Smokeless Tobacco dependence and cessation measures in India

Smokeless Tobacco dependence and cessation measures in India

Ramu Venkatesan*1, Reena C. Jhamtani1, Shilpa Gupta1, Samir Vinchurkar1,2, Nilesh Jain1

1Harm Reduction Research and Innovation Center [HRRIC], Mumbai, India.
2National University of Ireland at Galway, Ireland.

international journal of aging research

India being the largest smokeless tobacco (SLT) producer and consumer in the South East Asia Region (SEAR) entitled with a range of products. SLT consumption is very common because it is associated with socio-economic and cultural perspectives in the India. After the implementation of the first treaty of the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), public health standards were reaffirmed and improvised through successful implementation of articles since 2007 as reported in the global progress factsheet. Many measures have been implemented for achieving the success of WHO-FCTC in India and to control the huge disease burden induced by tobacco use. The objective of the present study was to understand and explore the factors involved in the SLT demand reduction by revealing the dependence and cessation implementation in India in the context of strategies and policies. For this study, we searched for SLT dependence and SLT cessation literature survey in PubMed and obtained 102 literatures consisting of studies and reviews, which were further scrutinized by excluding the reviews, studies conducted abroad and studies conducted within the last 5 years (after 2015). No statistical significance was observed in comparison of National to International SLT dependence and an attempt to quit SLT following the tenure of a year. This is in-line with GATS-2 and international data. We have also discussed a diverse approach in the control of SLT at different levels-such as SLT users, healthcare professional, policy advocates supplier, labeling, legal policies, and educating at various platforms. Effective strategies for the cessation of SLT is mandatory with proper guidance for the manufacturer, users and sellers in controlling SLT products.

Keywords: Smokeless Tobacco, Cessation, WHO-FCTC, Healthcare provider

Free Full-text PDF

How to cite this article:
Ramu Venkatesan, Reena C. Jhamtani, Shilpa Gupta, Samir Vinchurkar, Nilesh Jain. Smokeless Tobacco dependence and cessation measures in India. International Journal of Aging Research, 2020, 3:68. DOI: 10.28933/ijoar-2020-06-1305


1. “GATS-2; Global Adult Tobacco Survey- Fact Sheet, India, 2016-17.”, 2017.
2. R.S. Abdulkader, D.N. Sinha, K. Jeyashree, R. Rath, P.C. Gupta, S. Kannan, N. Agarwal, and D. Venugopal: “Trends in tobacco consumption in India 1987 – 2016: impact of the World Health Organization Framework Convention on Tobacco Control.” Int. J. Public Health. 14 May, 2019.
3. “Smokeless tobacco in South-East Asia in relation to the WHO FCTC.”, 2013.
4. J. Kaur and D.C. Jain: “Tobacco control policies in India: implementation and challenges.” Indian J. Public Health. vol. 55, no. 3, pp. 220–227, 2011.
5. G.-I. The: “India – COTPA, 2003 – national.pdf.” Ministry of Law and Justice, New Delhi, 2003.
6. “Framework Convention on Tobacco Control (FCTC) Article 14 guidelines: a new era for tobacco.” WHO-FCTC (2011).
7. C. Secretariat: “Guidelines for implementation of Article 14 of the WHO Framework Convention on Tobacco Control (Demand reduction measures concerning tobacco dependence and cessation).” FCTC. vol. 4, no. 8, 2010.
8. “National Tobacco Control Programme.”, 2020.
9. “Manual on Tobacco Control in Schools: WHO-SEAR.”, 2006.
10. B.S. Lynch and R.J. Bonnie: “Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths.” National Academy of Sciences, 1994.
11. “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020.” World Health Organization. pp. 103 (2020).
12. G. of I. Ministry of Health and Family Welfare: “National guideline for tobacco cessation.”
13. P. Murthy, B.N. Subodh, D. Sinha, M. Aghi, and P. Chaturvedi: “Smokeless Tobacco (SLT) use and cessation in India: Lessons from user and health care provider perspectives.” Asian J. Psychiatr. 2018.
14. K. Nguyen, L. Marshall, S. Hu, L. Neff, N. Carolina, and S. Carolina: “State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults Aged ≥ 18 Years — United States, 2011 – 2013.”, 2015.
15. “Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.”, 2012.
16. T.J.W. Mary Theobald, Richard J. Botelho, Saria Carter Saccocio, Thomas P. Houston, Tim McAfee, Sarah Mullins: “Ask and Act Tobacco Cessation Program – Treating Tobacco Dependence Practice Manual – A Systems-change Approach,”, (2017).
17. “MMWR; Quitting Smoking Among Adults — United States, 2001 – 2010.”, 2011.
18. J. Middleton: “E-Cigs Promise & Perils.”
19. U. of California: “Pharmacologic product guide: FDA-Approved Medications for Smoking Cessation,” (2019).
20. P. Regulation, T.P. Regulation, and T.C. Act: “Tobacco Products Regulation – Action on Smoking and Health.”
21. FDA: “DH Consultation on Implementation of the revised Tobacco Products Directive (2014/40/EU), Response from Action on Smoking and Health.”, 2014.
22. R. Bertollini, S. Ribeiro, K. Mauer-Stender, and G. Galea: “Tobacco control in Europe: A policy review.” Eur. Respir. Rev. vol. 25, no. 140, pp. 151–157, 2016.
23. FDA: “Rules, Regulations and Guidance; FDA.” pp. 2, 2020.
24. FDA: “Family Smoking Prevention and Tobacco Control Act – An Overview,”
25. FDA: “Modifed Risk Tobacco Products; FDA.”, 2020.
26. J.S. Gordon, L. Akers, H.H. Severson, B.G. Danaher, and S.M. Boles: “Successful participant recruitment strategies for an online smoke-less tobacco cessation program.” Nicotine Tob. Res. vol. 8, no. January, pp. 8, 2007.
27. N. (Grant number(s) CA60586): “Snuff, Enough – Research-Tested Intervention Programs (RTIPS),”, (2020).
28. HRRIC: “QuitX.”, 2020.
29. K. Siddiqi, P.C. Gupta, V.M. Prasad, R. Croucher, and A. Sheikh: “Smokeless tobacco use by south Asians.” Lancet Glob. Heal. vol. 1, no. 2, pp. e71, 2013.
30. S.T. Nethan, D.N. Sinha, K. Chandan, and R. Mehrotra: “Smokeless tobacco cessation interventions: A systematic review.” Indian J. Med. Res. vol. 148, no. October 2018, pp. 396–410, 2018.
31. P.M. Patel, M.P. Rupani, and A.N. Gajera: “Dependence on smokeless tobacco and willingness to quit among patients of a tertiary care hospital of Bhavnagar, Western India.” Indian J. Psychiatry. vol. 61, no. 5, pp. 8, 2020.
32. A.D. K. J. Divinakumar, P. Patra, Jyoti Prakash: “Prevalence and patterns of tobacco use and nicotine dependence among male industrial workers.” Ind. Psychiatry J. vol. 26, no. 1, pp. 19–23, 2018.
33. M.J.K. Periyanan and A.K.P.D.M. Raj: “Patterns of tobacco usage among subjects with potentially malignant oral lesions or conditions in Chennai city: A comparative study.” J. Cancer Res. Ther. vol. 13, no. 2, pp. 230–234, 2017.
34. V. Arumugam, S. Kumar, and S. Sarkar: “Smoked and smokeless tobacco use among pulmonary tuberculosis patients under RNTCP in urban Puducherry, India.” Indian J. Rheumatol. pp. 4–12, 2016.
35. P. Sharma, P. Murthy, and P. Shivhare: “Nicotine quantity and packaging disclosure in smoked and smokeless tobacco products in India.” Indian J. Pharmacol. vol. 47, no. 4, pp. 440–443, 2015.
36. C.D. Almas Binnal, G Rajesh,Junaid Ahmed: “Determinants of Smokeless Tobacco Consumption and its Cessation among its Current Users in India.” J. Clin. Diagnostic Res. vol. 10, no. 10, pp. 16–19, 2016.
37. P. Jain, Raka, Jhanjee, Sonali, Jain, Veena, Gup-ta, Tina, Mittal, Swati, Chauhan, P, Raghav, R, Goelz and A. Robert: “Biochemical Validation of Self-Reported Smokeless Tobacco Abstinence among Smokeless Tobacco Users: Results from A Clinical Trial of Varenicline in India.” J. Psychoactive Drugs. vol. 47, no. 4, pp. 331–335, 2015.
38. R.S. SonaliJhanjee, Raka Jain, Veena Jain, Tina Gupta, Swati Mittal, Patricia Goelz: “Evaluating the effects of Varenicline on craving, withdrawal and affect in a Randomized Double-blind Placebo-Controlled Clinical Trial of Varenicline for Smokeless Tobacco dependence in India.” J. Psychoactive Drugs. vol. 47, no. 4, pp. 325–330, 2016.
39. “Largest Tobacco Producing Countries in The World.” World List Mania-The Dly. Rec. 2018.
40. “2018 global progress report on implementation of the WHO Framework Convention on Tobacco Control,” (2018).
41. “WHO Framework Convention on Tobacco Control.” WHO-FCTC.
42. F. Tr, W. Halliwell, N. Lindson, and P. Aveyard: “Tobacco cessation interventions for young people.” Cochrane Database Syst. Rev. pp. 1–102, 2017.
43. L.C. Dale, J.O. Ebbert, E.D. Glover, I.T. Croghan, D.R. Schroeder, H.H. Severson, and R.D. Hurt: “Bupropion SR for the treatment of smokeless tobacco use.” Drug Alcohol Depend. vol. 90, no. 1, pp. 56–63, 2007.