Hazards of Tobacco
Dr. G. SAMARAM
National President (2009-10)
Indian Medical Association
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 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 India
Below 35% : 2 states
Punjab 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% : 11states
Madhya Pradesh, Bihar,
Chattisgarh, Orissa, West Bengal,
Assam, Meghalaya, Manipur,
Tripura, Mizoram, Nagaland
TOBACCO & MEN
61
57
50
13
11
7
Urban
Rural
Women
Total
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
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 34weeks
More than 4,000 substances have
been identified in cigarette smoke
Cigarette smoking antigenic,
cytotoxic, mutagenic, carcinogenic
Nicotine increases systolic and
diastolic blood pressure
 Cardiovascular Diseases
CLINICAL
AFFECTS
 Cancer
 Respiratory Diseases
 Pregnancy related
complications
 Gastrointestinal disorders
 Depression
ACTIVE SMOKING
PASSIVE SMOKING
TOBACCO & WOMEN
TOBACCO & WOMEN
• 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 - 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
What can we do?
Legislation
Taxation
Advertisement ban
Behaviour Change Communication
Life skills
Empowerment of youth
Harm reduction
De addiction
Rehabilitation
Multisectoral approach
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.