Pattern of Smokeless Tobacco Initiation and Use among School Going Adolescents in Delhi, India: A Mixed Method Study.

INTRODUCTION: With growing trends in tobacco consumption, it has been observed that the age of initiation is gradually decreasing. To combat the deep-rooted problem of the Society, we need to target the adolescents at the time of their first consumption of tobacco forms. Hence, this study was conducted to assess the pattern of smokeless tobacco use among school going adolescents in senior secondary schools with the assessment of the sociodemographic factors responsible for initiation of smokeless tobacco use by adolescents. METHODS: A cross-sectional survey of total sample of 714 students across 9-11 standards in 3 schools of Delhi was done using a self-administered questionnaire after obtaining approval from Institutional Ethics Committee and School Health Scheme, Delhi. RESULT: Consumption of tobacco was found to be 27.9% at a frequency of 6-9 days in a period of one month and a majority of 31 (39.2%) students initiated the use in the age group of 10-11 years. Among the different SLT products, pan masala combined with zarda with 56 (70.8%) users, was found to be the most commonly consumed SLT product. Grocery shops were preferred POS among the students as (67%) of students obtained the SLT product from this POS. 56 (70.8%) of the students wanted to quit the habit of SLT use whereas 49 (62%) students tried to quit the habit and 43 (54.4%) students sought help in order to quit the habit. DISCUSSION: Such alarming results in terms of low age of initiation in Delhi is an emerging health problem. Adequate cessation programmes and schemes must be developed and strict implementation of laws and policies to achieve a tobacco free youth is the need of hour.

Compliance Assessment of Tobacco Products to Cigarettes and Other Tobacco Products Act in India with Reference to Third Amendment Rules, 2020.

OBJECTIVE: Tobacco use is associated with mortality in low- and middle-income countries including India with dual burden of smoking and smokeless tobacco (SLT). Aligning with the FCTC, India has made substantial amendments in strengthening graphic warning under Cigarettes and Other Tobacco Products Act (COTPA) for sections 7,8 9 and "Specified warning". Compliance assessment studies are necessary to understand current status of implementation for packaging laws. This study aimed to assess the compliance of COTPA sections 7,8 9 and Cigarettes and other Tobacco Products (Packaging and Labelling) Third Amendment Rules, 2020 in Delhi. METHODS: Cross-sectional study was conducted in two districts of Delhi selected by simple random sampling. Fifteen points of sales were selected from each district through purposive sampling and 57 smoking and smokeless tobacco products were collected with Indian and foreign origin. An observation checklist for product analysis was prepared and pack analysis done based on COTPA sections 7,8 and 9 along with Third Amendment,2020 which included pictures and warnings to be circulated in 2021. RESULT: Total 57 samples has smoking (49.1%), smokeless (50.9%) with no SLT product of foreign origin. SLT and foreign products had low compliance of Section 7 and third amendment 2020 rules which includes manufacturing date and origin. Indian smoking products were highly compliant to section 8 and 9 whereas foreign and SLT products showed low compliance to section 8. COTPA Third Amendment Rules (2020) compliance was seen in Indian products with regards to SW (68.4%), PW (61.4%) and quit line (78.9%) with no compliance at all for foreign products. CONCLUSION: Foreign brands and SLT products had low compliance with sections 7 and 8 of COTPA and its amendments (2020). Compliance with illicit trade and SW needs regulation and strict implementation of law for SLT products.

Non-compliant packaging and illicit smokeless tobacco in Bangladesh, India and Pakistan: findings of a pack analysis.

INTRODUCTION: Illicit smokeless tobacco (ST) trade has seldom been documented despite ST use in at least 127 countries across the world. Based on non-compliance with packaging regulations, we report the proportion of illicit ST products from samples on sale in Bangladesh, India and Pakistan where 85% of global ST users reside. METHODS: We purchased unique ST products from tobacco sellers in two purposively selected administrative areas (division/district) in each of the three countries. The criteria to determine illicit ST products were based on country-specific legal requirements for ST packaging and labelling. These requirements included: 'market retail price disclosure', 'sale statement disclosure', 'pictorial health warning (PHW) pertinence', 'appropriate textual health warning' and 'using misleading descriptors (MDs)'. Non-compliance with even one of the legal requirements was considered to render the ST product illicit. RESULTS: Almost all ST products bought in Bangladesh and India were non-compliant with the local packaging requirements and hence potentially illicit, all products in Pakistan lacked desirable features. The most common feature missing was health warnings: 84% packs in Bangladesh, 93% in India, and 100% in Pakistan either did not have PHW or their sizes were too small. In Bangladesh, 61% packs carried MDs. In India and Pakistan, the proportions of such packs were 32% and 42%, respectively. CONCLUSIONS: Weak and poorly enforced ST control policies may be slowing the progress of tobacco control in South Asia. Standardised regulations are required for packaging and labelling ST. Improving compliance and reducing sale of cheap illicit products may require business licensing and market surveillance.

Prevalence and Social Contextual Factors of Smokeless Tobacco Use: Insights from Schools of Delhi, India.

BACKGROUND: It was observed that adult users start tobacco use in childhood or adolescence. The influence of digital and print media, social acceptance among peers, and in order to mimic role models from films attracts youth towards tobacco. Hence this study was conducted to assess the prevalence of smokeless tobacco (SLT) use among school-going adolescents with the assessment of the influencing factors such as exposure at school, home, and public places along with the role of various media in SLT use by adolescents. METHODS: Cross sectional study was conducted with 860 students of class 9th -12th enrolled in schools. Purposive sampling of three schools was done from the study area to reach desired sample size. All the students of class 9th - 12th within selected schools were given chance to participate in the study. Data collection was done using pretested modified Global Youth Tobacco Survey (GYTS) questionnaire. RESULTS: Consumption of smokeless tobacco (SLT) was observed in 79 (11%) of 714 subjects. Significantly higher proportion (18.4%) of study subjects consumed SLT who were exposed to tobacco at school premises and 19.1% of study subjects who were exposed to teacher using SLT in schools compared to non-exposed group. (p=0.016). It was observed that 8.1% of subjects without any exposure to tobacco at home and 9.8% of subjects without exposure to tobacco at outdoor public space consumed SLT. Consumption of SLT use was highest (16.7%) among subjects exposed to tobacco advertisement or promotion through social media (p=0.04). CONCLUSION: High prevalence of SLT was detected among adolescents in school. Factors such as exposure to tobacco at home, public places, school and school teacher using SLT, exposure of tobacco advertisement and promotion via different modes of media was found to be significantly associated with the use of SLT in the adolescents of school.
.

Critical interpretative synthesis of herd immunity for COVID-19 pandemic.

INTRODUCTION: Countries globally are evaluating the concept of herd immunity and its critical role in the control of pandemic. The current paper attempts to conduct a critical interpretative synthesis (CIS) on the role of herd immunity in current COVID-19 pandemic. METHODS: CIS is tool for developing theoretical framework using interpretation drawn from relevant empirical and non-empirical sources. This review is done by formulating review question for literature search. Purposive sampling of literature was done followed by reciprocal translational analysis of extracted data. RESULTS: Herd immunity is indirect protection from a contagious infectious disease when a population is immune either through vaccination or natural immunity developed through previous infection. The reproduction number for COVID-19 in India was found to be 2.56 and herd immunity threshold as 61%. DISCUSSION: Exposing 71% young population in India to the SARS-CoV-2 infection can achieve herd immunity but with high morbidity as well as mortality. Vaccine are under process. Feco-oral transmission and reinfection of COVID 19 are major factors to develop or break the circle of herd immunity in community. "Immunity passport" can give false sense of security. Surveillance and seroprevalence studies assess immunity status, gradual exposure of infection to younger population and collaborative partnerships on organizations are few strategies to acquire herd immunity. CONCLUSION: Herd immunity is a measure for prevention and control of COVID-19 pandemic against the backdrop of mortality and morbidity. Vaccine can be boon but if herd immunity is to be acquired by natural infection then preparedness is necessary.

Challenges of the Deaf and Hearing Impaired in the Masked World of COVID-19.

Difficulties of the hearing impaired have increased due to COVID-19, leading to lack of inclusiveness along with the breakdown of their mental, physical, and social health. The study objective was to assess the challenges faced by the deaf and hearing-impaired people during COVID-19 by a literature review. Literature search was done using keywords such as "challenges" OR "barriers" and "COVID-19" OR "Deaf" OR "Hearing Impaired" OR "Communication" on PubMed and Google Scholar from November 2019 to June 2020. The challenges faced were lack of information, face mask making communication difficult, social distancing affecting their physical, mental health, stigma and barriers related to the health-care system. Strategies included use of technology, help from sign language instructors, and preparedness of health-care settings for the hearing disabled. System strengthening, tele-medicine, and policy amendments can be the pillars to build up the support system for the hearing impaired to protect them from COVID-19.

Protocol for a feasibility study of longitudinal surveys to assess the impact of policies on tobacco use among school-going adolescents in South Asia.

Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world's 300 million ST users live and use the most lethal ST forms. Little is known about the impact of tobacco control policies on the youth ST uptake in those countries. We planned to conduct longitudinal surveys among secondary school students to evaluate existing tobacco control policies on ST uptake and use, and a feasibility study for that prospective, observational cohort study. Study objectives: (1) To demonstrate the feasibility of selection, recruitment and retention of schools and of study participants; (2) To assess the feasibility and acceptability of the study procedure and study tool (questionnaire); (3) To assess if the questionnaire can assess tobacco uptake and use, and the potential predictors of tobacco uptake and use of the envisaged main study. Methods and analysis: The feasibility study will be conducted in two administrative areas within each of three South Asian countries: Bangladesh, India and Pakistan. We will use both quantitative and qualitative data collection methods. Eight eligible secondary schools will be randomly selected within purposively selected sub-districts from each country. We plan to conduct one baseline and one follow up survey among secondary school students, one year apart. At each time point, data on tobacco uptake and the potential predictors will be collected from students via self-administered questionnaires. The qualitative component will be embedded into the study with each round of data collection to assess the acceptability of the study instrument (questionnaire) and data collection methods, via focus group discussions with students and semi-structured interviews with schoolteachers. Recruitment and retention rates, completeness of the questionnaires, frequencies and associations of tobacco use and explanatory variables will be reported. Data gathered from the focus group and interviews will be analysed using the framework approach.