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Abstract Background Food policies and environment (availability, accessibility, affordability, marketing) in and around educational institutes can influence food choices and behaviours of children and adolescents. Methods Cross-sectional, mixed-methods study was implemented in schools (n = 9; Private = 6, Public = 3) and colleges (n = 4) from Delhi and National Capital Region (India). The data was collected from students of schools (n = 253) and colleges (n = 57), parents of school students (n = 190), teachers (n = 12, schools = 9, colleges = 3) and canteen operators of Private schools and colleges (n = 10; schools = 6, and colleges = 4). The primary and secondary data was collected to: 1) identify the strengths and weaknesses of the existing guidelines and directives (desk review); 2) examine food environment, existing policies and its implementation (structured observations, in-depth interviews, surveys, focus group discussions), and; 3) assess food choices, behaviours of students (focus group discussions). The thematic analysis was used for qualitative data and descriptive analysis for quantitative data. Results The available food and beverage options, in and around the participating educational institutes were either high in fat, salt and sugar (HFSS), despite government and educational institute guidelines on restricting the availability and accessibility of HFSS foods. The healthy food and beverage options were expensive compared to HFSS foods both inside and outside educational institutes. In total, 37 vendors (Private = 27; Public:10) were observed outside schools at dispersal and twelve at lunchtime. Around colleges, vendors (n = 14) were seen throughout the day. Students from all Private schools (n = 6) and colleges (n = 2) were exposed to food and beverage advertisements either HFSS (Private schools = 1–3 and colleges = 0–2 advertisements), whereas no advertisements were observed around Public schools. Conclusion It is imperative to implement food policies to improve the food environment in and around educational institutes to ensure the availability of healthy foods to establish and sustain healthy eating behaviours among students. Thus, the study findings emphasise stringent implementation, regular monitoring and surveillance of recently introduced Food Safety and Standards (Safe food and balanced diets for children in school) Regulation 2020, ensuring its compliance through effective enforcement strategies.

Background Electronic Nicotine Delivery Systems (ENDS) - e-cigarettes and e-hookahs and traditional products like hookah, revamped in attractive forms, have garnered wide popularity in India, particularly among young people. Without a national legislation to regulate these products, the tobacco industry has spearheaded surreptitious promotional campaigns to market these products, exploiting gullible consumers. This qualitative study aimed to gauge perceptions of multiple stakeholders (students, parents and teachers) on ENDS and hookah, underscoring the urgent need for regulating these products, which are circumventing the current inadequate regulatory framework. Methods Eleven Focus Group Discussions (FGDs) were conducted with 102 respondents [school students, 12-15 years (19), teachers (15), parents (37) and college students, 18-25 years (31)], using a standardised FGD guide. The intent was to gauge perceptions/knowledge about use of and access to ENDS and hookah, among youth. Thematic issues explored included: information and knowledge gaps around constituents/harmful effects; accessibility and affordability; characteristics; mis-leading claims ['non-tobacco'/herbal (hookah)]; marketing/advertising; possible regulatory mechanisms etc. FGDs were audio-recorded and transcribed for qualitative analysis using ATLAS.Ti (version 6.2). Results Gross mis-information and myths existed about ENDS and regular hookahs, being non-tobacco or non-nicotine products, which are safe or less hazardous/addictive than regular tobacco products, particularly cigarettes. High popularity, social acceptance, convenient availability and easy affordability were reported, particularly by students. College students were most updated about recent trends, followed by school students, teachers and parents (least aware). All schools visited, reported cases of ENDS confiscation/search. Widespread exposure to promotional campaigns was reported, maximally on e-commerce sites. All respondents stressed on the need of a comprehensive and nation-wide regulation on ENDS and hookah, similar to other tobacco products. Conclusions There is an urgent need for progressive regulation/prohibition on ENDS and hookah under the Indian tobacco control law/other applicable legislation, for strengthening the implementation of the Framework Convention on Tobacco Control (FCTC), in India.

Background Tobacco consumption is a critical concern in populous low-income countries, like India. The social acceptability of tobacco perpetuates its use: the positive portrayal of tobacco in the media has been associated with increased consumption of tobacco. Hence, to counter the pro-tobacco imagery in the visual media, the Government of India modified its tobacco control law in 2011/2012, called as "Film Rule", requiring film theaters and television channels to screen pre-approved anti-tobacco public service announcements and a disclaimer at the beginning and during the middle of programs when tobacco consumption is depicted; and, health warning scrolls on screen while tobacco is in use onscreen. Methods Four studies were undertaken to monitor the genesis, implementation and effectiveness of the Rule. First, a news media analysis in the lead up the implementation of the Film Rule identified industry arguments against the Rule. Two observational studies, including exit interviews of cinema-goers, monitored the implementation and effectiveness of the Rule. Finally, legal research identified legal loopholes and opportunities. Results Findings from this comprehensive set of studies identified standard arguments against the Rule - such as impingement of creative freedom, arguments that health warnings are ineffective - and provide guidance for addressing these attacks preemptively. The observational studies identified over 80% compliance with the Film Rule in film theaters but less than 10% compliance by television channels. Exit interviews among film-goers also found positive impact among those exposed to anti-tobacco messaging. Legal research identified strengths in the current law, enabling implementation, and opportunities for its advancement within existing media laws and procedures. Conclusions The Film Rule is a novel health financing mechanism for sustained mass media campaigns at low (or no) cost to governments. Our studies show positive impact of the Rule and offer valuable lessons for strengthening the law within India and for other countries considering similar approaches.

IntroductionWe assessed the prevalence of substance use and its association with high blood pressure among adults in Addis Ababa, Ethiopia.MethodsWe employed a cross-sectional descriptive study design. The World Health Organization instrument for stepwise surveillance of risk factors for chronic diseases was applied on a probabilistic sample of 4001 men and women aged 25 to 64 years in Addis Ababa. We determined the prevalence of cigarette smoking, alcohol drinking, and khat (Catha edulis Forsk) chewing. We measured blood pressure by using a digital device and determined mean levels of systolic and diastolic blood pressure.ResultsSmoking cigarettes, drinking alcohol, and chewing khat were widely prevalent among men. Among men, the prevalence of current daily smoking was 11.0% (95% confidence interval [CI], 9.5%–12.5%). Binge drinking of alcohol was reported by 10.4% (95% CI, 9.0%–11.9%) of men. Similarly, 15.9% (95% CI, 14.1%–17.6%) of men regularly chewed khat. Consequently, 26.6% of men and 2.4% of women reported practicing one or more of the behaviors. Current daily smoking and regular khat chewing were significantly associated with elevated mean diastolic blood pressure (β = 2.1, P = .03 and β = 1.9, P = .02, respectively).ConclusionCigarette smoking and khat chewing among men in Addis Ababa were associated with high blood pressure, an established risk factor for cardiovascular disease. Health promotion interventions should aim to prevent proliferation of such behaviors among young people and adoption by women. Surveillance for risk factors for cardiovascular disease should be implemented nationwide to provide information for policy decisions and to guide prevention and control programs.

Objective To estimate the magnitude of illicit cigarette consumption in India using a tax-gap approach. Methods In the tax-gap analysis, illicit cigarette consumption in India was defined as the difference between total and legal consumption. Data on total cigarette consumption came from two national Global Adult Tobacco Surveys carried out from 2009 to 2010 and from 2016 to 2017. Legal consumption was derived from Government of India data on domestic cigarette production and trade. Findings Estimated total cigarette consumption was 104.8 billion sticks in 2009 to 2010 and 94.2 billion sticks in 2016 to 2017, a decrease of 10.6 billion sticks, or of 10%, over the time period. Legal cigarette consumption fell from 99.4 to 88.5 billion sticks over the same period, a drop of 11%. Estimated illicit cigarette consumption was, therefore, 5.4 billion sticks in 2009 to 2010 and 5.6 billion sticks in 2016 to 2017, and accounted for 5.1% and 6.0% of the market in these periods, respectively. Consequently, only about 1 in 20 cigarettes consumed in India was illicit. Between 2016 and 2017, the estimated equivalent retail sales value of illicit cigarettes was 49 billion Indian rupees (753 million United States dollars, US$) and the estimated tax revenue foregone was 25 billion Indian rupees (US$ 390 million). Conclusion Illicit cigarette consumption is relatively modest in India by global standards. Nonetheless, India should strengthen its capacity to control the illicit tobacco market as part of a comprehensive tobacco control strategy, while also continuing to implement traditional demand reduction measures, such as tobacco taxation. [phrase omitted] [phrase omitted] Objectif Estimer l'ampleur de la consommation illicite de cigarettes en Inde grace a une approche basee sur l'ecart fiscal. Methodes Pour proceder a l'analyse de l'ecart fiscal, la consommation illicite de cigarettes en Inde a ete definie en calculant la difference entre la consommation totale et la consommation legale. Les donnees relatives a la consommation totale de cigarettes proviennent des resultats nationaux de deux Enquetes mondiales sur le tabagisme chez l'adulte (GATS), menees de 2009 a 2010 et de 2016 a 2017. Celles sur la consommation legale ont ete extraites des donnees du gouvernement indien concernant la production et le commerce de cigarettes dans le pays. Resultats La consommation totale s'elevait a 104,8 milliards de cigarettes de 2009 a 2010, et a 94,2 milliards de cigarettes de 2016 a 2017. Ce qui represente une baisse de 10,6 milliards de cigarettes, donc de 10%, au cours de cette periode. La consommation legale a chute, passant de 99,4 a 88,5 milliards de cigarettes sur la meme periode, une diminution de 11%. Par consequent, la consommation illicite est estimee a 5,4 milliards de cigarettes de 2009 a 2010, et a 5,6 milliards de cigarettes de 2016 a 2017. Lequivalent de 5,1% et 6,0% du marche, respectivement. Ainsi, sur l'ensemble des cigarettes consommees en Inde, seule une cigarette sur vingt environ etait illicite. Entre 2016 et 2017, on considere que le commerce illicite de cigarettes a rapporte l'equivalent de 49 milliards de roupies indiennes (753 millions de dollars americains) de ventes au detail, tandis que le manque a gagner fiscal s'est eleve a 25 milliards de roupies indiennes (390 millions de dollars americains). Conclusion La consommation illicite de cigarettes est relativement modeste en Inde par rapport aux standards internationaux. Neanmoins, le pays devrait renforcer ses capacites de controle du commerce illicite du tabac dans le cadre d'une strategie complete de lutte contre le tabagisme, tout en continuant a mettre en reuvre les mesures traditionnelles visant a reduire la demande, comme la taxation du tabac. [phrase omitted] Objetivo Estimar la magnitud del consumo ilicito de cigarrillos en la India mediante la aplicacion de un enfoque de diferencias impositivas. Metodos El consumo ilicito de cigarrillos en la India se definio en el analisis de la diferencia impositiva como la diferencia entre el consumo total y el consumo legal. Los datos sobre el consumo total de cigarrillos procedian de dos Encuestas mundiales sobre el tabaquismo en adultos de alcance nacional que se realizaron entre 2009 y 2010 y entre 2016 y 2017. El consumo legal se obtuvo a partir de los datos del Gobierno de la India sobre la produccion y el comercio nacional de cigarrillos. Resultados Se estima que el consumo total de cigarrillos fue de 104 800 millones de cigarrillos entre 2009 y 2010 y 94 200 millones de cigarrillos entre 2016 y 2017, lo que supone una reduccion de 10 600 millones de cigarrillos, o del 10 %, durante ese periodo. El consumo legal de cigarrillos se redujo de 99 400 a 88 500 millones de cigarrillos en el mismo periodo, un descenso del 11 %. Por lo tanto, el consumo ilicito de cigarrillos estimado fue de 5400 millones de cigarrillos entre 2009 y 2010 y de 5600 millones de cigarrillos entre 2016 y 2017, lo que represento el 5,1 % y el 6,0 % del mercado en estos periodos, respectivamente. Por consiguiente, solo 1 de cada 20 cigarrillos que se consumen en la India es ilicito. Entre 2016 y 2017, el valor equivalente estimado de las ventas al por menor de cigarrillos ilicitos fue de 49 000 millones de rupias indias (753 millones de dolares estadounidenses, USD) y el estimado de los ingresos fiscales no percibidos fue de 25 000 millones de rupias indias (390 millones de USD). Conclusion El consumo ilicito de cigarrillos es relativamente moderado en la India segun las normas mundiales. No obstante, la India deberia fortalecer su capacidad para controlar el mercado ilicito de tabaco como parte de una estrategia integral de control del tabaco, al tiempo que continua aplicando medidas tradicionales para reducir la demanda, como los impuestos sobre el tabaco., Introduction The widespread availability of illicit tobacco products can undermine the effectiveness of both public health interventions, such as health warnings on tobacco packs, and fiscal measures, such as tobacco [...]