Two for the price of one: Purchase price of chewing …...Johns Hopkins Bloomberg School of Public Health Two for the price of one: Purchase price of chewing tobacco and pan masala

Johns Hopkins Bloomberg School of Public Health

Two for the price of one: Purchase price of chewing tobacco and pan masala twin packs in 5

states in India

Michael Iacobelli, MPH

Sejal Saraf, BDS, MPH

Kevin Welding, PhD

Kate Smith, PhD

Joanna Cohen, PhD

Disclosures

• Funding Source: The work was supported with

funding from Bloomberg Philanthropies’ Bloomberg

Initiative to Reduce Tobacco Use

(www.bloomberg.org)

• Industry funding to investigator in the last 5 years:

None

• Off label medication uses discussed: N/A

© 2014, Johns Hopkins University. All rights reserved.

© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.

Background

• India is the world’s 2nd leading consumer, 3rd largest producer and 5th largest exporter of tobacco products, including smokeless tobacco (SLT)

• 21.4% (199.4 million) of the Indian adult population use SLT. Use of SLT is higher among women than combustible products; 12.8% of women use SLT, whereas only 2% smoke

• There are at least nine types of SLT products available on the market, including chewing tobacco, Khaini, Zarda and Gutka

• These products are often sold in single-serving pouches that are inexpensive and easily accessible



Why Focus on Gutka?

• Beginning in 2012, complying with a Supreme Court judgement and notification from the Food Safety and Standards Authority of India (FSSAI), all States in India eventually banned gutka

• Maharashtra bans the sale of pan masala, flavored SLT, and any other product that facilitates the mixing of tobacco and spices by consumers, including single use packets

• Objective: To examine the prevalence of chewing tobacco and pan masala double packs in rural India

Gutka“ready to consume mixes”

Chewing Tobacco

Spice Mixture

Post Ban


TPackSS (Tobacco Pack Surveillance System)



Methods

We systematically collected unique SLT products and any accompanying spice packets available in rural India as part of the Tobacco Pack Surveillance System (TPackSS) project

Twenty-five towns (<50,000 people) were visited across five states: Assam, Maharashtra, Uttar Pradesh, Rajasthan, and Karnataka

240 state-unique SLT packs and 121 spice packets were collected, visually inspected for product type, and double coded

Results



Presence of Gutka and Twin Packs

• Over half of the SLT tobacco packs were

sold as double packs with a spice mixture

• Of all the state-unique double pack

combinations purchased:

• Highest proportion: U.P. (35%)• Lowest proportion: Maharashtra (16%)

Gutka Single Pack Twin Pack State total

Assam 0 23 19 42

Karnataka 1 11 24 36

Maharashtra 0 19 11 30

Rajasthan 0 18 24 42

Uttar Pradesh 2 45 43 90

Combined 3 113 121 240

Gutka packs purchased in U.P. and Karnataka

Example of a Twin Pack



Top Product Types and Brands

Spice Mixture Top Brands

Smokeless Tobacco Top Brands

Spice Mixture Type Number of Packs

Pan Masala 111

Pan Supari 10

Total 121

Smokeless Product Type Number of Packs

Plain Chewing Tobacco 54

Zarda 37

Nasal/oral snuff 13

Gul 9

Tobacco Paste 6

Gutka 3

Mishri 1

Unknown (product type not written on the pack)

117

Total 240

V-1 N-1 KP

Vimal Kamla Pasand

Dabangg



Printed vs Paid

Product Type Sample Size w/Printed Price Over Paid Even Under Paid

SLT (twin pack) 121 116 (96%) 116 (100%) 0 (0%) 0 (0%)

SLT (single pack) 119 112 (94%) 33 (29%) 64 (57%) 15 (13%)

Printed Price: ₹1 Purchase Price: ₹5



Conclusion

• Consumers are still able to recreate gutka using chewing tobacco and pan masala packets, which are available for purchase in all states sampled

• The flavored SLT and pan masala ban in Maharashtra shows progress in curbing the availability of these products when compared with states without a ban

• 29% of single SLT packs were over paid – based on price printed – suggesting that vendors are not adhering to the Maximum Retail Price printed on the package

• These results should be considered as state governments consider strengthening existing bans or proposing new SLT policies

Acknowledgments: We would like to thank the entire TPackSS team in

Baltimore and the data collection team in India –

Healis Sekhsaria Institute for Public Health

Thank you!

[email protected]

Two for the price of one: Purchase price of chewing …...Johns Hopkins Bloomberg School of Public Health Two for the price of one: Purchase price of chewing tobacco and pan masala

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