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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
© 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.
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
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.
TPackSS (Tobacco Pack Surveillance System)
© 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.
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
© 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.
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
© 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.
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
© 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.
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
© 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.
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!