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SHIVA

World No Tobacco Day- 31-05-2015


Chikkodi: STOP ILLICIT TRADE OF
TOBACCO
Dr.Jagadish
Nuchin .MD, MBA.
District
Surveillance
Officer,
Belagavi,
Karnataka.

World No Tobacco Day is


observed annually on 31
May to raise awareness
around the world about
the dangers of tobacco
products, the single
largest preventable
cause of disability and
death.

Introduction
Tobacco plant is native to
North and South American
continents and they knew its
cultivation 8000 years ago.
It was Christopher Columbus Deadly
who landed in America in the Plant
year 1492 who brought this
plant to European countries.
.
Portuguese traders brought
tobacco plants to India
during 1600 through Goa and
Indians started cultivating it.
3

Thus, the tobacco use


spread from Americas to
rest of the world.
In India, earlier it was
restricted to Royal people
but later in 17th century
even common people
started using it.
Gradually tobacco got
assimilated into the
cultural rituals and social
fabric due to presumed
medicinal and actually
addictive properties
attributed to it.

Tobacco in India
British East India company
grew tobacco in India as
cash crop and its use
became widespread
wherever British ruled.
Cultivated tobacco in India
Exported to Britain

e-imported cigarettes to India to


earn revenue
5

Tobacco can be consumed in the forms of


smoking, chewing, dipping or sniffing.

Smoking
tobacco and
Smokeless
tobacco
7

Smoking tobacco -- use in India


Smoked
forms of
tobacco use

- Bidis
- Cigarette
- Cigars
Cheroots
- Chuttas
- Dhumti
- Pipe
- Hooklis
- Chillum
- Hookah.
8

Smokeless tobacco
Known as spit
tobacco, chew,
snuff, and dip, is a
form of tobacco
that has become
popular, especially
with athletes.
Chewing on an
average-size piece
of chewing tobacco
for 30 minutes can
deliver as much
nicotine as smoking
three cigarettes.

Smokeless forms of tobacco use- in India

- Pan (betel
quid) with
tobacco,
Pan Masala
with tobacco
- Tobacco,
areca nut
and slaked
lime
preparations
, Manipuri
tobacco,
Mawa,
Khaini,
chewing

10

Smokeless forms of tobacco use

Tobacco
products for
application:
Nicotine patch,
Mishri, Gul,
Bajjar, Lal
dantmanjan,
Gudhaku,
Creamy snuff,
Tobacco
water,
Nicotine
chewing gum.

11

12

World Tobacco Facts


130 Crore people worldwide smoke.
6,00,000 Crore cigarette sticks are
smoked worldwide every year.
Tobacco kills up to half of its users.
Half the people that smoke today that is
about 65 Crore people will eventually be
killed by tobacco.
Tobacco kills nearly 60 Lakh people each year.
More than 54 lakh of those deaths are the
result of direct tobacco use, while more than 6
lakh are the result of non-smokers being
13
exposed to second-hand smoke.

Unless urgent action is taken, the annual


death toll could rise to more than one
Crore by 2020 and 1.6 Crore by 2025.
Nearly 80% of the world's 130 Crore
smokers live in low- and middle-income
countries.
Tobacco is the second major cause of
death in the world.
Approximately one person dies every six
seconds and 10 per minute
due to tobacco, accounting
for one in 10 adult deaths.

14

Children who are


engaged in tobacco
related works are
especially vulnerable
to "green tobacco
sickness", which is
caused by the
continuous absorption
of nicotine through
the skin from the
handling of wet
tobacco leaves.

15

Tobacco caused 10 Crore deaths in the 20th


century. If current trends continue, it may
cause 100 Crore deaths in the 21st century.
Tobacco use is linked to a large number of
diseases and is the single most preventable
cause of death in the world, according to
the World Health Organization.
Smoking kills more people
each year than AIDS, fires,
car accidents, murders,
suicides, alcohol and
other drugs combined.
16

Tobacco is responsible for one in four deaths


in the United States.
In some countries, it is even more in
Turkey, nearly 40% of deaths among males
are related to tobacco.

The prevalence is decreasing in


developed countries but increasing in
developing countries.
Developed countries have reduced
smoking by 10% while developing
countries have increased by 60% after
1970.

17

Smoking is increasing in the


developing world

Male adult prevalence, 1995


US
28 % (was 61% in 1939)
East Asia
61 %
Europe, Central Asia 57 %
Latin America, Caribb 40 %
South Asia
41 % (cigs + bidis)
Sub-Saharan Africa 29 %

Smoking prevalence for men

Male Smoking
global scenario

ICELAN
D

FINLAN
D

NORWA
Y
SWEDE
N
UNITED
KINGDO
M

IRELAN
D

GREENLAN
D

ESTONI
A

DENMAR
K
NET

LATVIA

CZECH

BELGIUM

HUNGAR
Y
ROMANI
A

CROATIA B-H YUGOSLAVIA


MARINO
SAN

ANDORR
A

48%

SPAI

ALBANIA

MALTA

GE
O AR AZE
M R

CYPRUS

ALGERI
A

BAHAMA
S

LEBAN
ON
ISRAEL
WEST
BANK
&
GAZA

LIBYAN
ARAB
JAMAHIRIY
A

ST VINCENT &
GRENADINES
NICARAGUA
COSTA RICA
VENEZUEL
PANAM
A
A

BARBADOS
TRINIDAD &

52%

TOBAGO

SENEG
AL
GAMBI
A
GUINEA

COLOMBI
A
ECUADO
R

CTE
DIVOIR
E

DEM.
REP.
CONGO

44%
PER
U

URUGUA
Y

Hong
LAO
Kong
SA
PDR
R
VIETNAM
THAILAN
D
CAMBODI
A

BANGLADE MYANMA
SH
R

E OMA

45%

PALAU

SRI
LANKA

BRUNEI
DAR.

MALAYSIA

49%

SINGAPO
RE

SEYCHELLE
S

50

MAURITIUS

AUSTRALI
A

KIRIBATI
TOKELA
U

NAURU

54%

FIJI

COOK

0
18

2
1

2
4

1
0
3

14

32

16
4
1

38

37

5
30

6
6

Swede
n
Syrian Arab
Republic
U
K

USA
18 and
over

29

Chin
a
Colombi
a
Denmar
k

2
UK
16 and
over

22

0
28

1999

Chil
e

1998

40

1990 26%

NE
W
ZEALAN
D

Morocc
o
Republic of
Korea
Russian
Federation
Saudi
Arabia
Spai
n

1979 28%

1990 28%

Bosnia and
Herzegovina

2000

20

Australi
a
Banglades
h

61%

55

1970 38%

42%
1980 31%

1990 54%

44%

6
1

Icelan
d
Indi
a

52%
1965

24

Indonesi
a
Lao Peoples Democratic
Republic

Smoking prevalence among


physicians
2000 or latest available
data selected countries
percentages
women
13
1
men
43

12

55%
1970

NIUE

TONGA

Physicians who smoke

61%
1960

SAMO
A

TUVALU

VANUATU

percentage of male smokers


19602000 selected
countries

70%
1980

PAPU
A
NEW
GUINE
A

I N D O N E S I A

ZIMBAB
WE

SOUT
H
AFRIC
A

PHILIPPINE
S

ARGENTIN
A

Smoking trends

24

NEPA
L

INDIA

UA

NAMIBI
A

PARAG
UAY

feature on the
landscape.

Japan
15 and
over

PAKISTA
N

JAPA
N

MALA
WI

ZAMBI
A

50%

BOLIVI
A

78%
1970

KUWAI
T
BAHRAI
QATA
N
R

MALDIVES
UGAND
A
KENY
A
RWAND
A
UNITED
REP.
TANZANIA

REP.
KORE
A

CHIN
A

ISL.
REP.
IRAN

YEME
N
DJIBOU
TI

NIGERI
A

BRAZI
L

81%
1960

MONGOLI
A

TURKME
N

SAUDI
ARABIA

SUDA
N

CHA
D

SAO
TOME
&
PRINCIPE

CHIL
E

47%

KYRGYZSTA
N

GHAN
A

HONDURAS

SYRIAN
ARAB
REPUBLIC
JO
IRA
R
Q

EGYP
T

DOMINICA
N
REPUBLIC
PUERTO
RICO

HAITI
GUATEMALA
EL
SALVADOR

UZBEKISTA
N

TURKEY

TUNISI
A

MOROCC
O

CUBA

RUSSIAN FEDERATI
ON

KAZAKHST
AN

GREEC
E

TUNISI
A

ALGERI
A

CA

MEXIC
O

44%

BULGARIA

47%

MOROCC
O

ESOF AMERI

REP.
MOLDOVA

FYR
MACEDONIA

N PORTUGAL

UNITED STAT

below 20%
Top
highest
overall smoking
ten
rates of men and women
combined

UKRAIN
E

REPUBLIC SLOVAKIA

no
data

30%
20%
29%

50% 59%
40% 49%

BELARU
S

POLAN
D

L
AUSTRIA
FRANC UX SWIT
. Z. ITALY SLOVENIA
E

C A N A D A

60% and above


39%

RUSSIA
N
FED.

LITHUANIA

GERMANY

H.

Smoking among males aged 15 and


over
latest available data

6
8

19 25

Ranki
ng

Country

No. of
Cigarettes
per adult
per year

16

Kuwait

1800

17

Spain

1752

18

Switzerland

1743

Greece

2,924

19

China

1712

Serbia

2,822

20

Austria

1650

Bulgaria

2,786

51

USA

1028

Russia

2,479

Moldova

99

Pakistan

468

2,401

Ukraine

2,360

158

India

98

Slovenia

2,278

164

Sudan

75

Bosnia

2,266

165

Somalia

67

Belarus

2,157

170

Afghanistan

69

10

Montenegro

2,139

174

Ghana

44

11

Lebanon

2,125

12

Czech

178

Ethiopia

42

2,125

13

South Korea 1,958

180

Uganda

24

14

Kazakhstan

1,934

184 Solomon Islands 18

15

Japan

1,934

185 Guinea

20

Indian Scenario

700, 000 deaths per year due to smoking accounting


for nearly 2200 deaths every day and 3 people every 2
minutes.
800, 000 to 900, 000 deaths per year due to all forms
of tobacco use/exposure
4 lakh cases of cancer, 13 lakh cases of heart ailments,
80 to 90% of lung cancer cases due to smoking.
Single most preventable cause of premature
death

21

Tobacco Use Among Youth in India


Tobacco is used by the youth all over

India with a wide range of variation


among states.
Two in every ten

boys and one


in every ten girls
use a tobacco
product.
Initiation to

tobacco products
before the age
of 15 years is
increasing.

22

There are currently about


24 Crore tobacco users
aged 15 years and above
(19.5 Crore male users
and 4.5 Crore female
users) in India.
India is the worlds third
largest producer of
tobacco (Next to China and
Brazil) and also the second
largest consumer of
unmanufactured tobacco.
It is a second largest
exporter of
unmanufactured tobacco.

23

Tobacco deaths are on the increase in India

24

Tobacco in India
In late Nineteenth
century Beedi industry
grew in India
Oldest Beedi
manufacturing firm
established in 1887
Introduction of Gutkha
aggravated the problem
Bihar, Jharkhand,
Chhattisgarh, Nagaland,
Orissa, Tripura and
Mizoram show more than
40% of the prevalence
where as Karnataka 19%.

25

Pattern of Consumption in India

54% Bidis, 19% Cigarette and


27% Pan Masala, Snuff, Chewing tobacco
55,000 children start smoking in an year.
Indians smoke 9000 Crore cigarettes an year.
At an average Rs. 12 a cigarette, Rs. 1,08000
Crores goes up in smoke.

26

According
to
Indian Council of
Medical Research
the
cost
of
treating tobacco
related diseases
and cancers was
Rs. 27760 Crores.
Whereas
the
value of tobacco
products
sold
nation wide is
about
24,400
Crores. If this
trend
goes
unchecked 13%
of all deaths in

27

Nicotine is highly addictive


Nicotine --> release of serotonin,
dopamine, norepinephrine
Neuro-adaptation

Each year, nearly 3.5


Crore people make a
concerted effort to
quit smoking.
< 7% stay smokefree for a year; most
start smoking again
within days.

Smoke-A DEADLY MIXTURE


Cigarettes burn at 900 0 C 10000 C
Cigarette smoke contains over
4000 chemicals and 69 of these
are known to cause cancer.
Even if you don't smoke you can
still get sick from these poisonous
chemicals just by breathing in
other people's smoke.
The smoke contains:
Tar,a black, sticky substance that
contains many poisonous chemical
such as:ammonia (found in floor
and window cleaner),
toluene(found in industrial
solvents) andacetone(found in
paint stripper and nail polish

29

carbon monoxide,a
poisonous gas that reduces the
amount of oxygen taken up by
a person's red blood cells
hydrogen cyanide,the poison
used in gas chambers during
World War ll
metals,
includinglead,nickel,arsenic
(white ant poison)
andcadmium(used in car
batteries)
pesticidessuch
asMethoprene(found in flea
powder). Other chemicals such
asBenzene(found in petrol)
andNaphthalene(found in
mothballs) are also in tobacco
smoke.

30

And even
including
radioactive
polonium 210.
These chemicals
are absorbed into
the blood,
reaches every
organ system in
the body and are
cancer causing,
mutagenic and
tumor causing.

31

Are some cigarettes


better?

No such thing
as a safe
cigarette
light, low tar
cigarettes are
deceptive
- Manipulation by
maker
- Compensation
by smokers so
actual yields not
= FTC (machine)
yield

33

A cigarette
contains 8 or 9
milligrams of
Nicotine

A cigar contains
100-200mg of
Nicotine
There is enough
nicotine in 4 or
5 cigarettes to
kill an average
adult if ingested
whole
34

Illicit trade of tobacco products must be stopped

The illicit cigarette trade is defined as the


production, import, export, purchase, sale,
or possession of tobacco goods which fail
to comply with legislation (FATF 2012).
Illicit cigarette trade activities fall under
3 categories:
Contraband:Cigarettes smuggled from
abroad without domestic duty paid
Counterfeit:Cigarettes manufactured
without authorization of the rightful
owners, with intent to deceive consumers
and to avoid paying duty
Illicit whites:Brands manufactured
legitimately in one country, but smuggled
and sold in another without duties being
paid.

35

Illicit trade of tobacco products must be stopped

It is estimated
that one in
every 10
cigarettes and
tobacco
products
consumed
globally are
illicit.
Illicit tobacco
products are
typically sold at
lower prices,
thereby

36

The illicit trade of tobacco


products poses major health,
economic and security concerns
around the world.
Eliminating illicit trade in tobacco
will reduce the harmful
consumption of tobacco by
restricting availability of cheap,
unregulated alternatives and
increasing overall tobacco prices.
Critically, this will reduce
premature deaths from tobacco
use and raise tax revenue for
governments
37

Raise the tax


Ban the
advertisements
Put the pictorial
health warnings
on the packets
Strict
implementation
of COTPA-2003

38

Takes 10-25 years


to be discomposed
into the land

39

Health effects
of tobacco
40

Diseases caused by tobacco use


Cancer- mouth, lips, tongue, gums, palate , larynx, the lung, pancreas,
kidney, Cervix
COPD (emphysema, bronchitis, etc)
Stroke (bleeding in the brain)
Heart attack and heart disease
Narrowing and clogging of arteries
Peptic ulcers (stomach bleeding)
Respiratory infections and compromise (cough, wheezing etc)
Gum disease and tooth loss
Low birth weight and SIDS
Asthma
Ear infections
Compromised sexual performance
Greater susceptibility to TB?
Cataracts
Age-related macular degeneration, a leading cause of blindness in
older people
Hearing loss
41

42

43

44

Smoking decreases the blood supply to


your brain, constricts the blood vessels
and causes atherosclerosis.
45

Smoking & chewing tobacco are the main cause


of cancers of the tongue, salivary gland, mouth,
46
pharynx and for brown teeth.

Cancer of the cheek with erosion of tissue

47

Smokers are ten times as likely to get


lung cancer and emphysema as nonsmokers.

48

Nicotine causes the blood clots &


development of plaque which leads to
Risk of heart attack.
49

Esophageal cancer in
esophagus happens due to
smoking.
50

Tobacco smoking or chewing accelerate


the process of Stomach cancer.
51

Kidney cancer is more common and


aggressive among tobacco users.
52

Poor blood circulation damages the


blood vessel lead to death of body tissue
which increases risk of Gangrene.
53

Tobacco smokers suffer more


fractures due to higher rate of
Osteoporosis (Decreased bone
density).

54

Effects on Male Fertility and


Erectile Dysfunction
Smoking can harm a man's sexuality
and fertility.
erectile dysfunction because it
decreases the amount of blood
flowing into the penis
impairs sperm motility, reduces
sperm lifespan, and may cause
genetic changes that can affect a
man's offspring.
55

Women who smoke during


pregnancy are more likely to have:
LBW/Premature baby
An ectopic pregnancy

Spontaneous abortion/miscarriage

Vaginal bleeding
Placental abruption) placenta peels
away, partially or almost completely,
from the uterine wall before delivery)
A stillbirth

56

SMOKE
ZONEFREE
SMOKIN
G

57

Second-hand smoke kills

Second-hand smoke is the smoke that fills restaurants, offices or other


enclosed spaces when people burn tobacco products such as cigarettes,
bidis and water pipes. There are more than 4000 chemicals in tobacco
smoke, of which at least 250 are known to be harmful and more than 50
are known to cause cancer.
There is no safe level of exposure to second-hand tobacco smoke.
In adults, second-hand smoke causes serious cardiovascular and
respiratory diseases, including coronary heart disease and lung cancer. In
infants, it causes sudden death. In pregnant women, it causes low birth
weight.
Almost half of children regularly breathe air polluted by tobacco smoke in
public places.
Over 40% of children have at least one smoking parent.
Second-hand smoke causes more than 600 000 premature deaths per
year.
In 2004, children accounted for 28% of the deaths attributable to secondhand smoke.
Every person should be able to breathe tobacco-smoke-free air. Smokefree laws protect the health of non-smokers, are popular, do not harm
business and encourage smokers to quit.
58

59

Strict
warning for
tobacco
misuse was
also issued
in ancients
times.

60

1604 (England) King James I


pronounced in his counter blast to
tobacco that smoking was
Loathsome to eyes, hateful to nose,
harmful to the brain and dangerous
to the Lungs
1633 (Turkey)
Death penalty for smoking
61

COTPA-2003
The Government of India has passed an
anti-tobacco legislation.
The Cigarettes and Other Tobacco
(Prohibition of Advertisement and
Regulation of Trade and Commerce,
Production, Supply and Distribution)
Products Act 2003, which came into
force on May 1, 2004. This replaces the
Cigarette Act 1975.
If this act is enforced fully, there can be a
tobacco-free India.
62

TOBACCO
CONTROL ACT,
2003
Cigarettes and
Other tobacco
products
(Prohibition of
Advertisement and
Regulation of Trade
and Commerce,
Production, Supply
and Distribution)
Act, 2003

SCOPE OF THE ACT


The Act is applicable to all
products
containing
tobacco in any form i.e.
cigarettes, cigars, cheroots,
bidis, gutka, pan masala
(containing
tobacco)
khaini, mawa, mishri, snuff
etc. as detailed in the
schedule to the Act.
The Act extends to whole of
India.

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