Tobacco: Addressing the Fire Not Just the Smoke

Review ARTiCLeas adults. 10The media offers a nudge by glamorizing smoking.A study in Norway reported that a ban on tobacco advertising in 1975 resulted in a 9% decline in smoking.Tobacco contains nicotine, which is highly addictive. 11In India, the nicotine content is 1.23, 1.8, and 3.82% of the tobacco weight in each cigarette on average for domestic cigarettes, imported cigarettes, and pipe cigarettes, respectively. 12Indian brands of smoking tobacco have higher nicotine content than international brands, making them more addictive. 13Nicotine concentration in bidis (26.9 mg/gm) is higher than in cigarettes (15 mg/gm).The level of dependence on nicotine makes it difficult for individuals to quit smoking, as sudden quit attempts are met with severe withdrawal symptoms and cravings. 10 OvercOming t h e challenges Policy EffortsIn its relentless crusade against tobacco, the World Health Organization (WHO) has come up with several initiatives.The Framework Convention on Tobacco Control (FCTC), through MPOWER (Monitoring tobacco use and prevention policies, intrOductiOn Magnitude of the Tobacco EpidemicTobacco use kills >8 million people annually, 7 million due to the direct use of tobacco, 1.2 million due to exposure to secondhand smoke. 1 The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) virus, in comparison, killed 1.8 million people in its 1st year, leading to unprecedented public health measures. 2Eighty percent of tobaccorelated deaths occur in middle-and low-income nations. 3About 1.8% of the world gross domestic product (GDP), or USD 1.4 trillion, is spent on health care; tobacco is a significant contributor to costs. 3 India accounts for a sixth of the global deaths due to tobacco. 4 It is the world's second-largest producer of tobacco after China, with an estimated annual production of 750 million kg. 5 The second Global Adult Tobacco Survey in 2016-17 (GATS-2) reported that 266.8 million people in India currently consume tobacco in various forms.About 40% of them use smokeless tobacco, 20% use cigarettes, and 40% smoke bidis (tobacco rolled in a tendu leaf tied by a string). 3 While the trends suggest that overall tobacco use is on the decline, this is heterogeneous, the decline being less in older ages, among women, and lower socioeconomic strata. 6 Effects of TobaccoTobacco use increases the risk of cancer of the mouth, larynx, pharynx, kidney, cervix, liver, pancreas, and stomach 7 and increases the risk of heart disease and strokes. 8Tobacco smoke causes coughing, wheezing, shortness of breath, lung infections, and ear infections. 9India witnesses more than 1.3 million tobacco-related deaths each year. 3 Of these, oral cancers contribute the most, and India accounts for almost half of the world's patients with oral cancer. 3 Addiction to TobaccoThe GATS-2 survey revealed that 92.4% of adult Indians believed that smoking caused serious illness and 95.6% of adults believed the same for smokeless tobacco.Yet, several factors contribute to high consumption.Peer pressure experienced during teenage years often nudges individuals toward risk-taking behaviors. 10According to the American Cancer Society, nine out of 10 individuals under the age of 18 who experiment with smoking continue to smoke