Dr. G. SAMARAMDr. G. SAMARAMNational President (2009-10)Indian Medical Association

Hazards of TobaccoHazards of Tobacco

The Global Scenario A whooping 4.2 million embraced death due to smoking Men: 3.4 million (Developed countries: 1.6 million & developing 1.8

million); India shares 19.9% Women: 0.8 million (Developed countries: 0.5 million & developing 0.3

million); India shares 5%

Cause of 1 in 10 adults

Smoking statistics: Men: Globally 1 billion (35% in developed and 50% in developing

countries) Women: Globally 250 million (22% in developed & 9% in developing

countries)

Individuals are starting to smoke at an earlier age

The rate of smoking is increasing: Global cigarette consumption is 6319 billion of sticks

By 2030, 70% of all deaths from tobacco use will occur in developing countries (10 million will die each year)

The Indian ContextThe Indian Context In India tobacco is used in a wide variety of ways.

6.7 Lacs Smoke to die in India (India accounts for approx. 24% of tobacco related death globally)

In India 2200 persons die every day from tobacco related diseases

Oral Tobacco consumption is highest in India

Economic burden on the country is Rs.2.5 million through direct medicinal costs, absenteeism for treatment and loss of income due to premature death due to tobacco related diseases

Smoking –induce lung obstruction followed by pollution were responsible for 80% of COPD cases which is predicted to be the third major killer by 2020

The prevalence rate of COPD cases in India is : in men 0.5% in women 0.25%

Prevalence of Tobacco use in Prevalence of Tobacco use in IndiaIndia

Below 35% : 2 statesPunjab and Goa

Between 35 - 50% : 8 states

Andhra Pradesh, Tamilnadu, Karnataka, Kerala, Maharashtra, Haryana, Himachal Pradesh and Delhi

Between 50 – 65% : 8 states

Gujarat, Rajasthan, Jammu&Kashmir,

Uttarakhand, Uttar Pradesh, Jarkhand,

Sikkim, Arunachal Pradesh

Above 65% : 11statesMadhya Pradesh, Bihar,

Chattisgarh, Orissa, West Bengal, Assam,

Meghalaya, Manipur, Tripura, Mizoram,

Nagaland

7

50

13

61

11

57

Urban Rural Total

Women Men

• Any Tobacco Use – Prevelance: 57%• Currently smoke Cigarette or Bidi: 32.7%• Currently chews pan masala, ghutkas or other tobacco: 36.5%• About 7% of male aged 13-15 yrs smoke cigarettes in India

TOBACCO & MEN

Cigarette Smoking is the principle cause of Premature Death

Smoking withdrawal symptoms

Anger

Anxiety

Difficulty in

Concentration

Hunger

Impatience

Restlessness

Most of the symptoms peak in 2-3days and return normal within 3-4weeks

More than 4,000 substances have been identified in cigarette smoke

Cigarette smoking antigenic, cytotoxic, mutagenic, carcinogenic

Nicotine increases systolic and diastolic blood pressure

CLINICAL AFFECTS

Cardiovascular DiseasesCancerRespiratory DiseasesPregnancy related

complicationsGastrointestinal

disordersDepression

ACTIVE ACTIVE SMOKINGSMOKING

PASSIVE PASSIVE SMOKINGSMOKING

TOBACCO & TOBACCO & WOMENWOMEN

• The overall prevelance of tobacxco use among women is 12.8% (15-49 yrs)

• Currently smoke Cigarette or Bidi: 1.4%

• Currently chews pan masala, ghutkas or other tobacco: 8.4%

• Prevalence in rural areas (13.3%) is reported higher than

urban areas (8.8%)

•About 7% of female aged 13-15 yrs smoke cigarettes in India

•According to studies, female smokers in India die an average of eight years earlier than their non-smoking peers.

TOBACCO & WOMEN

TOBACCO & WOMEN - MATERNITY STATUS• Prevalence of tobacco use amongst non-pregnant women:

12.8% (2.3% smoking & 11.2% smokeless)

• Prevalence of tobacco use amongst pregnant women: 11.6% (1.7% smoking & 10.3% smokeless)

• Prevalence among pregnant women who belong to the poorest economic strata is high (20.8%) as compared to the pregnant women in the richest economic strata (3.7%)

• The pregnant women with high school & above education reported a low prevalence of tobacco use (3.9%) as compared to the pregnant women with no education (15.4%)

• Prevalence among working class (16.8%) is higher than the non-working class (10%)

Therefore, prevalence among pregnant and non-pregnant women clearly demonstrates a complete lack of attention to tobacco use during pregnancy in reproductive health care system of our country.

TOBACCO & LEVEL OF EDUCATION

•Tobacco use is more prevalent among men and women with no education

•78% of men and 18% of women with no education use tobacco

•Compared to no education, 38% of men & 1% of women with 12 or more years of education use tobacco

According to National Household Family Survey (NHFS) -3:

Tobacco use is high but as become further concentrated among less educated and lower socio- economic strata

Prevalence is quite low among college educated and middle class

Essential aspects of tobacco control laws

The rationale for the following under the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 and the role of enforcement officers in this regard is discussed:

Ban on smoking in public places;

THE CABLE TELEVISION NETWORKS (REGULATION) ACT 1995 : Ban on advertisements of tobacco products;

Prohibition of sale of tobacco products to and by minors; and

Specified health warning labels on all tobacco products

Legislation

Taxation

Advertisement ban

Behaviour Change Communication

Life skills

Empowerment of youth

Harm reduction

De addiction

Rehabilitation

Multisectoral approach

What can we do?

Conclusion

Taking into account the socio-economic environment and the prevalent infrastructure for educating the masses about the abuse of tobacco, it is suggested that exhaustive community based development programme be formulated and implemented in a phased manner.

For IEC activities, our target audience is poor people who are literate or semi literate.

Among youth, target should be out of school, employed or homeless children.

They are most difficult to reach segments of the population and difficult to work with but we need to make difference there.