ABSTRACT
Cigarette smoking is a major public health issue in India and leads to significant morbidity and mortality. Addressing the issue of smoking is a major challenge to public health, as the addiction is hard to break. Counseling smokers regarding smoking cessation is the first step to achieving cessation, but the quit rates remain low. Several pharmacological interventions have been developed over the years. Nicotine replacement therapy is available in a variety of formulations, each with different advantages, drawbacks, acceptability among smokers and quit rates. In addition, a range of novel nicotine and tobacco products, including Heated Tobacco Products (HTPs), have been developed which leverage nicotine to aid in smoking cessation. A group of medical experts convened to review the evidence on the burden of smoking, the concept of Tobacco Harm Reduction (THR), novel nicotine and tobacco products for THR, and the potential of HTPs to aid in smoking cessation. This paper outlines the findings and recommendations regarding THR in the Indian context. The panel opined that tobacco cessation centers and counseling remain the foundation of tobacco cessation in India. At the same time, there appears to be potential for the application of THR products in India. The relevant authorities must review the potential of THR products, and make these available, to provide the best possible cessation strategy for the Indian population that is currently at risk of mortality and severe morbidity.
ABSTRACT
Justification: Screen-based media have become an important part of human lifestyle. In view of their easy availability and increasing use in Indian children, and their excessive use being linked to physical, developmental and emotional problems, there is a need to develop guidelines related to ensure digital wellness and regulate screen time in infants, children, and adolescents. Objectives: To review the evidence related to effects of screen-based media and excessive screen time on children’s health; and to formulate recommendations for limiting screen time and ensuring digital wellness in Indian infants, children and adolescents. Process: An Expert Committee constituted by the Indian Academy of Pediatrics (IAP), consisting of various stakeholders in private and public sector, reviewed the literature and existing guidelines. A detailed review document was circulated to the members, and the National consultative meet was held online on 26th March 2021 for a day-long deliberation on framing the guidelines. The consensus review and recommendations formulated by the Group were circulated to the participants and the guidelines were finalized. Conclusions: Very early exposure to screen-based media and excessive screen time (>1-2h/d) seems to be widely prevalent in Indian children. The Group recommends that children below 2 years age should not be exposed to any type of screen, whereas exposure should be limited to a maximum of one hour of supervised screen time per day for children 24-59 months age, and less than two hours per day for children 5-10 years age. Screen time must not replace other activities such as outdoor physical activities, sleep, family and peer interaction, studies, and skill development, which are necessary for overall health and development of the children and adolescents. Families should ensure a warm, nurturing, supportive, fun filled and secure environment at home, and monitor their children’s screen use to ensure that the content being watched is educational, ageappropriate and non-violent. Families, schools and pediatricians should be educated regarding the importance of recording screen exposure and digital wellness as a part of routine child health assessment, and detect any signs of cyberbullying or media addiction; and tackle it timely with expert consultation if needed.