Mumbai Tobacco: Role of Print Literature Review

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Because the tobacco industry sells a product that kills one million people in India annually, therefore, industry's interests will always be in conflict with public health. It is high time that national tobacco control policies in India are congruent to what India is obligated to do by ratifying the international global tobacco treaty - WHO Framework Convention on Tobacco Control (WHO FCTC).'" (CNS, 1)

This underscores the basic policy position of the AFTC as it has voiced the public demand for more aggressive product-labeling. Particularly, the AFTC has reported on evidence that current health warning policies lack effectiveness. This has underscored the push for pictorial warnings depicting the mouths of tobacco users who have developed cancer. (CNS, 1) This is an important consideration as it helps to delineate an appropriate intervention strategy within the print media. The AFTC is working based off of findings in other developing nations that demonstrate the effectiveness of the pictorial warnings as a deterrent, especially to young users. As the research will demonstrate recurrently, there is a great need to intervene in the initiation of addiction for young users and other particularly vulnerable demographics such as those residing in the deeply impoverished and broad rural regions of India. Here, CNS reports, "the coalition collectively highlighted the importance of pictorial warnings in conveying the harmful health effects of tobacco to users, especially in rural areas and those unable to read and write." (p. 1) This is a lesson which our research demonstrates would be well-minded where the design of a print media intervention is concerned.

Sociocultural Aspects of the Tobacco Industry:

Sorenson et al. (2005) inform the sociocultural dimension to our discussion, indicating that the context of Mumbai alone helps to reveal the connection between socioeconomic status and usage. Incorporating such variables as level of education attainment and occupation into an examination of tobacco-risk indices in Mumbai, Sorenson et al. demonstrate that there is indeed a need to take policy actions that might help to diminish the vulnerability of those who are demonstrated to be particularly susceptible to nicotine addiction. Sorenson et al. report that in a Mumbai-based "risks were higher among illiterate participants (male OR = 7.38, female OR = 20.95) than among college educated participants. After age and education had been controlled, odds of tobacco use were also significant according to occupation; unskilled male workers (OR = 1.66), male service workers (OR = 1.32), and unemployed individuals (male OR = 1.84, female OR = 1.95) were more at risk than professionals." (Sorenson, 1003)

This seems to suggest that education might play an important role in reducing the penetration of tobacco use into Mumbai society. Indeed, this is the primary motive for a print media intervention. Therefore, this intervention would have to inherently increase the coverage saturation of tobacco in contexts where these vulnerable demographics are likely to be exposed. It also denotes an approach to such intervention that is largely pictorial in nature so as to reach those of limited educational background. The research by Sorenson et al. offers the determination that tobacco use may be connected to a lack of access to proper education on its impact. This suggests that the pictorial approach to warning labels on tobacco products could carry a real and measurable reduction to those populations which have demonstrated the greatest vulnerability and should therefore also be considered as an aspect of the print media intervention.

This pictorial approach should also be viewed as relevant to what is likely the greatest sociocultural trespass committed by the tobacco companies. Namely, the fact that so many tobacco users ultimately die of cancer and heart disease means that tobacco companies must constantly work to keep a steady influx of new customers. This denotes the priority of targeting younger smokers, a trend which diverges heavily from prevailing legal and ethical discourse on the subject. Though many policy initiatives have been dedicated to standing between the tobacco companies and younger would-be users, TNN (2005) reports that poor regulatory oversight is allowing for an array of marketing loopholes that are directly contrary to the nature of this pattern. An example that TNN reports on is that of 'anytime cigarettes,' which are availed by unmanned vending machines in various contexts throughout Mumbai. As TNN reports, "an unmanned machine contravenes the spirit of the law, making cigarettes accessible to street children who already spend more on tobacco products than on food and nutrition, says anti-tobacco lobbyist Shobha John, adding that research shows that a street child spends most of his income -- as much as Rs 173 a month -- on cigarettes.

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" (TNN, 1)

Here, the article refers to what research demonstrates to be a connection between conditions of poverty and a proclivity toward cigarette addiction. Accordingly, the TNN article describes the degree to which this addiction impacted 'street children' at extremely high rates. Accordingly, the article reports that homeless and impoverished children between the ages of 13 and 18 form a large portion of the cigarette buying public. This denotes a multilayered set of health consequences for a demographic which is already highly vulnerable to illness, injury and early mortality.

Evidence also suggests that tobacco companies have designed product lines with the nefarious intention of appealing to younger users. So is this suggested in the research by Joshi (2006), which claims that bidis are a particular problem where the marketing of tobacco to youths is concerned. Joshi reports that "Bidis are Indian cigarettes, wrapped in tendu or temburini leaf and secured with a string at one end of the cigarette. This relatively small tobacco product provides a powerful dose of chemicals. Bidis contain more than three times the amount of nicotine and more than five times the amount of tar than regular cigarette smoke. Bidis come in flavored varieties such as strawberry, chocolate, and mango and are subject to complaints by those who believe makers of bidis are trying to appeal to a young audience." (p. 605)

This echoes concerns cited in the area of policy legislation and suggests that the nature of the current public health crisis in India is today more commercial and cultural than it is legal. Evidence suggests that the GOI's efforts at reducing the influence of tobacco advertisers is as unsatisfactory as its efforts at reducing usage in public spaces.

Research also confirms the major sociocultural concern that this advertising can be shown to target particularly vulnerable groups. Most disturbing, Bansal et al. tell, is the evidence suggesting that advertising and marketing tactics in the region can be show to pursue young tobacco users. Accordingly, Bansal et al. report that "advertisements and product placements at low heights and next to candies at point of sale were easily accessible by children." (Bansal et al., 201) This is not an idle concern either. This may connect closely with the rate of tobacco penetration amongst India's youths. Here, alarmingly high numbers suggest that the fatality rate and health of Indian youth have been directly threatened by the cultural popularity of cigarettes. Bansal et al. report that the "the 2000 Global Youth Tobacco Survey (GYTS) of youth aged 13-15 years in 12 Indian states estimated that tobacco use in any form was greater than 40% in nine north eastern states." (Bansal et al., 201)

The youth culture has shown itself both to be particularly vulnerable to such penetration and distinctly receptive to cigarettes in contrast to many other products which are marketed to the young. ANI (2010) reports that "the particular content of tobacco marketing resonates with youth and that the vivid imagery in tobacco advertising captures their interest, although teens typically are more resistant to the promotional seduction of other products." (p. 1)

This denotes the high penetration of a positive portrayal of cigarettes in print media contexts appealing to youths. It also denotes that addiction can be an outcome of social pressures or opportunities relating to cigarette smoking. This suggests one of the more pressing cultural challenges presented to the GOI as it juggles the pressure of the tobacco industry with the outcry from public health advocacy groups. This is a major sociocultural crisis with serious public health implications. It also demonstrates a connection between the penetration of usage and the predominance of an overwhelmingly positive portrayal of tobacco use in print media pre-intervention.

Role of Media:

As the section above denotes, the Government of India has indeed created or passed many policy initiatives designed to reduce the saturation of tobacco advertising through all manner of media outlet. However, its legislation has more often than not been blunted by its own incapacity to enforce any of said policies. The voluntary nature of policies designed to limit or remove tobacco advertising from public media outlets denotes that these policies ultimately have little power or meaning. So denotes the informational website provided by Cancer Patients Aid Association India (CPAA). The CPAA….....

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