Say Goodbye to Tobacco: A Health Inspector's Perspective

1. SAY GOOD BY TO TOBACCO Sreeraj.V.TJr.Health Inspector PHC Udayagiri

2. What is Tobacco? • Tobacco is a plant that has been known to release dangerous chemicals when burnt. • Tobacco comes in various methods such as: • Chewing Tobacco • Smoking (cigarettes) • Pipes • Cigars • ALL OF THESE METHODS ARE DEADLY!!!! • If you smoke cigarettes, you are not only effecting yourself, but people around you as well, by second-hand smoke.

3. The Methods Cigars A dried up roll of tobacco that is much more dangerous than a Cigarette. A cigar has no filter like a cigarette, so the poisonous gases does for damage to your lungs, etc. Cigarette Cigarette is made from dried up tobacco chopped up and rolled in a piece of paper. When Cigarette is burnt, it releases dangerous chemical gases such as carbon monoxide, and hydrogen cyanide. Chewing Tobacco Chewing Tobacco is also made from chopped up tobacco. It is placed between the gum and teeth. The tobacco is crushed by the teeth to release the nicotine. Pipe Pipe is a tool for smoking. Tobacco is placed in the chamber and burnt. The smoke then gets inhaled into the lung through the stem and mouthpiece.

4. Cigarette Smoking is the principle cause of Premature Death

7. 1 tobacco related death every 6 seconds WHAT IS AT STAKE? = 10 million annual deaths by 2030 1 Billion deaths in 21st Century

9. Tobacco Is Now the World’s Leading Single Agent of Death Unless urgent action is taken, tobacco will kill 1 billion people this century World Health Organization

10. Prevalence of Tobacco use in India Below 35% : 2 states Punjab and Goa Between 35 - 50% : 8 states Andhra Pradesh, Tamilnadu, Karnataka, Kerala, Maharashtra, Haryana, Himachal Pradesh and Delhi Between 50 – 65% : 8 states Gujarat, Rajasthan, Jammu&Kashmir, Uttarakhand, Uttar Pradesh, Jarkhand, Sikkim, Arunachal Pradesh Above 65% : 11states Madhya Pradesh, Bihar, Chattisgarh, Orissa, West Bengal, Assam, Meghalaya, Manipur, Tripura, Mizoram, Nagaland

11. TOBACCO & MEN • Any Tobacco Use – Prevelance: 57% • Currently smoke Cigarette or Bidi: 32.7% • Currently chews pan masala, ghutkas or other tobacco: 36.5% • About 7% of male aged 13-15 yrs smoke cigarettes in India

13. CIGARETTE SMOKE CONTAINS 4000 POISONS

14. More than 4,000 substances have been identified in cigarette smoke

15. Nicotine increases systolic and diastolic blood pressure

16. Cigarette smoking antigenic, cytotoxic, mutagenic, carcinogenic

17. Normal lung and Smokers lung

18. CLINICAL AFFECTS Cardiovascular Diseases Cancer Respiratory Diseases Pregnancy related complications Gastrointestinal disorders Depression

19. TOBACCO AND CANCERS • Lung • Mouth (oral) • Throat (Pharynx & Larynx) • Food Pipe (Oesophagus) • Urinary Bladder • Other Sites

20. OTHER DISEASES • Chronic Bronchitis • Emphysema • Asthma • Cataract • Tuberculosis • Diabetes • Still Birth and Low Birth Weight > 25 Diseases

21. CARDIOVASCULAR RISKS OF SMOKING 100% Increase in Risk Stroke; CHD; Impotence 300% Increase in Risk Death from undiagnosed CHD > 300 % Increase in Risk Peripheral Arterial Disease 400 % Increase in Risk Aortic Aneurysm

23. CLOGGING OF CORONARY ARTERIES

26. Emphysema Lung

27. ACTIVE SMOKING

28. PASSIVE SMOKING

29. What is Second Hand Smoke • Second-hand smoke: that is inhaled involuntarily or passively by someone who is not smoking. • Second-hand smoke is also called involuntary smoking or passive smoking

30. Second hand smoke causes serious Health Hazards • Lung cancer -risk up 24% • Heart diseases -risk up 25% • Asthma attacks • Sudden Infant Death Syndrome (cot death) • Childhood respiratory diseases • Chronic cough, phlegm, and wheezing • Chest discomfort • Lowered lung function

31. PASSIVE SMOKING (ETS) • Second Hand Smoke increase risk of • Cancer by 30% • Heart attack by 25% in spouse of the smoker • Increased risk of asthma and lung disease in children

32. TOBACCO & WOMEN

33. Main cause of oral cancer is chewing of Tobacco

36. ECONOMIC COSTS OF TOBACCO Health Care: Just for 3 diseases (Coronary Heart Disease; Cancer; Chronic Lung Disease) Health Care cost in 2002 – 2003 was Rs. 308.33 Billion (USD 7.2 Billion) Tobacco also has: Environmental costs & Social costs

38. Pictorial Health Warnings (Globally)

39. More Pictorial Health Warnings from Thailand

40. Pictorial Health Warnings from Brazil

41. Cigarettes and Other Tobacco Products(Prohibition of Advertisement and Regulationof Trade and Commerce, Production,Supply and Distribution) Act, 2003 (COTPA)

42. Section 4: Ban on Smoking in Public Places • Secondhand smoke (passive smoking) of smoke causes many diseases like lung cancer, respiratory diseases, heart disease, breast cancer, asthma, bronchitis. In some cases, it can trigger severe, even life-threatening reactions in individuals. • Children are the worst affected. It causes sudden infant death syndrome. • People working, especially in the food service industry are affected. • Ban on smoking in public places would prevent damage to the health of non smokers and smokers

43. Section 5: Ban on Advertisements of Tobacco Products • In India children and the youth have been greatly influenced by tobacco advertisements, especially those for cigarettes and gutka which definitely harms their health. • Advertisements and placing of the product at a low height and next to candies at points of sale is a strategy they use to give undesirable exposure and access to children. • A study found that children who had seen sports events being sponsored by a tobacco company were more likely to start smoking. This was during the period when a cigarette company sponsored cricket matches. • Many tobacco industries are promoting tobacco products to target women. • This provision would prevent women and children from being influenced by glamorized advertisements of tobacco products.

44. Section 6: Prohibition of Sale of Tobacco Products to and by Minors. • 18 വയസ്സില്‍ താഴെ പ്രായമുള്ളവര്‍ക്ക് പുകയില ഉല്‍പ്പന്നങ്ങള്‍ വില്‍ക്കുന്നത് ശിക്ഷാര്‍ഹമാണ്.

45. വിദ്യാലയങ്ങളുടെ 400 മീറ്റര്‍ ദൂര പരിധിയില്‍ പുകയില ഉത്‌പന്നങ്ങള്‍ വില്‍ക്കുവാന്‍ പാടില്ല.

46. Section 7: Specified Health Warning Labels on all Tobacco Products • Images help smokers visualize the nature of tobacco-related diseases and convey health messages in a clearer way. • Pictorial health warnings are intended to serve as visual cues to prompt smokers to take action to quit. They are designed to shock people into realizing that smoking kills and causes serious illness. • Pictorial warnings also make the health warnings accessible to those who are illiterate. • They are effective tool in conveying health risks to the tobacco users. It also has an impact on intention and ability to quit. • In countries like Brazil, Canada and Thailand many pictorial warnings have helped in decreasing consumption of tobacco products

47. Section 7(5): Every tobacco package to have nicotine and tar contents along with the maximum permissible limits • Nicotine and tar are carcinogens • Nicotine and tar contents along with permissible limits should mentioned on the packages • Having them on the package would help people making an informed choice

48. Increasing Tax and Price of Tobacco Products • Price and tax measures are an effective and important means of reducing tobacco consumption by various segments of the population, in particular young persons. • Implementing tax policies and price policies, on tobacco products would contribute to the health objectives aimed at reducing tobacco consumption. • This measure acts as a demand reduction measure for tobacco products.