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National Health Mission

Ministry of Health and Family Welfare, Government of India

FAQs

Frequently Asked Questions

  1. What is COTPA?

COTPA stands for the "Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003". The Act is applicable to all products containing tobacco in any form as detailed in the Schedule to the Act. The Act extends to the whole of India including the State of Jammu and Kashmir. It is an Act of Parliament of India enacted in 2003 to prohibit advertisement of, and to provide for the regulation of trade and commerce in, and production, supply and distribution of cigarettes and other tobacco products in India.

Link: COTPA, 2003 and Rules made thereunder

  1. What is Tobacco Surveillance?

The Global Tobacco Surveillance System (GTSS) aims to enhance country capacity to design, implement, and evaluate tobacco control interventions, and monitor key articles of the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) and components of the WHO MPOWER technical package. GTSS includes the collection of data through four surveys:

  • Global Youth Tobacco Survey (GYTS);
  • Global School Personnel Survey (GSPS);
  • Global Health Professions Student Survey (GHPSS) and
  • Global Adult Tobacco Survey (GATS).

GYTS focuses on youth aged 13-15 and collects information in schools. GSPS surveys teachers and administrators from the same schools that participate in the GYTS. GHPSS focuses on 3rd year students pursuing degrees in dentistry, medicine, nursing and pharmacy. GATS is a nationally representative household survey that monitors tobacco use among adults aged 15 years and older.

GATS India is conducted as a household survey of persons aged 15 years and above. The first round of GATS was conducted in 2009-10 and second round in 2016-17. GATS provides information on respondents’ background characteristics, tobacco use (smoking and smokeless), cessation, second hand smoke exposure, economics, media, and knowledge, attitudes and perceptions towards tobacco use. GATS enhances countries’ capacity to design, implement and evaluate tobacco control policies and programs. It also assists countries to fulfill their obligations under the WHO FCTC to generate comparable data within and across countries.

The prevalence of any form of tobacco use (for persons aged 15 years and above) has decreased significantly by six percentage points from 34.6 percent (GATS-1, 2009-10) to 28.6 percent (GATS-2, 2016-17). The number of tobacco users has reduced by about 81 lakh (8.1 million).

Link: Report of the Global Adult Tobacco Survey-2; and

         State Fact Sheets

  1. Does COTPA completely ban tobacco products in the country?

No. However, the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003" (COTPA) regulates the consumption, production, supply and distribution of the tobacco products by imposing restrictions on advertisement, promotion and sponsorship of tobacco products; prohibiting smoking in public places; prohibiting sale to and by minors; and prohibiting sale of tobacco products within a radius of 100 yards of educational institutions, and through mandatory depiction of specified pictorial health warnings on all tobacco product packs. It doesn't ban tobacco products per se. However, the Production, Sale, Storage and Distribution of food products containing tobacco or nicotine such as Gutkha have been prohibited under The Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations, 2011 dated 1st August 2011, notified under the Food Safety and Standards Act, 2006.

  1. What are health impacts of tobacco use?

Both smoking as well as smokeless forms of tobacco have adverse health impact and contribute to premature deaths. India is the third largest tobacco producing nation and second largest consumer of tobacco world-wide. Mortality due to tobacco in India is estimated at upwards of 1.3 million. Out of these, one million are attributed to tobacco smoking and the rest to smokeless tobacco use. Further, as per the study conducted by the Indian Council of Medical Research (ICMR) titled "Assessment of Burden of Diseases due to Non-communicable Diseases" based on analysis of published literature till 2004, the risk of diseases attributable to tobacco use was for stroke (78%), for tuberculosis (65.6%), for ischemic heart disease (85.2%), for acute myocardial infarction (52%), for esophageal cancer (43%), for oral cancer (38%) and for lung cancer (16%) respectively.

As per the Report on ‘Economic Burden of Tobacco Related Diseases in India’, (2014) more than 80% of all non-communicable diseases (NCDs) related deaths in India are attributed to four major diseases viz. Cardiovascular Diseases; Cancers; Chronic Respiratory Diseases and Diabetes. Mortality due to tobacco in India is estimated at upwards of 13.5 lakhs (Report on Global Adult Tobacco Survey, 2016-17). If the current trends continue and if effective steps are not taken to control tobacco consumption, it is estimated that by the year 2020, tobacco use will account for 13% of all deaths in India every year.

  1. Which is the national programme of the Government of India to curb smoking and consumption of tobacco products in the country?

Government of India launched the National Tobacco Control Programme (NTCP) in the year 2007-08, with the objectives to (i) create awareness about the harmful effects of tobacco consumption, (ii) reduce the production and supply of tobacco products, (iii) ensure effective implementation of the provisions made under "The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003" (COTPA) and (iv) help the people quit tobacco use through Tobacco Cessation Centres.

National Tobacco Control Programme (NTCP) has been institutionalized with the main objective to create awareness about the harmful effects of tobacco consumption and to ensure effective implementation of the provisions under COTPA, 2003 and is being implemented through a three-tier structure viz. National Tobacco Control Cell at Central level; State Tobacco Control Cell and District Tobacco Control, Cell at District level.

Dedicated State Tobacco Control Cells and District Tobacco Control Cells are established at State and District level for effective implementation and monitoring of tobacco control initiatives including Training; IEC activities; School awareness programme and Setting-up and strengthening of cessation facilities including provision of pharmacological treatment facilities at the district level. State/District Tobacco Control components viz. State Tobacco Control Cell and the District Tobacco Control Cell since 12th Five Year Plan have already been subsumed under NCD Flexi-pool of NHM for effective implementation.

The programme is presently under implementation in all 36 States/Union Territories covering about 612 districts.

Link: State-wise list with Districts under NTCP

  1. What is Second Hand Smoke (SHS)?

Second-Hand Smoke (SHS) is the combination of smoke from the burning end of a cigarette/bidi etc. and the smoke breathed out by smokers.

Involuntary (or passive) smoking is the exposure to SHS i.e. it involves inhaling carcinogens and other toxic components that are present in SHS.

  1. Is SHS dangerous for health?

Exposure to SHS results in lung cancer and heart diseases among adults, and SIDS (Sudden Infant Death Syndrome), chronic respiratory infections, worsening of asthma, reduced lung function growth, middle ear diseases and acute respiratory illnesses among children. Smoking at home affects babies and young children as well as the elderly and other adults, especially women.

As per WHO, there are carcinogenic effects of SHS. In June 2002, a scientific working group of 29 experts from 12 countries convened by the Monographs Programme of the International Agency for Research on Cancer (IARC) of the World Health Organization, Lyon, France, reviewed all significant published evidence related to tobacco smoking and cancer, both active and involuntary. Its conclusions confirmed the cancer-causing effects of active smoking. It also concluded its evaluation of the carcinogenic risks associated with involuntary smoking and classified second-hand smoke as carcinogenic to humans1

There is clear scientific evidence of an increased risk of lung cancer in non-smokers exposed to SHS. It has also been shown that non-smokers exposed to SHS have a 25 to 35% increased risk of suffering acute coronary diseases2 .

[1] International Agency for Research on Cancer. IARC Monographs on the evaluation of carcinogenic risk of chemicals to humans - Tobacco smoking and tobacco smoke. Vol.83 (2002).

[2]Law MR, Morris JK, Wald NJ. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. British Medical Journal 1997, 315:973–80.

  1. What does the term SLT mean?

SLT stands for 'Smokeless Tobacco Products'. It encompasses all tobacco products that are consumed in an unburned form. Smokeless tobacco can be used orally or nasally. Smokeless tobacco in India is used as chewing tobacco, with or without lime. Gutkha, Khaini, Zarda etc. are all examples of such use. Snuff is an example of the nasally used form. Both smoking as well as smokeless forms of tobacco have adverse health outcomes and contribute to premature deaths.

Links:

WHO FCTC GLOBAL KNOWLEDGE HUB ON SMOKELESS TOBACCO

http://www.nicpr.res.in/index.php/component/k2/item/386-who-fctc-global-knowledge-hub

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/health_effects/index.htm

  1. Is it possible to quit tobacco use?

Yes, it is definitely possible to quit tobacco use. Strong willpower along with proper counseling and social support holds the key. At times, severe addicts may require temporary use of nicotine chewing gum or nicotine patches (Nicotine Replacement Therapy - NRT) to aid in the de-addiction process.

Research has clearly shown that definite health benefits, apart from socio-economic benefits, are associated with quitting tobacco use.

  1. How can one opt to quit tobacco?

Tobacco Cessation Centres (TCCs) exist almost in every State/Union Territory apart from the hospitals providing cessation facilities. One who wants to quit tobacco may visit these Centres and take pharmacological therapy (if required).

The Ministry has also started National Tobacco Quit Line to provide tobacco cessation counseling services to the community through a toll-free number (1800-11-2356) and has launched a pan-lndia, “m-cessation" initiative to reach out to tobacco users who are willing to quit tobacco use and to support them towards successful quitting through text-messaging via mobile phones (on 011-22901701).

  1. Who can provide Tobacco cessation services?

Any health care professional with some training can provide tobacco cessation services that include Doctors, Psychologists, Social Workers, Nurses, and Dentists. Experienced lay counselors can also provide basic tobacco cessation services. ANMs can also be trained to provide simple guidance on tobacco cessation. However, pharmacological interventions can be carried out only by medical practitioners.

  1. Is there any mechanism where violations related to COTPA, 2003 can be reported?

Yes, MoHFW, Government of India has a toll free and 24x7 helpline number (1800 110 456). This initiative was launched in 2008. The violations reported to the helpline number are forwarded to concerned States/Union Territories for appropriate action.

  1. Does Tobacco also contribute to environmental pollution and contamination?

Yes, Tobacco is one of the major contributors to environmental pollution. It contributes to deforestation, depletion of soil nutrients, and contamination of water bodies.

  1. What is Electronic Nicotine Delivery System (ENDS)?

Electronic Nicotine Delivery Systems (ENDS) are devices that heat a solution to create an aerosol, which frequently also contains flavours, usually dissolved into Propylene Glycol or/and Glycerin. Electronic cigarettes, the most common prototype, are devices that do not burn or use tobacco leaves but instead vaporise a solution, which the user then inhales. Electronic Nicotine Delivery System (ENDS) aerosol contains nicotine, the addictive component of tobacco products. In addition to creating dependence, nicotine can have adverse effects on the development of the foetus during pregnancy. It may contribute to cardiovascular disease to the people who use ENDS. Also, nicotine may function as a “tumour promoter” and seems to be involved in the biology of malignant diseases.

Considering the adverse health impact of ENDS/E-Cigarettes and in order to prevent the initiation of nicotine through ENDS by non-smokers and youth, with special attention to vulnerable groups, this Ministry has issued an Advisory to all States/Union Territories to ensure that any Electronic Nicotine Delivery Systems (ENDS) including e-Cigarettes, Heat-Not-Burn devices, Vape, e-Sheesha, e-Nicotine Flavoured Hookah, and the like devices that enable nicotine delivery are not sold (including online sale), manufactured, distributed, traded, imported and advertised in their jurisdictions, except for the purpose & in the manner and to the extent, as may be approved under the Drugs and Cosmetics Act, 1940 and Rules made thereunder.

Link: Advisory on ENDS

  1. Is there any measure to test tobacco products?

Setting up of tobacco testing laboratories is one of the major thrust area under National Tobacco Control Programme. For tobacco product testing, three (03) National Tobacco Testing Laboratories (NTTLs) have been established in the campuses of existing Drug Labs- Central Drug Testing Laboratory, Mumbai (CDTL Mumbai), Regional Drug Testing Laboratory, Guwahati (RDTL Guwahati) and at National Institute of Cancer Prevention and Research under ICMR. The NTTLs have already initiated the small testing of tobacco products and the major equipment/machinery for the National Tobacco Testing Laboratories (NTTLs) is being procured.

NTTL at Guwahati and Mumbai are designated as the Regional Labs while NTTL at NICPR has been termed Apex lab due to certain additional responsibilities.