Putting Lips on Fire
QUIT BEFORE IT KILLS YOU

World No Tobacco Day or Anti-Tobacco Day is marked every year on 31 May. As the name suggests, this annual campaign is marked to spread awareness about the adverse effects of smoking. The main aim of the day is to highlight the risk associated with the use of tobacco and to protect the health of smokers.
The World Health Organization (WHO) promotes the campaign to enlighten the health risks associated with the use of tobacco and to encourage governments to draw up policies to help people reduce smoking and usage of other tobacco products.
Tobacco (smoking or smokeless) use is one of the biggest public health threats the world has ever faced and it is one of the major preventable causes of death and disability worldwide.1 Cigarette smoking is the most popular form of tobacco use. There are 1.1billion tobacco users in the world, 70% of whom are in low-income countries2. Tobacco use in children and adolescents is reaching pandemic levels. The World Bank has reported that between 82,000-99,000 children and adolescents worldwide and 5,500 adolescents in India begin smoking every day. About half of them will continue to smoke to adulthood and half of the adult smokers are expected to die prematurely due to smoking related diseases. In view of the deep-rooted nature, the eradication of tobacco habit would require concerted action resulting into a social change. Community education regarding tobacco and its health hazards would necessarily be an integral component of such an action plan. Anti-tobacco education needs to be targeted at decision-makers, professionals and the general public, especially the youth. Efficacy of educational activities in tobacco cessation had amply been demonstrated by various organizations.
If current smoking trends continue, tobacco will kill nearly 250 million of today’s children. The World Health Organization (WHO) estimates that 4.9 million deaths annually are attributable to tobacco i.e., an average of one person every six seconds and that tobacco accounts for one in 10 adult deaths worldwide. This figure is expected to rise to 10 million in 2030, with 70% of these deaths occurring in developing countries like China and India. These are frightening statistics.
The prevention of tobacco use in young people appears to be the single greatest opportunity for preventing non- communicable disease in the world today as it is home to one sixth of the global population and thus India’s share of the global burden of tobacco-induced disease and death is substantial. The WHO, which provides these estimates, also predicts that India will have the fastest rate of rise in deaths attributable to tobacco in the first two decades of the twenty first century.7
Currently, about one-fifth of all worldwide deaths attributed to tobacco occur in India, where more than 800,000 people die and 12 million people become ill as a result of tobacco use each year. India amassed over 1.7 million disability-adjusted life years (DALYs) due to disease and injury attributable to tobacco use. As per reports use of any kind of tobacco in women was 10.8% and in men 57.0% and if only smoking is considered it was 1.6% in women and 33.3% in men. A Global Youth Tobacco Survey (GYTS) , in collaboration with WHO, conducted a survey in the age group of 13-15 years, shows 6.1% students had ever smoked cigarettes, 14.6% currently use any tobacco product, 4.4% currently smoke cigarettes, 12.5% currently use tobacco products other than cigarettes, and 15.5% of never smokers are likely to initiate smoking in the next year. The increasing prevalence of tobacco use may be due to lack of effective tobacco control by the government.
Chewing tobacco
Chewing tobacco is slowly becoming endemic. Students, professionals, taxi drivers, labourers, children, young and old people all take it. A recent survey revealed use of chewing tobacco by nearly 70% of college students in several cities.Locally, it’s often called as “Gutka” (also known as gutkha, guttkha, guthka) or “Sir”. This smokeless tobacco is so popular that highly qualified professionals, such as doctors, also use it. Gutka’s main ingredients are betel nuts mixed with areca nut, slaked lime, catechu and tobacco in granulated form, collectively known as Pan Masala, when added to betel leaves (known as Paan) may be harmless without the tobacco. The idea is to chew and later spit it out or it can be swallowed. There are several reasons for its use. Mostly it may be preferred to smoking tobacco because it is fume-free and can be well hidden inside the mouth. Thus users may believe that it creates less of a nuisance for others. Its small, striking and low-cost sachets appeal to many young people. A primary ingredient of chewing tobacco is nicotine. The biggest risk from chewing tobacco is oral cancer. Annual oral cancer incidence has been estimated to be as high as 10 per 100,000 among males. Its use also leads to decay of the roots of the teeth and stains on teeth.
Legislation regarding tobacco use
Considering the effects of smoking on health calls for strong legislation to deter people from taking up smoking, to protect people, especially young people from the harmful effects of tobacco.
Framework Convention on Tobacco Control (WHO):
The WHO used its mandate of proposing international treaties on public health for the first time in its history, by initiating the Framework Convention on Tobacco Control (FCTC). After several years of negotiations, in which over a hundred countries participated, the Convention was adopted by the World Health Assembly in May 2003. India was one among the first few countries to sign and ratify the FCTC.
Recommendations
In India, people have used tobacco in many forms for several centuries. Its use often starts early in life. There is tendency towards an increase in tobacco use among youth for the past few decades, with an emphasis on smokeless tobacco use. This is a matter of great public health concern. Psychosocial factors have an important role to play in initiation of this habit. It has been observed that a large number of adolescents pick up this habit from their family members or the peers. Enforcement of regulations on sale of tobacco products may be useful. However, legislation regarding the use of tobacco products needs to be strengthened to decrease availability, accessibility and affordability of tobacco products. It is also necessary to keep abreast of the policies and conventions of the international agencies such as WHO, United Nations International Drug Control Program (UNDCP) and other similar agencies on tobacco use, in order to utilize their expertise for curbing this problem. A major tobacco control strategy is an appropriate price policy to keep the price of tobacco products high with regular increases above the level of inflation. This is because price and consumption, especially the initiation of tobacco use by young, shows a strong inverse correlation everywhere in the world. There is also an urgent need to take effective steps, especially to increase the education of parents to help prevent children from taking-up this habit in the first place, and also to have targeted school intervention strategies through counselling and direct education of school children regarding this issue. The adult population must be educated, through launching community awareness programs, about the consequences of tobacco use.