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Stark figures on smoking initiation after exposure to onscreen smoking, reveals US survey

In another step towards proving that onscreen smoking does have a definite negative impact on adolescent, and a villain’s smoking makes even more impact than a hero’s smoking; two studies were published recently from the USA.

A study to determine exposure to movie smoking in relation to smoking initiation among US adolescents was conducted by random–digital-dial survey on 6522 adolescents aged 10 to 14 years. Prevalence of smoking was about 2% among those with the lowest exposure to smoking in movies, steadily going up to almost 30% among those with highest exposure.

This study demonstrates, in a nationally representative US sample of young adolescents, that exposure to movie smoking has a strong association with smoking initiation and that the association holds within broad racial and ethnic categories and regardless of where the adolescent resides. It also suggests that, exposure to movie smoking is a primary independent risk factor, accounting for smoking initiation in more than one-third of US adolescents 10 to 14 years of age.

In light of the recent unfortunate comments made by the Union Health Minister Ghulam Nabi Azad that smoking in movies has little effect on children, these studies provide definite proof that exposure to smoking in films does impact the youth and influence them to initiate smoking.

In another longitudinal, random-digit-dial telephone survey of 6522 US adolescents, conducted by the American Academy of Pediatrics, current smoking status and movie exposure was assessed 4 times over 24 months. The adolescents surveyed were asked whether they had seen any recently released movies, in which smoking by major characters was identified, along with the type of portrayal. The portrayal was divided into negative, positive, and mixed/neutral categories.

By the 24-month follow-up survey, 15.9% of the baseline never-smokers had tried smoking. Within the sample of movies selected, 3848 major characters were identified, of whom 69% were male. Smokers represented 22.8% of 518 negative characters, 13.7% of 2486 positive characters, and 21.1% of 844 mixed/neutral characters.

The study clearly shows that smoking in movies and impacts adolescent smoking initiation – regardless of character type, which demonstrates the importance of limiting exposure to smoking as it is portrayed on screen. In fact, the study has also shown that negative character portrayals of smoking have stronger impact on low risk-taking adolescents; undercutting the often-repeated argument that smoking by villain in a film is ok.

“These are just some of the multitude of studies that have been, and are being conducted internationally that prove that depiction of smoking in films does have definite impact on the smoking behaviour of youth across geographies,” said Dr. P.C.Gupta, Director, Healis – Sekhsaria Institute for Public Health. “In light of such conclusive research reports, it is essential for the authorities to recognize the health risks that such exposure creates, and take necessary action to see to it that smoking in films is banned. The urban and semi-urban youth in India are either avid moviegoers or watch movies at home, and when they see their favourite stars on screen, whether hero or villain, they try and emulate this by beginning to smoke themselves. By curbing scenes which depict smoking in movies, a lot can be accomplished in preventing initiation smoking among youth” he added.

In India today, the movie-watching population – especially among adolescents – is in the millions, and since it is proven that any depiction of smoking on-screen has the ability to impact these young moviegoers and influence them to initiate smoking, the authorities need to take immediate steps to curb such on-screen depiction of smoking, and not pass such depictions in the name of ‘creative freedom, as is being done today.

Written by sreelakshmi

17 July, 2009 at 6:06 am


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Remarks termed as irresponsible; scientific evidence from global studies proves adverse effects of on-screen smoking on viewers

Recently, the new Union health minister, Mr. Ghulam Nabi Azad, has made certain comments that are detrimental to the massive tobacco control efforts in India and keenly supported by the erstwhile health minister Dr. Anbumani Ramadoss and the tobacco control communities in the country. “On-screen smoking in movies and television was defended as creative expression and freedom.” This is in direct contradiction to the efforts to curb the portrayal of smoking on screen earlier by the health ministry.

There seems to be little awareness of the fact that the demand for restrictions on such depictions of smoking has been made on the basis of scientific research. In a recent survey conducted by WHO on the same clearly showcases that exposure to onscreen smoking causes the impressionable youth and other non-smokers to light up.
The WHO has currently made demands based on scientific evidence that countries should enact enforceable policies that would severely restrict on-screen depiction of smoking. The WHO report on the issue has also recommended that all future movies with scenes of smoking should be given an adult rating, with the possible exception of movies that reflect the dangers of tobacco use or that depict smoking by a historical figure who smoked.

The Union Health Ministry is responsible for the upkeep of public health standards in the country, and through such statements, it is not only sending out a wrong message but also is totally contradictory to the efforts being put up by Government & non-governmental organizations to curb the menace of Tobacco related issues.

Reacting to the comments made by Mr. Azad, Dr. P.C. Gupta, Director, Healis Sekhsaria Institute for Public Health, said, “The tobacco control movement has gained a lot of impetus in India with the support of the union health ministry in the past. However, the comments made by the new health minister are extremely detrimental to the cause, and could actually derail the progress made in this regard. The Union health ministry should realize that smoking on screen does lead to non-smokers, especially the impressionable youth, to try and emulate their on-screen heroes by beginning to smoke.”

When the new government was elected, Public Health was announced as one of the key areas that will receive focus and Tobacco related health issues are definitely on the verge of reaching epidemic proportions in India. At this juncture, when all efforts are being made to control the use of this deadly substance, such remarks from an elected official of the ministry responsible for public health are quite unwarranted, and show lack of concern for public health,” he added.

WHO reports state that tobacco kills more than five million people every year. Alarmingly, the reports also state that approximately, a staggering 100,000 young people take up smoking every day. Based on a recent study on on-screen smoking, the WHO has come to the conclusion that “voluntary agreements to limit smoking in movies so far have

not – and cannot – work,” and that “logic and science now support enforceable policies to severely restrict smoking imagery in all film media.” Under circumstances where studies clearly reflect that smoking in movies misleads the youth into thinking that tobacco use is normal, without any portrayal of the harm of tobacco, national policies to restrict smoking in movies can produce wide-ranging global benefits.

In such a situation, public remarks that do not take into consideration such scientific evidence, and instead promote on-screen smoking are singularly inappropriate. If an issue of such high importance is so lightly disregarded, then in the long term it is bound to be extremely detrimental to the health of millions who view smoking on screen everyday.

Written by sreelakshmi

2 June, 2009 at 10:08 pm


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Restaurants and Hotels in the city extensively enforce the law prohibiting smoking in public places

It has been six months since the national law prohibiting smoking in public places was passed, and three months since Mumbai launched the ambitious Smoke-free Mumbai campaign—led by the joint efforts of Action Council against Tobacco—India, Municipal Corporation of Greater Mumbai and leading tobacco control organizations including Healis Sekhsaria Institute for Public Health and Salaam Bombay Foundation.

Globally, the hospitality industry has been regarded as the single-most important stakeholder in any attempts toward achieving a smoke-free environment. Every successful smoke-free initiative has invited wholehearted participation and support from the regional hospitality associations.

In Mumbai alone, there are over 7500 such establishments that are spread across the 24 wards of the MCGM. Since October 2, 2008, several such establishments had proudly proclaimed their smoke-free status. The Association of Hotels and Restaurants in Mumbai (AHAR), which has membership exceeding 5000, including restaurants, bars, etc., is a classical example of the proactive support toward realizing smoke-free Mumbai.

Dr. Surendra Shastri, Professor and Head of Department of Preventive Oncology, Tata Memorial Centre says, “The Smoke free campaign aims to ensure effective compliance and enforcement of the smoke-free law in the city of Mumbai in all public places like restaurants, hotels, bars, pubs, coffee houses, discotheques, and workplaces. Reinforcing the benefits of this widespread implementation, the findings from a survey amongst the restaurants in Mumbai have shed some interesting trends with regard to the smoke-free compliance amongst restaurants in the city and suburbs. Nearly 80% of the restaurants in the city and 70% in the suburbs are smoke-free.”

This was further reiterated during the recent workshops that were conducted by the Municipal Corporation of Greater Mumbai (M.C.G.M) for restaurant owners and operators in Mumbai. “My clothes no longer smell of cigarette smoke” or “Smoke-free law has helped me save on my electricity bill” are just some of the feedback from the restaurant owners regarding the success of the smoke-free law.

However, it would be too presumptuous to regard testimonials as an indication of success. The city still has a long way to go to be extensively compliant to the smoke free law—the recent air quality monitoring survey conducted by Healis Sekhsaria Institute for Public Health clearly indicates just that. The list of hotels and restaurants surveyed would be displayed on the ‘Smoke-free Mumbai’ website soon.

As stated by Dr. P.C. Gupta, Director, Healis Sekhsaria Institute for Public Research, & President, ACT India, “In a survey designed to assess the impact of smoke-free policies on indoor air quality—indicated by the concentration of particulate matter <2.5 microns—it was observed that while 88% of the venues proclaimed their smoke-free status, only 64% actually implemented the law. Compared to the average particulate matter concentration of 97 PM2.5 µg/m3 in non-smoking venues, smoking venues averaged nearly 363 PM2.5 µg/m3. This was worse than the average values observed at different garbage dumping grounds in Mumbai (149—169 PM2.5 µg/m3)”.

In essence, the aforementioned findings clearly highlight both the benefits of the smoke-free law as well as the potential consequences of the failure in implementing it—consequences that are not borne by the smokers’ alone but also by the innocent bystanders who choose to remain passive victims of cigarette smoke.


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Tobacco use is the biggest cause of death, disease and disability. The death clock of tobacco strikes every six seconds globally and the product kills nine lakh Indians every year. Since the first notification of the pictorial health warnings in July 2006, nearly 26, 52,500 Indians have died from tobacco-related diseases.

Studies point that forewarning tobacco users of the ill-effects of tobacco use through pictorial health warnings is one of the most effective measures to contain tobacco use and the consequent death, disease and disability. Evidence from countries having pictorial health warnings have revealed that larger, comprehensive warnings on tobacco packages are more likely to be noticed and rated as effective by tobacco users and contribute to reduction in tobacco use, since more people are willing to quit tobacco after repeatedly seeing the warnings.

However, it seems politics has overtaken scientific evidence and abandoned public health commitments, to sound a retreat from the implementation of a tested measure against a known pandemic. The GoM, mostly comprising of the prominent candidates contesting in the general elections for the 15th Lok Sabha, in the absence of the former Health Minister and under pressure from the tobacco industry – there is no reason to believe otherwise – has disregarded all scientific evidence, undermined an international treaty (Framework Convention on Tobacco Control-FCTC) obligation and transgressed the Model Code of Conduct to derail an important public health measure.

The civil society alliance for tobacco control in India had already voiced this concern when the GoM sought to meet on April 8, though it seems the Election Commission did not grant the permission for the GoM to convene. But no one would have ever imagined that the GoM could go back and alter the minutes of its February 3 meeting to oblige the tobacco industry and to influence the voters in their tobacco dependent constituencies.

It is shocking to believe that the apprehensions expressed by the former Health Minister on Saturday (he has said, “The minutes of that (GoM February 3, 2009) meeting seems to be changed after I quit the government“) have come true. Such a hasty decision by the GoM and the consequent notification by the Ministry of Health is a serious concern for the Government of India and the Election Commission of India should take notice of this politically motivated move and initiate immediate corrective action to uphold the democratic ethos and practices of the country and save an important public health measure from being needlessly diluted.

For very short term political considerations, the GoM must not be allowed to drag the country back from its commitment by diluting rules, breaking promises and endangering India’s image before the international community. The global public health movement which previously applauded and honoured India for its pro-people actions to curtail tobacco consumption will now react with dismay as the Government dishonours its commitments. Besides, this is contrary to the standards set by a pro-public health Government which is responsible for the launch of the National Rural Health Mission and the National Tobacco Control Programme during its regime.

It is unfortunate that the GoM since its constitution, in early 2007, has already delayed the implementation of the pictorial warnings for two years and during this time diluted stronger warnings for milder ones, reduced size of the warnings from 50% of the principal display area to 40% besides exempting large packs from the purview of the packaging labeling rules. As if all this was not sufficient in itself to negate the efficacy of the pictorial warnings, the GoM on Sunday (May 3) cast a death blow to the warnings by making them appear only on one side of the pack – thereby scaling them down to 20% of the principal display area which is below the minimum standard set (30% of the principal display areas) by the FCTC – and only on the packages meant for retail sales.

Speaking on the dilution of the pictorial warnings, Dr. P.C.Gupta, Director – Healis Sekhsaria Institute for Public Health has said, “It is most unfortunate that the GoM since its constitution in early 2007 has already delayed the implementation of the pictorial warnings for two whole years, not to mention having diluted stronger warnings for milder ones. This is a serious issue of concern, considering that the warnings have not only been delayed, but have also been cut down. Serious measures need to be taken at this juncture to highlight the grave irresponsibility of the GoM towards public health through this action”. “I would state that the tobacco control community strongly condemns this irresponsible decision by the GoM to dilute and amend the pictorial warnings notification”.

Evidence from countries like Panama and Brazil with warnings restricted to a single side indicates that industry sabotages the initiative by advising retailers to stack the packs on the retail shelves in a manner that hides the warnings from public view. Further, even as Parties to the FCTC, including India are negotiating a protocol to curb illicit tobacco trade, health warnings on wholesale and export packages are a key marker to track and trace illegal tobacco products across the borders.

The apparent urgency of the GoM to revisit and alter the rules pertaining to the pictorial warnings at a time when the general elections are in progress, with the Model Code of Conduct in force, and above all when the implementation of the rules was to be considered by the Supreme Court of India only two days later (Tuesday, May 5), is uncalled for and amounts to a colourable exercise of power.

The tobacco control community strongly condemns this devious decision by the GoM to dilute and amend the pictorial warnings notification that was to come into force from, May 31, 2009, the World No Tobacco Day the theme of which, ironically, is tobacco pack warnings. We appeal to the Prime Minister of India to urgently intervene and prevent this repudiation of public interest. While politicians may count their success in terms of votes gained, statesmen should count their success in terms of lives saved.

Tobacco addiction is a major cause of Tuberculosis!

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Half of all male deaths by tuberculosis in India a result of smoking

“I Am Stopping TB”this is the slogan that has been adopted worldwide for the World TB Day, 2009. “I Am Stopping TB” is the start of a two-year campaign internationally in support for control of TB. In keeping with the theme, a significant effort should be made to highlight the fact that a significant amount of TB deaths in India are caused by smoking – most starkly, including half the amount of males who succumb to TB in the country. Almost 200,000 people a year in India die from tuberculosis because they smoked, and half the smokers killed by TB are still only in their thirties, forties or early fifties when they die. 

On the occasion of World TB Day (24th March 2009), Dr.P.C.Gupta, Director, Healis Sekhsaria Institute for Public Health, said “Smokers expose themselves to a plethora of diseases and illnesses, and as research and studies show, Tuberculosis is one of the most life threatening diseases caused by tobacco.
We therefore urgently need to take extensive measures to increase social awareness about tobacco as a cardinal cause of tuberculosis and make an effort to educate society about the dangers of the disease.”

Studies have shown that half the male tuberculosis deaths in India are caused by smoking, and three quarters of the smokers become ill with tuberculosis (TB) through smoking. A major study led by the Epidemiological Research Center in Chennai, India and funded by the UK Medical Research Council and Cancer Research UK have come up with detailed results on tobacco being a major cause of tuberculosis. The study found that in India male smokers are about four times as likely to become ill with TB as non-smokers, and consequently four times as likely to die from the disease. The study also showed the smokers had higher death rates from heart disease and from various types of cancer. In total, about a quarter of the smokers studied were killed at ages 25-69 by their habit, those killed at these ages losing, on average, 20 years of life.

Tuberculosis still causes about 1.6 million deaths a year worldwide, including more than a million in Asia, 400,000 in Africa and 100,000 in the Americas and Europe, and in some countries it is now becoming more common.


Indians Support a Smoke Free Nation

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According to the results of a survey released in January 2009, conducted by the Healis-Sekhsaria Institute for Public Health
through Synovate’s Global Omnibus
on attitudes and behaviour among consumers in four major Indian cities, a near-unanimous majority of Indians strongly believe that the government should implement all new regulations that prohibit smoking inside all public places and workplaces in India.

An overwhelming 99% of the respondents of the survey have voiced their opinions strongly in favour of enforcement of rules prohibiting smoking in all public places and workplaces. 98% of the respondents have come out in favour of regulations prohibiting smoking in workplaces.

Speaking on the results of the survey, Dr. P.C. Gupta,
Director, Healis – Sekhsaria Institute for Public Health, said,
“The results of this survey have now shown that Indians clearly support the implementation of the law to ensure a right of citizens to breathe clean. Every aspect of controlling the brazen incursion of tobacco in public life must be exercised fully. By next year smoking will cause about 930,000 adult deaths each year in India, up from about 700,000 deaths per year in 2004. It is therefore vitally essential for the government and public bodies to take substantial steps to make sure that the compliance and implementation of the law on tobacco control is in fact realized, so that every common man can be protected from the dangers posed by tobacco.”

“India has always been faced with the rampant use of tobacco across all sections of society. However, the results of this survey show that most Indians are still resistant to tobacco usage, and the general consensus achieved by the survey is a very positive indicator of the sentiments of the public. It is very heartening to know that Indians recognize the fact that secondhand smoke is a major health hazard, and feel that the ban on smoking in public places should be more strictly enforced”, said Dr. S.S. Shastri, Professor and Head, Department of Preventive Oncology, Tata Memorial Hospital, Mumbai.

The respondents have also shown a high regard for the adverse effects of secondhand smoke, with 92% clearly stating that exposure to secondhand smoke constitutes a serious health hazard for non-smokers. With regard to office environment, 94% percent of Indians surveyed strongly agreed that all workers in India should be protected from exposure to secondhand smoke in the workplace. These concerns translate to the very strong belief among Indians that the right of customers and employees to breathe smoke-free air in workplaces and public places (including restaurants and bars) is more important than the right of smokers to smoke inside these places.

The majority of respondents from all locations have said that restaurants and bars are healthier and more enjoyable now that they are smoke-free. 85% of the respondents have agreed to this fact, out of whom 72% have agreed very strongly that these places are healthier. 88% of the respondents have strongly agreed that it is nice to go out and enjoy local restaurants and bars without smelling like smoke when they get home.

The results of the survey have highlighted the fact that Indians have decisively spoken out against smoking in public, and the recognition of the fact that secondhand smoke is a health hazard. This clearly shows that there is ample scope for the ban on smoking in public places has ample scope to succeed in the country, and it is the responsibility of civic bodies to ensure that the rules necessary for the campaign to succeed are uniformly enforced.

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Maharashtra earns an estimated 6 lakhs from fines for smoking in public places

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Less than three months of the ban on smoking in public places, the FDA claims to have already collected a whopping fine of Rs. 5, 79,925 from those found breaking the rule in Maharashtra. This collection is the amount that has been taken till November 2008 and is among the biggest collected from a state in the country.

The ban on smoking in public places was already in place since 2004. However, due to lack of awareness, required manpower and infrastructure, it did not provide the expected results. The Central government had reinforced the ban on smoking in public, which was imposed under the Prohibition of Smoking in Public Places Rules, 2008. The ban came into force from October 2, mainly to protect individuals from the hazards of second-hand smoke and to help smokers kick the habit. With the help of 250 FDA officials and support of police personnel, fines were successfully collected.

Mr. Mohan Patankar, Jt. Commissioner FDA, says, “This ban was long introduced in 2004 and we did our best to fine the offenders even then. The collections from 2004-2008 (July) amounted to Rs 2, 55,000 as against Rs. 5,79,925 in just four months (Aug- Nov 08).This was largely due to lack of infrastructure, necessary manpower, vehicles etc. Now, due to increased awareness and support from police personnel, we have noticed significant reduction in such instances. Hotels and restaurants have also strictly been following the ban. Easy availability of challans and receipts has also facilitated the process. It can be downloaded from the net for HR administrators and other competent authorities.”

The public was also more sensitized about the ban and there was a massive public support for the ban which played a significant role in the implementation of the ban.

Dr. PC Gupta, Director, Healis Sekhsaria Institute for Public Research said, “We applaud the FDA on providing us with this encouraging sign. The fines are crucial in the attitudinal transformation among general public and create a higher level of awareness. The general public already understands the significance of the ban and supports its cause. In our survey 92% respondents all over India and 96% in Mumbai strongly favoured regulations for making all workplaces and public places in India smoke-free. We are confident that effective implementation of policies such as smoke-free public places and pictorial warnings on tobacco products will play a concrete role in improving public health. Perhaps the government should take a cue from the success of this ban and implement the much awaited law on pictorial warnings; it is high time to do so in the interest of the public.”

The implementation of a smoke-free environment is the primary and most effective way to ensure that a non-smoker’s right to good health and right to breathe air devoid of smoke should be given preference over a smoker’s right to smoke and cause harm to those around him/her.

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Written by sreelakshmi

7 January, 2009 at 10:56 pm