Problem Statement :

Effectiveness of anti-tobacco campaigns on tobacco usage

Introduction

Tobacco was introduced in India by Portuguese barely 400 years ago during the Mughal era. Mainly due to a potpourri of different cultures in the country, tobacco rapidly became a part of socio cultural milieu in various communities, especially in the eastern, north eastern and southern parts of the country. India is the second largest producer of tobacco in the world after China.

The challenge posed by tobacco has been countered by different countries with various levels of success. In South East Asia, Bhutan (2004), Thailand (2006) and India (2008) are some of the countries that have successfully enforced a smoking ban in public places. Bhutan is the first country in the world to impose a total ban on tobacco products-sale and use. China introduced a smoking ban in public buildings in Beijing from May 2008 as a run-up to the Olympic Games and a ban on smoking in public places came into effect from 1st May 2011. Singapore has had smoke-free legislation since 1970, but has strengthened it recently. Hong Kong enacted the smoking ban law in 1982 but could enforce it only since 2007. Countries like Indonesia (2006), Kazakhstan 2003), Malaysia (2004), Bangladesh (2006), Pakistan (2003), Philippines (2002), Vietnam (2005), Brunei Darussalam (1988) have banned smoking in public places, but implementation is far from complete.

Current scenario in India

INDIAN TOBACCO MARKET:

There are almost 275 million tobacco users in India. In India alone, cigarette production is valued around Rs. 22,000 crores and 12% out of this is exported. India is also the second largest consumer of tobacco in the world, second only to China. The prevalence of tobacco use among adults (15 years and above) is 35%. The prevalence of overall tobacco use among males is 48 percent and that among females is 20 percent. Nearly two in five (38%) adults in rural areas and one in four (25%) adults in urban areas use tobacco in some form. Among youth (age 13-15), 4% smoke cigarettes (boys 5%; girls%).

Around 14% of Indian adults smoke cigarettes and “beedis” (hand-rolled cigarettes), but nearly 26% use smokeless tobacco, including chewing tobacco, according to the Government of India and World Health Organization Global Adult Tobacco Survey of 2009 – 2010.

CONSEQUENCES :

Smoking kills : ~ 1 mn Indians / PA• smokers die 6 to 10 years earlier than non-smokers. 27% of youth (age 13-15) are exposed to secondhand smoke athome, while 40% of youth are exposed to secondhand smoke in public places.

TRENDS :

In India, the total spending by government and NGOs on anti-tobacco activities is less than 5% of the total spent by the tobacco companies for advertisement. If current trends continue tobacco will account for 13% of all deaths by 2020.

Over all 100,000 children below age of 15 start smoking every day. Quit rate in India is 10% , which is not significant as compared to the measures taken . Average number of quitting attempts ranges from 3-5. Source: GATS: India, WHO -2009-2010 report, nccd.cdc.gov, sunley EM India, Tobaco Atlas .

Initiatives taken by Government in India

India has played a leadership role in global tobacco control. With the growing evidence of harmful and hazardous effects of tobacco, the Government of India enacted various legislations and comprehensive tobacco control measures. The Government enacted the Cigarettes Act (Regulation of Production, Supply and Distribution) in 1975.The statutory warning "cigarette smoking is injurious to health" was mandatorily displayed on all cigarette packages, cartons and advertisements of cigarettes. Some states like Maharashtra and Karnataka restricted smoking in public places. In the case of Maharashtra, specification of the size of boards in English and Marathi were prescribed, declaring certain premises as smoke free. Tobacco smoking was prohibited in all health care establishments, educational institutions, domestic flights, air-conditioned coaches in trains, suburban trains and air-conditioned buses, through a Memorandum issued by the Cabinet Secretariat in 1990.

Since these were mainly Government or administrative orders, they lacked the power of a legal instrument. Without clear enforcement guidelines and awareness of the citizens to their right to smoke-free air, the implementation of this directive remained largely ineffective.

Under the Prevention of Food Adulteration Act (PFA) (Amendment) 1990, statutory warnings regarding harmful health effects were made mandatory for paan masala and chewing tobacco.

In 1992, under the Drugs and Cosmetics Act 1940 (Amendment), use of tobacco in all dental products was banned. The Cable Television Networks (Amendment) Act 2000 prohibited tobacco advertising in state controlled electronic media and publications including cable television. Under the Chairmanship of Shri Amal Datta, the 22nd Committee on Subordinate Legislation in November 1995 recommended to the Ministry of Health to enact legislation to protect non-smokers from second hand smoke. In addition, the committee recommended stronger warnings for tobacco users, stricter regulation of the electronic media and creating mass awareness programmes to warn people about the harms of tobacco. In a way, this Committee's recommendation laid the foundation of developing the existing tobacco control legislation in the country.

The Government enacted the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA), in 2003. The provisions under the act included prohibition of smoking in public places, prohibition of advertisements of tobacco products, prohibition on sale of tobacco products to and by minors (persons below 18 years),

ban on sale of tobacco products within 100 yards of all educational institutions and mandatory display of pictorial health warnings on tobacco products packages. The law also mandates testing all tobacco products for their tar and nicotine content.

In 2004, the Government ratified the WHO Framework Convention on Tobacco Control (WHO FCTC), which enlists key strategies for reduction in demand and reduction in supply of tobacco. Some of the demand reduction strategies include price and tax measures and non-price measures (statutory warnings, comprehensive ban on advertisements, promotion and sponsorship, tobacco product regulation etc.). The supply reduction strategies include combating illicit trade, providing alternative livelihood to tobacco farmers and workers and regulating sale to and by minors. India has been in the forefront of negotiations under various Working Groups of the WHO FCTC and also played a leadership role in bringing region specific issues e.g smokeless tobacco to the global attention. India has actively contributed to drafting of guidelines as a member of the Inter Government Negotiating Body (INB) to curb the illicit trade of tobacco products. India provided valuable contribution to development of guidelines for Article 9 and 10, 12, 13, 14, 17 & 18 of WHO FCTC.

In August 2005, India became the first country in the world to ban smoking scenes in film and television.

Although the Rules pertaining to various provisions under the law were notified during 2004 to 2006, there were many legal challenges which the Government had to face in view of the tobacco industry countering most of these Rules in the court of law. However after a long legal battle and interventions by the civil society, Revised Smoke-free Rules came into effect from 2nd October, 2008. The ban on smoking in public places, which included work places also, was a remarkable achievement in terms of political will and national commitment. Subsequently the law pertaining to pictorial warnings on tobacco products packages was implemented with effect from 31st ay 20M09. After getting positive and supportive judgments in other court cases, the Government was forthcoming in notifying laws pertaining to ban on sale to and by minors and sale of tobacco products within 100 yards of educational institutions.

National Tobacco Control Programme

As the implementation of various provisions under COTPA lies mainly with the State Governments, effective enforcement of tobacco control law remains a big challenge. To strengthen implementation of the tobacco control provisions under COTPA and policies of tobacco control mandated under the WHO FCTC, the Government of the India piloted National Tobacco Control Programme (NTCP) in 2007-2008. The programme is under implementation in 21 out of 35 States/Union territories in the country. In total, 42 districts are covered by NTCP at present. This was a major leap forward for the tobacco control initiatives in the country as for the first time dedicated funds were made available to implement tobacco control strategies at the central state and sub-state levels.

The main components of the NTCP were:

National level

Public awareness/mass media campaigns for awareness building and behavior change. Establishment of tobacco product testing laboratories, to build regulatory capacity, as mandated

under COTPA, 2003. Mainstreaming the program components as part of the health care delivery mechanism under the

National Rural Health Mission framework. Mainstream Research and Training on alternate crops and livelihoods in collaboration with other

nodal Ministries. Monitoring and Evaluation including surveillance e.g. Global Adult Tobacco Survey (GATS) India.

State level

Tobacco control cells with dedicated manpower for effective implementation and monitoring of anti tobacco laws and initiatives.

District level

Training of health and social workers, SHGs, NGOs, school teachers etc. Local IEC activities. Setting up tobacco cessation facilities. School Programme. Monitoring tobacco control laws.

A well designed public education campaign that is integrated with community and school based programmes, strong enforcement efforts, and help for tobacco users who want to quit, can successfully counter the tobacco industry. Such integrated programmes have been demonstrated to lower smoking among young people by as much as 40%. An intensive national level mass media campaign for awareness generation on harmful health effects of tobacco and provisions under COTPA has been a major initiative under NTCP for the last three years. The anti tobacco TV/radio messages were translated into 18 languages for the national campaign. The World Lung Foundation provided technical support for development of well tested and good quality TV/radio spots.

WHO Tobacco Free Initiative in India

Setting up of Tobacco Cessation Clinics in India has been one of the major highlights of WHO/Ministry of Health and Family Welfare collaborative programme in the area of tobacco control. Tobacco cessation is one of the important links of tobacco control as it helps current users to quit tobacco use in a scientific manner. Article 14 of the WHO Framework Convention on Tobacco Control (FCTC) also requires countries to take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence. During 2001-02, a series of 13 Tobacco Cessation Clinics were set-up in 12 states across the country in diverse settings such as cancer treatment hospitals, psychiatric hospitals, medical colleges, NGOs and community settings to help users to quit tobacco use. This network of Tobacco Cessation Clinics was further expanded in 2005 to cover five new clinics in Regional Cancer Centers

(RCCs) in 5 states of which two centers were in the North-Eastern States of Mizoram and Assam, having high prevalence of tobacco use. The Tobacco Cessation Clinics were renamed as Tobacco Cessation Centres (TCCs) and their role was expanded to include trainings on cessation and developing awareness generation on tobacco cessation. In 2009, two new TCC's were set up in Rajasthan and Delhi. A model for Workplace TCC was also set up in Nirman Bhawan in Delhi, where the Ministry of Health and Family Welfare is housed.

The role of TCCs was further expanded in 2009 and they were designated as 'Resource Centre for Tobacco Control (RCTC)'. Besides providing tobacco cessation services, these RCTCs helped in capacity building of other institutes to develop tobacco cessation facilities. Many of them have developed outreach programs for the community and are regularly doing awareness programs at schools, colleges, slums and workplaces.

Taking into consideration the definite felt need for tobacco cessation both in rural and urban areas, as revealed by the GATS India, 2010, the Government is looking at further capacity building initiatives to expand the tobacco cessation facilities in the country. The emphasis is now being laid on mainstreaming tobacco cessation in the health care delivery system by encouraging health care institutes to set up tobacco cessation facilities in their respective premises utilizing their existing infrastructure, where the Government and WHO will provide the requisite technical support. With this approach, many medical, dental colleges, general and TB hospitals have set up tobacco cessation clinics in their respective institutes. The Indian Dental Association, a professional organization has also initiated Tobacco Intervention Initiative (TII) to train the dental professionals in tobacco cessation and help set up cessation clinics.

With support from WHO, the following training and IEC material has been developed for facilitating tobacco cessation in the country. National Guidelines for Treatment of Tobacco Dependence have also been developed and disseminated by the Government in 2011, to facilitate training of health professionals in tobacco cessation. Various intervention and research studies were also supported to develop community based tobacco cessation models. These included, "An Intervention study on tobacco use practices and impact of cessation strategies among women of Jodhpur districts of Rajasthan' undertaken by Dr. S.N. Medical College, Jodhpur, Rajasthan, "An Intervention study on community based tobacco cessation among women in Varanasi district' undertaken by Banaras Hindu University, UP and a "Community based Tobacco Cessation Interventions project" in 4 states (Bihar, Assam, Tamil Nadu and Goa), coordinated by RCTC Goa (WHO India supported projects, unpublished).

Under GOI-WHO collaborative Tobacco Free Initiative, consultants have been provided in 12 out of 21 NTCP states to support state governments in implementation of the programme. WHO has also been supporting activities on World No Tobacco Day (WNTD), every year on 31st May.

Other initiatives for tobacco control

Advocacy for tobacco control - low awareness regarding the anti-tobacco law and its provisions at all levels of governance and policy making has been an important impeding factor for effective implementation of tobacco control policies. The states had not trained enforcement officials from

various departments e.g. police, food, drug, health, labor, transport, railways etc. who have been authorized to enforce provisions under COTPA, resulting in failure to initiate action for violations and the implementation of the law suffered. Moreover many of the States lacked the capacity and the mechanism for implementation of COTPA.

The Government of India organized a series of advocacy workshops in the country with the following objectives:

• Sensitization and awareness building of policy makers, law enforcers at various levels of governance and civil society groups;

• Capacity building of the states.

• Preparation of National and State-wise enforcement action plans for effective implementation of COTPA and WHO FCTC.

Tobacco Control Policies

• Cigarettes and Other Tobacco Products (Prohibition of Advertising and Regulation of Trade and Commerce, Production, Supply and Distribution) Act 2003

•Ban on smoking in public places;

•Ban on advertisements of tobacco products;

•Prohibition of sale of tobacco products to and by minors; and

•Specified health warning labels on all tobacco products

• Since October 2008, smoking has been banned in government buildings, private worksites, educational facilities, and healthcare facilities; and has been restricted in restauraunts, nightclubs and bars, and in other public places

• Advertising, promotion, and sponsorship has also been banned since October 2008

• The "Packaging and Labelling" rules came into force on May 31, 2009 targeting smoked tobacco and other chewing/smokeless tobacco products

• Graphic health warnings implemented June 1, 2011

In the State of Maharashtra, the ban on gutka has been more effective than in other states because the manufacture and sale of paan masala has also been prohibited since July 2012.

In November 2012, Rajasthan Government has issued a circular stating that a declaration needs to be collected from the candidate who joins the Government Service, giving an undertaking that he/she will not smoke or consume gutka during the service.

• In 2013, 4 states and 1 union territory banned sale of gutka, pan masala, and other chewing tobacco products

The government is set to launch two new advertisement spots it its anti-tobacco drive Oct 2, 2013. These will run in 16 different languages to reach across the country.

The new advertisement spots, "Child" and "Dhuan" (smoke), warn of the deleterious effect smoking has on health, and the destruction second-hand smoke can cause, besides also listing the penalties that those violating the law against public smoking can face. The spots have been developed by the World Lung Foundation (WLF).

Oct 2 also marks five years of the implementation of smoke-free laws in India.

The launch of these two spots will reinforce the government's emphasis on the issue of second-hand smoke and the implementation of smoke-free policies in India. The new spots will replace the earlier advertisements "Mukesh" and "Sponge" depicting the harm that smokeless and smoked forms of tobacco can do.

With the two new Anti-tobacco health spots Child and Dhuan (tobacco smoke) reinforcing the Indian government emphasis to curb second-hand smoke to implement a smoke-free policy, it is mandatory for Films screened after Oct 2, 2013 with smoking scenes to depict these two health spot warning for 30 seconds during the beginning and middle of the film.

Challenges and Opportunities

India is a major stakeholder in global tobacco control efforts and has always played a leadership role on various forums to bring the challenge posed by tobacco to the forefront. The country has taken many initiatives for tobacco control including legislative measures, ratification of the WHO FCTC and implementation of the National Tobacco Control Programme. The Indian anti-tobacco law is reasonably strong to comply with most of the provisions in the WHO FCTC. The Government is committed to face the challenge posed by high prevalence of tobacco use in the country and has tried mainstreaming tobacco control by integrating it into the ongoing national health programmes and National Rural Health Mission. As the implementation of the law and programme mainly lies with the state governments, much depends on prioritization of tobacco control by the states in view of the huge burden of tobacco related diseases, deaths and disability and resulting health cost burden. This is particularly relevant as the country is now facing the rising burden of non-communicable diseases for which tobacco is a major risk factor.

One of the areas needing attention is tobacco taxation. Taxation as a tool for price policy is at a very low level and even the low level of taxes are not effectively collected for all tobacco products except perhaps for cigarettes, rendering tobacco products quite inexpensive and affordable even by school children through their pocket money. Taxes have traditionally been raised targeting cigarettes. Bidis got more or less exempted from taxation for various reasons. There are reported incidences of huge tax evasion in

the smokeless tobacco sector. Globally raising the tobacco taxes on tobacco products has been effective in reducing the prevalence of tobacco use. Recently some of the state governments have come forward and raised VAT on bidis and smokeless tobacco products to the levels comparable to taxes on cigarettes.

Surrogate advertisements of tobacco products, brand stretching and brand extension by the tobacco industry amounts to gross violation of Section 5 of COTPA. Article 13 of the WHO FCTC also prohibits the same. With the Cable Television Networks (Amendment) Act 2009, which actually never came into force, there was a spurt of surrogate advertisements of paan masala in mass media. The Ministry of Health and Family Welfare took strong exception to these developments and the matter was taken up with the Ministry of Information and Broadcasting at the highest level to withdraw this amendment.

The country has also witnessed examples of community level initiatives for tobacco control e.g. tobacco free villages and educational institutions being reported from many states. Even before the revised smoke-free rules came into effect, Chandigarh was the first city to be declared smoke-free in 2007. This is an excellent example of partnership of state administration and civil society for tobacco control in the country. Sikkim was the first state in the country to be declared smoke-free in 2010.

Warning labels on tobacco products are an effective way of communicating the consequences of tobacco use and bring about behavioral changes like quitting and reducing the tobacco consumption (Fong and Hammond, 2009). Research studies in developed countries have shown that large and colorful and scary images warnings placed on the tobacco products are more effective in informing consumers and nonusers (Pan American Health Organization, 2009).

In India, warning on tobacco products is mandated under The Cigarettes and Other Tobacco Products (COTPA) (Prohibition of Advertisement & Regulation of Trade & Commerce, Production, and Supply & Distribution) Act, 2003. The current health warning appearing on tobacco products consist of a drawing of scorpion on smokeless form of tobacco and a picture of diseased lungs or a X- ray of lungs with cancer for smoked form of tobacco.

Indian studies have also recognized tobacco use as a major health hazard in India. Association of smokeless tobacco use with oral cancer was pointed out as early as 19087. Subsequent Indian studies on tobacco have amply shown its association with major diseases entities, both in smoking as well as in smokeless form. Tobacco is used for smoking as well as in smokeless form in India. Smoking of tobacco is mainly in the form of bidi, followed by cigarette, hukah, chilum, chutta, etc. The habit of smokeless tobacco (also referred as tobacco chewing) is also very common. Some common forms of smokeless tobacco include khaini, Mainpuri tobacco, mawa, mishri, etc. Careful review of Indian studies concluded that bidi smoking is also associated with the diseases caused by cigarette smoking and results in similar physiological changes9. Association of smokeless tobacco has been observed with cancers of oral cavity,pharynx, larynx and oesophagus, and precancerous lesions of oral cavity.

Major efforts for tobacco control in India

Warning on cigarette packages/ advertisements: Recognizing the health hazards of tobacco, the Government of India promulgated The Cigarette (Regulation of Production, Supply and Distribution) Act

1975. Under the act, all packages and advertisements of cigarettes are to carry a statutory warning, “Cigarette smoking is injurious to health”. The Act provides specific instructions related to minimum font size, colour contrast, etc. However, the Parliament’s Committee on Subordinate Legislation in its 22nd report (December 1995) on this legislation, observed that these guidelines were often not followed.

Warning on smokeless tobacco products:

In India, nearly half of the tobacco users consume tobacco in smokeless form. Realizing the need for a warning on smokeless tobacco products (which are classified as food material), the provisions under the Prevention of Food Adulteration Rules (1955) were applied in 1990, which necessitates that every package and advertisement of smokeless tobacco product should have a warning stating that “chewing of tobacco is injurious to health”. Packages of arecanut should also state that “chewing of supari may be injurious to health”. An expert committee of Directorate General Health Services also provided the minimum font size and other guidelines for this purpose.

Cabinet guidelines for smoking in public places: Cabinet secretariat by an administrative order in 1990, prohibited smoking in certain places such as hospitals, dispensaries, educational institutions, conference rooms, domestic air flights, A/C sleeper coaches in trains, sub-urban trains, A/C buses, etc. State Governments were also advised to discourage sale of tobacco products in and around educational and health related institutions. Direct advertisements of tobacco products had already been prohibited in government media, including Doordarshan and All India Radio. These cabinet guidelines were reiterated in 1998.

Legislation has also been promulgated by the states of Delhi, Kerala, Goa and Rajasthan, aimed mainly on prohibition of smoking in public places. Recently, many states such as Tamil Nadu, Maharashtra, Andhra Pradesh, etc., have imposed a ban on production and sale of gutka and pan masala-containing tobacco, as a short-term measure.

Multi-sectoral approach for tobacco control: The problem of tobacco in India is complex, in view of the varied nature of its use; association of a large number of sectors like health, agriculture, finance, mass media, labour, education, industry, welfare, etc.; unorganized nature of work for many tobacco products; dependence of a large number of people on tobacco production & processing; and need for action by many agencies. The situation necessitates multi sectoral approach, wherein different sectors (government as well as non-government) identify themselves as contributor to a radical social change leading to tobacco control.

A major exercise involving different sectors was organized in July 1991, through organization of a national conference on tobacco or health. Ban on consumption of tobacco products in other public places; Ban on sale of tobacco to minors; Ban on advertising; Statutory warning on all tobacco products; Printing of tar & nicotine levels; Compulsory licensing of tobacco products; Afforestation by tobacco producers; Regulation of tobacco production; Preference for non-smokers in certain jobs; Study of tobacco economics; varied economic and agro-industrial restructuring measures aimed at reduction of involvement of government, Reduction of tobacco crop with rehabilitation of concerned, Removal of

subsidies & guarding against involvement of foreign players, Increased taxation, etc.; Health education through various strategies; Involvement of 50 Years of Cancer Control in India

TOBACCO ADVERTISING KEY FACTS

Tobacco advertising Tobacco advertising encompasses direct and indirect advertising, promotion and sponsorship of tobacco products and brands. In some countries the tobacco industry can use print and broadcast media, billboards, electronic mail and direct mail and the internet to market its products. For example, one third of countries responding to a World Health Organization questionnaire still allow television advertisements, 40 years after they were first banned in other countries. Advertising in local magazines and on billboards has only been banned in just over half of the countries. Advertising on the internet is rarely controlled. Point of sale promotion is particularly powerful and can account for more than 75% of marketing spend by the leading tobacco companies. It is allowed in practically every country in the world.

Cigarette packs are also a key advertising medium for the tobacco industry. As more countries introduce larger text and pictorial warnings, opportunities for the tobacco industry to advertise on the pack are becoming limited. However, no country has yet introduced plain or generic packaging, which would completely remove all advertising from the pack. The use of direct tobacco advertising is being restricted or prohibited in a growing number of countries. This has led to an increase in the use of indirect advertising. Tobacco marketing by indirect advertising thrives on legal loopholes. Indirect advertising includes sponsorship of sports, cultural and music events, image and logo advertising, merchandising, manipulating pack designs, and product placement in television shows and films. Another form of indirect advertising is brand stretching – using tobacco brand names on non-tobacco merchandise. Only one third of countries prohibit brand stretching.

The effect of advertising by Companies :

The effect of advertising on tobacco consumption Advertising increases tobacco consumption. Young people are particularly vulnerable to it and are the main target of brand stretching. Tobacco advertising is also used to target women. Advertising glamourizes tobacco use and makes it socially acceptable. About half of the world’s children live in countries that allow the free distribution of tobacco products.

The tobacco industry maintains that the role of advertising is to encourage smokers to switch brands. However, industry documents have shown that advertising causes characteristics such as independence, glamour and machismo to be associated with smoking. Branding is used to discourage smokers from quitting, to encourage new smokers, and to undermine restrictions on tobacco marketing.

Tobacco companies use indirect advertising methods to circumvent bans.

Advertisement and Communication Campaign Mass Media Campaign Target Group:

General Public Communication Channel :

Urban: Newspaper advertisement, Newspaper articles, Bill Boards, TV ads, Radio, Out of Home media (OOH), Social media (Facebook Page, Yahoo groups)

Rural: TV ads, radio, Newspaper, articles, Wall paintings, Nukad Natak

OOH Media have a great coverage like shopping mall, BEST buses, Office Cafeteria on target group in metros.

Show the average cost of each cigarette is more than a “Vadapaw” (a food item) Person to Person CampaignTarget Group: College students, Corporate offices

Communication Channels:

Urban: Workshops, Health Center, Seminar Rural: Workshops, PHCs, Seminars Through: Doctors, Health Experts, NGOs, Quitters, and Volunteers

Introduction of fake cigarettes, which is anicotine.

NGO/Organisational Initiatives:

Nicorette support Facebook application for helping Face book Indian fans to quit smoking.

Ceche’s tobacco control program in south India –Incentives to refrain from tobacco related activities Source : Burning Brain Society, ncbi.nlm.nih.gov ,Primary Survey

Techfest, Indian Institute of Technology, Bombay have created national record for the maximum number of doodles (picture of a person holding anti-smoking message) used as social initiative on spreading a message against smoking among youth on social media. Doodle is the important tool which Techfest has started in association with Indian Cancer Society to support the movement to kill cancer campaign. They distributed sheets to various college students and asked them to write a message on it, hold up the paper, click a picture and upload it on social media like Face book and Twitter.

They also involved in reaching out to students in different colleges and organized lectures where doctor informed students about harmful effects of smoking. They also created an android application which provided information about cancer hospitals in India, medication reminders and a provision for student queries to be answered by Indian Cancer Society (ICS).

Indian Cancer Society :

CANCER DETECTION & AWARENESS PROGRAMS

Indian Cancer Society along with Johnson & Johnson India Contribution (J&J) team conducted Cancer Detection camps for underprivileged commercial sex workers in Mumbai.

During the period 1st April 2012 to 30th June2012 61 awareness programs were conducted at different location at Tata Institute of Social Science, MAVIM, Jagrut Ghar Kamgar Sanghatna, Johnson & Johnson, Tata Power, Lions Club of Bombay Vile Parle. 2100 individuals benefited from the program.

Being a pioneer in Cancer Awareness and given that Tobacco is one of the biggest causes of increase in the number of Cancer cases in India, Indian Cancer Society in 2012 has taken the initiative to commemorate World No Tobacco Day and spread awareness about the illeffects of chewing tobacco amongst the public. For this ICS conducted Anti-Tobacco Campaign in association with Lions Club of Bombay Vile-Parle on 31st May 2012, on the occasion of World No Tobacco Day 2012 at Dadar station. ICS did number of activities during Anti-Tobacco event on 31st May with a purpose to reach maximum number of people and make them aware about ill effects of consuming tobacco.

ICS conducted a Signature campaign in association with Voice Against Tobacco. Two Dummy Cigarettes were used in the campaign to encourage people to take a pledge to ‘Stop smoking’. People signed the Dummy cigarettes and filled up the Pledge form. ICS also conducted Anti-Tobacco Campaign in association with High Street Phoenix, Lower Parel. An art installation of 8ft.was displayed at HSP which act as a magnet to catch people eye during the event and also help ICS to achieve its purpose of campaign. This art installation was made by a renowned art director in industry named Khemchand Khadgi alias KK. At both events around 650 Pledge forms were filled. More than 1000 signatures were done on 2 Dummy Cigarettes. 3150 individuals benefited from this campaign.

CANCER REGISTRY

Mumbai Cancer Registry has undertaken following Projects:

1.Cancer Incidences in Maharashtra and Goa in collaboration with IARC/TMH

2.Mumbai Cohort Study: Cancer Epidemiology in Urban India in collaboration with Healis Sekhsaria Public Health Institute and National Institute of Health.

SALLAM BOMBAY FOUNDATION

On May 10th, 2011, SALAAM BOMBAY FOUNDATION in association with the MINISTRY OF HEALTH AND FAMILY WELFARE launched its National Anti-Tobacco Youth Campaign with singer SHAAN as the tobacco control ambassador for India. Shaan dedicated himself to the cause and pledged to do all he could to stand up against the tobacco menace.

Shaan's new music video titled "Life se Panga Mat Le Yar" has also been released. The new track is targeted at youth and sends a strong message that Life Without Tobacco Is A Life Worth Living. The 3.48 minute track has lyrics written by Rekha Nigam. The video shows Shaan dancing with children encouraging them to take all problems in their stride and not to make things worse by consuming tobacco. Ultimately, sending a message that tobacco use is a 'panga' they can live without. The entire video has a very pro-life stance, is youth centric and speaks of their dreams and aspirations.

Salaam Bombay Foundation is present in 147 Government schools reaching out to over 4 lakh children, providing them with the skills required to live a healthy and productive life.

In another move to stop consumption of tobacco amongst youngsters the Maharashtra Government on Wednesday i.e 5th October informed the Bombay High Court that all municipal corporations in the state have been asked to incorporate the provisions of Cigarette and Other Tobacco Products (Prohibition) Act (COTPA) in the license agreements of restaurants and eating outlets implicating a complete ban on sale of hookah and other tobacco products at such places. The action of the state government comes in the backdrop of a public interest litigation filed by an NGO called Crusade Against Tobacco. The NGO had alleged that minors were allowed to purchase hookahs in hookah parlors and eating outlets serving hookahs. The Brihanmumbai Municipal Corporation, based on an earlier order from the high court, had included the sections of COTPA in the license agreements of restaurants by which the eating joints would be prohibited from selling tobacco products, including cigarettes and hookah.

CONCLUSION PART

Best practice

• Adopt a comprehensive ban on all direct and indirect forms of tobacco advertising, promotion and sponsorship. Comprehensive bans on tobacco advertising, promotion and sponsorship reduce tobacco consumption. Partial advertising bans do not work. Article 13 requires parties to implement measures that allow for a comprehensive ban on direct and indirect tobacco advertising, promotion and sponsorship.

• Cover all media players and platforms comprehensively.

• Discard voluntary codes proposed by the tobacco industry.

• Carefully define the terms ‘advertising’, ‘sponsorship’ and ‘promotion’.

• Ensure the ban covers promotion originating in and entering a country.

• Ban commercial displays of product packages.

• Impose substantial penalties on those who breach the ban.

• Announce the ban well in advance of implementation.

• Amend the ban as required to include innovations in industry tactics and media technology.