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In harm’s way: tobacco industry revenues from sales to underage tobacco users in India

Authors: Pranay Lal, Sonu Goel and Deepak Sharma

Publication: Global Health Promotion


Background: In 2010, the Global Adult Tobacco Survey (GATS) for India revealed that nearly 40% of current smokers and 42% of current chewers had initiated tobacco use before they were of the legal age (18-years-old). Global evidence shows that those who initiate earlier have a lower probability of quitting the use of tobacco. In order to sustain its profits, the tobacco industry will make every effort to recruit underage users who become lifelong users of their products.

Aims and objectives: We estimate the consumer expenditure on tobacco products by underage users in India.

Methodology: Using nationally representative data we estimated the number of daily underage tobacco users for a year and their annual expenditure on different types of smoked and chewed tobacco products.

Results: There are nearly 4.4 million underage daily tobacco users (age group 15–17-years -old) in India. Approximately 7.2% of the population in the 15–17 age group are current daily users of tobacco (0.1% cigarette smokers, 0.5% bidi smokers and 6.6% tobacco chewers). Underage users spend nearly US$16.9 million and US$270.8 million respectively on smoking and chewing tobacco products.

Conclusion: There is substantial expenditure on tobacco products by underage individuals in India. A significant number of new users are added every year that provide an estimate for the size and nature of the future of the tobacco epidemic, one on which the tobacco industry depends on for its sustenance. The government of India’s efforts to reduce sale to underage users has had limited effect and needs to be strengthened.

Citation: Lal, P., Goel, S., & Sharma, D. (2015). In harm’s way: tobacco industry revenues from sales to underage tobacco users in India.Global health promotion, 1757975914567927.

Contact: Sonu Goel, This email address is being protected from spambots. You need JavaScript enabled to view it.


Smoking cessation and smokefree environments for tuberculosis patients in Indonesia-a cohort study

Authors: Tara S. Bam, Aditama Y. Tjandra, Chiang Chen-Yuan, Rubaeah Rubaeah, and Suhaemi Acep

Publication: BMC Public Health


Background: Research indicates that smoking substantially increases the risk of tuberculosis (TB), delay in diagnosis, failure of TB treatment and death from TB. Quitting smoking is one of the best ways to prevent unwanted outcomes. Exposure to second-hand smoke increases the risks of both TB infection and development of active TB disease among children and adults. TB patients who smoke in the home are also placing their families at a greater risk of TB infection. It is very important to keep homes smokefree. The present study assessed the implementation and effectiveness of an intervention that promotes smoking cessation and smokefree environments for TB patients.

Methods: All consecutive new sputum smear-positive TB patients (aged 15-years-old) diagnosed and registered in 17 health centres between 1 January 2011 and 31 December 2012 were enrolled. The ABC (A=ask, B=brief advice, C=cessation support) intervention was offered for 5 to 10 minutes within DOTS services at each visit. Smoking status and smokefree environments at home were assessed at the first visit, each monthly follow up and at month six. Factors associated with quitting were analysed by univariable and multivariable analysis.

Results: Of the 750 TB patients registered, 582 (77.6 %) were current smokers, 40 (5.3 %) were ex-smokers and 128 (17.1 %) were never smokers. Of the 582 current smokers, 66.8 % had quit smoking at month six. A time from waking to first cigarette of >30 minutes, having a smokefree home and the display of “no smoking” signage at home at month six were significantly associated with quitting. Of the 750 TB patients, 86.1 % had created a smokefree home at six month follow-up compared with 18.5 % at baseline. All 80 health facilities were 100 % tobacco-free at the end of 2012 compared with only 52 (65 %) when the intervention began in March 2011.

Conclusions: Brief advice of 5–10 minutes with minimal cessation support at every visit of TB patients resulted in high quit rates and higher awareness of adverse health effects of second-hand smoke exposure, which led patients to make their homes smokefree and health providers to make health care tobacco-free.

Citation: Bam, T. S., Aditama, T. Y., Chiang, C. Y., Rubaeah, R., & Suhaemi, A. (2015). Smoking cessation and smokefree environments for tuberculosis patients in Indonesia-a cohort study.BMC public health,15(1), 604.

Contact: Dr Tara Singh Bam, This email address is being protected from spambots. You need JavaScript enabled to view it.


Clearing the smoke around the TB-HIV syndemic: smoking as a critical issue for TB and HIV treatment and care

Authors:Jackson-Morris, A.; Fujiwara, P. I.; Pevzner, E.

Publication:The International Journal of Tuberculosis and Lung Disease

Summary: The collision of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics has been described as a ‘syndemic' due to the synergistic impact on the burden of both diseases. This paper explains the urgent need for practitioners and policy makers to address a third epidemic that exacerbates TB, HIV and TB-HIV. Tobacco use is the leading cause of preventable death worldwide. Smoking is more prevalent among persons diagnosed with TB or HIV. Smoking is associated with tuberculous infection, TB disease and poorer anti-tuberculosis treatment outcomes. It is also associated with an increased risk of smoking-related diseases among people living with HIV, and smoking may also inhibit the effectiveness of life-saving ART. In this paper, we propose integrating into TB and HIV programmes evidence-based strategies from the ‘MPOWER' package recommended by the World Health Organization's Framework Convention on Tobacco Control. Specific actions that can be readily incorporated into current practice are recommended to improve TB and HIV outcomes and care, and reduce the unnecessary burden of death and disease due to smoking.

Contact: Morgan Zeiss, This email address is being protected from spambots. You need JavaScript enabled to view it.


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