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Tobacco is the foremost preventable cause of death and disease in the world today, killing nearly half the people who use it, and endangering many others who passively inhale the smoke. As per WHO Report on the Global Tobacco Epidemic, 2015, smoking prevalence in India for males and females together stand at 14.6 per cent amongst the youth and 14 per cent amongst the adult population. Also as per the India Tobacco Industry Report – 2015, during 2010-13, central excise revenues from tobacco products grew at a compound annual growth rate of 21 per cent. This perhaps indicates tobacco use is on the rise despite tobacco killing nearly 6 million people, of which nearly 0.6 million premature deaths can be attributed to exposure to second-hand smoke (SHS), which is a mixture of the smoke given off by the burning end of tobacco products; side-stream smoke (SS) and the mainstream smoke exhaled by smokers (Operational Guidelines: National Tobacco Control Programme 2012).
If current trends continue, tobacco use will kill more than 8 million people worldwide each year by 2030. It is estimated in the 2012 Report that 80 per cent of these premature deaths will occur among people living in low and middle income countries.
Over the course of the 21st century, tobacco use could kill a billion people or more unless urgent action is taken. As per the report on Tobacco Control in India (2004), nearly 8-9 lakh people die every year in India due to diseases related to tobacco use. Furthermore, up to one in five deaths from tuberculosis (TB) could be avoided if TB patients did not smoke.
Harmful Effects of Tobacco
Smokeless tobacco contains about 3095 chemicals; of which 28 are carcinogens (cancer causing substances). Studies have also demonstrated presence of high levels of heavy metals (lead, cadmium, chromium, arsenic and nickel) in tobacco products. The use of smokeless tobacco is associated with cancers of the oral cavity, oesophagus, stomach, pancreas and throat. Likewise, tobacco smoke including SHS contains more than 7,000 chemicals; hundreds of which are hazardous, with at least 69 of these carcinogens. Most cardiovascular diseases and lung disorders are directly attributable to tobacco use. Besides these, tobacco use can cause stroke, cataracts, and peripheral vascular diseases. Moreover, there are studies which show that tobacco use also leads to impotence. Tobacco use by pregnant women leads to low birth weight babies, premature deliveries, still births and birth defects. Passive smoking or SHS is harmful and hazardous to the health of the general public and particularly dangerous to children. It increases the risk of serious respiratory problems in children, such as bronchospasm, asthma attacks, lower respiratory tract infections, as also middle ear infections. Inhaling SHS can even cause lung cancer and coronary heart disease in non-smoking adults.
Global Youth Tobacco Survey
GYTS is a school-based survey, conducted by WHO and Global Tobacco Surveillance System, designed to enhance the capacity of countries to monitor tobacco use among youth and to guide the implementation and evaluation of tobacco prevention and control programmes. The Indian GYTS was conducted in grades 8, 9 and 10 for the 13-15 years age group. The third round of the survey was conducted in 2009 and included data on prevalence of cigarette and other tobacco use as well as information on five determinants of tobacco use: access/availability and price, exposure to SHS, cessation, media and advertising, and school curriculum.
As per the Indian GYTS, conducted by Ministry of Health and Family Welfare and WHO: Fact sheet of Global Youth Tobacco Survey 2009, it was found that one in five students live in homes where others smoke in their presence, and more than one-third of the students are exposed to smoke due to those who smoke in places outside the home. Besides, one-quarter of the students were found to have at least one parent who smokes. Exposure to SHS results in lung cancer and heart diseases among adults, and sudden infant death syndrome (SIDS), chronic respiratory infections, exacerbation/worsening of asthma, reduced lung function growth, middle ear diseases, and acute respiratory illnesses among children. Smoking in the house affects babies and young children as well as the elderly and other adults, especially women.
The Government of India has taken measures including, inter alia, the following, to curb smoking:
- Enactment of Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, (COTPA) 2003.
- Ratification of the WHO Framework Convention on Tobacco Control.
- Launch of the National Tobacco Control Programme (NTCP) in 2007-08, to:
- create awareness about the harmful effects of tobacco consumption;
- reduce the production and supply of tobacco products;
- ensure effective implementation of the anti-tobacco laws; and
- help people quit tobacco use through tobacco cessation centres.
- Notification of rules to regulate depiction of tobacco products or their use in films and TV programmes.
- Notification of rules on new pictorial health warnings on tobacco product packages.
- Launch of public awareness campaigns through a variety of media.
Government of India has banned certain kinds of smokeless tobacco products like gutkha and chewing tobacco through the notification issued under the Food Safety and Standards Act, 2006. Other tobacco products are regulated by the COTPA 2003 which contains provisions, inter alia, relating to:
- ban on sale of tobacco products by/to minors;
- ban on sale of tobacco products within 100 yards of educational institutions; and
- ban on promotions/advertisements of tobacco products, etc.
The state governments/union territories of Uttarakhand, Punjab, Rajasthan, Haryana, Mizoram, Chandigarh, Uttar Pradesh, and Jharkhand have issued orders/notifications banning the sale of loose cigarettes.
The government has initiated several measures to check the use of tobacco. However, active and passive smoking continue to be a major health risk for both children and adults in India. To curb the use of tobacco, increased awareness among the wider public is absolutely essential to bring down the consumption and exposure to smoking in the better interests of public health.
Ministry of Health and Family Welfare. (2016, March). Impact of Passive Smoking on Children. Retrieved from http://pib.nic.in/newsite/PrintRelease.aspx?relid=137951.
Ministry of Health and Family Welfare. (2012). Operational Guidelines: National Tobacco Control Programme, 2012. Retrieved from http://mohfw.nic.in/WriteReadData/l892s/2945310979Operational%20Guidelines.pdf.
Research and Markets. (2016). India Tobacco Industry Report – 2015. Retrieved from http://www.researchandmarkets.com/reports/3250785/india-tobacco-industry-report-2015.
World Health Organisation. (2015). WHO Report on the Global Tobacco Epidemic, 2015. Retrieved from http://www.who.int/tobacco/surveillance/policy/country_profile/ind.pdf?ua=1.
World Health Organisation. (2009). Findings from the Global Youth Tobacco Survey (GYTS) and Global School Personnel Survey (GSPS). Retrieved from http://www.searo.who.int/india/tobacco/GYTS_India_report_2003-09.pdf?ua=1. India 2003-2009.