KOCHI: The world marks the No-Tobacco Day today to fight the nasty ‘epidemic’ that claims more than 80 lakh lives every year. According to the World Health Organization (WHO), of these, at least 12 lakh are victims of passive smoking.
“Tobacco use is a major risk factor for many chronic diseases, including cancer, lung disease, cardiovascular disease and stroke,” notes WHO. “It is one of the major causes of death and disease in India and accounts for nearly 1.35 million deaths every year.”
According to experts, India is at the precipice of the second stage of the tobacco epidemic. The good news is that there is a gradual drop in smoking among men. On the flip side, however, more women, especially in urban areas, are picking up the cigarette.
“The lure to smoke starts at the adolescent stage. Peer influence and social desirability, curiosity about experimenting, considering it a method of stress relief, seeing family members using it and easy availability are the influencing factors,” says Dr Aju Mathew, a senior oncologist based in Kochi.
“In the case of women, other factors also contribute. There still exists a misconception in society that links tobacco consumption, especially smoking, to empowerment. It is one of the significant factors for the rising number of women smokers.”
He adds there is a “significant increase in the number of women smokers in Kerala” and, hence, an “increase in the subsequent tobacco-related health diseases as well”. Oncology surgeon Dr Jojo Joseph, of Mission Cancer Care IGCH, agrees. The trend trickles down from the West, he says. “A pattern can be observed. Initially, men tend to smoke. In the subsequent stage, women begin to follow suit, leading to an increase in tobacco consumption among females,” he explains.
“In the third phase, men experience higher rates of illness and death due to smoking. And the impact of tobacco use among women also increases. Finally, in the last phase, there is a general decline in smoking. Nevertheless, the negative health consequences from the previous stages persist, resulting in continued morbidity and mortality.”
Studies show that India is at the second stage of the tobacco epidemic where women tend to follow male patterns. “This is an expected rise,” says Dr Jojo. “Various factors interplay to explain the rise in female tobacco consumption. India is a developing nation witnessing tremendous socio-economic development along with financial autonomy of women.”
Dr K R Thankappan, Department of Public Health and Community Medicine of the Central University of Kerala, believes the percentage of women smokers is still relatively low. “However, I see a tendency among the tobacco industry to increase women smokers by introducing light cigarettes,” he adds.
According to a report by the Public Health Foundation of India (PHFI), the number of women who have taken up smoking and/ or consuming tobacco has doubled over the past two decades.
“Cigarette smoking is the most prevalent form of tobacco use in urban areas,” says Dr Chitrathara K, senior consultant and surgical oncologist at Lakeshore Hospital. “And there is growing concern about the increasing trend of female smoking. It is booming at a faster rate than males; this is an emerging concern that requires the attention of policymakers.”
Cinema’s influence over Indians is well-known, and films containing tobacco imagery are bound to play a major role in gravitating young viewers toward smoking, she adds. “Filmmakers should keep in mind that they have the power to drastically affect the population’s mindset and refrain from glorifying smoking,” she cautions.
Dr Chithrathara also highlights that women face additional health risks due to smoking, such as adverse pregnancy outcomes, female-specific cancers — breast and cervical cancer — and increased cardiovascular risks. “The government needs to re-strategise on tobacco control. Gender‑blind policies should be amended in sync with the times,” she adds.
Protect the youth
Another worry is the rising popularity of smoking among adolescents. According to the 2019 data from the Central health ministry, 8.5 per cent of Indian adolescents (13 to 15 years) consumed tobacco in some form. An analysis of the data showed children were being introduced to tobacco earlier than before.
As India has the largest youth population globally, adolescents are particularly vulnerable to initiating tobacco use, often falling victim to the aggressive marketing tactics employed by the tobacco industry.
According to Dr Aju, prevention of early tobacco initiation among youth is crucial for reducing the burden of non-communicable diseases, including cancers. “The majority of tobacco-related deaths occur at a young age,” he cautions.
Dr Chitrathara concurs, adding that “early experimentation often leads to nicotine dependence”, and adverse health consequences, with many adolescents continuing tobacco use into adulthood.
Notably, a University of California report says nicotine “has been proven to be as addictive as cocaine and heroin and may even be more addictive”.
“Many people who smoke develop nicotine dependence, which makes quitting all the harder, especially when they try to stop smoking on their own. In fact, 70 per cent of smokers report wanting to quit, but many wait until they develop a significant tobacco-related disease such as heart disease, cancer or stroke,” the report notes.
That’s true, says Dr Jojo. “And if current trends continue, a huge chunk of the Indian population will die prematurely from tobacco-related diseases,” he warns. He also touches upon the legalisation of e-cigarettes aka vapes. Many believe that the use of vapes is a safer substitute for cigarettes, and argue that e-cigarettes should be legalised.
“E-cigarettes deliver nicotine through an aerosol that is inhaled into the lungs. Vapes may be less harmful when compared with cigarettes, but it doesn’t mean that they are not harmful. In fact, vapes can initiate the use of tobacco among young individuals,” says Dr Jojo.
Better awareness, more barriers
Dr Chitrathara believes talk on the harmful health effects of smoking should begin at an early age, at two levels. “One, in the schools, where doctors can be invited to interact with children in the early education stage. Two, within families, by the parents,” she says.
Dr Aju stresses the role of parents. ”Rather than talking negatively or restricting children from trying out harmful substances, parents should try to inculcate a positive environment at home by suggesting healthy alternative activities such as cycling, sports, reading, etc.,” he says.
On the policy front, he adds “revisiting tobacco control laws in India and enhancing barriers” can have a significant impact on curbing tobacco consumption. “In this way, we can work towards effectively combating the tobacco epidemic and safeguarding the well-being of the population. It is crucial to view tobacco control not only as a public health issue, but a fundamental human right,” he says.
He offers some final words of wisdom. “It is never too late to quit tobacco,” he says. “If you intend on quitting tobacco you will have to stop it right away and go cold turkey. There is no such thing as tapering down. Switch to good habits.”
The smoke-effects
General issues
Cancer
Tobacco consumption is the number one risk factor for lung cancer. It can also cause cancer in the colon, cervix, liver, stomach and pancreas.
COPD
Chronic obstructive pulmonary disease is an obstructive lung disease that makes it hard to breathe and lead an active lifestyle
Heart diseases
Tobacco consumption can create obstructions and narrowing of your arteries resulting in lesser blood and oxygen flow to your heart.
Stroke
Because smoking affects your arteries, which means the blood supply to your brain is temporarily blocked, it can trigger a stroke.
Asthma
It is a chronic lung disease that makes it hard to breathe and tobacco smoking can trigger a sudden and severe asthma attack.
Diabetes
Users are more likely to get type-2 diabetes.
Blindness
Tobacco consumption can damage your eyes, which can result in blurred vision or complete loss of vision. It can trigger cataracts and age-related macular degeneration.
Other health effects
High blood pressure, mood swings, and lower concentration.
In adolescents
Tobacco use can severely impact brain development.
Leads to decreased lung growth and function resulting in an inactive lifestyle. This can be carried on to adulthood.
In women
Helpline number: National Tobacco Quit Line Services - 1800 112 356 (TOLL-FREE)
Nicotine Anonymous helpline (Kerala): 09995449744, 09745601584
With inputs from Arya U R