1. Dr. G. SAMARAM National President (2009-10) Indian Medical Association Hazards of Tobacco

2. 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)

3. 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%

4. 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

5. 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 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 TOBACCO & MEN

6. Cigarette Smoking is the principle cause of Premature Death

7. Smoking withdrawal symptoms Anger Anxiety Difficulty in Concentration Hunger Impatience Restlessness

8. Most of the symptoms peak in 2-3days and return normal within 3- 4weeks

9. More than 4,000 substances have been identified in cigarette smoke

10. Cigarette smoking antigenic, cytotoxic, mutagenic, carcinogenic

11. Nicotine increases systolic and diastolic blood pressure

12. CLINICAL AFFECTS Cardiovascular Diseases Cancer Respiratory Diseases Pregnancy related complications Gastrointestinal disorders Depression

13. ACTIVE SMOKING

14. PASSIVE SMOKING

15. TOBACCO & WOMEN

16. 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. 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

17. 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. 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.

18. 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 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

19. 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

20. 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

21. Legislation Taxation Advertisement ban Behaviour Change Communication Life skills Empowerment of youth Harm reduction De addiction Rehabilitation Multisectoral approach What can we do?

22. 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.