“Quitting smoking is easy. I have done it a thousand times.” — Mark Twain
May 31 marked World No Tobacco Day. This year, the 25th anniversary theme selected by the World Health Organisation (WHO) is “Tobacco industry interference” to focus on the need to expose and counter the industry's brazen and increasingly aggressive attempts to undermine the WHO Framework Convention on Tobacco Control because of the serious danger posed to public health.
The WHO estimates that tobacco will cause eight million deaths every year by 2030. Among them, nearly five million deaths will be of users of tobacco and those addicted to tobacco but have given up. And the remaining deaths will be of non-smokers, who are exposed to secondary smoke, called passive smoke.
In India, around 2,500 people are dying every day due to tobacco use. By recent counts, there are about 94 million smokers in India in the country. Of these, about 14 million are ill with the chronic obstructive pulmonary disease (COPD). It is the fourth leading cause of adult deaths in India and it has been found to be mostly caused by smoking.
Almost five per cent of women and a third of all men aged between 30 and 69 in India smoke. They smoke bidis, apart from conventional cigarettes. Bidi smoking has been found to cause deaths faster; about six years for men and eight years for women, than a non-smoker. Smoking cigarettes causes death 10 years sooner.
Why do people smoke? Apart from flavour, stress, pleasure, boredom, friendship and taste, there is really one reason for smoking — the rising tide of anxieties.
Statistics show that every year, 8,00,000 new cancer cases are registered — 3,20,000 of whom are suffering from head and neck cancers largely attributed to tobacco habits. While tobacco claims about 4.9 million deaths annually globally, an alarming one million of them are from India.
What is more alarming is the increasing popularity of smokeless tobacco (falsely considered a safe alternative to smoking cigarettes) among men, women and adolescents alike. In India, it is socially acceptable, particularly among women, to chew various forms of tobacco compared to smoking cigarettes. Smokeless tobacco comes in various forms like gutka, khaini, zarda, mishri, mawa and pan masala, and is sold cheaply in small sachets. Apart from the plastic packets causing environmental pollution, all these products contain poisonous and toxic cancer causing substances and are known to cause oral and pancreatic cancers, increased blood pressure and heart rate, and adverse reproductive outcomes.
Thousands of scientific investigations have confirmed the association of smoking with various diseases and provided additional evidence implicating cigarette smoking as a cause of coronary artery disease, stroke, obstructive airway disease, peripheral vascular disease, pregnancy complications including intra-uterine growth retardation and a variety of neoplasm including cancers of oral cavity, larynx, esophagus, urinary bladder, kidney, stomach, pancreas, cervix and, more recently, of the haematopoietic system. The studies have substantiated the risk of coronary heart disease due to passive smoking. Nicotine, tar, HCN, volatile aldehydes and nitrosamines are some of the identified hazardous substances in tobacco smoke.
Nicotine addiction is a brain “wanting” disease that can be fully arrested but not cured. As permanent as alcoholism, it enslaves the same brain dopamine pathways as do illegal drugs. Smoking-related illnesses that are prevalent in India are lung diseases, cancer, tuberculosis and heart attack.
Tobacco consumption is a leading cause of death among Indians aged 30-69 and one million Indians die from smoking-related diseases each year in India; among all women, 11% (over 54 million women) use some form of tobacco; approximately, 1 in 20 (or 90,000) deaths among women of ages 35-69 can be attributed to smoking.
In a study conducted on out-patients with a chronic and advanced stage of illness, Kalra Hospital, New Delhi, found that 60 per cent men and 62 per cent women aged between 20 and 70 will likely die from smoking-related diseases if proper treatment and counselling are not given and awareness of the seriousness of the illness and health hazards of smoking is not created. In patients with lung cancer, a history of active tobacco smoking is present in 87% of males and 85% of females.
Passive exposure
A history of passive tobacco exposure is found in only three per cent. The relative risk of developing lung cancer is 2.64 for bidi smokers and 2.23 for cigarette smokers, 2.45 being the overall relative risk. Bidi is more carcinogenic. Hooka smoking has also been associated with lung cancer.
This study also made the following revelations:
Smoking bidis heightens the risk of death by one-third and cigarettes doubled the risk factor.
Smoking is the cause of most middle-aged deaths among men.
The risks that smoking poses are not selective as they were found among the literate and the illiterate, among rich or poor people and those living in urban or rural areas.
Only two per cent of smokers in India quit smoking and it usually happens after they become sick.
Companies' tactics
A large body of evidence demonstrates that tobacco companies use a wide range of tactics to interfere with tobacco control. Such strategies include direct and indirect political lobbying and campaign contributions, financing of research, attempts to affect the course of the regulatory and policy machinery and engaging in social responsibility initiatives as part of public relations campaigns. Although more and more is known about tobacco industry tactics, a systematic, comprehensive guide is needed to assist regulators and policymakers in combating those practices.
The industry is not and cannot be a partner in effective tobacco control. It has and will continue to interfere in the implementation of effective tobacco control measures. Such interference can be minimised by strict controls on interactions and by setting rules of engagement, as well as by demanding transparency and disclosure of the industry's conduct and finances.
There is always only one rule ... no nicotine just one day at a time, Never Take Another Puff, Dip or Chew! Yes You Can!!
(The writer is Medical Director and CEO, Kalra Hospital, Sri Ram Cardio Thoracic Neurosciences Centre, New Delhi.
His email is dr_rnk@hotmail.com)
