The Union Minister of Health & Family Welfare, Shri Ghulam Nabi Azad has said that while livelihood of tobacco growing farmers cannot be endangered, we must work towards moving famers and farm workers out of the tobacco industry.  ‘We cannot indefinitely tolerate a public health hazard in the name of protecting livelihoods’, the Minister said after releasing the report of the first Global Adult Tobacco Survey (GATS) – India 2010, here today. 

            Emphasizing the need for  inter-sectoral coordination for comprehensive tobacco control strategies, Shri Azad informed about collaborations with Agriculture Ministry for a project on alternative crops to tobacco and coordination with other stakeholders Ministries such as Human Resource Development, Information and Broadcasting, Rural Development and Labour Ministry.  Speaking on the occasion, the Minister of State, Shri Dinesh Trivedi called for clearer  pictorial warnings and emphasis on monitoring chewing tobacco use.  He also emphasized the need for alternative crops to tobacco.  Minister of State, Shri S. Gandhiselvan stressed the need for increasing awareness among the people to combat the menace of tobacco use. 

GATS India provides information on both, tobacco smoking and use of smokeless tobacco along with varied dimensions of tobacco use including use of different tobacco products, frequency of use, age at the time of initiation and the like.  Additionally the report throws light on the other aspects of tobacco use like, exposure to second-hand smoke; cessation; the economies of tobacco; exposure to media messages on tobacco use; and knowledge of health impact of tobacco use.

GATS India Highlights

·        Current tobacco use in any form: 34.6% of adults; 47.9% of males and 20.3% of females

·        Current tobacco smokers: 14.0% of adults: 24.3% of males and 2.9% of females

·        Current cigarette smokers: 5.7% of adults: 10.3% of males and 0.8% of females.

·        Current bidi smokers: 9.2% of adults: 16.0% of males and 1.9% of females.

·        Current users of smokeless tobacco: 25.9% of adults: 32.9% of males and 18.4% of females.

·        Among daily tobacco users, 60.2% consumed tobacco within half an hour of waking up

·        Average age at initiation of tobacco use was 17.8 with 25.8% of females starting tobacco use before the age of 15

·        Among minors (age 15-17), 9.6% consumed tobacco in some form and most of them were able to purchase tobacco products.

·        Five in ten current smokers (46.6%) and users of smokeless tobacco (45.2%) planned to quit or at lease thought of quitting

·        Among smokers and users of smokeless tobacco who visited a health care provider, 46.3% of smokers and 26.7% of users of smokeless tobacco were advised to quit by a health care provider

·        About five in ten adults (52.3%) were exposed to second-hand smoke at home and 29.0% at public places(mainly in public transport and restaurants)

·        About two in three adults (64.5%) noticed advertisement or promotion of tobacco products.

·        Three in five current tobacco users (61.1%) noticed the health warning on tobacco packages and one in three current tobacco users (31.5%) thought of quitting tobacco because of the warning label.

Recommendations

            In view of the high prevalence of tobacco use in the country, there should be a national effort to prevent any further increase in the prevalence of tobacco use, especially among the vulnerable groups such as females, youth and children.  There should also be targeted programmes addressing different types of tobacco use and different user groups with special focus on cessation.  There is a need to further strengthen the implementation of Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003, at national, state and sub-state levels.    Establishment of a comprehensive implementation and regulatory structure at the national and state level is required.

            Tobacco control strategies need to be mainstreamed with other national health programmes, within the overall framework of the National Rural Health Mission (NRHM).  The multifaceted nature of tobacco problem in India calls for greater involvement and investment of various stakeholder ministries/departments, eg. Human Resource Development (Education), Finance, Agriculture, Labour, Commerce, Rural Development, Information & Broadcasting, Women & Child, etc. in addition to the Ministry of Health & Family Welfare, as also the Panchayati Raj Institutions, academic/public health institutions, civil society groups, media, etc.

            Findings from GATS India have added substantially to the knowledge about the tobacco use status of India’s population and will be a valuable source of information for strengthening and modifying tobacco control policies and tobacco control and prevention programmes in the country.

Tobacco use is a major preventable cause of death and disease causing 1 in 10 deaths among adults worldwide.  Approximately 5.5 million people die every year (globally), out of which close to 0.9 million deaths occur in India due to diseases related to tobacco use.  Majority of the cardiovascular diseases, cancers and chronic lung diseases are directly attributable to tobacco consumption.  Almost 40 percent of tuberculosis deaths in the country are associated with smoking.

            In India, both smoking and smokeless tobacco use is prevalent.  A varied range of chewing and smoking forms of tobacco available at different price points, reflect the varying socio-economic and demographic patterns of tobacco us in the country.  Smoking tobacco products, include, bidis, manufactured and hand-rolled cigarettes, pipes, cigars, hookah, water pipes and other locally produced smoking tobacco products, e.g. chuttas, dhumti and chillum, etc.  Smokeless tobacco is used either by chewing, applying to the teeth and gums, or sniffing.  Smokeless tobacco products used  in India include chewing tobacco products such as betel quid with tobacco, khaini, gutkha, paan masala, and other such products like mishri, mawa, gul, bajjar, gudakhu, snuff, etc.

            India is the second largest consumer of tobacco products and third largest producer of tobacco in the world.  The Adult Tobacco Survey (ATS) is an important component of the country’s comprehensive tobacco control programme and reflects an efficient and systematic surveillance mechanism to monitor the tobacco epidemic through collection of baseline data and study of key tobacco control indicators.

            In order to arrive at an accurate level of prevalence of tobacco use by age groups, gender and place of residence, a number of surveys including the National Family Health Survey III (2005-2006), National Sample Survey Organization (NSSO) 1995-1996 and Sample Registration System (SRS – 2004) were conducted in the country.  However, except the Global Tobacco Surveillance System (GTSS), tobacco use per se was not the focus in all these surveys.

            The survey was conducted under the stewardship of the Ministry of Health and Family Welfare, Government of India, with the International Institute for Population Sciences, Mumbai, an autonomous organization of MoHFW acting as the nodal agency.  Technical assistance was provided by the Centres for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Johns Hopkins Bloomberg School of Public Health, and RTI International.

            The Global Adult Tobacco Survey India (GATS India) was carried out in all six geographical regions for both urban and rural areas of 29 states of the country and the two Union Territories of Chandigarh and Puducherry covering about 99.9 per cent of the total population of India.  The survey is based on a sample of households which is representative at the national and state levels.  GATS India conducted interviews with 69,296 adults age 15 and above, 33,767 men and 35,529 women age 15 and above.  GATS India is unique in terms of its large sample size of 72,000 households and key survey activities having been carried out in 19 languages.  The standard GATS questionnaire was adapted to India based on the prevailing pattern of tobacco use in the country and experiences from previous surveillance of tobacco use in the country.  This is the first time that hand-held computers were used for conducting the survey.

            GATS India is a household survey of all Indian residents, age 15 and above, living in their primary residence prior to the survey date.  The institutional population comprising of those living in collective living places like, students’ dormitories, hospitals, hotels, prisons, military barracks, etc. is not included in the survey.

            The participation in the survey was purely voluntary.

            The major objectives of the survey are as mentioned below:

(i)                  to obtain estimates of prevalence of tobacco use (smoking and smokeless tobacco)

(ii)                exposure to second-hand smoke; cessation

(iii)               the economics of tobacco

(iv)              exposure to media messages and knowledge, attitudes and perceptions towards tobacco use.

(v)                knowledge of health impact of tobacco use.

DS/GK