Sixty lac people die every year worldwide due to tobacco use alone, as per World
Health Organisation. Tobacco kills ten lac people in India yearly. As per Global Adult
Tobacco Survey (GATS) 48% of males and 20% of females in India consume tobacco
products. More alarming is the fact that average age of initiation of tobacco use is just 1 7
years in India. 60,000 people succumb to tobacco related illness worldwide due to exposure
to second hand smoke. In India, more than 50% people are exposed to second hand
smoking everyday as per household survey. Tobacco consumption is known to reduce
normal lifespan by 1 0 years due to plethora of illness and disability linked to its use.
Smokers are twice likely to have heart attack compared to non smokers. One in three
people admitted with heart failure have strong tobacco consumption history. Smoking
increases two to four fold risk of stroke. Smoking increases the risk of asthma and
bronchitis, which can lead to gradually progressive breathlessness impairing ambulation and
leading to premature death. Pregnant women exposed to smoke have higher risk of
premature, low birth weight babies and still births. Young men often complain of erectile
dysfunction and premature ejaculation. Tobacco use has also been linked to poor appetite,
weight loss, loss of taste, cataracts, premature ageing and blindness.
Smoking is the most common preventable risk factor for lung cancer. More than 80%
of lung cancers are identified in current or past smokers. Unfortunately, more than 85% are
diagnosed in advanced metastatic stage where only one in ten patients manage to survive
more than five years. Moreover, smoking induced lung cancer respond dismally to standard
chemotherapy and radiotherapy compared to cancer in non- smokers. Smoking also
increases the risk by four-fold of throat, food-pipe, stomach, bladder, pancreas and blood
cancers. In India, prevalence of smokeless form of tobacco is 1 .5 times higher compared to
smoking. Consumption of tobacco, gutkha, pan masala, masheri, gul, snuff, areca nut,
naswar etc has led to epidemic of oral cancer in Indian Subcontinent. Majority of them
present in advanced stages where curative therapy is impossible and average survival is
measured in months.
Government on its part have introduced several prohibitive measures under the
provisions of Cigarette Act, Prevention of Food Adulteration Act and more recently Cigarette
and Other Tobacco Products Act (COTPA). Provisions under these acts include prohibition
of smoking in public places, prohibition of advertisements of tobacco products, prohibition
on sale of tobacco products to and by minors (person age less than 1 8 years) and
mandatory display of pictorial warnings on tobacco products. However, due to lack of legal
teeth and half- hearted attempt, implementation and monitoring of such provisions remain a
practical challenge and violators are rarely penalised. Moreover, active tobacco lobby with
deep pockets counteract such prohibitive measures with vengeance in court and civil society
by surrogate advertising, celebrity endorsement in mass media and sponsoring public
events targeting vulnerable youths.
Though two-third of active smokers are desirous to quit, but less than 3% manage to
do so by themselves without medical assistance, largely due to strong addictive ingredient
called nicotine in tobacco smoke. With integrated behavioural therapy and pharmacological
measures under specialised physician care tobacco quit rates can increase dramatically.
India shares 20% of oral cancer burden of the World, making it capital of oral cancers.
Similarly, 1 % of total population of India have underlying oral premalignant lesion which can
be easily detected by oral cancer screening programme and prompt complete cessation of
tobacco products. Though Low dose CT scan of chest can help detect early presymptomatic lung cancers in high risk smokers, but implementing on community level
remains a major technical and economic challenge in India. Primordial and primary
prevention by increasing awareness in community at schools, colleges and workplace level
respectively will boost the goal of achieving ‘no- tobacco’ milestones early in near future.
Implementing strict ban on advertisement, promotion and sale of tobacco products with
increase in taxation and embargo on tobacco mandates unwavering will and determination
by local authorities, government and civil society to curb this rampant menace of tobacco
with kills people like’ puff of smoke’.
Dr. Avinash Kumar Pandey,
MD, DM, DNB, PDCR, EC
