Gender & tobacco

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  • Framework convention on tobacco control
  • Gender & tobacco

    1. 1. Gender & tobacco Dr Sheelu Srinivas Consultant ENT Surgeon & Dept co ordinater Fortis Hospital, Bannerghetta road
    2. 2. <ul><li>Tobacco cultivation has a history of about 8000 years. </li></ul><ul><li>Europeans were introduced to tobacco when Columbus landed in America in 1492. </li></ul><ul><li>Portuguese traders introduced tobacco in India during 1600. Tobacco became a valuable commodity in barter trade and its use spread rapidly. </li></ul><ul><li>Gradually tobacco got assimilated into the cultural rituals and social fabric due to presumed medicinal and actually addictive properties attributed to it. </li></ul>History of Tobacco
    3. 3. Facts about nicotine <ul><li>plant nicotiana tabacum </li></ul><ul><li>When tobacco is smoked, nicotine is absorbed by the lungs and quickly moved into the bloodstream, where it is circulated throughout the brain </li></ul><ul><li>In fact, nicotine reaches the brain within 8 seconds after someone inhales tobacco smoke. Nicotine can also enter the bloodstream through the mucous membranes that line the mouth (if tobacco is chewed) or nose (if snuff is used), and even through the skin. </li></ul>
    4. 4. Effects on various organs <ul><li>Heart </li></ul><ul><li>Lung </li></ul><ul><li>Brain </li></ul><ul><li>nicotine gets into the brain, it attaches to acetylcholine receptors and mimics the actions of acetylcholine. </li></ul><ul><li>Acetylcholine and its receptors are involved in many functions, including muscle movement, breathing, heart rate, learning, and memory. </li></ul><ul><li>nicotine raises the levels of a neurotransmitter called dopamine in the parts of the brain that produce feelings of pleasure and reward </li></ul>
    5. 5. How cancer? <ul><li>Tobacco smoke contains chemicals that are harmful to both smokers and nonsmokers </li></ul><ul><li>Over 4000 chemicals ,250 have been found to be harmful </li></ul>
    6. 6. Toxic chemicals found in tobacco smoke <ul><li>hydrogen cyanide (used in chemical weapons), carbon monoxide (found in car exhaust), formaldehyde (used as an embalming fluid), ammonia (used in household cleaners), and toluene (found in paint thinners). </li></ul>
    7. 7. Cancer causing chemicals in tobacco <ul><li>arsenic (a heavy metal toxin ) </li></ul><ul><li>benzene (a chemical found in gasoline) </li></ul><ul><li>beryllium (a toxic metal) </li></ul><ul><li>cadmium (a metal used in batteries) </li></ul><ul><li>chromium (a metallic element) </li></ul><ul><li>ethylene oxide (a chemical used to sterilize medical devices) </li></ul><ul><li>nickel (a metallic element) </li></ul><ul><li>polonium-210 (a chemical element that gives off radiation ) </li></ul><ul><li>vinyl chloride (a toxic substance used in plastics manufacture) </li></ul>
    8. 8. The Health Effects of Smoking <ul><li>Airway irritability </li></ul><ul><li>Increased phlegm production </li></ul><ul><li>Persistent cough </li></ul><ul><li>Decreased physical performance </li></ul><ul><li>Increase in LDLs or “bad fat” </li></ul><ul><li>Plaque on the artery wall </li></ul><ul><li>Thrombosis, or clot, inside a blood vessel </li></ul><ul><li>Constriction of blood vessels </li></ul><ul><li>Increased heart rate </li></ul><ul><li>Increased blood pressure </li></ul><ul><li>Heartburn and reflux disease </li></ul><ul><li>Peptic ulcers </li></ul><ul><li>Periodontal diseases </li></ul><ul><li>Halitosis, or bad breath </li></ul><ul><li>Inflammation of the middle ear </li></ul><ul><li>Sinusitis </li></ul><ul><li>Congestion </li></ul><ul><li>Pneumonia </li></ul><ul><li>Scurvy and other micronutrient disorders </li></ul><ul><li>Oxidative damage </li></ul><ul><li>Drug interactions </li></ul>
    9. 9. LONG TERM EFFECTS <ul><li>Earlier menopause </li></ul><ul><li>Increased risk of having stillborn or premature infants or infants with low birth weight and children with conduct disorders </li></ul><ul><li>Increased probability that female children will smoke and will persist in smoking </li></ul><ul><li>Decreased physical performance </li></ul><ul><li>Impotence </li></ul><ul><li>Premature hair loss </li></ul><ul><li>Increased wrinkles and crow’s feet </li></ul><ul><li>Chronic coughing </li></ul><ul><li>Hearing loss </li></ul><ul><li>Vision problems and loss </li></ul><ul><li>Gum disease </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Delayed healing process </li></ul><ul><li>Susceptibility to colds and flu </li></ul><ul><li>Increased headaches </li></ul><ul><li>Increased stress </li></ul>
    10. 10. Why women? <ul><li>World over there is some decrease in men </li></ul><ul><li>Tobacco companies need new customers & targeting women </li></ul><ul><li>Because of reproductive role </li></ul><ul><li>Role in family :secondary smoke or educating children </li></ul>
    11. 11. Women & tobacco <ul><li>Female addiction may be reinforced more by the sensory and social context of smoking, rather than by nicotine, suggesting that patches may not be so effective an aid. </li></ul><ul><li>Women quit less easily than men due to their different responses to nicotine as well as a lack of social support, fear of weight gain, depression and hormones. </li></ul><ul><li>Relapse rates in women are higher, and it may take a number of attempts before the achieve success. </li></ul>
    12. 12. “ You’ve Come a Long Way, Baby!” <ul><li>Smoking is portrayed as a manly habit linked to happiness, fitness, wealth, power and sexual success, </li></ul><ul><li>The tobacco industry deliberately targets women with new products and glamorous, sexy, and independent themed advertising. </li></ul><ul><li>Tobacco is promoted to women as a buffer for negative feelings, a time-out from stress, and as way to control weight. </li></ul>
    13. 13. Tobacco use among women in India <ul><li>Smokeless & Smoking </li></ul>
    14. 14. Tobacco Toll in India <ul><li>700, 000 deaths per year due to smoking </li></ul><ul><li>800, 000 to 900, 000 per year due to all forms of tobacco use/ exposure </li></ul><ul><li>Fastest trajectory of rise in tobacco related deaths forecast for the next 20 years </li></ul><ul><li>Many of the deaths (>50%) occur below 70 years of age </li></ul>
    15. 15. Prevalence of Tobacco Use <ul><li>Tobacco use prevalence : 46.5% males and 13.8% females (1998 -1999) National Family Health Survey-2 </li></ul><ul><li>55.8% of males currently use tobacco (12 - 60 years of age) National Household Survey of Drug and Alcohol Abuse, 2002 </li></ul><ul><li>Tobacco use prevalence among males is higher compared to females and among older age groups compared to the younger age groups. </li></ul><ul><li>The prevalence of tobacco use is higher in rural population compared to that in urban areas. </li></ul><ul><li>India has a huge problem of widespread smokeless tobacco use among women , particularly among disadvantaged women. </li></ul><ul><li>The prevalence of tobacco use in pregnant women is similar to that in non-pregnant women of the same age. </li></ul>
    16. 16. Tobacco related risks higher in women <ul><li>In a study in the three centers of Bangalore, Chennai and Thiruvanthapuram </li></ul><ul><li>women who chewed pan-tobacco, has a 46 times higher risk than those women who had never chewed it (RR = 45.9) </li></ul><ul><ul><li>Men in this study had a 6 fold greater risk of oral cancer if they were pan-tobacco users than never users (risk adjusted for smoking) </li></ul></ul><ul><li>Balaram P, et al. International Journal of Cancer, 2002 </li></ul><ul><li>World over incidences of lung cancer in women is on raise. has already surpassed breast cancer </li></ul>
    17. 17. Easy to Start, Hard to Quit <ul><li>withdrawal symptoms :restlessness, hunger, depression, headaches, and other uncomfortable feelings. </li></ul>
    18. 18. Indian Law- At a Glance <ul><li>Key Provision of cigarettes and other tobacco product Act, 2003 </li></ul><ul><li>Ban on smoking in public places </li></ul><ul><li>Ban on direct and indirect advertising of tobacco products </li></ul><ul><ul><li>Point-of-sale advertising is permitted </li></ul></ul><ul><li>Ban on sales to minors </li></ul><ul><ul><li>Tobacco products cannot be sold to children <18 years </li></ul></ul><ul><ul><li>Tobacco products cannot be sold within a radius of 100 yards of educational institutions </li></ul></ul><ul><li>Pictorial health warnings </li></ul><ul><li>English and one or more other Indian languages to be used for health warnings on tobacco packs </li></ul><ul><li>Testing and Regulation: Ingredients to be declared on tobacco product packages (Tar and Nicotine) </li></ul>
    19. 19. <ul><li>Several legislations have been enacted to protect the beedi workers as they belong to the vulnerable section of society and work in adverse work and health conditions </li></ul><ul><ul><li>Bonded labour system (Abolition) Act, 1976: aims to abolish the bonded labor system to protect children and other workers to become forced labor in case of inability to repay a loan. </li></ul></ul><ul><ul><li>The child labour (Prohibition and Regulation) Act, 1986: aims to stop the exploitation of children involved in beedi rolling. </li></ul></ul><ul><ul><li>Minimum Wages Act, 1948: aims to fix minimum rates of wages in industry and trade where labour organizations are non-existent or ineffective. </li></ul></ul><ul><ul><li>The beedi and cigar workers (Condition of Employment) Act, 1966: aims to regulate the conditions of service of the beedi workers. </li></ul></ul><ul><ul><li>Beedi workers welfare fund Act, 1976: aims to provide for welfare schemes for the beedi workers and their families, related to health, education, maternity benefits, group insurance, recreation, housing assistance etc. </li></ul></ul><ul><ul><li>The beedi workers welfare cess (Amendment) Act, 1976: aims to improve living conditions and provide welfare measures to beedi workers. This cess collected by way of excise duty on manufactured beedis contributes to BWWF. </li></ul></ul>Policies Related to Protection of Labour
    20. 20. Implementation : Barriers to be Overcome <ul><li>Untrained and uncoordinated enforcement machinery </li></ul><ul><li>Inadequately educated community </li></ul><ul><li>Lack of awareness of rules among relevant group (e.g., restaurant managers) </li></ul><ul><li>Tobacco industry tactics </li></ul>
    21. 21. FCTC Ratification in India <ul><li>India signed FCTC : 10 th Sep 2003 </li></ul><ul><li>India ratified FCTC: 5 th Feb 2004 </li></ul><ul><li>India was the 8 th country to ratify the FCTC </li></ul><ul><li>Central ( Union) Government is the authority to enter into international treaties and subsequently ensure their implementation. </li></ul><ul><li>FCTC was ratified by India after Cabinet approval. </li></ul><ul><li>Each Party (ratifying country) of FCTC to ensure that its national law is in conformity with its treaty obligations </li></ul><ul><li>Indian Tobacco Control Act (2003) enacted in April- May 2003 </li></ul><ul><li>Most of the provisions in this Act are very similar to the FCTC’s articles </li></ul>
    22. 22. FCTC Implementation in India <ul><li>The Indian Act enactment preceded the adoption and enforcement of the FCTC </li></ul><ul><li>Indian Legislation needs to be upscaled to comply with the provisions of FCTC </li></ul><ul><ul><li>Tax and price measures to be implemented to reduce tobacco consumption </li></ul></ul><ul><ul><li>Duty free sales to be tackled by Ministry of Finance </li></ul></ul><ul><ul><li>Prohibiting use of misleading terms to label tobacco products </li></ul></ul><ul><ul><li>Mobilize stakeholders, engage civil society to promote and strengthen education, communication, training and public awareness on tobacco control issues </li></ul></ul><ul><ul><li>Promote effective measure for tobacco use cessation </li></ul></ul><ul><ul><li>Elimination of all forms of illicit trade in tobacco products including smuggling, illicit manufacturing and counterfeiting </li></ul></ul><ul><ul><li>Sale to and by minors </li></ul></ul><ul><ul><li>Curb cross-border advertising </li></ul></ul><ul><ul><li>Promote economically viable alternatives for tobacco workers, growers and individual sellers (as appropriate) </li></ul></ul>
    23. 23. A Report on Tobacco Control in India <ul><li>India’s first comprehensive scientific and advocacy tool on tobacco control </li></ul><ul><li>Government of India commissioned HRIDAY (Dr. K. Srinath Reddy) and Tata Memorial Hospital/ Healis - Sekhsaria Institute of Public Health (Dr. P.C. Gupta) to jointly produce and edit this report. </li></ul><ul><li>The Report explicitly discussed FCTC and delineated its implications for India. </li></ul><ul><li>The Report was released on November 25, 2004 in Delhi </li></ul>
    24. 24. Proposed Indian Health Warning on Gutkha Packs Packaging and Labelling of Tobacco Products
    25. 25. Proposed Indian Health Warning on Cigarette and Bidi Packs
    26. 26. Proposed Indian Health Warning on Cigarette Pack
    27. 27.                                                 Tobacco Cessation Centre, NIMHANS, Bangalore Manual for General Public – “Do You Know…”          English          Kannada   Patient's Manual – Tobacco Use: A Smart Guide          English          Kannada       Tobacco Free Initiative Non-communicable Diseases and Mental Health Core Programme Clusters
    28. 28. DE ADDICTION <ul><li>NICOTINE REPLACEMENT THERAPY </li></ul><ul><li>BUPROPION </li></ul><ul><li>COUNCELLING </li></ul>
    29. 29. Tobacco is the only legal consumer product that kills when used exactly as indicated by the manufacturer.
    30. 30. THANK YOU

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