Abstract
Nearly 8 million annual deaths occurring globally are attributable to tobacco use. Among more than 356 million smokeless tobacco (SLT) users in 140 countries, 82% reside in Southeast Asia with the vast majority being in India and Bangladesh. According to the Global Adult Tobacco Survey -2 data, 21.4% of adults in India consume SLT, among them 29.6% are men and 12.1% women. SLT has received less attention compared to its smoked counterparts in the public health measures to curb tobacco use. Though women are a sizable proportion of users, majority of the awareness building measures as well as governmental policies do not target them. This review aims to highlight these gaps objectively with constructive suggestions to enable a changed strategy to reduce tobacco consumption. (1) To critically review the gender sensitivity of tobacco control measures in India, (2) to conduct a comparative analysis of gender responsive strategies in India with those in smokeless tobacco high burden countries and (3) to make practical, feasible recommendations to enhance gender responsiveness of tobacco control measures in India in general and smokeless tobacco in particular. Following a comprehensive literature review to capture key information on gender responsiveness/sensitivity of strategies for tobacco control publications in English within the last 20 years, our search yielded 35 papers and reports from India describing policies relevant to SLT and women. Public health approach to tobacco control in general was found to be gender blind. It is evident that tobacco and smokeless tobacco related information and awareness activities need to focus more on women with improved messaging strategy to make it easily understandable and tailor the same to address the immediate and delayed health concerns. This much needed change would receive impetus with revisions in Governmental tobacco control policies, implementation and uptake.
Highlights
Tobacco use in smoked and smokeless forms, accounts for 10% of all deaths, worldwide, numbering to 8 million annually, most of them in developing countries (Sinha et al, 2018)
Among more than 356 million smokeless tobacco (SLT) users in 140 countries, 82% reside in Southeast Asia with the vast majority being in India and Bangladesh
SLT has received less attention compared to its smoked counterparts in the public health measures to curb tobacco use
Summary
Tobacco use in smoked and smokeless forms, accounts for 10% of all deaths, worldwide, numbering to 8 million annually, most of them in developing countries (Sinha et al, 2018). The various forms of tobacco used in Southeast Asia region include cigarettes, bidis (dried tobacco rolled in paper or leaf), SLT such as khaini (tobacco with slaked lime and aromatic spices), surti (dried tobacco leaves for chewing), or paan masala (tobacco with aromatic spices), gutkha (mixture of tobacco and molasses available in small sachets), application of gul or gudaku as dentifrice, and inhaling Nas and Naswar (nasal inhalation of tobacco powder) (Sreeramareddy et al, 2014) Majority of these products contain extremely high levels of nicotine resulting in chronic dependence. Conclusion: It is evident that tobacco and smokeless tobacco related information and awareness activities need to focus more on women with improved messaging strategy to make it understandable and tailor the same to address the immediate and delayed health concerns This much needed change would receive impetus with revisions in Governmental tobacco control policies, implementation and uptake
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