Beyond Gutka: Evidence of Illegal Smokeless Tobacco in Rural and Semi-urban Areas in India

Abstract

Introduction Gutka, a popular smokeless tobacco (SLT) product combining chewing tobacco, areca nut and spices, was banned by states in India beginning in 2012. Gutka can be recreated by the user mixing twin packets of tobacco and spice mixtures. We examine the availability of pre-mixed gutka, the sale of twin packets (chewing tobacco and spice mixture sold together but in separate packets) and whether SLT was sold without legally mandated health warning labels (HWL), without the printed maximum retail price (MRP), and above the MRP. Methods In October/November of 2017, unique SLT packets were purchased using a systematic protocol in 25 localities with populations under 50,000 across five Indian states. Purchase information (location, twin packets, price paid) and packaging information (SLT type, printed MRP, type of HWL) were used to assess legality. Results Of the 240 purchases of unique SLT packets, three were pre-made gutka. Twin packets were half of the sample, sold in every state, and illegally sold in Maharashtra where they were banned. Over half (62%) of single packets and 27% of twin packets did not feature a legal HWL. While only 5% of packets did not have a printed MRP, 29% of single packets and 38% of twin packets were sold illegally for more than the MRP. Conclusions SLT without the proper HWL or sold above the MRP were common. Twin packets were widely available. India should consider a country-wide restriction to ban single serving tobacco packets that would decrease affordability. Implications This study is the earliest and that first outside of Mumbai that we are aware of to present evidence of tobacco products being sold above the maximum retail price in India. While finding little evidence of pre-made gutka being sold, we found twin packets (chewing tobacco and spice mixture packets sold together) are widely available even in Maharashtra, which has a policy in place to ban twin packets. This study also finds evidence of SLT products sold without the correct HWL and without a MRP listed which shows that implementation and enforcement of regulations are as important as passing regulations.

How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement

“…Rewards in the form of cash (n = 2) were also a motivating factor, which relate to two studies arguing that the effect of enforcement is stronger when officials are compensated by the fines collected [ 43 , 44 ]. Several barriers raised by the news are consistent with global and Indian tobacco control literature, particularly with regard to gutka, where legal loopholes, lack of awareness and enforcement, and litigation by tobacco industries are associated with violation of the ban, sale of twin packets, without mandated health warnings [ 31 , 45 , 46 ]. Only four reports mentioned the role of academia or NGOs, in either individual or institutional capacity, implying they are also involved but receive insufficient coverage.…”