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Thursday, January 28, 2016

Sounding the smoke alarm

The high consumption of tobacco products by children under 18 is a warning that not enough is being done to spread awareness about health or enforce specific laws

Thanks to the Juvenile Justice (Care and Protection of Children) Act, 2015, tobacco companies in India may find it hard to lure children below the age of 18 into the tobacco habit. According to the Act, anyone who sells these products to underage children will face rigorous imprisonment up to seven years and a fine up to Rs. 1,00,000.
For long there has been a need to impose tougher punishment on those peddling dangerous substances to children, as existing legal provisions have been largely ineffectual. For instance, under the Cigarette and Other Tobacco Products Act, 2003, a paltry fine of Rs.200 was imposed on those who sold tobacco products to minors; this obviously did little to serve as a deterrent. Despite a ban on the sale of tobacco products to minors being in place since 2003, access to and availability of tobacco products was never a problem for children aged 13-15, according to the 2009-2010 Global Youth Tobacco Survey (GYTS), as over 56 per cent of those polled “bought cigarettes in a store were not refused purchase because of their age”. Most 15- to 17-year-olds were also able to purchase tobacco products.
Increase in consumption levels
Easy access to and availability of tobacco has had a direct impact on consumption levels. The GYTS found that nearly 15 per cent of children (19 per cent of boys and over 8 per cent of girls) in India as young as 13-15 years used some form of tobacco in 2009; another 15.5 per cent in the same age group who had never smoked before were likely to begin smoking the following year. The overall tobacco use among school students aged 13-15 increased from 13.7 per cent in 2006 to 14.6 per cent in 2009.
These startling figures on tobacco consumption by minors may still be a gross underestimate. By virtue of being school-based, the survey failed to take into account the most vulnerable population of children who are outside the schooling system and who are probably the earliest and most extensive users of tobacco. Several studies have found higher consumption levels of tobacco among uneducated children, among those with only primary-level education, and among those from the lower income strata.
Besides this, the 2010 Global Adult Tobacco Survey (GATS) report showed that nearly 10 per cent of children in India in the 15-17 age group consumed tobacco in some form. According to an August 2015 paper published in the journal Global Health Promotion, there are nearly 4.4 million children in India in the 15-17 age group who use tobacco daily.
Like in the case of the GYTS, the GATS report too suffers a major shortcoming. It does not have information on tobacco users from “many States”, the paper notes. Yet, taken together, the two surveys reveal that a quarter of children below the age of 18 consumed tobacco in some form or the other in 2009.
The data highlight how successful tobacco companies have been in employing multiple strategies to continually entice children into using tobacco at a very early age. For instance, tobacco companies offering free cigarettes to 13- to 15-year-old children, tobacco advertisements on billboards, the strategic placement of tobacco products inside shops, and the use of advertisement boards that do not meet the point-of-sale display specifications are some of the strategies employed by companies, according to a study published early last year in the journal, Asian Pacific Journal of Cancer Prevention.
That these strategies have been effective is evident: the average age at which there is daily initiation of tobacco in those above the age of 15 years is 17.8 years. This includes 14 per cent of those who smoke (cigarettes and bidis) and nearly 30 per cent of those who use smokeless tobacco.
Vulnerability of children
Why do companies target children? As the 1994 U.S. Surgeon General’s report had stated, companies are fully aware that the younger a person is when s/he begins to smoke, the more likely it is that s/he continue to smoke as an adult. Those who use tobacco at a younger age are more addicted to it and are less likely to quit the habit than those who begin using it later. Early use is also invariably associated with more frequent use. Early users are also less ignorant about the effects, making them easier prey for the tobacco companies.
While the Ministry of Women and Child Development’s initiative to disincentivise the sale of tobacco products to children through stiff penalty is commendable, the real challenge will be in its enforcement. Unlike in the developed countries where cigarettes are sold in licensed shops and outlets, “over 76 per cent sale of tobacco products in India is restricted to unlicensed small shops and kiosks found in every street corner”. Policing them will be a huge challenge.
Hence, a multipronged approach is necessary to keep the young ones away from tobacco. To start with, in accordance with India’s Cigarettes and Other Tobacco Products Act, 2003, enforcing the ban on the sale of tobacco within a 100-metre radius of schools coupled with a ban on advertisements on tobacco near schools should be a priority, as several studies have shown a link between availability and consumption.
Schools can also spread awareness about tobacco use among students to make the product less appealing. For instance, according to a 2012 paper in PLOS ONE, a unique programme in Mumbai that focussed on imparting life skills and creating awareness on tobacco among economically disadvantaged schoolchildren helped prevent more than 50 per cent of them from taking up the habit.
Meanwhile, more effective measures such as increasing taxes on tobacco products and introducing shocking pictorial warnings that cover 85 per cent of the front and back of packets are easily enforceable and would go a long way towards reducing consumption levels.
Since the Indian taxation structure is not linked to income growth and inflation, tobacco products get cheaper relative to income affordability. As an annual systematic inflation-adjusted increase in tobacco tax is not built into the process, there is a strong case to increase taxes every year. A steep increase in price will certainly prevent an overwhelming percentage of children from starting the habit and force many to quit. The negative impact on tobacco sales and consumption levels seen after an increase in taxes in the last two consecutive budgets serves as a pointer.
prasad.ravindranath@thehindu.co.in
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