Smokeless tobacco of Uzbekistan Nasway: PROCESSING: Sun and heatdried tobacco leaves, slaked lime, a

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Smokeless tobacco of UzbekistanNasway
PROCESSING Sun- and heat-dried tobacco leaves,
slaked lime, ash from tree bark, and flavoring
and coloring agents are mixed together. Water is
added and the mixture is rolled into balls
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Smokeless tobacco is used in many regions of the
world

• America
• North America and Venezuela
• Europe-
• Sweden, UK
• Asia
• Central Asia includes Nasway use
• East and
• Southeast Asia
• Middle-East includes Nasway use
• Iran, Saudi Arabia, and Arab countries
• Africa- Sudan

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Short and Long Term Health Effects of Smokeless
Tobacco Use

• Smokeless tobacco and cancer
• 28 carcinogens have been identified in smokeless
  tobacco in the US.
  
• Oral cancer, head and neck cancer, lung and
  pancreatic cancer
  
• Smokeless tobacco and hard and soft on-or
  pre-cancer oral lesions/conditions
  
• Leukoplakia, other mucosal lesions, recession,
  gingivitis and periodontitis, dental caries,
  tooth abrasion/attrition
  

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Nasway is as common as cigarettes among men in
all age groups in Uzbekistan
Source Uzbekistan Health Examination Survey
(UHES) 2002
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Nasway is more common among elderly women in
Uzbekistan
Source Uzbekistan Health Examination Survey
(UHES) 2002
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Smokeless is more common among the less educated
Evidence from Vietnam
Source Vietnam Living Standard Survey 1998
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But, in Uzbekistan, except high education groups,
men use nasway as much as cigarettes in all
education levels
Source Uzbekistan Health Examination Survey
(UHES) 2002
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Smokeless is more common among the less educated
women
Vietnam Living Standard Survey, 1998
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This is also the case in Uzbekistan.
Source Uzbekistan Health Examination Survey
(UHES) 2002
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As Income Increases, Smokeless Tobacco Use
Declines, Cigarette Smoking Increases An
evidence from Vietnam
Income Quintile
Source Vietnam Living Standard Survey 1998
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Significant youth prevalence rate for smokeless
tobacco in countries around the world Smokeless
tobacco leads to smoking
S. Africa Bahamas Zimbabwe Dominica
Ghana, Malawi Nigeria USA
13-19 yrs old
Source GYTS 1999-2001
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In the world today 48 of men 10 of women
smoke
Source Guindon Boisclair. 2003. WHO
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Unless current smokers quit, smoking deaths will
rise dramatically over the next 50 years
Source Peto and others, 1994 Peto, personal
communication.
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Tobacco was the second leading risk factor for
NCDs in Global Deaths in 2000
Deaths in 2000 attributable to selected leading
risk factors
Number of deaths (000s)
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Mortality pattern in Uzbekistan, 2003
Number of deaths are higher for diseases that
tobacco use may be one of the major causes
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Mortality due to cancer of lips, oral cavity and
throat by age groups in Uzbekistan, 2003?. (in
absolute numbers)
Source State Statistics Committee
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Mortality by sex and age ()
Pattern of mortality due to cancer in Uzbekistan,
2003 ( )
Cancer of lips, oral cavity and throat
Cancer of trachea, bronchi and lungs
Prevalence of cancer due to tobacco is 2 times
higher in men
Source State Statistics Committee, Uzbekistan
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Tobacco attributable deathsThe burden is moving
to developing countries

• tobacco kills 4.9 million persons each year
• half of them live in developing countries
• the death toll is estimated to double in the
  2020s
  
• 70 of these deaths will occur in developing
  countries
  
• 1 in 2 long term smokers die because of their
  addiction
  
• half of all long-term smokers will be killed by
  tobacco and half of them will die prematurely,
  losing 2025 years of life

Source WHR 2002 Peto et al. 1997
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Which interventions are effective?Measures to
reduce demand

• Higher tobacco taxes
• Non-price measures consumer information,
  research, bans on tobacco advertising and
  promotion, warning labels and restrictions on
  public smoking
• Increased access to nicotine replacement (NRT)
  and other cessation therapies
  

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Youth are more sensitive to price/tax increases

• Tax elasticity of snuff in 1985 for
• 16-25 yr old males -0.31
• 25 yr old males -0.13
• Ohsfeldt, Boyle 1994, Ohsfeldt, Boyle, Capiluto
  1997
  
• Tax elasticity of smokeless tobacco, 1992-94,
  for 8th, 10th, and 12th grade students in US was
  -0.07 and -0.04
  
• Chaloupka, Tauras, Grossman 1997

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Adults are also sensitive to tax increases

• Tax elasticity -0.15
• Snuff -0.1 and 0.6
• Chewing -0.13 and 0.6
• Economic substitutes
• Cross tax elasticity 0.10
• snuff- cig 0.13 and 0.6
• chewing-cig 0.09 and 0.5

Source Ohsfeldt and Boyle 1994, Ohsfeldt, Boyle,
and Capilouto 1995
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Very low price elasticity among youth and adults
requires substantial increase in taxes to achieve
a significant reduction
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Effectiveness and Feasibility of Smokeless
tobacco taxesHigher taxes work !!

• But
• Are substantial tax increases politically
  feasible?
  
• Yes! Given the relatively small share of tax in
  the price, a high tax increase would raise the
  prices a modest amount only.
  
• Could smokeless tobacco taxes be collected
  efficiently?
  
• Not certain that the cost of collecting taxes
  would be lower than the extra tax revenues.

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Revenues for government and the industry are
increasing despite reduction in consumption
Sales
Source The tax burden on tobacco 2000, FTC
report to Congress 2001
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Would other policies work? Yes!

• Raising minimum age from 18 to 19 would reduce
  probability of consumption by 25.
  
• Strong licensing provisions would reduce the
  probability of consumption by 9
  
• Ban on advertising could reduce consumption

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Changing Advertising Pattern
Source FTC Report to Congress 2001
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Results

• Urgently need country-specific research evidence
  to tailor TC policies in Uzbekistan
  
• Smokeless epidemic already hit the poorest of the
  poor countries where TC action is weak.
  
• Comprehensive TC measures to reduce smoking work
  for reducing smokeless tobacco, w/o depending on
  tax increases alone.
  
• Strong measures should be taken to reduce youth
  prevalence and access to smokeless tobacco
  products.

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Recommendations

• In countries where the smokeless tobacco already
  exist, protect youth from smokeless tobacco use
  by introducing comprehensive tobacco control
  measures
• Higher taxes supported by other tobacco control
  measures prevent youth to start using smokeless
  tobacco, but taxes should be increased
  substantially high to have significant reduction
  in smokeless tobacco demand.
• Although smokeless tobacco does not generate as
  much revenue as cigarettes, govt. will enjoy
  increasing revenues when taxes increase while
  consumption decreases.