Breaking New Grounds in Tobacco Control - Voluntary Health ...

Jan.-Mar. & Apr.-June 2012, Vol. 38 No. 1 & 2
Breaking New Grounds in Tobacco Control
From Despair to
Hope:
Breaking New
Ground in Tobacco
Control

This Republic Day, Budgam declared first
Smoke Free District in Jammu & Kashmir
Budgam is the first district in Jammu & Kashmir to be declared Smoke Free on 26 th January,
2012. The declaration was a result of the joint interventions of VHAI, J&K VHADA and the District
Administration supported by the International Union Against Tuberculosis and Lung Diseases under
the PAT & APPLE III project. The findings of the survey conducted by the District Statistics and
Evaluation Department revealed that nearly 91.1% of the public places in the district displayed
the ‘No Smoking’ signage and a strong enforcement mechanism has been institutionalized.
The declaration was done by Shri Ghulab Hassan
Mir, Honourable Minister for Agriculture, J&K
at a public event that was also attended by
other important dignitaries such as the District
Development Commissioner, Budgam, Senior
Superintendent of Police, Chief Education
Officer and the Chief Medical Officer. The
programme witnessed the presence of number
of government officials, law enforcers, media
representatives, civil society representatives
and citizens of Budgam District.
In the last year, various output-oriented
interventions activities were conducted
which included liaison and workshops
with concerned stakeholders, awareness
campaigns, community involvement, etc.
Simultaneously, technical support was
provided to institutionalize a sustainable enforcement mechanism up to the block level. The
Department of Education has also declared all Education Institutions under it as “Tobacco Free
Institutions”.
To honour the District Administration of Budgam a special programme was organized on
28 th January, 2012 in Srinagar where Honourable Minister for Information & Technology, Shri Aga
Syed Ruhullah Mehdi was the Chief Guest. The programme witnessed excellent media participation
which included senior editors & correspondents from all the leading print and electronic media in
J & K. As a result, the declaration and event news got extensive coverage across the state.

Editorial
Tobacco use has emerged as one of the foremost causes of preventable death and
disease today. It poses a greater public health challenge for India, which took a
leadership role in the formulation and ratification of the WHO FCTC in 2003, the first
international treaty for public health, ratified by 174 members so far. The Government
also enacted the Cigarettes and Other Tobacco Products Act, 2003 (COTPA), which
partly fulfilled India’s treaty obligations. The Act was applicable to the whole of India.
However, in the years that followed, implementation and enforcement of this law was
not effective across the country. The key reason was low priority accorded to tobacco
control by policymakers and lack of knowledge on the issue, resulting in laxity in
enforcement. The few achievements that did come in the area of smoke free and pack
warnings were a result of judicial orders following legal advocacy by civil society . In
addition, the WHO FCTC also enlisted key strategies to control supply of tobacco to
combat illicit trade, initiate alternative livelihoods for tobacco workers and ban sale
of tobacco products to and by minors, all of which left a lot to be achieved. It seemed
like a promise that had given way to despair …
However, in the last couple of years, some momentous steps have been taken by
state governments and civil society to break new grounds in controlling the tobacco
menace. Many states have declared their cities and districts as smoke free across
the country. New, stronger picture health warnings have been implemented through
continuous civil society pressure despite delay and challenges by industry and vested
interests and tax advocacy has proved to be a big success with taxes increased
on tobacco products in 11 states. Though burdened with several bottlenecks, new
policy initiatives have come into force on banning sale of tobacco to minors, ban
on gutka and regulating tobacco use and display in films. This apart, the National
Tobacco Control Programme (NTCP) currently operational in 21 out of 35 states and
Union territories, is looking at expanding and scaling up interventions in all districts
across the country. A path-breaking advocacy campaign has also begun by tobacco
victims themselves. Two small but noteworthy programmes by civil society to help bidi
workers to move to safer, viable livelihood options and enable rural women to quit
tobacco have begun to show some positive results. Most importantly, our judiciary and
the media have become significant allies in the advancement of tobacco control.
All these developments signify a new hope and herald a new chapter in tobacco
control campaign efforts by Government, civil society and key stakeholders. And this
is what the present special issue of Health for the Millions has attempted to capture
through the different features by a range of experts, health activists and public health
advocates. We sincerely hope that this issue is a useful resource for public health
organizations, civil society advocates and state level partners working on tobacco
control as well as newer NGOs, and activists who want to begin work in this very
crucial area towards building a tobacco free India!
Bhavna B. Mukhopadhyay

contents
For the Millions
Editorial 1
Addressing Gaps in Legal Provisions and Scaling
Up Tobacco Control in India 3
Dr. Prakash C. Gupta, Cecily S. Ray, Arpita Singh
The National Tobacco Control Programme
Critical Review and Next Steps 8
Dr. Jagdish Kaur
Tax Advocacy in Tobacco Control:
Scope and Opportunities 17
Praveen K Sinha, Seema Gupta and Bhavna B Mukhopadhyay
Enforcing Smoke Free Rules:
Successes and Challenges 23
Saju V Itty, Itishree Kanungo, A M Mir, Narendra Sharma
Role of Compliance Studies and Opinion Polls in
Strengthening Smokefree Legislation in India 29
Dr. Ravinder Kumar, Mr. Pranay Lal, Dr. Rana J. Singh
Behind the Scenes:
Regulating Tobacco Display and Use in
Films to Enforce Comprehensive Ban on TAPS 34
Barbara Zolty
The Game Changers: Media in Tobacco Control 38
Binoy Mathew and Jaspreet Kaur Pal
Charting New Paths: VhAI’s Initiative on
Alternative Livelihoods for Bidi Workers 42
Devashri Sinha and Chandra Ramakrishnan
Advocacy for Ban on Gutka: Voice of the
Victims Campaign – A Case Study 48
Ashima Sarin, Dr. Pankaj Chaturvedi, Dr. Prakash C. Gupta, Shahin Khan
Cessation Efforts on Smokeless Tobacco
Use with Disadvantaged Women 52
Dr. Mira B. Aghi, Cecily S. Ray
Research News Feature:
Summary of Recent Evidence-based Findings
for Tobacco Control 57
Policy Initiatives by Ministry of health and
Family Welfare, Government of India in 2011 64
Regular Columns
Tobacco News 65
News from State VhAs 74
Parliament Questions and Answers 77
For the Millions
n 2
health for the Millions
January - March & April - June 2012,
Vol. 38 No. 1 & 2
Publisher
Alok Mukhopadhyay
Editors
Bhavna B. Mukhopadhyay
Chandra Ramakrishnan
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Devashri Sinha
Sukriti Jain
Editorial Advisory Committee
Dr L.M. Nath
Bhavna B. Mukhopadhyay
Dr P C. Bhatnagar
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Subhash Bhaskar
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Managing Trustee
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Addressing Gaps in Legal Provisions and
Scaling Up Tobacco Control in India
Tobacco kills nearly 6 million people
globally every year including 600,000 nonsmokers
through exposure to secondhand
tobacco smoke. 1 In India, tobacco kills
around one million persons every year, 2
through its use in many forms of smoking
and smokeless products: cigarettes, bidis,
hookah, chuttas and cigars for smoking;
leaf tobacco, zarda, khaini and gutka, for
chewing; others, like gul and mishri for
applying to gums and teeth; and a tobacco
product even for gargling, known as tuibur.
The use of tobacco in any form, since it
contains nicotine, is highly addictive.
Smoking is the most important cause of
lung cancer to the extent that over 80%
of lung cancers are caused by smoking. 3
Smoking causes many other diseases,
including cancers, heart disease --globally,
about 11% of cardiovascular deaths are
caused by smoking: 4 stroke, chronic
bronchitis, peptic ulcer and several other
fatal diseases. Smokers are more vulnerable
to tuberculosis infection compared to
non-smokers with similar exposure to the
causative bacteria. 5
Smokeless tobacco causes oral cancer (90%
of cases in India are caused by tobacco
use 6 ); there is accumulating evidence that
smokeless tobacco may increase the risk of
cardiovascular disease. 7 Pregnant women
who use smokeless tobacco increase their
risk of giving birth to underweight babies
and having a stillbirth. 8
Faced with a growing pandemic of tobacco
use that is being fuelled by a very rich and
Dr. Prakash C. Gupta, Cecily S. Ray, Arpita Singh
powerful transnational industry, emerging
as a leading cause of premature adult
death even in developing countries, the
World Health Organization proposed and
developed the first international treaty for
public health, the Framework Convention
on Tobacco Control. This is by far one of
the most successful international treaties,
having been ratified by 174 members so far.
India was one of the first few countries to
sign and ratify this treaty.
India enacted a comprehensive tobacco
control law, the Cigarettes and Other
Tobacco Products Act, 2003 (COTPA, 2003),
which acted as part fulfilment of the
country’s treaty obligations. Brought to the
Parliament by the Ministry of Health and
Family Welfare, the Act came into force in
May, 2004 and is applicable to all tobacco
products in the whole of India. The law
covers six main areas: prohibition of
smoking in public places, no advertising,
no sale to or by minors, health warnings
and product testing.
All the notified sections of the COTPA
have been implemented in the entire
country. Implementation however, is
a state subject and enforcement has
not been strict or uniform across the
country. Part of it is due to specific
weaknesses in COTPA provisions, many of
them because of lobbying and litigation
by the industry, and part, due to laxity
in enforcement. In this article, the weak
points are highlighted and suggestions
are given for advancing tobacco control
in the country.
n 3
January - March & April - June 2012

The Legal Provisions and Weak
Points in Implementation
Prohibition of smoking in public places
The list of public places where smoking is
prohibited under Section 4 of COTPA is quite
exhaustive and includes all enclosed spaces,
restaurants, cinemas, shopping malls, clubs,
work places and even semi-open spaces like
stadiums, railway stations, and bus stops.
Implementation requires posting a no
smoking sign and a board with the name
of the authority to be approached in cases
of violation. Airports, hotels with at least
30 rooms and restaurants with 30 or more
seats have an exemption of designating a
smoking room that is sealed off from the
rest of the establishment with negative air
pressure and no service of any kind inside.
Civil society intervention has helped to
initiate smokefree public places campaigns
and get reasonable compliance. Examples
are Chandigarh, Chennai, 9 Mumbai, 10
Coimbatore, Vilupuram, Sikkim, Shimla,
Kottayam, Budgam and Bhubaneshwar. 11
A major impediment to smokefree public
places is the rapid spread of hookah parlours
in urban areas all over the country which
not only provide hookahs for smoking in
hundreds of flavours but also serve food
and drinks in the same area. These parlours
are largely patronized by the youth. In a
judgment on a Public Interest Litigation
(PIL), in May 2011, the Bombay High
Court directed the municipal corporation
to include the COTPA requirements in the
conditions for issue of restaurant licenses
and directed other Municipal Corporations
and Councils of Maharashtra to do the
same.
Advertising, promotion and sponsorship
Direct and indirect advertising of any
For the Millions
n 4
tobacco product is prohibited under
Section 5 of COTPA in all forms of audio,
visual, outdoor and print media. The ban
on direct advertising is well implemented
in all media except in outdoor media.
This is due to an exception granted at the
point of sale. Although the law permits
two boards of 90 x 60 cm at one place
specifying only the types of products sold,
it is largely flouted. This is helped by a
stay order from Bombay High Court on an
industry-inspired challenge. This situation
gives a widespread impression that
outdoor advertising of tobacco products
is a norm.
Although indirect advertising has been
banned under the law, it not been defined.
As a result, indirect advertising has been
rampant as brand extension in almost all
media. There are many examples - huge
billboards advertising shampoos and soaps,
clothing stores, awards and competitions
all bearing a tobacco brand or company
name.
The most glaring and blatant use of brand
stretching is advertising of pan masala on
all media – electronic, print, and outdoor.
This has resulted in immense increase in
gutka sales especially to youth. 12,13, It
is very clear that all this is indirect
advertising, for example, a study showed
that the cost of advertising tobacco-free
pan masala would have exceeded profits
from its sale, while profits from the sale of
a similar product containing tobacco were
vastly higher. 14 Even the assumption that
pan masala products contain no tobacco
is not correct as some brands contain
nicotine. 15
The law also prohibits sponsorship of
sporting and cultural events by tobacco
manufacturers. No prizes, gifts or payment

can be given for promoting tobacco
products. Still, sponsorships of festivals,
sports, musical events, fashion shows and
award ceremonies by tobacco companies
continue. There have been some successes
also. In 2011, the Smokefree Mumbai
campaign managed to prevent the Ganesh
Utsav of over 12,000 mandals from being
sponsored by manufacturers of pan masala
and gutka.
Smoking in films and showing cigarette
packs is another form of indirect
advertising. Although a ban on such
practices has been notified, it has not yet
been implemented. 16
No sale to or by minors
Sale of tobacco products by or to persons
under the age of 18 years (minors) is
prohibited under Section 6a of COPTA.
The seller must display a board declaring
that “sale of tobacco products to minors
is prohibited and is a punishable offence”
along with a photo of an oral cancer
patient. This was notified in September,
2011 but is yet to be implemented.
In the Global Youth Tobacco Survey of
2006, carried out nationally in India, 72%
of students who bought smoking products
in a store were not refused purchase
because of their age. 17 This showed a lack
of implementation of COTPA, Section 6a,
prohibiting sale to minors.
No sale within 100 yards of
educational institutions
Sale within 100 yards of educational
institutions is prohibited under Section
6b of COTPA in order to restrict access
of youth to tobacco products. A display
board is required to be put up outside
the each institution declaring, “Sale of
tobacco products in an area within a radius
of 100 yards of the educational institution
is strictly prohibited and is a punishable
offence”.
Although there have been several attempts
to enforce this rule, the implementation,
at best, is tardy. A survey in five states
reported tobacco sold near schools in all
five. 20
Health warnings on packaging
Specified health warning labels, both
text and pictorial, are required on all
tobacco product packages under Sections
7, 8, 9 of COPTA. The text warnings must
be prominent and legible and persons
responsible are manufacturers, distributors
and vendors.
The tobacco industry has been successful
in delaying and diluting the pictorial
warnings at every stage. From the first
notification of pictorial warnings issued
in July 2006, requiring the strong warning
of the skull and cross bones displayed on
50 per cent of space on both sides of
the package, the first implementation got
delayed to 31 May, 2009, with a totally
ineffective picture of an X-ray of lungs or
diseased lungs for smoking products and a
scorpion for smokeless products, on 40%
of the space on only one side. The date
of implementation of the warnings was
changed from the date of sale to date of
manufacture (that is not written on any
pack). In December, 2010 when a new,
more potent image of mouth cancer was
notified, it got scrapped. 22
The current pictorial warning which is
rather ineffective for smoking products
but reasonable for smokeless tobacco
products as it shows oral cancer, came
n 5
January - March & April - June 2012

into force on 1st December, 2011 which
is now presumed as specifying the date
of manufacture of the tobacco product.
The implementation of even these diluted
warnings with delays have been feasible
because of the PILs filed by civil society
organizations and consequent court
judgements in their favour. 22
Steps Needed for Advancing
Tobacco Control
A uniform shortcoming is an inadequate
dissemination of the law and its provisions
to the general public and specifically
to those responsible for enforcement
and implementation. For example, all
workplaces and their managers need to
be informed that smoking is not allowed.
Educational institutions need to be
empowered to enforce that no tobacco is
sold within 100 yards.
Within the near future, it is important
that loopholes in the law be closed and
certain provisions added. The two most
important loopholes to remove are perhaps
withdrawal of 1) the provision of smoking
room in restaurants, hotel and airports;
and, 2) the exemption of the point of
sale from the ban on advertisements.
In terms of upgrading the law, Australia
has already shown the way and plain
packaging of all tobacco products should
be made mandatory. Also a display of
tobacco products at the point of sale and
at any other place need to be deemed
as advertisements and banned under
Section 5.
The laws that promote the tobacco
industry need to be amended. Specifically
the Tobacco Board Act 1975 should be
amended to make the Tobacco Board of
India responsible for replacing tobacco
For the Millions
n 6
cultivation with alternate crops, rather
than promoting tobacco.
A regulatory mechanism at the national
level with representation from the legal,
medical and scientific communities has
already been envisioned and that could
help a great deal in the implementation
and strengthening of tobacco control in
India. 23
References
1. WHO Report on the Global Tobacco
Epidemic, 2011: Warning about the
2.
Dangers of Tobacco. Geneva: World Health
Organization; 2011 [cited 2012 Feb 22].
Available from: http://whqlibdoc.who.int/
publications/2011/9789240687813_eng.pdf
Jha P, Jacob B, Gajalakshmi V, Gupta PC,
Dhingra N, Kumar R, et al. A Nationally
Representative Case–Control Study of Smoking
and Death in India. N Engl J Med 2008 [cited
2012 Feb 22];358:1137-47. Available from:
http://www .nejm.org/ doi/pdf/10 .1056/NEJM
sa0707719
3. Jemal A, Bray F, Center MM, Ferlay J,
Ward E, Forman D. Global Cancer Statistics.
CA Cancer J Clin. 2011 Mar-Apr [cited
2012 Feb 22];61(2):69-90. Available from:
http://onlinelibrary.wiley.com/doi/10.3322/
caac.20107/pdf
4. Ezzati M, Henley SJ, Thun MJ, Lopez AD.
Role of Smoking in Global and Regional
Cardiovascular Mortality. Circulation.
5.
2005 [cited 2012 Feb 22]; 112: 489-497.
Available from: http://circ.ahajournals.org/
content/112/4/489.full
International Agency for Research on Cancer
(IARC). Monographs on the Evaluation of the
Carcinogenic Risk of Chemicals to Humans, Vol.
83. Tobacco Smoke and involuntary Smoking.
Lyon: IARC; 2004.
6. Control of Oral Cancer in Developing
7.
Countries. A WHO meeting. Bull World Health
Organ. 1984;62(6):817-30.
International Agency for Research on Cancer.
Monographs on the Evaluation of the
Carcinogenic Risk of Chemicals to Humans,
Vol. 89. Smokeless Tobacco and Some Tobaccospecific
N-Nitrosamines. Lyon: IARC; 2007.
8. England LJ, Kim SY, Tomar SL, Ray CS, Gupta

PC, Eissenberg T, et al. Non-Cigarette Tobacco
use Among Women and Adverse Pregnancy
Outcomes. Acta Obstetricia et Gynecologica.
2010 [cited 2012 Feb 6]; 89: 454–464.
Available from:
9. http://onlinelibrary.wiley.com/
doi/10.3109/00016341003605719/pdf
10. Kashiwabara M, Arul R, Goswami H,
Narain JP, Armada F. Local Governments
and Civil society Lead Breakthrough for
Tobacco Control: Lessons from Chandigarh
and Chennai. Indian J Public Health. 2011
Jul-Sep [cited 2012 Feb 6];55(3):234-9.
Available from: http://www .ijph.in/a rticle.asp
?issn=0019 -557X;year =2011;volu me=55;issu
e=3;spage= 234;epage= 239;aulast =Kashiwaba
ra
11. Bureau. 96%of restaurants now demonstrate
their awareness of tobacco control measures.
2010 Sep 13. www.aggregator.in. Available
from: http://www.aftcindia.org/press_
releases/Sep_13_www.aggregator.in.pdf
12. Lal PG, Wilson NC, Singh RJ. Compliance
Surveys: an Effective Tool to Validate Smokefree
Public Places in Four Jurisdictions in India.
Int J Tuberc Lung Dis. 2011 Apr;15(4):565-6.
[cited 2012 Feb 6] Available from: http://
www.ingentaconnect.com/content/iuatld/
ijtld/2011/00000015/00000004/art00027
13. Gupta PC, Ray CS. Tobacco and Youth in the
South East Asian Region. Indian J Cancer.
2002 Mar;39(1):1-33.
14. Kaur S and Singh S. Cause for Concern in
Punjab Villages. High Levels of Gutkha
Intake Among Students. Lifeline 2002;
7(January):3-4.
15. Sushma C, Sharang C. Pan Masala
Advertisements are Surrogate for Tobacco
Products. Indian J Cancer [serial online].
2005 [cited 2012 Feb 6];42:94-8. Available
from: http://www.indianjcancer.com/text.
asp?2005/42/2/94/16699
16. Tandon A. Tobacco-free Pan Masalas Found
High in Nicotine. The Tribune. 2011 Feb 22
[cited 2012 Feb 10]. http://www.tribuneindia.
com/2011/20110222/main7.htm
17. Verma S. Smoking Scenes: Information and
Broadcasting Ministry Blows Away Health
Ministry Notice. India Today. 2011 Dec 9
[cited 2012 Feb 20]. Available from: http://
indiatoday.intoday.in/story/i-and-b-ministrybacks-smoking-scenes-in-movies/1/163504.
html
18. Sinha DN, Gupta PC, Reddy KS, Prasad VM,
Rahman K, Warren CW, Jones NR, Asma S.
Linking Global Youth Tobacco Survey 2003
and 2006 Data to Tobacco Control Policy
in India. J Sch Health. 2008 Jul;78(7):368-
73.
19. Gangan S. Mumbai: Tobacco Shops Near Schools
on Hit List. DNA. 2011 Nov 10 [cited 2012
Feb 10]. Available from: http://www.dnaindia.
com/mumbai/report_mumbai-tobacco-shopsnear-schools-on-hit-list_1610225
20. Maharashtra Gets Over Rs. Lakh in Fine from
Anti-tobacco Drive. DNA. 2012 Jan 19 [cited
2012 Feb 10]. Available from:
http://www.dnaindia.com/mumbai/report_
maharashtra-gets-over-rs13-lakh-in-fine-fromanti-tobacco-drive_1496641
21. Sinha K. Survey Finds Tobacco Sold with
100m of Schools in 5 States. TNN. 2011
Nov 15 [cited 2012 Feb 10]. Available
from: http://articles.timesofindia.indiatimes.
com/2011-11-15/india/30400918_1_tobaccovendors-tobacco-products-advertisementand-regulation
22. Tobacco Ban Leaves Schools, Colleges
Bemused. Times News Network. 2011 Feb 15
[cited 2012 Feb 9]. Available from: http://
articles.timesofindia.indiatimes.com/2011-
02-15/bangalore/28541973_1_tobacco-bancigarettes-and-other-tobacco-tobacco-vendors
23. Arora M, Yadav A. Pictorial Health Warnings on
Tobacco Products in India: Sociopolitical and
Legal Development. National Medical Journal
of India. 2010 [cited 2012 Feb 13];23(6):
357-359. Available from: http://www.nmji.
in/archives/Volume-23/Issue-6/Medicine-and-
Societies-II.pdf
24. Reddy KS and Gupta PC, editors. Report on
Tobacco Control in India. New Delhi: Ministry
of Health and Family Welfare, Government of
India; 2004 [cited 2012 Feb 6]. pp 153-
167. Available from: http://mohfw.nic.in/
WriteReadData/l892s/911379183Tobaccocontr
oinIndia_10Dec04.pdf
About the Author
Dr. Prakash C. Gupta is Director, Healis
Sekhsaria Institute for Public Health
Cecily S. Ray is Sr. Scientific Officer and
Arpita Singh is Legal Officer at Healis Sekhsaria
Institute of Public Health
n 7
January - March & April - June 2012

The National Tobacco Control Programme
Critical Review and Next Steps
Introduction
Over the years, India has played a leadership
role in tobacco control. With growing
evidence of the hazards of tobacco use,
the Government of India enacted various
legislations along with tobacco control
measures 1 - the Cigarettes Act (Regulation
of Production, Supply and Distribution) in
1975 2 , and the Cigarettes and Other Tobacco
Products (Prohibition of Advertisement
and Regulation of Trade and Commerce,
Production, Supply and Distribution) Act
(COTPA), in 2003. The provisions under
the Act include prohibition of smoking in
public places, prohibition of advertisements
of tobacco products, prohibition on sale of
tobacco products to and by minors, ban on
sale of tobacco products within 100 yards of
all educational institutions and mandatory
display of pictorial health warnings on
tobacco product packages. The law also
mandates testing all tobacco products for
their tar and nicotine content. 3
In 2004, the Government ratified the WHO
Framework Convention on Tobacco Control
(WHO FCTC), which enlists key strategies
for reduction in demand and reduction in
supply of tobacco. Some of the demand
reduction strategies include price and tax
measures and non price measures (statutory
health warnings, comprehensive ban on
advertisements, promotion and sponsorship
of tobacco, and tobacco product regulation
etc). The supply reduction strategies
include combating illicit trade of tobacco,
providing alternative livelihood to tobacco
farmers and workers and regulating sale of
tobacco products to and by minors. 4
For the Millions
n 8
Dr. Jagdish Kaur
However, enacting the COTPA and ratifying
the WHO-FCTC in 2004 could not translate
into visible and effective tobacco control
policies at the ground level in India. The
main reasons for this abysmal state of
affairs included long-drawn litigations
in which the government is embroiled in
with the tobacco industry and industry
interference at policy level.
The National Tobacco Control
Programme (NTCP)
There are many countries where governments
have worked together with committed
individuals, health professionals and
civil society groups to define, advocate,
legislate and implement effective tobacco
control policies. Brazil is an example of a
high prevalence nation, which successfully
implemented the National Tobacco Control
Programme way back in the 1980s. The
NTCP was established in Brazil in 1987,
and this was the first time Brazilian people
were officially given information about
the damage caused by tobacco and the
importance of reducing its use. 5
The National Tobacco Control Programme
(NTCP) in India was conceived keeping
in view the provisions under COTPA, 2003
and the spirit of WHO FCTC, by bringing
together appropriate and effective tobacco
control strategies. The main objective
was to bring about greater awareness
regarding harmful effects of tobacco, and
institute a regulatory mechanism including
laboratory facility, effective monitoring and
implementation of anti-tobacco initiatives
at state/district level. 6

Sl. No. Name of the State/UT Name of Districts
1. Assam Kamrup, Johrat
2. West Bengal Cooch Behar, Murshidabad
3. Madhya Pradesh Khandwa, Gwalior
4. Uttar Pradesh Lucknow, Kanpur
5. Delhi New Delhi, East Delhi
6. Rajasthan Jaipur, Jhunjhunu
7. Gujarat Vadodara, Sabarkanta
8. Tamil Nadu Kancheepuram, Villupuram
9. Karnataka Bengaluru (U), Gulbarga
10. Nagaland Kohima, and Dimapur
11. Tripura West Tripura, Dhalai District
12. Mizoram Aizawl, and Lunglei
13. Arunachal Pradesh West Kameng & East Siang
14. Sikkim East Sikkim & South Sikkim
15. Jharkhand Dhanbad and Jamshedput
16. Bihar Patna and Munger
17. Uttarakhand Dehradun and Tehri Gadhwal
18. Maharashtra Thane and Aurangabad
19. Goa North Goa and South Goa
20. Andhra Pradesh Guntur and Hyderabad
21. Odisha Cuttak and Khurda
The programme was launched on a pilot
basis at the beginning of 11 th Five Year
Plan in 2007-08 in 9 states and 18
districts (2 districts each). In 2008-09,
it was expanded to cover 12 more states
and 24 districts. In the first phase, tobacco
control cells were established at the state
and district level. However, in the second
phase, only district tobacco control cells
were supported. At present, the programme
is under implementation in 21 out of 35
States/Union territories in the country. In
total, 42 districts are covered by NTCP at
present.
The implementation of NTCP was a major
leap forward for India as for the first time
dedicated funds were made available to
implement tobacco control strategies at
the central, state and substate levels. 7
The main components of the
NTCP are:
A. National level
I. Mass media campaign aimed at
increasing public awareness on harmful
effects of tobacco use and tobacco
smoke, and the existing tobacco
control laws and policies. The campaign
also intended to raise the motivation
for tobacco cessation by bringing in
desired behaviour change.
II. Establishment of tobacco product testing
laboratories, to build regulatory capacity,
as mandated under COTPA, 2003.
n 9
January - March & April - June 2012

III. Mainstreaming the programme
components as part of the existing
health care delivery system under
the overall framework of National
Rural Health Mission (NRHM), to
ensure effective implementation and
sustainability of tobacco control
strategies.
IV. Research & Training on alternate crops
and livelihoods in collaboration with
other concerned nodal Ministries with
the objective to reduce the supply of
tobacco in the long run.
V. Monitoring and Evaluation including
surveillance e.g. Global Adult Tobacco
Survey (GATS) India.
B. State level
I. Establishment of Tobacco control
cells with dedicated manpower and
resources for effective implementation
and monitoring of anti tobacco laws
and initiatives at the state and sub
state level.
C. District level – the District Tobacco
Control programme consists of the
following components:
I. Training of health and social workers,
Self Help Groups (SHGs), NGOs, school
teachers etc in tobacco control
strategies.
II. Decentralized and need - based IEC (Information.
Education & Communication)
activities.
III. Setting up tobacco cessation facilities
at the district hospital level.
IV. School - based Tobacco Control
Programme.
V. Monitoring implementation of tobacco
control laws at the district and subdistrict
level.
For the Millions
n 10
The above components are described in
detail as follows :
i. Mass media - A well-designed public
education campaign that is integrated with
community and school-based programmes,
strong enforcement efforts, and cessation
support for users who want to quit, can
successfully counter the tobacco industry.
Such integrated programmes have been
demonstrated to lower smoking among
young people by as much as 40%. 8 During
the course of implementation of various
components of NTCP it was necessary to
have appropriate and effective training and
advocacy materials to facilitate capacity
building in tobacco control at state and
sub-state level. Some of these included a
training module for doctors, a guide for
school teachers, guidelines for treatment
of tobacco dependence, a training module
for health workers and guidelines for
tobacco free schools among others. These
can be accessed at: http://www.whoindia.
org/en/Section20/Section385_1112.
htm; and http://www.whoindia.org/en/
Section20/Section25.htm).
Most tobacco users are unaware of the
harms caused by tobacco and a hardhitting
mass media campaign can reduce
tobacco use 9 . Paid mass media campaigns
for tobacco control can play an important
role in comprehensive tobacco control. They
can set the agenda for passage of stronger
tobacco control policies by building public
opinion through consumers, opinion
leaders, and policymakers about tobacco
control issues. 10 An intensive national
level mass media campaign, therefore, is
a major initiative under NTCP. For the first
time under the programme, anti-tobacco
messages (TV/radio), specifically targeting
tobacco products used in the country, were
developed, field-tested and translated into

18 languages for the national campaign.
Since 2008, at least three campaigns on
television, radio and print have been
conducted each year, with considerable
government commitment to media
buying. 11 Guided by the existing evidence
on effective anti-tobacco messaging and
in collaboration with the World Lung
Foundation, the Government of India
embarked in 2009, the first ever mass
media campaign on the harmful effects of
smokeless tobacco use. 12 An evaluation of
the campaign revealed that despite their
rural and low SES status, most smokeless
tobacco consumers were effectively reached
through mass media, especially television.
Also, under the programme, a first ever
campaign on the harmful health effects of
bidi, was developed and aired at national
level in 2011. In addition, this phase also
highlighted the cardiovascular effects of
tobacco use (other than cancer which was
the focus of earlier campaigns) for the
first time in the national campaign.
ii. Product Testing - The COTPA mandates
testing of all tobacco products for their tar
and nicotine content and displaying the
levels on tobacco product packages. Over
the years, as different provisions under
the law were notified, this is the only
provision which could not be implemented.
Although the Central Tobacco Research
Institute, Rajahmundry, Andhra Pradesh
and Bidi Station, Anand, Gujarat, under
the Ministry of Agriculture, have capacity
and capability to test tobacco products,
their overall mandate is to promote
tobacco products in various ways. In the
light of Article 5.3 of WHO FCTC, these
labs could not be used for regulatory
purposes for this reason. The Government
has identified some drug and food labs
under the Ministry of Health & Family
Welfare, and is taking steps to upgrade
these labs for testing tobacco products.
However, availability and use of diverse
products poses a major challenge to test
these for harmful contents and emissions
as per existing methods. Standardized and
validated methods for testing harmful
contents and emissions are available
mainly for cigarettes. The standards for
testing bidis and smokeless tobacco
products, developed by the Bureau of
Indian Standards (BIS) are influenced by
the tobacco industry.
iii. Mainstreaming of NTCP - The
Government of India is implementing
several national programmes for prevention
and control of communicable and noncommunicable
diseases. National Rural
Health Mission (NRHM) is a flagship
programme of the government which enjoys
political commitment at the highest level
to improve the overall health status of
rural masses. The NTCP was approved by the
government with the mandate to bring its
components under the overall framework
of NRHM over a period of time, with the
objective to mainstream tobacco control
policies and bringing in synergy with the
ongoing initiatives of the government.
Integration of tobacco control policies
with NRHM will also prove to be effective
in establishing monitoring mechanism for
NTCP at no additional cost.
iv. Research and Training - India being
the second largest producer of tobacco,
the government is bound to address
supply side issues of tobacco control. The
need to rehabilitate millions of tobacco
growers, farm workers, bidi rollers, sellers
and retailers cannot be overlooked in the
zeal and enthusiasm to implement tobacco
control strategies. While implementing
n 11
January - March & April - June 2012

strategies to reduce the demand of
tobacco, the ways and means for providing
economically viable alternative livelihoods
to tobacco workers need immediate
attention. As of today, the cultivation of
FCV tobacco (Flue-Cured Virginia variety)
is supported and regulated by the Tobacco
Board under the Ministry of Commerce. FCV
cultivation provides high net gains to the
farmers with export potential and there
are few alternative crops available to FCV
tobacco. Non-FCV tobacco (bidi/hukka/
chewing tobacco) constitutes almost half
the tobacco grown in the country, but is
not as lucrative as FCV. Some evidence
already exists on possible alternative
crops and livelihood options to non-FCV
tobacco. The Ministry of Health decided
to lead a pilot project on alternate crops
to non- FCV tobacco varieties in 2008-09
implemented by CTRI, Rajahmundry and as
per the preliminary report submitted by the
institute, economically viable options to
bidi/hukka/chewing tobacco are possible
in different agro-ecological zones in the
country. Meanwhile, taking further the
commitments to reduce the area under
tobacco cultivation, as mandated under
Articles 17, 18 of WHO FCTC, for the first
time in the history of tobacco control
in India, the Tobacco Board organized
sensitization meetings for FCV tobacco
growers in Guntur (Andhra Pradesh) and
Mysore (Karnataka) in 2011, to raise
awareness on provisions under WHO FCTC
and the need to shift over to alternative
livelihoods. The Board has also taken
stringent steps to limit the cultivation of
FCV tobacco to prescribed limits and has
taken punitive action against the farmers
violating such provisions.
v. The Global Adult Tobacco Survey
- GATS was also undertaken as part of
NTCP, which was the first ever dedicated
For the Millions
n 12
household survey to study the prevalence
of tobacco use among adults, exposure to
second hand smoke, cessation and other
tobacco-related indicators in the country.
The findings of the survey revealed that the
smokeless tobacco is the most prevalent
form of tobacco use among adults and also
provided baseline data to guide policies in
the country.
B. To strengthen anti-tobacco activities at
the state level, support was provided for
manpower and infrastructure to establish
State Tobacco Control Cells in 9 states in
the first phase of NTCP. One programme
assistant and one data entry operator were
provided for each of the states. However,
the establishment of State Tobacco Control
Cells was not supported for the 12 states
in the second phase of the pilot NTCP.
C. Under the District Tobacco Control
Programme, funds were provided to set
up District Tobacco Control Cells in each
of the 42 districts covered under the
programme. The support included hiring
of human resource in the form of one
Psychologist/Counselor, one social worker
and one data entry operator for each
district. Funds were also provided for the
infrastructure and identified activities to
be undertaken at the district and subdistrict
level. This was the first time that
cessation activities were expanded to be
made available at the district hospital
level. The establishment of District Tobacco
Control Cells also provided an opportunity
to integrate tobacco control with other
national health programmes and NRHM.
A sum of Rs 182 crore was approved for the
NTCP for the 11 th Five Year Plan. However
Rs 195 crore was actually budgeted from
2007 to 2012, out of which Rs 145 crore
was actually released. The programme

spent nearly Rs.112 crore over a period
spanning almost five years till the time of
writing this article. A major share of this
spending was on the national level mass
media campaign. However, expenditure on
establishment of tobacco testing labs was
nil.
Other Initiatives to Support
NTCP
Some crucial initiatives for tobacco
control, funded by the WHO and other
partners under the BI (Bloomberg
Initiative) lent timely support to NTCP
and strengthened implementation of its
various components:
• Smoke free initiatives by the
UNION (International Union Against
Tuberculosis and Lung Diseses) were
supported in various cities including
Delhi, Shimla, Kottayam, Ernakulam,
Ahmedabad, Mumbai, Chennai,
•
Bhubaneshwar and Budgam. Sikkim
was declared the first Smoke free state,
followed by Mizoram.
A series of national and regional level
advocacy workshops were organized
during 2009-11 across the country to
sensitize law enforcers and stakeholders
from different departments - Agriculture,
Customs, Labour, Education, Forest,
Tribal, Health, Transport, Railways,
Police and Judiciary - emphasizing
enforcement of COTPA, FCTC and
•
implementation of NTCP at state and
sub-tate level.
Taking proactive action on the tobacco
tax front due to continuous advocacy
by civil society, 12 state governments
raised VAT (value added tax) on
different tobacco products during
2010-12, bringing in the commonly
used tobacco products e,g. bidi and
smokeless tobacco under this purview.
• WHO provided support for appointing
state consultants in 12 states
under NTCP, which strengthened
programme implementation and eased
communication between the central
tobacco control division, state and
district tobacco control cells.
• Training of staff, consultants and
•
state/district focal points under NTCP
was also upported by the UNION and
John Hopkins School of Public Health
(USA).
Civil society and NGOs, supported by
the BI were effective in monitoring
law implementation and kept a
watchful eye on violations and industry
actions.
Monitoring NTCP
To regularly monitor NTCP at state and
sub-state level, various tools were devised
to report violations and action taken on
COTPA provisions:
• Steering Committees under Section
•
5 of COTPA were constituted at the
national, state and district level to
monitor violations and take cognizance
of violations.
Regular review meetings for NTCP were
undertaken at the national and regional
level with support from Government of
India-WHO Tobacco Free Initiative and
the UNION.
• A Toll-Free National Helpline (24x7)
(1800-110-456) in collaboration
with WHO was widely publicised to
encourage reporting of violations.
• A process of regular feedback to
states was established with follow
up on action taken by the relevant
authorities.
However, lack of a consistent monitoring
mechanism and dedicated manpower for
n 13
January - March & April - June 2012

NTCP at the national and state level acted
as a major barrier.
Current Status
An internal review of NTCP reveals that:
•
•
•
•
•
•
•
•
•
Out of 21 states, at present 16
(76%) have established mechanism
for enforcement of smoke-free rules,
however only 10 (47.6%) states were
successful in collecting fines for
violations.
Many states faltered in submitting
regular reports and only 55% of the
staff positions could be filled at the
state/district level.
West Bengal, Maharashtra and Jharkhand
failed to recruit any staff till the last
year of the 11th Five Year Plan, so
tobacco control activities under NTCP
suffered a major setback in these three
states.
Only 3 states (14.2%) collected fines
for the violation of provisions under
Section 5 (TAPS).
Enforcement of ban on sale of
tobacco products to minors and ban
on sale of tobacco products within
100 yards of educational institutions
also remains largely ineffective in
many states, with only 8 (38%)
states taking action for violating
these provisions.
Only 4 states (19%) had collected fines
for violating provisions under Section 7
(pictorial health warnings).
16 states (76%) have started tobacco
control activities in schools.
29 out of 42 districts (69%) have
tobacco cessation facilities available
at the district hospital under the
programme.
Almost all states barring West Bengal
For the Millions
n 14
and Jharkhand conducted trainings
of various stakeholders under the
programme.
Challenges
•
•
•
The availability, affordability and easy
access to a plethora of low-cost and
locally produced tobacco products in
the country has always remained a
major challenge to law enforcement
and overall tobacco control initiatives.
The findings of GATS India, 2010
revealed that high use of smokeless
tobacco among adults is a serious
cause of concern. Existing scientific
evidence from various parts of the
country reveals prevalence of harmful
effects of chewing tobacco in young
children. An evolving epidemic of
oral sub-mucous fibrosis attributed to
gutka use has been documented among
youth, with a resultant increase in oral
cancer in lower age groups. 13 Another
study also established appearance of
symptoms of cancer at an early age in
youngsters. 14
Although the central government
has the power to enact laws, the
implementation largely remains with
the state governments. States have
limited capacity to implement tobacco
control initiatives; it is up to the
state governments to determine their
priorities for public health programmes
and actions. In view of the high infant
and maternal mortality, and prevalence
of various communicable diseases, the
issues concerning non-communicable
diseases and associated risk factors
were never a priority with many state
governments.
India is the second largest producer
of tobacco. Millions of farmers and
tobacco workers are involved in tobacco
cultivation and manufacturing. The

•
•
•
issues concerning their rehabilitation
and shifting to economically viable
alternate livelihoods need simultaneous
attention in tobacco growing states.
Like in many other countries, tobacco
control in India has always been led
by the Ministry of Health, although
the issue concerns a large number of
ministries/departments like agriculture,
education, commerce, welfare,
industry, environment, information &
broadcasting, rural development etc.
Lack of cooperation and coordination
among them is also a crucial
challenge.
No progress on the establishment of
tobacco testing labs in the country
hinders regulation of contents and
emissions of a large number of tobacco
products marketed in the country.
The states have failed to effectively
utilize the dedicated funds provided for
tobacco control activities under NTCP in
a timely manner. Non-recruitment
of staff by almost half of the states
has resulted in delay and nonimplementation
of various components
of the programme. States are also
sluggish in the timely submission of
progress reports hindering effective
monitoring.
Conclusion
Despite all odds and setbacks, NTCP has
provided a platform for enforcing and
monitoring implementation of COTPA
provisions and other tobacco control
strategies. During the last four years,
there has been considerable rise in public
awareness on issues related to tobacco
control. Key stakeholders have been
sensitized and trained in tobacco control
and some states have taken initiatives
beyond NTCP by raising VAT on tobacco
products to increase prices and thereby
reduce use. It is also significant to note
that learning from the NTCP and with the
support of partners like the Bloomberg
Initiative and Gates Foundation, many non-
NTCP states have effectively implemented
tobacco control initiatives e.g. Himachal
Pradesh, Kerala, Jammu & Kashmir, Haryana
etc.
Next Steps
The Government on its part has been serious
in integrating relevant health programmes
at different levels to prevent duplication
of efforts and optimal utilization of
resources. Recently, the Working Group
on Non-Communicable Diseases of the
Planning Commission for 12 th Five Year
Plan recommended uniform coverage of all
the districts under NTCP and the National
Programme for Control of Cancer, Diabetes,
CVD and Stroke (NPCDCS). 15 Merging the
components of NTCP with NPCDS will provide
an established platform and requisite
infrastructure for implementing tobacco
control strategies at the grassroot level.
The methodology of the success of the
national mass media campaign under
NTCP can be replicated into strengthening
awareness generation campaigns at the
sub-national level. A large network of
medical, dental colleges and professional
bodies can be involved in these campaigns
for effective outreach and sustainability.
Tobacco control should be incorporated
in the course curriculum of undergraduate
medical and dental education. Capacity of
the states needs to be built to implement
tobacco control efforts through the existing
health care delivery system and multisectoral
coordination. These initiatives
will ensure wider availability of tobacco
cessation facilities.
n 15
January - March & April - June 2012

To address the issues concerning alternate
crops/livelihoods, strong partnerships
and collaborations are required to be
formed with the Ministry of Agriculture
for formulating policies to reduce area
under tobacco cultivation and facilitating
shifting over of tobacco farmers to other
alternate crops in a phased manner. The
awareness generation campaigns in the
tobacco growing states should include
sensitization and education programmes
for the farmers. The Tobacco Board
of India must be persuaded to bring
in requisite changes in their existing
policies to meet the obligations under
Articles 17, 18 of WHO FCTC. The efforts
to establish tobacco testing labs and a
regulatory mechanism must gain speed
to complete the work in a time bound
manner.
The monitoring of NTCP at various levels
needs to be strengthened by setting up a
workable mechanism for timely and regular
submission of progress reports.
References
1. Rao V, Chaturvedi P. Tobacco and Health in
India. Indian J Cancer 2010;47 Suppl 1:3-8.
2. Government of India. The Cigarettes Act
(Regulation of Production, Supply and
3.
Distribution) 1975.
The Cigarettes and Other Tobacco Products
(Prohibition of Advertisement and regulation
of Trade and Commerce, production, Supply and
Distribution) Act, 2003; An Act enacted by the
Parliament of Republic of India by notification
in the Official Gazette. (Act 32 of 2003).
4. World Health Organization (WHO). Framework
Convention on Tobacco Control, 2004.
5. Government Leadership in Tobacco Control:
Brazil Experience in J D Beyer and Linda
W Brigden (Edited) Tobacco Control Policy -
Strategies, Successes and Setbacks. 2003
For the Millions
n 16
6. RK Srivastava, Jagdish Kaur. Facing the
challenge of tobacco in India- National Tobacco
Control Programme. J of Postgraduate Medical
Education, Training & Research Vol. IV, No. 1-5,
Jan-Oct 2009:3-6. Editorial
7. Kaur J, Jain DC. Tobacco Control Policies in
India: Implementation and Challenges. Indian J
Public Health 2011;55:220-7
8. Rooban T, Kumar M, Ranganathan K. Reach of
mass media among tobacco users in India: A
preliminary report. Indian J Cancer 2010;47
Suppl 1:53-8.
9. WHO report on the Global Tobacco Epidemic.
Warning about the dangers of tobacco. 2011.
10. National Cancer Institute Tobacco Control
Monograph No. 19. The Role of the Media in
Promoting and Reducing Tobacco Use. US
Department of Health and Human Services.
National Institutes of Health. 2008.
11. Sandra Mullin, Vinayak Prasad, Jagdish kaur,
Tahir Turk. Increasing Evidence for the Efficacy
of Tobacco Control Mass Media Communication
Programming in Low- and Middle –Income
Countries. Journal of Health Communication,
16:49-58,2011.
12. Murukutla M, Turk T, Prasad CVS, Ranjana S,
Kaur Jagdish. Results of a national mass media
campaign in India to warn against the dangers
of smokeless tobacco (Published online on April
20, 2011 as 10.1136/tc.2010.039438 in Tobacco
Control (BMJ)
13. Jacob Kuruvilla. Utilizing dental colleges for the
eradication of oral cancer in India. Indian J of
Dental Research. 2008.vol.19:4;349-353
14. Babu S, Sesikeran B, Bhat RV. Oral Fibrosis
among teenagers chewing tobacco, areca nut
and pan masala. Lancet 1996;348:692.
15. Report of the Working Group on Non Communicable
Diseases for 12th Five Year Plan, Planning
Commission of India. 2011 (unpublished).
About the Author
Dr. Jagdish Kaur is Chief Medical Officer,
Directorate General of CGHS, Ministry of Health
& Family Welfare, Government of India
(Disclaimer – the views expressed by the author are her own, and not necessarily of the department)

Background
Tax Advocacy in Tobacco Control:
Scope and Opportunities
India is the second largest producer and
consumer of tobacco, after China. As per
the Global Adult Tobacco Survey-India
(GATS 2010) conducted in the age group
15 and above, over 35% of the population
in India consume tobacco, with 47% males
and 20.8% females consuming some form of
tobacco. As per newer studies, nearly one
million deaths annually can be attributed
to smoking alone in the last decade and
majority of these deaths will occur in
the most productive age group i.e. 30-69
years. (Jha et al 2008). Tobacco use has
also been identified as the risk factor for 6
of the 8 leading causes of death and 40%
of new non-communicable diseases can be
directly attributed to it. Tobacco use also
imposes huge costs to the economy, as per
the health cost study conducted by Indian
Council of Medical research (ICMR), in 1997-
98 and extrapolated to 2002-03. The cost
of treatment of just 3 diseases caused by
Praveen K. Sinha, Seema Gupta and Bhavna B. Mukhopadhyay
tobacco (Cancer, Lung Disease and COPD)
is over Rs. 30,000 crores, which accounts
for roughly 25% of all public spending on
health. There are also independent studies
according to which tobacco consumption
impoverishes roughly 15 million people
annually in India.
Tobacco also poses other social costs which
are not just paid by governments. A high
proportion of costs is borne by individuals
as tax paid on tobacco products is paid by
ill-informed and addicted users (the bearers
of social costs) rather than by the tobacco
industry (the prime source of these costs).
Taxation on Tobacco Products:
an Effective Means to Reduce
Tobacco Use
According to the WHO-FCTC, increasing the
price of tobacco through higher taxes is
the single most effective way to decrease
High level buy-in from Chief Minister and MLAs of Andhra Pradesh
n 17
January - March & April - June 2012

consumption and encourage tobacco users
to quit. Article 6 of the FCTC recommends
parties take into account tax policies
and price policies as part of their overall
national health policy. WHO recommends
that all governments should raise taxes, all
tobacco products should be taxed similarly
and regularly adjusted for inflation. In
addition, ‘R’ of the WHO evidence-based
MPOWER lays stress on raising taxes as
the most effective strategy among the six
strategies to reduce tobacco use. There
is also a growing body of evidence to
suggest that the most effective method to
reduce tobacco consumption is to increase
the price through tax increases. 1 Higher
tobacco prices encourage cessation among
users, prevent initiation among potential
users, and reduce the quantity of tobacco
consumed among continuing users. 2
Higher taxes are also particularly effective
in reducing smoking among vulnerable
populations, such as youth, pregnant
women, and low-income users. 3,4,5. Price
increase works well with other methods
of tobacco control like complete bans
on smoking in public places; prominent
graphic warning labels; public education
campaigns that warn people about the
dangers of tobacco use; complete bans on
tobacco advertisement and promotion; and
support for smokers trying to quit. (Jha
and Chaloupka 1999).
Studies from high income countries show
that a 10% increase in cigarette price
decreases consumption by about 4%. The
available data also indicates that the
consumption in low and middle income
countries are more responsive to price.
Studies of price elasticity in India find
that a 10% increase in tobacco prices
is estimated to reduce bidi consumption
by 9.1% and cigarette consumption by
2.6%. 6
For the Millions
n 18
history of Tobacco Taxation in
India
To understand taxation in India, it is
important to look at the patterns and
trends of tobacco taxation over the last
several decades. Excise Duty on tobacco
was introduced in 1943 through the
Tobacco Excise Duty Act, 1943 which was
later merged with the consolidated Central
Excise and Salt Act, 1944. Unmanufactured
tobacco was subject to excise duty till
1978-79 and the Central Board of Excise
and Customs had built up a network of
excise range offices in the tobacco belts
of the country to keep a close watch over
the area, production and movement of
tobacco; number of growers and curers and
quantity of tobacco cleared for domestic
consumption. With the abolition of the
excise duty on unmanufactured tobacco in
the Finance Bill 1979, the Central Board
of excise and customs gradually withdrew
their field staff from the tobacco growing
areas.
Tobacco taxation in India is a complex
issue, since the Indian tobacco market is
flooded with a plethora of tobacco products
in smoking as well as smokeless forms. Like
many taxation policies in India, it reflects
years of accumulated influences, lobbying,
and exemptions and in some cases, even
attempts to do social good. Tobacco is
subject to a range of taxes imposed by
the Government at the central and state
levels. The central government imposes
duties in the form of central excise on sale
of different tobacco products, a surcharge
towards National Calamity Contingency
Fund (NCCF) and special excise duties.
Since 2005-06, additional duties are also
levied on pan masala and other tobacco
products to partly finance National Rural
Health Mission (NRHM). 7

Most smoked tobacco products in India
are subject to specific excise taxes that
are levied as rupee amounts per 1000
sticks. However, the reality is that even
though most tobacco products are taxed,
these are lowest for the forms of tobacco
that are most commonly used — bidis,
for instance, are a particularly notable
instance of under-taxed tobacco products.
The specific taxes on smoked tobacco
products vary by product category and
tier, and are particularly low for bidis.
Most non-smoking tobacco products, in
contrast, are subject to ad valorem excise
taxes, levied as a percent of the retail
price.
Pattern of Taxation Structure of
Tobacco Products8 Cigarettes
For cigarettes, the excise rates vary by
the length of the cigarette and are higher
CIGARETTES
Tariff (Length in mm)
for filter than for non-filter cigarettes.
Currently there are over 6 slabs for cigarette
taxation.
Bidi
India imposes specific excises (per 1,000
sticks) on both bidis and the rates depend
on whether the bidis are hand-made or
machine-made. Hand-made bidis are taxed
at a lower rate than machine-made bidis.
About 98% of the bidis are hand-made. In
addition, bidis produced by manufacturers
producing less than 2 million bidis a year
are exempt from excise duty.
Gutka
The general rate of excise duty for pan
masala containing tobacco, commonly
known as gutka is 60% ad valorem.
However, gutka manufactured in pouches
with the aid of packing machines is subject
to compounded levy scheme wherein the
rates of duty are based on the number of
Customs Duty
(Ad valorem)
24022010 NON FILTER

operating machines installed in the factory
premises.
The rates of duty are as under:
S.
No.
Retail
Sale Price
(per
pouch)
For the Millions
n 20
Rate of Duty Per
Packing Machine Per
Month
(Rs. in lakh)
Pan
masala
(1) (2) (3) (4)
1. Up to
Rs. 1.00
2. From
Rs. 1.01
to
Rs. 1.50
3. From
Rs. 1.51
to
Rs. 2.00
4. From
Rs. 2.01
to
Rs. 3.00
5. From
Rs. 3.01
to
Rs. 4.00
6. From
Rs. 4.01
to
Rs. 5.00
7. From
Rs. 5.01
to
Rs. 6.00
8. Above
Rs.6.00
9.25 12.50
14 19
18 24
26 36
34 47
43 59
51 70
50
+ 8.36
* (P - 6),
where P
represents
retail sale
price of
the pouch
Pan
masala
containing
Tobacco
69 + 11.45
*(P - 6),
where P
represents
retail sale
price of
the pouch
Advocacy for Increasing Taxes
Across All Tobacco Products
In recent years in India, state governments
have displayed political willingness and
ability to tax tobacco, yet, taxes on
tobacco were only marginally increased.
In particular, in year 2007-2008 states
like UP, Bihar, AP and MP which are hubs
of tobacco production, bidi rolling and
manufacturing, increased taxes and then
rolled back due to pressure from tobacco
industry lobbies. Even levies like entry
taxes were subsequently abolished due to
vested interests.
VHAI, its state partners and other civil
society organizations, in the beginning
of 2010, began an earnest and consistent
advocacy campaign for increasing taxes on
tobacco products, specially because, bidis in
most states was exempt and out of the tax
ambit. Political leaders, policymakers and
senior bureaucrats from the state revenue
and finance departments were approached
over several months and commitment was
sought from the highest levels. Most states,
after persistent efforts, began to show
concern about the increased prevalence
of tobacco use over the last few years in
their states and were gradually convinced
about the public health as well as revenue
benefits of a tax increase. The result was
that 11 states increased Value added Tax
( VAT ) on tobacco products and many of
them for the first time included bidi in the
tax net. The best practise model in this
advocacy campaign has been Rajasthan,
which increased VAT on all tobacco products
from 20% to 40%. Other state governments
which increased VAT on tobacco products
during the last year include Jammu &
Kashmir, Himachal Pradesh, Gujarat, Odisha,
Tamil Nadu, Assam, Andhra Pradesh, Kerala,
Madhya Pradesh and Delhi.

A Glimpse of the Tax Increase in 11 states in 2011-12
S. No State/UT VAT
Cigarette Bidi Smokeless
2010-11 2011-12 2010-11 2011-12 2010-11 2011-12
1 Tamil Nadu 12.5% 20% 0% 20% 12.5% 20%
3 Kerala 12.5% 20% 0% 20% 12.5% 20%
4 Rajasthan 20% 40% 20% 40% 20% 40%
6 Gujarat 20% 25% 20% 25% 20% 25%
7 Himachal Pradesh 13.75% 20% 4% 13.75% 13.75% 20%
8 Assam 13.5% 20% 13.5% 20% 13.5% 20%
9 Odisha 12.5% 25% 0.0% 10% 12.5% 25%
10 J&K 13.5% 25%* 0% 25%* 13.5% 25%*
11 Andhra Pradesh 14.5% 25% 0% 0% 14.5% 25%
* J&K increased an additional 5% in the year 2012-2013 across all tobacco products making them the
second best practice state after Rajasthan. J&K taxes are now at 30% !
Challenges and Concerns of
Tobacco Taxation
Although taxes on tobacco products are
definitely on the rise in many states in
the last one year, yet, tobacco taxation
still remains a promising and underutilized
policy intervention for overall tobacco
control initiatives in India. Some of the
key concerns are as follows:
• The imposition of tax on tobacco
is recognized as an effective public
health tool to curb its consumption.
Unfortunately, the current taxation
policy on tobacco is unfair to the poor,
as it allows easy access of cheaper
cigarettes and bidi due to lower/
negligible tax. Duty raise on unfiltered
cigarettes to the same level as filtered
cigarettes is necessary as unfiltered are
more harmful.
• There are six different slabs of central
excise duty rates for cigarettes which
need to be changed. The existing levels
of taxation on bidi are abysmally low,
thereby facilitating tobacco users
to shift their consumption pattern
•
•
•
•
depending upon their ability to pay the
price. Therefore, the taxation structure
needs to be made rational and uniform
for all tobacco products to avoid any
distortion in consumption.
Bidi units producing less than 2 million
sticks are exempted from excise; there
is distinction between hand-made, and
machine-made bidis, majority of the
bidis (98%) being hand-made. This
exemption coupled with the distinction
between hand-made and machine-made
bidis should be done away with as this
is easily circumvented by the industry.
For civil society organizations dealing
with public health, it has been a big
challenge to convince the government
that tax increase saves lives and also
generates revenues for the state.
Non-availability of ready-made data
on tax collected for different tobacco
products is the major challenge to
analyze the actual situation of tobacco
taxes in the state.
Since tobacco sale is not regulated,
there is no data regarding the number
of vendors.
n 21
January - March & April - June 2012

•
•
There is also a paucity of data on the total
expenditure on tobacco-related diseases
and lives saved at the state level.
After the tax hikes were announced in
different states, the tobacco lobby tried
to put pressure on the government to
roll back the hikes. The argument given
by them was that the hikes would lead
to illicit trade. This sort of relentless
pressure created by the industry poses
a continuing challenge.
Learnings
For NGOs and public health organizations,
mounting a tax advocacy campaign meant
venturing into an unchartered territory
without any previous experience on taxation.
It was essential to build capacity and an
understanding of the taxation pattern in
India with special focus on tobacco taxation.
A clear strategy and steps to be followed
were devised. Overall, the campaign has
provided some very useful learnings:
• Developing a stakeholder analysis
•
of the key elected representatives
and bureaucrats is crucial to identify
potential partners and allies for any
campaign/advocacy initiative.
Advocacy efforts on tax should be
backed by local evidence, to convince
policymakers about number of lives
that can be saved if tobacco products
register a substantial price increase.
• While advocating with a particular state
government, it is very important to
analyze the tax trends and the revenue
generated from the taxation of tobacco
products in the state for the last four
years, to understand the pattern. In
addition, it is important to have the same
figures for the neighbouring states.
• It is most important to identify and
frame the key state-specific ‘ASKS’ for
giving representations to policy makers
and bureaucrats.
For the Millions
n 22
•
State-specific factsheets on the need
for tobacco taxation, giving some of the
national/state level figures using the GATS
data can be a very handy tool. Statistics
need to be presented in a lucid, userfriendly
manner with graphics to catch
the attention of policymakers within the
short span of the meeting time or while
submitting representations.
References
1. World Health Organization (WHO). WHO Report
on the Global Tobacco Epidemic, 2008: The
MPOWER Package. Geneva: 2008. Available from:
http://www.who.int/entity/tobacco/mpower/
mpower_report_full_2008.pdf.
2. Ross H, Chaloupka FJ. Economic Policies for
Tobacco Control in Developing Countries.
SaludPublica Mex. 2006;48Suppl 1:S113-20.
3. Chaloupka F, Pacula R. An Examination of
Gender and Race Differences in Youth Smoking
Responsiveness to Price and Tobacco Control
Policies. National Bureau of Economic Research;
1998. Available from: http://www.nber.org/
papers/w6541.pdf.
4. Ringel JS, Evans WN. Cigarette Taxes and
Smoking During Pregnancy. American Journal of
Public Health. 2001 November;91(11):1851-6.
5. U.S. Center for Disease Control and Prevention.
Responses to Increases is Cigarette Prices by
race/ethnicity, income, and age groups--United
States 1976-1993. Morbidity and Mortality
Weekly Report. 1998 July 31;47(29):605-9.
6. John RM, Rao RK, Rao MG, Moore J, Deshpande
RS, Sengupta J, Selvaraj S, Chaloupka FJ, Jha
P.The Economics of Tobacco and Tobacco Taxation
in India. Paris: International Union Against
Tuberculosis and Lung Disease; 2010.
7. Prabhat Jha, Emmanuel Guindon, Renu A
Joseph, A Nandi, Rijo M John, Kavita Rao,
Frank J Chaloupka, Jagdish Kaur, A Rational
Taxation System of Bidis and Cigarettes to
reduce Smoking Deaths in India, October, 15,
2011, VOL XLVI NO 42, EPW.
8. Rajya Sabha Starred Question Answered on
(30.08.2011)
About the Authors
Praveen K. Sinha is Consultant - Policy, Ministry of
Health and Family Welfare, Government of India
Seema Gupta is Regional Director, VHAI
Bhavna B. Mukhopadhyay is Executive Director,
VHAI

Introduction
Enforcing Smoke Free Rules:
Successes and Challenges
India is the second largest consumer of
tobacco products in the world. It is clear
that we need to heighten our concern
about tobacco usage being a leading
cause of death and debilitating disease
in our country. The increasing prevalence
of tobacco consumption among high risk
groups, including women and children and
exposure to secondhand smoke, either in
homes or in public places is a matter of
serious concern. About 10 million people
die every year from all the diseases caused
by tobacco in developed countries. Cigarette
smoking is responsible for as much as 90%
of all cases of lung cancer, 75% of chronic
bronchitis and emphysema, 25% of cases
of ischaemic heart disease in men under
65 years of age, as well as for cancers,
pregnancy and respiratory complications in
children from smoking families. This shows
Saju V. Itty, Itishree Kanungo, Ali Mohammed Mir, Narender Sharma
that smoke free environment is a strong
component of public health and no health
intervention will be complete without a
smoke free environment.
Efforts by public health organizations and
tobacco control activists over the last few
years have borne fruit to some extent.
Smoking is now more than just a health
issue and is a social issue. It is being seen
as a public nuisance and a practice that is
not socially acceptable. Passive smoking is
now known to be a sufficient risk to nonsmokers
to justify measures to protect them.
Smoking in the work place, or in public
spaces, is no longer a matter of individual
choice. It is a community decision and
societies are choosing health by coming
forward and declaring their jurisdictions as
Smoke free as in Bhubaneshwar, Chandigarh,
Shimla, Budgam, Kottayam and Ernakulam
Public event organised by J&K VHDA and District Administration to declare Budgam smoke free
n 23
January - March & April - June 2012

districts which have declared themselves as
smoke free. Sikkim has gone a step ahead
and declared the entire state as Tobacco
free.
Smoke free success is represented on one
side by effective enforcement of law and on
the other side by a positive civic sense to
comply with the laws. Enforcement of law
without people’s support may create conflict
in the society and tobacco companies
will manipulate this situation to promote
tobacco consumption. Mass movement and
mass campaign support tobacco control in
two ways. One, it helps to create awareness
on smoke free laws and hazards of tobacco
use. Secondly it brings the interest of
political leadership on the issue which is
responsible for the implementation and
enforcement of law.
Smoke Free Environment
The term smoke free deals with smoking
forms of tobacco and an environment
in which no one is forced to breathe
tobacco smoke is termed as a Smoke Free
environment or zone. It is considered
as the first step towards the control of
tobacco use, requiring compliance level in
terms of display of signage, keeping the
environment smoke free and a system of
violation reporting.
Key factors in the successful
implementation of smoke free law
The role of administration and political
leadership is very vital in smoke free efforts
to ensure compliance and sustainability.
Their commitment and vision reflects in the
process of institutionalization of tobacco
control efforts and its sustainability.
Thesuccess stories so far have all been
an outcome of integrated multi-sectoral
as well as sustained efforts over a period
For the Millions
n 24
of time. In different settings different
agencies/stakeholders took the lead role
highlighting the importance and role of
each one of them.
The model adopted for achieving smoke
free jurisdictions consist of certain integral
interventions/key methods:
I. Creating
Movement
Awareness for Mass
• Civil Society
• Media Campaign
II. Engaging Stakeholders
• General Public
• Public Place Managers
• Enforcement Officials (District
Administration,
Department etc.)
Police, Health
III. Enforcement of the Law
• Supporting Orders and Actions
• Banning Sale around Education
Institutions
• Ensuring provisions by Fine
•
•
Ensuring Compliance of the Smoke
Free Rules
Declaring Public Places Smoke Free
There was a well-structured collaboration
of government and civil society to carry
out these initiatives. Gradually the
partnership and collaboration spread
to other stakeholders like media, civil
society organizations, health institution,
other government departments and the
community members.
1. Creating Awareness for Mass
Movement
Advocacy Efforts
Studies indicate that effective
implementation of the law through
intensive advocacy campaigns have a
greater impact than focusing on individualcentric
measures. For smoke free, extensive

advocacy efforts have been initiated in all
settings with a focus on policy advocacy
with government officials and political
machinery for e.g. the Smoke Free Shimla
Campaign in 2007 was initiated with a
presentation of a memorandum to Governor
and Chief Minister. In Kerala, representations
were sent to the District Collector, Chief
Medical Officer, District Education Officer
and Panchayat officials. Meetings were set
up with Legislative Assembly Members,
Members of Parliament, Trade Union Leaders
and elected representatives of Panchayati
Raj Institutions. Continuous advocacy
helped in achieving the necessary outcome
with the active support of the District
Administration
Civil Society
Civil Society is the voice of the community.
A vibrant civil society coalition is necessary
to strengthen communication channels in
smoke free efforts. They are able to bring
the very latest developments in terms of
new legislation, new approach or new
achievement on the tobacco control front
to discussion tables at district, state or
regional level. These stakeholder networks
can apply oil whereever the machinery
needs it. The best practice model has
been depicted in Kottayam where the civil
society efforts demanded the same from
the administration.
Media Campaign
Media is an important ally for any advocacy
campaign to influence policymakers,
build opinion and garner support. It is
important to network with the English
and regional language media at the
onset of the campaign itself and keep
journalists updated with factsheets and
toolkits through the programme period. In
Kottayam, this proved extremely effective
to keep media interest in the campaign
alive and gradually build public support.
The visit of a senior journalist to Kottayam
from Outlook (Hindi) to do a feature also
made a huge difference in creating a wider
platform for the effort. In all smoke free
campaign efforts, media has been a major
player in carrying the campaign forward
and giving wide coverage to the issue.
Awards and commendations
Any form of recognition for interventions
ensures that we acknowledge their
contribution and motivate them to persist
their efforts. For e.g. On World No Tobacco
Day, 31 st May 2011, the State Government,
Odisha awarded 13 police officials for their
contribution in the effective implementation
of tobacco control laws and the Department
of Health and Family Welfare sanctioned a
cash award to the Police Commissionerate
for monitoring and enforcing COTPA.
Volunteers
A mass campaign cannot succeed without
the help of volunteers spread across
the campaign locations. It is helpful to
involve a large number of teachers, paramedical
students, National Service Scheme
volunteers, community group leaders,
student leaders and self-help group
members as volunteers to broad-base the
initiative.
2. Engaging Stakeholders
General Public
It is important to educate the public
as awareness is the first step to ensure
compliance to the law. Various interventions
for this have been adopted in different
settings: for e.g.-
• Mobile vans with public address system
going around the city – Collaborative
efforts by the Commissionerate Police
and VHAI-Aparajita sent a vehicle with
n 25
January - March & April - June 2012

a public address system that covered the
entire city including slum areas, public
places, streets and colonies spreading
awareness through announcements and
catchy slogans.
• Public Rallies – Rallies organized with
the help of civil society members,
corporate houses, youth, women,
media and police personnel can build
awareness through anti tobacco
messages on placards, slogans, street
plays etc. In Shahjahanpur district
of Lucknow in Uttar Pradesh, rallies
have proved successful for public
awareness.
• Film Screening - Films are a powerful
medium to sensitize the general public
on the health hazards of tobacco and
tactics of the bidi industry.
• Smoke Free Events –Smoke Free Events
•
can mobilize the public and important
stakeholders on key points on the
issue. The 71 st Assam Sahitya Sabha
in Golaghat was a Smoke Free Event
sensitizing over 1,000 people.
Sensitisation programmes in
Educational Institutions: Students
must be protected from the hazards
of tobacco use. They must also be
conscious about legal provisions of
tobacco control. The Department of
Education in Golaghat, Budgam and
Shahjahanpur have declared all the
education institutions under them as
‘Tobacco Free’ in order to protect their
students not only from SHS but also
tobacco initiation and the law. Similar
commitment is being shown in districts
of Srinagar, Jagatsinghpur and Khurda,
Jaipur and Lucknow.
Public Place Managers
The smoke free law is to be strongly
implemented at all public places as per law.
In order to ensure compliance, public place
managers need to be sensitized and trained
For the Millions
n 26
regarding their roles and responsibilities.
VHAI Aparajita covers all workplaces and
public places in their project districts to
sensitize public place managers and ensure
compliance of law.
Enforcement Officials (District
Administration, Police, Health Department
etc.)
The Enforcement officials (various
departments) must be engaged with a
focused objective as they need to ensure
that they comply with the law themselves
if they have to ensure its compliance.
Hence, they have to be sensitized through
multi-level workshops and made aware of
the internal orders for compliance etc. For
e.g they need to be motivated to decide
that no officials can smoke while on duty
and a signage showing “smoking tobacco is
an offence here” should be displayed in all
offices. The officials who have been trained
on this issue would further disseminate
the information among the other police
personnel at different levels.
3. Enforcement of the Law
Supporting Orders and Actions
To initiate the enforcement mechanism,
technical support and inputs need to be
provided by public health organizations or
NGOs on their own initiative provided to the
district administration in terms of capacity
building and issuance of orders/directives
etc. In several settings, the teams have
drafted orders, challan books etc for the
administration’s perusal in order to ease
and expedite the process. For e.g. due to a
concerted approach in 2009, a notification
was issued for the formation of a State Level
Coordination and Monitoring Committee for
Himachal Pradesh. In the same year, another
notification was issued to authorise police
personnel not below the Head Constable
Rank to impose, collect the fine and to

compound the office under section 4 and 6
of the Act; courts were also defined wherein
the challans could be compounded. All
these initiatives were closely supported by
the Himachal Pradesh VHA team.
Ensuring provisions of law by collecting
penalties from violators
• Tools to collect penalty against
violation of Act: Technical support
must be provided to the state/district
administration to develop a mechanism
for collecting violation and depositing
the money in the treasury. Media can
help in raising the need and build
pressure on the health ministry, in
certain settings RTI applications
•
was also filed to get the mechanism
activated for printing of Challan books
and receipts.
Formation of enforcement Squads:
Task force/enforcement squads were
notified in the various districts - in
certain settings like Budgam and
Jhunjhunu, they were notified uptil the
block level. These squads are responsible
for conducting enforcement drives and
have a reporting mechanism, usually
to the district collector. In the case
of Bhubaneswar, the Police Department
formed their enforcement squads and
also organized monthly review meetings
for COTPA to discuss the progress and
the targets achieved in the previous
month and to plan for the coming
month. NGOs, media representatives,
health experts and other fields are also
included in these meetings.
• Raid on bars and restaurants:
In
Kerala as well as Bhubaneswar, time
and again raids have been conducted
in the bars and restaurants. Wherever
smoking was prevalent, smokers and
the public place managers had to
pay penalty. These drives were widely
covered by the media which helped to
build pressure on the administration to
penalize violators and strictly enforce
the law in public interest.
Action against sale of tobacco products
within 100 yards of educational
institutions: As per the Act, the shop
keeper is to be penalized upto Rs 200/- for
violating Section 6 (b) which specifies that
selling tobacco products within 100 yards
of educational institutions is prohibited. In
various settings, the police was contacted
to support and implement this ban. The
power of raid and seizure was utilized
effectively to ban sale of tobacco products
near schools. There was immense support
for this from civil society, media, parents of
the children, school staff and the common
public. As a result, this provision is being
implemented.
Ensuring Compliance of the Smoke Free
Rules
It is important to ensure smoke free law’s
compliance through frequent interactions
with the public place managers to check if
No smoking signages were either accessed
from the government or developed as per
prototype provided to public place managers
for display at prominent points in the
premises. Strategic interventions were done
to sensitize these managers and empower
them to take ownership of their public
places. Once a specific workplace/office/
department is declared as smoke free, they
need to also ensure compliance on their
own as they have taken ownership.
Declaring Public Places Smoke Free
Formal declarations assist in building
support and exerting pressure on the
district/state administration to give
commitment on the issue. For e.g., by
declaring Budgam as first “Smoke Free
District” of J&K on 26th January 2012,
n 27
January - March & April - June 2012

the Govt. has demonstrated tremendous
commitment towards safeguarding the
health of the people of the state, which
has highest exposure of SHS reported in the
GATS Survey. This praiseworthy step will go
a long way in saving lakhs of lives.
Challenges
When a smoke free campaign is initiated
in any setting, certain challenges are
faced and strategies have to be devised to
overcome these barriers. Our experiences
indicate the following challenges -
• Tobacco control is not perceived as a
public health priority at the state level
and the industry employs varied tactics
to deflect attention or circumvent the
law.
• Very often, the nodal department i.e. the
Department of Health at the state level
is burdened with other priority health
issues or is not fully well- versed with
the details of implementation process of
the law. Resources are also either nonexistent
or limited. In such situations,
effective advocacy and sensitization of
relevant officials may work.
• Advocates may find that in their state
or district, the enforcement mechanism
may be present on paper but is not
active, therefore, issuing challans and
compounding fines become a muchdiscussed
and debated topic. It is
important to note that the enforcement
mechanism is inefficient unless coupled
with awareness generation and ensuring
a system.
• The key challenge is the lack of a formal
tobacco control cell at the state-level
if the setting is/is not under NTCP.
The presence of this cell with a Nodal
Officer would ease the current pressure
on the District Administration/Health
Departments for technical inputs, staff
and support.
For the Millions
n 28
Way Ahead
There is also an urgent need to strengthen
district-level coalition with strong
spokespersons or member organizations.
The coalition needs to be urgently revamped
and reorganized in terms of inculcation of
new organizations with varied skills, formal
meetings, more cohesive working and
regular updates on new developments. To
ensure smoke free, there is a larger role of
for civil society and government together
both at national and international level.
Sincere efforts of various sectors and a
collaborative approach is required to make
this a success.
The key to any successful initiative is the
means of sustaining it in the long term,
in the face of constant and innovative
industry tactics. During the last few years,
more cities, states and provinces are
coming up to the smoke free status. This
raises the discussion on the sustainability.
Enforcement, efficient reporting of
violations and effective monitoring are the
three major components of a sustainable
smoke free status. Institutionalization
of tobacco control efforts i.e. capacity
building of stakeholders, creating
awareness and engaging the media must
be other key pre-requisites as a pro-active
administration, an alert civil society and a
socially committed media are the pillars of
a sustainable smoke free effort.
About the Authors
Saju V Itty is Executive Officer, Kerala VHS
Itishree Kanungo is Manager, VHAI-
Aparajita,Orissa
Ali Mohammed Mir is Executive Director,
J & K VHDA
Narender Sharma is Executive Director,
Himachal Pradesh VHA

Role of Compliance Studies and Opinion
Polls in Strengthening Smoke Free
Legislation in India
Background
Tobacco kills its users or those exposed
to its smoke, prematurely and its use is
recognized by the World Health Organization
as the single most preventable cause of
death. Tobacco-related illnesses account
for 1 in 10 adult deaths worldwide, 1 and if
current trends continue, one billion people
are estimated to die from tobacco use in the
21 st century 2 . More than 80% of the world’s
smokers live in low- and middle-income
countries 3 . Tobacco use currently costs
the world hundreds of billions of dollars
each year and this is borne by individuals,
families and their government 4 .
India is the third largest producer of
tobacco worldwide and ranks second in
total tobacco product consumption. There
are almost 275 million tobacco users in
India; almost 1 in every 2 adult males
and 1 in 5 adult females use tobacco in
some form, 5 . Smokers are not the only ones
affected and killed by tobacco; scientific
evidences have unequivocally established
that exposure to secondhand smoke (SHS)
is as harmful as active smoking and causes
death, disease and disability. SHS is the
combination of smoke from the burning
end of a cigarette and the smoke breathed
out by smokers. Exposure to SHS may lead
to numerous health problems in infants and
children, including severe asthma attacks,
respiratory infections, ear infections and
sudden infant death syndrome (SIDS).
Some of the health conditions caused by
SHS in adults include heart disease and
Dr. Ravinder Kumar, Pranay Lal, Dr. Rana J. Singh
lung cancer 6 . Worldwide, 600,000 people
are estimated to die annually as a result
of exposure to SHS 7 . The toxic mix in
tobacco smoke includes 60 known human
cancer-causing agents. Secondhand smoke
is a complex mixture of more than 7,000
chemicals, including at least 69 known
carcinogens 8 . There is no risk-free level of
contact with secondhand smoke; even brief
exposure can be harmful to health 6 .
India has a high prevalence of exposure
to SHS; 29.9% adults of age 15 years and
above are exposed to SHS in workplaces,
(52.3%) at home and 29% at any public
place including governmental building,
health care facility, restaurant and public
transportation 5 . The Framework Convention
on Tobacco Control (FCTC), negotiated
in 2003 under the auspices of the World
Health Organization (WHO), is the world’s
first public health treaty and mandates
governments of all nations to take specific
steps to reduce tobacco use. Article 8 of
the FCTC binds governments to protect
their citizens from exposure to tobacco
smoke and requires them to adopt and
implement effective legislative, executive,
administrative and/or other measures for
this purpose. In 2008, the WHO developed
and recommended a policy package to
reduce the tobacco epidemic called MPOWER
– this package expanded the measures of
the WHO FCTC that have been proven to
reduce smoking prevalence.
In 2003, the Government of India
enacted a comprehensive legislation for
n 29
January - March & April - June 2012

tobacco control, called the Cigarettes
and Other Tobacco Products (Prohibition
of Advertisement and Regulation of Trade
and Commerce, Production, Supply and
Distribution) Act (hereafter referred to
as COTPA). Section 4 of COTPA prohibits
smoking in public places, public transport,
work places and all such areas where the
public has access. Restrictions on smoking
in public places as mandated in smoke free
rules not only protects non-smokers but
also serves to provide health benefits to
smokers, by limiting their opportunity to
smoke, reducing their level of consumption,
making smoking less socially acceptable
and encouraging them to quit 9 . However,
in the context of developing countries
like India, mere enactment of a smoke
free law does not automatically result in
smoke free public places and workplaces
by prohibiting smoking in public places.
It requires strong enforcement to ensure
compliance to the law by the public. It
is also necessary to regularly measure the
level of compliance to the law, monitor
progress as well as inform and guide
enforcement.
Opinion Polls
In a democratic country, supportive
public attitudes are often necessary for
introducing and facilitating a process of
social legislation by a local or national
government 9 . It is beyond doubt that the
implementation and enforcement of the
smoke free law in any jurisdiction in India
has to occur within a social and political
context, and therefore, it requires the multilevel
support of the general public and
other key stakeholders. Most importantly,
one may have to undergo potentially
difficult negotiations in order to ensure
enough votes for an easy introduction of
the legislation. A major determinant to an
For the Millions
n 30
enactment of the legislation will be the
level of awareness and concern about the
harmful effects of smoking and SHS in
the community. In the context of COTPA,
opinion polls and compliance surveys are
two important tools to assess and measure
public opinion about smoke free policies
and compliance to smoke free legislation.
Opinion polls can assess public perception
about the hazards of smoking and SHS
exposure, as well as public understanding
of the provisions of the law which offer
them protection. They can reveal public
attitudes towards both legal and voluntary
restrictions on tobacco use. Public opinion
has an impact on how well the provisions
under COTPA are complied with and
enforced; hence opinion polls can also prove
useful to assess whether public support for
the law is strong enough to move ahead
with a law in place or whether additional
public education is necessary. In fact, polls
findings can caution policymakers to take
appropriate care while passing legislation
so that the risk of a public backlash with
regard to tobacco control interventions
can be avoided 9 .
After the law has been passed and
implemented, opinion polls can track
levels of support and changes in these
levels over time 10 . They can, thus, also
become a guide to policymakers to include
or exclude certain kinds of public places in
the respective jurisdiction.
Opinion poll findings are, therefore, a
guide to policymakers to adopt the right
strategies which can conceivably impact
public attitudes regarding the harmful
effects of tobacco use and the need for
strong implementation of COTPA. The
scope of smoke free public places can be
further advanced to smoke free homes and
private places. In addition, any change in

public attitude can be gauged by opinion
polls. Globally, numerous jurisdictions
have shown that public support for smoke
free law is high before it is passed, and
that support increases after the law is
implemented. In jurisdictions that have
properly prepared for and implemented
smoke-free laws, support is generally
higher than 80% 11 .
Compliance Surveys
Compliance surveys are useful in assessing
the degree to which a smoke free law is
being obeyed and implemented in public
places as defined under the COTPA 2003
and other workplaces. They also provide
answers to another question, whether
compliance improves with successive waves
11 Steps to Conduct
Compliance Survey12 1. Know the Smoke Free Law
2. Determine status of enforcement
3. Clarify the purpose of your
conducting the compliance study
4. Assess available resources and
secure the needed resources
5. Clarify the scope of your
compliance surveys
6. Set up a timeline for a compliance
survey
7. Develop set tools and procedures
8. Choose locations to visit
9. Conduct compliance observation
10. Analyse your compliance survey
results
11. Use the results
of enforcement? The findings that emerge
can be used to document compliance rates,
to assess the status of implementation, to
identify types of venues and geographic/
demographic regions where intensive IEC
activities and fresh waves of enforcement
efforts are needed, and to monitor trends in
compliance over time 10 . Like opinion polls,
compliance surveys also serve a strategic
purpose. A timely presentation of survey
findings to policymakers can ensure a way
forward to smoke free public places and
can prove instrumental in policy change,
policy implementation and strengthening
enforcement.
There are two major ways of ensuring
compliance to implementation of tobacco
control law. First is awareness among
the people about the harmful effects of
tobacco and SHS and secondly, enforcement
of COTPA. Enforcement in case of COTPA
generally refers to the use of inspections
and application of sanctions (challans) for
non-compliance to increase compliance.
Public education about the law and its
sanctions is another critical component
of efforts to increase compliance with
the law. High compliance can occur
with or without enforcement, although
some means of enforcement is usually
necessary. High compliance, however,
does not always mean full protection from
second-hand smoke. If there are loopholes
or deficiencies in the law, full protection
may not be provided. It is important
to understand these distinctions before
planning compliance studies 12 . Surveys
such as baseline, midline, and endline
surveys are needed to be conducted on
the standardized format. Compliance
surveys are also useful in assessing
and identifying gaps in existing smoke
free laws, gaps in implementation and
enforcement and provide recommendations.
n 31
January - March & April - June 2012

Indian experiences show that in public
jurisdiction where public awareness has
been created with planned IEC activities,
and consistent waves of enforcement are
produced; maximum compliance to COTPA
is obtained 13 .The compliance survey also
breaks the myths of the tobacco industry
that while smoke free laws are generally
popular with the public, the industry will
not stop fighting the law after it has been
implemented. Through court challenges,
media campaigns and lobbying, they will
try their best to convince people that
the law is not working, is unpopular, or
is having a negative economic impact
and needs to be weakened or repealed.
Compliance surveys are the best defence
against these tactics by objectively
demonstrating that none of these claims
is true, and producing evidence that the
law is working as intended and having a
positive impact on public health 14 .
Case Studies
Available data from compliance surveys
supported by The Union and conducted
by a third party shows that many
jurisdictions which effectively enforced
smoke free achieved good compliance to
smoke free laws in public places. On World
No Tobacco Day 2010, four jurisdictions
(state of Sikkim, district of Villupuram
and cities of Coimbatore in Tamil Nadu
and Shimla in Himachal Pradesh) became
smoke free followed by Bhubaneshwar
in October 2010. Thereafter, the State
of Mizoram and Delhi, cities of Chennai
and Indore, districts of Ernakulum,
Trivandrum, Budgam and Mohali have
made good progress in implementation
of smoke free in 2011.The demonstration
of being ‘smoke free’ in many of these
jurisdictions was supported by a simple
survey that documented compliance with
For the Millions
n 32
the smoke free law in the country 13 . The
survey uses a generalised observation
checklist which essentially has five
parameters of assessment. Display of “No
Smoking Area” signages is one of the
prime variables. For this, all signages
(both written communication and
pictorial representation) which warn and
restrain people from smoking displayed at
entrances and other prominent sites can
be considered. The second prime variable
is observation of active smoking in the
premises of the public place at the time
of the visit. The presence of smoking
aids such as ashtrays, matchboxes and
lighters in the respective public places
is a third prime variable. There are two
other indirect evidences of smoking such
as evidence of recent smoking in the
form of ashes, typical smoke odour and
presence of cigarette butts and bidi ends
in the premises (tobacco litter).
There are enough evidences for the level
of community attitudes and support for
smoke free policies, as well as changes
in these that occur after enactment of a
legislation. Smoke free Shimla supports
this statement. An opinion poll conducted
in Shimla in September 2009 revealed
that 97% respondents supported effective
enforcement of the law for smoke free
public places 14 .
Conclusions
Opinion polls and compliance assessment
surveys can be essential monitoring and
guiding tools for policymakers in the
implementation of smoke free public
places. These are feasible and replicable
in any setting with local adaptation.
Compliance assessment surveys are
a simple and cost-effective tool for
validating progress in the enforcement,

implementing smoke-free public places
and in identifying the deficiencies. These
need to be done scientifically and must
be representative of the local realities.
Therefore third party assessments are
crucial to make them valid and acceptable.
Capacities need to be strengthened among
local research organizations and a common
protocol must be adopted to ensure
standardization of study methods which
can offer comparison across jurisdictions.
References:
1. Mathers CD, Loncar D. Projections of Global
Mortality and Burden of Disease from 2002 to
2030. PLoS Medicine 2006; 3(11):e442.
2. Peto R, Lopez AD. Future Worldwide Health
Effects of Current Smoking Patterns. In: Koop
CE, Pearson CE, Schwarz MR, eds. Critical Issues
in Global Health. San Francisco, Wiley (Jossey-
Bass); 2001:154–161.
3. Jha P. Avoidable Global Cancer Deaths and
Total Deaths from Smoking. Nature Reviews:
Cancer 2009 September; 9: 655-664.
4. Mackay J, Eriksen MP, Shafey O. The Tobacco
Atlas, 2nd edition. Atlanta: American Cancer
Society, 2006.
5. Ministry of Health and Family Welfare,
6.
Government of India. Global Adult Tobacco
Survey (GATS) India Report: 2009-2010. New
Delhi: Ministry of Health and Family Welfare,
Government of India, 2010.
U.S. Department of Health and Human Services.
The Health Consequences of Involuntary
7.
Exposure to Tobacco Smoke: A Report of the
Surgeon General. Atlanta: U.S. Department of
Health and Human Services, Centers for Disease
Control and Prevention, Coordinating Center for
Health Promotion, National Center for Chronic
Disease Prevention and Health Promotion, Office
on Smoking and Health, 2006. http://www.
surgeongeneral.gov/library/secondhandsmoke/
report/fullreport.pdf assessed on 05/02/2012.
Oberg M, Jaakkola MS, Woodward A, Peruga
A, Pruss-Ustun A. Worldwide Burden of
Disease from Exposure to Second-hand Smoke:
A Retropective Analysis of Data from 192
countries. Lancet 2010.
8. U.S. Department of Health and Human
Services. How Tobacco Smoke Causes Disease:
the Biology and Behavioral Basis for Smokingattributable
Disease: A Report of the Surgeon
General. Rockville, MD: Dept. of Health
and Human Services, Public Health Service,
Office of Surgon General, 2010. http://www.
surgeongeneral.gov/library/secondhandsmoke/
report/fullreport.pdf assessed on 05/02/2012
9. World Health Organization: International
Agency for Research on Cancer. Evaluating
the Effectiveness of Smoke-free Policies. IARC
Handbook of Cancer Prevention. Lyon: WHO
IARC, 2009.
10. Centers for Disease Control and Prevention.
Evaluation Toolkit for Smoke-Free Policies.
Atlanta: U.S. Department of Health and Human
Services; 2008. Available at http://www.cdc.
gov/tobacco.
11. Making Cities Smoke-free. World Health
Organization, available at http://whqlibdoc.
who.int/publications/2011/9789241502832_
eng.pdf
12. Centre for Tobacco Free Kids, John Hopkins
Bloomberg School of Public Health and
International Union Against Tuberculosis
and Lung Disease. Assessing Compliance
with Smoke Free Laws: A How to Guide for
Conducting Compliance Studies. 2011 http://
tobaccofreecenter.org/files/pdfs/en/smoke_
free_compliance_guide.pdf assessed April 15,
2011).
13. Lal PG, Wilson NC, Singh RJ. Compliance
Surveys: An Effective Tool to Validate Smoke
Free Public Places in Four Jurisdictions in
India; 2010 Int J Tuberc Lung Dis 15 (4): 565–
566.
14. Department of Health and Family Welfare,
Government of Himachal Pradesh. Tobacco Free
Initiatives in Himachal Pradesh. Department
of Health and Family Welfare, Government of
Himachal Pradesh, 2010 http://hphealth.nic.
in/pdf/2010CaseStudySmokeFreeHimachal.pdf
(assessed 20 June, 2011).
About the Authors
Dr. Ravinder Kumar is Technical Officer
(Tobacco Control), The Union South-East Asia
Office, New Delhi
Pranay Lal is Technical Advisor (Tobacco
Control), The Union South-East Asia Office,
New Delhi
Dr Rana J.Singh is Technical Advisor, The Union
South-East Asia Office, New Delhi
n 33
January - March & April - June 2012

Behind the Scenes:
Regulating Tobacco Display and Use in Films to
Enforce Comprehensive
Ban on Tobacco Advertising,
Promotion and Sponsorship
An increasing number of countries are
implementing bans on tobacco advertising,
promotion and sponsorship (TAPS) as called
for by the WHO Framework Convention on
Tobacco Control (WHO FCTC). However,
there remains one form of tobacco
promotion that is rarely considered by
policymakers. Around the globe, smoking
scenes continue to permeate movies,
including those that are rated as suitable
for youth. Thus far, India is one of the
only countries to take action to ensure
that tobacco imagery in moves is reduced
as part of a comprehensive ban on TAPS.
In 2008, the US National Cancer Institute
concluded a causal relationship between
exposure to movie smoking depictions and
youth smoking initiation 1 . The guidelines
for implementation of WHO-FCTC Article
13 also recognize that the depiction of
tobacco in films is a form of tobacco
promotion that can strongly influence
tobacco use, particularly among young
people, and recommend a set of specific
measures to limit movie smoking.
According to the definitions in Article 1
of the WHO FCTC, a comprehensive ban
on all forms of TAPS applies to “any
form of commercial communication,
recommendation or action with the aim,
effect or likely effect of promoting a
tobacco product or tobacco use either
directly or indirectly.” There can be no
For the Millions
n 34
Barbara Zolty
doubt that tobacco depictions in movies
fall into this definition. There is now a
substantial and growing number of studies
from both developed and developing
countries showing a link between
exposure to tobacco imagery and youth
tobacco initiation 1,2 . For example, a study
from India published in 2011 shows that
tobacco use is more than double for Indian
youth with high exposure to tobacco
images in Bollywood movies 3 . This type of
evidence only adds to the imperative for
countries to fulfil their obligations under
the Convention to take action to address
this issue.
The WHO-FCTC Article 13 guidelines 4 ,
adopted unanimously by the Conference
of Parties in 2008 also recommend
that a comprehensive ban should cover
traditional media and new technologies as
well as films. The guidelines also include
an entire section on depictions of tobacco
in entertainment media with specific
recommended measures:
• Certify no payoffs: Responsible
executives of the production company
must certify that nothing of value was
provided for the inclusion of smoking
scenes. This would be a legally binding
document filed with appropriate
authorities.
• No tobacco brands shall be shown on
screen: This provision would include
brand names on tobacco packages as

well as background images such as
billboards.
• Require strong anti-tobacco spots
approved by the appropriate government
authority to be shown before any
movie with tobacco depiction.
• Implement rating system to keep
smoking out of youth-rated films:
Movies with tobacco depictions should
receive an adult rating, with the
exception of films showing historical
characters who actually smoked, as
well as films showing the true health
consequences of tobacco use.
WHO has continued to speak out against
tobacco depictions in movies for nearly a
decade. During its 2003 World No Tobacco
Day campaign which focused on the
theme of Tobacco-free Film, Tobacco-free
Fashion,” WHO stated that “The world of
film [and fashion] cannot be accused of
causing cancer. But they do not have to
promote a product that does.” 5
The 2009 WHO report entitled, Smoke-free
Movies: From Evidence to Action, 6 discussed
the smoke-free movie recommendations in
the Article 13 Guidelines and called upon
countries to implement enforceable policies
to severely restrict smoking imagery in all
film media.
The second edition of the report, published
in 2011 4 , included a discussion on the fact
that in many countries, youth-rated films
which contain smoking scenes are receiving
substantial government production
subsidies. Because these subsidized films
are indirectly promoting tobacco use, WHO
concluded that these subsidies are a counter
to WHO FCTC Article 13 and its guidelines.
Consequently, WHO recommends that media
productions with tobacco depictions should
be made ineligible for public subsidies. This
recommendation would extend to preferable
tax rates as well.
All of these policies that WHO recommends
are realistic, reasonable, do not impinge
upon artistic expression, and can in no
way be viewed as censorship. Under
these recommended policies to implement
the WHO FCTC, filmmakers would be free
to include smoking and other forms of
tobacco use in their films. However, in the
same way that films which are violent or
contain crude language are not considered
as appropriate for children and are rated
accordingly, films with tobacco imagery
would not be rated for and marketed to
youth.
Movies help to shape social norms and are
an important source of information about
smoking for youth. However smoking
in movies does not reflect reality. Movie
smoking is mostly depicted among people
with a high socio-economic status, who
rarely smoke in reality, leading youth to
think it is more common than it really is.
With movies rarely showing the true health
consequences of tobacco use, smoking
imagery in movies is perceived by youth
as leading to positive social and personal
consequences.
Policymakers around the world are in
agreement that they need to take measures
to ensure that youth do not initiate tobacco
use. Implementing a comprehensive ban
on TAPS as required for Parties to the
WHO-FCTC is an important component
of preventing youth tobacco initiation.
However, governments which fail to take
serious action to limit tobacco depictions
in movies are disregarding an important
component of WHO FCTC Article 13 and
jeopardizing the lives of its youth.
n 35
January - March & April - June 2012

Measures to ensure that movies rated as
suitable for youth do not contain tobacco
imagery along with the elimination of
government subsidies to films that include
tobacco use will go a long way in protecting
youth from a lifetime of tobacco addiction
and countless unnecessary deaths.
Tobacco-free Movies: An
Important Component of COTPA
In 2003, the government of India enacted a
comprehensive tobacco control legislation,
the Cigarettes and Other Tobacco Products
Act (COTPA), which includes a section on
ban on tobacco advertising, promotion
and sponsorship (TAPS) 7 . Research shows
that following implementation of COTPA,
tobacco imagery in movies, including
display of tobacco brands, significantly
increased as other forms of TAPS were
banned.
In 2005, COTPA’s Rules were amended to
address the issue of tobacco imagery in
movies, and this included a complete
ban on depiction of tobacco products or
tobacco use in movies or on television.
However, the Ministry of Information and
Broadcasting (MoIB), which was responsible
for implementing the Rules asserted the
need for further flexibility. Following
further consultation with MoIB, in 2006,
the Union Ministry of Health and Family
Welfare (MoHFW) determined that tobacco
depictions would be allowed where there
was editorial justification, but that the
Central Board of Film Certification (CBFC),
a regulatory body under MoIB, would rate
the film with an “A”(adult) certification and
that additional provisions such as health
warnings scrolls would be required.
The tobacco-free movie provisions
were challenged in the High Court by a
For the Millions
n 36
Bollywood producer and the Rules were
quashed by the order of the High Court
of Delhi in 2009. The Government of
India filed an appeal with the Supreme
Court which stayed the order of the High
Court. Following additional consultation
with MoIB and other stakeholders, the
MoHFW issued a revised notification on
27 October 2011, 8 with the new Rules to
go into effect from 14 November 2011.
The Central Board of Film Certification
(CBFC) is responsible for enforcement of
these Rules. In September 2011, prior to
the Rules coming into effect, the MoHFW
in collaboration with WHO, organized a
workshop for MoIB, CBFC officials from all
the regional centers, and other stakeholders
to sensitize them on their role in curbing
tobacco use in movies and in shaping the
behavior of the youth in India.
The following measures which apply to
films and television programmes, are
key provisions that are included in the
Rules, officially titled the Cigarettes and
other Tobacco Products (Prohibition of
Advertisement and Regulation of Trade
and Commerce, Production, Supply and
Distribution) (Second Amendment) Rules,
2011:
• Films and television programmes
with tobacco depiction must show a
30 second anti-tobacco spot at the
beginning and middle of the film.
• These spots are being provided
by MoHFW to MoIB, and include
hard-hitting
advertisements.
anti-tobacco
• A health warning scroll is required at
the bottom of the screen during the
duration of scenes with tobacco use.
• The Telugu movie entitled
“Bezawada” was the first to
implement the health scrolls during
scenes with tobacco usage.

• New films and television programmes
with tobacco use must have strong
editorial justification.
• Representatives from MoHFW
shall also be represented in the
CBFC.
• MoHFW has provided a list of
representatives to MoIB for
representation in the CBFC review
panels.
• New films with tobacco depictions
shall be issued a “UA” Certificate.
• New films and television programmes
must include a disclaimer by the
concerned lead actor about the harms
of tobacco.
• No brand names of tobacco products
shall be shown on screen or any form
of tobacco product placement;
• Close-ups of tobacco products
and tobacco products packages is
prohibited.
• Television programmes with tobacco
imagery are only permitted to be
telecast on television at such timings
that are likely to have least viewership
of persons under age 18.
• Promotional materials such as movie
posters shall not depict tobacco use.
India holds the distinction of being the
world’s largest producer of movies. Indian
films are viewed in over 100 countries,
with a growing fan base in the West.
Worldwide, viewership for Bollywood
movies is even higher than for Hollywood
films. Therefore, the success of India
in fully implementing and enforcing
tobacco-free movie rules will help protect
youth in India and in countries around
the world from a lifetime of tobacco
addiction. Through these rules, India
has taken an important step towards
implementing a complete ban on TAPS
and set an international precedent in this
very important area of tobacco control.
References
1. The Role of the Media in Promoting and
Reducing Tobacco Use. Bethesda, MD, U.S.
Department of Health and Human Services,
National Institutes of Health, National Cancer
Institute. 2008 Tobacco Control Monograph No.
19; Accessible at http://cancercontrol.cancer.
gov/tcrb/monographs/19/index.html
2. World Health Organization. Smoke-free Movies:
From Evidence to Action, September 2011, 2nd
edition. Accessible at http://whqlibdoc.who.
int/publications/2011/9789241502399_eng.
pdf.
3. Arora M et al. Tobacco Use in Bollywood
Movies, Tobacco Promotional Activities and
their Association with Tobacco Use Among
Indian Adolescents. Tobacco Control, 2011,
doi:10.1136/tc.2011.043539.
4. WHO Framework Convention on Tobacco Control.
Guidelines for Implementation. Geneva, World
Health Organization, 2011. Accessible at
http://www.who.int/fctc/protocol/guidelines/
adopted/guidel_2011/en/index.html
5. World Health Organization. World No Tobacco
Day 2003. Tobacco free film, Tobacco free
fashion. Accessible at http://www.who.int/
tobacco/media/en/brochure-en.pdf
6. World Health Organization. Smoke-free
Movies: From Evidence to Action, 2009.
Accessible at http://whqlibdoc.who.int/
7.
publications/2009/9789241597937_eng.pdf
The Cigarettes and Other Tobacco Products
(Prohibition of Advertisement and Regulation
of Trade and Commerce, Production, Supply
and Distribution) Act, 2003. Gazette of India,
18 May 2003. Accessible at http://www.mohfw.
nic.in/WriteReadData/l892s/file9-61090433.
pdf
8. Cigarettes and Other Tobacco Products
(Prohibition of Advertisement and Regulation
of Trade and Commerce, Production, Supply
and Distribution) Act (Second Amendment)
Rules, 2011. New Delhi, Ministry of Health
and Family Welfare, Government of India,
2011. Accessible at http://www.mohfw.nic.in/
showfile.php?lid=963
About the Author
Barbara Zolty, MPH is Project Officer, Tobacco
Free Initiative (TFI), WHO Regional Office for
South-East Asia, New Delhi
n 37
January - March & April - June 2012

Introduction
There are only two forces that can carry
light to all the corners of the globe... the
sun in the heavens and the media.
The news media is recognized as among
the world’s most influential and powerful
elements. They are irreplaceable as a
mechanism for turning a problem into
a solution. There is a saying that a tenthousand-watt
light turned on a situation
focuses the minds of policymakers very
fast.” That is why media in a country like
India is an important source of health
information. The news media plays an
important role in advancing independent
discussion around policy debates. In a
democratic set-up, public policy issues are
highlighted in newspapers, magazines and
the electronic media to catch the attention
of people, policymakers and government
officials. It is unfortunate, but true, that
in India, most decision makers come to the
conclusion that problems exist after the
media highlights it. In fact media is the
vehicle that shapes public opinion as such it
is important to carry frequent and repeated
coverages to the public using all mediums,
contributing with qualitative messages to
help people realize their follies.
India has been the focus of the world’s
attention this past decade for its economic
potential and the huge opportunities the
developed world sees in the Asian giant. But
health is a key area where India has a long
way to go. And the one time bomb that is
ticking away is the menace of tobacco, whose
use is assuming alarming proportions. In
the twentieth century, the tobacco industry
constantly worked at creating new customers
For the Millions
n 38
The Game Changers:
Media in Tobacco Control
Binoy Mathew and Jaspreet Kaur Pal
for its products. Around the world, billions of
rupees were spent on advertising, sponsorship
and promotion activities. Mass media had a
dubious role in creating new generations of
tobacco users, even as evidence mounted
about tobacco’s deadly toll on public health.
Tobacco advertisements, featuring initially
doctors and later, film stars and celebrities
were instrumental in making smoking and
smokeless tobacco use fashionable, macho,
glamourous and alluring. There were also
innovative advertisements featuring a range
of feminized brands like light, slim cigarettes
marketed at women, associating smoking
with emancipation, slimness, modernity, and
sophistication.
In present times, when the scope and
potential of communication exchange has
expanded and evolved, harnessing the
media’s power to discourage tobacco use is
one of the major public health challenges
of the new century. Given the potential of
the media as a channel of influence, media
advocacy can give rise to significant policy
changes that prioritize strategic efforts
towards tobacco control. Realizing this,
public health and tobacco control advocates,
are beginning to successfully befriend and
use the media to influence how the public
and policymakers attend to and prioritize
tobacco-related issues. The relationship
between news coverage on tobacco and
coverage of other public health issues is
an important subject that largely has been
ignored, particularly as it pertains to the
potential impact on behavioral and policy
change. The competition for space within
the “news hole” is likely to be most fierce
across topics that public health advocates
would ideally treat as complementary.

Starting with humble, though committed
efforts, today tobacco issues are
increasingly becoming newsworthy in India
and have the capacity to frame discussions
on crucial issues among both policymakers,
civil society and the general public. A major
public health challenge today is finding
a way to harness the powerful influence
of the media to curtail tobacco use. As
media expands beyond traditional channels
such as newspapers, magazines, radio, and
television to the internet and interactive
video gaming, the challenge is even more
urgent. Both tobacco control and tobacco
industry forces are using the media to
influence the attitudes and behaviour of the
public in India. The industry for long has
seen the media as the key to its success.
It is time for the same media to turn the
tables and reverse the trend.
Stories that Changed the Game
Understanding the need of the hour to
use media tools in a way that results into
policy action; several interesting strategies
are often put into play. For example,
organizations working in this sector use
study-based findings or investigative
approaches to highlight issues which can
directly have a policy impact and be a critical
driver in decision making. In this digital
age of information overflow, it is certainly
very crucial to use tools intelligently so
as to grab eye balls and at the same time
fulfill underlying objectives.
•
A case in point is the Air Quality
Monitoring (AQM) study. AQM has
been considered as an effective tool
for Smoke-Free Advocacy Campaigns to
monitor Second Hand Smoke exposure
in public places in order to support the
need for strong smoke free policies, strict
enforcement and high compliance with
the law. An AQM study undertaken by
VHAI provided substantive data on air
quality in public places like restaurants
and bars. The study and the wide media
coverage received in India helped
strengthen the Smoke-Free Advocacy
Campaign for smoke free settings. The
media was very interested as this was
the first study of its type in India.
n 39
January - March & April - June 2012

•
•
•
•
Showcasing ground-breaking journalism,
an ‘exclusive’ story by News X & CNN
IBN exposed the alleged Government –
Tobacco Nexus. The story sent shockwaves
by exposing the pressure exerted by the
tobacco industry and other groups with
vested interests on the Government of
India to defer the new pictorial health
warnings. The story highlighted that
even after two years of Government of
India's notification for using the new
pictorial warnings in cigarette and gutka
packets, how tobacco companies were
still dragging their feet on the issue.
Yet another story highlighted the unholy
linkage between the government and
tobacco industry and exposed how the
Government is investing through shares
in tobacco companies in violation of
the Framework Convention on Tobacco
Control (FCTC). The story also raised
the issue of political parties receiving
donations from tobacco companies. Both
these investigative theories were critical
in unearthing the unseen linkages that
have been driving the flourishing tobacco
industry. They took reporting on tobacco
issues altogether to a different level. The
impact on decision-making that these
stories had is any man’s guess.
Apart from study-based and
investatigative stories, there were also
field visits made by senior journalists
to bidi rolling pockets in Jangipur,
Murshidabad to develop a deeper insight
into the pitiable condition of bidi rollers.
The stories that followed exposed the
exploitative bidi industry, especially
employment of child labour in bidi
rolling in violation of the law, health
hazards faced by bidi workers, poor
working conditions, lack of any facilities
or benefits and bare minimum wages.
Meanwhile, a civil society movement
pressing for a ban on smokeless tobacco
products gained momentum in the
For the Millions
n 40
context of Indian Media. Various NGOs
supporting the cause of tobacco ban
along with the doctors and survivors of
cancers of head and neck region started
a series called the ‘Voice of Tobacco
Victims’ where the victims of cancer
due to smokeless tobacco narrated their
stories of addiction and the struggle to
survive cancer to ministers, bureaucrats
and politicians invited at the sessions.
However, the tobacco industry too has risen
to the challenge adopting new and innovative
means constantly to carry their messages
across newer, younger populations using
ever-changing communication mediums.
Traditional methods of direct advertising
through TV, radio and print media have been
replaced by indirect, surrogate and point of
sale advertising methods. Some examples
of these are outdoor advertising through
banners and billboards; brand stretching;
internet marketing through social networking
sites; logos with colour patterns; music,
fashion and sports events sponsorships;
spin-off merchandise; sms marketing;
celebrity endorsements and corporate social
responsibility (CSR) activities.
Major Challenges & Obstacles
In India ome sections of the media in general
and even health correspondents and reporters
in particular consider tobacco control to be
a minor health issue and not as a serious
initiative which deserves more attention in
the media. A large part of the electronic
and print media does not give front page/
breaking news coverage to tobacco control
news and developments. Shifting priorities
of media houses which receive huge amounts
of revenue through tobacco company
advertisements is another area of concern.
A constant challenge faced is keeping the
media’s interest sustained over a long period

of time.. They need to be provided with new
and challenging aspects of key issues related
to tobacco control backed with substantive
local and region-specific evidence. Media
resistance to repetition of tobacco-related
news is also a challenge which needs to be
addressed while strategizing and planning
media events.
Another challenge is the selection of the right
media for sharing “exclusive stories” and
rivalry amongst media houses/personnel for
the same. For instance when the Government
of India deferred the implementation of the
new pictorial health warning from June 1st
to 1st December 2010, the information was
shared immediately with a senior journalist
of a prominent media house for an exclusive
story. As a result the leading national daily
carried an exclusive coverage of the news
in their publication the very next day.This
can be viewed both as a success and an
obstacle. It is a success because a senior
journalist and the country’s leading daily
with the widest circulation, breaks news
on the latest development and features
the issue prominently. However the same
became an obstacle since the journalists
of other national dailies, both English and
vernacular, showed less interest in carrying
the same story, as it was already carried as
an ‘exclusive’ in the leading national daily.
As a result the issue received less focus in
other newspapers.
Future Directions
Research on the volume of coverage of
tobacco issues, particularly compared with
other health topics, firmly establishes
tobacco control as a highly newsworthy
issue in India. News media coverage of
tobacco control could play a significant
impact on tobacco policy and individual
tobacco use. Further work needs to be done
to elucidate the nature of tobacco-related
news coverage and its broader impact on
public health. Research is needed on the
process for producing news coverage on
tobacco issues. The results of this work can,
in turn, inform future efforts of the tobacco
control community pertaining to the news
media, including media advocacy, framing
of key issues, and appropriate use of media
channels in broader policymaking efforts.
This could also help frame news in ways
that are more likely to interest journalists
in tobacco control stories.
Conclusions
The news media represents a key source of
health information for the general public. More
important, it serves as a framing mechanism
for issues surrounding on both sides of
tobacco-related issues. News coverage that
supports tobacco control has been shown
to set the agenda for further change at the
community, state, and national levels.
The major issues covered as news stories in
India include pictorial warnings, taxation
on tobacco products, smoke free, ban on
tobacco advertisements, restriction on sale
of tobacco products to minors, secondhand
smoke and the health hazards of tobacco
usage. The articles on these issues often
show that the majority of stories favour
tobacco control progress, including opinion
pieces. Hence, media plays a key role
in shaping tobacco-related knowledge,
opinions, attitudes, and behaviours among
individuals and within communities.
About the Authors
Binoy Mathew is Media Officer, VHAI
Jaspreet Kaur Pal, is Communications Director,
India, Campaign for Tobacco Free Kids
n 41
January - March & April - June 2012

Charting New Paths: VhAI’s Initiative on
Alternative Livelihoods for Bidi Workers
Bidi is most popular form of smoking in
India. It consists of a tendu leaf containing
coarse, uncured tobacco, tied with a
string at one end. According to GATS, bidi
smoking is highest among all forms of
tobacco consumption and is smoked by 9.2
percent of the adult population (above 15
years of age) as compared to 5.7 percent
of cigarettes smoking. Bidi manufacturing
is entirely a manual process engaging
intensive human labour through various
stages.
Bidi Manufacturing in India
Bidi is a mass consumed product,
manufactured using entirely manual
labour. The most prevalent form of bidi
manufacturing in India is the contract
system where the manufacturer gives to
the middlemen quantities of bidi leaves
and tobacco and the middlemen on
receiving the materials manufacture bidi
(i) by employing labourers directly (ii) by
distributing the materials amongst homebased
workers, as they are called, mostly
women who roll bidis in their homes with
the assistance of other members of their
family, including children. According to
latest available data, there are 51,28,206
bidi rollers in India and among them
36,96,049 are women bidi rollers making
almost 73 percent of the workforce female 1 .
But the data is inadequate as it only
quotes the number of bidi rollers who have
identity card. There are many more who are
For the Millions
n 42
Devashri Sinha and Chandra Ramakrishnan
“Throughout the centuries, there were men who took first steps, down new roads, armed
with nothing but their own vision” - Ayn Rand
engaged as bidi rollers without any identity,
deprived of all the benefits. Similarly, the
industry also engages a large number of
children. Although bidi rolling is classified
by the (India) Child Labour Prohibition and
Regulation Act as hazardous and a 1991
Supreme Court (India) ruling that child
labour in tobacco should be prohibited,
more than 3,25,000 children work as labour
in the bidi industry in India 2 .
health Issues Associated with
Bidi Rollers
Bidi not only has a labour angle but it is
also a hazardous product to produce as
well as consume. A bidi contains about
one-fourth the quantity of tobacco as a
cigarette, yet it delivers a higher amount
of tar and nicotine. As bidi rolling is
totally manual, the rollers handle tobacco
flakes during the entire occupation hours.
They inhale tobacco dust, as well as other
volatile components of tobacco in their
work environment. There is considerable
evidence that workers employed in the
industry are at risk of cancer and other
lung-related diseases. Tobacco dust
exposure induces mutation, damages to DNA
resulting in irreparable health problems.
In addition to dermal (skin) exposure,
workers in the tobacco processing facilities
receive exposure to unburnt bidi tobacco 3 .
There are many other studies to prove the
evidence of health hazards faced by bidi
rollers 4 .

Alternative Livelihoods for Bidi
Workers in the Tobacco Control
Framework
India is one of the signatories to FCTC
and has a number of obligations to reduce
both the demand and supply of tobacco.
The core supply reduction provisions in the
WHO-FCTC are contained in Article 17-18.
Article 17 gives a provision of support for
economically viable alternative activities
for tobacco growing households by stating
that “Parties shall, in cooperation with each
other and with competent international and
regional intergovernmental organizations,
promote, as appropriate, economically
viable alternatives for tobacco workers,
growers and, as the case may be, individual
sellers.” To realise the goals set under the
WHO-FCTC, it is imperative that there is
subsequent shift from tobacco-related
livelihood to alternative vocations.
Government Initiatives
To reduce rural poverty, the Government
of India launched the ‘Integrated Rural
Development Programme’ in 1978-79 with
the objective of providing employment
opportunities to the rural poor through
monetary and technical assistance in
the form of subsidy and bank credit for
productive employment opportunities
through successive plan periods. In 1999,
the IRDP and allied programmes, including
the Million Wells Scheme (MWS), were
merged into a single programme known
as Swarnajayanti Gram Swarozgar Yojana
(SGSY conceived as a holistic programme of
micro-enterprise development in rural areas
with emphasis on organising the rural poor
into self-help groups, capacity-building,
planning of activity clusters, infrastructure
support, technology, credit and marketing
linkages. In the later years, the programme
was again restructured National Rural
Livelihood Mission (NRLM) 5 . The objective is
to reduce poverty among rural populations
below poverty line by promoting diversified
and gainful self-employment and provide
wage employment opportunities which
would lead to an appreciable increase in
income on sustainable basis. The NRLM is
an approximately $7.7 billion programme
which aims to bring the poor families above
the poverty line by ensuring appreciable
sustained level of income over a period of
time (MRD, GOI).
The government has developed a series
of legislative acts and policies aimed at
monitoring working conditions of and
providing social security benefits to bidi
Members from the Mahamaya SHG who grow turmeric on their leased land in Jangipur
n 43
January - March & April - June 2012

labourers. The Bidi and Cigar Workers
(Condition of Employment) Act, 1966
regulates factory-based workers and
mandates establishment of industrial
standards – no overcrowding, proper
ventilation, and appointment of working
condition inspectors, proper working hours,
rest, leave, and prohibits child labour. The
Bidi Workers Welfare Cess Act, 1976 Act No.
56 of 1976 (7th April, 1976) levies excise
duty on manufactured bidis and the workers
to receive benefits from a government fund.
The current cess is Rs. 4 per 1000 bidis
and this applies to registered companies
manufacturing more than 2 million bidis
per year. As with other welfare benefits, to
receive funds, workers must have an ID card.
The Bidi Workers Welfare Fund Act, 1976 was
enacted to provide basic benefits such as
health care, education, insurance, housing
assistance, scholarships, and drinking water
supplies.
The reality is that these policies and
legislations have done very little to improve
the working conditions and livelihoods of
bidi workers and they remain among the
most marginalized sections of the society.
For the Millions
n 44
VhAI’s Initiative for Alternative
Livelihoods
While advocating for alternative livelihoods
for bidi workers, VHAI initiated a small
micro- credit livelihood programme for
bidi rollers with the objective to help
them seek safer and viable employment
opportunities. This initiative took place in
the Jangipur block of Murshidabad district
of West Bengal. A team from VHAI started
the intervention in the area in 2009. They
identified bidi rollers and their families and
organised free health camps and a major
convention to discuss the issues and know
their thoughts. Most of the bidi workers
who participated expressed a desire for
change to safer, viable livelihood options.
In 2009, under VHAI’s guidance and
support, 14 women who used to roll bidis
came together to form a SHG named as
Maharani and the group was willing to
learn the skills of knitting and stitching to
start a new livelihood. They took training
from the Zila Parishad and pooled some
resources to open a bank account. After
six months of maintaining their group,
Members from the Ganga SHG who produce and cell "chana sattu" in Jangipur

they applied for bank gradation and were
successful in getting a loan of Rs 10, 000
to start a knitting unit. As this amount
was not sufficient VHAI also invested Rs
10, 000 to purchase the knitting and other
required material. These women through
their dedicated efforts achieved modest
success after some time. After one year,
they again applied for loan and received
Rs 40, 000 from the bank. Now after two
years they have applied again and may
receive an advanced loan Rs 1,00,000 from
the bank.
Similarly in the subsequent years, other
groups like Islam Swanirbhar, Mahamaya,
Maa Tara and many other groups were formed
that were engaged in knitting, stitching,
embroidery, tailoring, rice marketing any
other similar businesses. These groups
took training from Zila Parishad or through
VHAI and started a small home-based
business. The Mahamaya group is engaged
in turmeric cultivation. The group members
jointly collected Rs 11, 000 which they
used to take a land on lease. In April 2011,
they sowed turmeric in this land with the
objective of cultivating turmeric to prepare
and sell turmeric powder in the local
market. The initial results are promising
and the group is considering doing some
more investments. Apart from these SHGs,
VHAI was successful in forming and helping
almost 40 groups that are engaged in
various other kinds of activity like poultry,
papad-making, traditional craft, pottery,
broom-making, basket-making and rice
trading etc.
VHAI also provided help to those SHGs
that were already in existence but were
not able to achieve any success. SHGs like
Mahalaxmi now engaged in poultry business
was formed by the bidi rolling women
themselves in 2008, but without guidance
and technical support, they were not able to
take their dream further. VHAI guided them
in documenting the accounts and preparing
a business proposal to be submitted in the
bank. With the combined efforts of VHAI
and the group they were able to secure a
loan of Rs. 10, 000 at a nominal interest
from the bank. The women who used to roll
bidis earlier are now moving forward in the
poultry business.
Once these groups were strengthened, a
federation named Ganga self help group
was formed. The women of this group
established a small production unit in the
village to produce and sell “chana sattu”
(chickpea flour) in neighbouring villages
along with the possibility of expanding it
to neighbouring states.
Apart from these initiatives, VHAI also
strived to make a difference in the lives
of the children of bidi rollers by providing
them an opportunity to learn computer
skills. In 2009, VHAI started a fundamental
6-month course on computer education
in collaboration with a local computer
education centre. The main objective was
to teach computer skills to the youth of
bidi rolling families and guide them to
build their career in this field. Within
six months the results were promising and
till date, many students have passed out
and got jobs in showrooms, government
departments, shops and shopping centres
as data assistants, operators, cashiers etc.
Realising the difference in their lives, these
students want to pursue further studies and
have vowed not to engage in bidi rolling
again.
By 2011, VHAI has formed more than 50
SHGs and more than 100 SHGs in that area
are supported and mentored by VHAI in
some way or the other.
n 45
January - March & April - June 2012

Relevance of this Initiative
The initiatives have made a small, but
significant change in the lives of the bidi
rollers. The shift to alternative vocation not
only brings financial gains for individual
members and their families but also makes
a long term contribution to the society by
developing positive ethos , bridging gender
disparity, creating awareness for socioeconomic
and health issues and creating
assertiveness for political rights But more
than anything else, it has succeeded in
opening a small window of aspirations and
hope for those who had been confined to
misery and poverty through generations.
In monetary terms, the groups are able to see
the potential for earning better and are also
able to spare more time for themselves and
their families. It’s a long way from earning
40-50 rupees per 1000 bidis for 14-15 hours
of back-breaking work. Initial analysis shows
that joining hands together and working as
a group has earned them not only income
but also respectability, more time, better
nutrition, schooling opportunity for children
and relief from occupational health hazards.
As the women spend only 6-7 hours of the
For the Millions
n 46
day in alternate vocations, they are able
to use their productivity in the spare time
like working in anganwadi, cooking mid-day
meals and teaching younger members to
earn some extra money.
In terms of non-monetary benefit, SHGs being
a micro enterprise are associated with many
opportunity costs. Micro enterprises have
been accepted as an engine of economic
growth and equitable development. Unlike
bidi rolling which has no potential for
any growth, micro enterprises have many
dimensions with growing chances from every
aspect. Apart from that as the government
has a long-term objective of tobacco
control, any livelihood activity which is
related to tobacco is not sustainable in
the near future. Enterprising activity is
also an engine for women’s empowerment.
Empowerment can serve as a powerful
instrument for women to achieve upward
social and economic mobility and power
and status in society. Engaging in this kind
of activity gives more control over material
assets, develops intellectual resources,
nurture ideology and enhance collective
bargaining power. With collective power,
Members from the Islam Swanirbhar SHG who are engaged in Embroidery and stitching work in Jangipur

the group will not only be able to negotiate
with the institutions but also be able to
pressurise for the implementation of welfare
laws, labour laws and fight any injustice and
wrongs with them. Livelihood initiative in
groups also engages the community. This
level of solidarity has also lead to collective
movements which have fought many social
evils prevalent at the time. The anti-alcohol
movement in Andhra Pradesh in the 90s is
one of this kind. In 1991, women from the
rural Dubuganta district in the Indian state
of Andhra Pradesh sought to address growing
alcohol dependency among men and the
consequent problems of domestic abuse and
squandered household income by staging
protests aimed at forcing out local liquor
traders. The protests quickly spread across
the whole state. The struggle catalyzed a
larger social movement, known as the Anti-
Liquor Movement, leading ultimately to
a state-wide ban on alcoholic beverages,
passed in 1995.
Learnings and Future Roadmap
Jangipur area in Murshidabad has seen
generations of bidi rolling and little else.
No other industry has been able to flourish
in the area except bidi rolling. In such a
scenario, any initiative seeking to move bidi
rollers towards alternate vocations seems a
difficult task. Although VHAI has initiated
the programme and helped activate a
number of SHGs, keeping them engaged in
this effort is th challenge main. In an era
where the cost of living is very high, it
becomes difficult for the sustainability of a
small initiative. With the production cost,
work place rent, machine cost, instalment
charges and overhead expenses, it becomes
an expensive affair. Any small setback
would be enough to send them back to
bidi rolling. Although the government has
programmes for initiating a micro credit
livelihood in the rural areas, it is bogged
by neglect and accountability.
To make any initiative successful, it is
important to take into consideration the
existing realites. Apart from funding and
investment, mentoring, support and regular
review are other essential necessities.
VHAI’s programme has only touched a small
section of the people and it is imperative
that this is expanded to a large scale as
well as across several settings and this is
possible only with Government support.
The political leadership has to realize that
bidi rolling is not serving anybody’s interest
apart from a few capitalist bidi industries,
at the cost of millions of lives - either lost
by tobacco use or exploited at the hands of
bidi barons. For any country aspiring to be
on the global map, the larger objectives of
development can never be achieved without
the upliftment of the poor and exploited.
References
1. Ministry of Labour and Employment, Parliament
Question no 86, Winter session 2011
2. Bidis, factsheet, CTFK, http://global.
3.
tobaccofreekids.org/bidis_fact_sheets (accessed
on 1st December 2011)
VHAI, 2009, Caught in a Death Trap: The Story
of Bidi Rollers of West Bengal and Gujarat, VHAI,
New Delhi
4. Gupta, PC and Samira Asma, 2008, Bidi Smoking
and Public health, MoHFW, New Delhi
5. National Rural Livelihood Mission: Framework for
Implementation, Ministry of Rural Development,
GoI, indiagovernance.gov.in/download.php?
filename=files/NRLM.pdf (accessed on 1st December 2011)
About the Authors
Devashri Sinha is Research Associate, Tobacco
Control at VHAI.
Chandra Ramakrishnan is Manager, Health
Promotion and Development Communication,
VHAI.
n 47
January - March & April - June 2012

Statistics about the disease consequences
of tobacco use are mind boggling. It is
estimated that in the 21 st century, a billion
people would die early because of tobacco
use. In India, it is estimated through
scientific studies at the national level
that nearly a million deaths occur every
year due to tobacco use. Going by these
statistics, restricting tobacco use or taking
necessary steps to reduce its usage should
logically be one of the highest priorities in
public health. This is, however, clearly not
so. A major reason for quite a bit of apathy
and inaction on tobacco control is that
statistics get treated merely as statistics;
the human face of suffering is completely
lost in the constructs of the statistics and
strong scientific evidence.
For the Millions
n 48
Advocacy for Ban on Gutka:
Voice of the Victims Campaign
A Case Study
Ashima Sarin, Dr. Pankaj Chaturvedi, Dr. Prakash C. Gupta, Shahin Khan
An effective way of sensitizing a policymaker
or a public luminary to the cause of tobacco
control might be is to take that person on
a tour of a hospital ward among patients
with diseases caused by tobacco. Specially,
the head and neck cancer ward in a cancer
hospital, because 90% of these cancers are
caused by tobacco use. But it is obviously
not feasible to take policymakers and media
personnel through this process for gaining
their support for tobacco control.
But, on the other hand, there are patients,
who upon learning about tobacco’s role in
causing their disease and suffering, often
want to give a message to others. Because,
in addition to their personal suffering,
their families, including spouses, parents
Leader of the Opposition, Ms Sushma Swaraj addressing the audience at the VOT event in New Delhi, March 2011

and children suffer much more for a longer
time. They, however, have no platform
to broadcast their message. As they are
already drained, physically, emotionally
and economically, there is no way they can
create a platform on their own.
The campaign ‘Voice of Tobacco Victims’
(VoTV) is an attempt to provide a platform
to these patients and their family members
who want to share their story with a wider
audience. It is easy to use this approach
to create awareness regarding the hazards
of tobacco use. Most importantly, the
difference this campaign makes is that
it channelizes victims’ messages towards
....Many more
such victims
specific tobacco control policy objectives
so that they do not remain merely
awareness generating exercises. This
platform almost always includes senior
policymakers and media as the audience.
The doctors who have treated the patients
are also a part of the platform for two
reasons - one, to reassure the victims and
secondly, to provide scientific backing to
the statements made by the victims. In the
VoTV campaign, these doctors are referred
to as ‘patrons.’ The campaign coordinators
remain in the background with relevant
research data and evidence on the
effectiveness of the policies demanded by
the victims.
Dear Minister Uncle, we almost lost our dad.... you don't know
how painful was the entire experience.... he had mouth cancer
because of Pan Masala chewing.... we do not want this to
happen to any child in India
Children of Ashish Jain (9425173999) Satna, MP
My father was addicted to the Gutka even after knowing the
consequences... simply because it was available in every nook
and corner.... my Family's sincere request to you to BAN this
Life threatening product.
Sanjoli, Daughter of Manoj (09300006895), Bhopal, MP
I lost my husband... he had mouth cancer following 12 years of
Gutka/pan masala chewing.... I see no reason why it cannot be
Banned when so much of information is already there.... how
can government be so insensitive....
Alka (9410132384) wife of late Rajeev Pandey, Dehradoon,
Uttaranchal
Despite being an advocate, I thought Gutka was mouth
freshner.... I had mouth cancer... lost my half jaw.... can't speak
and eat properly....living under constant fear of disease coming
back.... how long will this society live under this threat to life ?
Manoj Mishra (9415369350), Advocate, Allahabad.
n 49
January - March & April - June 2012

Described below are some events
which were a big success of the VoTV
campaign:
• The first event was organized in
Mumbai on World No Tobacco Day, 31st
May 2008, where Dr. Pankaj Chaturvedi
presented 10 cancer patients and
their stories. The experiment proved
immensely successful and the patients
shocked the media and audience with
their grit and determination. The
message “This is what tobacco did to
us, we want to save others!” evoked
an emotional response which led to
widespread media coverage.
• Cancer patients in their capacity as VoTV
members wrote letters to celebrities
who endorse tobacco products. These
letters were covered by media leading
gradually to a drastic decline in
celebrity endorsements.
• A VoTV meeting held in New Delhi in
collaboration with other public health
For the Millions
n 50
•
•
organizations in February 2011 with
Cabinet Minister, the junior Health
Minister and senior bureaucrats focused
media attention on the launch of a
national campaign against smokeless
tobacco.
In March 2011, VoTV held a meeting
in New Delhi with the Leader of the
Opposition in the Lower House and
about 40 Members of Parliament (MPs).
The event received a lot of media
coverage and provided a very significant
opportunity for strong advocacy among
MPs (Members of Parliament) for support
on action against smokeless tobacco.
VoTV Patrons conducted a campaign
around World No Tobacco Day, 31 May
2011, which resulted in Chief Ministers
of 11 Indian States, one Deputy Chief
Minister, three Governors & many
Ministers and administrators to pledge
their support to curb the tobacco
menace in their states. These received
News item in DNA Mumbai, March 2011 on the VoTV campaign

•
•
•
•
media coverage nationally and in the
states. The campaign also led to strong
policy action in many of the States.
In November 2011, under Save the Future
Campaign, three Chief Ministers and
three Health Ministers of states pledged
their support to effectively implement
Section 6 (prohibition of sale of tobacco
products within 100 yards of educational
institutions) of The Cigarettes and Other
Products Act (COTPA).
The VoTV network took a Bombay High
Court Order to ban hookah and punitive
action against smoke-free violations in
restaurants to 10 State capital cities.
This led to adoption of a similar policy
in at least three of those cities.
The United States Secretary of HHS
(Health & Human Services), Kathleen
Sebelius, during a visit to India,
attended a VoTV event. She was highly
moved and informed that CDC along
with the ACS (American Cancer Society)
is planning to embark on a similar
campaign in the USA. This paid TV
campaign is slated to begin in the US
in mid-March 2012.
VoTV events have also been held for
innumerable policymakers across the
country to obtain their support for
raising taxes on tobacco products, both
smoking and smokeless in a number of
states.
Evaluation
There has been no formal evaluation of
the VoTV campaign as yet. However, this
unique initiative has demonstrated its
ability to create an emotional connect with
policymakers and get them to take action
on tobacco control. It provides a muchneeded
face to tobacco control, reminding
policymakers that this is a crucial public
health issue which needs to be dealt with
urgently through policy advancement,
implementation and enforcement. Overall,
the VoTV campaign has resulted in tax
increase on tobacco products in 11 states,
and many other advancements in terms of
stronger implementation and enforcement of
tobacco control laws have also taken place.
Way Forward
The VoTV initiative serves as an extremely
effective platform for gaining commitment
from policymakers as well as to reach out to
media to create awareness among tobacco
consumers, both potential and existing. The
campaign also involves other public health
organizations, NGOs and social activists
and a joint effort will continue to ensure
commitment from political leaderships in
support of developing a comprehensive
tobacco control programme all over India.
References
1. Murukutla N, Turk T, Prasad CVS, Saradhi R,
Kaur J, Gupta S, Mullin S, Ram F, Gupta PC,
Wakefield M. Results of a national mass media
campaign in India to warn against the dangers
of smokeless tobacco consumption. Tobacco
Control. 2011 Apr 20. [Epub ahead of print]
Acknowledgements
Dr. Surendra Shastri, Patients, Action Council Against
Tobacco, Campaign for Tobacco Free Kids, Salaam
Bombay Foundation and Voluntary Health Association
of India.
About the Authors
Dr. Pankaj Chaturvedi is Professor & Associate
Surgeon, Department of Surgical Oncology, Tata
Memorial Hospital, Mumbai
Dr. Prakash C. Gupta is Director, Healis Sekhsaria
Institute for Public Health, Navi Mumbai
Ashima Sarin is Project Director, Voice of
Tobacco Victims, Healis Sekhsaria Institute for
Public Health, Gurgaon
Shahin Khan is Project Coordinator, Voice of
Tobacco Victims, Healis Sekhsaria Institute for
Public Health, Navi Mumbai
n 51
January - March & April - June 2012

Cessation Efforts on Smokeless Tobacco
Use with Disadvantaged Women
Introduction
Smokeless tobacco is a ‘Class A” carcinogen
and known to contain over 20 potential
cancer-causing agents. Arecanut, an
ingredient in some popular smokeless
tobacco products in India, including gutka
and mawa, confers taste as well as other
harmful constituents to smokeless tobacco.
Smokeless tobacco is responsible for the
high incidence of oral cancers in India in
both men and women. 1 Women tobacco users
in India are more likely to use smokeless
tobacco (18.4%) than smoke (2.9%). 2
Tobacco cessation is an essential component
for reducing mortality and morbidity related
to tobacco use. Without active cessation
interventions, tobacco control measures
such as public awareness, smoke free laws,
raising taxes and banning advertising,
focussing only on prevention, regulation
and enforcement, would not be enough to
reduce tobacco use and the death toll will
continue. A majority of tobacco-related
deaths that can be prevented over the next
40 years will be among current users who
can be persuaded to quit. Tobacco use is an
addiction and cessation as a strategy and
service should be a very important focus
area for governments. In India, especially,
cessation acquires an additional dimension
as tobacco is used in both smoking and
smokeless forms.
The WHO-FCTC also advocates for cessation
services as a significant area to be addressed
by governments working on in tobacco
control. The “O” in WHO-MPOWER package
emphasizes the importance of “offering
For the Millions
n 52
Dr. Mira B. Aghi and Cecily S. Ray
help to people who want to quit” as a key
policy intervention to reduce tobacco use.
In low and middle income countries like
India, integrating tobacco cessation into
primary healthcare and routine medical
visits provides an opportunity to remind
users of the hazards of tobacco use. It
helps to mobilize health professionals and
workers on the issue of tobacco control.
Doctors, nurses, midwives, dentists,
pharmacists, psychologists and counselors
can be mobilized to help people change
their behaviour. Their participation helps
to reinforce the message and advice from
health practitioners to increase abstinence
rates. Although guidelines exist for health
professionals in counseling tobacco users
on quitting, 4 most health care practitioners
in India have not yet received training on
how to do this. Also, in India, unskilled
labourers rarely visit healthcare providers.
Hence, there is a need for ways outside of
the healthcare system to reach people of
low socio-economic status with tobacco
cessation advice and counseling support.
This study demonstrates how among certain
rural populations, intensive small group
sessions on quitting tobacco have been
found effective. 3 Group counseling has been
found to be especially appropriate as it is
least threatening and where there is a large
socio-economic or cultural gap between the
counselor and the participants. Face-toface
support provides opportunities for the
counselor to assist the client in problemsolving
and in building problem-solving
skills. The more the contact between the

counselor and client, the more successful
the tobacco cessation attempt is likely to
be. The counseling concepts and methods
used in this intervention fit well into
behaviour change communication which
is evolved and developed by involving the
users.
Materials and Methods
Although 8 women and 15 men (co-workers
or family members) came voluntarily for
the workshop, on the request of their
employers, only the women decided to
participate. The eight women aged 22
to 37 years, all married, were daily users
of smokeless tobacco. They used basic
ingredients like tobacco, lime and areca
nut, which they mixed in the palm of one
hand with the thumb of the other. One
woman chewed paan (betel quid). Most of
the women said that they had been using
tobacco since early adolescence. Typically,
they had picked it up around 10 to 14
years of age and later on, when their
employers informed them this was harmful,
the women found it hard to give it up or
were not ready to do so. Several of their
employers had also shown resentment to
their use of tobacco in their homes.
This intervention consisted of an initial
11-day workshop and 2 follow-up sessions
in 2007. The workshop was carried out
using a classroom approach and the
duration of each session varied from 35-50
minutes depending upon the queries of the
participants and the counselor’s responses.
On the first 3 days of the quit attempt,
multiple sessions were scheduled to address
problems encountered.
Methods used in the sessions included:
1. An ice-breaking session, which was used
at the beginning to establish rapport
2.
3.
4.
5.
and build trust in the group and with
the counsellor. This was followed by 10
days of the actual intervention.
A preparatory lecture that provided
information on the specific harms of
tobacco use. The causes were designed
to get the women to think about
quitting. This was done in a nonjudgemental
manner.
A participative planning session to plan
the programme to make women feel
more committed to make the required
effort to quit tobacco. To begin the
planning session, the hazards and
unpleasant effects of tobacco were
reiterated to strengthen the intentions
of the women to quit. Participants were
encouraged to think for themselves.
Explanations on the experience of
withdrawal the women were likely to
face and how they should deal with it.
The anxiety expressed by 3 of the women
prompted the counselor to suggest
they start with delaying tobacco use
rather than abstinence. Accordingly,
instructions on how to delay tobacco
use were given. The importance
of avoiding things associated with
tobacco use, such as tea, for a while,
was emphasized.
Group discussion meetings were held
2 to 3 times daily for the first three
days of the simultaneous quit attempt,
wherein individual experiences were
heard and discussed in the group.
Thereafter the group met once a day
for the rest of the workshop. Strategies
to cope with craving for tobacco were
also suggested, such as a) wash face
and mouth; b) drink water; c) do
breathing exercises; d) chew gum; e)
suck on lozenges, cardamom, cloves, or
cinnamon; f) avoid carrying tobacco.
Practical exercises were taught,
including deep breathing and shoulder
n 53
January - March & April - June 2012

exercises. Success stories (anecdotes)
of how other women overcame their
problems of tobacco use were used to
help women cope with stress. Praise
was freely given for abstainers and
commitment to quitting was renewed
daily.
After 10 days of daily intensive sessions, the
counselor again renewed her commitment
to help the participants and plans were
laid to meet after 10 days.
Follow-up meetings: Two follow-up sessions
were held 1) after a gap of 10 days from
the last session and 2) after 6 weeks to
assess performance and reinforce the
content of the workshop in order to help
each participant stay on track. The purpose
of the follow-up sessions was mostly to
build self-confidence in the participants
to confront difficult situations during their
quit attempt and in future.
In the first follow-up meeting, the group
discussed domestic conflict as the main
obstacle in staying away from tobacco.
Chewing tobacco at the time had been
a source of solace for the women. The
counselor encouraged them to think of
other things to do when domestic conflict
arose, like going out to fetch water,
washing their face and gargling or cutting
vegetables. These alternatives would
usually be mentioned in little stories
(anecdotes) about how other women
have coped, rather than through straight
instructions.
Results
At the second and final follow-up meeting
held 6 weeks later, 4 women were
congratulated for continuing to abstain
from tobacco successfully. The intermediate
results are described as follows:
For the Millions
n 54
Within the group, 6 of the 8 women had
come without any intention of quitting
tobacco use. The only motivation mentioned
by two of them was that the employers
had said they did not like them to be
chewing tobacco. They had sporadically
mentioned that tobacco smelt bad and can
also cause diseases. Thereby, two of the
women expressed a desire to know more
about tobacco.
The preparatory lecture on the serious health
hazards caused by tobacco was a turning
point that helped those women, who were
not contemplating quitting, to at least
consider it. And soon enough, the women
who were not contemplating quitting on the
first day, all quickly progressed to thinking
about quitting and prepared themselves
to do so, but at different times. Progress
towards preparation to quit was helped
along by interaction among the participants
and mutual persuasion. However, when all
were ready, a simultaneous quit attempt
was begun.
To support the women during their
quit attempt, three sessions per day
were arranged for the first three days.
In each of the multiple, daily sessions,
the women brought up the personal
problems they were facing just prior to
the meeting. They shared the fact that
tobacco is their only refuge to escape
the tension, fatigue and to bear the
rebuke of others. It emerged that even
at home during quarrels, they would get
beaten up, so they had learnt to start
chewing tobacco as a coping strategy to
reduce stress and avoid arguing. During
the quit attempt, the women were very
responsive to the anecdotes explaining
how others have coped without tobacco,
especially in conflict situations and they
began practicing new ways of coping.

At the first follow-up meeting, after a
gap of 10 days, 3 out of 8 women had
successfully abstained and the others
remained motivated, though with some
difficulties. At the end of the programme,
6 weeks later, 4 women had successfully
abstained from tobacco use.
Discussion
The fact that the women started to think
seriously about quitting after being informed
of the specific harms tobacco can cause, is
similar to findings from other studies with
3, 5,6,7
low socio-economic populations.
Although small, the size of this group was
ideal for tobacco cessation counseling.
Personal interaction was easy: the leader
(counselor) was able to form a caring bond
with the participants and they motivated
one another. This experience of face-to-face
counseling in a small group for tobacco
cessation confirms the benefits reported
about such efforts in the literature. 8
It is important to note that the initial
exercises in postponement rather than total
abstinence from tobacco might have helped
the contemplators among the women to
get started and prevented their dropping
out from later sessions.
Domestic problems were a source of stress
that made quitting tobacco difficult. This
could be overcome in most cases through
empathy and encouragement in counseling
and the practice of special breathing
and relaxation exercises. Tobacco users
among low socio-economic status who are
attempting to quit have to control their
withdrawal symptoms, as well as deal with
highly stressful lives.
A high frequency of sessions - 15 intensive
interactions over a period of 11 days set
the whole group of women on track. This
intense schedule of meetings was effective,
with no room for long gaps or laxity.
The interest generated in husbands and
friends to quit tobacco use shows the
potential for snowballing such efforts, with
the availability of appropriate personnel.
It is likely that the spread of such efforts
would help to change social norms to make
tobacco use less acceptable.
This experience demonstrates that
community-based small group interventions
for tobacco use cessation among the lower
socio-economic strata can be effective in
India. Existing community health workers
in India need to be trained in this area to
fill in the gap for low-cost and accessible
cessation services. A special manual has
been prepared under the National Tobacco
Control Programme to guide health workers
in tobacco cessation counselling. 9
Conclusion
The tobacco problem in India is complex
due to the varied nature of tobacco use.
Cessation in Indian settings needs a
multi-sectoral approach. It must include
preventive, curative and rehabilitative
care. In India, clinical settings are few in
number with a smaller number of trained
professionals. Availability and affordability
of medication required for cessation is also
a severe constraint. Here, local communitybased
organizations and trained counsellors
who can bring in non-clinical, behavioural
methods of counselling, using a sensitive,
compassionate approach are essential to
rural grassroots level settings. However,
to spread this activity, dedicated workers
are required, including volunteers and paid
workers. Public health organizations and
civil society agencies working in the area
n 55
January - March & April - June 2012

of tobacco control can complement these
efforts further with more intensive group
counseling programmes with tobacco user
groups in their settings, using trained
counselors.
References
1. Parkin DM, Bray F, Ferlay J, Pisani P. Global
Cancer Statistics: 2002. CA Cancer
2. J Clin 2005;55(2):74-108.
3. Ministry of Health and Family Welfare. Global
Adult Tobacco Survey-India, 2009-10. New
Delhi: MOHFW, Government of India and Mumbai:
International Institute for Population Sciences;
2010 – [cited 2012 Mar 2]. Available from:
http://www.searo.who.int/LinkFiles/Regional_
Tobacco_Surveillance_System_GATS_India.pdf
4. Aghi MB, Gupta PC, Bhonsle RB and Murti
PR. Communication Strategies for Intervening
in the Tobacco Habits of Rural Populations in
India. In: Gupta PC, Hamner JE III, Murti PR,
editors. Control of Tobacco-related Cancers and
Other Diseases. Proceedings of an International
Symposium; 1990 Jan 15-19; Bombay, India.
Bombay: Oxford University Press; 1992. p. 303-
306. Available from: http://actindia.org/
5. World Health Organization. Tobacco Dependence
Treatment Guidelines. Tobacco Free Initiative.
New Delhi: World Health Organization, India
Office. Available from: http://whoindia.org/
LinkFiles/Tobacco_Free_Initiative_Tobacco_
Dependence_Treatment_Guidelines.pdf
For the Millions
n 56
6. Anantha N, Nandakumar A, Vishwanath N,
Venkatesh T, Pallad YG, Manjunath P, et
al. Efficacy of an Anti-tobacco Community
Education Program in India. Cancer Causes
Control. 1995;6(2):119-29. Erratum in: Cancer
Causes Control 1995;6(3):280.
7. Gupta PC, Mehta FS, Pindborg JJ, Bhonsle RB,
Murti PR, Daftary DK, et al. Primary Prevention
Trial of Oral Cancer in India: a 10-year follow-up
study. J Oral Pathol Med. 1992;21(10):433-9.
8. Mishra GA, Shastri SS, Uplap PA, Majmudar
PV, Rane PS, Gupta SD. Establishing a Model
Workplace Tobacco Cessation Program in
India. Indian J Occup Environ Med [serial
online] 2009 [cited 2012 Mar 3];13:97-103.
Available from: http://www.ijoem.com/text.
9.
asp?2009/13/2/97/55129
Stead LF, Lancaster T. Group Behaviour Therapy
Programmes for Smoking Cessation. Cochrane
Database Syst Rev. 2005;(2):CD001007.
10. Ministry of Health and Family Welfare. Health
Worker Guide. New Delhi: National Tobacco
Control Programme and National Rural Health
Mission; Ministry of Health and Family Welfare,
Government of India; 2010. Available from:
http://mohfw.nic.in/WriteReadData/l892s/file4-
46472593.pdf
About the Authors
Dr. Mira B. Aghi, Ph.D, is a freelance consultant
on Behavioural Sciences and Communication.
Cecily S. Ray, MPH, is a Public Health
Researcher.
Dr. Mira B. Aghi is the Luther L. Terry Award 2012
winner in the Outstanding Community
Service Category
The American Cancer Society Luther L. Terry Awards are held in honour of the
pioneering US Surgeon General who, in 1964, published a landmark report
linking smoking to lung cancer and other serious health issues. Although he
released a storm of controversy with this report, Dr. Terry’s determination to
pursue this groundbreaking work that established the foundation for tobacco
control is commendable. This award honours those who follow in his footsteps
in the fight against tobacco. Dr Aghi will receive the award at a special
ceremony on March 21, 2012 in Singapore during the 15 th World Conference
on Tobacco or Health.

Research News Feature:
Summary of Recent, Evidence-based
Findings for Tobacco Control
This feature presents summaries of a few recent published literatures on tobacco control
issues. The year 2010-11 was a significant year where many positive developments and
discourses took place in tobacco control. Tobacco taxes were raised in many states, the
Government issued guidelines to regulate smoking in movies, new pictorial health warnings
came into effect, more smoke free settings were declared and there was increased media
coverage on tobacco control. These developments signify a paradigm shift at the highest
level - policy makers are beginning to accept the arguments of public health experts and
activists. This research news feature is an effort to present an overview of evidence-based
findings that can serve as invaluable tools for tobacco control policies in India.
Research 1
Effectiveness of Mass Media Campaigns in Addressing
the Smokeless Tobacco Epidemic in India: Results of a
Recent Study
Nandita Murukutla, Tahir Turk, C V S Prasad, Ranjana Saradhi, Jagdish Kaur, Shefali Gupta,
Sandra Mullin, Faujdar Ram, Prakash C Gupta, Melanie Wakefield. Results of a National Mass
Media Campaign in India to Warn Against the Dangers of Smokeless Tobacco Consumption.
Tobacco Control, January 2012, Volume 21, Issue 1, pp12-17
A serious epidemic worldwide, tobacco
use prevalence is of significant concern in
India where it is has been projected that
tobacco-related deaths may exceed 1.5
million annually by 2020. India is also in
a unique situation, faced as it is with the
high levels of consumption of smoking and
smokeless forms of tobacco. In fact, 74%
of current tobacco users in India consume
it in smokeless forms. Smokeless tobacco
consumption has been linked to India’s
high oral cancer rates, poor reproductive
outcomes and high rates of cardiovascular
diseases.
Public education through mass media
campaigns is a proven effective strategy in
decreasing tobacco prevalence. Furthermore,
there is strong evidence that for anti-
tobacco messaging to be effective, it must
be graphic and negatively emotive, eliciting
fear, anger, disgust and concern. Armed
with this evidence, the Ministry of Health
and Family Welfare, with support from World
Lung Foundation, launched a campaign from
November through December 2009 targeted
at creating awareness about the harmful
effects of smokeless tobacco. Featuring
heartfelt accounts of patients who developed
oral cancers as a result of smokeless tobacco
consumption, this campaign was evaluated
with a nationally representative household
survey of smokeless tobacco users (2108
smokeless-only users and 790 dual users).
The study measured changes in knowledge,
attitudes, behavioral intentions and
behaviors towards smokeless tobacco as a
result of exposure to the campaign.
n 57
January - March & April - June 2012

The results of the study were very encouraging:
63% of smokeless-only users and 72% of
dual users recalled the campaign. 75%
of smokeless-only users and 77% of dual
users said that it made them feel concerned
about their habit. Campaign awareness was
associated with better knowledge, more
negative attitudes towards smokeless tobacco
and greater cessation-oriented intentions and
Research 2
For the Millions
n 58
behaviours among smokeless tobacco users.
This study suggests the feasibility and efficacy
of tobacco control mass media campaigns
in India. It suggests that when properly
developed and implemented, graphic and
hard-hitting campaigns can be an effective
strategy in increasing awareness and reducing
prevalence of tobacco use in India.
Rational Taxation System of Bidis and Cigarettes to
Reduce Smoking Deaths in India
Prabhat Jha, Emmanuel Guindon, Renu A Joseph, Arindam Nandi, Rijo M John, Kavita Rao,
Frank J Chaloupka, Jagdish Kaur, Prakash C Gupta, M Govinda Rao. Economic and Political
Weekly, October 15, 2011, Vol XLVI, No 42, pp 44-51
Background
Smoking bidis or cigarettes accounts for
nearly one million adult deaths a year or
about 10% of all deaths at all ages. Higher
taxation of tobacco products is the single
most effective intervention to reduce
consumption. The study reviews the key
economic issues related to tobacco use
and its regulation in India and concludes
that substantially higher and smarter
excise taxes of bidis and cigarettes
would prevent millions of premature
deaths, raise additional revenue, and
that higher taxation would incur minimal
economic costs.
Methodology
Prevalence data were drawn from the
nationally-representative Global Adult
Tobacco Survey (GATS) – India from 2009-
10 (GOI 2010). Mortality data from smoking
were drawn from the nationally-representative
“Million Death Study”. Retail prices for
bidis and cigarettes were obtained from the
Labour Bureau, Ministry of Labour. Excise
duty rates were drawn from the department
of revenue; Ministry of Finance. The impact
of higher taxes on consumption, mortality
and tax revenue was modi fied from a static
compartment model which is based on price
elasticities, current consumption and impact
on cessation or initiation.
Current Tax Structure in India
Tobacco in India is subject to a range of
taxes imposed by both the central and state
governments. For bidis, machine-made and
hand-made bidis are taxed differently and
at very low rates. Cigarettes are taxed based
on their length with filtered cigarettes being
taxed higher than non-filter cigarettes,
adding to tax complexities.
Major consequences of this existing tax
structure:
• Lower taxes on tobacco increases
consumption. Taxes on bidis are very
low, averaging only about 7% of
the retail price. Cigarette taxes only
account for approximately 43% of the
retail price, which remains much lower
than the average rate of 63% of retail
price in most high-income countries.

•
•
•
•
The complex tax structure makes it
more difficult to adjust for income
growth and inflation.
The tax variation due to lengths
minimise the effect of any tax increase
and enables smokers to switch to
different length in response to price,
and enables cigarette manufacturers to
alter the structure of products brought
to market so as to minimise tax.
The complex tax structure increases tax
evasion and corruption.
The final consequence is a far less
predictable revenue stream for
government.
Suggested Tax Reform
This study suggests a rational and simple
taxation system that would be implemented
in several phases;
•
•
•
•
To tax all cigarettes uniformly at the
highest rates currently applied to the
longest length of cigarettes; namely
at Rs 2,363 per 1,000 sticks. It would
raise the street price of cigarettes
from about Rs 30 (per pack of 10)
to about Rs 40 representing a 33%
increase in the average price and raise
the proportion of this price that is tax
from 43% to 58%.
For bidis, elimination of the tax
variation for hand-made and machinemade
bidis and an excise duty of Rs
100 per 1,000 sticks, up from the
current Rs 14 and Rs 26.
In the next phase, the excise duty will
be adjusted periodically for inflation.
Thus the excise duty will be raised
from the fiscal year 2013, in line with
overall inflation and preferably in
excess of inflation.
Finally, the tax reform will be
accompanied by several administratively
feasible efforts. These administrative
measures include:
i. Prominent warning labels (which are
already being introduced by GOI) in
regional languages to enable easier
identification of packs smuggled
from outside India.
ii. Tax stamps (ideally the more
sophisticated new generation of
encrypted stamps) that are inside
the plastic wrapper to help to
identify illicit products.
iii. Policymakers need to recognize
that the bidi industry is structured
and organised to evade taxes.
Several specific efforts need to be
implemented to eliminate small
producers.
iv. The sale of unbranded bidis should be
prohibited, and manufacturer names
should be printed on bidi packets to
ensure higher tax compliance.
v. The reporting of the sale and
purchase of processed bidi tobacco
by any persons or entity should
be made mandatory. The volume
of transaction and the names of
persons involved in it also should
be documented.
Potential Impact of Tax Reform
•
•
•
•
As suggested by studies that youth
are more price responsive than adults,
an increase in price will stop over 6.7
million youth below age 15 to start
smoking cigarettes and over 21.4
million to start smoking bidis.
Under our proposed reforms, health gains
from decreased tobacco consumption
are accompanied by increased tax
revenue as demand remains inelastic.
High specific excise duties are far more
likely to discourage switching between
different types of tobacco products, are
much easier to administer, and produce
a much steadier stream of revenue.
The use of excise duty also would
decrease the difference between higher
and lower- priced cigarettes, effectively
n 59
January - March & April - June 2012

•
increasing the public health impact.
Given evidence of a marked switch from
bidis to cigarettes, higher taxes on all
length of cigarettes would slow growth
of lower length cigarettes which appear
to be displacing bidi sales.
Finally, the simplicity and transparency
of a high excise tax rate enables easier
planning of sales by the tobacco
industry. This will result in good
monitoring and less tax evasion by
tobacco companies.
Specific Recommendations
A comprehensive approach for tobacco
control would dramatically reduce premature
mortality, and raise, in the medium term,
Research 3
For the Millions
n 60
substantial revenue. It is recommended
that the Government:
•
•
Implements a comprehensive tobacco
control strategy that uses price,
information and regulation measures
to curb consumption.
Adopt higher and smarter levels of
taxation, focused on a higher excise tax
rate on bidis and cigarettes, with annual
adjustment for inflation. These would
be paired with practicable strategies
to decrease tax avoidance and evasion,
while increasing transparency and
decreasing corruption. Modest action
on tobacco taxes in India might well
save millions of lives.
The Perverse Economics of the Bidi and Tendu Trade
Pranay G Lal, Nevin C Wilson, Economic and Political Weekly, January 14, 2012, Vol XLVII,
No 2, pp 77-80
Background and Summary
Tendu and bidi are considered the mainstay
of many rural economies. Despite its
profound impact there are few estimates
on the total number of bidis produced and
tendu harvested. Using back of the envelope
methods and data from forest departments,
the paper constructs the size of the total
tendu available for bidi rolling. Using
bidi tobacco produced in India, it derives
the total number of bidis produced in the
country. The difference between total bidis
produced and total tendu legally harvested
through forest departments, arrives at the
total illicitly harvested tendu leaves. As a
second level analysis, total number of tax
paid bidis are derived using excise data from
Ministry of Finance. The difference between
total bidis produced and tax paid bidis
derives the number of bidis that are untaxed.
The paper for the first time presents these
estimates and report on the black market
of tendu, bidi and untaxed bidis, which
together stymie public health goals.
The paper finds that The Union and state
governments do not have robust records of
tendu sales in state and lose out of revenues
through illicit plucking. These benefit
corrupt traders, local politicians and even
insurgent groups.
Illicit sale of tendu accounts for nearly
40% to 50% of the total trade. In 2007-
08 for example, only 310 billion tendu
leaves were legally available but near ly 605
billion bidis were made – which im plies
that about 49% tendu leaves were acquired
illegally by bidi manufacturers. The Global
Adult Tobacco Survey sug gests that nearly

553 billion bidis were consumed in India
in 2008-09.
Key Policy Implications
• The public health goals of reducing
smoking by raising retail prices through
taxes will be defeated in the absence
of rigorous estimates as it is crucial in
achieving the twin goals of reducing
the public health impact of tobacco
use, and improving tax collection while
reducing the illicit trade of bidi.
• As a first step, price correction of
tendu leaves must be made (tendu leaf
prices have remained virtually stagnant
since 1976). Currently, the arbitrary
nature of fixing tendu price provides
virtually no gain for forest dwelling or
tribal economies. The Haque Committee
Research 4
•
•
appointed by the Ministry of Panchayati
Raj in August 2010 has recommended a
set of mechanisms to determine the minimum
support price for tendu leaves.
Because of the significant size of the
bidi and tendu leaf trade and their
profound impact on local communities,
it is important that they are closely
monitored through a central authority.
All exemptions on bidi manufacturing
should be removed. Current exemption
on bidi producers who produce less than
two million bidis must be removed on
priority, and the distinction between
machine-made and handmade bidis
must be removed so as to reduce illicit
and unpaid bidi trade. This will correct
the existing distortions further and
improve collections.
Counting 15 Million More Poor in India, Thanks to Tobacco
Rijo M John, Hai-Yen Sung, Wendy B Max, Hana Ross, Tobacco Control, September 2011,
Volume 20, Issue 5, pp 349-352
Background
Over 300 million people in India live in
poverty and the poor represent 28.3%
and 25.7% of the rural and the urban
population, respectively. Many tobaccoconsuming
families live below or just above
the poverty line, and owing to their tobacco
consumption, the resources available to
them for other goods and services are on
par with families that have lower total
expenditure but do not consume tobacco.
The objective of the study is to quantify
the impact of tobacco use and the related
medical expenditure on poverty in India.
Data and Methodology
•
The 2004 National Sample Survey,
a nationally representative survey
•
•
of Indian households, was used to
estimate the true level of poverty.
Sample data is used from NSS 2004-
2005 on consumer expenditure,
employment and unemployment for
124, 644 households (79, 298 living in
rural areas and 45, 346 living in urban
areas).
Tobacco expenditure and associated
medical expenditure attributable to
tobacco use were subtracted from
the household monthly consumption
expenditure in order to derive an
appropriate measure of household
disposable income.
Major Findings
•
Tobacco consuming households spend
2.3% of their monthly expenditure on
n 61
January - March & April - June 2012

•
•
tobacco. Adjusting the official poverty
level for this data, it is found that 14
million people are below the poverty
line but not counted. Non-smoked
tobacco and dual use are responsible
for 58%, 23%, and 19% of this increase
in poverty as a result of tobacco
expenditure, respectively.
18% of medical expenditure by rural
households and 17% of medical
expenditure by urban households
can be attributed to tobacco use.
Accounting for these tobacco-related
medical expenditure increased the
poverty level to 28.4% in rural India
and to 25.7% in urban India, meaning
that an additional 0.9 million people
should have been classified as poor.
The combined effect of both direct
tobacco purchases and tobaccoattributed
medical expenditure means
15 million people became poor
after accounting for tobacco use in
2005. These 15 million people were
Research 5
For the Millions
n 62
misclassified as being above the
poverty line.
Policy implications
•
•
•
Poverty eradication is the first of the
eight MDGs and reducing tobacco use,
along with other strategies, can be a
very effective means of achieving this
goal. Regulating tobacco use is not only
a good public health policy, but also a
good poverty alleviation strategy.
As poor are relatively more responsive
to tobacco price increases than the
rich, one of the most effective tobacco
control measures is a price increase via
higher tobacco taxes.
Tax increase will reduce tobacco use
and free up money for the consumption
of essential goods and services such
as food, clothing, healthcare and
education, it will improve labour
productivity and will also increase the
earning potential of the family.
Tobacco Use in Bollywood Movies, Tobacco Promotional
Activities and their Association with Tobacco Use Among
Indian Adolescents
Monika Arora, Neha Mathur, Vinay K Gupta, Gaurang P Nazar, K Srinath Reddy, James D
Sargent, Tobacco Control, 2011, doi:10.1136/tc.2011.043539 [Open Access]
Background
Studies in developed countries have
established that exposure to smoking
in Hollywood movies leads to increased
risk of smoking among adolescents.
This was a cross-sectional study among
Indian school-going adolescents to study
whether exposure to tobacco use through
Bollywood movies is associated with youth
tobacco use.
Methodology
•
A cross-sectional sample of 3956
adolescents (eighth and ninth grades,
ages 12 to 16 years) from 12 randomly
selected New Delhi schools was surveyed
in 2009, assessing tobacco use status,
receptivity to tobacco promotions
(based on owning or being willing to
wear tobacco-branded merchandise) and
exposure to tobacco use in movies.

•
•
Quartiles of exposure to tobacco use in
popular Bollywood movies released from
2006 to 2008 (n=59) were determined
by content-coding them for tobacco use
and querying the adolescents whether
they had seen each one.
Logistic regression was used to control
for covariates including age, gender,
parent education, school performance,
sensation-seeking propensity, family
and peer tobacco use, and authoritative
parenting.
Major Findings
•
•
•
•
•
•
Watching tobacco use in Bollywood
movies and receptivity to tobacco
promotional activities were both
independently associated with ever
tobacco use among adolescents in
India.
With respect to tobacco promotions,
11.8% of adolescents were receptive,
of which 283 (7.3% of all students)
responded that they owned a personal
item that had a tobacco brand name
or logo on it.
Exposure to tobacco use in movies
was significantly associated with the
demographic profile of the adolescents
and other risk factors such as social
influences and characteristics of
adolescent and parenting.
Boys had higher exposure than
girls. Exposure was also higher for
adolescents belonging to higher Socio
Economic Status (SES) than lower SES,
and among ninth graders compared to
eighth graders.
Those who were receptive to tobacco
promotions or who had tobacco users
as friends were also significantly more
exposed to movie smoking.
Exposure was also significantly higher
for those with higher level of sensation
seeking and, surprisingly, for those
with more authoritative parents.
Limitations
•
•
•
First, its cross-sectional design limits
our ability to draw causal inferences;
further longitudinal studies are required
to assess whether exposure to tobacco
use in Bollywood movies predicts onset
of tobacco use behaviour.
Second, the study’s generalisability
is limited to urban school-going
adolescents, as non-school-going
adolescents and adolescents from rural
areas were not included.
Third, in contrast to other studies, the
prevalence of tobacco use decreased up
to an exposure to 100 movie tobacco
occurrences and increased thereafter.
The sensitivity analysis raises possibility
that survey item non-response could
partially explain this phenomenon, and
further study is required to determine
whether the observed non-linear dose
response to tobacco use in movies is a
real phenomenon in this population.
Key Implications
•
•
The present study confirms a relation
between exposure to tobacco use
depictions in Bollywood movies and
tobacco use behaviour of school-going
Indian adolescents. This study provides
some evidence in favour of the pending
litigation in Supreme Court by a
Bollywood film producer according to
whom, banning tobacco use depiction
in movies would impinge upon creative
freedom. .
Despite a comprehensive regulation,
restricting tobacco promotions, 7.3%
of all the students reported owning
a tobacco promotional item which
suggests that tobacco companies are
violating the prescribed regulations for
tobacco promotions under Section 5 of
COTPA. This suggests that enforcement
of Section 5 of COTPA needs to be
strengthened.
n 63
January - March & April - June 2012

Policy Initiatives by Ministry of health and Family
Welfare, Government of India in 2011
A. The Ministry of Health & Family Welfare vide
Notification GSR 619 (E), dated 11 th August,
2011, notified the Rules to enforce Section 6
(a) of COTPA (Prohibition on Sale of Tobacco
Products to Persons Below the Age of 18 years).
The main features of the Rules are:
(1) A board with a minimum size of 60 X 30 cm of white
background, containing the warning “sale of tobacco
products to a person below the age of 18 years is a
punishable offence”, and a pictorial depiction of the
ill-effects of tobacco use on health, is to be displayed
at the entrance of the place where cigarettes or other
tobacco products are sold.
(2) The owner, manager or the in-charge of the affairs of
a place where cigarettes or other tobacco products
are sold has to ensure that.-
(i) the warning board shall not have any
advertisement or promotional messages or
pictures or images of cigarettes or any other
tobacco products.
(ii) no tobacco product is sold through a vending
machine;
(iii) no tobacco product is handled or sold by a
person below the age of 18 years;
(iv) tobacco products are not displayed in a manner
that enables easy access of tobacco products
to persons below the age of 18 years.
B. The Government vide gazette notification dated
27 th October 2011, G.S.R. No. 786 (E) has
notified the tobacco free movies and television
programmes Rules (in effect from 14 th November,
2011).
The salient features of the Rules are:
(1) In Old Films and Television Programmes displaying
tobacco usage:
(i) mandatory display of health warning scroll during
the duration of the scene and a health message
of 30 seconds each in the beginning and middle
of films and television programmes.
(2) In new Films and Television Programmes displaying
tobacco usage:
(i) a 'UA' Certificate is to be given.
(ii) mandatory display of health warning scroll
during the duration of the scene and a
health message of 30 seconds each in the
beginning and middle of films and television
programmes.
For the Millions
n 64
(iii) a disclaimer by the concerned actor on the illeffects
of tobacco use of 20 seconds each, in
the beginning and middle of film.
(iv) an editorial justification explaining the
necessity of such scenes.
(3) The Rules prohibit:
(i) the display of brands of cigarettes or other
tobacco products or any form of tobacco
product placement;
(ii) close-ups of tobacco products and tobacco
product packages.
(iii) display of tobacco product or its use in
the promos and poster of films television
programmes.
(4) The Rules prescribes cropping or masking the brand
names or logos of tobacco products forming part of
the pictures to be printed in any form of print or
outdoor media or footage to be aired through any
form of electronic media.
(5) The Rules envisage that scenes depicting tobacco
products or its usage may be permitted to be
telecast on television at such timings that are
likely to have least viewership from persons below
the age of 18 years.
C. The Food Safety and Standards Authority
of India, Ministry of Health and Family
Welfare, Government of India has notified the
Food Safety and Standards (Prohibition and
Restriction on Sales) Regulation, 2011, vide
F.No. 2-15015/30/2010, dated 1 st August 2011,
which has come into force on 5 th August 2011.
The Regulation 2.4.3 of the said regulations states:
“Product not to contain any substance which may
be injurious to health: Tobacco and nicotine shall
not be used as ingredients in any food products.”
As the Supreme Court in the case of Godawat Pan
Masala Products I.P. Ltd. & Another Vs Union of
India & Others, 2004 7 SCC 68, has held Gutka as
an article of food, hence the said regulation bans
the sale of Gutka which is a food item containing
tobacco and nicotine.
D. The Ministry of Health & Family Welfare has
notified the new set of pictorial warnings vide
the Cigarettes and Other Tobacco Products
(Packaging and Labelling) Amendment Rules,
2011, G.S.R. No.417 (E), dated 27 th May 2011.
The new pictorial warnings have come into effect
from 1 st December, 2011.

National News
Smokeless tobacco claims lives
of 17% of 30-plus adults
Almost two in five deaths among adults
aged 30 years and above in India are caused
due to smokeless tobacco. According to
WHO’s “Mortality attributable to tobacco
report” released on Tuesday, globally 12%
of all deaths among adults aged 30 years
and over were due to smokeless tobacco in
2004 compared with 16% in India, Pakistan
(17%) and Bangladesh (31%).
Direct tobacco smoking was responsible for
five million deaths. Another six lakh people
died from second-hand smoke. Over the
next 20 years, the annual death toll from
tobacco will be eight million, with more
than 80% of those fatalities projected to
occur in low and middle-income countries.
WHO says tobacco could kill over one
billion people in the 21st century. Many
think smokeless tobacco is safer than the
smoking form. However, that’s not really
true.
Union Health Minister Ghulam Nabi Azad
said at Parliament last September that in
India 70,261 people were detected with
mouth cancer, tongue and hypopharynx due
to “smokeless tobacco products”. Quoting
data from the Indian Council of Medical
Research (ICMR), the minister had said the
numbers of those affected were rising -
66,129 in 2008 and 68,160 (2009).
Bhavna Mukhopadhyay, Executive Director
of Voluntary Health Association of India,
added, “2500 people die every day due to
tobacco-related diseases in India. Display
of harsher pictorial warnings on tobacco
products is one of the most effective tools
to reduce tobacco consumption. Chewing
tobacco and gutka contribute to 90% of
oral cancer cases.”
According to the Global Adult Tobacco
India Survey (GATS), 21% of the country’s
population is addicted to smokeless tobacco,
and another 5% smoke as well as use
smokeless tobacco. Around 75% of the 275
million Indians consume smokeless tobacco
products. A large number of children and
youth in India are addicted to smokeless
tobacco that contains nicotine and is
highly addictive. There are 3,095 chemical
components in tobacco, among them 28
are proven carcinogen. Among smokeless
tobacco products, khaini is used the most,
followed by gutka. Around 91% of female
tobacco users use smokeless products like
betel quid.
The WHO report added that the proportion
of mortality attributable to tobacco is
higher among men than women. Globally,
5% of all deaths from communicable
diseases and 14% from non-communicable
diseases among adults aged 30 years and
above are attributable to tobacco. Within
communicable diseases, tobacco use is
responsible for an estimated 7% of all
deaths due to tuberculosis and 12% due
to lower respiratory infections. Within
non-communicable diseases, tobacco use
is responsible for 10% of all deaths from
cardiovascular diseases, 22% of all cancer
fatalities, and 36% of all deaths from
diseases of the respiratory system.
Source: The Times of India, New Delhi, 16 February, 2012
Australian NGO sounds alert
over promotion of gutka by
Indian company
Tobacco News
Anti-tobacco activists in India have
welcomed the move by an anti-tobacco
n 65
January - March & April - June 2012

lobby, Action on Smoking and Health, in
Australia which alerted and pressurised
Cricket Australia to immediately remove
a surrogate advertisement by an Indian
company promoting gutka in Australia.
“The advertisement of an Indian gutka
company was seen displayed on the
boundary rope during the Australia-India
Test series in Melbourne, Sydney, Perth and
Adelaide. The controversial advertisement
was once again on display in the two
T-20 international matches and a one-day
international match played in Melbourne.
After being alerted by a local nongovernment
organisation, the Australian
cricket administrators immediately ordered
removal of all the Hindi advertisements of
the gutka.
“Tobacco companies continue to target
people, especially the youth, by making use
of surrogate means to advertise tobacco
products. Legislation in India needs to be
effectively enforced and loopholes need
to be tightened to avoid advertising and
promotion of tobacco products through
surrogate means. A big applause to the
Australian Government for taking strict
and timely action,” said Voluntary Health
Association of India executive director
Bhavna Mukhopadhyay.
“It’s a shameful moment for India that
clever surrogate marketing of tobacco
products still continues to lure teenagers
towards tobacco and this time in Australia,”
she added.
Voluntary Health Association of India
said Cricket Australia is under fire for the
boundary line advertising and could face
fines. All forms of tobacco advertising are
banned in Australia under the Tobacco
Advertising Prohibition Act-1992 and the
For the Millions
n 66
Australian Government is in the process of
banning the use of tobacco industry logo,
brand imagery and even product names.
Source: The Hindu, New Delhi, 13 February, 2012
Budgam is first smoke-free
district in Jammu & Kashmir
The central Kashmir district of Budgam has
become the first district in the State of
Jammu & Kashmir to be declared as Smoke
Free. In an effort to safeguard the health of
people from hazardous effects of smoking
and tobacco chewing, the administration
has banned use of tobacco and smoking at
3500 public places in the district.
While making this revelation during media
sensitization programmes organized in
Srinagar, Executive Director of JK Voluntary
Health and Development Association, A M
Mir said the declaration to this effect was
made by Deputy Commissioner Budgam
Mohammad Rafi on January 26, 2011.
Under this declaration, made under Section
4 of Cigarette and other Tobacco Products
Act 2003 and COTPA, the administration in
Budgam has declared all 3500 public places
including health institutions, schools and
offices as free of smoking.
Sikkim was the first State in India to be
declared as Smoke Free while Chandigarh
was the first Smoke Free Indian city.
The administration Budgam in collaboration
with J&K VHA is implementing tobacco
control programmes since last one year
during which various meetings and seminars
on tobacco control laws and measures
were organised with an aim to educate
people about the ill-effects of tobacco
chewing and smoking. Subsequently, as
a follow action, all public places in the
district were brought under the purview

of ban on tobacco chewing and smoking,
which finally culminated in declaring the
whole district as Smoking Free.
While giving an overview of the compliance
monitoring study conducted by JK VHADA,
District coordinator of NGO Mohammad
Altaf Dar said at 3500 public places in the
district including educational institutions,
government offices, public parks, hospitals,
smoking has been banned.
“Besides, all the smoking signages have
either been removed or defaced in the
district with the help of administration
and Food and Drug Control Organisation”,
he said while giving a presentation on
compliance monitoring study by the JK
VHADA.
The study revealed of the 352 sample
public places visited, the signage boards
depicting “No Smoking Area-Smoking here
is an offence” were found at 321 places. At
the remaining 31 places, no signage boards
were seen.
Deputy Commissioner Budgam Mohammad
Rafi said the district is known for the
negatives but it has many positive
potentials as well.
Stating that the district is not averse
to change, he said Budgam people have
always welcomed positive change. “Though
Budgam is backward in education sector
but we are making strides in this sector
also. The implementation of COTPA and
declaring Budgam as Smoke Free district
is one such step. This will help in a long
run,” he said.
Minister of Science and Information
Technology and MLA Budgam Aga Ruhullah,
who was also chief guest on the occasion,
took a public pledge that he will try to quit
smoking.
Source: Rising Kashmir, Srinagar, 29 th January, 2012
Bid to scuttle tobacco warning
NGOs have claimed that recent reports
suggesting that one of the pictorial
warnings for tobacco products resembles
footballer John Terry could be an attempt
by the manufacturers to scuttle the pictorial
warnings once again.
In a recent RTI filed by the Voluntary
Health Association of India (VHAI), the
issue was brought to the notice of Union
health ministry earlier in November by
Philip Morris, manufacturer of the leading
cigarette brand Marlboro. “However,
digging the issue once again now could
be a deliberate move by the manufacturers
to put the warnings in trouble.” According
to the representatives of the VHAI, even
as the letter by Philip Morris mentioned
that pictures notified by the government
for smoking form of tobacco products
“bears a close resemblance to English
soccer player John Terry, the ministry had
clarified then itself that pictures for the
health warnings were being developed by
Directorate of Audio Visual Publicity (DAVP)
in consultation with them and the pictures
were mere sketches and did not relate to
any person living or dead.”
“Further the cigarette company has the
option to choose any one picture out
of the set of four each of lung and oral
cancer. Since the images are blurred and
sketchy such resemblance can be attributed
to scores of people,” the RTI said.
Bhavna Mukhopadhyay, VHAI Executive
Director, said, “The tobacco lobby is trying
to create unnecessary confusion to derail
n 67
January - March & April - June 2012

the process of implementation of the new
pictorial health warning. More than a month
has passed since the warnings have come
into effect but most of the leading brands
have not printed the new pictures.”
Source: Deccan Chronicle, New Delhi, 11 January, 2012
Survey finds tobacco sold within
100m of schools in 5 states
Tobacco is openly available outside schools
even though a ban exists on its sale within
100 yards of a school premise. A study in
five states - Assam, Jammu and Kashmir,
Orissa, Uttar Pradesh and Rajasthan - has
found that more than 48% of educational
institutions had tobacco products being
sold within 100 yards.
According to the ministry, nearly 37%
children in India start smoking before they
reach 10 years, and each day about 5, 500
children begin tobacco use.
Conducted in June, 2011, by the Voluntary
Health Association of India (VHAI) and five
other partner organizations, the study found
that despite having the rules notified by
the health ministry, tobacco vendors were
openly selling tobacco products within 100
yards of educational institutions.
The government agencies, however, had not
taken any action against the vendors.
According to Global Youth Tobacco Survey
(GYTS) conducted among the students
in India, 14.1% of youth use some form
of tobacco products, 51.7% purchase
cigarettes from stores and kiosks and 72.5%
who bought cigarettes in a store were not
refused purchase despite being minors.
“By permitting sale of tobacco products
outside educational institutions alongside
For the Millions
n 68
candies and soft drinks, young people will
get the misleading message that tobacco in
any form is normal and socially acceptable”,
said Bhavna B Mukhopadhyay, executive
director of VHAI.
In the study, around 557 educational
institutions were visited for the survey in
five districts - Golaghat in Assam, Srinagar
and Budgam in Jammu and Kashmir,
Jagatsinghpur in Orissa, Shahjahanpur in
Uttar Pradesh and Jhunjhunu in Rajasthan.
About 47.5% of the educational institutions
had tobacco products being sold within
100 yards in the six districts.
Section 6(a) of Cigarettes and other Tobacco
Products (Prohibition of Advertisement
and Regulation of Trade and Commerce,
Production, Supply and Distribution) or
COTPA, 2003 mandates that the owner of
a place where tobacco products are sold
should prominently display a board of
60cm x 30cm specifying the warning, in
the applicable Indian language(s), that
“sale of tobacco products to a person
under the age of 18 years is a punishable
offence”.
The survey reports that of all the tobacco
vendors observed in the six districts
(175), only 15 had the required boards on
the shop. Of these 15 shops, 12 were in
Jhunjhunu, two in Shahjahanpur and one
in Golaghat. The remaining 160 vendors
did not have the required signage.
Among the shops, where the signage was
displayed, 13.3% were observed selling
tobacco products to minors. The shops
without signage also had 16.25% incidence
of tobacco products being sold to minors.
The presence of no-smoking signage in
educational institutions was less than 5%

in Shahjahanpur, Jhunjhunu and Golaghat
(0.4, 2.1 and 3.7%, respectively). It was
6.7% in Budgam and 12.5% in Srinagar
and Jagatsinghpur.
Among educational institutions, Budgam
is the fore-runner in violations with
active smoking observed in 43.3% of the
institutions within the campus. It was
followed by 29.6% in Golaghat, Srinagar
(12.5%), Shahjahanpur (8.4%), Jhunjhunu
(2.1%) and Jagatsinghpur (0%).
Section 6 of COTPA says, there is a ban
on sale of tobacco to and by minors
and prohibition on sale of tobacco
products within 100 yards of educational
institutions.
Rules under COTPA were framed on the
recommendations of the Parliamentary
standing committee on human resource
development in 2001, which had suggested
a ban on the sale of tobacco products within
500 yards of educational institutions.
Source: The Times of India, New Delhi, 15 November, 2011
Campaigners cheer tax hike on
tobacco
The decision of the Odisha State Government
to raise value added tax on cigarettes,
bidis and every other form of tobacco
products has got the thumbs up from the
anti-tobacco campaigners and the medical
fraternity.
The move would go a long way in not only
saving a large number of lives but also
effect reduction in Government spending
on treating tobacco-related diseases, they
have asserted.
The State Government has increased VAT on
cigarettes and smokeless forms of tobacco
to 25 per cent from 13.5 per cent and
also has gone ahead to impose a 10 per
cent tax on bidis and the raw materials
that go into its making from an absolute
nil. The State has now joined the ranks
of counterparts like Kerala, Gujarat, Bihar,
Andhra Pradesh, Himachal Pradesh, Jammu
and Kashmir, Rajasthan, Delhi, Tamil Nadu
and West Bengal to opt for high taxation
as a viable route for countering tobacco
menace.
Higher prices of cigarette, bidi and other
smokeless forms of tobacco like zarda,
gutka and khaini have been found to
discourage the youth at the initiation
level. They also encourage addicts and
users to quit the habit. Studies on price
elasticity in India have found that a 10
per cent increase in tobacco prices has
led to reduction in bidi consumption by
9.1 per cent and cigarette consumption by
2.6 per cent, manager of the anti-tobacco
campaign organisation Voluntary Health
Association of India (VHAI- Aparajita)
Itishree Kanungo.
According to the Global Adult Tobacco
Survey (GATS) India 2010, about 46.2
per cent of the population in Orissa uses
tobacco in one form or the other. About
4.7 per cent smoke cigarettes, 6.5 per cent
bidi and an overwhelmingly high 43 per
cent chew tobacco in different kinds.
This has resulted in very high incidence
of oral, head and neck cancers. Orissa
ranks among the states with highest
incidence of oral cancer. These cancers
are being seen mostly among the lower
income groups. Besides, the youth are
also imbibing the habit further increasing
the threat of cancer and other serious
disease burdens as a fallout. The increase
in tax is a step in the right direction and
n 69
January - March & April - June 2012

will help discourage tobacco consumption
to a significant extent, said Dr Sanjay
Panda, surgeon, head and neck oncology,
at the Panda Curie Centre and Research
Institute.
Taxes on tobacco products in India are
well below the World Bank recommended
rates of around 65 to 80 per cent of retail
rates. With low tax rates, products are
becoming increasingly affordable and thus
leading to more than a million deaths
in the country annually due to tobaccorelated
diseases.
Raising tax is not burdening consumer but
saving lakhs of lives by decreasing tobacco
consumption, Hemlata Cancer Research
Institute Chairman and Managing Director,
Dr AK Rath stated.
Source: New Indian Express, Odisha, 12 December, 2011
LIC’s tobacco stain shows
The Life Insurance Corporation (LIC)
invested more than Rs 3,600 crore in the
year 2010 - 11 in the tobacco industry,
anti-tobacco activists and cancer specialists
said, describing the investments as ironical
and unethical.
Figures obtained through the right to
information route by a consortium of
activists and doctors show that in 2010-11,
LIC had invested in shares of ITC and VST
Industries and in debentures of Dharampal
Satyapal Ltd, which makes chewable
tobacco products.
The LIC investment in ITC had a book value
of more than Rs 3,561 crore, while its
investment in VST Industries was about Rs
15 lakh, according to information released
by the company. It also invested Rs 50
crore in Dharampal Satyapal.
For the Millions
n 70
“It’s ironic that LIC is investing in an
industry that contributes to ill-health
and death, and an industry that some
arms of the government are trying to
discourage,” said Pankaj Chaturvedi,
associate professor at the Tata Memorial
Hospital, Mumbai.
“The public should know where LIC is
investing its funds,” Chaturvedi told The
Telegraph. “The government has enforced
the ban on public smoking and it has
also outlined steps to phase out tobacco
cultivation in the coming years.”
The RTI application had been filed by a
consortium called Voice of Tobacco Victims,
mainly representing patients with cancer.
LIC officials were not immediately available
to explain its policy of investing in the
tobacco industry.
The number of shares held by LIC in ITC
jumped from about 522,089,903 on March
31, 2010, to 995,891,658 on March 31,
2011, according to the company’s response
to the RTI query.
Tata Memorial doctors said the RTI response
from LIC suggested it was not charging
extra premium on all tobacco users. “It
is ridiculous.… LIC invests in tobacco,
it doesn’t charge higher premium from
addicts, but they may reject the claims
of addicts,” Surendra Shastri, head of
preventive oncology at Tata Memorial, said
in a statement.
In response to the RTI query on LIC’s
policy on insurance for tobacco users,
the company said the risk assessment
for consumption of tobacco would take
into consideration multiple health factors
ranging from quantity and type of tobacco
to health conditions of the applicant.

“The adverse health effects of tobacco
consumption is dependent on (the)
quantity of consumption, type of tobacco
consumed, duration of consumption and any
other associated health condition of the
insurance applicant,” LIC said. “Depending
on these factors, while large numbers of
customers are accepted without any extra
premium, some of the applicants may be
charged higher premium.”
Public health specialists campaigning against
tobacco said the investment was unethical
because it was against the principle that
governments should not invest in tobacco,
enshrined in an international convention
to which India is a signatory.
“On the one hand, India incurs a cost
of nearly Rs 10,000 crore each year from
tobacco-related health expenses, on the
other, LIC invests Rs 3,600 crore in tobacco,”
Prakash Gupta, director of the Sekhsaria
Institute of Public Health, Mumbai, said in
a statement.
Source: The Telegraph, New Delhi, 12 October, 2011
International News
Gulf countries adopt graphic
warnings
From April 2012, six Gulf countries will
display graphic warnings on tobacco
packages illustrating the effects of smoking
cigarettes and shisha. Bahrain, Kuwait,
Oman, Qatar, Saudi Arabia and United
Arab Emirates are members of the Gulf
Cooperation Council (GCC) Standardisation
Organization (GSO), which adopted the
labelling standard on 9 August 2011.
The warnings will depict different illnesses
and cancers caused by smoking, and cover
50 percent of the packages’ front and back,
with an Arabic warning on the front and an
English warning on the back.
Misleading terms like “light”, “mild”, “low
tar” and “extra light” will also be banned.
There will be two specific warnings for
shisha (water pipe) tobacco. The new
standard will replace the old one, which
covered only about 16 percent of the
package’s front.
Source: Gulf Times, 1 st January, 2012
Tough new smoking fines
AUSTRALIA’S toughest anti-smoking
provisions are to be policed by just two
people.
Tasmanian Minister for Health Michelle
O’Byrne released details of widened antismoking
legislation which will come into
force from 29 th February, 2012. People who
smoke in smoke-free areas risk an on-thespot
fine of at least $260 with the maximum
for an offence is $2600.
But there are to be just two State Government
tobacco control officers statewide who
would enforce the toughened requirements.
The State Government says the Director of
Public Health Roscoe Taylor also had the
power to empower people to carry out the
same duties, and police and some council
officers could enforce smoke-free areas.
Both Hobart City Council and Tasmania
Police said no infringements have been
issued to smokers since the introduction
of smoking bans in August 2010. The
widened law makes all outdoor dining area
smoke free from March 1,2012 with other
provisions including making smokefree
pedestrian malls and bus malls, and within
three metres of covered bus shelters; all
outdoor areas of public swimming pools,
n 71
January - March & April - June 2012

in and within 10m of public children’s
playground equipment, at patrolled
beaches across the breadth of the beach
between the flags, and in and within 20m
of the competition and seating area at
all outdoor public places where organised
sport was held during the event and
including 30 minutes before and after the
game was played.
Some Tasmanian municipal councils have
previously introduced some of these
provisions. Ms O’Byrne said the changes
provided consistency for businesses across
the state. She said it had been found a
raft of people to police the legislation were
not needed with enforcement to be largely
achieved through education.
“Because what we are doing is incremental
change to behaviours and once people
realise they are not allowed to smoke
somewhere they actually don’t smoke
somewhere and move outside the area -
that has been absolutely the case in every
single area,” she said.
She said when 50 per cent of outdoor
areas had been smoke-free people obeyed
this and she expected the same with these
changes. Ms O’Byrne also added there was
no doubt smoking harmed health and
increased the risk of heart disease, cancer
and emphysema and other diseases and
emerging evidence showed tobacco smoke
affected air quality outdoors as much as
indoors.
“By expanding smoke-free dining areas we
are further reducing exposure to harmful
second-hand smoke in areas where people,
especially children gather.” She said actions
to reduce Tasmania’s high smoking rates
were working and said the changes were to
“denormalise” smoking.
For the Millions
n 72
The Cancer Council Tasmania, Quit Tasmania
and the Asthma Foundation of Tasmania all
welcomed the changes.
Source: Agencies, February 28, 2012
New anti-smoking rules good
but not enough
Smoking in Malta remains rampant. It is
abundantly clear that the rise in cigarette
prices is too small an inducement for
smokers to give up their habit.
A 2008 European health interview survey
showed that 32 per cent of men and 21
per cent of women in Malta are smokers.
Of these, 72 per cent usually smoke 20
cigarettes a day, 20 per cent smoke between
20 and 40 and 2.5 per cent smoke more
than 40 cigarettes a day.
The next generation provides no solace
because the proportion of 15-year-olds
who smoke in Malta is higher than that
of countries such as Italy and England
– 10 per cent of boys and 14 per cent
of girls.
In 2010, 26 per cent of male and nine per
cent of female deaths were attributed to
lung cancer, which is closely related to
cigarette smoking.
It was announced that Mater Dei Hospital
will become completely smoke-free in March
2012, forcing smokers to use three booths
set up in the extensive grounds. Even
smoking in a car on the hospital grounds
will become illegal.
Welcome news indeed. However, one should
not be too optimistic because, despite a
legal smoking ban in public places, the
study mentioned above had shown that
passive smoking is highest in places of

entertainment (28 per cent), followed
by the workplace and the school (24 per
cent) and at home (20 per cent).
The smoking ban did contribute to a
drop in the heart disease death rate and
hospital admissions in every country where
it was introduced. Unfortunately, it has
had no impact in Malta where the ban has
held sway since April 2004, a local study
revealed.
The authors suspect that in places of
entertainment the law is not enforced
for fear of losing out on business.
This notion was backed by The Times
when 14 bars in Paceville were visited
over two evenings and patrons could
be noticed smoking with impunity. An
Italian study based in bars, cafés and
restaurants in 2009 had shown that
customers had increased by three per
cent, a clear sign that we collectively
prefer a smoke-free environment.
The impact of second-hand smoke cannot
be overestimated: a 1992 study by the
American Heart Association had indicated
that those exposed to environmental
tobacco smoke at home had their risk of
death due to heart disease increase by
about 30 per cent. Children are particularly
vulnerable because they not only inhale
smoke but also pick up the belief that
smoking is acceptable.
The medical complications are serious
and include the risk of chest infections,
ear infections, admissions to hospital
with wheezing or asthma and cot death.
Thankfully, this is being slowly addressed
by recent legislation such as prohibiting
smoking in playgrounds.
Even more can be done. For example,
a campaign called Fresh Start, meant
to stop people smoking in cars when
children are travelling with them, has
been launched by the Welsh government.
And an outright ban will be considered
depending on the success of this threeyear
campaign. This is because the level
of toxic chemicals rises to very high
levels in cars, even with a window open.
This is tantamount to parents deliberately
poisoning their children.
The British Medical Association has
gone further, urging a total ban on
smoking in cars, regardless of the
occupant’s age because even the elderly
are put at risk when inhaling secondhand
smoke.
Source: The Times, Malta, 20 th February, 2012
Numbers Rise Astronomically
According to Global Adult Tobacco Survey
2009, at least 41.3 million people aged
above 15 used tobacco either in smoke
or smokeless form in Bangladesh. The
number was 32.3 million in 2007.
According to experts, tobacco usage
has decreased in developed world but
increased in developing countries due to
lax tobacco control laws.
Estimation suggests with 5.4 trillion
cigarettes consumed, the developing world
constitutes about 70 percent of the total
global tobacco use.
According to the World Health Organisation,
'very poor' households in countries such as
Bangladesh, Indonesia, Mexico and Egypt
spend up to 15 per cent of their income
on buying tobacco products.
Source: bdnews24, Dhaka, 25 th February, 2012
n 73
January - March & April - June 2012

News from VhAI & State VhAs
Voluntary health Association of
India, New Delhi
Field Visit of the Journalists to
Jangipur, Murshidabad
VHAI coordinated two exposure visits of
senior journalists from Associated Press
(AP) & The Times of India during the month
of January and February 2012 to the bidi
rolling pockets in Jangipur, Murshidabad
to cover the whole issue related to the
poverty and misery of bidi rollers in the
district of Murshidabad in West Bengal.
The journalists were also oriented on the
alternative livelihoods programme for Bidi
Workers initiated by VHAI.
The stories will soon prepare in Associated
Press as well as well in the Times of India
newspapers.
Bloomberg Initiative Partners Meeting,
New Delhi, February, 2012
VHAI team attended the meeting of BI
Partners at India Habitat Centre on 24th
February 2012. It was a fruitful meeting
to share progress, achievements with
other partners and know more about the
For the Millions
n 74
other initiatives as well as way forward
undertaken by BI partners in India.
Press Conference: Launch of Music
Video on Ill Effects of Tobacco Usage
by Ministry of Health & Family Welfare,
Govt. of India
VHAI team attended the press conference
on 2nd February, 2012 organized by Ministry
of Health & Family Welfare, Govt. of India
to launch the music video on the ill effects
of Tobacco Usage titled “Life Se Panga Mat
Le Yaar”.
The video is mainly targeted at the youth
and it speaks of living life to the fullest
and not destroying it with tobacco. This
programme proved to be a significant
milestone in tobacco control. A team of
creative talent from Mumbai came together
to make this unique campaign which will
revolutionize the way a public service
message is conveyed.
The media personnel interacted with the
VHAI media team and took briefs on the
initiatives taken by Health Ministry on the
above.
VHAI team members at the Bloomberg Initiative Partners Meeting, New Delhi, February, 2012

Orientation to Vietnam Parliamentary
Delegation to India
A Vietnamese Parliamentary Delegation
visited VHAI office on December 23, 2011
to know about our role in the tobacco
control campaign programme in India. The
group comprised about 15 Vietnamese MPs.
The delegation led by Ms. Truong Thi Mai,
a senior parliamentarian included Member
of Standing Committee, Chairperson of
Parliamentary Social Affairs Committee
(status of Minister); Chair of Female
Parliamentarians consisting of MPs, Govt.
officials from Vietnam.
An orientation was given to the
Parliamentarians on the overall advocacy
efforts undertaken in the tobacco control
campaign programme by VHAI and state
partners at both national & state level.
Jammu & Kashmir Voluntary
health and Development
Association
Tax Increased on All Tobacco Products
in Jammu & Kashmir in the year
2012 – 13
Steadfast in its commitment to protect
its citizens from the growing menace of
tobacco products, the Government of Jammu
& Kashmir under the leadership of Chief
Minister, Shri Omar Abdullah, announced
an increase in Value Added Taxes (VAT)
from 25% to 30% on all tobacco products
in the the year 2012 – 13.
The decision by the Government of Jammu
& Kashmir to increase VAT from 25% to
30% on all tobacco products was welcomed
by public health advocates and individuals
working on tobacco control within the
state and across the country. This is a very
commendable step in the right direction
taken by the J & K government to put a
control on tobacco consumption of (both
smoking and smokeless forms) of tobacco.
In his Budget speech, Shri Abdul Rahim
Rather, Hon’ble Minister of Finance,
Government of Jammu & Kashmir
categorically stated as a part of the health
protection measures and said that he
proposed to continue with his anti-tobacco
campaign, which he had started last year,
and announce a further increase in the rate
of VAT on all tobacco products from 25% to
30% in the year 2012-13.
VHAI in collaboration with its state
partner J & K Voluntary Health Association
organized a press conference on 9 th
March, 2012 in Jammu appreciating the
Government decision on the increase of
taxes on tobacco products.
The press conference was attended by
Dr. N.C Prabhakar, Liasion Officer, Bushan
Primon, Binoy Mathew, Media Officer &
Tanu Sharma, Advocacy Officer from VHAI.
A total of 25 – 30 representatives were
present from the press. All the major dailies
were represented including Greater Kashmir,
Kashmir Times, Greater Jammu, State Times
and The Tribune.
The press meet overall was conducted well
with satisfactory results and generated a
lot of media interest.
BUDGAM First District in the State of
Jammu & Kashmir declared Smoke Free
on the Occasion of the Republic Day of
India 2012
Budgam was the first district of Jammu
& Kashmir to be declared Smoke Free as a
result of the joint interventions of VHAI,
J&K VHA and the District Administration.
n 75
January - March & April - June 2012

The declaration was done on the basis of
the findings of the Survey conducted by the
Statistics and Evaluation Department of the
District that reflected that 91.1% of the
public places in the district displayed the
signage banning Smoking in Public Places and
a strong enforcement mechanism has been
institutionalized by the district administration
to monitor and sustain compliance.
The declaration of “Smoke Free Budgam”
District was done on 26th January, 2012, by
Shri Ghulab Hassan Mir, Honourable Minister
for Agriculture, J&K. Other important
dignitaries present during the event were
the District Development Commissioner,
Budgam, Senior Super-intendant of Police,
Chief Education Officer and the Chief Medical
Officer. The programme was attended
by number of government officials, law
enforcers and the media.
himachal Pradesh Voluntary
health Association
Himachal Pradesh Voluntary Health
Association (HPVHA) is implementing a
Smoke Free Himachal Pradesh project in
collaboration with the Department of
Health and Family Welfare and District
Administration with the Technical and
Financial Support of The Union South
East Asia under Bloomberg Initiative
to reduce tobacco use. The project
was launched in May, 2011 and has
completed its 9 months period. During
this period, the project has achieved
some milestones and has faced challenges
from the tobacco industries.
A brief of activities/achievements
undertaken:
•
500 officials including HODs have
been sensitized and trained on
implementation of COTPA.
For the Millions
n 76
•
•
•
•
8 district headquarters have qualified
for Smoke Free Status as per the
compliance survey conducted in
January, 2012 by Department of Health,
with the compliance of more than 92%
under section 4 of COTPA, 2003.
50 Gram Panchayats have been
identified for Smoke Free status.
5000 copies of IEC material were
developed and disseminated.
Signage and notice boards have been
developed for district administration
and police department has printed
signboards, receipts and challan books
in every district.
Bihar Voluntary health
Association
•
•
•
•
In the last quarter, the BVHA team
conducted a media sensitization
workshop at Scada Business Centre to
sensitize media persons on COTPA. In
this programme, most of the important
print and electronic media participated.
The State Health Society, Bihar
coordinated a launch programme to
issue chalaans to enforce COTPA in
Bihar. The Principal Secretary, Health
launched the chalaan in Patna and BVHA
extended support to the programme.
The team visited and met the Principal
Secretary, Health, GOB, the Executive
Director (SHSB) cum Secretary, Health,
GOB, the State Nodal Officer- Tobacco
Control Dr. N. K. Mishra, and the State
Consultant Tobacco Control Mr. Masood.
Letters have been sent to the Principal
Secretary, Health, GOB and the Health
Secretary-cum-Executive Director (SHSB)
for speedy notification of the monitoring/
steering committee members under the
National Tobacco Control Programme.
A meeting was held with the senior
reporter of Rashtriya Sahara, Hindustan,
Times of India and Dainik Jagaran to
discuss media advocacy strategies.

Cancer Caused by Tobacco and
Non-tobacco Products
The Government of India has not
conducted any comparative study on
cancer caused by tobacco and non–tobacco
products in the country. As per Section
7 of the Cigarettes and other Tobacco
Products (Prohibition of Advertisement
and Regulation of Trade and Commerce,
Production, Supply and Distribution) Act,
(COTPA) 2003, it is mandatory to display/
print specified pictorial health warning
on cigarettes and other tobacco products
packages. In pursuance to this section,
Ministry of Health and Family Welfare has
notified “the Cigarettes and Other Tobacco
Products (Packaging and Labelling) Rules,
2008 vide G.S.R. No. 182 dated 15 th March,
2008 which came into force from 31 st May,
2009.
A set of new pictorial health warnings has
been issued vide notification G.S.R No. 417
(E) dated 27 th May, 2011 and shall come
into force with effect from 1 st December,
2011. The Ministry of Health & Family
Welfare has notified four pictorial warnings
for chewing or smokeless tobacco packages
depicting various type of cancer picture.
Lok Sabha, Unstarred Question No. 781, 25 th November,
2011
Ban on Smokeless Tobacco
Products
The Ministry of Health and Family Welfare
has conducted the Global Adult Tobacco
Survey (GATS) India, 2010. As per the GATS
India Report 34.6% of adults (47.9% of
males and 20.3% females) in the age group
of 15 years and above consume tobacco in
any forms and 26% of the adults consume
smokeless tobacco. In absolute numbers
there are 163.7 million (16.3 crore) users
of smokeless tobacco in India.
Parliament Questions & Answers
The Global Youth Tobacco Survey (GYTS)
India, 2009 conducted among school
going youth in the age group of 13 – 15
years revealed that 12.5% (Boy = 16.2%,
Girl = 7.2%) youth used tobacco products
other than cigarettes.
The Government of India has no such
proposal to impose a complete ban on
smokeless tobacco products. However,
as per the notification of the Food
Safety and Standards Authority of
India dated 5 th August, 2011 tobacco
and nicotine should not be used as
ingredients in any food products. The
Government filed an affidavit as per
the directions of the Hon’ble Supreme
Court in the matter of Ankur Gutka vs.
Indian Asthma Care Society, to support
the Health Report on the contents and
ill effects on health.
Lok Sabha, Unstarred Question No. 784, 25 th November,
2011
Smoking and Non – Smoking
Zones
The Government of India has notified the
Rules related to “Prohibition of Smoking
in Public Places 2008” which came into
force from 2 nd October, 2008. As per
the extant Rules smoking in prohibited
in all public places including private
workplaces. However, hotels having
thirty or more rooms or restaurant having
seating capacity of thirty persons and
airports may create a smoking areas/
space. These rules have come into effect
from 2 nd October, 2008 and it will be too
early to predict any reduction on smoking
and as the State Governments have just
geared up to implement these Rules and
some of them have formed raiding squads
and conducting raids at regular intervals
at various public places.
n 77
January - March & April - June 2012

The Ministry of Health & Family Welfare
has also formulated step by step guidelines
to facilitate the implementation of these
Rules. Further, in order to create awareness
on harmful effects of second hand smoke
and the Smoke Free Rules dedicated spot/
public service advertisements has also been
developed and aired.
Lok Sabha, Unstarred Question No. 911, 25 th November, 2011
Tobacco Cessation Centres
The Government of India has set up a
network of 18 Tobacco Cessation Centres
in collaboration with World Health
Organization (WHO) to assist tobacco users
to quit tobacco use across the country.
These centres have used established
strategies for tobacco cessation including
behavioral counseling and pharmacotherapy
including Nicotine Replacement Therapy
(NRT), however the primary focus is on
behavioral counseling to tobacco users to
assist them quit use of tobacco products.
Under the National Tobacco Control
Programme, tobacco cessation services are
included in the District Control Programme
with the provision to set up centres
with dedicated staff to provide cessation
facilities in the district hospitals of 42
districts in 21 states.
The Ministry of Health & Family Welfare has
developed “A Training Manual for Doctors”
, to train them in providing tobacco
cessation services including use of NRT
as well as modules for health workers for
tobacco control, which includes behavioral
counseling for tobacco cessation.
The Ministry of Health & Family Welfare
has also developed “Tobacco Dependence
Treatment Guidelines” recognizing the need
for professional help to tobacco users to quit
as well as with an objective to sensitize,
For the Millions
n 78
train and equip health care providers with
the knowledge and skills of providing
treatment for tobacco dependence.
The Ministry of Health & Family Welfare has
also written to National Pharmaceutical
Pricing Authority (NPPA) to take steps
to make NRT available at affordable cost
and accessible to the general population.
NPAA has forwarded the representation
of this Ministry to the Department of
Pharmaceuticals to take a suitable view in
this regard.
Lok Sabha, Starred Question No 172, 2 nd December, 2011
harmful Ingredients in Pan
Masala
The Government currently set no regulatory
standards and limits prescribed for Pan
Masala containing tobacco. However, the
Bureau of Indian Standards has laid down
standards for minced type chewing tobacco,
flake type chewing tobacco (zarda) and
quiwam. These standards, apart from other
requirements, stipulate the following:
•
•
•
The material shall be free from any
mould attack
The material shall not contain any
harmful substances
Any substances, if added shall be of
a nature and purity which are suitable
for use as food additives and as
permitted under the Prevention of Food
Adulteration Rules 1955 (The PFA Act,
1955, has since been replaced by the
Food Safety and Standards Act, 2006
and the regulations therein).
Further, the safety standards of Pan
Masala have been prescribed under clause
2.11.5 of Chapter 2 of the Food Safety
and Standards (Food Products Standards
and Food Additives) Regulation 2011.
Regulation 2.3.4 of Food Safety and

Standards (Prohibition and Restrictions
on Sales) Regulations, 2011 provide that
tobacco and nicotine shall not be used as
ingredient in any food product.
The implementation of Food Safety and
Standards Act, 2006 rests with the State/
U.T Governments. In this regard, random
samples of various food articles including
Pan Masala are drawn regularly by the
State/U.T Governments and penal action is
taken against the offenders, in cases where
samples are found to be not conforming to
the provisions of the Act and Regulations
and Rules made thereunder.
As per the direction of Hon’ble Supreme
Court, National Institute of Public Health
had undertaken a comprehensive analysis
and study of the contents of gutkha,
tobacco, pan masala and similar articles
manufactured in the country and harmful
effects of consumption of such articles. As
per the report, substantive quantities of
nitrosamines, Benzo(a)pyrene and heavy
metals like lead, Arsenic, cadmium, Selenium,
Nickel, Mercury, Chromium etc are found in
various smokeless tobacco products.
Lok Sabha, Starred Question No. 237, 9 th December, 2011
Welfare Fund for Bidi Workers
The following legislations have been
enacted by the Parliament to set up welfare
funds to provide health care, education,
housing and recreational facilities to the
beedi workers, cine – workers and certain
non – coal mine workers:
•
•
•
The Beedi Workers Welfare Fund Act,
1976
The Limestone and Dolomite Mine
Labour Welfare Fund Act, 1972
The Iron Ore Mines, Manganese Ore
Mines and Chrome Ore Mines Labour
Welfare Fund Act, 1976
•
•
The Mica Mine Labour Welfare Fund
Act, 1946
The Cine Workers Welfare Fund Act,
1981
The Ministry of Labour and Employment has
initiated action for rehabilitation for the
beedi workers by providing them vocational
training in certain courses according to the
local market needs for viable alternative
sources of livelihood. Various welfare
schemes are also been implemented by the
Government for welfare of beedi workers
in the field of health, education, housing,
recreation and social security etc.
Lok Sabha, Unstarred Question No. 2856, 12 th December,
2011
Sale of Tobacco Products
The Government of India has notified “The
Cigarettes and Other Tobacco Products
(Display of Board by Educational Institutions)
Rules, 2009” vide GSR No. 40 (E) dated 19-
01-2010 and it has come into effect from 19-
01-2010. The rules provide that no person
shall sell, offer for sale, or permit sale of,
cigarette or any other tobacco product in an
area within a radius of one hundred yards of
any educational institution.
The implementation of the aforesaid rules
relating to banning sale of tobacco products
within 100 yards of educational institutions
vests mainly with State/UT Governments. A
list of authorized officers to take cognizance
of violations have been notified vide
G.S.R. No. 619(E) dated 11-08-11. Further,
Government of India has issued necessary
instructions/guide lines to all State
Governments/ UTs for implementing the
ban on sale of cigarette or other tobacco
products near educational institution. A
Public Notice has also been published in the
leading national and regional newspapers.
Lok Sabha, Unstarred Question No. 3870, 16 th December,
2011
n 79
January - March & April - June 2012

For the Millions
n 80

Advocacy Package on Tobacco Control
developed by Voluntary Health Association of India
Contact:
Voluntary Health Association of India
B-40, Qutab Institutional Area,
New Delhi - 110016
Phones : 011-47004300, 26518071-72
Resource Centre for Tobacco Free India - www.rctfi.org - is an exclusive web
Fax: 011-26853708
information portal for useful resources, knowledge-sharing and important updates Email: ceo@vhai.org, vhai@vsnl.com
from national and state levels. lt is also a medium for advocacy with policymakers, Websites: www.vhai.org, www.rctfi.org
bureaucrats, journalists and partner organizations campaigning on the issue.

ISSN:0970-8685 Price: Rs. 120/- RNI: 28527/75
World No Tobacco Day 2012
The theme of the next World No Tobacco Day, 31 May 2012 is
“Tobacco Industry Interference”.
The campaign will focus on the need to expose and counter the tobacco
industry’s brazen attempts to undermine the WHO Framework Convention
on Tobacco Control (WHO FCTC). As more and more countries move to
fully meet their obligations under the WHO FCTC, the tobacco industry’s
efforts to undermine the treaty are becoming more and more
aggressive.
World No Tobacco Day 2012 will educate policymakers and
the general public about the tobacco industry’s nefarious and
harmful tactics. It will also be in keeping with the letter and the
spirit of the WHO FCTC. The preamble of the treaty recognizes
“the need to be alert to any efforts by the tobacco industry to
undermine or subvert tobacco control efforts and the need to
be informed of activities of the tobacco industry that have a
negative impact on tobacco control efforts”. In addition, Article
5.3 of the treaty states that “in setting and implementing their
public health policies with respect to tobacco control, Parties shall act to
protect these policies from commercial and other vested interests of the
tobacco industry in accordance with national law”.
Furthermore, the guidelines for implementation of Article 5.3 recommends
Parties to “raise awareness about … tobacco industry interference with
Parties’ tobacco control policies”. On World No Tobacco Day 2012 and
throughout the following year, countries are urged to put the fight against
tobacco industry interference at the heart of their efforts to control the
global tobacco epidemic.