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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@
United News of India
4 days ago
- Health
- United News of India
E-cigarettes readily available in India, nicotine devices continue to target youths
Kochi, May 31 (UNI) Despite ban, E-cigarettes are readily available unabated in India where iIIegal promotion of vapes, e-cigarettes and other new-age nicotine devices continues targeting adolescents and youths. Sharing insights and raising serious concern on this issue on the occasion of World No Tobacco Day, Dr Naresh Purohit, Advisor, National Tobacco Control Programme (NTCP), in his investigative scientific report, pointed out how, despite a nationwide ban, the promotion and sale of nicotine devices remain rampant through digital loopholes, influencer marketing and surrogate advertising. "The ICMR's White Paper on Electronic Nicotine Delivery Systems , May 31, 2019, emphasised that e-cigarettes were highly addictive and, posed severe risks to the respiratory, cardiovascular, and neurological systems, similar to conventional smoking, while also endangering infant and child development," he averred. "E-cigarettes are highly addictive and harm the lungs, heart, and brain" the noted public health expert added. He revealed that social media platforms like Instagram and Facebook are flooded with content that glamourises vaping, often through popular influencers portraying it as harmless and fashionable. It highlights how young users are being misled through subtle, stylised videos ranging from smoke tricks to lifestyle Vlogs, that present vaping as aspirational, trendy and even humorous. "This form of stealth marketing is particularly dangerous because it circumvents direct advertising bans while still delivering targeted messaging to minors," he added. He warned about the serious health risks associated with e-cigarettes, including increased lung infections, lung damage, asthma, heart attacks, changes in heart rhythm and addiction. Acclaimed neuro-physician raised alarms over a potential link between e-cigarettes and attention deficit hyperactivity disorder (ADHD), emphasising their highly addictive nature, which can lead to dependence and withdrawal symptoms. According to him, the widespread appeal of e-cigarettes can be attributed to the availability of attractive flavours, the persistence of an illegal market, and a lack of awareness about the ban. These factors have played a significant role in fuelling interest and continued usage despite regulatory restrictions. "The peer pressure misconception that e-cigarettes have no harmful effects and addiction remain key factors driving their preference, especially among the youth." he told UNI. 'Local vendors, including small paan shops, discreetly stock them, and in social circles where vaping is common, getting devices and refills is effortless. The variety of flavours and smooth taste make it appealing, especially for first-time users. E-cigarette brands are still widely available in the country,' he pointed out. He emphasised the importance of mass public awareness, saying, 'Public involvement is important, but for that to happen, citizens need to be aware that these devices are banned in India. Therefore, it is critical that the government launch strong awareness campaigns to inform people about the illegality and dangers of these devices.' UNI DS ARN
India Gazette
5 days ago
- Health
- India Gazette
J-K: Health department organises walkathon on World No Tobacco Day in Srinagar
Srinagar (Jammu and Kashmir) [India], May 31 (ANI): In a strong message against tobacco use, the Directorate of Health Services Kashmir (DHSK), under the National Tobacco Control Programme (NTCP), organised a Walkathon at the scenic Dal Lake in Srinagar to mark World No Tobacco Day. The event aimed to raise public awareness about the harmful effects of tobacco consumption and promote a healthier, tobacco-free society. The Walkathon witnessed enthusiastic participation from doctors, students, and health professionals who marched together, holding placards and banners bearing anti-tobacco messages. The walkathon highlighted the growing concern over tobacco-related diseases and the urgent need for preventive measures, especially among the youth. According to Shabbir Hussain, a member of DHSK, the walkathon aimed to give a message to the youth regarding the harmful effects of tobacco and how it is hampering the present generation. 'Today is No Tobacco Day. This is a big issue in society because the young generation is falling prey to it the most. Through this initiative, we want to tell them that this is not a good thing because it is destroying our generation', he told ANI. Another participant of the walkathon, Aftab Ahmed, said that tobacco contains harmful chemicals that can cause lung and kidney-related diseases. 'Today we celebrated No Tobacco Day. It contains harmful chemicals like nicotine and it has a bad effect on us. It causes lung cancer and many other diseases. It also contains many other substances which are responsible for lung and kidney diseases', he said. World No Tobacco Day, observed every May 31, serves as a global platform to advocate for effective policies to reduce tobacco consumption and engage communities in the fight against the tobacco epidemic. (ANI)
