Most doctors in training smoke to beat stress,

Most doctors in training smoke to beat stress, 35% dependent
Keep-The-Promise Campaign
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[Healthcare staff needs tobacco cessation services first. Unless we ensure smoke-free workplaces in healthcare settings, and build capacities of healthcare service providers to render tobacco cessation services to people, how are we going to ever enforce anti-tobacco laws effectively and save needless burden of diseases, deaths attributed to tobacco use?]
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AIIMS Survey: Most doctors in training smoke to beat stress; 35% dependent
Indian Express
Monday 14 May 2007


Survey among medical students of region says undergrad smokers increase as semesters go by.

Cigarette Smoking is Injurious to Health", says the warning on every packet. But let alone the public, not even the would-be doctors heed to the advisory. An AIIMS survey on smoking among medical students in the Capital and other parts of the region has found that 56 per cent of them stick to the butt.

According to the survey, 35 per cent of medical students surveyed were found to be "nicotine-dependent".

The year-long survey was done by AIIMS' medicine department, with students from major medical colleges like AIIMS, Maulana Azad Medical College, University College of Medical Sciences and other colleges of North India answering questionnaires based on smoking habits.

How the survey was done

* Dr Randeep Guleria, professor of medicine at AIIMS, said the survey used the "Fagerstrom test for nicotine dependence", developed by Dr Karl Fagerstrom, one of the world's leading authorities on the effects of smoking.

"Dependence on smoking was assessed by the quantitative method with questions like number of cigarettes smoked every day and the time of lighting up the first cigarette after waking up," Guleria said.
"The motivation to stop smoking was assessed qualitatively by direct questions about intentions to quit."

What the survey found

* Of the total 182 medical students who filled the questionnaire, 102 (56%) were found to be smokers, while the other 80 said they did not smoke.
* Percentage of undergraduate smokers increased as the semesters went by.
* The average age of smokers was found to be 23 years, and the mean age of starting smoking was 18.65 years.
* 37.5 per cent students took to cigarettes after seeing others smoke, a further 32.5 per cent smoked since they felt it was a stress-buster; 8.75 per cent started due to "peer pressure".
* 11 per cent were found to be "heavy smokers", and 45 per cent had a "family history of smoking".
* 35 per cent showed "nicotine-dependence".
* 65 per cent had made attempts to quit, while 62 per cent were willing to quit if assisted.

Who says what

* An AIIMS undergraduate: "We are future doctors but we also have mood swings - sometimes stress-related (studies), and at time personal issues. Smoking at these times is found to be the best way to get relief."
* Dr Randeep Guleria, professor of medicine, AIIMS: "The use of tobacco by doctors reflects their attitudes to tobacco. Besides endangering their own health, doctors who smoke send a misleading message to patients and to the public."

The endgame

The study also found that most of the students surveyed are willing to quit smoking. So the doctors have recommended hospital authorities to set up "quit-smoking clinics" with psychotherapy facilities.

Online at: http://in.news.yahoo.com/070513/48/6fq5e.html

Let's find those alternatives

The Fiji Times

News- Let's find those alternatives

May 15 2007

Fiji will soon lose the preferential sugar price that it has enjoyed with the EU since 1974.
Sugar revenue, already in decline, will be further reduced causing loss of livelihood, displacement of large numbers in the farming community, and exacerbating socio-economic problems associated with such phenomena.

Therefore, economic recovery in the agriculture sector must be the topmost priority for any government, interim or elected.
Presently, the interim Government is reorganising the sugar industry to reduce the cost of production and introducing new varieties of cane with high sugar content.
But this is not enough: We need to explore other options and diversify into commercial farming for revenue generation and income generation in order to avoid urban exodus with its associated social fallout and erosive impacts on urban infrastructure.
Commercial agriculture for tourist and niche markets.
There is an urgent need to seriously explore the viability of commercial farming for the tourist industry in order to reduce the import bill and to provide alternative income in farming communities.
The time is right for generating organic farms for niche markets for our hotels as well as for export, given the recent upsurge of demand for chemical-free foods in first world countries.
Government needs to conduct research immediately to determine the demands and needs of the tourist industry in terms of fruit and vegetables.

This must include research and planning for transportation.

Further, this will entail the creation of small and medium industry (SMEs) in/near the farming areas to process and freeze the produce for the local tourist markets as well as for export.
Government will need to identify areas that are suitable for large scale farming, and organise a system for co-operatives in order to enable production in sufficient quantities.
Farms of about 1000 acres each, perhaps in three or four areas (say, in the North, West and Central divisions) would be ideal pilot projects.
For commercial farming to be viable the first priority is the security of land tenure.
The interim or any future government will need to work out a long-term lease facility that will offer security and encourage sugar cane and/or commercial agriculture farming for the tourist industry and exports.
In the recent past, India has been a success story of commercial farming via the Indian Tobacco Company (ITC) and multi-nationals like Pepsi.
The ITC, as the investor, undertakes the required logistics for the commercial farming venture: It identifies the produce suitable for regions and supplies all seeds, fertilisers, insecticides etc.
ITC's success in this venture is based on a scientific approach it has access to specific weather data through the Indian weather satellite to help determine the timing of planting, spraying, harvest, etc.
Many processed vegetables from India are now available in Europe, the United States of America, Australia and New Zealand thanks to ITC.
Similarly, Pepsi (the multinational giant) has joined in and is getting farmers in Punjab to plant potatoes for its local and overseas markets.
There is no reason why Fiji cannot gain a good share of such a market. Now, how do we attract these companies to Fiji?
Government will need to organise a very attractive investment package similar to that of the hotel industry and this should be valid for at least 10 years.
It is suggested this industry be given an 80 per cent return on investment through tax rebates annually.
This incentive will undoubtedly attract overseas investors as well as encourage local businesses to explore opportunities for commercial vegetable farming.
The local tobacco company might wish to emulate ITC, in view of the decline in the demand for tobacco, and utilise its set up and resources for alternative products.
Under Indian Government aid, two agricultural scientists with experience in commercial vegetable farming and the food preservation industry were posted in Fiji.

Fiji could request such aid and use their expertise for commercial farming.
I have been reliably informed that an Indian weather satellite passes over Fiji every three weeks.
Perhaps the Government should explore avenues to access this satellite for weather information for the suggested commercial vegetable projects.
India has openly stated it is willing to help Fiji.
We could absorb our Fiji College of Agriculture graduates into commercial vegetable farming through offering micro economic grants for such SMEs.
Fiji is eligible to access economic aid for such projects from the EU Economic Partnership Agreement under the key areas of EPA Development Needs and Adjustments Costs for Pacific ACP States'.
Funding can be sourced under private sector agro-processing and commercial organic agriculture for niche markets.
Tourism
It is common knowledge that tourism has overtaken sugar as the main income generator in a number of counties such as Mauritius.
Therefore, we need to explore avenues to diversify our tourism industry.
Medical tourism was the brain child of Finance Minister Mahendra Chaudhry in 2000 and was later followed up by Prime Minister Qarase, but nothing concrete has been achieved.
This latest trend in medicine is a lucrative venture and one that Fiji must not fail to take advantage of at any cost.
We need to identify accessible locations for this type of tourism, ensure that there is good infrastructure, hotel room facilities and resort-type facilities for carers of patients.
Government will need to devise an attractive economic package for such investment, and perhaps the Finance Minister would like to pursue this option once again.

Eco-tourism took off with a big bang at one stage but then the momentum was lost.
Eco-tourism attracts a special type of tourist and their numbers are growing every day.
An important aspect of this type of tourism is the requisite provision of infrastructure government will need to ensure that infrastructure to such areas is adequate otherwise such sites will become white elephants.
Abaca, for example has not been able to realise its full potential as a tourist destination because of a lack of infrastructure.
In this endeavour, too, the Government can access the EU-EPA aid for tourism development.
Fiji's marine resources in the Yasawas, Toberua, are potential revenue earners in eco-tourism.
The Abaca and marine reserve sanctuaries should be developed as joint ventures with the resources owners to whom low interest rate funding from FDB can be made available.
Eco-tourism development will blend well with the initiative in organic farming.
Fuel alternatives
Fiji's demand for fuel is very high and the cost is killing foreign exchange reserves.
The Government needs to stop paying lip service to the concept of alternative fuel sources.
It needs to conduct a study to determine:
The possibility of ethanol production; the cost of converting motor vehicles to use ethanol, and to compare the costs and long term benefits of ethanol use for the economy.
This should now form an integral part of the restructure of the sugar industry, together with co-generation of electricity from bagasse. Such an inclusive vision will give the sugar industry renewed life and enhanced economic value.
It will be worthwhile to study proposals for alternative energy generation projects (some that have been submitted to FEA) and have independent assessment of their applicability and benefits.
Information technology
The IT industry is huge in India. Many Australian and New Zealand companies are outsourcing from big Indian IT companies.
However, there are small and medium-sized companies that would be interested in coming to Fiji.
Fiji has resources such as high literacy, English speaking workforce, good infrastructure and telecommunications facilities, and ease of access to Australia and New Zealand.
If we are able to provide attractive tax packages to these SMEs, they will be lured to Fiji and we will benefit in terms of market and employment.
Suggestions/action required
In order for Fiji to achieve any economic growth, it is imperative that we are able to offer security of land tenure as well as security to life and produce.
Some areas that need attention are: NLTB can play a vital role in facilitating economic advancement for land owners, especially in view of recent criticism of its performance;
NLTB should emerge beyond the race factor and educate landowners/mataqali on options for land utilisation.
Once productive sugar cane lands now lying unused does not benefit the indigenous community or the nation.
It is more visionary to examine avenues for tie-ups and profit sharing for the benefit of investors as well as landowners in commercial vegetable farming; the personal involvement of landowners will guarantee the security necessary for investment and profit.
It will provide an alternative o the unfortunate recent trend of marijuana growing for subsistence;
NLTB must put an immediate stop to the leasing of reserved sugar cane farmlands for residential squatter settlement. These give short-term benefit to landowners, but commercial farming is a more sound alternative for both landowners and farmers;
NLTB must classify agriculturally viable land for long-term lease and develop conditions for renewals linked to the economy of Fiji.
In the future, there will be more indigenous Fijian farmers than Fiji-Indians.
This should be the determining factor for all procedures that are drawn up; the race factor should not be used to determine lease terms and/or renewal of leases.
Diversification of existing tourism resources England has laid the red carpet for tourists from India, and Australia and New Zealand are following suit.
Fiji needs to draw these tourist to our shores.
It would be worthwhile to do a package of concessions for hosting film festivals and Bollywood Awards in Fiji.

With its reputation as an exotic location, its beauty and good infrastructure, Fiji can explore these opportunities and benefit from the publicity. bnefits to economy Commercial vegetables farming will mean utilisation of land lying vacant, import substitution leading to savings in foreign exchange, and foreign exchange earnings form export of vegetables and fruit; generating employment and creating farms into small commercial ventures for our people and resource owners; diversification of the economy through organic farming and medical tourism will open up more land areas and earning opportunities for indigenous resource owners. Creation of new industries like food processing and freezing, ethanol production; saving foreign exchange and reducing fossil fuel consumption; expanding IT industry for employment generation and foreign exchange.

The views expressed are the writer's and not those of the Fiji Chamber of Commerce, of which he is acting president, or of the Consumer Council of Fiji, of which he is chairman.

online available at- http://www.fijitimes.com/story.aspx?id=62615

Rise in tobacco use in India alarming

Tamilnadu, Chennai

News- Rise in tobacco use in India alarming

May 14 2007

CHENNAI: While the use of tobacco and tobacco products in Western countries is showing a fall, it is alarming that their use is increasing in India, V. Shanta, director, Cancer Institute, has said.
Speaking at a workshop on `100 per cent smoke-free environment,' Dr. Shanta said after years of intervention and fighting the tobacco lobby, mortality rates due to cancers caused by smoking and using other tobacco products had dropped.
"Unless we start now in India, we will soon have a large youth population affected by disease."
The only way to generate awareness about the harmful effects of smoking was to ensure that each and every individual was reached with the message. Unless the government and media pitched in, it would be difficult to take the topic to the larger population.
The workshop was organised for representatives of auto drivers, according to E. Vidhubala, Principal Investigator in the WHO and Central Government-sponsored Tobacco Cessation Clinic at the Cancer Institute.
These `master' trainers would train other colleagues, even their clients, and spread awareness about the need for creating smoke-free, healthy environments.
Publicity material including posters, handouts and bills were given to each participant, to be displayed prominently and also distributed. They would have to document their work over the rest of the month in order to produce a report at the end of the period. Three best performers would be awarded.
Dr. Vidhubala also urged the government to ensure that the Central specification on displaying pictorial warning signs on tobacco product packages was implemented stringently.

Health Minister KKSSR Ramachandran said it was a good idea to use the auto driver as a vehicle for communicating the message about smoking and cancer. Prevention was the only way to tackle non-communicable diseases and lifestyle modifications were important. Mr. Ramachandran congratulated Dr. Shanta and her team at the Cancer Institute for not only serving people already affected by cancer but also launching a number of programmes aimed at prevention of the condition.

online available at - http://www.hindu.com/2007/05/13/stories/2007051304240600.htm

Hollywood to stub out smoking in movies

News- Hollywood to stub out smoking in movies

14th May 2007,

Australian anti-tobacco lobbyists have put their weight behind regulations initiated in the US by the Motion Picture Association of America to award pictures an R rating if they include smoking.
The Australian Council on Smoking and Health said that Australia should adopt the policy immediately and classify movies that promoted smoking with an R rating.

An R rating in the US means people under 17 must be accompanied by a parent or adult guardian. This can restrict the box office takings of many blockbusters which seek to attract the key teenage market.
ACOSH president Mike Daube said the tobacco companies were promoting smoking in films insidiously and evidence from the tobacco companies themselves showed they paid for tobacco placement in films.
“US research shows that smoking in films is a significant factor in children taking up the habit and increases the chance by two to three times,” he said.
The MPAA guidelines will not affect films where smoking is historically portrayed but will impose a tougher classification if smoking is glamorised, gratuitous or pervasive.
But leading US anti-smoking activist Stanton Glantz told The West Australian the new measures were “loophole-ridden guidelines”.
Professor Glantz said the studios, which control the MPPA, want the measures to include an option for smoking in films and want to keep paid product placement. Spider-Man 3, which just set a record for the highest grossing weekend in film history and will be seen by children around the globe, features smoking characters as do recent films such as the Cameron Diaz release The Holiday, Leonardo DiCaprio’s Blood Diamond, Pirates of the Caribbean 2, Mission Impossible III and The Da Vinci Code.
Heart Foundation chief executive Maurice Swanson disputed the necessity of increasing classifications and said a more effective strategy would be to require studios or cinema chains to commission hard-hitting advertisements before a film to combat the “massive, evil force” of cigarettes.
“Increasing the rating invokes censorship questions. Research in NSW shows that hard-hitting warnings heightened young people’s awareness and it gets them to think about why cigarettes are in a film at all,” he said.
Federal Attorney-General Phillip Ruddock said he would write to the director of the Board of Film and Literature Classification to draw the issue to his attention and seek information on how smoking in films was currently being considered by the board.

India’s Health Minister Anbumani Ramadoss recently banned all cigarette smoking and tobacco product placement from Bollywood productions.

online available at- http://www.thewest.com.au/default.aspx?MenuID=23&ContentID=28591

Integrate tobacco cessation in healthcare services

By Bobby Ramakant

Opinion- Integrate tobacco cessation in healthcare services


E.X.C.E.R.P.T.S....[With appalling health systems failing to meet even the primary healthcare needs of more than a billion people, it is not going to be easy to meet the tobacco cessation needs in India. But sooner and faster we proceed, all the better]. Please read more below.....thanks


Despite rising taxes and increasing restrictions against tobacco use in India, an alarming number of young people are beginning tobacco use every year. Union Health and Family Welfare Minister of Government of India Dr Anbumani Ramadoss informed our parliament that there are more than 25 crore tobacco users in India. And if you go by WHO statistics, over 50 per cent – 12.5 crores – of them will die prematurely of a tobacco related disease. Not only quitting tobacco is difficult (and often unsuccessful) for an individual, but also it’s not easy to integrate tobacco cessation services in existing healthcare services effectively so as to help an estimated 25 crore of tobacco users in India to quit tobacco use and save needless burden of diseases and deaths.

“Why can’t we integrate tobacco cessation in already existing health systems? India has a massive network of primary to tertiary level healthcare systems across the country, and the effort should be to do ‘value addition’ of healthcare professionals by building their capacities in tobacco cessation” says a veteran frontline tobacco control advocate Professor (Dr) Rama Kant.

Strengthening of tobacco control legislations and the many diseases – 29 on the World Health Organization (WHO)’s last count, including stroke, heart diseases, various cancers and emphysema – associated with tobacco use are bringing in a change with India’s youth perceiving tobacco as a killer. The National Sample Survey Organization conducted a study during 1993-2004 which concludes that there is a 30% decline in tobacco consumption in urban India. The proportion of households with beedi smokers has also declined across the rural-urban divide, by 26-35%.

However many studies show higher tobacco use rates in medical students than in the general population. With a considerable section of healthcare professionals themselves using tobacco, how effective tobacco-cessation advocates will they become?

With deceptive tobacco advertising and misconceptions associated with tobacco use, the addiction takes roots before the age of 18, says Prof Kant. Adolescence is the age of adventure, exploration and naivety. By the time tobacco-related hazards begin to manifest, the person is already addicted to nicotine dose. Nicotine is as addictive as heroin and cocaine, stated a US Surgeon General Report in 1988. It is not easy to quit tobacco, but it is also not impossible, asserts Prof Kant.

Nicotine is a psychologically and physically addictive substance. Psychological and pharmacological aids are available to help people quit tobacco use, although success rates are relatively low. So far India has about 20 tobacco cessation clinics supported by World Health Organization across the country, mandated with the mountainous task of facilitating tobacco cessation for a population of 25 crore tobacco users!

How will we scale up tobacco cessation services in India? Should we invest astronomical amount of money in creating a new speciality of tobacco cessation experts, or rather build capacity of existing healthcare staff? Before we do that healthcare workers should be encouraged to quit tobacco and ‘choose life’ as the WHO slogan says.
There are lot of learning lessons from other public health interventions in India. Disease control and public health programmes of tuberculosis, AIDS, reproductive health, family planning and other related spheres have existed in isolation initially and only later over a considerable period of time we realized the benefits of integration. Not only resource maximization is achieved by integrating programmes as those of TB and HIV, or reproductive health, family planning and HIV, but also it is more sustainable and increases the overall effectiveness of health interventions.

It is vital for health policy makers to understand that the best way is certainly not to resurrect tobacco cessation facilities all across India rather to integrate tobacco cessation in existing healthcare systems. And this makes it all the more vital to urgently respond to the daunting challenge posed by weak health systems.
Also it is high time for healthcare professionals to ‘do what they preach’ – be a role model of a healthy lifestyle.

Tobacco use continues to be the second biggest cause of death in the world, according to the WHO. It currently kills about 50 lakhs people – one in 10 adult deaths – each year globally. According to the Indian Council of Medical Research (ICMR) tobacco use is responsible for over 10 lakh deaths in India each year, which is about 3000 deaths every day.

The urgency to reduce or decimate preventable burden of life-threatening diseases attributed to tobacco is compelling. There is no place for complacency. To reduce this goliath burden, not only we need to reduce the number of youth, who may begin tobacco use, but also we need to scale up quality tobacco cessation services and make it accessible, affordable and available to the most underserved communities at the earliest.

A serious commitment to arresting nicotine dependency is fundamental. Although significant proportions are successful, many people fail several times. Many tobacco users find it difficult to quit, even in the face of serious tobacco-related disease in themselves or close family members or friends.

Moreover unless tobacco users have access to quality affordable tobacco cessation services, how will we enforce anti-tobacco legislations and smoke-free air policies in India overnight? Knowing that nicotine is as addictive as heroin or cocaine (US Surgeon General Report 1988), ignoring the healthcare needs of tobacco using people is being naïve.

Indian tobacco needs a quality check`

May 10 2007

News- `Indian tobacco needs a quality check`

"I have been coming to India for the last 15 years but I am yet to see fully-flavoured or even semi-flavoured tobacco. I have come across and purchased only filler tobacco," starts off Jean Lafanechaire, area manager of Altadis.

Altadis, the fifth largest tobacco company in the world and the world leader in cigar manufacturing, has been buying tobacco from India for over 25 years.

Jean disagrees with the assessment of J Suresh Babu, Tobacco Board chairman; farmers’ leader Y Sivaji, and scientists of the Central Tobacco Research Institute that Indian tobacco is in no way inferior to that of Brazil, Zimbabwe or any other country.

“You cannot compare Indian tobacco with Brazilian or Zimbabwean tobacco. The latter are far superior to Indian tobacco in quality and flavour,” he points out.

“Cigarette companies these days consider it a good year if they make just 3 per cent profit. They pay 80 per cent of the retail prices as taxes and another eight per cent goes to retailers. Then come all other expenses. Tobacco is purchased based on competitive prices in the international market. The fully-flavoured tobacco (best) comes from Brazil, Zimbabwe and the US, and it is mixed with filler tobacco from countries like India to increase the profit.”

“While Karnataka tobacco is a clean filler (better), AP tobacco is less matured with less filling power. Hence, buyers rush for Karnataka tobacco,” he explains.

Jean also has the solutions. “Indian farmers should be helped in improving crop quality and per hectare yields, which has remained stagnant. In Karnataka, the maximum yield is 1,200 kg per hectare while in Brazil it is 12 tonne. Contract farming and cultivation of aromatic tobacco can bring in better prices. The monsoon crop experiment of the Indian Tobacco Board and ILTD in Prakasam holds great hopes for Indian farmers.”

“The auction system is pitted against the Indian farmers. Bright, medium and low-grade tobaccos get almost the same price, which is not the case anywhere in the world. Moreover, there is no duty for tobacco exports from Africa to Europe. But the Indian government levies duties on exports to Europe. All these need to be changed,” he says.

online available at- http://www.business-standard.com/economy/storypage.php?leftnm=3&subLeft=1&chklogin=N&autono=283954&tab=r

World AIDS Orphan Day,

Article of Amit Dwivedi in Swatantra Bharat on World AIDS Orphan Day, May 7 2006


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