|Year : 2016 | Volume
| Issue : 4 | Page : 279-283
Knowledge about the ill effects of tobacco use and “Cigarettes and other tobacco products (Prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) Act.” among adult male population of Shimla City
Dineshwar Singh Dhadwal, Kanica Kaushal
Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||14-Sep-2016|
Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: Cigarettes and other tobacco products act 2003 (COTPA) is the principal law governing tobacco control in India. However, enforcement of the provisions under the law is still a matter of concern. The desired impact and level of enforcement of the COTPA legislation and the gutka and pan masala ban in Himachal Pradesh need assessment. Objective: The objective of this study was to assess the knowledge and attitudes about the ill effects of tobacco use and COTPA among the adult male population of Shimla City. Materials and Methods: This study was a cross-sectional community-based survey carried out in Boileauganj, Shimla. Data were collected using a structured schedule by interviewing 100 participants. Proportions, percentages were calculated, and the Fischer's exact test was applied for the categorical variables. Results: About 58% had heard of ban on smoking in public places and 53% knew that Himachal Pradesh has been declared as a no smoke state. Only 50% of the participants had heard of COTPA. Conclusion: These dismal findings suggest average knowledge levels of male adults about COTPA, which calls for a sensitization workshop and advocacy for all the stakeholders.
Keywords: Cigarettes and other tobacco products act, knowledge, Shimla, smoke-free
|How to cite this article:|
Dhadwal DS, Kaushal K. Knowledge about the ill effects of tobacco use and “Cigarettes and other tobacco products (Prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) Act.” among adult male population of Shimla City. CHRISMED J Health Res 2016;3:279-83
|How to cite this URL:|
Dhadwal DS, Kaushal K. Knowledge about the ill effects of tobacco use and “Cigarettes and other tobacco products (Prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) Act.” among adult male population of Shimla City. CHRISMED J Health Res [serial online] 2016 [cited 2020 Feb 25];3:279-83. Available from: http://www.cjhr.org/text.asp?2016/3/4/279/190577
| Introduction|| |
The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing nearly six million people a year. More than five million of those deaths are the result of direct tobacco use while more than 600,000 are the result of nonsmokers being exposed to second-hand smoke (SHS). Approximately, one person dies every 6 s due to tobacco, accounting for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease. Tobacco is the only legal product that kills a large proportion of its consumers when used as intended by the manufacturers.
Tobacco comes in smoked and smokeless forms, both of which have been shown to cause harm to both the tobacco users and those who are getting SHS from them. Smoked forms of tobacco include various kinds of cigarettes, cigars, pipes, bidis, hookahs, and many others. Smokeless tobacco is not burned when used. It may be sucked, chewed, dipped, gargled, or applied to the gums or teeth while fine tobacco mixtures are inhaled into the nostrils.
SHS is also known as environmental tobacco smoke. Sidestream smoke has higher concentrations of cancer-causing agents (carcinogens) and is more toxic than mainstream smoke. Moreover, it has smaller particles than mainstream smoke. These smaller particles make their way into the lungs and the body's cells more easily.
The bill proposes to set up a National Tobacco Control Organisation that will implement and monitor the provisions of COTPA, 2003. Smoke-free initiatives have gained significant momentum since India enacted comprehensive smoke-free legislation in October 2008.
On World No Tobacco Day 2010, four jurisdictions demonstrated that public places within their jurisdictions were “smoke-free.”
Tobacco use is one of the most important preventable causes of morbidity and mortality in India. It is essential to study the existent knowledge about tobacco use and cigarette smoking to formulate the intervention for addressing this problem in the community. Not many studies have been done on awareness and attitudes of the general public regarding cigarettes and other tobacco products act (COTPA). For effective implementation of tobacco control knowledge regarding the awareness, attitudes, and practices of the population toward tobacco control is necessary. Hence, this study was undertaken assess the smoking and tobacco consumption patterns and to assess their awareness regarding ill effects of smoking and tobacco use among adult males of Boileauganj, urban field practice area of the Department of Community Medicine, IGMC Shimla.
| Materials and Methods|| |
Boileauganj has a total population of 8205 individuals living in 2243 households as per Census 2011. The study will be conducted on 100 male adults fulfilling the eligibility criteria for participation in the study. The study was conducted using a two-stage sampling design. In the first stage, the households were selected by systematic random sampling.
Inclusion criteria were ever use of tobacco (used tobacco anytime in the past), current tobacco use (any use of tobacco in the past 30 days), current smoking (use of any smoking tobacco in the past 30 days), and current smokeless tobacco use (any form of smokeless tobacco use in the past 30 days).
The whole study area was mapped, and all the main roads were identified. UHTC Boileauganj was taken as the starting point for the purpose of this study. Four directions were identified, and one direction was selected randomly. The main road leading in that direction was approached first and the first house reached was considered as the first household for the study. Thereafter, every third household was selected and visited for the purpose of the study. Once the boundary of population served by Boileauganj in that direction was reached; the adjacent direction starting from UHTC was approached for the same.
In the second stage, a single eligible participant was chosen from the selected household which formed the secondary sampling unit. An inquiry regarding an eligible participant (based on the inclusion criteria) was made in the selected household. For households with only one eligible participant that person becomes the designated participant and was included in the study. In case of more than one eligible participant in the selected household, all the eligible participants were included in the study. The search was carried till we found a sample of 100 participants who consumed tobacco either in smoked form or orally or both.
The pro forma consisted of twenty closed-ended questions. It was a self-administered, structured, pretested, closed-ended anonymous questionnaire consisting of questions on details regarding demographic and socioeconomic characteristics such as participant's self-reported age, sex, educational status, occupation, education and occupation of the head of the family, total family income, and various questions were asked to notice the smoking or tobacco consuming trends among the people of Boileauganj and to assess the awareness levels regarding COTPA. Informed consent was taken from every participant.
Due permission was taken from the Institutional Ethics Committee beforehand for conducting the study.
| Results|| |
The mean age of the sample population was 50.83 ± 15.75 years and mean years of smoking among the smokers were 30.51 ± 14.34 years.
[Table 1] shows sociodemographic characteristics of the sample population. [Table 2] shows awareness about harms of cigarette smoking and awareness about COTPA act.
|Table 1: Sociodemographic characteristics of the sample population (n=100)|
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|Table 2: Awareness about harms of cigarette smoking and awareness about Cigarettes and other tobacco products act (n=100)|
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The mean number of cigarettes smoked were 9.24 ± 6.44 per day. All participants were male, and 94% of them were married. Of 100 participants, there were 55% smokers, 21% consumed oral tobacco, and 24% doing both. Of 24 participants who were consuming both, 9% found smoking most impossible to give up, 5% said its tobacco they cannot resist and rest 10% said both smoking and oral tobacco.
Tobacco consumption patterns among the participants revealed mainly three varieties of it-gutka, khaini, and patta chhap. Forty-three (of the 45 tobacco consuming participants) consumed gutka, 27 took khaini, and 8 still consumed patta chhap. Nearly 32% found it difficult to refrain from using oral tobacco or smoke in places such as temples, cinema halls. About 29% and 47% consumed tobacco within 1 h and 2 h, respectively of waking up in the morning indicating dependency on it. Mean number of times oral tobacco product consumed per day was 2.07 ± 2.14.
Fisher's exact test revealed that there was significant association of education status with the knowledge of the passive harms of smoking (P < 0.002), knowledge of ban on smoking in public places (P = 0.03), and that Himachal Pradesh is a no smoke state (P = 0.045).
| Discussion|| |
The Indian Parliament enacted the COTPA (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) on May 18, 2003. The Union Ministry of Health and Family Welfare on 13 January, 2015 proposed the COTPA (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) (Amendment) Bill 2015. The bill proposes to ban on-site advertising of tobacco products and shops selling cigarettes, and other tobacco products will no longer be able to display the brand names. It proposed scrapping of designated smoking areas from hotels, restaurants, and airports making an exception only for international airports to prevent exposure of nonsmokers to harmful emissions. The penalty for smoking in restricted areas has been raised from 200 to 1000 Rs. Anyone found producing tobacco products without the specified warning will be liable for imprisonment for up to 2 years for the first offence or fine up to 50,000 rupees or both. For the second and subsequent offences, the imprisonment can be up to 5 years with a fine of up to 1 lakh rupees. Selling products without warning will incur a fine of up to 10,000 rupees or a jail term of up to 1 year or both and subsequent offence will draw a fine of up to 25,000 rupees and a jail term of 2 years. Tobacco products and cigarettes in approved packaging will now be sold only to those above 21 years of age. The proposed age limit will be revised after evaluating the impact of raising the minimum age. The draft bill also proposes a ban on spitting of tobacco products, pointing it out as the biggest cause of the spread of diseases such as tuberculosis, avian flu, and H1N1 virus. It has also been proposed to extend the ban on sale of cigarettes and tobacco products from 100 yards of an educational institution to 100 m.
This study reported good awareness about harmful effects of tobacco use in an urban community in Boileauganj block of Shimla district of Himachal Pradesh. In our study, participants consisted of male participants only, which points toward less prevalence of smoking among female population here. We found that 96% were aware of the fact that smoking is harmful to health and 77% viewed SHS to be equally dangerous as active smoking.
However, this study reported poor awareness about COTPA act (50%). Similar findings were reported in the study by Kumar and Misra. Increasing the level of awareness among people and members of PRIs as well as efforts to change people's attitude through behavior change communication will help in effective implementation of anti-tobacco measures. A high level of support among community representatives at the grass root level may be used by the planners to their advantage. The awareness levels regarding COTPA have to be raised further for effective implementation of the legislation and dissuade people from using tobacco and other related products.
Similar to our findings, study done by Sharma I on awareness regarding the implementation of the tobacco product law in Assam reported that nearly half of participants had an awareness of COTPA and that efforts should be made to increase the awareness of COTPA focusing on younger population, less educated, and those belonging to the low socioeconomic status (SES).
However, the participants reported several barriers for effective implementation of the act. Awareness of COTPA significantly increased with age and education, and positive attitude toward COTPA was significantly associated with better education, higher SES, and better awareness of the harmful effects of SHS. Training of implementers on COTPA will also be useful for proper implementation of the act.
Compliance surveys were done as an effective tool to validate smoke-free public places in four jurisdictions in India. Active smoking was not observed in more than 95% of all public places visited during the survey. Shimla had a slightly lower proportion of signage conforming to law, at 80% as compared to 90% of all public places in Villupuram District, Coimbatore City. The air in these public places was free of the smell of tobacco smoke in most public places and very little tobacco-related litter (cigarette butts, bidi ends) was observed in these jurisdictions.
In this study, education was significantly associated with better knowledge of the fact that smoking is harmful and is an economic burden. Higher proportion of literate study subjects was aware of the fact that smoking is banned in public places and wanted the government to take hard actions to control the smoking epidemic. The results are consistent with other studies which also showed a significant difference in knowledge regarding active and passive smoking with respect to education. More employed individuals knew about that smoking is banned in public places as compared to unemployed.
Implementation of various provisions under COTPA and effective enforcement of tobacco control law remains a big challenge. To strengthen the implementation of the tobacco control provisions under COTPA and policies of tobacco control mandated under the WHO FCTC, the Government of the India piloted National Tobacco Control Programme (NTCP) in 2007–2008. The programme is under implementation in 21 out of 35 States/Union territories in the country. In total, 42 districts including Himachal Pradesh (Shimla) are covered by NTCP at present. The objectives remained to create awareness about the harmful effects of tobacco consumption and to ensure effective implementation of the provisions made under “The COTPA (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) 2003.” This was a major leap forward for the tobacco control initiatives in the country as for the first time dedicated funds were made available to implement tobacco control strategies at the central state and sub-state levels.
| Conclusion|| |
Prevalent practices of tobacco use were reported in this study, despite the good levels of awareness about harmful effects of tobacco. Smoking is a socially and culturally unacceptable habit; hence, people are less likely to report it which may lead to underreporting and in turn to decrease prevalence. The study concluded that there was high knowledge about deleterious multidimensional effects of smoking among residents and a high support for the implementation of COTPA. Efforts should be made to make Himachal Pradesh a “smoke-free district.” Further, some prevention initiatives to target smoking initiation among youth and smoking cessation should be directed at residents.
There were certain limitations of our study. The study was conducted in Boileauganj and hence cannot be generalized to all people in Shimla.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]