Note: World Lung Foundation united with The Union North America. From January 2016, the combined organization is known as “Vital Strategies.”
(August 25th, 2015, New York, USA) – World Lung Foundation (WLF) today joined calls for regulation of smokeless tobacco products, recommending the introduction of graphic warning labels on smokeless tobacco packs, greater use of mass and social marketing campaigns to raise awareness, restrictions on marketing of the products and on sales to minors. A study led by public health experts at the University of York and published in BMC Medicine found that smokeless tobacco kills more than a quarter of a million people every year and harms the health of millions more.
Smokeless tobacco takes many different forms; while the study confirms that the majority of global consumption is in South-east Asia, recent cases of chewing-tobacco related death and disease among US sportsmen underline that this is a global problem which kills young and old alike. The University of York-led study confirmed that the problem is particularly acute in India, where 75 percent of smokeless-tobacco related deaths occur. WLF’s powerful mass media campaign, Sunita, was launched in 2014 to warn people in India about the devastating health harms of using smokeless tobacco.
Dr. Nandita Murukutla, Country Director, World Lung Foundation, commented: “There is a real and urgent need to change attitudes and practices towards smokeless tobacco, as many people aren’t aware of the real dangers. The problem is exacerbated if tobacco control regulation focuses solely on combustible tobacco products, leaving smokeless tobacco comparatively unregulated. The Mukesh, Sunita and other victim testimonial campaigns in India shone a light on the dangers of incomplete or inadequately enforced regulation of smokeless tobacco products and showed that even young people can develop oral and other cancers as a result of their habit.
“Tobacco does not discriminate; its use can destroy the health and happiness of anyone, even young men and women with significant family responsibilities, like Mukesh and Sunita. Their stories – and deaths – certainly raised awareness of the issue in India, as people started to realize that it could happen to them or to someone they love. Yet scientific studies of public health campaigns show that messages about health harms need to be repeated consistently over a period of time for knowledge to become embedded and habits to change. What is clear from this report is that more needs to be done in India and in many other countries around the world to raise awareness and reduce the terrible toll of smokeless tobacco.”
Sunita’s story
Sunita Tomar was a 27-year old wife and mother who developed oral cancer after using smokeless tobacco. The Sunita Public Service Announcement (PSA) shows Sunita before and after an operation to remove the cancerous growth and a part of her mouth. She describes how happy she was before tobacco took its terrible toll on her health and her appearance and how she never expected to develop oral cancer. The ad closes with a warning against using tobacco. The campaign was developed by the Ministry of Health of India with technical assistance from World Lung Foundation. It was one of a series of anti-tobacco ads screened in cinemas and theatres under India’s Cigarettes and Other Tobacco Products Act (COTPA) Film Rule. Unfortunately, Sunita lost her battle with cancer at the end of March 2015. A social media campaign, with the tag #AnswerSunita, called on the government to accelerate the adoption of tobacco control measures in India, particularly large graphic warnings on all tobacco packs.
Smokeless tobacco use in India and misperceptions about tobacco and dental health
According to The Tobacco Atlas, the regulation of smokeless tobacco products should be tightly integrated into tobacco control policies. In addition, specific communication strategies must be effected to change cultural beliefs and historic perceptions around smokeless tobacco. This is particularly important in countries like India, where 29.5 percent of adults use smokeless tobacco – one of the highest levels of prevalence in the word. A 2004 study found that many students in India use tobacco products as dentifrice, in spite of a 1992 law banning the use of tobacco in toothpaste or tooth powder. This reflects widespread misconception in India that tobacco is good for teeth and some manufacturers package and market their smokeless tobacco products as dental care products. Female tobacco users can be particularly susceptible to these messages; one study in an area of Kerala found that over 90 percent of female tobacco users started using tobacco because of tooth-related problems.
Research has shown that mass media campaigns are one of the most effective means to encourage people to stop using tobacco. Hard-hitting campaigns can compel tobacco users to quit, increase knowledge of the health risks of tobacco use, and promote behavior change in both smokers and non-smokers. It is one of the World Health Organization’s M-P-O-W-E-R (W=Warn) strategies to reduce tobacco consumption. MPOWER strategies are endorsed and promoted by the Bloomberg Initiative to Reduce Tobacco Use, of which World Lung Foundation is a principal partner.