Identifying misleading propaganda of Electronic Nicotine Delivery Systems (ENDS) and hookah in New Delhi, India: building youth self-efficacy skills to resist new industry tactics

Background and challenges to implementation The Indian tobacco control law (COTPA) prohibits tobacco advertising, promotion and sponsorship. However, emerging products like e-cigarettes and e-hookahs (ENDS) remain unregulated and traditional hookahs are regulated inadequately. Rampant promotional propaganda for these products has created a general mis-perception that they are safe/less harmful than regular tobacco products, resulting in increasing popularity among adolescents and youth. Intervention or response A youth-led monitoring exercise was conducted to build their capacity for identifying mis-leading and false ENDS and hookah advertisements and promotional campaigns, at multiple Points of Sale (PoS), at New Delhi, India. Sensitisation sessions were conducted for 104 school and college students, (13-23 years) from 6 schools and 5 colleges, on the hazards of ENDS and hookah usage; deceptive strategies of the tobacco industry to take advantage of policy loopholes. These empowered youth monitored 79 PoS (64 physical and 15 e-commerce sites), using standardised monitoring protocols/tools. Results and lessons learnt Approximately 31% of physical sites were within 100 yards of an educational institution (prohibited under COTPA). Warning boards against sale to minors were missing in more than half of the PoS. ENDS were commonly being promoted as: safe, herbal, as cessation devices and also as 'trendy' tobacco products. At 47% of PoS, hookah flavours were arranged as power walls. A range of e-commerce sites were selling ENDS and hookahs, without asking for any age proof or only self-declaration of age, which can be mis-reported. These websites offered attractive discounts and 'free home delivery' to boost sale. [Youth led monitoring_Key Findings] Conclusions and key recommendations Youth-targeted promotion and sale of ENDS and hookah is rampant. E-commerce sites are particularly lucrative PoS. The youth had many false notions about ENDS and hookah. There is an urgent need to regulate these products through national and global policy measures, in order to prevent the tobacco industry from exploiting this grey area in tobacco control policy

(Mis)perceptions related to Electronic Nicotine Delivery Systems (ENDS) and hookah: making a case for policy strengthening through a multi-stakeholder qualitative study from New Delhi, India

Background Electronic Nicotine Delivery Systems (ENDS) - e-cigarettes and e-hookahs and traditional products like hookah, revamped in attractive forms, have garnered wide popularity in India, particularly among young people. Without a national legislation to regulate these products, the tobacco industry has spearheaded surreptitious promotional campaigns to market these products, exploiting gullible consumers. This qualitative study aimed to gauge perceptions of multiple stakeholders (students, parents and teachers) on ENDS and hookah, underscoring the urgent need for regulating these products, which are circumventing the current inadequate regulatory framework. Methods Eleven Focus Group Discussions (FGDs) were conducted with 102 respondents [school students, 12-15 years (19), teachers (15), parents (37) and college students, 18-25 years (31)], using a standardised FGD guide. The intent was to gauge perceptions/knowledge about use of and access to ENDS and hookah, among youth. Thematic issues explored included: information and knowledge gaps around constituents/harmful effects; accessibility and affordability; characteristics; mis-leading claims ['non-tobacco'/herbal (hookah)]; marketing/advertising; possible regulatory mechanisms etc. FGDs were audio-recorded and transcribed for qualitative analysis using ATLAS.Ti (version 6.2). Results Gross mis-information and myths existed about ENDS and regular hookahs, being non-tobacco or non-nicotine products, which are safe or less hazardous/addictive than regular tobacco products, particularly cigarettes. High popularity, social acceptance, convenient availability and easy affordability were reported, particularly by students. College students were most updated about recent trends, followed by school students, teachers and parents (least aware). All schools visited, reported cases of ENDS confiscation/search. Widespread exposure to promotional campaigns was reported, maximally on e-commerce sites. All respondents stressed on the need of a comprehensive and nation-wide regulation on ENDS and hookah, similar to other tobacco products. Conclusions There is an urgent need for progressive regulation/prohibition on ENDS and hookah under the Indian tobacco control law/other applicable legislation, for strengthening the implementation of the Framework Convention on Tobacco Control (FCTC), in India

Improving the school experience of children with diabetes: Evaluation of the KiDS project

Background: The International Diabetes Federation (IDF) launched the Kids and Diabetes in School (KiDS) project in collaboration with the International Society for Paediatric and Adolescent Diabetes (ISPAD) and Sanofi Diabetes to inform and teach school staff, children and parents on the management of diabetes in school. Brazil and India were chosen as pilot countries. Methods: The evaluation was conducted using a qualitative methodology using semi-structured face to face in-depth interviews. Five out of fifteen schools were selected, where teachers and parents of children with and without diabetes were interviewed. Interviews took place one and three months after the implementation of KiDS. Findings: Diabetes knowledge among the school staff and parents of children without diabetes was very limited prior to the KiDS Project in both countries. After introducing the KiDS information pack both groups mentioned increased knowledge on the management of diabetes. This was reflected through healthier food choices at school and the encouragement of physical activities. Increased awareness and understanding in the school staff were observed by parents of children with diabetes. Interpretation: The KiDS project received positive feedback on the educational materials. The pack was deemed informative, interesting and engaging, creating increased awareness and understanding among school staff, parents and children. The project has created a demand for diabetes intervention in schools. The pack has been translated into fourteen languages and was downloaded over 17,000 times by November 2018