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International Journal of Head and Neck Surgery, September-December 2013;4(3):115-118 115
Assessment of Gutka Ban in Maharashtra: Findings from a Focus Group Discussion
IJHNS
ORIGINAL ARTICLE
Assessment of Gutka Ban in Maharashtra: Findings from a
Focus Group Discussion
Gauri G Dhumal, Prakash C Gupta
10.5005/jp-journals-10001-1156
ABSTRACT
According to Global Adult Tobacco Survey (GATS) India 2009-
2010, around 8.3% (13.4% among male and 2.5% among
female) of people in Maharashtra are gutka users. Gutka
consumption not only causes oral cancer, but has also been
linked with development of oral submucous fibrosis, a
precancerous lesion. Considering its harmful effects, gutka and
pan masala were banned by Maharashtra Government from
July 19, 2012 disallowing their sale, manufacture, distribution
and storage. Though the ban has come into enforcement, the
evidence stating the extent of its implementation is sparse. The
objectives of the study were to learn about perception of gutka
ban, impact of the ban on gutka consumption, changes in the
trend of tobacco related products consumption, availability of
gutka to the public on demand and economic effects of the ban
on users.
A Focus Group Discussion was conducted among current
and ex-gutka users on January 24, 2013 at Healis Sekhsaria
Institute for Public Health, Navi Mumbai, India. A total of 11
male, ex-gutka users from different professions, participated in
the discussion. The FGD lasted for 40 to 45 minutes. The verbal
consent for participation in the FGD was taken from the
respondents.
The findings showed that with enforcement of the ban, 3
out of 11 respondents completely stopped consumption of gutka
or any other tobacco product, whereas the rests switched to
other tobacco products. All the respondents were aware about
gutka ban and agreed that its a good step to reduce its
consumption; however, most of them felt that the ban has not
been implemented properly. According to them, the vendors
still manage to sell gutka to their known regular customers.
Since the ban has helped in compelling most of the users to
quit gutka, it clearly implies that enforcement of ban with proper
implementation is required to diminish gutka consumption
among people.
Keywords: Gutka, Pan masala, Ban, Oral cancer, Oral
submucous fibrosis, Mumbai, Gutka users.
How to cite this article: Dhumal GG, Gupta PC. Assessment
of Gutka Ban in Maharashtra: Findings from a Focus Group
Discussion. Int J Head Neck Surg 2013;4(3):115-118.
Source of support: Nil
Conflict of interest: None declared
INTRODUCTION
Gutka is an industrially manufactured form of betel quid,
containing crushed areca nut, tobacco, catechu, slaked lime
and sweet or savory flavorings or sandalwood fragrance.1,2
Although oral use of any tobacco product can cause oral
cancer, gutka consumption can additionally cause oral sub-
mucous fibrosis, a precancerous lesion.3 The disease can
develop fibrous bands in the mouth, causing mucosa to lose
their elasticity and eventually decreasing the opening of
mouth. Furthermore, the disease stands with a high potential
to turn malignant, the risk being 400 times higher compared
to nonusers.4
According to Global Adult Tobacco Survey (GATS) India
2009-10, around 13% of males and 3% of females uses gutka
in India. When compared for Maharashtra, around 8.3%
(13.4% among male and 2.5% among female) of people are
current gutka users. What is more alarming is, its increased
consumption among youth, the prevalence being 8 to 10%
among 15 to 44 years of age group.5 Also, the consumption
was found to be most common in uneducated and low socio-
economic group.1
Gutka and pan masala were banned in Maharashtra from
July 19, 2012 disallowing their sale, manufacture, distribution
and storage. With this ban, Maharashtra became the fifth state
to ban gutka and the first one to ban pan masala in India. The
ban has been enforced under the provision of centrally enacted
Food Safety and Standards (Prohibition) Act, 2006 (FSSA),
Section 30(2)(a) Food Safety and Standards Regulations in
so far they relates to Food Safety and Standards (Food
Products Standards and Food Additives) Regulations, 2011
(Regulation 3.1.7)6 and Food Safety and Standards
(Prohibition and Restrictions on sales) Regulations, 2011
(Regulation 2.3.4)6 that bans any food product known to
contain harmful adulterants like tobacco and nicotine. Under
Indian laws, gutka and pan masala considered as food items.
Supreme Court judgment has stated that ‘Since pan masala,
gutka or supari are eaten for taste and nourishment, they are
all food items’. Besides this, though pan masala does not
contain tobacco, laboratory tests conducted by FDA almost
always found magnesium carbonate in it. Therefore the pan
masala has also been banned in Maharashtra. While the
Act allows these food products to be banned for a period of
1 year only, it can be extended further, year on year before
the ban lapses.1
But the announcement of the ban alone does not solve the
problem. Its implementation is equally important in
successfully reducing the consumption of gutka.
The objective of this study is to assess the effect of
implementation of ban, to learn about perception of gutka
ban, impact of the ban on gutka consumption, changes in the
trend of tobacco-related products consumption, availability
of gutka to the public on demand and economic effects of the
ban on users.
116
Gauri G Dhumal, Prakash C Gupta
MATERIALS AND METHODS
A Focus Group Discussion (FGD) was conducted among
current and ex-gutka users on January 24, 2013 at Healis
Sekhsaria Institute for Public Health, Navi Mumbai, India.
Recruitment and Data Collection
The FGD was carried out by the first author, who had
previous experience of conducting FGD and two researchers
acted as note takers of the discussion. The participants were
approached personally and a brief introduction about the
organization and the study was provided. About 40 people
who were approached, 11 gave their consent to attend the
Focus group discussion and among them FGD was
conducted.
FGD was carried out by using a standard FGD guide. In
addition to taking notes, a tape recorder was used to record
all conversations. A verbal consent of the participants was
taken for taking down notes and for tape recording of all the
conversation. The FGD lasted for 40 to 45 minutes. The
themes listed in Table 1 were discussed.
Data Analysis
All tape recorded interviews were transcribed by the
researchers and computerized in the word document format.
The analysis included a thorough reading of the texts, resulting
in the identification of significant statements and phrases,
including all those referring to the themes of the discussion.
The ethical research approval was obtained for conduction
of this study from the Institutional Review Board of Healis
Sekhsaria Institute for Public Health.
RESULTS
The participants were from Mumbai city having different age
groups and backgrounds (Table 2).
Demographics of the Participants
A total of 11 ex-gutka users participated in the discussion.
All the participants were males engaged in different
professions. Their age varied within the range of 19 to
43 years and the mean age calculated was 28 years. Of the 11
respondents, six were married and rests were unmarried.
Tobacco Habit
Most of the respondents started consuming gutka at the age
of 15 to 17 years.
All the respondents used to consume gutka before the ban.
After the ban was enforced, out of 11 respondents,
3 users stopped the consumption of gutka or any other tobacco
product whereas 8 users switched to other tobacco products.
The most common tobacco products consumed include
tobacco flakes which are marked under various brand names
and also the custom-made product like ‘Mawa’ which consist
of areca nut, lime and tobacco. One of the respondents used
to have betal quid (pan) and gutka but after the ban, he had
stopped consuming both of them.
Table 3 demonstrates the type, frequency and preparation
method of the tobacco product being used currently by the
respondents.
Three respondents mixed lime with tobacco and one
respondent added mixing areca nut (supari) with tobacco and
lime for preparation of the tobacco flakes for consumption.
Three respondents also smoked cigarettes, out of which two
smoked once in a week and one admitted smoking
occasionally.
All the respondents were aware about the gutka ban and
they are agreed that it’s a good step to reduce its
consumption. They are also suggested to ban all tobacco
products as it will help in reduction of its use. Among all
the respondents, five quit gutka after the ban was imposed;
other two quit it on the advice of their friends; two
respondents had a tooth loss and thereafter they quit this
habit and one respondent quit gutka consumption after his
friend got stomach cancer.
Current Trends in Gutka and/or
Tobacco-Related Products
Three respondents knew about the places where gutka is
available even after the ban. These places are located in the
city area at a distance of few meters to half a kilometer from
Table 1: Themes of the FGD guide
• Tobacco consumption habit
• Knowledge about gutka
• Past history of tobacco consumption
• Knowledge on the gutka ban
• Knowledge on current trends in gutka and/or other tobacco-
related products
• Perception of users on the gutka ban
• Knowledge on the health effects of gutka/tobacco-related
products
Table 2: Demographics of the participants
Respon- Age Gender Occupation Marital
dent no. (in years) status
1 26 Male Laborer Married
2 19 Male Plumber Unmarried
3 20 Male Waiter Unmarried
4 43 Male Security guard Married
5 27 Male Catering Married
6 22 Male Clerk Unmarried
7 24 Male Recycler Unmarried
8 40 Male Canteen owner Married
9 31 Male Driver Married
10 31 Male Courier boy Unmarried
11 29 Male Peon Married
International Journal of Head and Neck Surgery, September-December 2013;4(3):115-118 117
Assessment of Gutka Ban in Maharashtra: Findings from a Focus Group Discussion
IJHNS
their workplace or residential area. The vendors sell these
products to their regular customers. One of the respondents
mentioned that they wrap it in plastic bags to keep it from
being noticed while another respondent mentioned that
vendors stock it in or just outside their house. Also, the price
of gutka has increased—a packet which was initially available
for 2 rupees was now being sold for 5 rupees.
Most of the respondents felt that with the ban on gutka,
availability and demand of other tobacco products increased
in the market. Even though there has been increase in the
prices of these tobacco products, its consumption rates have
not decreased.
Perception on Gutka Ban
All the participants stated that the ban should stay as it will
help them not to start gutka use again. Most of them felt that
the ban has not been implemented properly. According to
one of the respondents, a vendor in his vicinity sells to around
100 known customers a day.
Three of the participants said that gutka manufacturing
units should be completely shut down for the firm
implementation of the ban. Two of them felt that without
community’s support the complete ban on gutka cannot be
accomplished. According to one of the respondent, black
marketing of the gutka product should be stopped for stringent
application of the ban.
Out of 11 respondents, 9 admitted that they are saving the
money, which they initially used to spend in purchasing gutka.
However, for one respondent, the money which was used for
gutka is now being used for other tobacco products.
Some of them said that government is in the huge loss
after the ban as they used to put heavy taxes on gutka and had
huge earning from it.
DISCUSSION
The result of the FGD clearly pointed out that ban on gutka
is effective in terms of reducing its consumption. It has helped
few of the respondents to quit all types of tobacco products
completely, though some of the respondents have switched
to other tobacco products and/or non-tobacco products. All
the vendors and gutka users were aware about the ban on
gutka and also supported the ban. Respondents also
mentioned that it was a good step to reduce its consumption,
therefore the ban should continue and the ban should shift on
to the other tobacco products as well. The respondents also
stated that, although the gutka is not sold openly, few vendors
still manage to sell gutka with high prices but only to their
known regular customers.
An endeavor to assess the enforcement of ban was done
by rapid surveillance, conducted in the low socioeconomic
community of Mumbai, in mid-August 2012. During this
surveillance, 2 months immediately after the ban was
imposed, it was reported by shop owners that gutka is still
available in bulk at higher prices and in the shops located at
the interior regions of the community. The cost of gutka was
increased beyond the written price and it was sold to regular
Table 3: Type and frequency of current tobacco use
Respon- Tobacco product used Duration for Any other Frequency
dent no. Type Frequency/ Weight of Preparation method which a product of other
day one packet packet last used product used
1. Branded tobacco 2-3/day 5 gm Mix lime (chuna) and A week No NA
flakes tobacco (tambaku)
2. Has quit gutka and
does not use any
tobacco product.
3. Branded tobacco 4-5/day – Mix lime (chuna) and 4-5 days Cigarette Once/week
flakes tobacco (tambaku)
4. Has quit gutka and
does not use any
tobacco product.
5. Branded tobacco 2/day 25 gm Mix a pinch of tobacco A week Cigarette Once/week
flakes (tambaku) with lime
(chuna)
6. Mawa 2-3/day – Mix supari, lime (chuna) NA No NA
and tobacco (tambaku)
7. Branded tobacco – – Mix lime (chuna) and
flakes tobacco (tambaku) A packet a day No NA
9. Branded tobacco 2-3/day 5 gm Mix lime (chuna) and
flakes tobacco (tambaku) 4-5 days No NA
10. None NA NA NA NA Cigarette Rarely
11. Branded tobacco Mix lime (chuna) and No NA
flakes – – tobacco (tambaku)
NA: Not applicable
118
Gauri G Dhumal, Prakash C Gupta
customers’ only.7 Thus, the findings of this study coincide
with the results of the focus group discussion.
The focus group discussion also revealed that most of the
users started consuming gutka at very early age. Even though
ban on gutka is a good initiative by Government of India to
reduce its consumption, its firm implementation can only help
in achieving the goal. Since the ban has helped in compelling
most of the users to quit gutka, it clearly implies that
enforcement of ban with proper implementation is required
to diminish gutka consumption among people.
ACKNOWLEDGMENTS
The study was supported by a grant from the Campaign for
Tobacco-Free Kids (CTFK). We are thankful to Dr Mangesh
S Pednekar, Dr Pooja Sharma, Mr Akshay Pai, Dr Lalit Raute,
Dr Bharti Prabhakar for their valuable contribution at different
phases in completion of the study.
REFERENCES
1. Kharat P, Shailendra S, Bhushan P. Gutka: A malignant entity
seeks benign exit in India. J Evol Med Dent Sci 2013;2(3):
245-51.
2. Gupta PC, Ray CS. Epidemiology of betel quid usage. Annals
Acad Med Singapore 2004;33:31-36.
3. Ashima S, et al. Advocacy for ban on gutka: Voice of the victims
campaign. This Republic Day, Budgam declared first smoke
free district in Jammu and Kashmir. Available from: http://
www.vhai.org/Health_For_The_Millions_Despair_to_Hope.
pdf#page=50.
4. Gupta P. Gutka: A major new tobacco hazard in India. Tobacco
Control 1999;8(2):132.
5. International Institute for Population Sciences (IIPS), Mumbai
and Ministry of Health and Family Welfare, Government of India
(2010). Global Adult Tobacco Survey India (GATS India), http:/
/www.mohfw.nic.in/global_adult_tobacco_ survey.htm.
6. Ministry of Health and Family Welfare. Food Safety and
Standard Authority of India. Available from: FNo. 2-15015/30/
2010, Dated August 1, 2011.
7. Nair S, et al. Local responses to the Maharashtra gutka and pan
masala ban: A report from Mumbai. Ind J Cancer 2012;
49(4):443.
ABOUT THE AUTHORS
Gauri G Dhumal (Corresponding Author)
Senior Research Fellow, Healis Sekhsaria Institute for Public Health
601 Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur
Navi Mumbai, Maharashtra, India, Phone: 912227575487, e-mail:
shedgeh@healis.org
Prakash C Gupta
Managing Director, Healis Sekhsaria Institute for Public Health, Navi
Mumbai, Maharashtra, India
