|Year : 2016 | Volume
| Issue : 2 | Page : 325-330
The ban on smokeless tobacco products is systematically violated in Chennai, India
E Vidhubala1, C Pisinger2, B Basumallik1, DS Prabhakar1
1 Resource Center for Tobacco Control, Cancer Institute (W.I.A), Chennai, Tamil Nadu, India
2 Research Center for Prevention and Health, Glostrup University Hospital and University of Copenhagen, Copenhagen, Denmark
|Date of Web Publication||6-Jan-2017|
Resource Center for Tobacco Control, Cancer Institute (W.I.A), Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: India is the world's third largest consumer of tobacco. There are twice as many users of smokeless tobacco products (STPs) as cigarette smokers. The Government of Tamil Nadu has banned the sale of gutkha and pan masala in 2013. Our aim was to identify the varieties of illegal STP available in Chennai, India. Methods: In systematically chosen zones and regions of Chennai city, we randomly identified three kinds of kiosks (n = 18) and asked for “gutkha” and “pan masala,” one of each product available. Details of each product were reviewed based on the information printed on the sachets. Results: Totally 65 STPs were collected; 26 distinct products and 23 brands. All products were claimed to be “tobacco” by the shop keepers. Sixty-five percent of the products informed to contain tobacco and 15.4% to contain pan masala. Five sachets did not inform about the content; 30.8% did not have a pictorial warning; a text warning was printed on 80.8%, but only two products had the messages in Tamil; 70% had promotional messages printed, and 57% had their registration numbers printed. Conclusion: The ban on STP is being systematically violated in Chennai. STP are cheap and easily available and due to promotional laudatory messages and lacking information about the content and warning of health damage, the consumers are left with the perception that they buy more or less harmless product. The Indian Government must introduce policies to control production, import, and sale of illicit STP but we also call for a coordinated international solution.
Keywords: Gutkha, illicit trade, India, pictorial health warning, smokeless tobacco products
|How to cite this article:|
Vidhubala E, Pisinger C, Basumallik B, Prabhakar D S. The ban on smokeless tobacco products is systematically violated in Chennai, India. Indian J Cancer 2016;53:325-30
|How to cite this URL:|
Vidhubala E, Pisinger C, Basumallik B, Prabhakar D S. The ban on smokeless tobacco products is systematically violated in Chennai, India. Indian J Cancer [serial online] 2016 [cited 2019 Aug 23];53:325-30. Available from: http://www.indianjcancer.com/text.asp?2016/53/2/325/197722
| » Introduction|| |
India is the second largest producer and the third largest consumer of tobacco. According to the Global Adult Tobacco Survey India Report (2009–2010), there are more than twice as many users of smokeless tobacco (26%) as cigarette smokers.
Smokeless tobacco products (STPs) are used in various forms in India such as paan with tobacco, paan masala, tobacco, areca nut and slaked lime preparations, mawa, snus, mishri, and gul. In addition to the locally prepared products, recently many commercially packed products have come into the market making it affordable and accessible to everyone, particularly for the young and poor. Moreover, STP products are also marketed and sold online  and the use has increased from 28% to 33% among men and 12–18% among women in a decade. More than 28 carcinogens have been identified in tobacco leaves for smokeless use, and STP is responsible for cancers of the oral cavity, esophagus, pharynx, cervix, and penis. The use of chewing tobacco increases the relative risk of death by 15–30%.
India has banned the sale, manufacture, distribution, and storage of gutkha (a chewing tobacco containing areca nut) and all its variants since 2011. In 2013, the Government of Tamil Nadu notified the ban in the state, and it is extended for the 3rd year now. The notification prohibits the manufacture, storage, distribution, or sale of the STP gutkha and pan masala and any other food products containing tobacco or nicotine as ingredients by whatsoever name it is available in the market, in the whole of the state of Tamil Nadu, for a further period of 1-year with effect from May 23, 2015. However, even after 2 years, both gutkha and pan masala seem widely available on the market and affordable to everyone. The theme of the WHOs World No Tobacco Day 2015 was “Stop illicit trade of tobacco products” which inspired us to perform this study.
The aims of the current study were to identify the varieties of illegal STPs available in Chennai city, Tamil Nadu, and to describe the manufacturing and product details of those brands.
| » Methods|| |
Chennai metropolitan city is classified into three regions: North, Central, and South, and it is further divided into 15 zones. Two zones were randomly chosen from each region, namely Thiruvottiyur and Royapuram (North), Perungudi and Sholinganallur (South), and Adyar and Teynampet (Central). From each zone, three different types of kiosks (permanent, temporary fixed, and mobile) were identified. The permanent and temporary fixed shops were primarily selling tea, snacks, sweets, soft drinks, and fruits. Two permanent shops also sold newspapers. One mobile shop was selling locally made snacks, shampoos, and pickles and five sweet beeda shops. One of each type was randomly chosen without any beforehand knowledge of the eventual sale of STP. The STP sold in each of the specific kiosks (n = 18) were procured by asking for “gutkha” and “pan masala,” one of each product available. Further, the details of each product were reviewed based on the information printed on the sachets which include the type of tobacco product, brand name, manufacturing company and state, registration details, details regarding pictorial health warning (PHW), quantity, price, promotional messages, etc., Each product was labeled and coded. Two gutkha brands had more than one type of sachet. They were labeled as Hans 1, Hans 2, and Hans 3; Cool Lip 1 and Cool Lip 2.
In this field study, we used simple calculations of percentages only.
| » Results|| |
Availability of smokeless tobacco products
Totally 65 STPs were collected from the 18 randomly selected kiosks in Chennai city. Among the sample products procured, 26 distinct products (23 brands) were shortlisted [Table 1]. All the products collected were claimed to be “tobacco” by the shop keepers. The most frequently available STP in the shops was as follows, Hans and MDM (61.1%), Mawa and DS (44.4%), UMA (38.9%), Cool Lip 1 (33.3%), Chaini and Garuda (27.8%), and M and Swagat (16.7%) [Table 1].
|Table 1: Availability and product details as printed on the sachet of the smokeless tobacco samples collected|
Click here to view
Packaging and labeling
Sixty-five percent of the products informed to contain tobacco, and 15.4% informed to contain pan masala. Five sachets did not have information about the content of product; three of these did not have any information other than the name [Table 1]. The quantity was mentioned in six out of ten products (from 1.44 to 100 g) and eight out of ten of the products had the price printed (Rs. 2–52.30) [Table 1]. Mawa, a highly sold product did not follow any packaging or labeling rules as it is sold in transparent plain sachets.
Half of the products mentioned that their product is regulated under the cigarettes and other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003) with statements as “Covered under COTPA 2003,” “A Tobacco product regulated by COTPA 2003”).
Health warning and promotional text
Majority (61.5%) had an image of oral cancer printed, except the snuff products that had a scorpion image. One sachet had the warning printed in the middle of two sachets (JRD-pan masala). The area covered by health warnings ranged from 10% to 58%, and in only one out of three products, the area was covered by at least 40%.
A text warning was printed on eight out of ten of the products. The messages were “Tobacco Kills,” “Tobacco Causes Cancer,” and “Chewing of Tobacco/Pan Masala is/may be injurious to Health.” Only two products had the messages in Tamil. The remaining warnings were in English (30.8%), both English and Hindi (26.9%), or Hindi only (15.4%). In addition, 42.3% of the products had the text message as “Not for Sale to Minors.”
The majority, about seven out of ten products, had promotional messages printed (“Simply Delicious,” “10% or 50% Extra,” “Premium,” “Filter,” “Good Smell,” “Status, safety, satisfaction,” “Flavored,” “World largest selling premium,” “Super in freshness and taste,” “Quality guaranteed,” “Saffron blended,” “An admixture of vegetables and fruits,” “Enjoy the True Freshness,” “High People, High Choice,” “Mild,” “Sundried simple tobacco,” “Hygiene, pure, satisfaction with new feeling,” “No. 1,” “Ready Made,” “Better than the best,” “Scented/flavored tobacco,” “Gold,” “To chew again and again,” “Special Tobacco,” and “One country one choice”1).
The information about the manufacturing company and state was available for 21 products [Table 2]. Two snuff (UMA, DS) and one tobacco product (Wanted Panneer) were manufactured in Tamil Nadu, but all the remaining STP products were from other states such as New Delhi, Bengaluru, Haryana, Bihar, Punjab, Kanpur, Gujarat, and Rajasthan, respectively, with decreasing frequency. Some products were manufactured in one state and packed in another or manufactured in two states.
More than half the products had their registration numbers printed on the sachet [Table 2]. Contact details were available for 80.7% of the products whereas 69.2% had given their customer care number. The website address was mentioned for approximately a quarter of the products. The availability of the websites was cross-verified and of the six, four brands manufactured by two companies had their websites active. One pan masala product (RMD) did not have a registration number; however, it was stated that this material passed ISO 17088:2008 which is the certification given for compostable plastic material.
| » Discussion|| |
In this field study, we found that all randomly selected kiosks in Chennai violated the law by selling STPs by claiming that they were selling tobacco. Furthermore, we found that several of these banned products had no information about the content, three out of ten products did not have any pictorial warning, a text warning was printed on only eight out of ten products and the majority had promotional laudatory messages printed on the sachet.
Even after 3 years of ban, the gutkha and pan masala products are widely and easily available on the market. All vendors in our study claimed that they were selling tobacco only. This might be an excuse of bypassing the ban, but it also might be a misperception or lack of knowledge about the products. As the content of several STP was stated to be tobacco, it cannot be ruled out that some vendors actually sell STP without being aware that they are breaking the law. One might also question whether the consumers know about the ban on STP in Tamil Nadu. A recent study from Mumbai showed that although all STP users were aware about the ban on gutkha, very few knew about the ban on pan masala. The study also showed that almost every fourth gutkha user had quit his/her habit postban and more than half had reduced their gutkha consumption. This was despite its availability through illegal sources. Nonavailability of gutkha was the most important reason for quitting/reduction of use.
Mawa, which was one of the highly sold products and easily accessible on the road side and all types of shops, do not follow any packaging and labeling rules as it is sold in the transparent plain sachets. It was found to be locally manufactured in Chennai as a cottage business. However, the mechanisms of supply and the players involved in the supply chain are not yet understood. Mawa is also smuggled to many South East Asian countries and Western countries.,
The majority of the STP products available in Tamil Nadu are smuggled from other states and also here the supply chain mechanism is unknown. Some of the products did not have any details on the manufacturers. Twelve percent of the STP products sold in Bangladesh and Nepal and 27% in Pakistan are manufactured in India, and they do not have the full information of the manufacturers. As these products are banned, they escape from tax and PHWs. This confirms the findings of a study by Khan et al. As per the latest notification, the STP products should display the PHW (mouth or cheek cancer) covering 85% of the principal display area. However, the implementation of this rule is still pending. As per the previous notification, the current PHWs are a picture of a cheek or lower lip cancer on STP and text warning is “Tobacco kills;” occupying 40% of the principal display area of the front panel of the pack. Majority of the products did not have the pictorial warning and did not comply with the specified size. Compared to the STP smuggled to England from Bangladesh, the products smuggled from India had pictorial warnings but over half (58%) of these were observed to be incorrect. Moreover, compliance by STP manufacturers to packaging and labeling rules, PHW, language used for text warning, and disclosure of ingredients were not as per the rules. The same observations have been made in Nepal, Pakistan, and Bangladesh.
Promotional statements on cigarettes have been forbidden by law since 2004. As STP are banned in Tamil Nadu, they escape from both mandatory health warnings and ban on promotional statements. Consumers of STP are thus less informed/protected than cigarette smokers. Our study found that most manufacturers used promotional statements to praise their STP, almost every third did not have PHWs and only two products had warning messages in Tamil. Promotional statements as “Status, safety, satisfaction,” “Mild,” and “Hygiene, pure, satisfaction with new feeling” are of special concern as they mislead smokers to believe that they are buying a harmless product.
As a majority of the STPs were manufactured in other states, strengthening the mechanism to control illicit trade of STPs at the border will prevent the availability in the market. Evidence strongly suggests that the key to controlling smuggling is controlling the supply chain and that the supply chain is controlled to a great extent by the tobacco industry. Other types of illicit trade than smuggling has emerged in the last decade such as illegal manufacturing, including counterfeiting and the emergence of new cigarette brands, produced in a rather open manner at well-known locations, which are only or mainly intended for the illegal market of another country. In a newly published study by Siddiqi et al., the researchers used a snowball sampling technique to interview point of sale vendors, wholesale retailers, manufacturers, raw-tobacco retailers, and farmers and succeeded to identify actors involved in the supply chain of STP in Bangladesh, Nepal, and Pakistan. The technique provides valuable information to policy makers and enables them to effectively regulate illicit STP products if there is political will to do so.
A report has compiled case studies from 13 European Union countries on the fight of illicit tobacco trade. Most of the countries dealt with it as a part of their comprehensive strategy to reduce tobacco use with coordinated approaches using a combination of interventions. Prioritization of dealing with illicit tobacco trade within the criminal justice system provides support for tougher punishment and for resource allocation toward enforcement. Almost all countries have a designated lead agency that coordinates the overall strategy and specific approaches with all stakeholders, including tax administration, enforcement authorities, the public health community, and the business community. Even though the main focus of the interventions is large-scale smuggling and illegal manufacturing, measures such as public awareness campaigns, retailers-focused interventions, tax harmonization, and customs regulations also address small-scale smuggling. All these interventions when implemented efficiently brought in positive results. Countries such as Italy, Spain, and the United Kingdom have shown that tobacco smuggling can be successfully tackled. Another example is Romania. The Romanian government implemented a national illicit trafficking strategy in 2010 and updated it in 2012 with the goal of reducing the level of illicit tobacco on the market by creating a better legislative framework, strengthening the administrative capacity of customs, investing in border security, and improving inter-institutional collaboration, cross-border cooperation, and fighting corruption. Stringent actions were taken against the corruption and 28 immigration officers were prosecuted for corruption related to illicit tobacco trade. They were sentenced to prison for 120 cumulative years and fined RON25 million (US$ 7 million) in total. This was the biggest operation of this kind in Romania since 1990. All these efforts resulted in 57% reduction in the illicit trade of cigarettes in the year 2013 in Romania.
The Indian Government must therefore introduce policies to control illicit trade of STP and create adequate provisions and resources for the strict enforcement of tobacco control laws. As STP are banned products, it is crucial that the government bring in necessary amendments in the cigarettes and other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (COTPA) 2003 incorporating the Food Safety and Standard Authority of India rules to make the law clear to all the stakeholders. However, this cannot stand alone and must be followed by clear cut guidelines on the implementation of the rules and training of the stakeholders. It is also crucial that the government cancels the registration of manufacturers and take stringent action against the violations of law to prevent the tobacco-related morbidity and mortality in the country.
However, the global scope and multifaceted nature of the illicit tobacco trade require a coordinated international response, so a strong protocol to the Framework Convention On Tobacco Control is essential.
The weakness of our study is the small size and restriction to one city only, which limits the coverage of all the STP products available in Tamil Nadu. As a supplement to the study, we identified few more STP through personal sources (Tulsi and SNT-1 – Pan Masala, Rathinam Vilas, Shanti Strong, and Pasu Tobacco) which were not available in the randomly chosen kiosks but sold on the market in Chennai. Availability of illicit STP may also differ by state, city, and urbanization. The strength is the real-life setting of this field study and that the kiosks/vendors were randomly selected in different parts of the city and also differed by type of kiosk.
| » Conclusion|| |
The ban on STPs is being systematically violated in Chennai, Tamil Nadu. STP are cheap and easily available. There is generally lacking information about the content and warning of health damage, and the majority has promotional laudatory messages printed on the sachet, leaving the consumer with the perception that they buy a legal and more or less harmless product. The Indian Government must introduce policies to control production, import, and sale of illicit STP, but as the illicit tobacco trade is a global problem, we also call for a coordinated international solution.
We acknowledge Dr. E. Hemanth Raj for reviewing the article and giving his critical comments. We thank Dr. R. Swaminathan for his assistance in designing the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]