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Indian Journal of Community Medicine

Vol. 32, No. 3 (2007-07 - 2007-09)

Editorial

Year : 2007 | Volume : 32 | Issue : 3 | Page : 169-170

Chandigarh: The first smoke-free city in India

Thakur JS
School of Public Health, Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Date of Submission 31-Jul-2007

Correspondence Address:
Thakur J S
School of Public Health, Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
India

Source of Support: None, Conflict of Interest: None
How to cite this article:
Thakur JS. Chandigarh: The first smoke-free city in India. Indian J Community Med 2007;32:169-70
How to cite this URL:
Thakur JS. Chandigarh: The first smoke-free city in India. Indian J Community Med [serial online] 2007 [cited 2007 Nov 30];32:169-70. Available from: http://www.ijcm.org.in/text.asp?2007/32/3/169/36817

Tobacco smoking is one of the chief preventable causes of mortality in the world. WHO, in the year 2002, estimated that in developed countries, 26% of male deaths and 9% of female deaths can be attributed to smoking. Use of tobacco currently accounts for 3 million deaths each year worldwide, and nearly a third of these deaths occur in India alone. Tobacco use, including both the smoking and the nonsmoking forms of tobacco, is common in India. Tobacco use in different population groups ranges from about 15% to over 50% among men.[1] Recent multicentric study done in Chandigarh, Delhi, Kanpur and Bangalore has shown the prevalence of "ever smoker" as 15.6%, with 28.5% among males and 2.1% among females. Vigorous anti-tobacco measures under the tobacco control programs yielded only a "quite" rate of 10%. Problem of smoking among adolescents is also increasing as ever smoking among the school-going youth of age 13-15 years reported on an average a prevalence of about 10% as a part of the Global Youth Tobacco Survey (GYTS). The smoking rates increase with age. Similar trends were seen in Chandigarh, with an overall prevalence of ever smoking as 26.0% (95%CI: 22.3%-30.1%) among youth (15-24 years) - with 37.2% among males and 8.7% among females. Prevalence of current smoking among males was 29.9% as compared to 5.6% among females.[2] Chandigarh is already experiencing an epidemic of noncommunicable diseases (NCDs), and the trends are disturbing.[3],[4] The prevalence of hypertension has almost doubled from about 27% in 1968 to 45% in 1996-97 among those above 35 years of age.[5] The deaths due to cardiovascular diseases have almost doubled in the last two decades, with 35% in 2002 from 18% in 1983 of the total deaths in Chandigarh.[6]

Effective tobacco control needs multipronged strategies focusing on reducing the demand for tobacco products. These strategies include anti-tobacco legislation, anti-tobacco education, increase in taxes, etc. The WHO Framework Convention on Tobacco Control has been developed as a scientific, evidence-based approach to global tobacco control, which has the potential to significantly advance national and international efforts to curb the growth of this pandemic. This initiative by the WHO provides countries a platform to sit together and discuss the issue and agree or disagree on a certain set of tobacco control measures for adoption.

In India, health legislation has been enacted at the state level. India's first national-level anti-tobacco legislation was the Cigarette Act of 1975, which mandated health warnings on cigarette packets and on cigarette advertisements. Then, Prevention and Control of Pollution Act included smoking in the definition of air pollution. Motor Vehicles Act of 1988 made it illegal to smoke in a public vehicle. Cables Television Network Amendment Act of 2000 prohibited the transmission of tobacco commercials on cable TV across the country. The Cigarette and Other Tobacco Products Act 2003 in India is a comprehensive legislation which prohibits the advertisement of - and provides for the regulation of trade and commerce in, and production, supply and distribution of - cigarettes and other tobacco products.[7] However, the Act is not being strictly enforced in different parts of the country due to various reasons and is mostly limited to papers only.

To control the rising trends of NCDs in the city, Chandigarh Healthy Heart Action Programme (CHHAP) is being implemented in Chandigarh Union Territory since 2004 in partnership with Health Department, Chandigarh, PGIMER, and supported by WHO-Government of India biennium program. It is working for an integrated control of noncommunicable diseases (NCDs) in Chandigarh. The project was launched with the objectives to increase awareness of the community for major risk factors of NCDs, like smoking, unhealthy diet, sedentary life style, alcohol and stress, by providing relevant health education; implement standard treatment protocols by the health care staff and to do surveillance of selected risk factors. CHHAP, from the time of its conception, has been working with stakeholders, including NGOs, for the control of tobacco smoking in Chandigarh. The main activities under the program can be assessed on its website (www.chhap.org).

The smoking rates have declined in the US population over a period of time. This has become possible because of the fact that as of July 3, 2007, there are 24 states and commonwealths with 100% smoke-free laws currently in effect for at least one of the three categories of workplace, restaurants or bars.[8] About two-fifths (41%) of the US population is covered with 100% smoke-free workplaces law, while 26% had 100% smoke-free workplaces, restaurants and bar laws. However, we could not encounter any smoke-free city in Southeast Asia. Chandigarh has perhaps become the first city in this region and in India to be declared as a smoke-free city from 15 th July 2007.

As per the public notice issued by Chandigarh administration, smoking at public places is banned - viz., at hotels, restaurants, beer bars, hospitals, bus stands, railway stations, buses, taxis, etc. All public places (buildings having open and other space, including private offices) should paste a poster of at least 30 cm × 60 cm in size stating "No Smoking" and nobody should be allowed to smoke even near the public places. All the police officers have been given instructions that they can take action against anybody smoking at a public place. Persons throwing the half-burnt buds shall be held responsible and can be penalized on the spot. Boards stating "No Smoking" should be placed at all the indoor places under rule 3 of section 4. Hotel-Restaurant owners have to make their premises totally smoke free. They should paste at least two posters/ hoardings of at least 30 cm × 60 cm in size stating "Cigarette smoking is an offense here." Heads of all the educational institutes should put a poster at the boundary of their premises stating that "Cigarette smoking in a radius of 100 meters of these premises is an offense." Tobacco outlets must put a poster of at least 30 cm × 60 cm size outside their shop stating that "Sale of tobacco or its products to a person of less than 18 years of age is an offense." A Tobacco Control Cell has been established in the city under the chairmanship of Health Secretary with police chief and other stakeholders as members to oversee the implementation of "smoke-free city" campaign. A website and "smoke-free" logo have been launched. The impact of these measures on prevalence of smoking and consequent diseases is likely to occur over a period of time. The Govt: of India is actively considering making New Delhi and Mumbai smoke free in the next 2 years. However, Chandigarh initiative is indeed a good beginning in the country, and its model would be a trendsetter for other cities in the country and region to follow. The members of public health professional bodies should work together with civil society organizations in the country for replication of this experience in other parts of the country.

References

1. Jindal SK, Aggarwal AN, Chaudhry K, Chhabra SK, D'Souza GA, Gupta D, et al . Tobacco smoking in India: Prevalence, quit-rates and respiratory morbidity. Indian Chest Dis Allied Sci 2006;48:37-42.
2. Bhardwaj S. Smoking habits and use of other tobacco products among youth in Chandigarh. MD Thesis, PGIMER Chandigarh; Dec 2005.
3. . Thakur JS. Emerging epidemic of non-communicable diseases: An urgent need for control initiative. Indian J Commun Med 2005;30:103.
4. Kumar R, Singh MC, Ahilawat SK, Thakur JS, Srivastava A, Sharma MK, et al . Urbanization and coronary heart disease: A study of urban-rural differences in Northern India. Indian Heart J 2006;58:126-30.
5. Ahlawat SK, Singh MM, Kumar R, Kumari S, Sharma BK. Time trends in the prevalence of hypertension and associated risk factors in Chandigarh. J Indian Med Assoc 2002;100:547-52. [PUBMED]
6. Bhatia SP, Gupta AK, Thakur JS, Goel NK, Swami HM. Trends of cause specific mortality in Union Territory of Chandigarh. Indian J Commun Med 2007;32:(in current issue).
7. The Cigarette and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003. The Gazette of India, Ministry of Law and Justice; No. 34, 2003.
8. Available from: http://www.no-smoke.org/pdf/100map.pdf. [Last assessed on 2007 July 30].

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