Smokeless Tobacco | Effects of Smoking -Staindia

StrongHealth

Warning

LegalCases

BanSmokeless

TobaccoPlasticBan

Jarda / KhainiTobacco Industry

52% adults

exposed to

passive smoking

at home

They are Ignoringharm caused by

smoking.Is it because we are

SWADESHIIndustry?

Good..!Let their focus

be only onprevalence

in India

JARDA / KHAINI TOBACCO

2

Will you support this?

To increase sales of Videshi products,If Swadeshi products are banned?

VIDESHI Cigarette Industry cheers

• Health Ministry is formulating a smokeless tobacco specific policy

• Separate harsher pictorial warnings have been designed for smokeless tobacco products

• National Consultation for Smokeless Tobacco recommends ban on smokeless tobacco products

• Despite Food Safety and Standards Act (FSSA) excludes Tobacco from its purview ,

some states are trying to cover Jarda / Khaini under prohibitory order , thus imposing unjustified ban.

4

5

6

7

8

SWADESHI Chewing Tobacco Industry cries

• High potential from women users and switch from non-cigarettes to cigarettes will aid cigarettes companies1

• Government goes soft on statutory warnings for cigarette packs

Rollback of blanket ban on depiction of smoking in films

2

3•

If you do not support this, then please read this booklet to understandhow Swadeshi Smokeless Tobacco Industry is being targeted for the

benefit of Videshi Smoking Industry

3

Lie - Smokeless Tobacco contains 28 carcinogenic chemicals -13

Advocates of Tobacco Control often say this giving reference of InternationalAgency for Research on Cancer (IARC). However, Table given by IARCMonograph on Smokeless Tobacco clearly shows that there are only 11chemical agents in Chewing Tobacco (not 28), for 6 chemicals there isinsufficient evidence available and for 5 chemicals, no evidence is available asregards carcinogenicity in humans .

14Reality -As per IARC itself, no chemical

agent present in chewing tobacco is found to be carcinogenic in humans.

Lie - Deaths due to tobacco are equivalent to 10 packed jumbo jetscrashing every day or 10 Tsunamis hitting Indian shores every year -

17

Advocates of tobacco control describe tobacco related deaths in India as 20jumbo jets crashing every day. This figure is derived assuming 10 lac deaths inIndia due to tobacco and dividing 10 lac by 365 days. However GATS (GlobalAdult Tobacco Survey India) report has mentioned that smoking causes 9.30lac adult deaths in India .

18

Reality - This means 93% of tobacco related deaths in India are due tosmoking. This booklet will explain further how smoking related deaths aremuch more than 9.30 lacs.

Lie - Almost 2 in 5 deaths among adults in India are caused due tosmokeless tobacco -

15

even 17% is incorrect.

News in a prominent daily said this giving reference of WHO Global Report- Mortality Attributable to Tobacco. The said report however does notmention this anywhere, and this news is completely misleading. 2 in 5 means40%, whereas title of the news itself says 'Smokeless tobacco claims lives of17% of 30 plus adults'. Further, Reality -

how smoking related deaths are morethan 95% of tobacco related deaths in India

Page 182 ofthis report clearly says that proportion of deaths attributable to tobacco is7%. Here tobacco means smoking as well as smokeless tobacco.This booklet will explain further

.

16

Brief Facts

Smokeless tobacco is tobacco consumed without burning. It is 98 to 99% safer than cigarettes. In India,

various types of smokeless tobacco products are used like Chewing tobacco, Jarda, Khaini, Spit Tobacco.

These are manufactured by Swadeshi Industry since centuries providing livelihood to millions. Unfortunately,

livelihood in this industry is in danger due to dual approach. Most harmful tobacco i.e. cigarettes are favoured

and least harmful tobacco like smokeless tobacco is treated harshly. In setting policies, all tobacco products

consumed without burning are combined into one category called .

9 10

'Smokeless Tobacco' Even products like

Gutkha / Pan Masala are wrongly perceived as Smokeless Tobacco products. Actually, these are

primarily anAreca Nut based products because their principal ingredient (> 80%) isAreca Nut.11

The scientific basis of tobacco product regulation: report of a WHO study group clearly says -

.

'The differences in risks associated with use of different smokeless tobacco products meanthat it would be scientifically inappropriate to consider smokeless tobacco as a singleproduct for the purposes of estimating risk or setting policies

12

However, this aspect is completely ignored by policy makers.

Extracts from ' ' written by -(DDS) & (DDS)

ORAL AND MAXILLOFACIAL PATHOLOGY Dr. Robert E. MarxDr. Diane Stern University of Miami, School of Medicine, Miami, Florida

19

But based on high prevalence, smokeless tobacco is regulated...

"In order for electrophilic intermediates that damage DNA or become

bound to DNAto be generated from tobacco products, the tobacco must

be combusted (smoked). Thus, these

and, despite the claims of several organizations, do not

produce a higher incidence of oral squamous cell carcinoma than that

which spontaneously occurs in the nonsmoking, nonusers of

smokeless tobacco population"

"However, 9% of all squamous cell carcinomas in our major cancer

center occurred in individuals with no direct tobacco history, indicating

that

epoxides of tobacco tars, not

nicotine, are the actual DNA damaging agents (i.e. carcinogens)"

"Nicotine is the addictive agent and is not by itself carcinogenic.

Therefore, because these epoxides are not formed in "smokeless"

tobacco, such tobacco products are not significantly

carcinogenic

"smokeless tobacco" history is coincidental rather than

causative"

-

Tobacco control policies in India are framed considering prevalence and ignoring which type oftobacco is causing real harm. I dvocates of tobacco control mention combined harmcaused by all types of tobacco (smoking as well as smokeless). However their appeal is restricted toban on smokeless tobacco .

4

20

n their appeal, a

4

As per GATS India 2009-2010 report

9.30 lac Smoking related deaths in India18

Smokeless tobacco is more prevalent than smoking in India21

What should be banned?More harmful smoking orMore prevalent smokeless

Is it not injustice to focus on prevalence instead of harm?

Smokeless Tobacco is less harmful

Because it is not burnt

Prevalence of smokeless tobacco is more...

but can you ignore passive smoking ?

Per

cen

tage

of

Ad

ult

sin

Ind

ia

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

SmokelessTobacco

users23

Smokers23

Home24 Public

Places24

PublicTransport

24

Restaurants24

Government

Buildings24

HealthCare

Facility24

25.90% 14% 52.30% 29% 17.50% 11.30% 6.60% 5.40%

Pass

ive

Sm

ok

ing

Pass

ive

Sm

ok

ing

Pass

ive

Sm

ok

ing

Pass

ive

Sm

ok

ing

Pass

ive

Sm

ok

ing

Pa

ssiv

eS

mo

kin

g

Exposed to second hand smoke at various places

Second hand smoke is four times more toxic than mainstream cigarette smoke22

5

Only 14% adults smoke in Indiabut second hand smoke affects larger population

23

24

Only 14% adults smoke in Indiabut second hand smoke affects larger population

23

24

Please refer page 7 for harmful effects of passive smoking

Unfortunately those affected include innocent children

6

Emphysema

COPD

AsthmaChronic

Bronchitis

Currently, India has close to 2.40 crore ( 1 in 50 people) COPD cases25

It is One of the main causes of death in India (more than 5.50 lakh p.a.)26

Passive smoking doubles kids' risk of developing COPD as adults28

Lack of awareness on this disease in health care providers and policymakers has led to the increase in prevalence rate of lung diseases

26

Cigarette smoking is the most important risk factor for COPD27

Not only COPD,

Leading site of cancer is Lung Cancer, not Mouth Cancer

As per Page 111 of[Published by Central Bureau of Health Intelligence - Government of India

National Health Profile 201029

]

Lung cancer is the leading cancer site among males in 7 Population Based Cancer Registries (PBCRs).Mouth cancer is not leading site of cancer in any of the 16 PBCRs.

At Rank 1 At Rank 2

3 PBCRs29

2 PBCRs29

- -

FEMALE

At Rank 1 At Rank 2

4 PBCRs29

7 PBCRs29

- 2 PBCRs29

MALE

Lung Cancer

Mouth Cancer

Chronic Obstructive Pulmonary Disease (COPD) epidemic in India

7

World over these harmful effects of cigarettesare shown in Pictorial Warnings

Harmful effects of

Harmful effects of

SMOKING

PASSIVE SMOKING

- As per Report of U.S. Department of Health and Human Service30

52% adults inIndia are

exposed topassive smoking

at home32

As per W.H.O.40% of

Tuberculosis Burdenin India

is attributable tosmoking

31

Not only COPD & Cancer... Cigarettes are harmful in many ways!

Harsh Pictorial Warnings on cigarettes Worldwide33

showing various harmful effects

8

Malaysia

Brunei

Singapore

Hong Kong New Zealand

Singapore Singapore

America

Australia

Malaysia

Brazil

European Union

European Union

SMOKING CAUSES92% of ORAL CANCERS

QUIT: 1800-438-2000

SMOKING CAUSESNECK CANCER

QUIT 1800-438-200

USA has mild warnings for smokeless tobacco products

TYPE

Warning area 50% of front and rear panel 30% of 2 principal sides

Type 9 different Harsh & Gory Pictures Only 4 Text warningsNo pictures

Harmfuleffects

covered

Addiction, Harm to Children, Fatal Lung Disease(Smokers as well as non smokers), Cancer, Strokesand Heart Disease, Harm to baby during pregnancy,Death, Serious risk to health

Addiction, Mouth Cancer,Gum disease and tooth loss

Difference inWordings

Cigarettes cause cancer This product can causemouth cancer

9

Cigarette Packages34

Smokeless Tobacco Products35

USA has proposed 9 harsh pictorial warnings for cigarettes

but only 4 text warnings on smokeless tobacco products34

3 similar and animated pictures, is this a "Find the difference" contest?

Comparison of employment

Smokeless tobacco industry3 times more employment

than cigarette industry,but favour is given to cigarettes

So 70% cigarette customers do not see the warning.

In many countries law does not allow such loose stick sale.

WHO Framework Convention on Tobacco Control (FCTC) also says

"Each party shall endeavour to prohibit the sale of cigarettes

individually or in small packets".38

10

CigaretteIndustry

(9.43 lacs)25%

Smokeless TobaccoIndustry

(27.59 lacs)75%

36

39

Mild Pictorial Warnings on cigarettes in India

Pictorial Warnings on Cigarettes are not noticed because

In India 70% of sales are in Loose Sticks37

In India pictorial warnings on cigarettes show only lung and mouth cancer!

As explained in Lies Vs Reality on page no. 3, as per IARC itself,

Despite of this, only in India warnings on smokeless tobacco products are harsher than cigarettes.

What about other harmful effects about which there is no awareness at all?

no chemical agent present in chewing tobacco is found to be carcinogenic in humans.

But in India, cigarettes are favoured

Dr. Brad Rodu, Prof. of Medicine, Tobacco Harm Reduction Research University of Louisville (U.S.A.) estimatedthat if all 46 million smokers used smokeless tobacco, United States would see, at worst, 6,000 deaths from oralcancer, versus current 419,000 deaths from smoking-related cancers, heart problems & lung disease.

42

SmokelessTobacco &

PassiveSmoking(1 lac)

9%

40

Smoking (10 lacs)91%

41

Had Dr. Rodu seen situation in India, he would have suggested The Harm Reduction theory (THR) of switchingto smokeless tobacco from smoking. Unfortunately National Consultation on Smokeless Tobacco hasrecommended ban on only smokeless tobacco products This recommendation if accepted, then present16.37 crore users of only smokeless tobacco may switch to smoking to satisfy crave for nicotine. In thisscenario present 11 lac tobacco related deaths will increase multi-fold to 35.78 lacs. If The Harm Reductiontheory (THR) as stated above is followed, then present 11 lac tobacco related deaths can be reduced to57,000, if smoking is banned. (Assuming that present 6.89 crore users of only smoking switch to smokelesstobacco)

6

40,41 43

40,41

44

.21

21

35 lacs

30 lacs

25 lacs

20 lacs

15 lacs

10 lacs

5 lacs

A) Currently (10 Lac due to

smoking & additional 1 Lac

(60,000 passive smoking +

40,000 smokeless tobacco ).

41

45

46

C) Ban on smoking tobacco(57,000 deaths due to smokeless

tobacco)44

No. of Deaths

11

B) Ban on smokelesstobacco (35.78 lac deaths

due to smoking)43

National Consultation onSmokeless tobacco

recommended ban onsmokeless tobacco products

which may lead to this scenario

6

DA

NG

ER

AH

EA

DBan smokeless tobacco - deaths will increase to 35.78 lacs

Smoking kills more than 10 lac adults every year

If we compare no. of estimated deaths for the year 2008 ( dueto (which are considered asTobacco Related Cancers apart from Lung Cancer), then , despite ofalleged prevalence of smokeless tobacco to be the highest. In Bhutan, such no. of deathsare more despite of ban on tobacco.

Secondly while reporting tobacco related cancers, sites associated with the use oftobacco are reported by Population Based Cancer Registries (PBCRs) , without verifyingwhether these cancer patients are users of tobacco or not.

As per report of WHO )47

Mouth, Oropharynx, Oesophagus and Bladder cancers

India is the lowest

This means even cancer patients who do not use tobacco are counted in

reports of 'tobacco related cancer' (TRC) figures. Please ask age-wise break-up of

TRC to any PBCR and you will find some patients in the age group of 0-4 also.

48

Is it possible that an infant uses tobacco?

UnitedKingdom

Japan

20.27

China

20.09

Bhutan

16.74

Australia

14.88

Canada

14.54

NewZealand

UnitedStates ofAmerica

Bangladesh

12.71

INDIA

11.93

30.00

25.00

20.00

15.00

10.00

5.00

0.00

27.82 13.67 13.26

This is what is advocating.This theory says that, if it is not possible for a smoker to quit smoking, then

smoker should switch to less harmful products like smokeless tobacco.

The Harm Reduction Theory (THR)

India is 2 highest tobacco producing country in WorldBut TRCs (excl. lung cancer) deaths in India are lowest in these 10 countries

This must be because use of tobacco in smokeless form than smoking(which is 98% safer than smoking )

nd 49

9

12

Lowest deaths in India from tobacco

related cancers per 1 lac population

What are the advocates of The Harm Reduction theory (THR) saying?

Some Extracts from Tobacco Harm Reduction 2010 - a yearbook of recent research and analysis

Edited by - Dr. Carl V. Phillips & Paul L. Bergen

Worst case:If all tobacco users

were smokers(1,35,542)

Current case:(1,04,999)

Best case:If all smokers

were smokelesstobacco users

(1,103)

Cancer risk from a lifetime of smoking compared to a lifetime of smokeless tobacco use.

�

�

�

�

�

The evidence shows that the risk for any life-threatening disease from Smokeless Tobacco use is so lowthat it cannot be reliably measured or even definitively established.

There is evidence ofAmerican men switching to ST as a method for quitting smoking (Dr.Rodu & Dr.Phillips2008), and THR is increasingly being discussed in the scientific literature, and is gaining acceptance in themedical community (Dr.Nitzkin & Dr.Rodu 2008)

In their response to the EU Green Paper Consultation on Public Smoking, the Swedish Ministry of Healthand SocialAffairs drew attention to the need to take account of the Swedish experience with the use of snusas an alternative to cigarettes.

I believe that FDA regulation of tobacco products will be effective and beneficial for public health if itincorporates tobacco harm reduction, which involves the substitution of alternative sources of nicotine,including smokeless tobacco products, for cigarettes by smokers who are unwilling or unable to abstainaltogether from nicotine and tobacco.

52b

52C

52d

52e

52f

Thus, discouraging a smoker, even one who would have quit entirely, from switching to a low-riskalternative is almost certainly more likely to kill him than it is to save him.

13

Dr. Gilbert Ross ofAmerican Council on Science and Health (ACSH)

"The simple truth, however, is that for those smokers who are trying to quit and have beenunsuccessful with current FDA-approved cessation methods-as is the case in the large majority-smokeless tobacco is an excellent alternative and has a great track record, especially in Sweden"

51

Jeff Stier of American Council on Science and Health (ACSH) advises US PresidentObama how he can quit smoking by switching to smokeless. He says :-

"Surprisingly, the risk of oral cancer from smokeless tobacco is low--far lower than theoral cancer risk from smoking cigarettes. And switching from cigarettes to snuseliminates the risk of heart disease, lung cancer and the other systemic diseasesrelated to smoking--not to mention secondhand smoke"

50

52a

Based on American estimates of 7 cancer mortalities for 35+ males (re Lee & Hamling, 2009)

American President Obama advised to

switch to smokeless tobacco

14

FTC Reports Indicate Smokers Finally Getting The Right Message

U.S. tobacco users are

getting the message that smokeless tobacco products are up to 99% safer than smoking.

“For over a decade, smokers have been given the scientifically untrue message that smokeless

products are just as dangerous as smoking,

most people

would consider a less than 1% health risk as quite safe compared to the smoking risks.

53

Two encouraging reports released Saturday by the FTC may indicate that

According to the reports, smokeless tobacco consumption has increased 3.6% from 2006 to 2008 and

smokeless tobacco advertising spending increased 55% during the same period. Additionally, nationwide

cigarette advertising and promotional expenditures declined 20% from 2006 to 2008 and cigarette consumption

declined by 8%.

because tobacco manufacturers are prohibited by law to tell the

whole truth,” said Elaine Keller, CASAA's vice president. “They are required to place warnings on their

packaging that the products 'are not a safe alternative to smoking.' While this is technically true,

Worldwide Cigarette companies are focusing more

on smokeless tobacco, but in India scenario is opposite

Tobacco companies are shifting their advertising dollarsfrom high-risk cigarettes to these low-risk smokeless alternatives

53

Smokers in USA have already started believing in

The Harm Reduction Theory (THR)….

15

Definitely, it is not smokeless tobacco alone,but other factors also responsible for these cancers.

Otherwise how is it possible that,a country like Poland (very less prevalence of smokeless) has more cancers

than India (prevalence of smokeless tobacco 33 times more in males).

As a explained on page no. 4, smokeless tobacco is not burnt and hence less harmful.19

This is not just a theory but can be proven with following example....

POLANDLess smokeless

but more cancers

INDIAMore smokelessbut less cancers

Only 1% male &0.1% females use

smokeless tobacco54

33% male &18% females use

smokeless tobacco55

20.83 per 1 lacpopulation

47

11.93 per 1 lacpopulation

47

Deaths from Tobacco Related Cancers(excl. Lung Cancer)

India - Lowest consumption of cigarettes, hence great potential for smoking.

Hence smoking tobacco companies trying to eliminate smokeless tobacco?

Russia

2319

2500

2000

1500

1000

500

0

2028 1648 1196 1130 897 790 565 172 99

Japan China UnitedStates

Australia Canada UnitedKingdom

NewZealand

Bangladesh

India

Number of cigarettes per adult per year56

Refer page 10which showsdanger ahead

(35.78 lac deathsdue to smoking

in India)

Smokeless Tobacco is not so harmful...

4. Atlanta, GA: U.S. Department of Health and HumanServices, Centers for Disease Control and Prevention, Page 225The 2004 Surgeon General's report,

(U.S. Department of Health and Human Services [USDHHS] 2004),concluded that the evidence is sufficient to infer a causal relationship between

, esophagus, pancreas, bladder, kidney,cervix, and stomach, and acute myeloid leukemia .

A Report of the Surgeon General.

The Health Consequences of Smoking: A Report of theSurgeon General

smoking andcancers of the lung, larynx, oral cavity, pharynx

59

5. An article published in “Journal of Cancer Research and Therapeutics” Apr-Jun 2009,Volume 5, Issue 2. Article written by Department of Head andNeck, Tata Mem. Hospital, Mumbai“There has been a rising international recognition of the role of HPV as an etiologic agent ina subset of oral cancers.

of any extragenital human malignancy. Given this high rate of positivityHPV may be recognized as a tumorigenic factor for development of head and neckcancers.”

Dr. Pankaj Chaturvedi,

The HPV detection rate of 20%-50% in oral carcinomas isamong the highest

60

6. “The evidence for carcinogenic effects of alcoholic beverage consumption on the risk forcancers of the oral cavity and pharynx in humans was considered to be sufficient by a previousIARC Working Group (IARC, 1988)”

61

Smoking

1. “In countries where betel nut is consumed extensively, there is a much higher

level of oral cancer. There is a dire need to initiate a drive against this sweet poison. To saveour oral and general health, children you need to be aware of the harmful effects of theseeasily available packets of sweet supari and gutka”

2. In countries around the world, smoking is public health's enemy No 1. But there are uniqueand vexing problems everywhere. In Taiwan, for example, there's a major push to convincepeople to eschew the addictive areca, or betel nut, because chewing it is a major cause ofcancer.

3. It has been conclusively proven that OSFOccurs because of areca nut consumption and is not associated with tobacco.

According to the WHO, chewing supari leads to cancer of the mouth even if tobacco isnot added to it.

The areca nut causes 90 per cent of oral cancers in Taiwan, the world's secondleading producer of the crop behind India.

Gutka is primarily an areca nut based product.

57

58

11

- Dr. Ajay Nayak, Yogesh Chhaparwal, Keerthilatha M.Pai (Manipal College of DentalSciences) in OOOOE Journal

7.a. History of Oral Precancer Lesionsb. Family history of cancerc. Age > 35 years, Chronic irritation of the mouth, Diet low in vegetables and fruits, Male

gender, Poor oral hygiene, Sun exposure

Other Risk FactorsOral cancer -62

63

64

It will be an injustice to blame chewing tobacco alone for oral cancers

Unfortunately only in India there areMild health warnings on smoking products

No awareness about HPVNo health warnings on alcohol & many areca nut productsBut chewing tobacco products have strong health warnings

Main causes of oral cancer :

16

Hence Taiwan (Chinese Taipei)is No.1 in Oral Cancer

Why blame chewing tobacco alone?

As per data from WHO Top 20 countries in crude rate of

Lip-oral cavity cancers per 1 lac population65

France

(met

ropol

itan)

Chin

eseTai

pei

Hunga

ry

Papua

New

Guin

ea

Spain

SriLan

ka

Aust

ralia

Mal

dives

Portu

gal

Cro

atia

Slova

kia

Bel

gium

Den

mar

k

Bru

nei

Luxe

mbou

rg

Est

onia

Alb

ania

Mon

teneg

ro

Cuba

France

, La

Reu

nion

20.9

14.9

12.111.6 11.4

9.9 9.8 9.6 9.4 9.4 9.2 9.1 9 8.7 8.7 8.6 8.4 8.4 8.3 88.17.7

5.4

2.8

7.9

1.9

3 3.2

4.4

2.4

5.1

2.3

3.2

1.81

4.5

2.9 2.93.6

2.8

22

20

18

16

14

12

10

8Cru

de

rate

per

1la

c

6

4

2

0

Incidence

Mortality

*Crude Rate of incidence in India is 5.9 per 1 lac population (almost 1/4 of Taiwan)

India is not inTop 20 list*

Lip-Oral Cavity

Lung Cancers55,540

Otherreasons

Cardio-vasculardiseases

Tuberculosis,RespiratoryInfections &RespiratoryDiseases

Maternal &Perinetal

Conditions

DigestiveDiseases

STDs&

HIV

RoadTraffic

Accidents

Diabetesmellitus

Mouthand

oropharynxcancers

Diarrhoealdiseases

30 lacs

25 lacs

20 lacs

15 lacs

10 lacs

5 lacs

0

If we compare various reasons of death from the data of World Health Foundation - Global Burden Disease DeathEstimates 2008 , then it can be seen that there are other serious health problems than mouth cancer.

66

What about health problems in India which are

more serious than mouth cancer?

17

India is not the oral cancer capital of the world,

but Taiwan is with 20.9 incidences per 1 lac population

18

Smoking causes deaths due to fire accidents...

As per a study by the Indian Institute of Forest Management, Bhopal, the use offuelwood between 1962 and 2002 for tobacco curing and production of cigarettes and othersmoking consumables has destroyed and degraded 680 sq. km of scrub forests, or nearly 868million tonnes of wood, through successive extraction.

There is a global evidence of deforestation linked to tobacco production. An average of7.8 kg of wood is needed to cure 1 kg of tobacco.

India - Second largest producer of tobacco in the world. Output of approx. 600 M.Kgs(dry weight) of which Flue Cured Virginia (FCV) tobacco accounts for 185 M.Kgs.

67

68

69

This means 1443 million Kg of wood is needed to cure 185 M.Kgs. of FCV tobacco.70

However, smokeless tobacco is Sun-Dried. It does not require wood for curing.Thus it does not cause harm to the forests and environment.

71

72

Smoking causes deaths due to fire accidents. More people die in fires caused by smoking than in firescaused by anything else. According to a report in 1998 due to fires caused by smoking, worldwidethere was a destruction of property to the tune of 2700 crore dollars (1,21,500 crore rupees)

73

74

Smokers turned off detectors at AMRI hospital. The 93 persons who suffocated to death in theblaze at Kolkata's AMRI hospital on Friday may well have been saved if

and staffers, had not turned off the smoke alarms before puffing away75

insensitive smokers,including doctors

Curing of smoking tobacco causes destruction of Forests

SMOKING TOBACCO SMOKELESS TOBACCO

19

No. of users 6.89 crores , no. ofdeaths 10 Lacs . Deaths due topassive smoking 60,000 . So no.of deaths per 1 lac user = 153864 times more harmful thansmokeless tobacco products.

21

41

45

No. of users 16.37 crores , no. ofdeaths 40,000 . So no. of deathsper 1 lac user = 24.This is 1.56% as compared tosmoking, means 98% safe.

21

46

As per WHO, 40% of TuberculosisBurden in India is attributable tosmoking

31

Harms to non smokers due tosecond hand and third hand smoke.As per GATS India survey, morethan 52% adults are exposed topassive smoking at home.

32

Does no harm to non users

Cigarette filters are made fromcellulose acetate and are resistantto degradation. Duration of thedegradation process is cited astaking as little as 1 month to 3years to as long as 10–15 years .It is estimated that 4.5 trillioncigarette butts become litter everyyear (9 lac tonnes, worldwide)

76

77 76

76

Plastic ban for Chewing tobaccoproducts is being enforced . Butuse of plastic by cigarette industryis still continued in the form of filters(made of cellulose acetate ) andcigaret te pack wrapped incellophane.

78

76

Close to 4000 chemicals arepresent in tobacco smoke, many ofthem harmful. Among more than4000 constituents of tobaccosmoke, over 60 are known orsuspected carcinogens

79

80

Nearly 3000 chemicals identified insmokeless tobacco .But tobacco mustbe burnt for these chemicals to beharmful . As explained in Lies VsReality (page no. 3), as per IARC itself,no chemical agent in chewing tobaccois found to be carcinogenic in humans.

79

19

Profits taken away in foreigncountries through dividends &royalties. Major harm to Indians &profits taken out of India ?

Dir./Indirect employment 9.42 lac39

Profits are retained in India.

Dir./Indirect employment 27.58 lac39

Not responsible for Tuberculosisburden in India

EMPLOYMENT

100HARM

80

60

40

20

0

SM

OK

ING

SMOKELESS

There will be lot of news in the media about

(other than Gutkha / Pan masala).

We sincerely request you to

Smokeless Tobacco

Analyze the truth before believing...

Comparison at Glance

References

20

1. High potential from women users and switch from non-Cig to Cig will aid ITC (Cig account for 15% of total tobacco usage) as theduplication is high in these categories which will enhance tobacco users' upgrade to cigarettes —As per post dated 21 August2012 on equitybulls.com.

2. Government has watered down the pictorial warnings to be printed on cigarette packets depicting the health risks of smoking -News dated 31 May 2011 in Mumbai Mirror.

3. The Union health ministry has rolled back its original call for a blanket ban on the depiction of smoking in films - News dated 10August 2012 in The Times of India.

4. Noting that 26 per cent of the total population is chewing cancer-causing tobacco, the Centre on Monday said it was formulatinga smokeless tobacco specific policy - News dated 17 January 2011 in Jagran Post.

5. For the first time that separate harsher pictorial warnings have been designated for smokeless tobacco - News dated 28 May2011 in The Times of India

6. Aprogressive ban on smokeless tobacco products in the country was one strong recommendation that delegates of a NationalConsultation agreed upon and urged the Government to move in that direction. —Press Release published on 5 April 2011 byCentre for Tobacco Control and Health Promotion.

7. According to the FSSAI CEO, Dr V N Gaur , ”At present, theAct clearly says tobacco is not a food item.” —News dated 26 March2011 —FSSAI news archive.

8. Chewable tobacco products such as gutkha and khaini may soon be banned in Delhi. —News dated 23 August 2012 inHindustan Times.

9. Use of smokeless tobacco is 98% safer than smoking.

10. Smokeless tobacco products are up to 99% safer than smoking.

11.12. Page 9 of 'The scientific basis of tobacco product regulation: second report of a WHO study group' (WHO technical report

series ; no. 951).

13. Union health minister Ghulam Nabi Azad had informed Lok Sabha on March 11, 2011 that there are more than 3,000 chemicalingredients in chewing tobacco products. Out of these, 28 chemical ingredients are proven carcinogens.

14. Table 3. Chemical agents identified in smokeless tobacco products (IARC Monographs on the Evaluation of CarcinogenicRisks to Humans - VOLUME 89 - Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines)

15. News dated 16 February 2012 in The Times of India.

16. Page 182 of WHO global report: mortality attributable to tobacco.

17. Deaths due to tobacco are equivalent to 10 packed jumbo jets crashing every day or 10 Tsunamis hitting our shores every year -News dated 27 July 2012 in kanglaonline.com.

18. It has been estimated that in 2010 smoking will cause about 930,000 adult deaths in India; and about 70 percent of them will bebetween the age 30—years : Page No. 5 of 'The GlobalAdult Tobacco Survey India, 2009-2010' (GATS Report)

19. Page 286, ORAL AND MAXILLOFACIAL PATHOLOGY' written by professors of , University of Miami, School of Medicine,Miami, Florida —Dr. Robert E. Marx (DDS, Professor of Surgery and Chief Division of Oral and Maxillofacial Surgery) Dr. DianeStern (DDS, Clinical Professor of Surgery, Division of Oral and Maxillofacial Surgery)

20. Billboards in India: Ban Smokeless Tobacco (This billboard displayed in front of Hon'ble Supreme Court mentions 10 lac deathsper year, but appeals to ban only smokeless tobacco. Surprisingly, it is displayed by 'World Lung Foundation' which shouldspeak more against smoking than smokeless tobacco.

21. The estimated number of tobacco users in India is 274.9 million, with 163.7 million users of only smokeless tobacco, 68.9million only smokers, and 42.3 million users of both smoking and smokeless tobacco. - Page xxxv of Global Adult TobaccoSurvey India 2009-2010 (GATS Report)

http://www.equitybulls.com/admin/news2006/news_det.asp?id=109615

http://www.mumbaimirror.com/article/15/2011053120110531033122548ed6c363a/Govt-goes-soft-onstatutory-warnings-for-cigarette-packs.html

http://articles.timesofindia.indiatimes.com/2012-08-10/india/33136438_1_tobacco-use-occurrences-i-b-ministry-foreign-films

http://post.jagran.com/centre-to-frame-smokeless-tobacco-specific-policy-azad-1295272976

http://articles.timesofindia.indiatimes.com/2011-05-28/india/29594315_1_pictorial-warnings-smokeless-tobacco-tobacco-products

http://www.ctchp.org/index.php?option=com_content&view=article&id=161:national-consultation-forsmokeless-tobacco-ban-is-an-instrument-need-more-actions-under-12th-five-yearplan&catid=16&Itemid=112

http://fssai.gov.in/Daily_News_Archive/March.aspx

http://www.hindustantimes.com/India-news/NewDelhi/Chew-on-this-Delhi-set-to-ban-gutkha/Article1-917951.aspx

http://www.smokersonly.org/

http://www.onlineprnews.com/news/158413-1312221121-ftc-reports-indicate-smokers-finally-getting-the-right-message.htmlhttp://www.ooooe.net/article/S1079-2104(10)00488-9/fulltext

http://www.who.int/entity/tobacco/global_interaction/tobreg/publications/9789241209519.pdf

http://www.downtoearth.org.in/content/kerala-becomes-second-state-ban-chewing-tobacco

http://monographs.iarc.fr/ENG/Monographs/vol89/mono89.pdf

http://articles.timesofindia.indiatimes.com/2012-02-16/india/31066047_1_smokeless-tobacco-harsher-pictorial-warnings-tobacco-report

http://whqlibdoc.who.int/publications/2012/9789241564434_eng.pdf

http://kanglaonline.com/2012/07/manipur-has-the-highest-tobacco-consumption-in-india/

http://www.searo.who.int/LinkFiles/Regional_Tobacco_Surveillance_System_GATS_India.pdf

http://worldlungfoundation.org/ht/d/ViewBloggerThread/i/15655


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22. Philip Morris toxico logical experiments with fresh side stream smoke : more toxic than main stream smoke - S Schick, S Glants

23. Table 4.36 (Smokeless tobacco) and Table 4.14(Smokers) : From Page 72 & Page 43 resp. from 'GlobalAdult Tobacco SurveyIndia 2009-10' (GATS Report)

24. Graph prepared on the basis of Page No. 129 & 133 of 'GlobalAdult Tobacco Survey India 2009-10' (GATS Report)

25. Currently, India has close to 24 million (1 in 50 people) COPD cases which are expected to increase by 34 per cent to 32 millionby 2020

26. Although COPD is one of the main causes of death in India — more than 5.50 lakh people every year — lack of awareness onthis disease in health care providers and policy makers has led to the increase in prevalence rate of lung diseases

27. Cigarette smoking is the most important risk factor for COPD. It is estimated that 80% of COPD patients have significantexposure to tobacco smoke

28. Exposure to passive smoking doubles kids' risk of developing chronic obstructive pulmonary disease (COPD) as adults

29. Page 111 of National Health Profile 2010, Published by Central Bureau of Health Intelligence - Government of India

30. Figure 1.1 The health consequences causally linked to smoking and exposure to secondhand smoke —Page 4 of

. Dept. of Health and Human Services, Public Health Service, Office of Surgeon General, 2010.

32. 52.3% adults exposed to second-hand smoke at home – Pg.129-'GlobalAdult Tobacco Survey India 2009-10' (GATS Report)

33.34.

On the top 50 percent of both the front and rear panels of each cigarette package.

35. For smokeless tobacco packaging, the warning must be located on the two principal sides of the package and cover at least 30percent of each side.

36.37. According to appellants 70% of sales by the retailers are in the form of loose sticks and only 30% of sales are in packages [1998

(104) E.L.T. 151 (Tribunal) I.T.C. Ltd. Versus C.C.E. Bangalore]38. WHO Framework Convention on tobacco control (FCTC) - Article 16: Sales to and by minors - Each Party shall endeavour to

prohibit the sale of cigarettes individually or in small packets which increase the affordability of such products to minors.

39. Impact of Anti-Tobacco Legislation (including a ban on advertising) on direct employment in the Tobacco Sector Reportprepared for Government of India (UNION MINISTRY OF LABOUR) : Dr. P. Pullarao.

40. In addition, there are excess deaths due to smokeless tobacco use, which is common among men as well as womenand also deaths due to exposure to second-hand smoke. These deaths have not been quantified, but it appears reasonable toassume that these will add at least another 100,000 deaths.- Page 89 of Report on Tobacco Control in India - Published byMinistry of Health and Family Welfare, Government of India.

41. Tobacco use has assumed the dimension of an epidemic resulting in enormous disability, disease and death with 17% of thesmokers of the world living in India. It is estimated that in 2010 smoking will cause about one million adult deaths in India,annually. - Letter dt. 12 Feb 2010 written by 'Advocacy Forum for Tobacco Control' (AFTC) to Dr. Manmohan Singh, HonourablePrime Minister of India. This letter is signed by 5 prominent personalities working in the field of tobacco control i.e. Dr. K. SrinathReddy, Dr. Prakash C. Gupta, Dr. Mira B.Aghi, Shri.Alok Mukhopadhyay, Ms. MonikaArora).

42. Table 1 showing comparison of deaths in equal no. of smokers and smokeless tobacco users.

43. Present 6.89 core users of smoking + 16.37 crore users of only smokeless tobacco may switch to smoking. Hence totalsmokers will be 23.26 crore. Presently there are 10 lac deaths due to smoking and 60,000 deaths due to passive smoking .Hence no. of deaths in 23.26 crore smokers will be 35.78 lacs (10.60 Lacs x 23.26 crore / 6.89 crore)

44. Present 6.89 core users of smoking + 16.37 crore users of only smokeless tobacco may switch to smokeless. Hence totalsmokeless tobacco users will be 23.26 crore. Presently there are 40,000 deaths due to smokeless tobacco . Hence no. ofdeaths in 23.26 crore users of smokeless tobacco will be 57,000 (40,000 x 23.26 crore / 16.37 crore = 56,836 say 57,000)

45. As per there are 40,000 passive smoking deaths in Americadue to 4.60 crore smokers. In India, as per page xxxv of GlobalAdult Tobacco Survey India 2009-2010, there are 6.89 crore onlysmokers . Hence, in India, passive smoking deaths are assumed at 60,000 (40000 x 6.89 / 4.60 = 59,913, say 60,000).

46. As per page 89 of Report on Tobacco Control in India - Published by Ministry of Health and Family Welfare, Government ofIndia, there are 1 lac deaths due to smokeless tobacco and passive smoking . Hence if we deduct 60,000 passive smokingdeaths as calculated above, smokeless tobacco related deaths can be assumed at 40,000.

47. As per data from, World Health Organisation Burden Disease Death Estimates for the year 2008, estimated deaths frommouth, oropharynx, oesophagus and bladder cancers (which are considered as Tobacco Related Cancers by Population

HowTobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of theSurgeon General

21 21

41 45

21 21

46

21

40

45

http://tobaccocontrol.bmj.com/content/14/6/396



http://health.india.com/news/1-out-of-50-indians-will-have-copd-by-2012/

http://www.dnaindia.com/health/report_never-smokers-more-vulnerable-to-copd_1467854

http://www.ijpbs.com/data/OCT-DEC2011/447-456.pdf

http://www.medindia.net/news/exposure-to-secondhand-smoke-raises-copd-risk-in-kids-99016-1.htm

http://cbhidghs.nic.in/writereaddata/mainlinkFile/File1012.pdf

http://www.surgeongeneral.gov/library/reports/tobaccosmoke/full_report.pdf

http://www.searo.who.int/LinkFiles/Regional_Tobacco_Surveillance_System_GATS_India.pdfhttp://www.tobaccolabels.ca/healthwarningimageshttp://www.fda.gov/downloads/TobaccoProducts/Labeling/UCM259401.pdf

http://www.fda.gov/TobaccoProducts/Labeling/ucm259214.htm#Placement_of_New_Warnings_on_Cigarette_Packages_and_Advertisements

http://www.fda.gov/TobaccoProducts/Labeling/Labeling/SmokelessLabels/default.htmhttp://www.tobaccolabels.ca/healthwarningimages/country/india

http://www.who.int/tobacco/framework/final_text/en/index6.html

http://mohfw.nic.in/WriteReadData/l892s/911379183TobaccocontroinIndia_10Dec04.pdf

http://www.aftcindia.org/pdf/Letter%20to%20PM.pdf

www.smokersonly.org/our_harm/scientific_rationale.html

http://www.smokersonly.org/our_harm/scientific_rationale.html

31. Page 1 of FACT SHEET ON TUBERCULOSISAND TOBACCO (Sept. 2009) Published by World Health Organisation (WHO)http://www.who.int/tobacco/resources/publications/factsheet_tub_tob.pdf

Disclaimer

External web site links are subject to change. Operation of these web sites is not in our control.

22

Based Cancer Registries in India) calculated per 1 lac population.

48. Table 3.2 on Page 61-62 of 'Three year Report of Population Based Cancer Registries 2006-2008' reports no. of tobaccorelated cancers (TRCs) in different PBCRs & related sites. These sites of cancer considered in calculating TRCs are Lip,Tongue, Mouth, Oropharynx, Hypopharynx, Pharynx Unsp., Oesophagus, Larynx, Lung & Bladder. If individual report of eachPBCR is verified, then these figures will exactly match with total no. for each such site. This means, sites associated with theuse of tobacco are considered in calculation of TRCs without verifying whether these patients are users of tobacco or not.

49. Tobacco is an extremely important commercial crop in India. It is the world's second largest producer of tobacco.

50.51.52. Tobacco Harm Reduction 2010 - a yearbook of recent research and analysis edited by Carl V. Phillips & Paul L. Bergen

a) Page 217 b) Page 17 c) Page 26 d) Page 46 e) Page 113 f) Page 15053.

54. Prevalence of smokeless tobacco in Poland : World Health Organisation

55. The extent of use of smokeless tobacco products among males (33%) is higher than among females (18%) - As per page xxxvof GlobalAdult Tobacco Survey India 2009-2010 (GATS Report)

56. Graph prepared for 10 countries from List of countries by cigarette consumption per capita

57.58. =59.60.61. As per Page 237 of IARC Monographs on the Evaluation of Carcinogenic Risks to Humans - VOLUME 96 - Alcohol

Consumption and Ethyl Carbamate

62.63.64.65. Graph available on web site of IARC-Globocan

66. As per data from, World Health Organisation Burden Disease Death Estimates for the year 2008, estimated deaths arecalculated per 1 lac population for various reasons

67.68.

69.70. An average of 7.8 kg of wood is needed to cure 1 kg of tobacco. 3 Output of Flue Cured Virginia (FCV) tobacco accounts for 185

M. wood needed = 185 million kgs. X 7.8 = 1443 million kgs.

72.

75.76.77. Our filter tips are biodegradable over a period of between a month and three years

78. India bans plastic tobacco pouches

79. Page 76 of Report on Tobacco Control in India Published by Ministry of Health and Family Welfare, Government of India.

80. Page 290 of Report on Tobacco Control in India Published by Ministry of Health and Family Welfare, Government of India.

http://www.tobaccoasia.net/features/389-tobacco-consumption-in-india-an-overview.htmlhttp://www.acsh.org/healthissues/newsID.1871/healthissue_detail.asphttp://www.acsh.org/factsfears/newsid.2875/news_detail.asp

http://tobaccoharmreduction.org/thr2010yearbook.htm

http://www.onlineprnews.com/news/158413-1312221121-ftc-reports-indicate-smokers-finally-getting-the-right-message.html

http://www.who.int/entity/tobacco/surveillance/en_tfi_gats_poland_2010.pdf


http://en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capitahttp://www.dawn.com/2011/09/10/health-sweet-poison.htmlhttp://www.canada.com/story_print.html?id=d1fb2308-1705-4342-8059-b2328a4b41bd&sponsorhttp://www.surgeongeneral.gov/library/tobaccosmoke/report/full_report.pdfhttp://www.cancerjournal.net/temp/JCanResTher5271-3358555_091945.pdf

http://monographs.iarc.fr/ENG/Monographs/vol96/mono96.pdfhttp://sites.google.com/site/quitnut/arecapedia/arecancer/oral-cancer/risk-factorshttp://my.clevelandclinic.org/disorders/oral_cancer/hic_oral_cancer.aspxhttp://www.bettermedicine.com/article/oral-cancer-1/causes

http://globocan.iarc.fr/bar_site.asp?selection=12010&title=Lip%2C+oral+cavity&sex=0&statistic=1&populations=5&window=1&grid=1&info=1&orientation=1&color1=20&color1e=&color2=30&color2e=&submit=%A0Execute%A0

http://www.who.int/entity/gho/mortality_burden_disease/global_burden_disease_death_estimates_sex_age_2008.xlshttp://www.gobartimes.org/content/smoking-realityhttp://articles.timesofindia.indiatimes.com/2012-03-29/india/31254073_1_tobacco-production-world-lung-foundation-cigarette-productionhttp://commerce.nic.in/psft/fs_tobacco.htm

http://theblacklisters.com/wp-content/themes/theblacklist/images/facts-deforestation-aboutit.jpg

http://en.wikipedia.org/wiki/Cigarette#Cigarette_litter

http://www.bat.com/group/sites/UK__3MNFEN.nsf/vwPagesWebLive/4572237B0C2D456CC1257314004EF667

http://www.bbc.co.uk/news/world-south-asia-11939933



Kgs . 4 Hence70

71. Khaini is made from sun-dried or fermented coarsely cut tobacco leaves. Page 51 - IARC MONOGRAPHS VOLUME 89

73.74. Smoking is a leading cause of fires and death from fires globally, resulting in an estimated cost of nearly $7 billion in the United

States and $27.2 billion worldwide in 1998.

http://monographs.iarc.fr/ENG/Monographs/vol89/mono89-6A.pdf

http://www.direct.gov.uk/en/HomeAndCommunity/InYourHome/FireSafety/DG_071693

http://www.sciencedaily.com/releases/2000/08/000807064005.htmhttp://www.hindustantimes.com/India-news/Kolkata/Smokers-turned-off-detectors-at-AMRI-hospital/Article1-781134.aspx

On screen smoking targets youth and women...

...but there is rollback of blanket ban on smoking in films3

23

You do not censor on screen smoking......and least harmful tobacco (smokeless) is recommended complete ban?

6

Humble Appeal

1. Smokeless tobacco is tobacco consumed without burning. It is 98-99% safer than smoking.2. As per WHO - It would be scientifically inappropriate to consider smokeless tobacco as a single

product for estimating risk or setting policies3. As per IARC - No chemical agent present in chewing tobacco is found to be carcinogenic in humans4. It is a complete lie to say that almost 2 in 5 adult deaths in India are caused due to smokeless

tobacco.5. Smoking causes 1538 deaths in its one lac users whereas smokeless tobacco causes 24 deaths in

its one lac users. This means Smokeless tobacco is 98% safer than smoking.6. Smoking kills 10 lac adult Indians every year. In addition, there are deaths due to passive smoking.

More than 52% adults in India are exposed to passive at home. Despite of this, pictorial warnings inIndia are harsher on smokeless tobacco products than cigarettes.

7. If smokeless tobacco products are banned, people will switch to smoking & it will cause more than35 lac deaths.

8. There are various reasons for oral cancer. Smokeless tobacco alone cannot be blamed for it.9. As per National Health Profile – 2010, Lung cancer is the leading cancer site among males in 7

Population Based Cancer Registries (PBCRs). Mouth cancer is not leading site of cancer in any ofthe 16 PBCRs.

10. India is not the oral cancer capital of the world as accused always. It is Taiwan (Chinese Taipei) with20.9 incidences per 1 lac population. Crude incidence rate in India is 5.9 per 1 lac population.

There will be lot of news in the media about smokeless tobacco.We sincerely request you to analyze the truth before believing.

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Vidarbha Tambakhu Kamgar Sanghatna,(Affiliated with Bhartiya Majdur Sangha)Kostipura, Nagpur- 8

Lal Tara (Lal Bavta),Sangamner, Dist.- Ahmednagar

Maharashtra Chewing Tobacco Workers FederationShramik Sangha(Affiliated with Bhartiya Majdur Sangha)Amalner, Dist- Jalgaon

Lal Bavta Kamgar Union

Tal. Shirol, Dist KolhapurJaysingpur - 416101

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Smokeless Tobacco | Effects of Smoking -Staindia