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

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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people that the law is not working, is unpopular, or is having a negative economic impact and needs to be weakened or repealed.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
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Page 3 and 4: Editorial Tobacco use has emerged a
Page 5 and 6: Addressing Gaps in Legal Provisions
Page 7 and 8: can be given for promoting tobacco
Page 9 and 10: PC, Eissenberg T, et al. Non-Cigare
Page 11 and 12: Sl. No. Name of the State/UT Name o
Page 13 and 14: 18 languages for the national campa
Page 15 and 16: spent nearly Rs.112 crore over a pe
Page 17 and 18: • • • issues concerning their
Page 19 and 20: Background Tax Advocacy in Tobacco
Page 21 and 22: Most smoked tobacco products in Ind
Page 23 and 24: A Glimpse of the Tax Increase in 11
Page 25 and 26: Introduction Enforcing Smoke Free R
Page 27 and 28: advocacy efforts have been initiate
Page 29 and 30: compound the office under section 4
Page 31 and 32: Role of Compliance Studies and Opin
Page 33: public attitude can be gauged by op
Page 37 and 38: well as background images such as b
Page 39 and 40: • New films and television progra
Page 41 and 42: Starting with humble, though commit
Page 43 and 44: of time.. They need to be provided
Page 45 and 46: Alternative Livelihoods for Bidi Wo
Page 47 and 48: they applied for bank gradation and
Page 49 and 50: the group will not only be able to
Page 51 and 52: and children suffer much more for a
Page 53 and 54: • • • • media coverage nati
Page 55 and 56: counselor and client, the more succ
Page 57 and 58: At the first follow-up meeting, aft
Page 59 and 60: Research News Feature: Summary of R
Page 61 and 62: • • • • The complex tax str
Page 63 and 64: 553 billion bidis were consumed in
Page 65 and 66: • • Quartiles of exposure to to
Page 67 and 68: National News Smokeless tobacco cla
Page 69 and 70: of ban on tobacco chewing and smoki
Page 71 and 72: in Shahjahanpur, Jhunjhunu and Gola
Page 73 and 74: “The adverse health effects of to
Page 75 and 76: entertainment (28 per cent), follow
Page 77 and 78: Orientation to Vietnam Parliamentar
Page 79 and 80: Cancer Caused by Tobacco and Non-to
Page 81 and 82: Standards (Prohibition and Restrict
Page 83 and 84: Advocacy Package on Tobacco Control

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