Implementing section - 6b of Cigarettes and Other Tobacco Products Act 2004, prohibiting the sale around educational institutions using technology based software - safe zone

Background and challenges to implementation Section 6b of Cigarettes and Other Tobacco Products Act (COTPA)-2004 and Article 16 of Framework Convention on Tobacco Control (FCTC) insists on restricting the access and availability of tobacco products to children as one of the supply reduction measures. Several countries have taken initiatives restricting the sale of tobacco products near Educational Institutions (EIs) and in India it is prohibited around 100 meter radius. However, the implementation has become a major challenge as it is difficult to map the distance between EIs and tobacco outlets, and to prove the shop keepers that they are evading the law. To address this issue, an android based application called Safe Zone is designed. Intervention or response Safe Zone is a Software tool that helps to identify tobacco outlets in and around EI. The technology used was Google MAP API, Google Maps, HTML5 / CSS3 / Java Script, GPS - Global Positioning System and GPRS - Data connection, Geo-coordinates algorithm. The details of the software are given as Figure 1. Results and lessons learnt This software gets your current GPS location and finds all EIs within 100 meter radius nearby and flags us along with the distance. It can show us the precise DISPLACEMENT between given shop and given EI locations. This software works in almost all smart phones that have GPS and GPRS - data connection. [The internals of the software] Conclusions and key recommendations This can be customized and used in any country based on their respective country law. It will help the Social activists, Government officials and Law Enforcement officers, who wants to enforce the Law of the Land in creating safe zone to take evidence based actions to curtail the sale of tobacco in the EI zones and General Public who wants to check whether their kid's school/ home is located in a tobacco free zone or not

Does 85% pictorial health warning on the tobacco products have the impact among tobacco users in India?

Background After persistent civil society and judicial interventions, 85% Pictorial Health Warning (PHW) was implemented in India since April, 2016. The previous 40% PHW had negligible impact in preventing new users and motivating existing users to quit tobacco. The current PHW printed on smoking products is picture of a throat cancer and on smokeless tobacco products is cancer of oral cavity and this should cover 85% of the outer panel of the tobacco products. Text message as "Smoking causes cancer, Smoking kills" also printed on the packs. The present study aimed at understanding the impact of 85% PHW on motivating tobacco users to quit. Methods Tobacco users (n=99) were chosen by convenient sampling from Chennai, Tamil Nadu. One cigarette packet and one chewing tobacco packet printed with 85% PHW was shown to them and interviewed using a semi structured questionnaire. The questions included were, their current tobacco use, comprehension of text and PHWs printed on tobacco products and its ability to motivate the users to quit. Results Majority of the tobacco users (84.8%) noticed the health warnings on tobacco products (PHW-13.1%, Text warning-14.1%, Both-57.5%). Overall 67.6% tobacco users(Smoking-46.4%, smokeless-21.2%) were able to identify the picture correctly and 55.5% related the picture to health problems. A few users (8%) couldn't read the text warning since it was printed in English. The understanding is better if they could read the text warning also. The 52.5% of the users reported that the PHW made them to think about quitting and 72.7% reported that PHW will motivate the users to quit. The users (38.3%) reported total ban as the best measure for tobacco control. Conclusions The 85% PHW has positive impact in motivating the tobacco users to quit. However, printing the text warning in regional language will be effective for the people who cannot read English

Evaluation of chemical constituents of E-cigarette liquid refills marketed through online in India using NMR analysis

Background Electronic cigarette (e-cigarette) is an emerging class of electronic nicotine-delivery system claimed by the industries as a quitting aid. Laboratory testing of some refill liquids for e-cigarettes(e-liquids) contain impurities and toxic substances, or are not filled true to label. The additional impurities in the liquids or vapour (e.g., polyaromatic hydrocarbons (PAHs), Tobacco specific nitrosamines (TSNAs), aldehydes and acrolein), unexpected toxins and/or unreliable nicotine in different glycols mixed with concentrated flavours, warrants a thorough evaluation of the chemical constituents of these E-liquids. Previous research in the evaluation of these constituents involved gas or liquid chromatography (GC, LC) combined with mass spectrometric (MS) detection for the analysis in combination with 1 H- Nuclear Magnetic Resonance (NMR) analysis. This study aimed to evaluate the chemical composition of e-liquid refills using 1 H- NMR, 13 C-NMR along with DEFT, GCMS and IR spectroscopic analysis. Methods A total of 6 samples marketed and sold highly in India through online, claimed to have 0,3,6,12 and 18 milligrams of nicotine and one sample claiming no nicotine/no tar were identified and purchased. The presence of Tobacco Specific Nitrosamines (TSNAs), tobacco alkaloids, Polycyclic Aromatic Hydrocarbons (PAHs), Volatile Organic Compound (VOCs) were analysed using 1 H- NMR, 13 C-NMR along with DEPT, Gas Chromatography Mass Spectroscopy (GCMS) and IR spectroscopy. Results Significant levels of VOCs were noted which included glycerin, propylene and ethylene glycol. Acrolein and PAH were not detected in the samples. However, presence of additional organic compounds including nitrosamines, and nicotine were detected by 13 C- NMR, DEPT and IR spectroscopy. Conclusions NMR spectroscopy is a useful and rapid method to simultaneously detect several ingredients in e-liquids, and GCMS, IR and DEFT also provided additional information on the constituents of e-liquid products. Systematic evaluation of chemical constituents of the e-cigarette may hence throw light on its possible short term and long term health effects

Quality of life among young women with breast cancer: Study from a tertiary cancer institute in south India

Background : The incidence of breast cancer in young patients less than 35 years is less than 1%. The physical and psychosocial morbidity may affect their ability to successfully function in their social roles. Hence we studied the quality of life (QOL) issues in this subset. Materials and Methods :Younger women with age less than 35 years, diagnosed with non-metastatic breast cancer at our Institute, from 1995 to 2005, were included in the study. Quality of life issues were studied during the follow-up using EORTC QOL C30 and BR23. Descriptive and inferential statistics were used in order to analyze the data. Results : A total of 51 patients were included for the study. The mean age at diagnosis was 30 years. The effect of breast cancer on the occupation and marital status was minimal. The global health status and the functional scores were high, while the overall sexual function was lower. The global health status was higher in the mastectomy group. The arm symptoms (P = 0.027) and pain were higher in the Breast conservation surgery (BCS) group. The sexual symptoms appeared to be higher in the ovary ablated group when compared to the ovary preserved group. The sexual functional scores (P = 0.02) and sexual enjoyment scores (P = 0.003) were better in the mastectomy group. Conclusion : The overall QOL in younger patients with breast cancer appeared to be good. The QOL and sexual function were marginally worse in the breast conservation group when compared to mastectomy group

Coping preferences of head and neck cancer patients - Indian context

Background: Cancer is a major health-related stress and demands adequate coping. Patients with head and neck carcinoma (HNC) often face exhaustive and debilitating treatment as well as physical and functional residual effects such as disfigurement, compromised speech, dry mouth and difficulty in swallowing. Understanding how patients cope with these challenges is important in comprehensive care of patients with HNC. Objective: To assess and evaluate the coping preferences of head and neck cancer patients. Materials and Methods:Towards this goal, a prospective study was conducted at the Cancer Institute (WIA), Chennai. 176 HNC patients participated in the study. The age group ranged from 19 to 87 years. The questionnaire used for assessing coping preferences was Jalowiec coping preference scale containing 40 items, with responses ranging on a 5-point scale. The variables chosen were treatment, site, education, survival, age and gender. Statistical analysis used: SPSS 9.0 version was used for both descriptive and multivariate analysis. Results: No significant difference was observed in the preference of Emotion-Oriented Coping (EOC) in relation to age, treatment, site, education and survival. Treatment, site, education and gender showed significant differences in the preference of Problem-Oriented Coping (POC). There was, however, no difference in the preference of POC among the patients with different survival periods and age. Conclusion:In conclusion, HNC patients adapt both EOC and POC during the course of the illness. Literates, males and patients subjected to different modalities of treatment preferred more of POC compared to other groups

Coping preferences of head and neck cancer patients - Indian context

Background: Cancer is a major health-related stress and demands adequate coping. Patients with head and neck carcinoma (HNC) often face exhaustive and debilitating treatment as well as physical and functional residual effects such as disfigurement, compromised speech, dry mouth and difficulty in swallowing. Understanding how patients cope with these challenges is important in comprehensive care of patients with HNC. Objective: To assess and evaluate the coping preferences of head and neck cancer patients. Materials and Methods:Towards this goal, a prospective study was conducted at the Cancer Institute (WIA), Chennai. 176 HNC patients participated in the study. The age group ranged from 19 to 87 years. The questionnaire used for assessing coping preferences was Jalowiec coping preference scale containing 40 items, with responses ranging on a 5-point scale. The variables chosen were treatment, site, education, survival, age and gender. Statistical analysis used: SPSS 9.0 version was used for both descriptive and multivariate analysis. Results: No significant difference was observed in the preference of Emotion-Oriented Coping (EOC) in relation to age, treatment, site, education and survival. Treatment, site, education and gender showed significant differences in the preference of Problem-Oriented Coping (POC). There was, however, no difference in the preference of POC among the patients with different survival periods and age. Conclusion:In conclusion, HNC patients adapt both EOC and POC during the course of the illness. Literates, males and patients subjected to different modalities of treatment preferred more of POC compared to other groups