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Balsaraf et al: use worldwide

Review Article

Tobacco: Culture and legislature worldwide Balsaraf SV1, Chole R2

ABSTRACT 1Dr Balsaraf SV Oral cancer affects as many as 274000, people worldwide annually. MDS, Sr.Lecturer, Department of Tobacco use is one of the major preventable cause of premature Public Health Dentistry death and disease in the world. TSNAs are considered the most potent Sri Aurobindo Institute of Medical Sciences, Dental College classes of carcinogens with N-nitrosonornicotine (NNN) and 4- , (methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Risk Factors for 2Dr Revant Chole includes family factors, school factors, peer factors, MDS, Reader, Department of community factors, stress and domestic violence. Tobacco is an Oral Medicine & Radiology KIDS, Bhubneswar, Odisha, India integral part of the culture and tradition in many countries of the [email protected] South-East Asia Region. Tobacco use resulting in 5.4 million deaths every year. A new term, "thirdhand" smoke, has been proposed to Received: 06-08-2014 describe the particulate residual toxins deposited in layers all over the Revised: 22-08-2014 Accepted: 04-09-2014 home furniture after a cigarette has been extinguished. Many countries are putting ban for smoking in public places. Half measures Correspondence to: are not enough, when one form of advertising is banned; the tobacco Dr Balsaraf SV industry simply shifts its vast resources to another channel. 919977838788 [email protected] Governments are urged to impose a complete ban to break the tobacco marketing net. An effort is made to comprehend articles on tobacco by searched from journals through Google and Ebscohost Keywords: Tobacco legislation, TSNAs, third hand smoke, betel quid chewing, FCTC

Introduction world.[6] Smoking is the single most Tobacco plant was first grown (5000–3000 significant risk factor for periodontal BC) in Peruvian / Ecuadorian Andes. After disease [7] although potential periodontal the discovery of America tobacco was health effects of (ST) introduced to Europe. Court physicians in have received much less attention.[8] the European palace garden grew tobacco plants for its medicinal potential. Jean Chemical contents of tobacco products Nicot, a French ambassador to Portugal Oral tobacco products contains more than used an ointment made from tobacco 30 carcinogens- volatile aldehydes, leaves ‘to cure’ the tumor of a man in lactones, polycyclic aromatic Lisbon. His name was immortalized by hydrocarbons (PAHs), heavy metals, labelling the genus, ‘Nicotiana’. [1] radioactive metals and tobacco-specific N- Tobacco was introduced in India by nitrosamines (TSNAs) [9, 10] TSNAs are Portuguese 400 years ago during the considered the most potent classes of Mughal era. India is also the second carcinogens with N-nitrosonornicotine largest consumer of tobacco in the world, (NNN) and 4-(methylnitrosamino)-1-(3- second only to China. [2, 3] India is the pyridyl)-1-butanone (NNK).TSNA, 4- world’s third largest producer of (methyl-nitrosamino)-1-(3-pyridyl)- 1- tobacco.[4]. Oral cancer affects as many as butanol (NNAL) has recently been 274,000 people worldwide annually.[5] reported in US moist snuff products. [10] Tobacco deaths are preventable resulting In response to local exposure to in premature death and disease in the smokeless tobacco an increase in blood

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Balsaraf et al: Tobacco use worldwide

flow in the gingiva of humans is found, interviews with the vendors explained oral increased IL-2 production and decreased aesthetics and behavioral aspects. [17] In IL-12 production from macrophages, Javanese culture, it is considered decrease in growth of human oral inappropriate and dangerous to fibroblasts, prevalence of gingival experience and / or express strong recession is also reported in snuff users. emotions. Taking time out to smoke a [11] CSC (cigratte smoke condensate) can cigarette helped men reduce their feeling increase P. gingivalis HGF (human gingival of stress and helped control perceived fibroblast)-mediated collagen negative emotions, such as anger. [18] Gift degradation. [12] Bidis can deliver more tar giving has long been considered a tactic of and carbon monoxide than manufactured establishing and maintaining guanxi cigarettes. [12] Conversly in India the most (relationships) in Chinese milieus. common form of smoking tobacco is in Cigarettes were the most popular gift the form of bidis. [13] during Chinese New Year. [19]

Risk factors for smoking Public health problem Parental monitoring and conflict, school Tobacco use results in 5.4 million deaths factors include low academic every year. [20] In 2007, 19.3% of the achievement; peer-factors: drug using United State’s adult population smoked peers and individual level risk factors such tobacco cigarettes. [21] Over half of all as impulsivity, rebelliousness, and tobacco consumed in India is smoked as depression. Community factors including bidi (Indian specific non-filtered cigarette) community disorganization, is also a risk and about one-fourth of tobacco factor. Youth who smoke may do so to consumption is in smokeless form, such as alleviate or reduce stress both general and Mishri (tooth stress and family stress. [14] Domestic cleaner applied tobacco). [22]In Europe, violence is associated with higher odds of cigarette smoking is most common risk smoking and chewing tobacco in India. [15] factors for death from cardiovascular disease. [23] In Britain, mortality rates from Sociocultural dimension these cancers have fallen since 1950 for Tobacco is an integral part of the culture males and females despite rises in and tradition in many countries of the tobacco and alcohol consumption for South-East Asia Region. Offering raw much of that period. [24] About 40% of tobacco by children to the elderly in tobacco users in Thailand believe that a celebrations is a common practice in some hand-rolled cigarette is less harmful than communities in , India. In Myanmar manufactured cigarettes and this belief is people believe that tobacco smoke harms common particularly among the rural the fetus and husbands keep away from population where its use is also high. [16] smoking. Bhutanese people consider using A new term, "thirdhand" tobacco as a sin hence tobacco smoke, has been proposed to describe the consumption in the country is very low. In particulate residual toxins that are Sri Lanka, smoking among women is deposited in layers all over the home after regarded as a “village behavior” and not a cigarette has been extinguished. These appreciated by urban women. [16] It is not volatile compounds are deposited and quite clear why the Betel Quid Chewing "off gas" into the air over months. [25] habit is vanishing in Thailand, the Health promotion researchers state that

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culturally specific (CS) interventions are reductions in smoking among US adults. important in addressing smoking-related [34] In India, accepting the suggestions of health disparities. [26] the 1995 Parliamentary Committee on Subordinate Legislation, the Ministry of Tobacco legislation Health and Family Welfare introduced the Tobacco companies link their products to Bill in the in every conceivable cultural symbol, icon 2001. (Bill No. XXIX-F of 2001) “The bill and image. [27] The is may be supported to evolve into an Act as now turning increasingly to developing follows:—“This Act may be called the countries. World’s 1.3 billion smokers, live Cigarettes and Other Tobacco Products in developing and transitional economy (Prohibition of Advertisement and nations (February 2006 WHO fact sheet). Regulation of Trade and Commerce, [28] Smokeless tobacco use is on the Production, Supply and Distribution) Act, upswing in parts of the world, including 2003.” [3] Gutka smokeless tobacco is some countries of the South East Asian banned from sale in India from March Region (SEAR) of the World Health 2011 because its plastic packaging is Organization. [29] They have been striving harmful to the environment. The case was to increase the tax rates on tobacco brought under the country’s Plastic products and strengthen the tax Management and Disposal Rules, 2009. administration for tobacco control. Snus [35] The World Health Assembly in May has been heavily marketed in its native 2003 finally adopted the Framework Sweden, as well as Norway, Canada and Convention on Tobacco Control (FCTC), the USA. [2] However, test marketing in which the member states of WHO Japan is still there. [30] Tobacco cultivation adopted. [36] The WHO FCTC also calls on in India began in the late seventeenth countries to establish surveillance century, and bidis were first created when programs of the consequences of tobacco workers took left over tobacco magnitude to which tobacco is consumed. and rolled it in leaves for smoking. [13] The [6] The minimum age for the legal tobacco industry’s efforts to assuage purchase of tobacco increased from 16 to health concerns in smokers by marketing 18 years in England, Scotland and Wales cigarettes labeled as ‘‘light’’ and ‘‘mild’’ on 1st October 2007. [37] In 2003 the and low tar cigarettes are well Health Promotion Law was introduced in documented. Tobacco defined mild as Japan, which remains one of the most ‘‘delicacy of aroma and taste, soft-touch influential tobacco policies introduced in in mouth, smooth to throat, and low recent years in Japan. [38] The Member irritation,’’ and light as ‘‘low tar and countries of South-East Asia have been nicotine as well as still providing impact in striving to increase the tax rates on the mouth’’ [31, 32] Cigarettes that are tobacco products and strengthen the tax frequently labeled light, mild or low tar, administration for tobacco control. the smoke usually tastes weaker and Bangladesh is imposing duty and VAT on produces less irritation to the throat and the unmanufactured tobacco products chest than smoke from regular cigarettes and smokeless products. India is going to because it is inhaled in larger, more dilute introduce the Goods and Services Tax puffs. [33] Recent significant increases in (GST) with cascading tax rates. [16] funding for tobacco control media Research indicates that people who campaigns may contribute to meaningful experiment with smokeless tobacco

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generally develop a pattern of regular use, even as tobacco use declined. From 1994 and increase consumption over time. [39] to 2001, excise revenues more than The New Zealand Government has doubled as a result of tax increase in recently committed to the goal of making South Africa. In Thailand, tax increases New Zealand (NZ) smokefree by 2025. [40] between 1994 and 2007 raised cigarette In order to achieve a significant impact on excise taxes from 60% to 80% of the reduction of smoking and ETS wholesale price, increasing tax revenue (environmental tobacco smoke) exposure fromb20,002 million THB in 1994 to among adolescents in Juarez, Mexico, 41,528 million THB in 2007 even as greater compliance and enforcement of consumption decreased. [44] the existing laws is needed, which prohibit On average, from 2001 to 2005 the sales of tobacco to minors and smoking on price of tobacco products rose by an school grounds. [41] Researchers have annual rate of 6.8% above inflation in the observed increased advertising and European Union countries, which was promotion of smokeless tobacco in recent good progress when compared to the years, which target cigarette smokers. previous annual rate of increase of 2.7% Additionally, the opportunity exists to use observed in the same group of countries smokeless tobacco for nicotine delivery in during the period 1997–2001. Cyprus, public places and workplaces covered by France, Germany, Hungary, Lithuania and smoke-free indoor air policies, a Slovakia managed a greater increase. behaviour which could deter smoking However, real prices increased by less cessation attempts and negate social than 3% annually in Austria, Greece, norm change induced by this policy Luxembourg, Poland, Spain and the intervention. These two factors may result United Kingdom over the same period. in increased use of cigarettes and Prices were almost stable in Sweden and smokeless tobacco, termed ‘dual use’. [42] even fell in Denmark and Finland. The President Barack Obama signed prices of cigarettes and rolling tobacco the Tobacco Control Act on June 22, 2009, followed similar trends. In the the FDA's actions to protect the public CIS(Commonwealth of Independent health have included launching and States) and SEE(south eastern European) enforcing a ban on fruit- or candy-flavored countries (apart from Bulgaria) there was cigarettes, prohibiting the labeling of an unpromising trend towards cheaper products with the misleading terms tobacco products. On 29 March 2004, a "light," "low," and "mild;"'" and issuing a major development occurred in Ireland broad set of laws restricting access to and when smoking bans were extended for marketing of cigarettes and smokeless the first time in the European Region to tobacco products to young people. [43] pubs, bars and restaurants. On 1 June Every nation and sub-national entity with 2004, Norway became the second country an efficient tax system that has in Europe to impose a countrywide ban on significantly increased its cigarette tax has smoking in all public places, including all enjoyed substantial increases in revenue, restaurants and bars. [45] even while reducing tobacco use. Belgium, Greece, Ireland, In South Africa, every 10% increase Luxembourg, and Austria regulate tobacco in excise tax on cigarettes has been advertising, although it is still allowed. The associated with an approximate 6% laws have set out terms and conditions for increase in cigarette excise revenues, the advertising of tobacco products, such

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