According to a Lancet study (2012), in India, tobacco-related cancers represented 42·0% of male and 18·3% of female cancer deaths India also has one of the highest rates of oral cancer in the world as the consequence of high prevalence of smokeless tobacco use

1. NATIONAL TOBACCO
CONTROL PROGRAMME
DR.NEELAM AHIRWAR
DNBSS RESIDENT (SURGICAL ONCOLOGY)
APOLLO CBCC

2. Introduction
• India is second to China in terms of number of smokers aged 15 or
above accounting for 106 million of the world's 1.1 billion smokers
• 9 million adolescents (13-15 years) used tobacco in South-east Asia-
sizeable portion in India
• According to the Global Adult Tobacco Survey-2 (GATS-2), 2016-17,
28.6% adults use tobacco (smoke or smokeless tobacco)

3. Introduction
• 19% of men and 2% of women smoke tobacco.
• 6% of men and 12.8% women use smokeless tobacco
• India has the largest number of Smokeless Tobacco users in the
world- accounts for 66% of world’s smokeless tobacco users
• Prevalence of tobacco use decreased by 6% from 2009-10 to 2016-17
• Projection: Prevalence to further drop to 8.5% by 2025

5. Issues - Health
• According to a Lancet study (2012), in India, tobacco-related cancers
represented 42·0% of male and 18·3% of female cancer deaths
• India also has one of the highest rates of oral cancer in the world as the
consequence of high prevalence of smokeless tobacco use
• Tobacco use also leads to cardiovascular diseases and chronic obstructive
pulmonary diseases
• Significant relation is also seen between passive or active exposure to
tobacco smoke and tuberculosis infection

6. Issues - Health
• GATS 2 report shows that 39% of adults in India are exposed to
second-hand smoking (SHS).
• High health Expenditure- Direct medical cost, indirect morbidity cost,
productivity loss due to premature mortality

7. Issues
Economy
Economic burden of tobacco-related diseases in India', tobacco-related
disease was over INR 1, 04,500 crores (1.16% of GDP) for the year 2011, just
among adults aged between 35 and 69.
Environment
Tobacco cultivation and the curing process contribute towards deforestation,
soil depletion, loss of soil nutrients and pollution due to the heavy use of
agrochemicals.

8. Issues
Toxic waste
• Cigarette and bidi butts are non-biodegradable.
• Cigarette filters are made of cellulose acetate (a form of plastic) which
is resistant to biodegradation and can persist in the environment for a
very long time.
• Further, the butts contain toxic substances which contaminate the
environment with heavy metals and poisonous chemicals like
nitrosamines, polycyclic aromatic hydrocarbons, nicotine

9. Issues
Society
Affects household welfare
Expenses incurred in tobacco use substitute the basic needs of food
and education among disadvantaged population-lower socio-economic
group
Adverse effects on children and adolescents

10. WHO FCTC (The Framework Convention on Tobacco Control)
• Most important global initiative for tobacco control
• GOI ratified the WHO Framework Convention on Tobacco Control
(WHO FCTC) in 2004, the first ever international public health treaty
focusing on the global public health issue of tobacco control.

11. MPOWER
Technical assistance package by WHO
six evidence-based tobacco demand
reduction measures contained in the
FCTC

12. National Tobacco Control Programme (NTCP)
• The Ministry of Health and Family Welfare launched the pilot phase of
the National Tobacco Control Programme in 2007-08 in 9 states of the
country covering 18 districts. In 2008, it has been upscaled to 42
districts across 21 states
• Currently, the Programme is being implemented in all 36 States/Union
Territories covering over 600 districts across the country

13. The National Tobacco Control Cell (NTCC)
• Responsible for overall policy formulation, planning, implementation,
monitoring and evaluation of the different activities envisaged under
the National Tobacco Control Programme (NTCP).
• Functions under the direct guidance and supervision of the
programme in-charge from the MoHFW i.e. Joint Secretary

14. Aim
• To bring greater awareness about the harmful effects of tobacco use
and about the Tobacco Control Laws
• To facilitate effective implementation of the Tobacco Control Laws
• Reduce the production and supply of tobacco products.
• Helps the people quit tobacco use through Tobacco Cessation Centers
• Training of health and social workers, NGOs, school teachers
• Information, education, and communication (IEC) activities

15. Aim
• National level mass awareness campaigns
• Establishment of tobacco product testing labs
• Monitoring and evaluation, including Adult Tobacco Survey (ATS)
• Setting up of National Regulatory Authority
• Coordination with Panchayati Raj Institutions for village level activities

16. Manuals and guides by NTCP
• Manual on Tobacco Control in Schools
• National Tobacco Control Programme-Health Worker Guide
• Training Manual for Doctors
• Tobacco Dependence Treatment Guidelines
• Establishment of Tobacco Cessation Centers in Dental Institutes-An
Integrated Approach in India-Operational Guidelines 2018
• Operational Guidelines for National Tobacco Testing Laboratories (NTTL)

17. Structure
(i) National Tobacco Control Cell (NTCC)
at Central level
(ii) State Tobacco Control Cell (STCC) at
State level
(iii) District Tobacco Control Cell (DTCC)
at District level.
There is also a provision of setting up
Tobacco Cessation Services at District
level

18. National level
• Public awareness/mass media campaigns for awareness building and behavioural
change
• Establishment of tobacco product testing laboratories.
• Mainstreaming research and training on alternative crops and livelihood with
other nodal Ministries.
• Monitoring and evaluation including surveillance
• Integrating NTCP as a part of health-care delivery mechanism under the National
Health Mission framework.

19. State Level
• Dedicated State Tobacco Control Cells
• Refresher training of the DTCC staff.
• Training on tobacco cessation for Health care providers.
• Law enforcers training / sensitization Programme

20. District Level
• Dedicated District Tobacco Control Cells
• Training of Key stakeholders: health and social workers, NGOs, school
teachers, enforcement officers etc.
• Information, Education and Communication (IEC) activities.
• School Programmes
• Monitoring tobacco control laws.

21. District Level
• Setting-up and strengthening of cessation facilities including provision
of pharmacological treatment facilities at the district level.
• Co-ordination with Panchayati Raj Institutions for inculcating concept
of tobacco control at the grassroots.

22. Tobacco Control in India
• Cigarettes and Other Tobacco Products (Prohibition of Advertisement and
Regulation of Trade and Commerce, Production, Supply and Distribution)
Act, 2003 (COTPA 2003)
• Food Safety and Standards (Prohibition and Restrictions on Sales)
Regulations,1st August 2011 , tobacco and nicotine shall not be used as
ingredients in any food products, Gutkha is banned
• Section-77 of the Juvenile Justice (Care and Protection of Children) Act,
2015

23. Tobacco Control in India
• The Prohibition of Electronic Cigarettes (production, manufacture,
import, export, transport, sale, distribution, storage and
advertisement) Ordinance, 2019
• Cable Television Networks Amendment Act of 2000- Prohibited the
transmission of advertisements on tobacco and liquor in India
• Prevention and Control of Pollution Act of 1981- smoking as an air
pollutant

24. COTPA 2003 (MoHFW)
• applicable to all products containing tobacco in any form i.e.
Cigarettes, Cigars, bidis, gutka, pan masala, khaini, mawa, mishri,
snuff

25. Main provisions of the COTPA
1. Prohibition of smoking in public places
2. Prohibition of advertisement, sponsorship and promotion of
tobacco products
3. Prohibition on sale to minors section( less than 18 yrs)
4. Prohibition of sale of tobacco products near educational institutions
5. Regulation of health warning in tobacco products packs
6. Regulation of tar and nicotine contents of tobacco products.
7. Pictorial health warnings also to be included.

26. Health warnings

27. Prohibition of smoking in public places
• An offence punishable with fine up to Rs. 500 and is
• compoundable.
• Display of board in public place

28. Prohibition on sale of tobacco products near
educational institutions section 6(b)
• sale of the same is prohibited in an area within radius of 100 yards of
any educational institution

29. • An advertisement includes any visible representation (notice, circular,
label, wrapper)
• All forms of audio, visual and print media
• Both direct & indirect advertisements are prohibited.
• Total ban on sponsoring of any sport/cultural events by cigarette and
other tobacco product companies.
Prohibition of advertisement of all tobacco
products(section 5)

30. Prohibition of advertisement of all tobacco
products(section 5)
• No trade mark or brand name of cigarettes or any tobacco product
can be promoted in exchange for sponsorship, gift,prize or
scholarship
• Offence punishable with maximum of 2 years of imprisonment
• fine up to Rs. 1000. In subsequent offence,
• imprisonment up to 5 years and with fine up to Rs. 5000

31. Provisions of the COTPA
CREATION OF SMOKING AREAS - hotels having 30 rooms, restaurants having
seating capacity of 30 persons and in airports.
Board at point of sale of tobacco products-
Size of board used for advertisement for tobacco products
shall not exceed 90 cms by 60 cms
• shall contain warning “Tobacco causes cancer” or “Tobacco kills” occupying
25% of top area of board.

32. mTobacco Cessation program
• GOI launched mCessation using text messages in 2016 as part of the
government’s Digital India Initiative
• allows people who want to quit tobacco use to register by giving a missed call to a
dedicated national number
• progress is monitored in real-time
• National toll-free quit line
• uses two-way messaging between the individual seeking to quit tobacco use and
programme specialists providing them dynamic support.

33. mTobacco Cessation program
• TO QUIT TOBACCO, CALL 1800 112 356 (TOLL FREE) OR GIVE A
MISSED CALL AT 011-22901701

34. mTobacco Cessation program
• recently released version-2 of the “mTobaccoCessation” platform,
which can deliver content through SMS or interactive voice response
in 12 languages.
• average quitting rate of 7 per cent for both smokers and users of
smokeless tobacco six months after enrollment.

35. Tobacco taxation
• According to WHO Report on the Global Tobacco Epidemic 2017,
cigarette taxes in India are amongst the highest in the world
• Cigarettes are subjected to high and discriminatory rates of taxation,
As of 2014-15 Government collected 87% of its total tobacco revenue
from legal cigarettes
• India has banned foreign direct investment in cigarette manufacturing

36. Alternate crop cultivation
• The main tobacco producing states include Andhra Pradesh, Telangana,
Chhattisgarh, Madhya Pradesh, Assam, West Bengal, Bihar, Uttar Pradesh &
Gujarat
• provides employment to around 36 million people
• Domestic tobacco industry also contributes nearly Rs.8000 crore to government
through indirect and direct taxes
• The union government is actively pursuing with states like Andhra Pradesh and
Karnataka, major growers of tobacco, to chalk out plans to help farmers

37. Alternate crop cultivation
• The Rajahmundry-based Central Tobacco Research Institute
suggested alternative crops like black pepper, sugarcane and maize
• Federation of All-India Farmers’ Association (FAIFA) is working in
coordination with government to draft a “well-balanced’’ tobacco
control policy.

38. ENDS
• Battery-operated devices that produce aerosol by heating a solution
containing nicotine, which is the addictive substance in combustible
cigarettes.
• These include all forms of Electronic Nicotine Delivery Systems, Heat
Not Burn Products, e-Hookah and the like devices.

39. The Prohibition of Electronic Cigarettes (production,
manufacture, import, export, transport, sale, distribution,
storage and advertisement) Ordinance, 2019
• punishable with an imprisonment of up to one year or fine up to Rs. 1
lakh or both for the first offence; and imprisonment of up to three
years and fine up to Rs. 5 lakh for a subsequent offence

40. Impact
• Global Adult Tobacco Survey India (GATS 1) 2009-2010 ,covered 69,296
adults, comprising,33,767 males and 35,529 females.
• GATS 2- 2016-17
• Tata Institute of Social Sciences, Mumbai - agency for carrying out the
GATS2
• The technical assistance for GATS 2 was provided by the U.S. Centers for
Disease Control and Prevention (CDC), the World Health Organization
(WHO)

41. GATS2
• 28.6 percent(266.8 million) of adults in India aged15 and above currently
use tobacco
• men was 42.4 percent, women it was 14.2 percent
• Every third adult (32.5%) from rural areas and every fifth adult (21.2%)
from urban
• 64.5 percent in Tripura to 9.7 percent in Goa.
• khaini - a tobacco, lime mixture- is the most commonly used
• bidi, smoked by 7.7 percent of adult Indians
• gutka - a tobacco, lime,areca nut mixture- ranks the third (6.8%)

42. The current levels of tobacco use are still very high across the nation
which calls for sustained efforts at all levels.
The strict enforcement of COTPA2003, enhanced implementation of
National Tobacco Control Programme and WHO FCTC will definitely
lead to acceleration of existing efforts for prevention and control of
tobacco and achievement of the global targets

43. Thankyou