Latest news with #GlobalAdultTobaccoSurvey
The Hindu
4 days ago
- Health
- The Hindu
Can mHealth and AI amp up tobacco cessation efforts?
If we compare the GATS 1 (Global Adult Tobacco Survey) with the GATS 2, all parameters related to tobacco cessation show a downward trend. While the sustained efforts by the government through implementation of national programs such as NTCP, COTPA, and NOHP; ratification of strategic frameworks such as WHO's MPOWER or FCTC; or multilateral collaboration with global health organisations, NGOs, and other stakeholders, the efforts fall short in responding to the tobacco scourge prevalent in the country. 28.6 % of the people aged 15 and above use tobacco in India, the use of smokeless forms being double that of smoked forms. This can be attributed to the social acceptability of smokeless tobacco (SLT), especially among women in old times. Tobacco continues to hold cultural value in local traditions, where it is offered to guests and gods with equal reverence. The second largest consumer—and third largest producer—of tobacco, India is home to 72.7 million smokers. It is responsible for 13.5 lakh deaths, 1.5 lakh cancers, 4.2 million heart diseases, and 3.7 million lung diseases every year. With a 20 % share of the global burden load, India is touted as the oral cancer capital of the world. Also Read | From tea stalls to tumours, tobacco affordability fuelling cancer epidemic in India Secondhand smoking (SHS), caused by the inhalation of toxic fumes when somebody is smoking in the vicinity, compounds the problem further. It contributes to 14% of total tobacco deaths, with the brunt falling squarely on the most vulnerable—women, children, and older people. Almost half of the non-smoking women and over one-third of pregnant women are exposed to tobacco smoke in India and Bangladesh. According to GATS 2, despite 85.6% of people being aware of the detrimental effects of SHS, 38.7% of people working at home and 30.2% working indoors were exposed to smoking. A 2023 report by WHO on global tobacco epidemic believes that physical distancing—whether it be designated smoke rooms (DSRs) or ventilation—fails to protect from the exposure of SHS. The smoke residues from 7000 chemicals, including over 70 carcinogenic substances, cling to physical surfaces long after a cigarette is stubbed out. Through case studies of popular smoke ban laws in Atlanta and Finland, WHO FCTC's Section 8 advocates for strict legislation for a smoke-free environment to protect our basic right to breathe in clean air. Also Read | Two decades after India's public smoking ban, challenges persist in tobacco control Dependency on tobacco Multiple studies have shown that dependence on tobacco and bidis significantly impairs individuals' ability to quit. The wide availability of locally-produced tobacco brands in India further complicates regulation of nicotine content. Moreover, Big Tobacco is frequently accused of deliberately maintaining high nicotine levels to promote addiction. Furthermore, the tobacco industry lobbying has actively obscured critical information and deflected public discourse from the health risks linked to tobacco use. This has resulted in manufacturing of narratives, such as conflating the harms of tobacco smoking with air pollution. What harm will one cigarette cause when the level of pollution amounts to breathing 20 cigarettes a day!? (While air pollution demands urgent action, the harm caused by cigarette smoke is 2 to 2.5 times greater, according to a Chinese study.) In the 1996 issue of Time Magazine, the president and CEO of Philip Morris was quoted saying that cigarettes are no more addictive than coffee or gummy bears. This impact on teenagers by Big Tobacco propaganda is concerning. 8.5% of young adolescents (between 13 and 15 years) consume tobacco in some form in India. With stylish names, flashy packaging, fancy brand ambassadors, and fun flavours, the tobacco industry preys on the young to initiate tobacco use as well as continue it. A WHO report highlighted the addition of sweetening agents, flavorings, bronchodilators, and additives such as levulinic acid and menthol to tobacco products—measures intended to reduce the harshness of nicotine and create a cooling effect in the throat. These modifications in taste, smell, and sensory appeal, experts believe, hype the demand of these products among the youth. Kicking the habit The GATS 2 survey revealed that out of the total people who wanted to quit, 70% had to do it alone, and most couldn't sustain it beyond a month. We must also realize that cessation is not a one-off thing but a continuum—the counselling must always be ongoing and adaptive. Pranav Ish, a pulmonologist at VMMC and Safdarjung Hospitals said even 2-3 minutes of reinforcement has worked wonders in his patients. GATS 2, however, reveals a dismal picture when it comes to the attitude of healthcare providers: only 31.7% of healthcare providers advised their patients to quit in the last month, and 48.8% in the last year. Aninda Debnath, assistant professor, Community Medicine, MAMC, Delhi, says that while a lot of programs related to tobacco cessation are in place, a critical look at their functioning and utilisation is important. The COTPA Act prohibits advertising of tobacco in any form; however, a study by Vital Strategies found 75 % of online surrogate marketing of tobacco on Meta platforms. Vikrant Mohanty, HoD and Project Head, National Resource Centre for Oral Health and Tobacco Cessation, MAIDS, Delhi, said: 'While the government is doing its bit through cessation services at primary level, dedicated counsellors in NCD clinics, dentist training under NOHP, a comprehensive approach with integration of stakeholders at various levels is the need of the hour. The dropout from follow-up still remains huge, and faith in the treatment low.' Also Read | Smokeless tobacco products contribute to over 50% of oral cancer cases in India, study finds AI to the rescue Traditional forms of counseling are, for one, not equitable—the social desirability bias kicks in when hospitals expect the patient to come back. Plus, affordability and accessibility to TCCs is an issue for most who come from lower to lower-middle classes and work in informal sectors or as daily wage workers. Researchers have found that the results of tobacco cessation have stagnated, or at times gone down, for people with social disadvantage. While mCessation in the form of encouraging text messages or telephonic counselling through NTQLS has been an innovative solution (as part of WHO's Be He@lthy, Be mobile), limited success has been observed. Some of the gaps in successful implementation of mHealth include voice recognition inaccuracies, network connectivity issues, poor digital literacy, shoddy interface, absence of personal connection, poor long-term engagement, and high attrition rates. Integrating mHealth with innovative solutions such as PSD (Persuasive Systems Design) or just-in-time-adaptive-intervention (JITAI) that deliver an intervention in moments of elevated need or receptivity has shown great promise. This is where AI can give us a leg up. Mohanty adds that large language models can bridge the gap of delivery, provide personalized healthcare systematically, capture data, and use them in improving the outcomes.' AI can be harnessed not only through chatbots but also indirectly to train healthcare professionals so they can assess, advise and follow-up with the patients rigorously. Dr. Debanath emphasised the importance of refresher training—a component often neglected—which can be made significantly more accessible and efficient with the help of AI.' Monika Arora, Vice President of Research and Health Promotion at PHFI, believes, 'Chatbots and virtual assistants powered by AI can provide round-the-clock support, track and monitor tobacco use behavior, offer evidence-based information, and deliver personalized motivational messages. AI can also utilize predictive analytics to identify individuals at higher risk of relapse and tailor interventions accordingly.' However, this can't happen in isolation. All the interviewees believed that AI should not be thought of as an alternative but as an adjunct to traditional strategies. Dr. Arora and others are working on an AI-based model under Project CARE, where the focus is on 'co-development with users and healthcare providers' who can come up with innovative and contextually relevant solutions. Also Read | The tobacco epidemic in India Digital literacy challenge However, all is not rosy with mHealth and AI. While mobile penetration in the country is good, the lack of digital literacy might act as a massive deterrent. Debnath shared a personal anecdote: 'My mother has a smartphone, but she uses it only for calling and WhatsApp.' Moreover, in this age of digital revolution, when we are always bombarded with text messages and the ubiquitous 'ting' of notifications, the impact of one more message needs to be looked at with a fair bit of skepticism. These newer innovations should be complemented with other time-tested strategies. Plain packaging, which was initiated by Australia for the first time in 2012—and was followed by a wave of countries—should be considered as the next step to challenge the growing empire of tobacco corporations. Stronger warnings, higher taxes, increasing the size of graphic warnings, banning e-cigarettes, and hiring brand ambassadors cam aid our efforts. Emerging approaches such as adaptive counseling, designed to provide stepped care that addresses patients' unmet needs and parallels chronic disease management, can also be considered. Dr. Ish added: 'It feels rewarding that a patient who could earlier smoke three cigarettes had to contend with only one due to high costs.' India has garnered international attention for its tobacco cessation program, but the sheer burden of tobacco warrants that we not only explore newer strategies while also ensuring rigorous implementation of the existing ones. (Kinshuk Gupta is a writer, journalist, and public health physician. His debut book is Yeh Dil Hai Ki Chor Darwaja. kinshuksameer@
News18
4 days ago
- Health
- News18
Do You Smoke? It Might Be Making Your Term & Health Insurance More Expensive
Last Updated: Insurers usually classify someone as a smoker if they've consumed any form of tobacco—including cigarettes, cigars, beedis, or chewing tobacco—within the past 12 months. World No Tobacco Day: World No Tobacco Day is celebrated every year on May 31, as a stark reminder of the dire consequences of consuming tobacco not only in our health but also on our wallets too. According to Global Adult Tobacco Survey 2016-17, 28.6 per of adults aged 15 and above use tobacco in any form. The survey states that every tenth adult smokes tobacco in India. Little did we know that smoking also directly affects our wallets, especially when it comes to buying insurance policies. Be it term or health insurance, smokers often end up paying significantly higher premiums than non-smokers. Term Insurance: Twice the Price For Smokers According to Varun Agarwal, Head of Term Insurance at Policybazaar, smokers may pay 80% to 100% higher premiums on their term insurance policies. The reason is simple—tobacco use greatly increases the risk of fatal diseases like cancer, heart conditions, and chronic respiratory issues. These health risks make smokers a high-risk group for insurers, translating into higher premiums. Smokers normally pay between 20% and 50% more in premiums than non-smokers, depending on the company and the overall health profile of the company and the overall health profile of the person, explained Chetan Vasudeva, Senior Vice President – Business Development at How Is Being Smoker Classified? advetisement Varun Agarwal explains that insurers usually classify someone as a smoker if they've consumed any form of tobacco—including cigarettes, cigars, beedis, or chewing tobacco—within the past 12 months. 'This classification is based on both self-declaration and medical evaluation," he adds. 'Non-disclosure or misrepresentation may result in rejection of claims or even cancellation of the policy," Vasudeva warned. What If You Quit Smoking Later Part Of Life After Buying Term Insurance? Unfortunately, it doesn't change much. 'Once your term life insurance policy is issued with a 'smoker' classification, the premium is locked in for the entire term," Agarwal said. In other words, quitting after purchase won't reduce your premium. The good news is there is no waiting period for tobacco-related illnesses in term insurance once the policy is active. Health Insurance: Higher Costs And Waiting Periods There's a bit more flexibility in health insurance. If a smoker stays tobacco-free for 12 to 24 months and can provide medical proof, some insurers may reclassify them as a non-smoker during renewal, potentially lowering the premium. But this isn't guaranteed and depends on the insurer's policies, explains Chetan Vasudeva. However, a waiting period of 2 to 4 years is usually applied for tobacco-related illnesses such as lung cancer or COPD, especially if the condition existed before policy issuance. Disclaimer: The views and investment tips by experts in this report are their own and not those of the website or its management. Users are advised to check with certified experts before taking any investment decisions. About the Author Varun Yadav First Published: May 31, 2025, 12:57 IST
India Today
5 days ago
- Health
- India Today
Not just lungs, tobacco silently damages the heart years before symptoms appear
Tobacco consumption, in any form, remains a significant cause of cardiovascular issues, silently weakening heart health long before visible stealthy effects of tobacco and its constituents trigger a series of changes within the cardiovascular system, laying the foundation for life-threatening conditions like a heart attack or stroke, years before any clinical signs become has one of the highest rates of smokeless tobacco use in the world. Unlike smoking tobacco, smokeless tobacco products, such as chewing tobacco, snuff, and snus, are not burned. Instead, they are used orally or nasally, allowing nicotine to be absorbed through the mucous membranes of the mouth or According to the Global Adult Tobacco Survey (GATS) 2016-17, 21.4% of Indian adults use smokeless tobacco, compared to 10.38% who use smoking tobacco. This indicates that nearly one in five adults in India consumes some form of smokeless tobacco, as highlighted by the National Health FIRST TARGETOne of the first targets of tobacco's harmful effects is the endothelium, a thin layer of cells lining the blood vessels. Chemicals mainly in cigarette smoke, like carbon monoxide, nicotine, and reactive oxygen species, affect the endothelium, reducing its ability to produce nitric oxide, which is essential for vessel relaxation and quality blood issue, called endothelial dysfunction, is one of the earliest changes in smokers that is detectable. Second-hand exposure to smoke can also contribute to the narrowing of arteries and set the stage for further vascular AND OXIDATIVE STRESSA chronic inflammatory response in the body is triggered by tobacco smoke. The oxidative chemicals in smoke affect the expression of adhesion molecules on the walls of vessels, which causes the sticking of platelets and WBCs to the endothelium. One of the first targets of tobacco's harmful effects is the endothelium, a thin layer of cells lining the blood vessels. () This not only promotes inflammation but also accelerates the uptake of Oxidised LDL (low-density lipoprotein) cholesterol by immune cells, transforming them into foam cells- a sign of the formation of early atherosclerotic time, these plaques increase and stiffen the arteries, silently increasing the chances of a heart attack and HIDDEN THREATThe delicate balance of the blood clotting system is also disrupted by smoking. It increases the concentration of fibrinogen, a type of protein involved in the formation of clots, and alters the platelet function, making blood thicker and stickier, and more likely to changes create a prothrombotic state, where clots form more easily and start blocking narrowed arteries, often with catastrophic consequences. The most concerning part here is that these alterations occur well before any symptoms of chest pain or breathlessness LIPID CHANGESTobacco chemicals, like nicotine, cause blood vessels to constrict, which raises blood pressure and heart rate. Tobacco chemicals, like nicotine, cause blood vessels to constrict, which raises blood pressure and heart rate. () At the same time, the use of tobacco raises triglyceride levels and lowers HDL (high-density lipoprotein) cholesterol, and both of these contribute to the buildup of arterial alterations increase the workload of the heart very quietly in the SILENT PROGRESSIONCardiovascular damage done by tobacco is more alarming because of its stealth. Sometimes, years can pass before any sign emerges in the form of a heart attack, stroke, or sudden cardiac the time it is diagnosed, the damage is often awfully advanced or may be irreversible. However, studies have shown that quitting tobacco can somewhat halt or even reverse some of these changes, significantly reducing the risk of any fatal outcome.(Disclaimer: This is an authored article. The views and opinions expressed by the doctors are their independent professional judgement, and we do not take any responsibility for the accuracy of their views.)Must Watch
United News of India
5 days ago
- Health
- United News of India
Tobacco consumption claims over 78,000 lives annually in Rajasthan
Jaipur, May 30 (UNI) Tobacco consumption claims the lives of approximately 8 million people worldwide each year, with India accounting for over 13.5 lakh deaths and Rajasthan witnessing over 78,000 fatalities annually. Moreover, more than 5,500 children in the country and over 350 in the state start consuming tobacco and other smoking products daily. Pawan Singhal, Senior Professor at the ENT department of Sawai Man Singh Hospital in Jaipur, highlighted these alarming statistics ahead of World No Tobacco Day - May 31. Citing the Global Adult Tobacco Survey (GATS), Dr. Singhal emphasized that the increasing trend of tobacco consumption among Rajasthan's youth is detrimental to their health, with nearly 78,000 people succumbing to tobacco-related deaths in the state. The Global Youth Tobacco Survey (GYTS 2019) reveals that 74.3% of adolescents in Rajasthan have been exposed to tobacco product promotions, while 15.6% are aware of e-cigarettes. Dr. Singhal stressed that the tobacco industry uses innovative marketing strategies to attract young people, which has a direct impact on the youth. On World No Tobacco Day 2025, the theme "Unmasking the Appeal: Exposing the Industry's Tactics to Hook New Generations" will be discussed globally. The campaign aims to raise awareness among school and college students about the harmful effects of tobacco and the deceptive marketing strategies employed by the tobacco industry. Shyam Maru, Trustee of Sukham Foundation, emphasised the need for collective efforts to reduce cancer cases and promote a healthy society. According to the Global Adult Tobacco Survey (GATS-II) 2017-18, 26.7 crore adults (28.6%) in India use tobacco, with 21.4% consuming smokeless tobacco and 10.7% smoking cigarettes and bidis. The survey also reveals that over 5,500 children start using tobacco daily in the country. UNI XC AKT SSP
Scroll.in
25-05-2025
- Health
- Scroll.in
Does India have the collective will to quit smoking?
This year marks the 25th year of the ban on smoking in public places, a landmark judgement of the Kerala High Court. Subsequently, the Cigarettes and Other Tobacco Products Act, 2003, was passed, which prohibited smoking in public places and introduced penalties for violations. Despite decades of policy action, however, India is the world's second-largest consumer and producer of tobacco, and consequently faces a formidable public health and economic challenge. The Global Adult Tobacco Survey 2016-'17 says that nearly 267 million Indian adults – about 29% of the adult population – use tobacco in some form. More recent estimates suggest there are around 253 million tobacco users in India as of 2022. The lack of updated national surveys since 2022 limits precise tracking of current trends, highlighting the need for frequent surveys to inform evidence-based policymaking. While the ban under act has led to reduced passive smoking, enforcement remains inconsistent across states, according to the Report on Tobacco Control in India 2022, by the Ministry of Health and Family Welfare. Nicotine is among the most addictive substances in the world, with some researchers deeming it to be more addictive than cocaine and heroin. 'The tobacco industry takes advantage of this by targeting young people through advertisements and behavioural strategies, aiming to create lifelong customers,' says Ravi Mehrotra, Program Lead at the India Cancer Research Consortium, affiliated with the Indian Council of Medical Research. 'A significant portion of tobacco users, including smokers, begin using tobacco products before age 18.' One-third of all daily smokers aged 20-34 had started smoking tobacco on a daily basis before attaining the age of 18, the Global Adult Tobacco Survey found. Every state has different enforcement policies, as a result of which India has no uniform evaluation metrics for the outcomes. In states with weaker enforcement, limited funding and inadequate training for enforcement officers hinder compliance with the act. 'Today, the cessation facilities available in India are very few, and there has been little to no scientific study or random clinical trials to see how many people have benefited and what the actual quit rate is due to these facilities,' says Mehrotra, who serves on the board of directors of the India Cancer Genome Atlas and is the founder of the Centre of Health Innovation & Policy foundation. In India, smoking causes 930,000 deaths each year while smokeless tobacco leads to 350,000 deaths – together adding up to about 3,500 deaths every day, estimates suggest. In addition, over 200,000 people die from causes attributable to second-hand smoke exposure. The economic cost is staggering: tobacco use cost India nearly Rs 1.7 trillion in 2017-'18, taking into account the healthcare expenses and lost productivity. Geographical variations The National Family Health Surveys suggest a decline in tobacco consumption. In 2019-'21, 38% men aged 15 to 49 years reported using some form of tobacco, down from 57% in 2005-'06. Among women, this number fell from 11% to 9%. North East Indian states report the highest prevalence of tobacco use. Driving factors Several factors contribute to the widespread use of smoking tobacco in India. From a behavioural science perspective, a 2023 paper groups the reasons for tobacco use initiation into six categories based on the Capability, Opportunity, Motivation-Behaviour (COM-B) model. Psychological capabilities play a role, as many individuals lack knowledge about the harmful health effects of tobacco, struggle with self-control, or face mental challenges. Many people start using tobacco believing it will relieve stress, anxiety, or improve mood. Individuals with mental health disorders are particularly vulnerable. Pratima Murthy, director, National Institute of Mental Health and Neurosciences, Bengaluru, and an expert in addiction psychiatry and tobacco cessation, points out the mental health links to smoking. 'Research shows that the risk of smoking is doubled among people with depression, and those with depression are more likely to develop dependent patterns of tobacco use and experience more severe withdrawal symptoms.' Integrating tobacco cessation into mental health services at primary health centres could address higher relapse rates among individuals with depression or anxiety. Physical opportunities, including the widespread presence of tobacco advertising, easy access to tobacco products, and seeing celebrities smoke on screen, create an environment that encourages smoking initiation. Social opportunities, like peer pressure, parental tobacco use, cultural traditions that normalise tobacco, and notions of masculinity, further reinforce the habit. For example, in Uttar Pradesh and elsewhere, the cultural practice of chewing paan with tobacco, often offered at social gatherings, normalises smokeless tobacco use, particularly among women. One notable driver of physical opportunities is the widespread sale of single cigarettes. Nearly 75% of all cigarettes are sold as single sticks, estimates show, making them more affordable and accessible, especially to minors and low-income users. 'This practice undermines the impact of health warnings and taxation, as single sticks do not display the mandated graphic warnings and evade higher taxes applied to full packs,' explains Mehrotra. Automatic motivation, such as using tobacco to manage emotions, seeking temporary pleasure, or engaging in risk-taking, and reflective motivation, which includes beliefs about perceived benefits, underestimating risks, and coping with stress – also drive people to start smoking or to persist with the habit. India has implemented strict tobacco control measures, including large pictorial health warnings covering 85% of tobacco packaging. However, as Mehrotra points out, 'They have been shown to have some effectiveness, but the impact can diminish over time. Many young people become desensitised to the current warning labels.' Regularly updating and strengthening warning labels and combining them with other anti-tobacco campaigns is therefore essential. The Ministry of Health and Family Welfare announced new packaging and labelling rules in December 2024, introducing stronger warnings and a national quitline number, effective from June 2025. According to the World Health Organization, the most effective way to discourage tobacco smoking has been to increase the taxes on it and other smoking products. 'The single best way of increasing the effectiveness of tobacco control is increasing the taxes. In countries like Australia, where the cigarette tax is as high as 69%, there has been a significant decline in smoking in the past decade,' said Mehrotra. While India's cigarette taxes, reaching 53% of retail price, are high, they fall short of WHO's 75% benchmark, limiting their impact on reducing affordability. Quit smoking efforts The government has made several efforts for individuals seeking to quit smoking. The National Tobacco Control Programme focuses on establishing Tobacco Cessation Centres in district hospitals, offering free behavioural counselling, medication, and nicotine replacement therapy. This also reflects in the data: About 32% of people who use tobacco reported trying to quit in the 12 months prior to the 2019-'21 health survey. With only 600 centres nationwide, however, India has roughly one cessation centre per two million people, with rural areas particularly underserved. The National Tobacco Quit Line provides community-based counselling through a toll-free number, and the m-cessation initiative uses text messaging to support quitting. Specialised institutes like NIMHANS in Bengaluru and Tata Memorial Centre in Mumbai offer tobacco cessation services. AI-powered apps like QuitNow, tailored for Indian users, could complement m-cessation by offering personalised quitting plans. Community-based programmes There is an urgent need to strengthen community-based programmes and implement effective screening initiatives, especially in rural and underserved areas. Mehrotra urges the community leaders and social workers to focus on their level with the help of technology. 'Leveraging the widespread availability and affordability of mobile devices and internet connectivity, community health workers can use smartphones and tablets to conduct screenings, maintain records, and ensure that no one is left out of follow-up care.' Mehrotra stresses the need for early screening and cancer detection to minimise the burden on healthcare and personal expenses. 'Early screening is essential because many individuals, especially women from lower-income groups who are busy with daily work, may not recognise the importance of getting checked for early signs of disease. By making screening accessible, affordable, and trusted, health systems can detect health issues in asymptomatic individuals and improve outcomes across communities.' Rakesh Gupta, president, Strategic Institute for Public Health Education and Research, and a tobacco control advocate, tells IndiaSpend how the model was established by the National Tobacco Control Program in Punjab, a state that has seen a significant decline in tobacco consumption. 'We had a state-level coordination committee, which included most of the stakeholder ministries, like the health department, the education department, and the home department under which they have the police. All the stakeholders are part of the state-level coordination committee, and meetings were held every three months.' There are enforcement squads at the state level, district level and block level with similar bodies to ensure cooperation on the ground. These enforcement squads are responsible for raiding premises which violate the tobacco laws frequently. 'The NTCP [National Tobacco Control Programme] in the state earned enough through challans (fines) in these squares to regulate its tobacco enforcement. This framework is being replicated in states like Rajasthan, Bihar, Uttar Pradesh and Karnataka, though ensuring these are enforced properly is a challenge. It depends on the state programme officer, state nodal officer, and the political will in the state.' India needs to find a collective will to eradicate smoking from its public places, through community-led interventions that prevent the initiation altogether, and take inspiration from model states to establish policies tailored to their regions.
