P1.01-005 First of Its Kind Study in India Finds That Government's Ban on Gutka (Highly Popular Smokeless Tobacco Product) DID NOT Increase Smoking at All

Abstract

India with 11.2%(111.9 million) of world’s smokers has 2nd largest population at elevated risk of lung cancer. Almost twice, 206 million(GATS, 2010), are Smokeless tobacco(ST) users in India, highest globally. Supreme Court of India observed that gutka and pan-masala are food products. Beginning in 2012, almost all state governments in India banned gutka and pan-masala containing tobacco. APPREHENSION was raised that ban on ST products will cause switching to smoking by huge ST user population vastly increasing risk of lung-cancer in India. This ban provided natural experiment on which this observational research studied how ban on popular ST products alters pattern of tobacco-use, especially smoking. Findings are expected to be strategically significant to inform future policies. Questionnaire of Global Adult Tobacco Survey-India (2010), developed by WHO,CDC and Govt. of India was modified to answer research questions and accommodate retrospective-cohort study design. Through 2-step randomization process, 500 households were sampled from Delhi. Participants were adults and interviewed during March-June, 2016 comprehensively, including tobacco-use currently and before gutka-ban. Inbuilt mechanisms in standardized questionnaire cross-validated self-report and minimised recall bias. Data was entered into SPSS and statistically analyzed. 94% of 500 households visited agreed to participate. 73.4% of pre-ban gutka-users switched to twin-sachet (pan-masala and chewing-tobacco sold separately by gutka-manufacturers to circumvent law). Delhi’s order bans all ST products. But, except premixed gutka, remaining ST products are freely available and consumed. 21.8% switched to khaini or other ST products. A large fraction switched from single dose sachets to multidose sachet. Interestingly, 96.2% respondents believed tobacco as very harmful (84.6%) or somewhat harmful (11.6%). However, only 18.6% gutka users attempted quitting after ban. 4.8% successfully quitted. In our sample, we DID NOT find anyone switching to smoking due to gutka unavailability. On an opposite thought, one may expect, ban on an ST product (Gutka) will increase awareness and motivate smokers to quit as spillover effect. But it wasn’t observed either. In absence of strong quitting promotion campaign, ban on selective tobacco products has limited role in changing prevalence of tobacco use. If selective ST products are banned, ST users preferably switch to other available ST products, BUT NOT to smoking. As majority ST users switched instead of quitting (after gutka-ban without simultaneous quitting campaign), we may logically conclude that effective ban on all ST products may lead ST users to switch to less favourable option of smoking. This is, however, subject to verification by similar study if there is ever effective ban on all ST products.