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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 14
| Issue : 3 | Page : 121-126 |
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Awareness about loose tobacco ban among tobacco users and vendors : A cross-sectional study
Sinu Ezhumalai
Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| Date of Submission | 21-Feb-2021 |
| Date of Acceptance | 17-Apr-2021 |
| Date of Web Publication | 27-Aug-2022 |
Correspondence Address:
Sinu Ezhumalai
Department of Psychiatric Social Work, NIMHANS, Bengaluru - 560 029, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijds.ijds_25_21
Background: Ban on smoking in public places reduced the number of smokers considerably. According to Global Adult Tobacco Survey-2, tobacco use is decreased by 3% in Karnataka. However, the loose sale of tobacco products encourages the practice as tobacco users continue to use tobacco by purchasing loose tobacco products. Hence, the present study was carried out to assess the compliance of loose tobacco ban in Bidar city of Karnataka. Aim: The aim of this study is to assess the compliance on loose tobacco ban in Bidar City. Methods: The exploratory research design was used. The study was cross-sectional and community based in nature. Sample Size: 98; 50 vendors and 48 consumers were randomly selected using the time-cluster sampling. Data were collected from 22 different locations using the observation and interview method within 2 km radius of Bidar City. Two separate pretested and predesigned semi-structured interview schedules were administered to tobacco users and vendors. The study was carried out in November 2019. Ethical clearance was obtained from the Institutional Ethics Committee. Statistical analysis was done using the percentages and frequency tables. Results: Majority (96%) of the tobacco users were unaware of loose tobacco ban in Karnataka and prefer to buy cigarettes in loose. Four percent of tobacco users were aware that loose tobacco is banned. Majority of (76%) tobacco users think buying a full pack of cigarettes would increase smoking. There is absolutely no compliance on loose tobacco ban by tobacco vendors.
Keywords: Compliance, Cigarettes and Other Tobacco Products Act, loose cigarette, single cigarettes, tobacco control
How to cite this article:
Ezhumalai S. Awareness about loose tobacco ban among tobacco users and vendors : A cross-sectional study. Indian J Dent Sci 2022;14:121-6 |
How to cite this URL:
Ezhumalai S. Awareness about loose tobacco ban among tobacco users and vendors : A cross-sectional study. Indian J Dent Sci [serial online] 2022 [cited 2023 Mar 27];14:121-6. Available from: http://www.ijds.in/text.asp?2022/14/3/121/354895 |
| Introduction | |  |
Tobacco epidemic is one of the major public health concerns in India. Nearly 8–9 lakhs of people die every year in India due to diseases related to tobacco use. Global Adult Tobacco Survey (GATS-2) revealed that the prevalence of overall tobacco use among males is 42.4% and among females is 14.2%. One in six adults in the rural areas (32.5%) and one in five adults (21.2%) in the urban areas use tobacco in some form.[1] Bidis, along with smokeless tobacco, account for 81% of the Indian tobacco market GATS-I.[2] Amount spent by the governments for treating diseases arising out of smoking is more than the revenue generated from the tobacco products. Smokers are two and a half times more likely to suffer from stroke. Smoking is responsible for 90% of all cases of chronic obstructive pulmonary disease.
The Government of India consistently working toward to control tobacco epidemic since the enactment of Cigarettes and Other Tobacco Products Act (COTPA) in 2003. The Government of India has taken several initiatives to control tobacco use in the country such as the National Tobacco Control Program in 2007–08, GATS-I in 2009–2010, GATS-II in 2016–2017 as the part of Global Tobacco Surveillance System and hike in taxes on tobacco, anti-tobacco messaging notably in cinema theaters, movies, other mass media, health warning covering 85% on tobacco package and total ban on manufacture and sale of gutka and pan masala, ban on tobacco advertising in print media and televisions.
Tobacco control measures in India have yield positive outcome in terms of reduction in prevalence and increased awareness among public. Tobacco use in Indian is reduced by 6% to 28.6% in 2017 from 34.6% to 2010. Positive news is that the prevalence of tobacco use among children aged 15–17 years as well significantly decreased to 4% from 10%. However, globally, more than seven million people die each year due to tobacco use.[2] More than one billion persons who use smokeless tobacco live in low- and middle-income countries. Nearly 90% of global smokeless tobacco users live in the South-East Asia region. Second-hand smoking is attributable to 1% of deaths worldwide with 47% of these deaths occur in women and 28% in children. Tobacco has been identified as the risk factor for six of the eight leading causes of death. Majority of these deaths are projected to occur in developing countries.
Punjab government became first state to ban sale of loose cigarettes citing that loose cigars do not have pictorial warning. Lax in implementing a ban of loose tobacco and it was not practical for the police to take action and book cases under COTPA for offenders and persons who often violate the loose tobacco ban.
The sale of single cigarettes is a major threat to public health and makes it easily available, more accessible and affordable. Buyers of single cigarettes are less exposed to health warning labels. In developed countries, it has been found that individuals with less income, less education, and more socioeconomically disadvantaged tend to buy more single cigarettes. The public health impact of sale of single cigarettes is unclear and has not been extensively studied. The per-unit is more costly than cigarettes sold in packs. Further purchase of single cigarettes has been considered as an effective strategy in quitting by many tobacco cessation clinics. Compliance refers to the degree in which a law is being obeyed. Loose tobacco refers to single cigarettes, single beedi, and single roll of tobacco leaves (chuttu/cigar). Loose tobacco ban refers to the prohibition of sale of single cigarette, bidi as per the Government of Karnataka order 2017.
[Table 1] shows the studies carried out in India and abroad on 12 different aspects of loose tobacco such as prevalence, profile of loose tobacco purchasers, and their perception about purchasing loose tobacco, compliance on loose tobacco ban, association of smoking severity and purchasing loose tobacco ban, estimating the proportion of sale of single cigarettes, and its cost, Advertising of single cigarettes, trends in availability of single cigarettes and illegal practice of sale of single cigarettes.
Male, smokers aged 15–34 years, single, less educated, unemployed, living in metropolitan cities, menthol cigarette smokers and those who are planning to quit in the next 30 days were more likely to purchase loose cigarettes.[3] Single cigarettes are widely available and sold at higher prices. Smokers opt for single cigarettes to reduce their consumption. Law enforcement has been a negligible effect on the sale of single cigarettes.[4] Stores selling loose cigarettes accounted for around 80% in Bangalore.[5] The sale of single sticks of cigarettes is widespread in Africa and poses a serious problem even in countries where it is banned. Single sticks are available for sale from cigarette brands owned by major tobacco multinationals. Advertising of single sticks of cigarettes occurs through different channels in African countries.[6]
More than half of current cigarette smokers bought loose cigarettes. The proportion of buying loose cigarettes decreased with increasing education and wealth index and least among government employees. The intensity of smoking was 70% less among loose cigarette buyers than non-buyers.[7] Most shops sold single cigarettes within 100 yards of school in Mangaluru.[8] Most cigarettes are sold as single sticks, valued at nearly Rs.359 billion or 30% of India's excise revenues from all cigarettes in ten jurisdictions of India (Shimla, Goa, Jaipur, Baroda, Agartala, Jorhat, Chennai, Indore, Patna and Delhi). There is a wide variation in the proportion of single cigarette sales across jurisdictions. Goa, among all jurisdictions, has the lowest proportion of single cigarette sales and higher pack sales.[9]
The sale of single cigarettes has been reported as widely visible. Most participants saw singles sold daily in their neighbourhood of Mexican city. Smokers living in neighbourhoods with higher access to single sticks were less likely to make a quit attempt and more likely to relapse.[10] Most respondents reported seeing single cigarettes sold daily on the street.[11] Most (91%) of cigarettes as sold single. Single-cigarettes sales are highly prevalent among informal economic sectors in Guatemala City and its neighbouring towns.[12] Single cigarette sale was associated with reducing consumption and, less consistently, the frequency of being cued to smoke after seeing single cigarettes for sale. Using single cigarettes to reduce consumption was positively associated with quit intention.[13]
The sale of single cigarettes is widely prevalent in many developed and developing countries where the law prohibits it. Buying single cigarettes is common across all types of smokers going to bars Current smokers regularly saw loosies available for purchase. Perceived approval and non-daily smoking were associated with more purchases of loose cigarettes.[14]
A common point of sale of single cigarettes is street vendors.[15] Most stores in Central Harlem, New York, sold single cigarettes.[16] Single cigarettes are reportedly being sold at almost double the unit cost of cigarettes sold in packs in a few places. As an unintended consequence of tax increase, 15% of smokers bought single cigarettes.[17] Price increase causes fewer sales of factory-made cigarettes and higher sales of cheaper loose tobacco in Germany.[18]
The Government of Karnataka banned the sale of loose tobacco which includes sale of single cigarettes and bidi in 2017. Since then there has been no compliance studies on the same. There is a dearth of research studies on sale of loose tobacco, awareness about loose tobacco ban in India. Worldwide, the sale of single cigarettes has not been extensively studied. Hence, the present study aims to evaluate the progress made in implementing the loose tobacco ban in Karnataka and identify the gaps in the effective implementation of the same.
| Methods | | |
The study was cross-sectional in nature and community-based study. Sample size: 98; 50 vendors and 48 consumers were randomly selected using time-cluster sampling. Data were collected at two different points of time 11 am – 2pm and 4 pm – 6 p. m from 22 different locations using observation and interview method within 2 km radius of Bidar City. The study was conducted at public places such as hospitals, educational institutions (engineering colleges), hotels, banks, busstops, cinema theatre, markets and shopping areas, playground (stadium), tourist places, religious places, industrial areas, railway station, and bus stations. Two separate pretested and predesigned semi-structured interview schedules were administered to tobacco users and vendors. The study was carried out in November 2019. Ethical clearance for the study was obtained from the Institutional Ethics committee on April 2019. Statistical analysis was done using the percentages and frequency tables. Normality of the data was tested using the Shapiro–Wilk test. Outcome parameter: the study indicator was whether the sale of loose tobacco is observed in particular location or not.
Procedure for data collection
Two research assistants who completed postgraduation in social work and had previous experience in working with communities were recruited for the study purpose. They were trained in COTPA 2003 and data collection procedures as per the data collection protocol and Institutional Ethics Committee guidance. Before the actual collection of data, the pilot study was conducted in Bruhat Bengaluru Mahanagara Palike locations. Appropriate supervision was provided to the research assistants in the data collection procedures. They were asked to observe the sale of loose tobacco and smoking in public places for 15 days in another location before travel to study location (Bidar). Interview schedule was translated to Kannada, official language of state, and used for the data collection. Google forms were created to enter the responses from the interview schedule. The study followed the protocol and it is in accordance with guidance prescribed by the best practices for compliance studies on smoke free laws.[19]
Study universe
Bidar is in the north-eastern part of Karnataka, located at the farthest of around 700 km from Bengaluru capital city. Bidar has 5 Talukas, Bidar, Humnabad, Bhalki, Aurad, and Basavakalyan. Bidar district has a population of 17.03 lakhs, its sex ratio is 952 females per 1000 males, and a literacy rate of 71.01%.[20] In 2006, the Ministry of Panchayati Raj named Bidar one of the country's most backward districts. It is one of the five districts in Karnataka receiving funds from the Backward Regions Grant Fund Program. Bidar district was selected as the study universe owing to backwardness and the farthest district from the capital city. Bidar city has 34 schools, 13 banks, 10 colleges, one Government District Hospital. Bidar City alone has a population of 2.16 lakhs with average literacy rate of 85.90%.
| Results | | |
[Table 2] shows that the majority of (52%) tobacco users and (64%) vendors were educated up to 10th or below. One-fourth (26%) of tobacco users, (24%) vendors were illiterate. Majority of the tobacco users (86%) and vendors (74%) belong to the productive age group of 20–49 years.
Nearly half of the (48%) of tea stalls sell loose tobacco followed by petty shops (30%), pan shops (16%), and Bakery cum tea stall (6%). Almost all the tobacco vendors and 95% of tobacco users in Bidar City were unaware about the sale of loose tobacco ban. Hence, this may be one reason for noncompliance of sale of loose tobacco ban in Bidar city. Most tobacco users anticipate buying cigarettes in pack would increase usage. Sale of loose tobacco was observed more in tea stalls and petty shop in the commercial areas.
| Discussion | | |
As per the Section 7 (2) of COTPA: No person shall carry on trade or commerce in cigarettes or any other tobacco products unless every of cigarettes or any other tobacco products sold, supplied or distributed by him bears thereon, or on its label, the specified warning. Individual cigarettes and bidis do not carry a statutory health warning. Hence, central government banned loose tobacco.
In the present study, people from across all age groups and educational level purchased loose tobacco. Nearly half of the tobacco users were in the age group of 20–29 years and another 40% of the tobacco users aged 30–49 years. This finding was similar to previous study findings.[7]
The present study reported 95% noncompliance on sale of loose tobacco in Bidar city of Karnataka. This study finding was in concordance with previous study findings,[5],[9] where loose tobacco sale accounted for 75% in Chennai, Delhi, Jaipur, Patna, Agartala, Baroda, Shimla, and 80% in Bengaluru.
In India, 70% of the cigarettes sold in India are loose. Many tobacco users, including minors and students, prefer buying loose cigarettes because they are more affordable than the whole pack. The Indian government increased the excise duty on cigarettes in the range of 11% and 72%, depending on the length of the stick. Despite this hike, cigarettes are still cheaper in India compared to other countries. A large part of cigarette sales happen through kiosks and tobacco vending machines as well. Although increasing taxes is one of the most effective means of smoking prevention and reduction the increased price of cigarettes can lead to tax-avoidance such as buying untaxed packs smuggled from states with lower cigarette taxes and purchasing loose cigarettes.
Cigarettes form the smallest segment of tobacco consumption in India and banning loose tobacco would have little impact. Loose tobacco ban is largely noncompliant with laws. Ban would likely increase the level of contraband and illegal trade and shift in the consumption of tobacco to other forms. Loose tobacco ban may affect legal domestic cigarette industry in India and the livelihoods of over 38 million people who are engaged in the tobacco industry. Only few consumers would be able to afford the shift to packets. India has a unique pattern of tobacco consumption with legal cigarettes accounting for 12%. The remaining 88% is represented by illegal cigarettes and a host of traditional products such as bidis, chewing tobacco and Khaini. The cigarette industry generates more than Rs. 25,000 crore in tax revenue.[21] As there are lakhs of pan shops and selling points and implementing this could be a challenge. Availability and visibility of loose tobacco can promote smoking and encourage relapse. It is likely that the cue of seeing loose tobacco in one's environment also motivates nondaily smokers to smoke.
Previous research has shown that educating sellers about laws prohibiting loose tobacco sales is effective in increasing compliance.
Recommendation
- Rigorous enforcement and awareness activities are recommended.
- Extend Bloomberg initiative project to Bidar district
- Issue warning letters for loose tobacco ban violations
- Geographic information system to map tobacco vendors
- Need for stronger quality monitoring processes across Taluk and district
- Increase age limit to sell and consume tobacco from 18 to 21 years
- Formation anti-tobacco squad cell at district level and taluk level
- Tobacco retailer education
- Statutory health warning in single cigarette as well
- Licensing of vendors for the sale of tobacco would bring them under surveillance
- More attention needs to be paid to tea stalls and petty shop owners with regard to enforcement of loose tobacco ban and creating awareness.
| Conclusion | | |
There was no compliance on sale of loose tobacco in Bidar City. Most consumer and almost all the tobacco vendors in Bidar City were unaware of loose tobacco ban. Most consumers and vendors prefer to buy and sell tobacco in loose, respectively. Most tobacco users anticipate buying cigarettes in pack would increase more consumption. Sale of loose tobacco was observed more in commercial areas and point of sale of loose tobacco was more in tea stall and petty shop.
Ethical clearance
The study was approved by Institute Ethics Committee (NIMHANS/EC (Beh.Sci.Div) 19th Meeting/ 2019 dated 02.07.2019).
Financial support and sponsorship
This study was funded by State Anti-Tobacco Cell, under National Tobacco Control Programme, Department of Health and family Welfare, Government of Karnataka.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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