Public health leadership “Transformation of Dreams to Reality”

This oration examines the multifaceted nature and skills of leadership in the field of public health from the eyes of public health practitioner. Through diverse examples from personal and professional experiences, the oration debunks common misconceptions surrounding leadership and underscores its capacity to motivate and steer individuals or groups towards a shared vision. It challenges the notion that leaders must possess all-encompassing knowledge, instead emphasizing the significance of traits such as courage, confidence, strategic thinking, and collaboration. Moreover, the oration also delves into the question of whether leadership is an innate quality or one that can be acquired through experience and training, recognizing that while some individuals exhibit inherent leadership qualities, others develop them over time. Throughout the article, the author shares his personal and professional journey in public health leadership, recounting formative experiences ranging from serving as a class representative to working in rural areas and marginalized communities. These encounters at various levels, encompassing departmental, institutional, national, and international, enabled the author to apply leadership attributes such as empathy, effective communication, teamwork, and change management to affect positive transformations in healthcare utilisation. The article summarises the fact that leadership is a continuous (not abstract) variable which is present in everyone, albeit, in different proportions and that, it can be acquired by persistence and perseverance.</p

Debunking claims and prioritizing public health: India’s bold stand against tobacco imagery on OTT platforms

India has taken a ground‑breaking step in public health by mandating anti‑tobacco warnings and disclaimers on over‑the‑top (OTT) platforms. Concerns over the prevalence of tobacco imagery in media, including OTT platforms, prompted this decision due to its role in normalizing and glamorizing smoking, particularly among the youth. The Indian government aims to comprehensively address this issue and protect public health. This article reviews recent news articles on the developments in the 2023 amendments to Cigarette and other tobacco products act COTPA 2004 and relevant studies on the ill effects of tobacco imagery to form the viewpoint. To effectively implement the new order, clear guidelines, and standards need to be established. Additionally, comprehensive awareness and education campaigns should be launched, while strict monitoring and enforcement mechanisms must be implemented. Supporting research initiatives should evaluate the impact of the warnings, and multiple stakeholders should be involved in the decision‑making process. India’s commitment to protecting public health and curbing tobacco advertisements on OTT platforms necessitates clear guidelines, awareness campaigns, monitoring and enforcement mechanisms, research initiatives, and stakeholder engagement. This government order aligns with international public health frameworks and can serve as a precedent for other countries. By implementing these measures, we can counter the normalization and glamorization of tobacco use and create a healthier future.</p

Awareness of electronic cigarettes in India: Findings from the 2016–2017 Global Adult Tobacco Survey (GATS)

Electronic nicotine delivery systems (ENDS) have recently emerged as a public health threat globally. Despite the low proportion of e-cigarette users (1.22%) reported in the Global Adult Tobacco Survey-2, the Government of India enacted the Prohibition of E-cigarettes Act 2019 (PECA), prohibiting all forms of ENDS/ENNDS. The current analysis presents nationally representative findings on the level of awareness of e-cigarettes in India and its correlates and characteristics of those aware of e-cigarettes. Methods: The current secondary analysis from GATS-2 among adults aged 15 years and above from all states and Union Territories (UTs) of India used a standard protocol for data collection & management. A multi-stage cluster sampling design was used. The respondents who were aware of e-cigarettes were included (n=2524). Binomial Logistic regression analysis was conducted, and adjusted odds ratios (aOR), with 95% CI, were calculated to measure the associations between independent and dependent variables. Results: 3.4% of the respondents were aware (either heard or seen) of e-cigarettes and their awareness was found significantly higher among males (aOR=2.07; 95%CI= 1.90-2.24), urban population (aOR=2.83, 95%CI=2.61-3.07), higher education (aOR=0.41, 95%CI=0.38-0.45). Conclusion: Public awareness campaigns about the harms of e-cigarettes and the law (PECA) need to be rolled out in urban and rural areas. Capacity-building exercises of implementers and enforcers at the grassroots level could also support communicating the harms to hard-to-reach groups. Further, regular compliance monitoring of the legislation and prosecution of violators would facilitate its effective implementation at the national and sub-national levels. </p

Perception of global participants of ITEC nations on country's preparedness and response to COVID-19 pandemic

Background: The Coronavirus disease 2019 (COVID-19) pandemic has exposed the public health preparedness and response system across the world. The current study was conducted to gauge the perception of public health professionals of Indian Technical and Economic Cooperation (ITEC) countries regarding the preparedness and responses of their countries in mitigating the COVID-19 pandemic. Methodology: Three capacity-building programs, namely “Managing COVID-19 Pandemic–Experience and Best practices of India” were conducted by PGIMER, Chandigarh, for public health professionals from ITEC countries from April to May 2021 in which 97 participants from 13 countries have participated. The tools used in the study were adapted from WHO’s COVID-19 Strategic Preparedness and Response (SPRP), Monitoring and Evaluation Framework, interim guidelines for Critical preparedness, readiness and response actions for COVID-19, and a strategic framework for emergency preparedness, and finalized using Delphi technique. The overall preparedness ofmanaging COVID-19 was rated using five-point Likert scale, whereas the overall score for the country in combating the COVID-19 pandemic was assessed using 10 point scale. Results: We found that the perception of public health professionals to government response regarding COVID-19 for fostering improvement on COVID-19 situation was “moderate” with respect to transmission and surveillance mechanism, uniform reporting mechanism, and availability of adequate personal protective equipment (PPE) for health workers. However, the participants rated government response as “poor” in the availability of multisectoral national operational plan, human resource capacity, availability of trained rapid response team (RRT), preparedness in prevention and clinical management, training of healthcare workers, communication and community engagement strategies, facilities to test samples of patients, and transparent governance and administration. Conclusion: A poor level of preparedness of countries in diverse domains of managing the COVID-19 pandemic was observed. As the global threat of COVID-19 is still looming, great efforts on building a robust preparedness and response system for COVID-19 and similar pandemics are urgently required. </p

Editorial: Tobacco industry accountability - current practices, emerging issues and challenges

The long and intricate history of the tobacco industry (hereafter TI) is marked by periods of expansion and disintegration, changing legal frameworks, and evolving public perception of tobacco use and its detrimental effects on health (1). The global TI is dominated by the five largest tobacco businesses, i.e., Philip Morris International, British American Tobacco, Imperial Brands, Japan Tobacco International, and China National Tobacco Company (2). These are also known to historically work together in concealing scientific evidence on the adverse effects of tobacco consumption, telling lies under oath before the US Congress, and manipulating and destroying evidence (3). Since the mid-20th century, the evidence against tobacco products has been mounting, linking tobacco use (smoked as well as smokeless forms) to various cancers and other health problems (4). There is evidence that smoking leads to many cancers, not just lung cancer (5). In response, tobacco companies launched aggressive marketing campaigns to reassure the general population about the safety of their products and undermine the credibility of scientific research on the harms of smoking (1). In the 1990’s, public pressure and lawsuits led to a series of major legal settlements and the implementation of tighter regulations on tobacco advertising and sales (6). To circumvent this new regulatory environment, numerous tobacco firms expanded their product portfolios to include smokeless tobacco and other items containing nicotine (7). More recently, the industry has also moved its focus onto creating and marketing substitutes, notably, heated tobacco products and electronic cigarettes, misleading consumers with the term “harm reduction,” or “less harmful,” or “safer” used for such products (8, 9). While TI has long been criticized and subject to legal action due to its part in promoting and making money from a harmful and addictive product, TI has employed several tactics to counter the legal and public health regulations put in its way by governments in different countries (9).</p

Is India on a path to reduce the tobacco industry’s influence in tobacco control? Insights from the global tobacco industry interference Index (2019–2023)

The tobacco industry (TI), driven by profit motives, consistently conceals health risks through deceptive strategies, notably in countries like India. These tactics create vulnerabilities that hinder effective tobacco control measures and enable the TI to exploit legal gaps. Understanding these TI strategies is essential for policymakers to take appropriate preventive and corrective measures in order to limit tobacco industry interference (TII) in policy-making. The study aims at understanding the trend of TII in India between 2019 and 2023. Methodology: The secondary data from the Global Tobacco Industry Interference report, consisting of seven major domains of the TII index, viz. policy participation, corporate social responsibility (CSR) activities, industry benefits, unnecessary interaction, transparency, conflict of interest, and preventive measures, were retrieved. A composite score was obtained after adding scores of different domains, for each year. Results: The findings of the study demonstrated an initial improvement in India’s implementation of WHO FCTC Article 5.3, as evidenced by a decreasing score between 2019 and 2021. However, this trend halted in 2023, with data showing a slight increase in the score. When compared with other Asian countries, India shows marginal improvement in score than Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Nepal, Philippines, Thailand, and South Korea. Some of the countries in the region, including India, Pakistan, Bangladesh, Sri Lanka, Myanmar, Brunei, China, and Vietnam experienced a decline in TII. Discussion: There has been a rise in CSR activities, forms of unnecessary interactions of TII with policymakers, and participation in policy development; however, improvements are observed in providing benefits to the TI, conflict of interest, and preventive measures. In order to fortify the regulatory framework, it is imperative to create awareness among stakeholders on conflict of interest, denormalize corporate social responsibility (CSR) initiatives by the TI, provision of a watchdog for TII in the country and “whole of government” approach in implementation of FCTC Article 5.3.</p

Safety, efficacy and health impact of electronic nicotine delivery systems (ENDS): an umbrella review protocol

Background Electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes or vapes, have witnessed a rise in popularity, particularly among the youth. Although they were initially introduced as an alternative to traditional smoking, the design and function of ENDS vary. The potential health effects of ENDS, especially in comparison to traditional cigarettes, are a matter of ongoing debate. Given the increasing number of clinical studies and systematic reviews on this topic, there exists a demand for an umbrella review that offers a comprehensive assessment. The goal of this study is to perform an umbrella review of systematic reviews and meta-analyses to assess the safety, efficacy, health implications and potential gateway effect associated with ENDS. Methods and analysis This umbrella review will adhere to the Joanna Briggs Institute (JBI) framework and the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A planned literature search will be executed across databases such as OVID, PubMed/ MEDLINE, EMBASE, Cochrane Library and Web of Science. The inclusion criteria are systematic reviews that discuss ENDS and e-liquids in the context of safety, efficacy and health outcomes. The exclusion criteria include narrative reviews, non-systematic reviews and studies not in English. Quality of the selected studies will be evaluated using the AMSTAR V.2 Scale. An overlap assessment will be done using the Corrected Covered Area, and data synthesis will be presented both narratively and in tabulated forms Ethics and dissemination Ethics approval is not required for this study, as it does not involve the collection of original data. The results will be disseminated through peer-reviewed publication. The findings will offer crucial insights for stakeholders, policy-makers and the general public, underlining the health implications and the role of ENDS in tobacco cessation.</p

Prevalence and predictors of risk factors for cardiovascular diseases among women aged 15–49years across urban and rural India: findings from a nationwide survey

Background Women’s health is usually looked upon in terms of their reproductive health. However, cardio-vascular diseases are one of the leading causes of death and disability among women, globally as well as in India. Risk factors of today can be disease of tomorrow. Gradience in level of epidemiological transition is observed across different states. The study aims to estimate the national and regional prevalence, and sociodemographic determinants of biological and behavioural risk factors for cardiovascular diseases. Materials and methods The present study was conducted among women in the age group of 15 to 49 years using nationally representative sample from fifth round National Family Health Survey in India. The data analysis in the current study included 7,24,115 women in the age group of 15 to 49 years. SPSS version 20 was used for the purpose of analysis. Weighted prevalence was computed for the studied behavioral and biological (dependent variable) risk factors using women specifc weights as provided in the dataset. Binary logistic regression model was employed to calculate the adjusted odds ratio (OR) with the corresponding 95% confidence interval (CI) to study the sociodemographic determinants (independent variables) of these risk factors. Results Highest prevalent risk factor for cardiovascular diseases was reported to be central obesity (78.2%), followed by overweight/obesity (23.9%), oral contraceptive use (13.4%), raised blood pressure (11.8%), raised blood sugar (8.6%), tobacco use (4.0%), and alcohol use (0.7%). Higher odds of all the studied risk factors were reported with increasing age. All of the studied risk factors, except for alcohol consumption [OR (95%CI): 0.9 (0.8–0.96)], had higher odds in rural areas compared to urban areas. Compared to other castes, the odds of tobacco [OR (95% CI): 2.01 (1.91–2.08)] and alcohol consumption [OR (95% CI): 5.76 (5.12–6.28)], and raised blood pressure [OR (95% CI): 1.07(1.04–1.11)] was signifcantly higher among the people belonging to schedule tribe. Conclusion and recommendation The present study highlights the state-wise disparities in the burden and pre?dictors of risk factors for cardio-vascular diseases among women of reproductive age. The study provides insights to these disparities, and focuses on the need of tailoring the disease prevention and control measures suiting to the local needs.</p

Prevalence of risk factors and estimation of 10-year risk for cardiovascular diseases among male adult population of Tamil Nadu India-an insight from the National Family Health Surveye-5

Objective: Cardiovascular diseases (CVD) are one of the most addressed preventable diseases of public health importance. However, the risk estimates and use of these risk scores for CVD prevention are the least explored areas. So, in this study, we explored the different categories of Framingham heart study (FHS) 10-year-CVD risk score and their associated factors among the adult male population in Tamil Nadu, India.Methods: We used the risk factor level data for male adults aged 18 years and above from the National Family Health Survey (NFHS-5) of Tamil Nadu state, India. Sociodemographic variables, behavioral factors, and physiological/biochemical factors were considered as the risk factor and were estimated using the world health organization (WHO) STEPS categories. FHS 10-year-CVD risk score was calculated using a body-mass index-based published Cox regression equation.Results: Out of 2289 adult males, only 1.12% of the participants had a 10-year CVD risk score greater than 30% and ~4% of the total participants require statin treatment (FRS-CVD risk score ≥ 20). Educational status (aOR:14.21, 95 CI: 4.36e46.22- no formal schooling when compared to 10th and above standard), weekly fruit intake (aOR:0.51, 95 CI: 0.27e0.97 when compared to daily fruit intake) and abdominal obesity (aOR:2.43, 95 CI: 1.58e3.74) were found to be associated with higher FRS scores when adjusted for all other factors not involved in FRS calculation.</p

Hypertension and its correlates among pregnant women consuming tobacco in India: Findings from the National Family health Survey-4

Background: Hypertension (high blood pressure) during pregnancy has significant implications on maternal and perinatal morbidity and mortality. Tobacco use during pregnancy amplifies this burden and increases the risk of hypertensive disorders along with adverse birth outcomes. The current study aimed to evaluate the joint risk atpopulation-level of tobacco use and hypertension among pregnant women in India. Methodology: Data of 32,428 “currently pregnant” women aged 15–49 years was obtained from the National Family Health Survey (NFHS-4) 2015-16to estimate bivariate (tobacco user vs. non-user) and binomial logistic regression analysis in order to get odds ratios of having hypertension. The analysis included socio-demographic variables such as the respondent’s age, type of residence, wealth index, and education status. Results: Prevalence of hypertension among pregnant tobacco users (7.5%) was significantly higher than that of non-users (6.1%). The unadjusted odds of having hypertension were 1.17 (95% CI: 1.02–1.35) times among tobacco users than non-users and increased with age (p 0.05; NS) and wealth quintile (p = 0.01).Conclusion: The present study identifies the higher co-existence of hypertension among tobacco-using pregnant women and highlights the need for tobacco control/cessation and hypertension prevention and management during pregnancy considering socio-demographic disparities.</p