TOBACCO KILLS! The glaring statistics

Tobacco is a well acknowledged social and health evil. The history of tobacco use traces back to the dawn of human civilisation and has been deeply entrenched into the human society since time immemorial. The social, economic, and health impact of tobacco has been a subject of intense debate over the recent decades.

For India, this problem has been a unique one, with the consumption patterns either largely influenced by the socioeconomic backgrounds or dictated by the cultural diversity. With more than 200 million tobacco consumers in the country at present, it becomes imperative to address this health hazard and stir up strong measures toward damage control.

Statistics

• Out of 10 lakh new cases in India, 3.3 lakh are Tobacco related
• 40 per cent of the people less than 15 years of age use tobacco.
• 1.5 lakh to 3 lakh children less than the age of 18 develop bronchitis and chronic chest diseases.
• Each day 50 children get admitted for asthma, cough and wheezing.
• Spouses have 30 per cent increased risk of any cancer.
• 91 per cent spouses have high risk of heart attack (regular report) while 58 per cent have high risk of exposure
• Pregnant Women are at more risk.

Pregnant Women

Inhaled carcinogenics get into the blood of unborn baby which result in low birth weight, miscarriage, prematurity and sudden infant death.

Fact

Cigarettes contain over 4,000 toxic chemicals – 50 of which are known to cause cancer. Some chemicals in tobacco smoke includes acetone, ammonia, arsenic, benzene, butane, cadmium, carbon monoxide, formaldehyde, hydrogen cyanide, methanol, naphthalene, nickel, propane, stearic acid, uranium and vinyl chloride.

Passive smoking effects on children

38 per cent of children develop lung problems right from 2 months to 5 years.

4.3 lakh episodes of bronchitis in 5.3 doctor visits for asthma

1.9 lakh premature deaths among children

20 lakh have ear infection and hearing problems

Suffer from cough and wheeze, asthma, sore throats, cold, eye irritation and hoarseness of voice

Health consequences

Globally, tobacco is responsible for the death of 1 in 10 adults (about 5 million deaths each year) with 2.41 (1.803.15) million deaths in the developing countries and 2.43 (2,132,78) million in the developed countries. A recent nationwide study on smoking and mortality in India estimated that cigarette and beedi smoking causes about 5 per cent of all deaths in women and 20 per cent of all deaths in men aged 30-69 years, totaling to 1 million deaths per year in India.

Health consequences arising from tobacco consumption virtually affect every organ of the human body leading to ill health, morbidity, and mortality. Broadly, the key health hazards commonly causing morbidity and mortality can be perceived under three groups, namely, cardiovascular diseases (CVDs), pulmonary diseases, and cancer.

CVD is one of the world's leading causes of death and far outweighs the deaths from cancer. A large proportion of these deaths are related to tobacco consumption. It is estimated that by 2020, CVD will be responsible for around 50 lakh deaths (about 40 per cent of the total deaths) in the country.

More than 80 per cent of the chronic lung diseases are attributed to smoking and would account for about 8 lakh deaths (6 per cent) by 2020. Tuberculosis deserves a special mention among the infections affecting the respiratory system. Tuberculosis is responsible for 1/3 of the deaths related to smoking, with half the deaths occurring within the fifth decade.

Added to this, the effects of passive smoking include respiratory infections, poor lung compliance, chronic obstructive pulmonary disease (COPD), and worsening of asthma. Tobacco consumption also adversely affects reproductive health, digestive process, vision, bone metabolism, dental hygiene, and perhaps, diminished performance in virtually every functioning cell.

Additional intangible losses arising from this "demerit good" are emotional burden to family, school dropout due to child labor used for tobacco cultivation, and most of all the pain and suffering evoked by dreadful diseases.

Tobacco Cessation Tips

• It is never too late!
• Set a date (usually in the next 10 days)
• Make specific plans to deal with temptation like taking a walk, chewing gum or calling friend
• Avoid smoker friend’s company
• Ask family and friends to stop smoking around you
• Cutting back will lead to deep inhalations to keep nicotine level constant
• Watch out for relapse
• Avoid “just one cant harm” excuse

Anti-Tobacco legislation

The Indian government has only recently woken up to the reality of the health hazards of these chewable tobacco products. While restrictions on smoking in public places and a ban on the advertisement of all tobacco products have been in existence since 2003, they have done precious little to curb the evil of tobacco-chewing. Subsequent to 2003, a modest reduction in the sale of cigarettes and other smoking products was negated by a significant increase in the sale and consumption of chewed tobacco.

A pictorial warning depicting oral cancer on all tobacco products (including chewed) was to replace the existing warnings. However pressure from the strong tobacco lobby has put this on hold as of now. The present warnings enforced from 31 May 2009 show an X-ray picture of a cancer stricken lung which is considered too soft to have any real impact.

Pictorial warnings have significantly reduced the consumption of tobacco products in countries such as Brazil and Mauritius and thus brought down the incidence of oral and lung cancers there. Many countries of the European Union, Canada, Singapore and others have also adopted pictorial warnings with encouraging results.

Hopefully, the Indian government will be able to resist pressures from vested interests to enact this legislation and curb the menace of tobacco-chewing, which has reached epidemic proportions in our country. Whether this rule, once enforced, will also apply to those pan masala products which do not contain tobacco is unclear.

These products are equally dangerous and are consumed by a segment of the population that is largely clueless about their catastrophic effects. Maybe only public interest litigation on the lines of what happened in the United States during the eighties in connection with smoking can ultimately result in any significant impact on the evil of tobacco-chewing in our country.

Prevalence

Presently, India has more than 200 million tobacco consumers; only 13 per cent of them consume it in the form of cigarettes, whereas 54 per cent consume it in the form of beedis and the rest in gutka form. Worldwide, 85 per cent of the tobacco cultivated is used in the production of cigarettes. Hence, the tobacco consumption pattern in India markedly differs from the rest of the world in terms of product configuration.

A recently conducted national cross-sectional household survey found the highest prevalence of tobacco use in South Bihar (94.7 per cent), followed by Uttar Pradesh (87.3 per cent), and high rates in the northeastern states. The lowest rates were found in Kerala (20.6 per cent). The National Household Survey of Drug and Alcohol Abuse conducted in 25 states (excluding Jammu and Kashmir) in 2002 reports that 55.8 per cent of males aged between 12 and 60 years currently use tobacco.

The prevalence of tobacco use among males is higher compared with females and among older age groups compared with the younger age groups. The prevalence of tobacco consumption was found to be 2.4 per cent for women smokers and 12 per cent for women consuming chewing tobacco.

Smoking among women in most high-income countries has increased over the past 20 years, although there has been a fall in smoking among men over the same period. The Global Youth Tobacco Survey (GYTS) reveals that among 13-15 year old school going children, the current use of any tobacco product varies from 3.3 per cent in Goa to 62.8 per cent in Nagaland.

Over the years, India's position has risen from the third largest to the second largest unmanufactured tobacco consuming country in the world. This suggests that compared with cigarettes, more of the other forms of tobacco are consumed in India and that this trend is increasing in recent years. The recent years have thus witnessed the tobacco industry mushrooming unabated with increasing numbers falling prey to the "demerit good”.