Control of Smokeless Tobacco (ST) is an Urgent Need to Tackling the Disparatity of Legislation-Implementation in Japan.

CHITTA RANJAN CHOWDHURY, PROFESSOR,

Other Contributors:

March 24, 2011

NOT PEER REVIEWED I refer to the paper entitled, "Regional disparities in compliance with tobacco control policy in Japan: an ecological analysis "by Takashi Yorifuji et al in Tob Control doi:10.1136/tc.2010.0414. I agree with them regarding uneven implementation of legislation for tobacco control, which has an influence on consumption, and that reflects the consequences of health and environment directly. In 1995, I was a collaborator in anti- tobacco research at Okayama University supported by the Japan Society of Promotion of Science, and that time I had an observation: There was a marked difference of the rate of consumption among different professionals/occupational groups at Okayama prefecture. Even if the legislation is well regulated, the disparity will also depend on the category of professionals consuming tobacco. Of course, this paper did not investigate that issue. Nevertheless, the scale of disparity needs to be investigated in different occupations/professions, even in a prefecture where the anti-tobacco legislation is implemented properly.

I need also to mention how the current trend of tobacco practice and devices may affect the disparity. Japan Tobacco (JT) has introduced the "Zero-style-mint," a kind of smokeless tobacco (ST), and that is an enormous threat to the Japanese people, because you cannot control ST as you can smoking. Producers are advising to the customers to use this ST in public places, because there is no issue of second-hand smoke. They are even propagating this item for use on flights, long-haul trains, including within the no-smoking cars of the Sinkansen (Bullet Train), when smoking has been banned in both settings long ago. Effective tobacco control in terms of implementable legislation may be different and difficult for ST, and that may affect human health differently. Therefore the issue of disparity of implementation of anti-tobacco legislation may need a review in relation to this issue. Use of smokeless tobacco (ST) with the gimmicky name of "Zero-style-mint" is shooting up quickly in the Japanese tobacco market.

In this regard, I feel it is important to add that, in our experience in India, and the SE Asian population living in the UK, I find it difficult to stop Smokeless Tobacco (ST), such as Paan and Gutkha products (Quid sachets). These are other forms of ST. Even if you implement the legislation complying with the WHO framework Convention for Tobacco Control (FCTC) 1 it does not help. Therefore, reinforcing the legislation to control ST and its health consequences will require extra efforts. Concerning the issue, this year on 15th February, we had an International Experts' Working-Group Meeting (vide Proceeding 2) in India. We came up with a recommendation/declaration to the SE-Asian Governments/policy makers and the WHO FCTC on how to control ST use in public places, and also a way to reduce the constraints and disparities in implementing anti-tobacco legislation on ST. We are also working as one of the stakeholders of the National Institute of Clinical Excellence (NICE, UK)3 in order to control ST and reduce ST related health hazards in the UK.

Anti-tobacco legislation in Japan needs to address ST (eg Zero-style-Mint) in order to reduce the morbidity and mortality due to current trends of tobacco consumption. Certainly the disparity of implementation of legislation will influence the inequalities of tobacco related health and diseases in Japan and it will worsen the situation if ST is overlooked, and will set back progress in tackling the legislative disparity in Japan, which has been discussed in the paper nicely.

References

1. WHO FCTC: World Health Organization. Framework Convention for Tobacco Control: Guidelines for implementation of Article 5.3. Guidelines on the protection of public health policies with respect to tobacco control from commercial and other vested interests. http://www.who.int/fctc/guidelines/article_5_3/en/index.html 2. Proceedings: International Experts' Working group meeting & Seminar -workshop on Oral Sub-mucus-Fibrosis(OSF). Centre for Oral Disease Prevention & Control, Department of Oral Biology & Genomic Studies, Nitte University, Mangalore, India. Published on 15th February 2011. (Editor: Professor Chitta Ranjan Chowdhury) 3. National Institute of Clinical Excellence (NICE , UK): Public Health Intervention Guidance on Tobacco: helping people of South Asian origin to stop using smokeless tobacco. Smokeless tobacco: South Asians - draft scope consultation. http://guidance.nice.org.uk/PHG/Wave23/20/ScopeConsultation

Chitta Ranjan Choudhury

PhD (Japan), MPH (UK), FFDRCS(Ire), FRSH (UK), DND(DU), BDS(DU)

Professor & Director, International Centre for Tropical Oral Health, PHT NHS Department of Maxillofacial Surgery, Longfleet Road, Poole, Dorset BH15 2JB, England.

Consultant GCDHTF, King's College London, London. England, UK President, Institute of Health Promotion & Education (IHPE), UK

Indian office: Nitte University AB Shetty Memorial Institute of Dental Sciences, Department of Oral Biology & Genomic Studies, Centre for Oral Disease Prevention & Control, Mangalore-575 018, India. cr_choudhury@yahoo.co.uk

Conflict of Interest:

None declared

Conflict of Interest

None declared