Rizwan Suliankatchi Abdulkader1, Dhirendra N Sinha2, Kathiresan Jeyashree3, Ramashankar Rath4, Prakash C Gupta5, Senthamarai Kannan6, Naveen Agarwal7, Deneshkumar Venugopal6. 1. Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, Tamil Nadu, 627012, India. sarizwan1986@gmail.com. 2. WHO FCTC Global Knowledge Hub on Smokeless Tobacco, Noida, Uttar Pradesh, India. 3. Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India. 4. All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. 5. Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India. 6. Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, Tamil Nadu, 627012, India. 7. South East Asia Regional Office of the World Health Organization, New Delhi, India.
Abstract
OBJECTIVES: We describe national and subnational trends in tobacco use over three decades in India, assess the impact of the World Health Organization's Framework Convention on Tobacco Control (FCTC) on them and draw inferences for regional tobacco control policy. METHODS: Data from nine cross-sectional surveys conducted between 1987 and 2016 were analysed. Time trends in gender- and state-wise prevalence were derived for different forms of tobacco. To assess Framework Convention's impact, relative changes in tobacco prevalence before and after its implementation were estimated. Progress towards global noncommunicable diseases target was also measured. RESULTS: Post-implementation of the FCTC, smoking and smokeless tobacco use declined by 52.9% and 17.6%, respectively. The tobacco product mix (exclusive smokeless/exclusive smoked/dual) underwent a reversal from 37:52:11 in 1987 to 65:22:13 in 2016. Having achieved 20.5% relative reduction since 2009, India is en route to achieving the global noncommunicable diseases target. CONCLUSIONS: Steep declines in tobacco use have followed the implementation of FCTC in India. However, the impact has been unequal on smokeless and smoked forms. Tobacco-control policies in high smokeless burden countries should take cognizance of this pattern and design comprehensive and flexible policies.
OBJECTIVES: We describe national and subnational trends in tobacco use over three decades in India, assess the impact of the World Health Organization's Framework Convention on Tobacco Control (FCTC) on them and draw inferences for regional tobacco control policy. METHODS: Data from nine cross-sectional surveys conducted between 1987 and 2016 were analysed. Time trends in gender- and state-wise prevalence were derived for different forms of tobacco. To assess Framework Convention's impact, relative changes in tobacco prevalence before and after its implementation were estimated. Progress towards global noncommunicable diseases target was also measured. RESULTS: Post-implementation of the FCTC, smoking and smokeless tobacco use declined by 52.9% and 17.6%, respectively. The tobacco product mix (exclusive smokeless/exclusive smoked/dual) underwent a reversal from 37:52:11 in 1987 to 65:22:13 in 2016. Having achieved 20.5% relative reduction since 2009, India is en route to achieving the global noncommunicable diseases target. CONCLUSIONS: Steep declines in tobacco use have followed the implementation of FCTC in India. However, the impact has been unequal on smokeless and smoked forms. Tobacco-control policies in high smokeless burden countries should take cognizance of this pattern and design comprehensive and flexible policies.
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