Gutkha, a chewing tobacco product responsible for oral cancer and several other negative health effects, has been banned in 26 states and six union territories in India since 2011.

The Food Safety and Standards Authority of India (FSSAI) issued the Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations in 2011 (2.3.4). This prohibits the sale of food products that contain nicotine and tobacco as ingredients as they are injurious to health. This led to a ban of the sale, manufacture, distribution, and storage of gutkha and all its variants.

However, the tobacco industry has violated this ban in many ways. Illegal production and sale of gutkha continues. We know this because of the continued seizure of smuggled gutkha packets by enforcement authorities. A novel approach highlighted by a World Health Organization (WHO) study in India can be seen at the roadside shops where gutkha, a mix of pan masala with tobacco, has been replaced by pan masala sachets and tobacco pouches. These are sold separately with the same brand name and logo/imagery. These are then mixed by the consumer to make their own gutkha.

The regulations have also been bypassed in the promotion of the products. The ban on advertising and promotion of tobacco products had completely restricted the marketing of gutkha. But since the ban, the tobacco industry has aggressively pursued the promotion of pan masala as a non-tobacco product.

Pan masala advertisements have been popping up across the city of Bengaluru, where I live. You see these on local government buses, inter-city government buses, autos, billboards, and many other public places. These products (which claim to NOT contain nicotine and tobacco) carry the same brand name, logo/imagery, and wordings/audio as that of tobacco products by the same company. “Unche log, unchi pasand,” used for Manikchand gutkha, is still being used for its non-tobacco counterparts, for example. This is a clear case of surrogate advertising, leading to recollection of tobacco products.

The irony here is that FSSAI’s Food Safety and Standards (Packaging and Labelling) Regulations, 2011 (through section 30 and 31 on labelling of products) permits surrogate advertising by allowing these products to be promoted if they carry the warning “Pan masala/ Supari is injurious to health” on their packs.

In addition, Bollywood film stars appear in the media promoting famous pan masala brands, which were earlier sold as gutkha. This is contrary to the Cable Television Networks (Amendment) rules, 2009, which aims to prevent brand extension of tobacco products in the media. The tobacco industry also uses the unregulated medium of the internet to promote even banned products such as gutkha.

Recently, I was shocked to see the scale of promotions in the India-South Africa cricket series. This was watched by millions of people across the country, including children and teenagers. The entire stadium was covered with billboards promoting Pan parag, Pan bahar, Shudh plus, Kuber, and Baba ‘elachi’ products. It is baffling to see these promotions in stadiums even in a state such as Himachal Pradesh, which has completely banned smokeless tobacco products.

These examples are clear evidence of surrogate advertising tactics used by the tobacco industry to promote its products. And it makes a concrete case for the government to prohibit these under COTPA section 5 by extending the current ban on advertisements and promotions to include pan masala as well. A better step would be to completely ban these products across the country as they also contain areca nut—a known carcinogen—to prevent it from being utilised to bypass the existing regulations.

Arun Jithendra works as an advocacy officer at the Institute of Public Health (IPH), Bengaluru. He acknowledges the contributions and feedback given by IPH colleagues Upendra Bhojani, Neethi Rao, and Pragati Hebbar.

Competing interests: I declare that I have read and understood BMJ’s policy on declaration of interests and I have no relevant interests to declare.

Related feature on thebmj.com: Gutkha wars: India toughens up on oral tobacco use