ICMR-Knowledge Hub on Smokeless Tobacco

Smokeless Tobacco Products:

 A wide range of SLT products with different characteristics are in use around the world, including chewing tobacco, snuff, gutka, betel quid with tobacco, snus, toombak, iqmik, tobacco lozenges, and others. Yet limited data are available on the properties of these products, how they are used, constituents, prevalence, health effects, production, marketing and regulations. All these factors vary with regions around the world (1).

 The serious health effects of SLT have been documented. International Agency for Research on Cancer (IARC) has documented that there is sufficient evidence to conclude that SLT causes oral, esophageal, and pancreatic cancer in humans (2). Smokeless tobacco use also causes adverse oral health outcomes including oral mucosal lesions, leukoplakia, and periodontal disease. Additionally, SLT products contain nicotine, and users of SLT products demonstrate signs of dependence similar to those of cigarette smokers (3).

 In many regions and countries of the world, such as South-East Asia, SLT use is the predominant form of tobacco use. India itself is home for 67% of global smokeless tobacco users (1). Yet international tobacco control efforts have largely focused on cigarettes, devoting only limited attention to smokeless tobacco.

Project Framework:

Knowledge Hub works with a dedicated infrastructural setup and staff for smooth functioning. As decided by the experts, the Director NICPR would be supervising the consultants/experts and allied staff. The entire resource team collectively functions to develop knowledge base and for developing/implementing mining tools, developing and implementing virtual network platform for sharing data and expertise in their respective regions.

Current Knowledge Gaps:

Surveillance and Monitoring: Ongoing, comprehensive surveillance is needed to assess the scope of SLT use and changes in patterns of use, and to evaluate the impact of policies, interventions, and other steps that could be taken to address SLT use. However, many countries lack data on SLT use; where such data are collected, information on the use of specific products is very limited.

Products: Given the diversity of products and modes of manufacture around the world, a more comprehensive characterization of the properties of different products and their constituents is needed. Additionally, attention should be given to non-tobacco products that are frequently used in conjunction with tobacco, such as areca nut.

Health Effects: There are a few research bodies on particular health effects of SLT use in a few countries; the diversity of products, practices, and patterns of use precludes broad generalizations about health effects.

Economics and Marketing: Very little information is currently available on pricing and sales volume of SLT products in many countries. Given the high prevalence of SLT use in some LMICs and among poor and rural populations, pricing information may be especially important for understanding patterns of use and developing effective public health interventions.

Interventions: New interventions for SLT use prevention and cessation should be developed and tested at both the population and individual levels along with their impact on use of combustibles, cessation, and relapse.

Specific Objectives of the project:

  1. To develop and maintain a dedicated interactive web portal and knowledge dissemination through web portal.
  2. To interact and collaborate with national tobacco testing laboratories (NTTLs) around the nation and globally, for generating database of product information and constituents.
  3. To serve as a repository for SLT based database and Laboratory analysis reports, and for other evidence based information.
  4. To disseminate the produced material via varied channels to relevant stakeholders (via publications, web portal, consultations at request, training, workshops and conferences).

 

Progress So Far:

  • A comprehensive web-portal has been created with provisions to update it on a regular basis. The knowledge hub has been working on the various policy aspects of smokeless tobacco use globally.
  • The Hub conducted a 2-day National workshop on Tobacco Control and Health Informatics” with a special focus on Smokeless Tobacco. The main objective of the workshop was to ascertain various aspects of tobacco control with special focus on Smokeless Tobacco (SLT).
  • The Hub organized first international Inter-Country Meeting on SLT Policy during 16-18 August, 2017. This Meeting was attended by delegates from 12 Parties dealing having high SLT burden, especially from SEAR. The Hub presented a Report on the progress on implementation of different FCTC Articles with respect to SLT, the policy gaps therein and set of recommendations to prioritize SLT prevention and control under the FCTC and MPOWER frameworks.
  • Online certificate course on Smokeless Tobacco is in progress and has completed 8 sessions till now.

Publications:

  • Sinha DN, Suliankatchi RA, Gupta PC, Thamarangsi T, Agarwal N, Parascandola M, Mehrotra R. Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis. Tob Control 2016; Nov 30. pii: tobaccocontrol-2016-053302. doi: 10.1136/tobaccocontrol-2016-053302.
  • Sinha DN, Kumar A, Bhartiya D, Sharma S, Gupta PC, Singh H, Mehrotra R. Smokeless Tobacco Use among Adolescents in Global Perspective. Nicotine Tob Res 2017; Jan 19. doi: 10.1093/ntr/ntx004.
  • Sinha DN, Bhartiya D, Kumar A, Singh H, Mehrotra R. Men in Myanmar Submerged in Tobacco: Women Following. Nicotine Tob Res 2016; Dec 7. pii: ntw31
  • Sinha DN, Gupta PC, Kumar A, Bhartiya D, Agarwal N, Sharma S, Singh H, Parascandola M, Mehrotra R. The Poorest of Poor Suffer the Greatest Burden from Smokeless Tobacco Use: Study from 140 countries. Accepted in Nicotine Tob Res
  • Nethan S, Sinha DN, Mehrotra R. Non Communicable Disease Risk Factors and their Trends in India. Asian Pac J Cancer Prev2017; 18(5):2005-2010
  • Bhatt D, Sharma S, Gupta R, Sinha DN, Mehrotra R. Predictors of hypertension among non-pregnant females attending health promotion clinic with special emphasis on smokeless tobacco: A cross-sectional study. Accepted in BioMed Research International 2017

References:

  1. International Agency for Research on Cancer. Betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines. IARC monographs on the evaluation of carcinogenic risks to humans. Vol. 85. Lyon, France: World Health Organization, International Agency for Research on Cancer; 2004.
  2. National Cancer Institute. Smokeless tobacco or health: an international perspective. Smoking and tobacco control monograph no. 2. Publication no. 92-3461. Bethesda, MD: U.S. Department of Health and Human Services, National Cancer Institute; 1992. (Available on: http://www.cancercontrol.cancer.gov/tcrb/monographs/2/index.html).
  3. National Cancer Institute. Smokeless Tobacco and Public Health: A Global Perspective, 2014. (Available on: https://cancercontrol.cancer.gov/brp/tcrb/global-perspective/SmokelessTobaccoAndPublicHealth.pdf).

Funder:  Indian Council of Medical Research