A tale of Android users and tobacco
The universe of hyperlocal delivery apps has made life easier for consumers by making it convenient to order our daily essentials through a mobile device. But did you know there is a product you can’t find on the Android version of Swiggy, Blinkit, Dunzo or any other hyperlocal delivery apps. And that product is tobacco.
The reason being Google Play Store does not facilitate the sale of tobacco products. It does not allow apps on the Play Store that sell tobacco, e-cigarettes and the like. Interestingly, there is no such restriction on the iOS version of the same apps. This development has happened since the beginning of this year. It is indeed a nice move by Google considering Android users dominate the smartphone landscape in India.
India and tobacco
India is not just the second-largest consumer of tobacco and tobacco products but also the third-largest producer in the world. Tobacco use is the leading single preventable cause of death worldwide, India is no exception (a leading cause of oral cancer). Most of these deaths will be in middle and low-income nations, which would account for almost 80% of all tobacco-related deaths.
According to the Ministry of Health and Family Welfare Government of India and Tata Institute of Social Sciences “Global Adult Tobacco Survey: India 2016–17 Report” (GATS 2).
- Every 1 in 10 adult (10.7%; 99.5 million) in India currently smokes tobacco
- The prevalence of smoking among men was 19% and 2% among women
- The prevalence of smoking was 11.9% in rural areas and 8.3% in urban areas
- Prevalence of tobacco use among men and women with no formal education is highest, at 66.1% and 25.9% respectively. Among those with secondary education or more, the prevalence of tobacco use is lower; it is 24.4% among men and only 2.5% among women
The economic costs of tobacco use are also enormous, totalling more than US$ 1.4 trillion in health care costs and resulting in lost productivity which is about 1.8% of the world’s GDP and over 40% of what the world spends on school education.
If we look at the India demographics, the population that calls for tobacco products using an app will be a few 100,000s and not more. The larger population procures the product offline. The offline distribution landscape is pretty dense and it remains the most widely available addictive substance that can be legally purchased everywhere.
You can bump into a kiosk/store selling tobacco products every ~50 meters. These are not mere kiosks/stores but they also act as the nerve centres for working professionals, daily workers and the population at large to take some time off from their day-to-day activities and indulge in some recreational and socialising activities.
Considering the above, the move by Google can be termed as mere posturing and being on the right side of the debate. In reality, It will not deter a sizeable population from accessing tobacco products, but nevertheless, it is a step in the right direction.
This initiative reminds me of a similar exercise undertaken by countries to deter people from consuming tobacco, albeit in the offline world. This was done by way of introducing pictorial health warnings (PHW) along with textual health warning labels on cigarette packages.
The efficacy of pictorial health warnings
Health warning labels on tobacco products constitute the most cost-effective tool for educating smokers and non-smokers alike about the health risks of tobacco use. Pictorial warnings elicit cognitive and affective reactions and are also advantageous in populations that have lower literacy rates who are the most susceptible to tobacco use.
Cigarette packages in most countries carry a health warning; however, the position, size and general strength of these warnings vary considerably across jurisdictions. To curb the global tobacco epidemic, the World Health Organization’s Framework Convention on Tobacco Control (WHO-FCTC) was launched in 2003. Since then, a total of 168 countries are signatories to the treaty with India becoming a party to this in 2009. Over the years, the guidelines around PHWs have undergone changes and as per the latest guidelines, PHWs now cover ~85% of cigarette packets.
Have these changes had the desired impact? There is some evidence globally supporting the effectiveness of PHW on the intention to quit. Results from a large randomised clinical trial in the US demonstrated that adult smokers who carried cigarette packs with PHWs attempted more quit attempts and were more likely to quit than those who carried packages with text-only warnings.
From an Indian context, an extensive survey was conducted as part of the GATS India report that has been quoted earlier in this article. One of the objectives of the survey was also to understand the impact of advertising and how the PHWs have played a role in acting as a deterrent.
- Television remains the number one source of encountering tobacco use advertisements followed by stores and OOH advertising (billboards and posters)
- A comparison of exposure to warning labels on cigarette packages between GATS 1 and GATS 2 shows a significant increase in the proportion of current smokers who noticed warning labels.
- Between 2009–10 and 2016–17, there was an increase of 12.8% points in the proportion of smokers who reported having seen health warnings on cigarette packets
- Among smokers, the net effect of health warnings that led to quitting increased by 23.9% between GATS 1 and GATS 2
Translating intent into action
India is still a largely ‘sachetised’ market, which means that cigarettes are sold as individual units rather than an entire packet — affordability being a key concern. Overall, the various efforts undertaken by the government in increasing the exposure to the prevention of tobacco use across multiple print and media sources have had the desired impact of increasing awareness.
Now, when we observe Googles and the PHW initiatives through a common lens, we realise that every initiative adds up in the larger scheme of things. The real challenge lies in ensuring people who choose to quit tobacco use are able to stay put. The intention is being seeded, challenges remain in acting upon it. To achieve this, a series of interventions are required that lets an individual stay on course and kick-off the habit for good. These have to go beyond the financial penalties that are applied in the form of sin tax that has not been able to make a dent in the demand.
If we look at the various initiatives, they are usually generic in nature considering the wider health and societal implications — one message across all segments is the preferred way. PHWs, restricting online access and the like are some of the examples. There are few ways to undertake this, which have been listed below:
- There is a need to map an addicts journey and understand the triggers and mental models at play. This will allow us to chart an intervention plan that is personalised enough but can be applied to a wider audience.
- Segmenting the target group based on age — youth and late adult or the elderly. The efficacy of the initiatives that are focused on youth can be way more cost effective and more productive in nature as compared to the ones focused on the elderly/late adults. It is a proven fact that overcoming addiction at a later stage is a difficult proposition.
- New therapies for treating nicotine dependence and measures to liberalise access to medicinal forms of nicotine have the potential to revolutionise the way societies address the problem of tobacco use in the future.
- Treating tobacco use as a taboo is not a desired way, as it triggers the consumer to act in a way that is often counter productive. A change in narrative something that has happened over the years with mental health can be a potential game-changer.
It will be great to hear your thoughts and perspectives on the above.
Until next time!
~ Sajid
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Sajid is a Strategy Consultant and founder at Le Monturé Strategy, who works at the intersection of human behaviour, business design and innovation strategy. He blogs at sknotes and tweets @sajidkhetani
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