Making people quit tobacco faster in India

A recent research report on tobacco control Reflecting the Past, Shaping the Future - An Assessment of WHO Framework Convention on Tobacco Control (FCTC) Implementation in India, brought out by Delhi-based research agency AF Development Care (AFDC) answers many pertinent questions on how India can quit tobacco faster than it is doing now.

The strategic research questions such as what the appropriate policy should be to reduce tobacco consumption in India, which tobacco cession approach works best for Indians to quit have got empirical answers for policymakers to focus on to get faster results. This study conducted a primary survey during January-March 2021 in states such as Assam and Odisha in the east, Gujarat in the west, Karnataka in the south, Jammu and Kashmir and Uttar Pradesh in the northern belt of India.

The study asked the respondents what methods were used to quit tobacco and the survey provided options such as whether it is through counselling, nicotine replacement therapy, prescribed medications, use of traditional medicines, switching to smokeless tobacco, enrolling in the tobacco cessation centres, personal effort including peer pressures. The survey findings suggest that the top three methods used for quitting tobacco in India are counselling, nicotine replacement therapy and prescribed medications methods.

The survey asked the respondents about the factors most important to quitting tobacco.

The top three answers in this national survey (six states representing north, south, east, west) are health problems, doctor’s advice, and family pressure. In the survey, tobacco users were asked what diseases forced them to quit tobacco and the answers are lungs, heart, eye-related diseases, diabetics, COPD, cancer, stroke, chronic bronchitis.

The study, in its analysis, concludes that tobacco consumption, specifically cigarette smoking and the use of smokeless tobacco (SLT) products, are the leading cause of avoidable illness and fatality in India. Each year, close to 1.35 million Indian die because of tobacco-related diseases. Today, nearly one in three Indian adults uses tobacco and half of all tobacco users in India consume bidi. If the current trend continues, a huge chunk of the Indian population will die prematurely due to tobacco-related diseases.

India produces and consumes many forms of smokeless tobacco and bidi. India’s advancement in fulfilling the Framework Convention treaty has been erratic. While a few Indian states are making progress, many states are reporting gaps in the law, pathetic regulatory surveillance, and overall defiance, as found by this research. The pro-tobacco lobbies in India claim against the legislation by forecasting that banning tobacco production (particularly bidi-making) will have a catastrophic impact on employment and a substantial adverse impact on the Indian economy.

These issues act as big deterrents to the country’s tobacco control initiatives and need an inner look on how to provide sustainable alternative employment to those engaged in this hazardous work. Other challenges in this work are the lack of effective law enforcement and not adopting the best methods of tobacco cessation.

Each type of intervention mentioned in this research report—educational, clinical, regulatory, economic will help the government and the WHO to re-strategise existing interventions to get faster results in the long run. The research work indicates the need for India to re-strategise its work on tobacco control on technical assistance, including tobacco taxation, drafting of legislation (as ground-level implementation is weak as found from this study), taking new research projects with an open mind, and scaling up cessation programmes. This study found that close to 34% opted for nicotine replacement to quit tobacco. The WHO and the government must realise and bring revision to the rigid stand on the issue, to help people quit tobacco faster in India.

(The writer is Director at AF Development Care (AFDC), New Delhi and the principal investigator of the study in question)