Policy Brief Assignment on Adolescents Tobacco Use

Question

Task:
Write a policy brief assignment exploring the policies undertaken by the government to reduce and eliminate the tobacco consumption among adolescents.

Answer

Executive Summary
The main concern of this policy brief assignment is “Tobacco” which is one of the major issues in many emerging markets and low-income earning economies which has contributed to ill health and social crimes. In India, Tobacco use is one of the main public health challenges as approximately 275 million adults have been consuming varied tobacco products. The Indian Government has created Tobacco Control Legislations (2003) and has become amongst a few countries for ratifying WHO Framework Convention on Tobacco Control. The tobacco policy in India though effectively introduced has failed to bring about major changes to the society and community as a whole. There need to be certain policy recommendations and strategic changes introduced as mentioned in the policy brief assignment such that the effectiveness of these policies prevails.

Introduction
Tobacco is one of the major issues in many emerging markets and low-income earning economies which has contributed to ill health and social crimes. In India, Tobacco use is one of the main public health challenges as approximately 275 million adults have been consuming varied tobacco products. The Indian Government has created Tobacco Control Legislations (2003) and has become amongst a few countries for ratifying WHO Framework Convention on Tobacco Control (WHO FCTC 2004). Consuming tobacco can acute severe health hazards like heart diseases, lung diseases, diabetes, a chronic obstructive pulmonary disease that includes emphysema, chronic bronchitis, and others. Smoking tobacco might also increase risks like tuberculosis, impair in eyes, issues in immunity services, and others (Heydari, 2020). The report on policy brief assignment will aim to discuss and evaluate the policies undertaken by the government for the reduction and elimination of tobacco trade and consumption.

Background of the Tobacco Consumption
WHO (2015) contemplates that India is a "high burden tobacco use country" which has implemented many best buy measures for reducing tobacco usage and consumption. India is one of the countries where health burdens have been majorly impacted by tobacco consumption. The country is not only constituting direct tobacco consumption like bidis, cigarettes & Hookahs but the nation has the highest consumers of smokeless tobacco. Consumption of smokeless tobacco is high in men than women. Examples provided in the policy brief assignment include khaini, gutka, betel quid with tobacco, and others. In this view, the MPOWER measure has been implemented in India due to which nation-wide campaigns have been conducted for raising awareness about the ill impacts and dangers of tobacco use. The country has collaborated with Bloomberg Initiative for supporting the Indian Government in controlling tobacco use. The collaborations have been impactful in running sustainable programs for protecting young adults towards exposure to tobacco and its smoke thus preventing premature deaths and other related diseases. This policy report will be drafted through secondary research on the topics for research on the challenges and opportunities of the Indian Government in managing this public health issue.

Policy Options
In the current scenarios, the Country has been using MPOWER measure for controlling the use and impacts of tobacco consumption.

MPOWER Measure in India
To curtail its one of the major public health challenges, India launched its MPOWER Measure in the year 2004. MPOWER is the evidence-based tool kit that has designed by the WHO framework on tobacco control. The GATS survey of 2009- 2010 revealed that smoking in men is the highest (33.4%) as compared to the national average of 24.3%. the survey also depicted that passive smoking in the region was high especially in households that 82.5% due to which many nonsmokers experienced health hazards. India required Financial and technical support which was bridged by collaborating with national and international institutes and organizations. Thus, it is stated in the policy brief assignment that the implementation of MPOWER helped insignificant achievement in demand and supply strategies for the reduction of tobacco buying and consumption.

The strategy was first implemented in the state of Himachal Pradesh, which showcased reductions from 16.1% to 21%. Mistry et al., (2018 ) conducted a study on the modifications and changes in the Community Tobacco Environmental Factors (CTE) as a tool for measuring the community compliance in the tobacco trade. The CTE factors include the density of tobacco vendors and advertisements that are directly linked with adolescent tobacco use in many parts of urban India. The author also depicted that community-level compliance with the control policies and youth tobacco consumption is completely absent. Thus, the author discussed that the burden of mortality rate and tobacco-related disease will require long term prevention and control actions for including the family factors, policies, and communities for reducing tobacco use amongst young adults. In this view, Malhi et al, (2015) also conducted a study on MPOWER for the years 2009, 2011, and 2013. Malhi et al, (2015) based his analysis on the research designs made by the tobacco control specialists of Iran and other countries. Kaur& Jain (2011) demonstrated that warnings on cigarette packages reduced the consumption of tobacco, however, taxation policies slowed this progress. Hence, herein policy brief assignment the author concluded that the MPOWER measure has to be improved in India for reducing the ill- effects on young adults from tobacco consumption and trade.

Alternative Policy Options
Tobacco Control Legislations of Australia
Advertisement Laws - “Tobacco Advertisement Prohibition Act 1992” bans the promotion and adverts of any campaigns that encourage or persuade individuals to use or smoke tobacco-related products. The state and territory governments have created strict laws in sponsorships, advertisements related to Point- of - Sale and display in retail outlets of tobacco-related products. The government has undertaken a special initiative banning the advertisement of tobacco smoking or other tobacco-related products.

Laws Related to Tobacco Packaging- The “Tobacco Plain Packaging Act of 2011” states that all the tobacco-related products in Australia Should be packed in plain packages. Thus, the packages shall not contain any logos, images of brand, and promotional texts. This approach has discouraged many producers and manufacturers that are involved in the production of tobacco. After the implementation of such laws, tobacco control has been significant in the regions. Imported or manufactured cigarettes should comply with mandatory standards for reducing fire risks. High taxes are also laid on the tobacco for reducing its affordability by the consumers. The Australian Government has made it illegal for selling or purchasing nicotine (Department of Health, 2020).

Tobacco Control Legislation in the United States
In the year 2009, President Barack Obama had signed the “Family Smoking Prevention and Tobacco Control Act” that provided numerous powers to the “US Food & Drug Administration" for controlling the manufacturing, sale, and advertisements of all tobacco-related products. Under the law, a new center for the Tobacco products was created defining aspects and product standards. To block the sales of tobacco-related products to youth advertisements, promotions, labeling was banned while selling the products. As per the research on policy brief assignment, the laws in the US restrict the sale of Cigarettes to youths that are aged below 18. This law has restricted the sale of tobacco in retail outlets to the minors (Public Health Law Center, 2020). Also, approximately 290 jurisdictions have been enforced and adapted to cigarette vending machines. There have been tremendous states as well as federal efforts banning the use of tobacco usage in the country.

Tobacco Control in New Zealand
Like India, New Zealand has also partnered with the WHO Framework Convention on Tobacco Control in the year Feb 2007. Smoking is prohibited in several indoor public places. Individuals cannot smoke in public transports, airports, and other areas used publicly. There are strict restrictions on smoking outside schools & early childhood centers. There is a strict ban on tobacco advertisements and promotions, sponsorships, or displays in retail outlets. Plain packaging should be done without enlarging the brand logo (Ministry of Health, 2020). The packets of cigarettes should contain pictorial warnings of health covering 75% of the pack. The Ministry of Health in New Zealand is the key authority for policy development in tobacco control, development of services as well as undertaking operational aspects related to controlling usage of tobacco. The government has adopted Smokefree 2025 New Zealand to make recommendations to the general population as well as to Maori Affairs preventing consumption of tobacco. The government has introduced insights into Maori smoking by the adoption of international best practices to bring about effectiveness in the group. Packaging requirement in New Zealand has also undergone a standardized approach for packaging tobacco with standardized and regulatory messages related to warnings. There are several smoke-free Environments Act in the country, which are applicable across early childhood centers, schools, licensed premises, sports club, retailers as well as employers to prevent usage of tobacco.

In India, similar strategies can be used for controlling tobacco control. The Indian Government has increased the taxes on the tobacco products due to which price one pack of cigarette costs approximately $0.9 (Rs.50 INR). As discussed in the policy brief assignment, several strategies have already been implemented like a ban on public smoking, retail display and others for reducing the use of tobacco. The Indian Government can broaden its policies high taxation on the cultivation and sale of tobacco leaves to the factories (Campaign for Tobacco-free Kids, 2020). Also, the government should define the standards of cigarettes so that poor quality product is not produced which was also reduce its affordability.

Discussion and Implications The scope of the current policy implemented in India suffers from various backdrops. Though usage of tobacco amongst the adult population as well as amongst adolescents is of growing concern, yet policies adopted in the past as well as in the current scenario have not been effective in bringing about transformation in tobacco use in the society. Usage of tobacco in India amongst the adult male population is 42% whereas amongst the adolescent population it is 19%, amongst the adult female population it is 14% and amongst adolescents, it is approximately 8%. This high number of people consuming tobacco also accounts for the majority of deaths arising from tobacco-related diseases. Hence in India, there are various aspects of policy issues that need to be considered where changes need to be implemented. Some of these changes are as stated below within the policy brief assignment;

• Operative issues: Though India has effectively introduced sets of tobacco control policies as introduced by the WHO Framework Conventions for tobacco Control. This policy also effectively prevents access to tobacco products and second-hand tobacco promotion. Due to the vast stretch of India especially across urban and rural areas brings about significant operative issues. There have been non-compliance related to low restrictions on tobacco advertisements especially at the point of sale. There have been operative issues in the implementation of smoke-free laws or banning the sale of tobacco. Implementation of community tobacco environment (CTE) though has brought about effectiveness in reducing the sale of tobacco products but increasing exposure to tobacco advertisements at the point of sale has brought about ineffectiveness in preventing impulsive consumption and the purchase of tobacco. Only where laws, where smoking is banned in public places, has been effective in preventing smoking amongst youth. The influence of family members is effective in the prevention of usage of tobacco amongst youth and adolescents. Policies to bring about awareness in families regarding the various impacts caused by tobacco can effectively curb the usage of tobacco amongst family members. Individual-level factors moderate effectiveness in the CTE factors amongst adolescent tobacco usage. One major operative issue in regards to individual factors includes the inability to identify the relevant impacts associated with tobacco usage.

  Strategies adopted to curb the usage of tobacco across developed countries such as the USA, Australia, and New Zealand can be implemented across India as well with appropriate measures being taken for its implementation. In India, an adaptation of policy framework along with step by step approaches and strategies needs to be implemented for bringing about effectiveness in the main policy framework. Thus, with the present effectiveness, it can be identified that in case operative issues associated with these laws can be effectively overcome, then tobacco usage can easily be curbed. A conceptual framework incorporating varied family, individual with community-level influences is required to bring about effectiveness to controlling usage of tobacco.

• Scalability: One major issue associated with implementing policy within India is challenges associated with scalability. As evident from the year 2010, most of the policies implemented to curb usage of tobacco failed to inability to implement policies across lengths and breaths of the country. Though policy implementation in India has been effective in some context in urban areas, however, the wide-spread reach of rural areas has been missing to quite some extent. Policy implementation across rural areas such as banning of advertisements, preventing the sale of tobacco and tobacco-related products near schools, early childhood centers, retailers needs to be banned. A prominent issue about this challenge of scalability identified in the policy brief assignment is the easy availability of tobacco products in local areas. Across most local areas in India, tobacco products are grown and cultivated locally. This leads to the pertinent challenge of banning tobacco when it is readily available. Thus, youths and also children from a very young age start the consumption of these products readily. The law banning strictly consumption of tobacco in Indian rural areas is also bleak, leading to ineffectiveness in the implementation of the strategy and policies related to the same.
• Lack of measures: Though policy measures are prevalent in India, there is lacking measures to evaluate and monitor these approaches implemented. Lack of widespread healthcare activities and measures to tackle the prevalence of tobacco usage has led to the policy failing to reach its directed objectives. Thus, similar to other countries as indicated above the policy approach in India needs to encompass certain changes to include monitoring standards to understand the effectiveness of these policies.

Recommendations
To conclude the above policy brief assignment, it can be stated that the tobacco policy in India though effectively introduced has failed to bring about major changes to the society and community as a whole. There need to be certain policy recommendations and strategic changes introduced such that the effectiveness of these policies prevails. Some of the recommended steps for effective implementation of the tobacco policy includes;

• Operational directives: In tune with the above discussion, there needs to be introduced operational objectives that need to be attained by way of policy implementation. Specific strategies that are distinct to one another that is rural from urban areas need to be implemented to bring about efficacy to the policy.
• Adoption of metrics: Policy implementation needs to come with appropriate performance metrics adoption to ensure effective implementation. These metrics need to be collected from across the country and frequently evaluated to ascertain the effectiveness of implementation. This will lead to the application of approaches to tobacco control.

References
Campaign for Tobacco-free Kids. (2020). policy brief assignment Summary https://www.tobaccocontrollaws.org/legislation/country/new-zealand/summary (Retrieved 05 Sep 2020).

Department of Health. (2020). Smoking and tobacco laws in Australia https://www.health.gov.au/health-topics/smoking-and-tobacco/about-smoking-and-tobacco/smoking-and-tobacco-laws-in-australia#:~:text=about%20advertising%20bans.-,Tobacco%20packaging%20laws,on%20how%20brand%20names %20appear. (Retrieved 05 Sep 2020).

Heydari, G. (2020). A decade after introducing MPOWER, trend analysis of the implementation of the WHO FCTC in the Eastern Mediterranean Region. Lung India: Official Organ of Indian Chest Society, 37(2), 120.

Kaur, J., and Jain, D.C. (2011). Tobacco control policies in India: implementation and challenges. Indian journal of public health, 55(3), p.220.

Malhi, R., Gupta, R., Basavaraj, P., Singla, A., Vashishtha, V., Pandita, V., ... & Prasad, M. (2015). Tobacco control in India; A myth or reality-five year retrospective analysis using WHO MPOWER for tobacco control. Journal of Clinical and Diagnostic Research: JCDR, 9(11), ZE06.

Ministry of Health. (2020). Tobacco control in New Zealand https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/tobacco-control-new-zealand (Retrieved 05 Sep 2020).

Mistry, R., Pednekar, M. S., Gupta, P. C., Raghunathan, T. E., Appikatla, S., Puntambekar, N., ... & McCarthy, W. J. (2018). A longitudinal study of adolescent tobacco use and tobacco control policies in India. Policy brief assignment BMC public health, 18(1), 815.

Public Health Law Center. (2020). Federal Regulation of Tobacco https://publichealthlawcenter.org/topics/commercial-tobacco-control/federal-regulation-tobacco#:~:text=On%20June%2022%2C%202009%2C%20President,and%20sale%20of%20tobacco%20products. (Retrieved 05 Sep 2020).

WHO. (2015). Tobacco control in India https://www.who.int/tobacco/about/partners/bloomberg/ind/en/ (Retrieved 05 Sep 2020).