Tobacco Smoke and Smokeless in India - Essay Example

Assessment of Population Health Needs (About tobacco smoke and smokeless in India) Name: Roll No. Subject: Teacher: University: Introduction and Aims Concerns over the rising trends in tobacco usage in India are increasing. There is a dire need to recognize the escalating issue of tobacco as an adverse effect to health that leads towards the ultimate death of user in many cases. There are many complications involved in the control of tobacco usage in India. A huge variety in tobacco usage is found, most of the variety in the kinds of tobacco introduced by the producers is in response to the heavy demand by public health concerns. The government response to address the public concerns on tobacco usage is not praise-worthy. This is also the case with many local NGOs, who are not much successful to highlight the destruction of tobacco smoke and smokeless in India. Critchley, J.A.(2005, p43). In India, there are almost one hundred and ninety million people belong to the category of tobacco smoke and smoke less. There are positive sings, Yach D.rvd.edn (2007-p66) across India for the control of tobacco usage, which are increasing by the passage of time. This report emphasizes on the ‘Health Need Analysis’(HNA) and explores various aspects in this regard in Indian perspective. Tobacco is a major public health problem. Given the current pattern of tobacco use globally, it is estimated that 250 million children and adolescents who are alive today, would die prematurely because of tobacco, most of them in developing countries. Different counties have adopted various strategies for control of use of tobacco. The launch of the Tobacco Free Initiative of the World Health Organization (WHO) and subsequently Framework Convention on Tobacco Control was a major landmark in the history of tobacco control. Most countries have responded positively with initiation of many steps for tobacco control. However, for a cost effective planning and evaluation of control measures, it is important to have information on tobacco use status in all countries. South Eastern region of WHO is specifically facing with multiplicity of tobacco use modalities and comprehensive information on various aspects of tobacco use has not been well documented in this region. Population Set of people that are selected in this study consist of the people in the country India. The quantum of population is very large. The spectrum of population is too wide. Since objectives are clear, focus is made on the different segments of people in India who are addicted to smoke and smokeless tobacco. The people who do not use tobacco are also taken into account. The doctors, research reports, research organizations, public and government sectors have also been included. [Appendices I-III] According to the WHO estimates, 194 million men and 45 million women use tobacco in smoked or smokeless forms in India. In India, tobacco consumption is responsible for half of all the cancers in men and a quarter of all cancers in women, in addition to being a risk factor for cardiovascular diseases and chronic obstructive pulmonary diseases. Several researches conducted in this regard that comprise thousands of people, present a concrete connection between a variety of tobacco usage and manifold results. Focus of most of the researchers is on a variety of characteristics of tobacco plague. Survey of Tobacco(2006-p432) creates powerful connection between usage of tobacco and tuberculosis and cancer recorded in different researches. A direct connection exists in the disease risk not communicated loudly and a foremost transferable cause of disease as shown by various research outcomes stated by Critchley, J.A.(2005-p98).India also has one of the highest rates of oral cancer in the world, partly attributed to high prevalence of tobacco chewing. Forms of tobacco chewing include pan (piper betel leaf filled with sliced areca nut, lime, catechu and other spices chewed with or without tobacco), pan-masala or gutkha (a chewable tobacco containing areca nut) and mishri (a powdered tobacco rubbed on the gums as toothpaste). In India tobacco use is estimated to cause 800,000 deaths annually. The World Health Organization predicts that tobacco deaths in India may exceed 1.5 million annually by 2020. However, considerable research is required to comprehend the actual trends. Nationally representative and reliable prevalence data on tobacco consumption are scarce. Similarly, the socio-demographic predictors of tobacco smoking and chewing are poorly understood. Attitudes towards tobacco: Data analysis was performed using statistical package for social sciences. Pearson's Chi-square test was used to find any significant difference between ever and never users of tobacco based on the type of institution. Analysis was also done to find the difference in the type of tobacco used based on the type of institution. Ninety-five percent confidence intervals were calculated and used to test for significance of difference. Tobacco & Its Types: Tobacco includes nicotine known as alkaloid. Usage of this form of nicotine results in physical and mental destruction. They are advertising tobacco products using mass media techniques targeting the youth of the world. To counteract the effect of this strategy in India, Critchley, J.A.(2005-p98) states it as in the rest of the developing world, there is an urgent need for good, scientifically sound data about tobacco use pattern that would allow cross-country and within-country comparison. This would permit the fulfillment of the dual objective of designing preventive strategies targeting "the global youth" while taking into consideration local peculiarities. The present study was done to build a database on prevalence of tobacco use among students of grade 8 to 10 in Chennai city. The above data can be used for the purpose of advocacy of tobacco control and planning tobacco control interventions and evaluation. One drop comprising seventy milligram is enough to kill an average grown-up. In addition to nicotine, tobacco comprises almost two hundred and thirty toxic chemicals. The inclusion of these chemicals, Malson, J.(2005-p56) mostly results in the commencement of cancer. There are two kinds of tobacco, smoke and smokeless. Smoking tobacco is used in different kinds. Some of the main forms are cigarettes, cheroots, bidis, hookaas, chillums, chuttas and dhumtis. About one billion cigarettes smoked daily in India and the usage is increasing. Nicotine contents are more heavily used in the cigarettes in India than other countries. The smokeless tobacco is used in different ways. Some of them are chewed. In this category are pan, khaini, mawa gutkha click, etc. Some of the smokeless tobacco is used in that is applied on teeth. It includes gudhaky, toothpaste, mishri etc. states Yach D.rvd.edn (2007 p-123). A strong misconception is found in the usage of smokeless tobacco. A general perception exists that the smokeless tobacco is not health hazard by Prabharkran. P.S (2004 p-45). This understanding needs correction. The chewing tobacco presents more dangerous effects, than the smoking tobacco. Some of the studies highlighted the high usage of smokeless tobacco in females and teenagers. Usage of pan masala results in a state called as oral sub mucous fibrosis. A person is exposed to more danger than the normal person is as much as four hundred times. Even if tobacco is not found in pan masala, it can provide same results. Most of the users in smokeless tobacco category are found in the age group between twenty and forty-five. Prabharkran. P.S (2004 p-45) says it more difficult for the users of smokeless tobacco to quit the usage than the person who use smoke tobacco. A general perception is present in India that the tobacco companies motivate young people for the usage of smokeless tobacco. These companies target youth, initially with such products that contain low nicotine. The motive is to transform them from low nicotine products, gradually towards high nicotine containing products. Most of the users in smokeless tobacco category are transferred to become smoke cigarettes users. (Critchley, J.A.2005). One of the main categories in smokeless tobacco is gutkha that is available in about hundred brands and according to an estimate a four thousand crores industry. The annual growth in the gutkha users is about thirty percent. A pre-cancer disease termed as sub-mucous fibrosis is mostly the outcome of the usage of gutkha. Effects of the usage of gutkha are more rapid than all other forms of smoke and smokeless tobacco by Prabharkran. P.S (2004 p-45) Reasons for these high-speed effects are high ingestion and younger age in the initial intake. Oral cancer is the forecast epidemic of gutkha that affects especially young age persons. Passive Smokers A high category of passive smokers also exists in India. Passive smoking is in fact inhaling of air that contains tobacco smoke. As it happens that almost two thirds of smoke from cigarette goes in air and does not reach the lungs of smoker. Studies show that in some of the cases the lung cancer is found in the wives of smoker husbands. Passive smoking does not result only in cancer. There are increased chances of heart disease in passive smokers also. The children are also affected. An enhanced occurrence of bronchitis ear infection and cough, etc is found in the children of smoker parents. Cancer The prevention of tobacco use in young people appears to be the single greatest opportunity for preventing non-communicable disease in the world today. In this era of globalization, youth and adolescents are adopting behavior patterns that are comparable from country to country. Tobacco companies are taking advantage of this situation. Cancer disease related to the body cells. Nature has placed a system in the human body that replaces the damaged and old cells with powerful cells. The cell in body that is affected by cancer fails to perform the job of replacement. As such, the old and damaged cells remain in the body. Yach D.rvd.edn (2007-p 46) this replacement of strong and new cell to cancer cell is the outcome of different factor, the major being the presence of toxic chemicals in smoke and smokeless tobacco. Material and Method: The present study was designed to find out the prevalence of tobacco use among 13 to 15 years old students (corresponding to grades 8 to 10) in the Chennai city. This study was carried out in July-August 2005. A stratified-random sample design was used to produce a representative sample of students. At the first stage, a list of all private/government aided private schools (private school group) and purely government aided corporation schools (corporation school) having grades 8 to 10 was prepared with enrollment numbers for boys and girls. The schools were grouped into three zones, namely North zone, Central zone and South zone schools, based on their location in the North, Central and South Chennai city respectively. At the second stage, one private/government aided private schools and one corporation aided schools was selected randomly from each zone of Chennai city. All students of grade 8 to 10 in the selected schools irrespective of age were eligible to participate. Data was collected by a pretested, closed-ended questionnaire. The questionnaire was self-administered with no identification (name of the student, class etc). The questionnaire was designed in such a way that there was no skipping or branching pattern and hence required answering all questions. Tobacco use was classified as ever use (the use of tobacco even once) and current use (use of tobacco within 30 days preceding the survey). In India tobacco is used for smoking as well as smokeless use. In Chennai city tobacco is smoked in the form of cigarettes, bidis and tobacco mixed with ganja. Smokeless tobacco use could include, betel quid, gutka, khaini, snuff etc. Lots of these habits are also common in other parts of India and have been described elsewhere. Categories of Smokers Researches have identified the presence of four groups in the smoker category:- Non-Smokers: Who have not smoked even a single cigarettes or have not taken a single puff during their life (Yach D.rvd.edn 2007) Past Smokers: Did not use the cigarettes for the past one-month or more. They are not mostly familiar with the usage of tobacco. (Critchley, J.A.2005). Modest Smokers: Category of Smokers, indulged in this habit for about ten to fifteen days, out of total month. Mostly they are called occasional smokers, with the habit of less smoking. Regular Smokers: Those smokers who smoke cigarettes more than twenty days during a month Awareness in Non-smokers and their Reasons It is pertinent to highlight in this study, the reasons of non-usage of tobacco products by non-users and their awareness of dangers in the habit. (Malson, J.2005) Non-users of smoke and smokeless tobacco are more vigilant in their health care and avoid emergence of obnoxious and undesirable symptoms in their human body. [Appendix I] That shows that their Health Need Analysis is much stronger than the people who are smokers. When we talk about the results of health problems faced by both of these groups; non-smokers are on the safer side and they show a better result in different studies. They realize the fact that tobacco usage, particularly smoke tobacco not only presents hazards to their own health but also for the people around them. Non-users are cognizant of the fact states Prabharkran P.S (2004 p-45) that the more is the usage of tobacco, the more they will spend their money ultimately inviting undesirable diseases, and the end-result could be the pre-mature death. Legislation In 2001, a bill for the cigarettes and tobacco products was passed in the assembly. Growing concerns over the increasing trend in the usage of smoke and smokeless tobacco in India forms the basis of this legislation. Law now prohibits providing sponsorship to any cultural and sporting occasion. It also prohibits direct and indirect advertisement of tobacco. It places ban on smoking in the public conveyance and in public places. (Tobacco companies cannot sell their products to the persons who are below eighteen years age. It also places a ban on selling of tobacco near one hundred meters of schools, colleges and universities. Tobacco companies are required to indicate a readable and clear warning to the users of tobacco products. (Gajalakshmi V, 2006). Implementation of Bills USD 4 and below is the fine that has to be imposed on smoking in public places. An equal amount of penalty is to be imposed for the sale of tobacco products to minors. Health warnings are questionable by the authorities. In the states of Kerala and Goa, already a ban is imposed on smoking. States of Maharashtra and Tamil Nadu has placed a complete ban on sale and usage of Gutkha and Pan Masala. Present Scenario Presently in India the sense of health needs is very poor among governmental authorities and individuals. India being the second largest producer of tobacco in the world enjoys a very liberal view about smoking and the habit or addiction is not strongly disapproved by the society as well. About eighty-five percent of the sales of tobacco in India comprise bidi, gutkha and Chewing tobacco. Tobacco usage kills about eight hundred thousand people per year in India. (Sims, K.2005)This forms about ten to twelve percent of total people killed due to the usage of tobacco worldwide. In developing countries, an increasing trend of about five percent per annum is registered while in developed countries this trend is on downward trend by one percent per year. [Appendices I] There are about five million smokers in the children category and fifty thousand plus children start smoking every year. (Global Youth Tobacco Survey Collaborating Group.2006). One out of every ten grown-up in India is killed due to the excessive use of smoke and smokeless tobacco. More than twenty five thousand crores worth of tobacco is sold every year. Government has to spend more than twenty seven thousand crores per year to provide free medication to the affected people and create awareness about health hazards of cigarettes. Highest frequency of incidence of oral cancer is found in India as compared to rest of the world.(Malson, J.2005) One person per minute or less dies due to the disease related to tobacco and or gutkha. (ttp://www.whoindia.org/LinkFiles/Cancer_resource_pg204to219.pdf)More than ninety percent of oral cancer cases reported due to the usage of tobacco products. (CMR, Tobacco Plain Facts 1996) Cancer affected patients are more in India than anywhere else in the world. More concerns are registered when the ever-increasing involvement of children in tobacco usage is recorded. Four new children are being involved in the usage of tobacco per second. Usage of gutkha is on increase in teenagers, an average of ten packets of gutkha is consumed per day by this segment. Most of the students in school level are addicted to gutkha due to the cheap price and easiness in availability. A major part of daily income of children is spent on the buying and usage of tobacco that leaves less income to be spent on other items especially food. Women and Tobacco: Trend in the usage of tobacco by women is also increasing in both categories of smoke and smokeless tobacco. The biological nature of women increases the risk of heart attacks particularly in those women who smoke three or more cigarettes per day. The use of Mishri by women may result in giving birth to low weight children. Carbon monoxide coupled with nicotine is passed to the pregnant women’s lungs. (Sankar D. 2005) It reduces the supply of oxygen to unborn babies resulting in an increase in the chances of asthma attacks and chest infection in babies. An average of five thousand newly born babies will not die, if all pregnant women quit smoking in their pregnancy period. (Survey of Tobacco, 2006) It means that not only the younger generation in India is addicted with smoke and smokeless tobacco, even pre-born and newly born babies are affected due to the usage by pregnant women. (Global Youth Tobacco Survey Collaborating Group.2006) Children and Smoking: The data available on tobacco use by school children is weak, except in few developing countries. This study was initiated as a means of providing baseline data on youth and their tobacco use. This study demonstrates that among the 13 to 15-year old school going children (corresponding to grades 8 to 10) in Chennai city, the current tobacco use is high. These results are along the same line as those found in studies conducted in Gujarat, Karnataka, Uttar Pradesh and other North-Eastern states of India. This is of concern since the younger the child starts using tobacco, the more likely are they become addicts and die from tobacco related diseases. Consequently, strategies to reduce initiation of tobacco use needs to be targeted more towards younger groups. Some users acquire products of tobacco through social contacts. The supply may come from borrowing it from friends or relatives or some one else purchase tobacco products on their behalf. Most of the users buy tobacco products by themselves directly form stores or common shops. Different studies made in relation to the awareness of dangers in the usage of tobacco products reveals that more than ninety percent of smoke and smokeless tobacco users are aware of the fact that it is harmful enough to pose threats on their lives. Some of the users agree that the tobacco users have comparatively more friends as compared to the non-users. (Malson, J.2005) A majority criterion for tobacco is the interval within which a tobacco product is needed after getting up in the morning. In this study, majority of the tobacco users reported needing tobacco first thing in the morning, showing that children were already developing dependency on tobacco at a very young age. Cigarette smoking outside the school campus was reported by a high proportion of the youth in the present study. It is not known whether this smoking was practiced in front of family members. Hardly any youth reported any difficulty in buying tobacco products despite their young age, indicating that laws restricting access to minors were not implemented adequate. The proportion of students who wanted to give up tobacco varied considerably. Similar variation was apparent in receiving help or advises to give up tobacco usage. Frequent users of tobacco products are not mostly concerned with the damage they cause to the environment. They use the products in work places, public places, homes etc not caring for the effects of especially smoke tobacco on the people around them. [Appendix I] Tobacco users in many cases are found to attract other people for the usage, especially in the children and school-going category. Children, particularly school-going students due to the lack in awareness of dangers of tobacco usage are more attracted. Tensions created in daily working and homes increase the usage of tobacco by women. (Gajalakshmi V, 2006). This shows that programmes and interventions targeting young people need to expand their focus to include both prevention, initiation as well as offering youth cessation programmes. There are several recent reports, predicting an increase in oral cancer incidence in India. This prediction is based upon the observation of an increase prevalence of oral submucous fibrosis, especially in younger individuals, caused by industrially manufactured smokeless tobacco products. In the present study around 65.3 and 75.8% of the tobacco chewers reported chewing gutka and pan masala respectively, confirming the countrywide trend. Gutka is one of the most highly advertised products in almost all medias and it is noteworthy that tobacco users reported seeing more tobacco advertisements. Youth-targeted media advertisements and sport sponsorship influence the children's mind and help them initiate tobacco use in India. In this study, similar to the other studies, a strong association was seen between tobacco use and parental and friends use of tobacco products. These associations were also seen worldwide. New tobacco users mainly join the circle, either by watching actors in television of movies. Young tobacco users are particularly influenced by the actors using tobacco products especially cigarettes. Usage of internet is also a source of increasing tobacco usage. Ads of tobacco on internet appear while surfing internet, which motivates and urge the usage. Companies are spending lavishly on the advertisement of tobacco products, especially the cigarettes companies. Their heavy promotional activities also motivate the non-users to become regular users.( Yach D.rvd.edn 2007) Despite high prevalence of tobacco use, it should be noted that two out of three young students are non-tobacco users and they need to be protected from tobacco in homes and public places. Perhaps little can be done about exposure at home except to educate the public on the needs to restrict smoking at home for health reasons, but for preventing exposure in public places, the Supreme Court of India has already imposed ban legally on smoking in public places, along with ban on selling tobacco products to minors. This needs to be implemented vigorously, while the public needs to be informed about the dangers of environmental tobacco smoke. In western settings, intervention programs have been successful, at least in delaying initiation of tobacco use. A comprehensive school tobacco control policy comprising a combination of tobacco-free school policies and an evidence-based curriculum linked to community-wide programs involving families, peers and organizations with counter-marketing campaigns and community-based activities have shown success in reducing tobacco in schools in USA.There is greater potential for school-based awareness programs in Chennai city as well as the whole of India followed by cessation initiatives. Conclusions and Recommendations The above study supported by quantitative and qualitative data offers to draw the following conclusions and recommendations. Usage of smoke and smokeless tobacco is too high in India, especially compared to the other countries of the world. This ratio is on increasing trend, especially children, pre-born and newly born babies also affected. (Kolappan C.2002). There is quite a mentionable category of people, between non-users of tobacco, and frequent users. They can be termed as experimental users. Another category is of the people who are called past users. They are not in currently, usage of tobacco product but had been using it in the past, beyond thirty days. Strategies and programs are to be developed, by segmenting the different groups. (Prabharkran. P.S 2004). This group, which lies between the non-users, past-users and frequent users, should be motivated. A general awareness is to be created among them. [Appendix III] The policy to quit the usage of tobacco should be on a systematic program. First of all the reduction in habit is motivated and then completes acquittal of the habit is ensured. (Kolappan C.2002). A general awareness plan is made for all groups of smoke and smokeless tobacco users. This program should aim to provide intensive information to all segments of tobacco users. Heavy promotional activities including all channels in promotions are utilized extensively. (Gajalakshmi V, 2006). Children should be special target group and all necessary support provided to create awareness about dangers in tobacco usage. [Appendix II] Special programs are developed to help the young ones to face the challenges and respond to the communication against tobacco usage. Children are more influenced than adults are to join the group of tobacco users through their peers and friends. As soon as they become addicted to tobacco use, they join the group of heavy users, which ultimately transforms them into a heavy user. (Sims, K.2005) Current users of tobacco depend on social network, borrowing it from other and purchase directly from stores. [Appendix I] The general awareness in the retailers is to be created who are to urge and motivate at the time of sale to highlight the dangers in usage. (Gajalakshmi V, 2006). Non-users of tobacco have fewer friends than the users, as shown by some surveys. The teams designed for motivating the acquittal of habit should reach the user group directly through seminars, conferences, rallies and other direct methods. (Sims, K.2005) Although legislation has been passed and implemented in 2001, yet the study of this legislation, prompt the need to enhance the spectrum of activities aimed at the reduction of tobacco usage. Campaigns aimed to curtail the habit of tobacco usage should also include in their activities the aspect of persuasion and motivation at home. The parents of addicted children, wives of addicted husbands, accordingly husbands of addicted wives, friends and relatives should also be motivated to provide support to the addicted for curtailing the habits.( Yach D.rvd.edn 2007) There is a sizeable quantity of data of addicted persons, who wish to quit the usage but find it difficult to do. Some persuasion and motivation can help them to resist against the desire for the usage of tobacco. Direct methods along with strong promotional campaign are to be undertaken in this aspect. (Global Youth Tobacco Survey Collaborating Group.2006). The ban on advertisement as mentioned in legislation is to be implemented without any discrimination and threats by corporate sector is faced effectively. It is pertinent to mention that children are more responsive to the advertisement. The TV channels, filmmakers, especially be motivated and urged, not to use the tobacco, especially the cigarettes scenes. References CMR, Tobacco Plain Facts (1996). Dvision of Noncommunicable diseases, Indian Council of Medical Research, New Delhi, India Critchley, J.A.(2005). Health effects associated with smoking tobacco. A systematic review thorax. p.435 Gajalakshmi V, (2006). Smoking and mortality from tuberculsis and other diseases in India. The Lancet. P.241 Global Youth Tobacco Survey Collaborating Group.(2006). Difference in Worldwide tobacco use by gender. Finds from the global youth tobacco survey. Journal School Health chp. 3, para 5, p -39 Gupta, I. (2004). Tobacco consumption in India: a new look using data from the national Sample Survey. journal of Public Health Policy. P 45 Kolappan C.(2002). Tobacco smoking and pulmonary tuberculosis. Malson, J.(2005) Comparison of the nicotine content of tobacco uses in bidis and conventional cigarettes. Tobacco Control. P. 181 Prabharkran. P.S (2004). Prevalance of tobacco use in India. final report of the study by the Indian council of medical research and world health organization. Sankar D. (2005) Increasing trend of Tobacco in India. National Sample Survey. Journal of Public Health Policy. Sims, K.(2005). Smoking and ethics practiced in India.. p 291-94 Survey of Tobacco-Gender wise in India.(2006), Journal of Public Health Policy- Jan/4- p13 Survey for Tobacco usage. (2007). Categories of Tobacco usage, India. Tobacco control policy. Strategies, successes and set backs. World Bank and Research for International Tobacco Control. Washington Yach D.(rvd.edn 2007) Partenering for Better Lung Health. Improving tobacco and tuberculosis control –p 162 World Health Organization.(2006) Tobacco and health in the developing world. Background paper for the High Level Round Table on Tobacco Control and Development Policy. P 65 World Health Organization. (2005). Increase and Decrease of Tobacco world wide., p -36 http://www.fip.org/projectsfip/pharmacistsagainsttobacco/NO5Reddy.pdf http://www.whoindia.org/LinkFiles/Cancer_resource_pg204to219.pdf Appendix I: Source Site: http://www.fip.org/projectsfip/pharmacistsagainsttobacco/NO5Reddy.pdf Appendix II: Source Site: http://www.fip.org/projectsfip/pharmacistsagainsttobacco/NO5Reddy.pdf Appendix III: Source Site: http://www.fip.org/projectsfip/pharmacistsagainsttobacco/NO5Reddy.pdf Appendix IV: Source Site: http://www.fip.org/projectsfip/pharmacistsagainsttobacco/NO5Reddy.pdf Read More