N T C P

NATIONAL TOBACCO CONTROL PROGRAMME

District Anti Tobacco Cell, Hassan.

Background:

The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year around the world. More than million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke. Around 80% of the 1.1 billion smokers worldwide live in low- and middle income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco. (Reference WHO)

Tobacco burden in India:

Tobacco is one of the greatest threats to the health and wellbeing of all citizens in India. It is a common risk factor for the development of most of non communicable diseases including cardiovascular diseases, respiratory disorders and cancer. The GATS-II conducted in 2016-17 showed that in India, lO.7% of all adults smoke while 21.4o/o of all adults use smokeless tobacco. Tobacco not only has adverse effects on the individual who is using it but also affects the people around through second hand smoke.

Health Burden of Tobacco:

Cancer of oral cavity, tongue, larynx and pharynx, esophagus, stomach, gall bladder, urinary bladder, uterine cervix and lungs.
Cardio-vascular Diseases and Chronic Obstructive Pulmonary Diseases [COPDs] linked with the Tuberculosis.
40% of TB and other related diseases are attributed to tobacco consumption.
Oral diseases
Low-birth weight babies
Reduced fertility and sexual impotence among men.
Early ageing and wrinkling of skin.
Pre-mature deaths,
Cancers: 50% of cancers in males and 20% cancers in females are attributed to tobacco use,
Majority of cardio-vascular and lung disorders.

Burden of Second Hand Smoke:

Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people bum tobacco products such as cigarettes, bidis and hookah. There are more than 7000 chemicals in tobacco smoke, of which at least 25% are known to be harmful and at least 69 are known to cause cancer. As per the WHO Report-

In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it raises the risk of sudden infant death syndrome. In pregnant women, it causes pregnancy complications and low birth weight.
Almost half of children regularly breathe air polluted by tobacco smoke in public places.
Second-hand smoke causes more than 1.2 million premature deaths per year.
65,000 children die each year from smoke.

Attributable to second-hand To curb this menace Urban Development Department has issued a declaration to keep all the restaurants smoke free. Further, to protect the interest of nonsmokers a provision of “Designated Smoking Area” has to be established in the restaurants with seating capacity of 30 or more. These DSAs have to comply with the necessary and mandatory provisions as mentioned in the COTPA Act 2003. The DTCC shall have the right of inspecting and providing the necessary support in establishment of DSAs at district level.

A) PROGRAMME

About National Tobacco Control Programme: Government of India launched the National Tobacco Control Programme (NTCP) in the year 2007-08 during the 11th Five-Year-Plan, with the aim to (i) create awareness about the harmful effects of tobacco consumption, (ii) reduce the production and supply of tobacco products, (iii) ensure effective implementation of the provisions under “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” (COTPA) (iv) help the people quit tobacco use, and (v) facilitate implementation of strategies for prevention and control of tobacco advocated by WHO Framework Convention of Tobacco Control.

During the 11th Five Year Plan, NTCP was implemented in 21 states covering 42 districts. To carry forward the momentum generated by the NTCP during the 11th Five Year Plan and baseline data generated through the Global Adult Tobacco Survey (GATS) India 2009-2010, indicating high level of prevalence of tobacco use, it was up scaled in the 12th Five Year Plan with a goal to reduce the prevalence of tobacco use by 5% by the end of the 12th FYP. As per the second round of GATS, the prevalence of tobacco use has reduced by six percentage points from 34.6% to 28.6% during the period from 2009-10 to 2016-17. The number of tobacco users has reduced by about 81 lakh (8.1 million).

The main thrust areas for the NTCP are as under:

Training of health and social workers, NGOs, school teachers, and enforcement officers;
Information, education, and communication (IEC) activities;
School programmes;
Monitoring of tobacco control laws;
Coordination with Panchayat Raj Institutions for village level activities;
Setting-up and strengthening of cessation facilities including provision of pharmacological treatment facilities at district level.

Objectives of National Tobacco Control Program are as under:

To build capacity of the State / Districts to effectively implement the tobacco control initiatives; To train the health and social workers;
To undertake appropriate IEC activities and mass awareness campaigns, including at schools, workplaces; public place etc;
To set up a regulatory mechanism to monitor.
Implement the Tobacco Control Laws;
To establish a system of tobacco product regulation.
Provide facilities for treatment of tobacco dependence To conduct Adult Tobacco Survey/Youth Survey for surveillance, etc.
Integration with other programs under NHM: manpower, IEC, funding, strategies / Augmenting Tobacco Cessation: NPCDCS, NOIIP, Tb-Tobacco collaboration.
Action Plan to meet the 2030 target of 3% Reduction in tobacco cultivation.
Coalition with all stakeholders, academic institutions and professional bodies.

Structure of NTCP:

NTCP is implemented through a three-tier structure, i.e.

National Tobacco Control Cell (NTCC) at Central level.
(ii) State Tobacco Control Cell (STCC) at State level &
(iii) District Tobacco Control Cell (DTCC) at District level. There is also a provision of setting up Tobacco Cessation Services at District level.

Currently, the Programme is being implemented in all 36 States/Union Territories covering over 600 districts across the country.

National Tobacco Control Cell (NTCC)

The National Tobacco Control Cell (NTCC) at the Ministry of Health and Family Welfare (Mo HFW) is responsible for overall policy formulation, planning, implementation, monitoring and evaluation of the different activities envisaged under the National Tobacco Control Programme (NTCP). The National Cell functions under the direct guidance and supervision of the programme in-charge from the MoHFW i.e. Joint Secretary. The technical assistance is provided by the identified officers in the Directorate General of Health Services.

The programme broadly envisages;

National level

Public awareness/mass media campaigns for awareness building and behavioural change
Establishment of tobacco product testing laboratories.
Mainstreaming research and training on alternative crops and livelihood with other nodal Ministries.
Monitoring and evaluation including surveillance
Integrating NTCP as a part of health-care delivery mechanism under the National Health Mission framework.

State Level:

Dedicated State Tobacco Control Cells for effective implementation and monitoring of tobacco

control initiatives. The Key activities include;

State Level Advocacy Workshop
Training of Trainers Programme for staff appointed at DTCC under NTCP.
Refresher training of the DTCC staff.
Training on tobacco cessation for Health care providers.
Law enforcers training / sensitization Programme.

District Level:

Dedicated District Tobacco Control Cells for effective implementation and monitoring of tobacco

control initiatives. The key activities include:

Training of Key stakeholders: health and social workers, NGOs, school teachers, enforcement officers etc.
Information, Education and Communication (IEC) activities.
School Programmes.
Monitoring tobacco control laws.
Setting-up and strengthening of cessation facilities including provision of pharmacological treatment facilities at the district level.
Co-ordination with Panchayati Raj Institutions for inculcating concept of tobacco control at the grassroots.

Structure of NTCP:

District Anti Tobacco Cell DATC) Key Objectives /Activities.

Training of Key Stakeholders – Advocacy, Cessation, Enforcement officer Training
IEC activities
School Program
Monitoring of Tobacco Control Laws
Setting up and Strengthening Tobacco Cessation facilities.
Coordination with Panchayath Raj Institutions to implement the Tobacco Control Program at grass roots.

Documents:

Acts/ Rules:

Tobacco Control Law and Related Laws In India:

Ministry of Health & Family Welfare, Govt. of India enacted a comprehensive legislation, namely the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003) to discourage the consumption of tobacco products in order to protect the masses from the health hazards attributable to tobacco use.
Regulation 2.3.4 of Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations, 2011 dated 1st August 2011, issued under the Food Safety and Standards Act, 2006 by the Food Safety & Standards Authority of India (FSSAI), lays down that tobacco and nicotine shall not be used as ingredients in any food products and as such Gutkha is banned.
As per Section-77 of the Juvenile Justice (Care and Protection of Children) Act, 2015, whoever gives, or causes to be given, to any child any intoxicating liquor or any narcotic drug or tobacco products or psychotropic substance, except on the order of a duly qualified medical practitioner, shall be punishable with rigorous imprisonment for a term which may extend to seven years and shall also be liable to a fine which may extend up to one lakh rupees.
The Prohibition of Electronic Cigarettes (Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage and Advertisement) Act, 2019

Guidelines / Manual

Circulars Issued at State or District Level:

IEC: Information, Education and Communication (IEC) activities.

IEC is one of the major components of the District Tobacco Control Programme. District -wide IEC or public awareness campaigns have also been launched in the print and electronic media for dissemination of various provisions of the Act. This included publicity in District / Regional newspapers, private and Government Radio & TV channels and dissemination of publicity materials such as posters, stickers, handouts, factsheets etc. Dedicated spots have been developed as well as adopted from the global best practices. The Campaigns are aired through the Government as well as Private Channels for both video/TV as well as radio/FM. Accordingly, there is also provision of dedicated funds for carrying out IEC activities at State/district level.

School Programme
Rose Campaign
Yellow line campaign
Other IEC activates

G) Enforcement Data:

H) Gallery:

Photo Gallery

News Media Gallery.

I) TRAINING:

The key thrust areas under the National Tobacco Control Programme include trainings of health and social workers, NGOs, school teachers, and enforcement officers The need for capacity building is fundamental to implement tobacco control policies to stave off the tobacco epidemic. Training is one of the vital components of the Programme.

Capacity building of the States/UTs is desirable for proper implementation and monitoring of the programme. Training and capacity building for tobacco control should be undertaken through State level advocacy workshops/sensitization programmes. Efforts should be directed to involve all the State government departments for tobacco control. Specific/tailor made trainings are organized for, Police, Food & Drug Administration (FDA), Health / Medical Professionals, Judiciary, Academicians, Students, Media etc. They also work very closely with NGO partners and involve them in advocacy workshops. The State Cell also organize Training of the Trainers Programme (ToT) for the District Tobacco Control staff appointed followed by refresher training at regular intervals. The trainings are organized at regular intervals and properly spaced in each quarter. Efforts are being made to integrate training with other health programmes such as NPCDCS, RNTCP, and others to maintain synergy. For conducting the State Level Trainings/Workshops, the existing State NHM norms should be used.

Tobacco Cessation Centre (TCC):

Focus Group Discussion involves gathering people from similar backgrounds or experiences, to bring them together to discuss a specific topic of interest. It is a form of qualitative research; here questions are asked about their perceptions attitudes, beliefs, opinion ideas, habits etc. In National Tobacco Control Program, FGD is conducted with identified tobacco users in a village; taluk and district level. and motivate them to quit tobacco consumption. It can be done with Self Help Group Meeting, Colleges, Youth Clubs, Parents Meeting at School and Colleges, Health Camps, Rotary club/Lions club, NGOs etc. Those who quit tobacco completely can share his/ her experience to motivate others. Tobacco victims and cancer patients can be invited to talk on tobacco ill effects and benefits so quitting tobacco. It can be done by using tobacco ill effects flipchart, posters and showing anti tobacco videos. Discussion should not only highlight the health hazards of tobacco, but it should also showcase the economic consequences on “how tobacco ruins a household”, “Economic Burden of tobacco”, “Social burden of tobacco” etc. The psychologist has to show them a different angle about their cultivated habit, how quitting will be beneficial to him/her in different was. At end of the FGD, psychologist should explain services available in Tobacco Cessation Centre and refer him to Psychiatrist working under DMIIP Program for any higher treatment, to those who are willing to seek tobacco cessation service. Educative materials, flipcharts, reading materials are given to FGD participants. Ideally, one FGD group consists of 1015 people. NTCP Psychologist has to be actively involved along with other NTCP team members. Counselor Psychologist under NTCP has to organize 4 such FGD’s in a month.

Telephonic Counseling/Phone Therapy:

Considering the current situations we encourage our Counselors/Psychologist to undertake “Telephonic Counseling” also called “Tele-therapy” or “Phone Therapy”. Phone Therapy or Phone Counseling is the process of talking to a client via telephone/Skype to resolve mental health issues. Telephone Therapy can be found effective in adolescents can be done through telephone or even Skype calls. Recent studies show that telephone therapy has much therapeutic value as Face to Face to therapy. It also can be used to supplement Online therapy sessions, send reminder SMS for follow up appointments etc,

Considering current scenario, TCC is a way of helping people who do not have means or opportunity to attend face toface sessions, and to receive the help that they want to receive.

WHO Framework Convention on Tobacco Control (WHO FCTC)

The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first international treaty negotiated under the auspices of WHO. There are currently 181 Parties to the Convention. It was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005. It has since become one of the most rapidly and widely embraced treaties in United Nations history.

The WHO FCTC was developed by countries in response to the globalization of the tobacco epidemic. It aims to tackle some of the causes of that epidemic, including complex factors with cross -border effects, such as trade liberalization and direct foreign investment, tobacco advertising, promotion and sponsorship beyond national borders, and illicit trade in tobacco products. The preamble to the Convention shows how countries viewed the need to develop such an international legal instrument.

Govt. of India ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2004, the first ever international public health treaty focusing on the global public health issue of tobacco control. WHO-FCTC provides for various measures to reduce the demand as well as supply of tobacco. India played a leading role in FCTC negotiations to finalize its provisions and was the regional coordinator for the South- East Asian countries.

The key demand reduction strategies are contained in Articles 6 to 14 which includes;

a) Article: 6 – Price and tax measures to reduce the demand for tobacco.
b) Article: 7 – Non-price measures to reduce the demand for tobacco
c) Article: 8 – Protection from exposure to second hand tobacco smoke.
d) Article: 9 & 10 – Tobacco content and product regulation
e) Article: 11 – Packaging and labelling of tobacco products.
f) Article: 12 – Education, communication, training and public awareness.
g) Article: 13 – Tobacco advertising, promotion and sponsorship
h) Article: 14 – Demand reduction measures concerning tobacco dependence and cessation

The key supply reduction strategies are contained in Articles 15 to 17 which includes;

i) Article: 15 – Illicit trade in tobacco products.
j) Article: 16 – Sales to and by minors;
k) Article: 17 – Provision of support for economically viable alternative activities.

About COP: The Conference of the Parties (COP) is the Governing Body of the WHO FCTC and is comprised of all Parties to the Convention. It keeps under regular review the implementation of the Convention and takes the decisions necessary to promote its effective implementation, and may also adopt protocols, annexes and amendments to the Convention. Observers may also participate in the work of the COP. The work of the COP is governed by its Rules of Procedure. Starting from COP3, the regular sessions of COP are held at every two years. COP sessions are as under:

COP 1: Geneva, 2006
COP 2: Bangkok, 2007
COP3: Durban, 2008
COP 4: Punta Del Este, 2010
COP 5: Seoul, 2012
COP 6: Moscow, 2014
COP7: Ministry of Health & Family Welfare, Government of India organized the Seventh Session of the Conference of Parties (COP7) under the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) from 7th—12th November 2016 in Greater Noida. Secretary, Health & Family Welfare became the President to the COP Bureau for two years.

The COP may establish such subsidiary bodies as are necessary to achieve the objective of the Convention. One example is the Intergovernmental Negotiating Body on a Protocol on Illicit Trade in Tobacco Products. The first Protocol to the WHO FCTC, the Protocol to Eliminate Illicit Trade in Tobacco Products, was adopted at the fifth session of the COP, held in November 2012 in Seoul, Republic of Korea, following several rounds of negotiations by the Parties. The Protocol builds the WHO FCTC in the fight against illicit trade, and is a new international treaty in its own right. India is Party to this Protocol.

COP 8: Geneva, 2018
MOP 1: Geneva, 2018

Link to WHO FCTC: https://www.who.int/fctc/about/en/

Sl. No	Name	Designation	Office Address
1	Dr. Shivashankar	District Surveillance Officer & Tobacco Control Officer	District Tobacco Control Cell 2^nd Floor District Health and Family Welfare office saligame Road Near indoor stadium Hassan -573201 E-mail: Phone No:9448220109
2	Mamatha.j	District Consultant
3	Vimala.P	Social Worker
4	Dimple gowda	Data Entry Operator