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.

Mobile Phone Addiction as an Emerging Behavioral Form of Addiction Among Adolescents in India.

INTRODUCTION: The advancements in mobile phones from simple basic phones to featured phones and smartphones resulted in the penetration of technology to different groups of people irrespective of age, gender, or region. Thus, mobile phone addiction has evolved as a form of behavioral addiction found to be increasingly prevalent among adolescents too. The study aimed to determine the prevalence of mobile phone addiction among adolescents and its associated risk factors among adolescents. METHOD AND RESULTS: A community-based, cross-sectional study was conducted among 264 adolescents (10-19 years) of low-income urban areas of Delhi. The prevalence of mobile phone addiction in the participants was 33.0% (95% CI: 27.2-38.6). The addiction was higher among boys (33.6%) than girls (32.3%) (p=0.835). Mobile phone addiction was found to be significantly higher among those adolescents who had ≥3 siblings, those belonging to nuclear families, and among late-onset users (≥16 years). Late-onset users (adjusted odds ratio {aOR}: 3.398; 95% CI: 1.307-8.833) and ≥3 siblings (aOR: 1.980; 95% CI: 1.141-3.437) were independent predictors of mobile phone addiction. The mean time spent on mobile phones was significantly higher among those with addiction but no significant gender difference was found between time spent on phones and addiction. CONCLUSION: The high prevalence of mobile phone addiction found in our study is an indication of the potential public health concern posed by mobile phone use among adolescents in urban settings. Hence, it is essential to limit the access to mobile phones for important utility purposes for adolescents.

Lifestyle practices predisposing adolescents to non communicable diseases in Delhi.

Background: Globally the prevalence of non- communicable diseases is on a rise. Adolescents are vulnerable to such diseases later on in life because of the susceptibility to behavioural risk factors like insufficient physical activity, unhealthy dietary practices and tobacco and alcohol consumption during this transition stage of their life. Adolescents who are from low-income families are also at increased risk of dual states of malnutrition such as underweight and obesity. So, this study aimed to estimate the prevalence of such behavioural risk factors among adolescents of low-income urban areas of Delhi. Methodology: A cross-sectional study was conducted among 264 adolescents (10-19 years) of low-income Urban areas of Delhi. Results: A total of 122 (46.2%) boys and 142 (53.8%) girls were enrolled in the study. The mean age of adolescents were 14.2 ± 2.4 years. The most prevalent NCD risk factor was physical inactivity (98.1% [96.4-99.7])). The screen time for television was significantly higher among boys than girls (p value 0.022). An age stratified analysis of risk factors showed that the intake of carbonated drinks (p value 0.026) and social media utilisation time (p value 0.037) was significantly higher among late adolescent boys (≥15 years) compared to early adolescents. Conclusion: There is high prevalence of physical inactivity and unhealthy dietary behaviours among adolescents which could be a warning sign for prompt actions as they are at risk of NCD in future. Hence healthier practices should be promoted among adolescents at community level.

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.

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.
.

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.