title: Local responses to the Maharashtra gutka and pan masala ban: a report from Mumbai.
abstract: BACKGROUND
  The Maharashtra government has banned the production, sale, distribution and storage of gutka, and pan masala in the Maharashtra State due to the increasing burden of cancer and reproductive health problems attributable to the use of these products. In view of this, it is important to understand the way producers', sellers' and users' are adapting to the ban.
  
  
  OBJECTIVE
  During the two months following the ban (July 19 th through Sept 30, 2012), a research team studying smokeless tobacco use and promotion in a low income community of Mumbai conducted rapid surveillance to assess the impact of the ban in the study community.
  
  
  METHODS
  Assessment involved documenting new points of sale, informal observations of tobacco use, and interviews with thirteen shop owners and eight gutka users'. Overall changes in accessibility, availability, patterns of use of tobacco products, perception of ban, social norms and surveillance activities were assessed.
  
  
  RESULTS
  Tobacco companies were marketing new products that resembled gutka, under similar brand logos. Surveillance, financial and social cost of selling gutka or using it in public have had an immediate effect on reducing local supply, demand and use and increasing stigma associated with its use. There was an increased recognition of ill-effects of gutka on cancer among sellers' but not overall.
  
  
  CONCLUSIONS
  To reduce the overall consumption of tobacco in the community, it is critical to include programs that create awareness about effects of smokeless tobacco on health and sustain surveillance levels. This would maintain requirements of the ban, and sustain limits on accessibility, availability and use of these products in the community and other similar communities.
authors: National Institute for Research in Reproductive Health, Mumbai, India. nairs@nirrh.res.in
authors: S
authors: S
authors: Nair
authors: J J
authors: JJ
authors: Schensul
authors: S
authors: S
authors: Bilgi
authors: V
authors: V
authors: Kadam
authors: S
authors: S
authors: D'Mello
authors: B
authors: B
authors: Donta
mesh_terms: D000293:Adolescent; D000328:Adult; D028023:Arecaceae; D005260:Female; D033161:Government Regulation; D006801:Humans; D007194:India; D007246:Infertility / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011203:Poverty; D061845:Smoke-Free Policy; D019460:Tobacco Industry; D020340:Tobacco Use Cessation / Q000379:methods / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000517:prevention & control; D014030:Tobacco, Smokeless / Q000009:adverse effects / Q000706:statistics & numerical data*; D014505:Urban Population; D055815:Young Adult