers as among never smokers.Gupta PC, et al. Cohort Studies,Cohort study for tobacco

attributable mortality in Mumbai, 2002.

Follow-up of a Mumbai cohort of 55000 people showed that all-

cause mortality relative risks for cigarettes use was 1.4 and 1.8for beedi users.

Gupta P.C., World Health Organization Bulletin, 2000


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Smokeless Tobacco

Smokeless tobacco is used to describe tobacco that is consumed

without heating or burning at the time of use.

Smokeless tobacco can be used either orally or nasally.

In South East Asia, smokeless tobacco product are commonly

handmade but commercial products are also available and widely

marketed. The oral use of smokeless tobacco is widely prevalent in

India.

Different methods of consumption include: chewing, sucking and

applying tobacco preparations to the teeth and gums.


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Smokeless Tobacco Products

ORAL: CHEWING TOBACCO

GUTKHA

Gutkha is a tobacco product industrially manufactured and

used mainly inIndia.

It is used by constantly chewing without letting the juice go in

and subsequently spitting the juice and contains sweeteners

and flavourings.

PAN (Betel Quid) WITH TOBACCO

It is common and specific to India.

Consists of 4 main ingredients: betel leaf (Piper betle), areca

nut (Areca catechu), slaked lime [Ca(OH2)] and catechu

(Acacia catechu).


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PAN MASALA WITH TOBACCO

Pan masala is a commercial preparation containing

areca nut, slaked lime, catechu and condiments with or

without powdered tobacco

Pan masala is very popular in urban areas and is fast

becoming popular in rural areas

TOBACCO WATER

Tobacco water is used as a beverage and manufactured

by passing tobacco smoke through water.

Traditionally, tobacco water was offered to

guests/visitors both at family and social level and was

considered very rude to omit this greeting.


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SUCKING TOBACCO

KHAINI (Tobacco and Slaked Lime)

It is a mixture of sun-dried tobacco and slaked

lime and is widespread in Maharashtra and

several states of north India.

A small quantity of tobacco is taken in the palm

and a little slaked lime is added. The ingredients

are mixed vigorously with the thumb and placed

in the mouth.


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TOBACCO PRODUCTS FOR APPLICATIONIn India, there is a widespread misconception that tobacco has beneficial effect ondental hygiene.

MISHRI

Mishri is a roasted, powdered preparation made by baking tobacco on a hot metal plate until it isuniformly black.

This practice is common inIndia (prevalent in Goa and Maharastra)

CREAMY SNUFF

Creamy snuff is a tobacco paste, consisting of tobacco, clove oil, glycerin, spearmint, menthol,camphor and sold in a toothpaste tube.

They are advertised as possessing anti-bacterial property.

GUL

Gul is a pyrolysed tobacco product.

It is marketed under different brand names in small tin cans and used as a dentifrice in the easternpart ofIndia.

GUDHAKU

Popularly known as Dant Manjan made of tobacco and molasses.

It is available commercially but can be made by users themselves.

Commonly used in states ofIndia like Bihar, Orissa, Uttar Pradesh and Uttaranchal.


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Health Consequences of Tobacco Chewing

Relationship between oral cancer and tobacco use (chewing of pan with tobacco)

has been reported since the early twentieth century.

Case control studies conducted on tobacco and oral cancer inIndia have shown

that chewing of tobacco tended to have a higher risk for oral cancer than smoking.

In a study in the three centres of Bangalore, Chennai and Thiruvanthapuram

- women who chewed pan-tobacco, has a 46 times higher risk than those

women who had never chewed it (RR = 45.9)

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

tobacco users thannever users (risk adjusted for smoking)

Balaram P, et al. International Journal ofCancer, 2002


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Indian Tobacco Industry:

Employment & Policy Issues

Employment Structure: Indian Tobacco Industry

Production of beedis dominates employment opportunities within

the manufacturing sector of the domestic industry.

Vast majority of employment position are available either on a

part time or a seasonal basis.

Full time employment: Leaf processing, cigarette manufacturing,

distribution and retailing.

Beedi manufacturing employs about 72% of the total tobaccoindustry employment as compared to cigarettes (1%)and other

products (1%).


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Beedi makin

g is ahighly labour i

nte

nsive activity, domi

nated by

home workers and involves much less sophisticated manufacturing

techniques.

It is predominantly unorganized sector and involves 3 major

categories of workers:

- forest based tribal workers (who collect tendu leaves)

- tobacco growing farmers

- beedi rolling home based workers (women and girls)

Beedi Manufacturing: Largest tobacco industry inIndia.

- beedis sold (1998): 858 billion

- projection for2007:1031 billion.

http://tobaccofreekids.org/campaign/global/casestudies

Beedi industry engages about 4.4 million workers. (two-thirds home

based women and 1 % children).

Beedi Sector in India


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Indias 1.5 million private sector beedi workers are among the

most exploited workers in India.

They belong to underprivileged sector of society, are illiterate and poor.

The beedi workers work under the control of the contractors.

They are subject to low wages and fraudulent exactions.

Beedi workers across India work in filthy, disease-causing conditions.

It is a healthhazardous industry.

Children are introduced when they are 5-8 years of ages.

Exploitation in the Beedi Industry


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Excise is imposed on the basis of a fixed amount per 1000 sticks for each

of the six categories with highest rate of excise applied to the longest

high quality filter tip cigarettes.

Excise structure for other tobacco products varies from zero excise on

cigars to a 50% excise duty on snuff and chewing tobacco through to a

300% excise duty on smoking tobacco.

Unorganized tobacco sector (beedis and chewing tobacco) receives a

preferential treatment through the imposition of lower excise.

Beedi manufacturing units producing less than 20 lakh beedis per annum

are relieved from paying taxes.

Federal Excise Revenue in India


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The government of India has enacted a number of legislative

measures to regulate the working and living conditions of workers

and their families involved in the beedi industry. The legislative

measures related to beedis can be categorized as:

Policies related to protection of consumer

Policies related to welfare of labour

Policies related to fiscal aspects

Legislations related to beedi in India


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The Cigarettes and other Tobacco Products (Prohibition of Advertisement

and Regulation of Trade and Commerce, Production, Supply and

Distribution) Act, 2003.

Advertising restrictions on beedis: Indian Tobacco Control Act, 2003

Consumer Protection Act, 1986.

The Standards of Weights and Measures ACT, 1976 and The Standards of

Weights and Measures (Packaged Commodities) Rules, 1977.

Policies Related to Protection of Consumers


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Indian Law- At a Glance

Key Provision of cigarettes and other tobacco product Act, 2003

Ban on smoking in public places

Ban on direct and indirect advertising of tobacco products

- Point-of-sale advertising is permitted

Ban on sales to minors- Tobacco products cannot be sold to children


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Proposed Indian Health Warning on Beedi Pack


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

the vulnerable section of society and work in adverse work and health conditions

Bonded labour system (Abolition) Act, 1976: aims to abolish the bonded labour system to protect

children and other workers to become forced labour in case of inability to repay a loan.

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

involved in beedi rolling.

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

organizations are non-existent or ineffective.

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

conditions of service of the beedi workers.

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

and their families, related to health, education, maternity benefits, group insurance, recreation,

housing assistance etc.

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

provide welfare measures to beedi workers. This cess collected by way of excise duty on

manufactured beedis contributes to BWWF.

Policies Related to Protection of Labour


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Recently cess is levied on cigarettes, pan masala and tobacco

products to fund the health sector.

It increased the specific rate on cigarettes by 10% and imposed a

surcharge of 10% on ad valorem duties on other tobacco products

including gutkha, chewing tobacco, snuff and pan masala.

Beedis have been exempted from this levy.

Policies Related to Fiscal Measures


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Implementation : Barriers to be Overcome

Untrained and uncoordinated enforcement

machinery

Inadequately educated community

Lack of awareness of rules among relevant group

(e.g., restaurant managers)

Tobacco industry tactics


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Other Measures that need to be Taken to

Strengthen Tobacco Control

Tax Net to be Uniform

- Current financial budget (2005-06) increased rate of excise tax on

cigarettes by about 10% and a surcharge of 10% ad valorem duties on

oral tobacco products (gutkh

a, ch

ewin

g tobacco, sn

uff an

d pan

masala).

- Beedis need to be brought under similar tax regime to avoid cost

influenced product choice by youth and poor.

Ban on Gutkha by Centre

- State governments requested the Centre to impose such a ban (as perSupreme Court judgement). Under consideration of the Centre.


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FCTC Implementation in India

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

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

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

- Duty free sales to be tackled by Ministry of Finance

- Prohibiting use of misleading terms to label tobacco products

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

communication, training and public awareness on tobacco control issues

- Promote effective measure for tobacco use cessation

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

manufacturing and counterfeiting

- Sale to and by minors

- Curb cross-border advertising

- Promote economically viable alternatives for tobacco workers, growers and individual sellers (as

appropriate)

Documents

Alternate Forms of Tobacco Use