Tobacco survey: A wakeup call for India

 
ASHOK B SHARMA
 
Despite several anti-tobacco measures being taken up by the government, India remains the second largest tobacco consumer in the world. About one million persons die due to tobacco-related diseases every year in the country. This reflects a higher mortality than the combined deaths resulting from other major diseases such as tuberculosis, HIV AIDS and malaria in this country.
 
The first Global Adult Tobacco Survey (GATS) – India 2010 recently released has revealed that Tobacco is the single most common preventable cause of death in the world after road accidents causing nearly five million deaths annually across the globe. More than 80% of these deaths occur in the developing countries. Majority of cancers, cardiovascular and lung diseases resulting from tobacco use also reflect a very high health cost burden.
 
As a result of stringent tobacco control initiatives by the developed countries, the tobacco industry have shifted its base to the developing countries. Countries like India are being targeted as potential markets by the global tobacco industry. According to a projection by 2030, seven of every 10 tobacco-attributable deaths are expected to be in the developing countries.
 
The GATS-India report is a wakeup call to the policymakers and the government that its anti-tobacco measures are not enough to contain the menace. The central government says that the implementation of The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution Act 2003 – COTPA – is the responsibility of the state governments. The law provides for banning smoking in public places, ban on all forms of direct and indirect advertisements, ban on sale of tobacco products to minors and sale within 100 yards of educational tribunals.
 
The central government had launched the National Tobacco Control Programme (NTCP) in 2007-08 in 21 states and 42 districts to field test tobacco control strategies, but the progress of this project is tardy.
 
India, which has ratified the Framework Convention of Tobacco Control (FCTC) in 2004, has a responsibility to contain the tobacco menace.
 
The central government is planning to persuade farmers to shift to alternative crops. The Union Minister of Health and Family Welfare, Ghulam Nabi Azad has said that while livelihood of tobacco growing farmers cannot be endangered, we must work towards moving famers and farm workers out of the tobacco industry. Alternative employment should be provided to the workers in the tobacco industry.
 
 
Emphasizing the need for inter-sectoral coordination for comprehensive tobacco control strategies, the minister informed about collaboration with agriculture ministry for a project on alternative crops to tobacco and coordination with other stakeholders ministries like human resource development, information and broadcasting, rural development and labour.

 
GATS-India survey was conducted under the stewardship of the Union Ministry of Health and Family Welfare alongwith the International Institute for Population Sciences, Mumbai. Technical assistance was provided by Centres for Disease Control and Prevention (CDC), World Health Organization (WHO), Johns Hopkins Bloomberg School of Public Health, and RTI International.
 
GATS-India provides information on both, tobacco smoking and use of smokeless tobacco along with varied dimensions of tobacco use including use of different tobacco products, frequency of use, age at the time of initiation and the like.  Additionally the report throws light on the other aspects of tobacco use like, exposure to second-hand smoke; cessation; the economies of tobacco; exposure to media messages on tobacco use; and knowledge of health impact of tobacco use.
 
The high prevalence of tobacco use makes India the second largest consumer in the world. India is among the few countries in the world where tobacco is consumed in oral form. GATS-India revealed that more than one-third (35%) of adults in India use tobacco in some form or the other. Among them 21% adults use only smokeless tobacco, 9% only smoke and 5% smoke as well as use smokeless tobacco. Based on these, the estimated number of tobacco users in India is 274.9 million, with 163.7 million users of only smokeless tobacco, 68.9 million only smokers and 42.3 millions users of both smoking and smokeless tobacco.
 
The prevalence of overall tobacco use among males is 48% and that among females is 20%. Nearly two in five (38%) adults in rural areas and one in four (25%) adults in urban areas use tobacco in some form. Prevalence of smoking among males is 24% whereas the prevalence among females is 3%. The extent of use of smokeless tobacco products among males (33%) is higher than among females (18%).
 
The prevalence of tobacco use among all the states and Union Territories ranges from the the highest of 67% in Mizoram to the lowest of 9% in Goa. Prevalence of tobacco use in Arunachal Pradesh, Bihar, Chhattisgarh, Jharkhand, Madya Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Odisha, Sikkim, Tripura, Assam and West Bengal is higher than the national average. In most of the states and Union Territories the prevalence of both smoking and smokeless tobacco use among males is higher than among females with exceptions in Puducherry, Tamil Nadu, Meghalaya, Tripura and Mizoram, where prevalence of smokeless tobacco is higher among females than males.
 
More than 75% of tobacco users, both smokers as well as users of smokeless tobacco are daily users of tobacco. In India, khaini or tobacco-lime mixture (12%) is the most commonly used smokeless tobacco product, followed by gutkha, a mixture of tobacco, lime and areca nut (8%), betel quid with tobacco (6%) and applying tobacco as dentifrice (5%). The prevalence of each of the smokeless tobacco products, except dentifrice, is higher among males than females. Among smoking tobacco products, bidi, leaf-wrapped tobacco sticks (9%) is used most commonly followed by cigarette (6%) and hookah (1%).
 
Among both males and females, the prevalence of cigarette smoking is higher in urban areas but the prevalence of all other smoking products is higher in rural areas. The prevalence of each of the smokeless tobacco product is higher in rural than in urban areas, however, gutkha is almost equally prevalent in both urban and rural areas.
 
On an average a daily cigarette smoker in India smokes 6.2 cigarette sticks per day and a daily bidi smoker smokes 11.6 bidi sticks per day. One-fourth of daily cigarette smokers smoke more than 10 cigarettes per day and more than half of the daily bidi smokers smoke more than 10 bidis per day.
 
The GATS-India shows that 52 % of adults were exposed to second-hand smoke (SHS) at home. In rural areas 58% and in urban areas 39% were exposed to SHS at home. The SHS exposure at home ranged from the highest of 97% in Mizoram to the lowest of 10% in Tamil Nadu. Exposure to SHS in indoor workplaces who usually work indoors or both indoors and outdoors was 30%. The exposure to SHS was highest (68%) in Jammu and Kashmir and lowest in Chandigarh (15%).
 
Exposure to SHS at any public places ranged from the highest of 54% in Meghalaya to lowest of 11% in Chandigarh.
 
India has enacted anti-tobacco laws and the state governments are the implementing agencies for most of these laws. The success of the anti-tobacco drive depends much upon generation of awareness and effective implementation of anti-tobacco measures by the central and the state governments.