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Survey stresses role of vaping in tobacco control

https://manilastandard.net/business/biz-plus/321405/survey-stresses-role-of-vaping-in-tobacco-control.html

Results of a first-of-its-kind survey in India highlight the potential of e-cigarettes as an additional option for tobacco control and how vaping can have a substantial impact on public health.

Peter Paul Dator, president of The Vapers Philippines, said the groundbreaking survey in India clearly shows that vaping helps smokers quit or reduce smoking.

“Its results are particularly relevant to the Philippines because like India, our country has a large number of smokers and a low smoking cessation rate. The Department of Health and other local policymakers should look at the evidence for e-cigarettes with an open mind and start making science-based decisions to help reduce smoking in the country,” said Dator.

Dator was referring to the interview-based survey involving 3,000 vapers aged 18 and older from eight of the largest metropolitan cities in India. The vast majority of respondents (71.3 percent) used e-cigarettes to quit (30 percent) or reduce (41.3 percent) smoking.

Similar results were observed in smokeless tobacco users. Most (79 percent) believe that e-cigarettes are less harmful than combustible cigarettes. Survey participants reported minimal side effects (cough, headache, dry mouth/throat) and some health benefits (improved general health, breathing, smell and taste) after they started vaping.

Around 81 percent of survey respondents were men and 19 percent women, with average age of 29 years. The majority (80 percent) were first exposed to nicotine through combustible cigarette smoking, SLT use or both.

Leading tobacco harm reduction expert Dr. Konstantinos Farsalinos and Indian researchers conducted the survey whose results were published on March 30, 2020 in Harm Reduction Journal.

Dator said that India and the Philippines face similar smoking-related public health challenges. The World Health Organization estimates that there are over 120 million smokers in India, accounting for almost 12 percent of the 1.1 billion smokers globally.

The 2016-2017 Global Adult Tobacco Survey revealed that India has the second-lowest quit rate among GATS countries surveyed at the end of 2017. It also showed that India has the second-largest tobacco consuming population in the world, estimated to be over 267 million, which includes at least 100 million tobacco smokers and over 199 million SLT users.

Dr. Farsalinos and his co-authors said that tobacco-related deaths in India are estimated to be over 1 million a year and are projected to rise to 1.5 million by 2020. They also pointed to the prevalence of smoking-related illnesses such as heart disease, lung cancer and chronic pulmonary obstructive disease in India.

Dator cited DOH data, which show that almost 88,000 Filipinos die from smoking-related diseases every year. Healthcare expenditures and lost income due to smoking-related sickness and premature death cost the country P188 billion ($4 billion) yearly.

These figures only cover four of more than 40 smoking-related diseases namely lung cancer, chronic obstructive pulmonary disease, heart disease and stroke.

GATS found that there are currently 16 million Filipino adult smokers. “Like India, the Philippines has a very low smoking cessation rate of 4 percent. This dismal quit rate indicates the ineffectiveness of currently approved smoking cessation strategies in the country such as ‘quitting cold turkey’, counseling, and nicotine replacement therapy,” Dator said.

“We all know that the combustion in cigarettes is what is harmful to the health of smokers. The harm from smoking is caused primarily through the toxins produced by the burning or combustion of tobacco. By contrast, non-tobacco, non-smoked nicotine products such as e-cigarettes are considerably less harmful,” Dator said.

He cited the widespread agreement among organizations such as Action on Smoking and Health, Public Health England, Cancer Research UK, the Royal College of Physicians and the Royal College of General Practitioners that, on the basis of current evidence, e-cigarettes or vapes represent a significantly less harmful alternative to tobacco cigarettes for smokers who are unable or unwilling to stop using nicotine.

“The DOH should pay particular attention to how the study authors described India’s e-cigarette ban as a ‘missed opportunity’ and urged the Indian government to promote additional research and consider revising the regulatory framework if the evidence warrants it,” Dator said.

The Indian government banned the import, manufacture, sale, advertisement, storage and distribution of e-cigarettes in September 2019. According to Dator, India’s vaping ban is a tobacco control approach that other governments should not adopt.

“Such a retrogressive policy will be a major blow to smokers who have switched to vaping. It will likely push them to go back to smoking combustible cigarettes,” he said.

Streaming services flouting India’s regulations banning tobacco imagery in all media

Working with colleagues at HRIDAY (Health Related Information Dissemination Amongst Youth) in New Delhi, and WHO, we just published “Tobacco imagery in on-demand streaming content popular among adolescents and young adults in India: implications for global tobacco control” in Tobacco Control.

https://tobacco.ucsf.edu/streaming-services-flouting-india%E2%80%99s-regulations-banning-tobacco-imagery-all-media

Here is the press release BMJ sent out about the paper:

Streaming services flouting India’s regulations banning tobacco imagery in all media

Stronger enforcement needed, while WHO guidelines should be updated, say researchers

Streaming services that are popular with teens and young people in India are flouting the nation’s regulations on exposure to tobacco imagery in any media platform, reveals an analysis of 10 on-demand streaming series, published online in the journal Tobacco Control.

The rules, which are designed to protect young people, should be more rigorously enforced, and the guidelines for the implementation of Article 13 of the WHO Framework Convention on Tobacco Control should be updated to include streaming services and other new media, conclude the researchers.

Almost 266 million people aged 15 and older use tobacco in India, and the resulting health problems are “substantial,” say the researchers.

In response, India has strengthened its tobacco control efforts, particularly in relation to teens and young people who are highly susceptible to the effects of tobacco imagery, by banning the advertising and promotion of all tobacco products in every media platform.

And since 2012, any film or TV programme containing tobacco imagery must include prominent audio-visual anti-tobacco health warnings for specified periods of time, irrespective of whether it’s produced in India or elsewhere.

On-demand streaming services, such as Netflix, YouTube, Hotstar and Amazon Prime Video, have become increasingly popular among young people in India. The researchers therefore wanted to find out how much tobacco imagery is present in streamed content and how well streaming services comply with Indian tobacco control regulations.

They held focus group discussions with school and college students, aged 15 to 24, in New Delhi, to find out which streaming services they used the most and what they watched.

Based on these discussions, the researchers came up with the 10 most popular series, comprising 188 episodes. All but two of the series were streamed on Netflix; the rest were streamed on Amazon Prime Video. Only two of the series were Indian productions.

The 10 series were: The Marvellous Mrs Maisel (rated 16+); Stranger Things (16+); Bodyguard (16+); Riverdale (13+); Narcos (16+); Sacred Games (18+); Mirzapur (18+); Chilling Adventures of Sabrina (16+); 13 Reasons Why (16+); and The Crown (16+).

The researchers used a validated method (Breathe California) to count the number of tobacco incidents in each series. Incidents were defined as the actual or implied use of a tobacco product by an actor.

The analysis showed that 70% of the series depicted tobacco incidents which ranged from zero to 1652 in The Marvellous Mrs Maisel. More than half of the total number of episodes (57.4%) contained at least one such incident.

Narcos contained 833 incidents; The Crown 599; Stranger Things 233; Chilling Adventures of Sabrina 171; Mirzapur 78; and Sacred Games 67.

The Marvellous Mrs Maisel (18 episodes over two seasons) had the highest average number of tobacco incidents (87.5) per episode for the entire series, followed by The Crown (20 episodes over two seasons) with 29, and Narcos (30 episodes over three seasons) with 26.5.

Indian productions contained fewer tobacco incidents per episode and per hour than those produced elsewhere.

Four out of the 10 series depicted tobacco brands, including Mayburn, Camel, Marlboro, Salem and Newport. All these series were foreign productions.

But none of the series that included tobacco incidents complied with the tobacco-free film and TV rules in India.

Their analysis suggests that the extent of tobacco imagery and brand placement in on-demand streaming service content in India is high, while compliance with the rules is low, say the researchers.

“There is no reason to expect that the effects of exposure to tobacco imagery in streaming shows should be any different than the effects of tobacco imagery in films,” they write.

“On-demand streaming content providers and governments should heed the lessons learnt from the film industry and apply the same rules to include tobacco imagery in the content available through on-demand streaming platforms,” they add.

And it’s clear that the legislation “is blatantly being violated in this new media, indicating the need for better enforcement of existing rules in India and updating the guidelines for implementation of Article 13 of the WHO Framework Convention on Tobacco Control,” they conclude.

Here is the abstract:

Background India implemented tobacco-free film and TV rules (Rules) to protect adolescents and young adults from tobacco exposure.

Objective To assess tobacco imagery in online series popular among adolescents and young adults.

Methods Ten popular online series on streaming platforms were identified after discussions with participants (aged 15–24 years) in New Delhi, and content-coded for tobacco imagery following the Breathe California protocol. Incidents of tobacco use and brand appearances in each series episode were counted, and compliance with Indian Rules was recorded.

Results 188 episodes across 10 series on Netflix and Amazon Prime Video were coded. Seven series were rated age 16+, two were 18+ and one was 13+. The median number of tobacco incidents per episode in foreign productions was as follows: Amazon’s ‘The Marvellous Mrs Maisel’ (87.5, IQR 62.0–116.0) and Netflix’s ‘The Crown’ (29.0, 18.0–36.0) were higher than Indian productions: Netflix’s ‘Sacred Games’ (9.0, 0.5–14.5) and Amazon’s ‘Mirzapur’ (7.0, 4.0–11.0) (p=0.84). Tobacco incidents per hour ranged from 0 (Bodyguard, Riverdale, 13 Reasons Why) to 106.1 (The Marvellous Mrs Maisel). Seven of 10 series had tobacco imagery and none were compliant with the Rules.

Conclusion Contrary to Section 5 of India’s Cigarettes and Other Tobacco Products Act, its Rules are not being complied with by the streaming platforms. US-produced streaming media contains more tobacco incidents than Indian-produced media. There is an urgent need for better enforcement of existing Rules on streaming platforms in India, and modernisation of the WHO Framework Convention on Tobacco Control, Article 13 guidelines to account for new streaming platforms to protect youth from tobacco imagery globally.

What this paper adds

Section 5 of India’s Cigarettes and Other Tobacco Products Act (COTPA) imposes a complete ban on tobacco advertising and promotion in any form of media.
Streaming is a new form of media popular among adolescents and young adults in India.
We found that out of the 188 episodes across 10 on-demand streaming series studied, the US produced series – Amazon’s ‘The Marvellous Mrs Maisel’ and Netflix’ ‘Narcos’ and ‘The Crown’ had higher tobacco imagery compared with Indian produced series – Amazon’s ‘Mirzapur’ and Netflix’ ‘Sacred Games’.
Section 5 of COTPA is blatantly being violated in this new media indicating the need for better enforcement of existing rules in India and updating WHO Framework Convention on Tobacco Control Article 13 guidelines.
The full citation is: Arora M, Nazar GP, Chugh A, Rawal T, Shrivastava S, Sinha P, Munish VG, Tullu FT, Schotte K, Polansky JR, Glantz SA. Tobacco imagery in on-demand and streaming content popular among adolescents and young adults in India: implications for global tobacco control. 2020; epub ahead of print 9 Apr 2020 doi 10.1136/tobaccocontrol-2019-055360. It is available here.

This item is cross-posted from the Smokefree Movies blog entry, which is here.

Mumbai cancer specialists seek ban on smoking at all airports in India

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Ban on pan masala and gutkha

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Licence Mandatory For Selling Tobacco Products: Health Ministry

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Want to sell tobacco? Get licence: Health ministry

Summary: VoTV state patron said that with licence to tobacco products, vendors will force them to follow the Cigarettes and Other Tobacco Products Act, 2003 (COTPA). Now all vendors selling tobacco products in Rajasthan will have to take a licence. The licence will also stop the mushrooming of shops selling tobacco products. “In case authorised tobacco vendors are found selling candies, chocolates and biscuits their licence might get cancelled,” said Dr Singhal. At present, tobacco products are sold after setting up temporary shops on the footpath and with licence, such shops will come to an end.

https://www.nyoooz.com/news/jaipur/925994/want-to-sell-tobacco-get-licence-health-ministry/

Now all vendors selling tobacco products in Rajasthan will have to take a licence. Union ministry of health has issued an advisory to all states for the same. The advisory has been issued to the chief secretary of Rajasthan on September 22 through the speed post. Voice of Tobacco Victims (VoTV) campaign state patron Dr Pawan Singhal said that Arun Kumar Jha economic adviser with the ministry has written a letter to chief secretary Ashok Jain of Rajasthan and has suggested that they develop a mechanism to provide permission/authorisation through the municipal authority to retail shops who are selling tobacco products. He said Jha has also put a condition that authorised shops selling tobacco products cannot sell any non-tobacco products such as toffee, candy, chips, biscuits, soft drinks etc, which are essentially meant for children. “In case authorised tobacco vendors are found selling candies, chocolates and biscuits their licence might get cancelled,” said Dr Singhal. He said at present shopkeepers intentionally keep products which lure children and it exposes them to tobacco and some of them tend to start using it , As Reported By Hindustan Times.

According to the Newspaper,The licence will also stop the mushrooming of shops selling tobacco products. A few tobacco manufacturing companies also make biscuits, wafers, chocolates etc and many of the vendors store cigarettes along with such products popular among kids. “This order is a big blow to the marketing tactics of most tobacco companies from targeting children,” he added. VoTV state patron said that with licence to tobacco products, vendors will force them to follow the Cigarettes and Other Tobacco Products Act, 2003 (COTPA).

Onam to see tobacco smoke-free zones bloom in the capital city

Ahead of the frenetic festival and wedding season, florists in the city have decided to make their shops tobacco smoke-free. The decision, taken by the Trivandrum Florists Association, seeks to protect the environs of its 600 member families and the health and well-being of thousands of customers.

http://www.evartha.in/english/2017/08/31/onam-to-see-tobacco-smoke-free-zones-bloom-in-the-capital-city.html

Passing the resolution – in line with the Indian tobacco control law COTPA’s prohibition of smoking in public places – at its annual Onam gathering on Wednesday, the association also decided to set up statutory warning boards in member shops.

Association President M Vairavan Pillai presided over the function. General Secretary C Sasidharan Nair, Treasurer Haridas, Vice Presidents C Sukumaran Nair, K Radhakrishnan and S Ambika and Joint Secretaries S Sreekumaran Nair, T Suresh Kumar, T Manikantan and J Reena were also present.

Tobacco Consumption: Going Up in Smoke

In a reassuring move, the Delhi government has warned of legal action against tobacco companies if they violate laws and advertise at outlets selling their products

http://www.indialegallive.com/health-updates/tobacco-consumption-going-up-in-smoke-34241

We all know how tobacco companies sneak in surrogate advertising as they are not allowed to advertise their products. But Philip Morris International (PMI) Inc., the 160-year-old tobacco giant, pushed its top cigarette brands like Marlboro blatantly. It approached small shops and kiosks selling cigarettes and gave them free attractive boards with its advertisement to adorn the front of their shops and paid shopkeepers around Rs 500 as an incentive to break the law. The tobacco major roped in smart, young executives, mainly girls, to gift cigarette packs to youngsters in bars, discos and at parties.

However, after the Cigarettes and other Tobacco Products Act of 2003, which allowed tobacco companies to advertise in shops, was amended, these ads were prohibited. And in mid-August, the Delhi government’s Directorate General of Health Services shot off a stern warning to Philips Morris threatening legal action if it did not remove advertisements from kiosks and other point of sale outlets. The letter asked the company why appropriate punitive action could not be initiated against it and its directors. The letter was sent when the health ministry realised that the tobacco company was violating India’s tobacco control law by advertising at outlets where it was selling its products. It also sent these notices to two other tobacco companies, Indian Tobacco Company Ltd., and Godfrey Philips.

But this was after a series of earlier warnings which were ignored by these tobacco companies. On March 24 this year, the government had told them to get the ads removed. This was largely ignored. Their stand was that the law only stipulated that the ads should not be outside the outlets and did not mention that these could not be carried within the establishments or shops. Last month, the government shot of another letter reiterating the same, but this too was ignored. An internal document of Philip Morris said that the India market had high potential.

Dr SK Arora, additional director, health, Delhi, and also the state tobacco control officer, told India Legal: “In the last three years, we have been constantly writing to tobacco companies like Philips Morris, Indian Tobacco Company and Godfrey Phillips that their ads on posters and billboards were not allowed as they were violating Section 5 of the Cigarettes and other Tobacco Products Act (COTPA-2003). Our teams used to challan vendors who displayed these ads. But they would again put up the ads after we left as they were paid by the tobacco companies.”

Though the government told the companies that they would be held responsible and legal action could be initiated against them, it made no difference as they said it was not being done by them, but by distributors and vendors. When the Act was amended in 2005, it clearly said that there would be no such ads outside shops.

Though the government told the companies that they would be held responsible and legal action could be initiated against them, it made no difference as they said it was not being done by them, but by distributors and vendors. When the Act was amended in 2005, it clearly said that there would be no such ads outside shops.

Arora added: “So the tobacco companies removed the ads outside the shops, but started putting them inside, arguing that the Act did not mention that they should not be within shops or point of sale counters. Recently, the government clarified there should be no such ads both outside and inside. The tobacco companies are now pleading that they be allowed to advertise within the shop or on counters. We have no fight with these companies as long as cigarettes can be sold legally. But they have to sell them within the legal provisions.”

A source from the health ministry said that as far as Delhi was concerned, most of the ads had now been taken off and if they spotted any new ones, legal action would be initiated. Till the Delhi government carries out its threat of cracking down on violators, it is unlikely they will ever comply with the rules.

This is not the first controversy that PMI has faced. In 2010, the tobacco giant admitted to using child labour at its production facility in Kazakhstan. Human Rights Watch documented 72 cases of children used as forced labour.

India alone has some 100 million smokers. Government data says that tobacco use annually kills over 9,00,000 people. WHO estimates that tobacco-related diseases annually cost India $16 billion. Arora warned: “Tobacco is a leading cause of 40 percent of all cancers, 90 percent of oral cancer, 30 percent of tuberculosis, and 20 percent of diseases like heart attack, diabetes and hypertension apart from other respiratory diseases. While we are rapidly developing curative strategies like setting up huge cancer, diabetics and hypertension clinics, we are not doing enough to work on a preventive strategy to ensure that these diseases do not happen.”

The reach and marketing power of tobacco companies is huge. According to a 2002 study in the American Journal of Public Health, the tobacco industry in the 1990s increasingly sponsored entertainment events in bars and nightclubs where it displayed cigarette brand paraphernalia and advertisements.

Globally, anti-tobacco campaigners have accused PMI of breaking an ethical code when it deliberately targeted new young smokers. Often, cigarettes were given free to those who had just entered the legal age to smoke. The company had earlier aggressively run an advertising campaign in about 50 countries, cleverly targeting the young. Internal documents of the company indicated that those between 18 and 24 years had to be zeroed in. Company executives were specifically told that they must never use the word “promotion or advertising” when they were interacting with sellers or potential users.

In 2013, Germany banned promotional images of Marlboro, saying it encouraged children as young as 14 to start smoking. But other countries did not do so despite the fact that seven anti-tobacco organisations in a report charged that Philip Morris was trying to get a new generation hooked to tobacco. The ads of PMI appealed to teenagers as they used attractive models partying, falling in love, travelling, exploring, being cool and even confused. PMI violated its own ethical code which stated that it would not use images and content that would appeal to minors.

India enacted the national tobacco control law in 2004 before being one of the first countries to ratify WHO’s Framework Convention on Tobacco Control treaty. It contains a raft of anti-smoking provisions, including tobacco taxes, warning labels on cigarette packs and advertising bans. India, thereafter, strengthened the law in line with the provisions of the treaty. It was ultimately signed by 181 countries.

A group of cigarette distributors challenged the law. But in 2013, the Supreme Court ordered that the law be implemented. It said advertisement of tobacco products would attract the younger generation and innocent minds who were not aware of the grave and adverse consequences of consuming it.

Delhi has acted strongly, but what about other states? The central government is supposed to monitor and supervise implementation of the Act all over India. Had it done that, all states would have cracked down on tobacco companies the way Delhi has done.

The Tobacco Control Programme has the infrastructure and manpower, but lacks commitment to crack down on the tobacco lobby. An anti-tobacco activist said these companies used to set aside a budget to ensure that monitoring officials were well-inclined towards them.

It is time to act before matters go up in smoke.

‘Quitting tobacco can decrease cancer chances eight times’

Increase in tobacco consumption has led to rise in cancer cases among the youth in recent years. “It is most common in people between 25 and 40 years of age,” said Dr Satsheel Sapre, HoD of Head and Neck Cancer Department at Rashtrasant Tukdoji Regional Cancer Hospital (RST).

http://timesofindia.indiatimes.com/city/nagpur/quitting-tobacco-can-decrease-cancer-chances-eight-times/articleshow/59814866.cms

Sapre was speaking at an awareness programme organized by RST and Indian Medical Association (IMA) to mark Head and Neck Cancer Day, on Thursday, on the premises of the hospital. “Vidarbha is world capital of tobacco related cancers. Quitting tobacco can decrease chances of cancer eight times,” he said.

“Young people mostly start smoking or chewing tobacco due to peer pressure or perceive it as something glamorous. But smoking causes lung cancer and increases development of unwanted, uncontrolled and abnormal cells,” Sapre added.

Making an appeal about quitting smoking, Sapre said, “Our body does not need tobacco. It only harms our body, still many youths take the suicidal path. According to WHO, one among every eight persons is likely to be affected with cancer before death.”

Talking about symptoms of cancer, Sapre said, “Bleeding from mouth, constipation, change in voice, stink from mouth and fever or cough for more than 15 days can be symptoms of cancer. Patients must visit doctors for fighting cancer, it will not disappear by itself.”

A cancer survivor Shrimad shared his experience. “In 2000, I developed a small lump on my chick, which was due to cancer. I use to chew tobacco but I didn’t lose hope and fought it. Now I am living a normal life. I will suggest everyone not to eat tobacco and never lose hope because you can fight cancer. Doctors are your closest friend against diseases like cancer,” he said.

A small play on banning tobacco, alcohol and smoking was also staged at the programme. It illustrated cancer as the ‘boss’ of all addictive materials that are driving people towards destruction.

Dr BK Sharma, director of RST, and Dr Avinash Wase, president of IMA, were also present at the programme.

WHO report gives India high marks for fighting tobacco use

A new report by the World Health Organisation on the global use of tobacco shows India, Bangladesh and Bhutan on top of the list of South East Asian countries that have achieved a high level of tobacco control.

http://www.domain-b.com/organisation/who_collaborating_centre/20170721_tobacco.html

The prevalence of tobacco use in India has fallen from 34.1 per cent to 28.6 per cent over the last seven years, the report says, comparing data from two rounds of the Global Adult Tobacco Survey (GATS) in 2009-10 and 2016-17.

The WHO report titled Global Tobacco Epidemic, 2017: Monitoring Tobacco Use and Prevention Policies, was released in New York on Wednesday on the sidelines of the United Nations High-Level Political Forum on Sustainable Development. The report covers 194 countries, divided into The Americas, South East Asia, Europe, Eastern Mediterranean, Western Pacific, and Africa. There are 11 countries in the South East Asia group, including India.

Though the population worldwide protected by tobacco control measures has grown almost five-fold than ten years ago, the World Health Organisation (WHO) on Wednesday called on countries to do more to prioritise these life-saving policies.

In India, Mumbai, Kolkata, Delhi, Hyderabad, Bengaluru, Pune, Surat, Kanpur, Jaipur, Lucknow and Nagpur are among the top 100 cities across the world named for the strict implementation of policies to prevent tobacco use. The report lists the cities population-wise, using figures published in the UN Statistics Division’s Demographic Yearbook.

Globally, the WHO report said about 4.7 billion people, or 63 per cent of the world’s population, are covered today by at least one comprehensive tobacco control measure. Ten years ago, in 2007, the number was only one billion, or 15 per cent of the world’s population.

However, tobacco use has still become the leading single preventable cause of death worldwide, killing over seven million people each year.

Its economic costs are also enormous, totalling more than $1.4 trillion in healthcare and lost productivity, according to WHO.

Meanwhile, the tobacco industry continues to hamper government efforts to fully implement life- and cost-saving interventions, by, for example, exaggerating the economic importance of the tobacco industry, discrediting proven science, and using litigation to intimidate governments, the report says.

Poor countries ahead
More than half of the top national performers on tobacco control are low- and middle-income countries, showing that progress is possible regardless of economic situation. A tracking of MPOWER measures – introduced by WHO in 2007 to assist in the country-level implementation of measures to reduce the demand for tobacco – has revealed that the number of people protected by at least one best-practice measure has quadrupled to 4.7 billion – or almost two-thirds of the world’s population.

As many as 121 out of 194 countries have introduced at least one MPOWER measure at the highest level of achievement (not including monitoring or mass media campaigns, which are assessed separately).

Thirty-four countries with a total population of 2 billion have adopted large graphic pack warnings. Six countries (Afghanistan, Cambodia, El Salvador, Lao People’s Democratic Republic, Romania and Uganda) have adopted new laws making all indoor public places and workplaces smoke-free. Six countries (El Salvador, Estonia, India, Jamaica, Luxembourg and Senegal) have advanced to best-practice level with their tobacco use cessation services, the report says.

India and Nepal are regional and global leaders in implementing large, pictorial warning labels on tobacco packaging. With the increase in the size of pack warnings to 85 per cent of both front and back panels on all tobacco products, India now has the third largest pack warning label among all countries.

The findings of GATS-2 showed that graphic warning labels depicting throat cancer and oral cancer are a strong tool to discourage the youth from initiating tobacco, and have motivated 275 million current users to quit.

Dr Vinayak Prasad, Geneva-based head of the WHO Tobacco Free Initiative, told The Indian Express that among the many measures to control tobacco in India was the joint WHO-International Telecommunication Union initiative mCessation, launched in 2015 with the Ministries of Health and Family Welfare and Communication and Information Technology. ”The programme to encourage people to quit tobacco use registered more than two million users last year and the initial evaluation showed that more than 7% quit successfully after six months,” Dr Prasad said.

The WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty negotiated under the auspices of WHO, was adopted by the World Health Assembly in 2003, and entered into force in 2005. It has since become one of the most widely embraced treaties in UN history.