Dr. Shalini Singh, DirectorICMR National Institute of Cancer Prevention and Research

WHO FCTC Global Knowledge Hub on Smokeless Tobacco

National Tobacco Testing Laboratory (NTTL) 1

CONTENTS

1.Prevalence of SLT-Global, SEAR, & India

2.WHO FCTC MPOWER measures

3.Challenges in cessation

2

NUMBER OF SLT USERS

10.8 10 10.9 5.3

169.5

3.75 1.3 2.8 0.8

77.9

1.80

40

80

120

160

200

Nu

mb

ers

(in

mill

ion

)

WHO regional groupings

Males

Females

Worldwide smokeless tobacco users are 303 million WHO (2018)

Number of SLT users in WHO regions (among adults ≥15years)

3

PREVALENCE OF SLT IN SEAR (AMONG ADULTS)

43.2

27.225

21.419.8

17.815.8

3.2 2.6 1.70

0

5

10

15

20

25

30

35

40

45

50

Pre

vale

nce

% (

amo

ng

adu

lts

age

d ≥

15

year

s)

WHO South East Asian countries4WHO 2018

PREVALENCE OF SLT IN SEAR (AMONG YOUTH)

21.6

16.2

9 8.4

6.2 5.74.5

2.7 2.4 2.1

00

5

10

15

20

25

Pre

vale

nce

(am

on

g y

ou

th (

%)

(13

–15

ye

ars)

)

WHO South East Asian countries

5

WHO 2018

SLT PREVALENCE IN INDIA

• SLT prevalence has ↓ by 4.5% (25.9%, GATS-1 2009-10 and

21.4%, GATS-2 2016-17).

• SLT prevalence(21.4%) is more than twice that of

smoking(10.7%).

• In GATS 2- Men 29.6% and Women 12.8%

• Rural- 150.3 million and Urban-49 million

• Two most commonly used SLT products are khaini

(104Million) and gutkha (63.5Million).

6

WHO FCTC MPOWER MEASURES

WHO FCTC introduced six cost-effective and high impact measures that help countries reduce demand for tobacco.

•Monitoring tobacco use and prevention policies.

•Protecting people from tobacco smoke.

•Offering help to quit tobacco use.

•Warning about the dangers of tobacco.

•Enforcing bans on tobacco advertising, promotion and sponsorship.

•Raising taxes on tobacco.

7

CHALLENGES IN CESSATION

1. SLT users’ perspective

2. Healthcare providers’ perspective

3. Policy

4. Research

8

SLT USERS’ PERSPECTIVE

Social and environmental factors:

• Socioeconomic status, Gender

• Lack of awareness

• Lack of support

• Clinic accessibility: Urban/Rural

• Fear of treatment failure

• Being around other tobacco users

• Other addictive behaviours

• Limited knowledge of effective treatment

• Coping up with withdrawal symptoms

9

DIALOGUES FROM USERS IN CESSATION CLINIC

• I would rather use acupuncture, hypnosis, or lasertherapy can be effective

•NRT can be harmful as it contains nicotine

• I need to take SLT to relax myself.

• I am using SLT for many (5, 10, 20 or more) years /grandfather used to chew SLT and lived for 90 yrs.

• I don't want to use medication because themedication is addictive

10

PROVIDERS’ PERSPECTIVE

•Time constraint / Clinical work load- separate

counsellors

•Knowledge about standard guidelines

•Training for cessation

• Lack skills to engage who declined to quit

•Fagerstrom test

•No equipment for monitoring SLT cessation

11

POLICIES

•National tobacco control programmes

• Interference from tobacco industries

• TAPS/Product marketing/Surrogate advertising

• Variation in products

• Content manipulation (Pan masala)

• Packaging

• Policy implementation- Monitoring / Evaluation

12

RESEARCH

• Social and environmental factors

• Behaviors associated with SLT use

• Product mapping

• Laboratory tests of SLT products

• Effective measures for treatment of withdrawal effects

•Handy equipment to test SLT consumption

• Factors for Success / Failure of cessation

•Monitoring and evaluation of policy implementation 13

FIGHT CORONAVIRUS WITH HEALTHY LIFE STYLE 14