Showing posts with label tobacco. Show all posts
Showing posts with label tobacco. Show all posts

Thursday, 7 December 2017

Tobacco use and smoking can be discouraged with a more positive approach

Tobacco use and smoking can be discouraged with a more positive approach
These habits can cause, among other things, heart diseases and eventually death

New Delhi, 06 December 2017: Tobacco use among children and teenagers claims about one million lives in India, indicate statistics. There is also a huge economic burden among people due to tobacco use. One of the major causes for continued tobacco consumption in India is the fact that it is a part of the country’s social culture. However, a recent study has also indicated that there have been many benefits due to the large pictorial warnings on product packs, higher taxes and an intensive awareness campaign against tobacco consumption.

Tobacco use is associated with many adverse health effects and is a major preventable cause of morbidity and mortality. As per the CDC, smoking increases the risk of coronary heart disease by 2 to 4 times, for stroke by 2 to 4 times, lung cancer by about 25 times. In addition, it reduces quality of life, and increases health care utilization and cost.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “India has a ‘National Tobacco Control Programme’ in place to make the public aware about the harmful effects of tobacco use, control tobacco consumption and minimize the deaths. ‘Smoking kills’ has been the message that has been conveyed in the campaigns on tobacco control with the expectation that highlighting the potentially life-threatening health consequences would deter people from smoking or using tobacco products. It’s time to alter the tone of such public health campaigns, from negative to positive. Quite often, we may rebuke a patient for failing in his efforts to quit smoking and say, ‘If you do not quit, you may die’. A statement worded as this may inadvertently sound discouraging to the patient. While it is important that people know the dangers of smoking or using tobacco products, a positive communication approach may have a more fruitful impact than a critical approach.

Kids start to smoke before they’re old enough to think about the risks; after starting they rapidly become addicted to smoking and then regret it later.

Adding further, Dr Aggarwal, said, “The chances that a patient would adhere to the lifestyle modifications are higher if communicated in an empathetic and supportive manner. IMA is committed to working closely with all National Health Programs alongside the government. As individual doctors, we too can contribute to the success of National Tobacco Control Program. Counsel your patients who smoke about quitting smoking but with a difference… Turn a negative situation to a more positive action.”
Some tips to help such people cope with and quit the habit are as follows.

  • Avoid violent communication. Do not condemn, criticize and complaint, the 3Cs of violent communication.
  • Use a nonviolent communication approach to help and support your patient in his efforts to give up smoking.
  • Tell your patient, who is trying to quit smoking, or other tobacco products, “Thank you for not smoking”.
  • Appreciate the hard work put in and their perseverance. This way the patient knows that he has your support and will have trust and faith in you. 

Friday, 15 September 2017

Prolonged consumption of tobacco can make a person blind

Prolonged consumption of tobacco can make a person blind AMD is a major outcome of tobacco consumption and an avoidable risk factor New Delhi, 14 September, 2017: A recent study has indicated that prolonged consumption of tobacco can lead to blindness. Exposure to tobacco over a period of 5 to 10 years tends to affect the optic nerve leading to loss of vision.[1] As per the IMA, people are only aware of heart disease, cancer, etc. as outcomes of smoking and chewing tobacco. However, the fact that it can also lead to blindness in the long run is definitely another strong reason to quit this deadly habit for good. Smoking also increases the risk of age-related macular degeneration (AMD), which is a leading cause of vision loss among people age 50 and older. It damage the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead in activities such as reading, sewing and driving. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Cigarette smoke contains a mixture of many harmful chemicals. These are absorbed through the lungs and some of them are oxidants, which can damage the retina when they travel through the bloodstream. Those who smoke are twice as likely to develop AMD as nonsmokers.[2] Dry AMD is the most common type of AMD. In this condition, fatty deposits form under the light-sensing cells in the back of the eye (retina). Vision loss in dry AMD usually worsens gradually. In wet AMD, tiny blood vessels under the retina leak or break open. This leads to vision changes and causes scar tissue to form. Wet AMD is less common, but harms vision more quickly. Smoking reduces the macular pigment density in the fovea (center of the macula). This pigment helps in protecting the macula from UV and blue light damage.” Symptoms of macular degeneration include dark, blurry areas in the center of vision; and diminished or changed color perception. AMD can be detected with the help of a routine eye examination. Adding further, Dr Aggarwal, said, “It is important to get vision tested on a regular basis and follow doctor’s recommendations. But, most importantly, one should aim at quitting smoking right away. Eat a diet rich in leafy green vegetables, and protect your eyes with sunglasses that block harmful UV rays.” The following tips may help to quit tobacco in any form and avert the risk of AMD in the long run. • Short-acting nicotine replacement therapies such as nicotine patches, gum, lozenges, nasal sprays, or inhalers can help overcome intense cravings. • It helps to identify the trigger situation. Knowing these will help in avoiding or getting through them without the need of using tobacco. • Whenever there is an intense craving tobacco in any form, it is a good idea to chew on sugarless gum or hard candy, or munch raw carrots, celery, nuts or sunflower seeds instead of tobacco. • Short bursts of physical activity such as running up and down the stairs a few times can make a tobacco craving go away. • Practice yoga, deep breathing exercises to relieve stress.

Tuesday, 14 February 2017

Thank you for not smoking: Run a positive campaign

Thank you for not smoking: Run a positive campaign

The prevalence of tobacco use in India is very high in India as shown by the Global Adult Tobacco Survey India (GATS India) 2009-2010, more than one-third (35%) of adults in India use tobacco in some form or the other. Of these, 21% adults use only smokeless tobacco, 9% only smoke and 5% smoke as well as use smokeless tobacco. The survey also showed that 52% of adults were exposed to second-hand smoke (SHS) at home.
Tobacco use is associated with many adverse health effects and is a major preventable cause of morbidity and mortality. As per the CDC, smoking increases the risk of coronary heart disease by 2 to 4 times, for stroke by 2 to 4 times, lung cancer by about 25 times. In addition, it reduces quality of life, and increases health care utilization and cost. India has a ‘National Tobacco Control Programme’ in place to make the public aware about the harmful effects of tobacco use, control tobacco consumption and minimize the deaths.
 “Smoking kills” has been the message that has been conveyed in the campaigns on tobacco control with the expectation that highlighting the potentially life-threatening health consequences would deter people from smoking or using tobacco products. It’s time to alter the tone of such public health campaigns, from negative to positive.
Quite often, we may rebuke a patient for failing in his efforts to quit smoking and say, “If you do not quit, you may die”. A statement worded as this may inadvertently sound discouraging to the patient.  While it is important that people know the dangers of smoking or using tobacco products, a positive communication approach may have a more fruitful impact than a critical approach.
Avoid violent communication. Do not condemn, criticise and complaint, the 3 Cs of violent communication. Instead use a nonviolent communication approach to help and support your patient in his efforts to give up smoking. Tell your patient, who is trying to quit smoking or other tobacco products “Thank you for not smoking”. Appreciate the hard work put in by him and his perseverance. This way the patient knows that he has your support and will have trust and faith in you. The chances that the patient would adhere to the lifestyle modifications are higher if communicated in an empathetic and supportive manner.
IMA is committed to working closely with all National Health Programs alongside the government.  As individual doctors, we too can contribute to the success of National Tobacco Control Program. Counsel your patients who smoke about quitting smoking but with a difference… Turn a negative situation to a more positive action.
Dr KK Aggarwal
National President IMA & HCFI

Saturday, 21 January 2017

Tobacco, drug use in pregnancy can double risk of stillbirth

Tobacco, drug use in pregnancy can double risk of stillbirth

D KK Aggarwal
National President IMA
New Delhi, Jan 20, 2017: Smoking tobacco or marijuana, taking prescription painkillers, or using illegal drugs during pregnancy is associated with double or even triple the risk of stillbirth, according to the National Institutes of Health. Researchers based their findings on measurements of the chemical by products of nicotine in maternal blood samples; and cannabis, prescription painkillers and other drugs in umbilical cords. The calculated increased risk of stillbirth for each of the substances examined were: • Tobacco use — 1.8 to 2.8 times greater risk of stillbirth, with the highest risk found among the heaviest smokers • Marijuana use — 2.3 times greater risk of stillbirth • Prescription painkiller use — 2.2 times greater risk of stillbirth • Passive exposure to tobacco — 2.1 times greater risk of stillbirth Padma Shri Awardee Dr. K.K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said that, “Stillbirth occurs when a fetus dies at or after 20 weeks of gestation. Smoking while pregnant leads to subtle changes in children's brain development and behavior, because of restricted development in the womb, and large doses of nicotine can damage brain cells. Growth-restricted babies born in such conditions are more likely to have health conditions such as diabetes and high blood pressure in early adulthood. Likely exposure to secondhand smoke can elevate the risk of stillbirth, birth weight, premature birth, respiratory disorders, and increased risk of sudden infant death syndrome (SIDS).” “It's not a choice to be made lightly. Cigarettes contain dangerous concoction of chemicals, such as nicotine, carbon monoxide, and tar. Most of the associated pregnancy complications can be fatal for the mother or the baby. Smoking also more than doubles the risk that an infant will die during, shortly after, or shortly before birth. There is also prominent dose related proportionality in the risk of stillbirth from smoking. If you smoke and are planning to conceive, quitting this dangerous habit should be a priority”, added Dr. Aggarwal. Other rarer complications from smoking can lead to problems with the placenta or slow fetal development. These issues can also cause a miscarriage or stillbirth or lead to respiratory and cardiovascular problems in the child’s early adulthood. Source: • https://consumer.healthday.com/encyclopedia/smoking-and-tobacco-cessation-36/smoking-cessation-news-628/smoking-and-the-fetus-645311.htmlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372174/

Thursday, 8 September 2016

A Brief on India’s recent implementation of 85% pictorial health warnings on tobacco packages

A Brief on India’s recent implementation of 85% pictorial health warnings on tobacco packages

India, first announced its commitment to 85% pictorial health warnings on both sides of tobacco products, up from the then existing 40% on one side, in October 2014, notifying April 1, 2015 as the date for implementation.  However, the implementation of the new warnings faced severe roadblocks due to intense tobacco industry lobbying and unscientific claims and proposals for delay by a Parliamentary Committee reviewing India’s tobacco control law. Following judicial interventions, the Ministry of Health and Family Welfare, committed to implementing the 85% pack warnings from April 1, 2016.[1]
As expected, tobacco industry deployed all tactics to stall implementation yet again citing livelihood and economic concerns and even halted production for over a month. On April 2, 2016, ITC announced a temporary closure of five of its plants. However, the tobacco industry was forced to relent and comply with the new regulation following the Supreme Court’s directive in May 2016 to all cigarette companies to follow the new rules on pictorial warnings in a move “necessary to educate people.”
On World No Tobacco Day 2016, civil society and youth representatives felicitated the Hon’ble Minister for Health and Family Welfare,Government of India Shri J.P. Nadda 3for standing firm on MoHFW’s commitment to implement the 85% pack warnings on both sides of tobacco packages. Doctors for Tobacco Control in India-DFTCI (a coalition of medical associations formed to accelerate tobacco control efforts in India and led by the Indian Medical Association) also felicitated Shri. Nadda for his firm resolve to implement the large-sized, graphic warnings, which now place India among the top countries vis-à-vis size of pack warnings.
The new rules have been implemented and the 85% pack warnings (both on front and back of the packages) can be seen at tobacco-selling kiosks. However, the rule to display graphic pictorial warnings on boards at kiosks to warn against tobacco sale to minors (below 18 years) is still not being implemented. 
                   
Current set of Pictorial Health Warnings (85% -both on front and back of the tobacco packages)          
  
The Karnataka High Court Case on PHWs
The Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2014, notified vide GS.R No. 727 (E) dated 15th October 2014 were challenged before the Karnataka High Court in the following cases: Tobacco Institute of India Vs Union of India (W.P No.  4470/15), Mr. B Shivanna Vs Union of India (WP No. 59460/14), G.R. Venkatesh Murthy Vs Union of India(W.P No. 56789/14) and Shri Javre Gowda Vs Union of India(WP No. 59587/14)], however no interim order was passed.
 The Karnataka Beedi Association filed a Writ Petition No. 53876/2015, on 02.12.2015, challenging the vires of the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2014, GSR No. 727(E). The Hon`ble Karnataka High Court vide an ex-parte order dated 4th December 2015 stayed the operation of the said Rules.
In May, 2016, the Supreme Court bench vacated all the stay orders issued against larger pictorial warnings by any other court in the country and said tobacco manufacturers must abide by the new norms.
The bench also directed that related petitions in three high courts should be transferred to the Karnataka High Court in two weeks and the matter should be decided in eight weeks and also held that:
“This order will not stand in the way of the Karnataka High Court deciding the matter on merit. Any stay granted by any court shall not be implemented until the final order is passed by the Karnataka High Court.” 
Following the directions by the apex court, a special bench of the Karnataka High Court, constituted to hear a batch of petitions on the 85 per cent health warning on cigarette and tobacco related product packages, started the hearing on August 24, 2016.
Arguments by the tobacco industry are being heard by the High Court since this date.
Broad Issues raised by the industry
1.      Focus on the legitimacy of the COTPA: The issue that they have raised is that there is a conflict between COTPA and the Tobacco Board Act, 1975. They have challenged the legitimacy of the Act as a whole and not only the 2014 PHW Rules.
2.      Secondly they have asked to present more scientific evidence establishing the link between tobacco and cancer.
3.      Whether the Centre has power to make such rules?
4.      Issues like the Trademarks Act have also been raised
Other points to be considered:
·         Three benches have been changed till date.
·         There are about 50 cases: 23 from Karnataka, 15 from Kolkata and the rest from other parts of the country (one of the cases in the Rahul Joshi case from the Rajasthan High Court).
·         The current bench comprises of Justice Patil and Justice Nagar.

Tuesday, 16 August 2016

Fiji increases tax on tobacco, alcohol and sugar-sweetened beverages

Fiji increases tax on tobacco, alcohol and sugar-sweetened beverages

Dr K K Aggarwal
In June 2016, the Government of Fiji increased taxes on tobacco, alcohol and sugar sweetened beverages1 as all lead to increased risk of developing NCDs2,3. Indian Medical Association commends the decision to control these cardiovascular risk factors through taxation. Evidence has shown that simple increases in tobacco prices through taxation are the most cost-effective way for governments to reduce tobacco use. According to the WHO a 10% increase in tobacco retail price (in middle income countries) results in a 5% decrease in consumption. It is a well-known fact that tobacco use is the leading preventable risk factor for NCDs, being the single risk factor common to all four main NCDs (CVD, cancer, diabetes and respiratory diseases)4. Over last decade childhood obesity rates have more than doubled in Fiji5. Introduction of a 5 cent per litre tax on sugary beverages will help prevent childhood obesity through reduction of soft drink consumption. Mexico started a similar tax in 2014. Mexico saw a 12% reduction in sugary drinks sales within a year of the tax being implemented6. The Pacific Islands have been described as the ‘per capita NCD epicentre of the world’7. Of the Pacific islands, Fiji has the highest percentage of deaths due to NCDs: 77%. A draft report by the World Bank and partners predicts that if no action is taken the economic burden in Fiji would reach 10.9% of GDP by 20408. The tobacco and alcohol taxes have been increased by 18.5% and a new levy on sugar sweetened drinks has been introduced.

Monday, 15 August 2016

Govt. must consider levying additional tax on products with a high sugar, sodium, salt or tobacco

Govt. must consider levying additional tax on products with a high sugar, sodium, salt or tobacco content to reduce burden of lifestyle disease: HCFI & IMA New Delhi, August 14, 2016: In June 2016, the Government of Fiji increased taxes on tobacco, alcohol and sugar sweetened beverages as all lead to increased risk of developing NCDs. The tobacco and alcohol taxes have been increased by 18.5% and a new levy on sugar-sweetened drinks has been introduced. Mexico started a similar tax in 2014, which resulted in a 12% reduction in sugary drinks sales within a year of the tax being implemented. “Indian Medical Association (IMA) & Heart Care Foundation of India (HCFI) commends this decision taken by both the governments to control these cardiovascular risk factors through taxation. We believe that a similar tax must also be imposed in India, which has seen a considerable rise in the number of lifestyle diseases over the past decade owing to the high stressed unhealthy lifestyle lived my majority of the population. India is already the diabetes capital of the world and is inching towards becoming the heart disease capital as well. The country is more at risk than ever before and steps must be taken on priority to raise awareness and reduce the disease burden”, said Padma Shri Awardee Dr KK Aggarwal – President HCFI & Honorary Secretary General IMA. While like the West, the consumption of sweetened beverages has proliferated to the masses in India; a compromised diet comprising of high trans fat food items including traditional sweets, ghee-friend delicacies – the consumption of which spikes during festival seasons further adds to the problem. The number of tobacco users in the country has also gone up considerably with people getting hooked on to cigarettes at a much younger age. It is a well-known fact that tobacco use is the leading preventable single risk factor common to all four main NCDs (CVD, cancer, diabetes and respiratory diseases). The first and foremost step is to raise awareness about the increasing burden of lifestyle diseases in our country and the ways in which they can be prevented. In the long run it is important for the administration to consider following taxation laws similar to that in Mexico and Fiji. Given the diversity of our country, it would be recommended to take Mexico and Fiji’s policy on sweetened beverages as a benchmark and customize it to suit the Indian needs. Evidence has shown that simple increases in tobacco prices through taxation are the most cost-effective way for governments to reduce tobacco use. According to the WHO a 10% increase in tobacco retail price (in middle income countries) results in a 5% decrease in consumption. A new report in The Lancet has estimated that reducing sugar content in sugar sweetened drinks by 40% over 5 years could prevent half a million people from becoming overweight and a million people from becoming obese.

Tuesday, 31 May 2016

IMA, DMC and HCFI appeal to the medical fraternity to actively prescribe staying away from active and passive smoking to all their patients

IMA, DMC and HCFI appeal to the medical fraternity to actively prescribe staying away from active and passive smoking to all their patients New Delhi, May 30, 2016: According to the World Health Organization, tobacco consumption is the second leading cause of death and fourth leading cause of diseases worldwide. As per the recently released Global Adult Tobacco Survey (GATS-India 2010), about 35 per cent of the adults in India consume tobacco in some form or the other.
“Tobacco use can trigger an onset of life-threatening non-communicable diseases (NCDs) like ischemic heart diseases, cancers, diabetes, chronic respiratory diseases and its increasing incidence must be curbed. The Delhi Medical Council, Heart Care Foundation of India & Indian Medical Association have jointly sent out a communication to members of the medical fraternity requesting them to actively prescribe refraining the use of all tobacco products as well as to stay away from smoke filled environments to each and every patient”, said Dr Arun Gupta – President DMC and Padma Shri Awardee Dr KK Aggarwal – President HCFI and Honorary Secretary General IMA.
IMA and HCFI have also written to the Health and Finance Ministry to consider treatment of tobacco de-addiction under the list of income tax exemptions. They also want them to consider giving concessions to non-smokers Mediclaim premium and include smoking de-addiction in the Mediclaim policy.
They have also appealed to the Chief Minister and Health Minister of Delhi to tweet on World No tobacco day asking general public to exercise their rights and ask smokers not to smoke in front of them.
Recently we had also sent an appeal to Honorable Health Minister of Delhi, Shri Satyendar Jain requesting him to declare May 31st as a dry tobacco day in the city. They had recommended a complete ban on the sale of all tobacco products including cigarettes, gutka, hookah and e-cigarettes for a period of 24 hours, said Dr Girish Tyagi Registrar DMC. 
World No Tobacco Day is observed across the globe on May 31st every year. It is aimed at encouraging people to abstain from consuming tobacco for 24 hours and raising awareness about the hazardous effects of tobacco consumption on a person’s health and well-being. Tobacco use is responsible for nearly 6 million deaths each year worldwide, 600,000 of which are the result of non-smokers being exposed to second-hand smoke.
IMA & HCFI also released the following policies 1. All IMA meetings to be tobacco free 2. Charity begins at home - Doctors should not smoke or consume tobacco 3. While writing a prescription, a doctor should write 'No Passive smoking' before the prescribed drugs column 4. Tobacco consumption is a disease and has to be treated by doctors 5. Tobacco de-addiction should be covered by CGHS, PSUs, Mediclaim 6. Income Tax exemption should be given to de-addiction treatment 7. In Mediclaim, insurance premium should be lower for non smokers and should be reduced for those who quit smoking 8. IMA meetings should be e-tobacco free 9. All IMA meetings should also be hookah free

Monday, 30 May 2016

Tobacco Spiting at public places will now be an offence – IMA


Tobacco Spiting at public  places will now be an offence – IMA

IMA has welcomed the new Tobacco Amendment Bill 2015 (COTPA) where Govt. of India has proposed banning spiting tobacco in the public place.

In a joint statement, Padma Shri Awardee Prof Dr A Marthanda Pillai, National President, and Padma Shri Awardee Prof Dr K K Aggarwal, Hony Secretary General Indian Medical association and President, Heart Care Foundation, said “the tobacco spiting in public place is one of the biggest cause of spread of infection such as TB, Pneumonia,  H1N1 Flu, Avian Flu and other ear, nose and throat  infections. TB bacilli can survive in spit for an entire day.  TB kill over two lakhs Indians every year.

IMA however wanted instead of banning tobacco spit, the Govt. of India should have banned spiting in public place as an offence.

IMA also welcomed

·         that now tobacco industry control will no more  be with  a State government but taken over by the Union Government.
·         That indirect tobacco (surrogate) advertisements and promotions  will be included as a violation of the act 
·         That the word Advertisement now has been broadened to include  marketing, promotion or  advertising through goods,  services and events
·         That apart from print, Radio, TV the ban will include, Mobile internet and any other new technologies.
·         That banning the sale- purchase of tobacco products will now be applicable to all people below 21 years. It is known that if a person is kept away from tobacco for first 21 years of life there is  very high probability  that he/she would not start tobacco consumption. Government is likely to increase this age from 21 years to 25 years for a period of time.
·         That on the packets of tobacco products apart from bold warning one would also have to disclose constituents and emissions of tobacco products instead of mentioning only nicotine and tar contents
·          That there will be designated courts for trial of tobacco related offences
·         That no loose cigarette  or tobacco products will be sold in the market.
·         That the sale of tobacco products will not be allowed within a radius of 100 yards of educational institutions. (earlier it was 100 meters.)
·         That Government will set up National Tobacco Control Organization ( NTCO)
·         That except for some designated areas in airports no non smoking areas will be built up in areas like hotels, restaurants etc.



IMA suggestions
1. That all offence under the act should be non bailable.
2. Infact IMa stand is to ban tobacco products all together and till, they are banned to make them available with a chemist as a drug
3.  Any form of spiting should be banned in public places not only tobacco spiting
4.  Doctors and celebrities should be prohibited to consume tobacco products in public
5.  Proposed fines/punishment  u/s 20 to be raised as under:-  

·         Any person who products or manufactures cigarettes or any other tobacco products, which do not contain either on the  package or on their label, the specified warning shall in the case of first conviction be punishable with imprisonment for a term which may extend to three years, or with both, and for the second or subsequent conviction, with imprisonment for term which may extend to five years and with fine which may extend to 10 lakhs rupees
·          Any person who sells or distributes cigarettes or any other tobacco products which do not contain on the package or on their label, the specified  warning shall  in the case of first conviction be punishable with imprisonment of a term, which  may extend to  three  years, or with fine which may extend to one lac rupees, or with both, and, for the second or subsequent conviction. With imprisonment for a term which may extend to five years and with fine which may extend to ten lak rupees
·         Any person who produces or manufactures cigarettes or any other tobacco products, does not disclose to the government the constituents and emissions of cigarettes or any tobacco products shall  in the case of first conviction be punishable with imprisonment for a term  which may extend to five year or  with fine  which may extend one lac subsequent conviction, with imprisonment for a term which may extend to 10 years and with find which may extend to 5 lakhs rupees
·         Any person who produces  or manufactures cigarettes or any other tobacco products, which do not contain either on the package or on their label, the constituents and emissions, shall in the case of first conviction be punishable with imprisonment for a term which may extend to five year or with fine which may extend one lac rupees or with both, and for the second or subsequent conviction, with imprisonment for a term which may extend to five years and with find which may extend to five lakh rupees