According to the World Health Organization (WHO), tobacco kills more than seven million people each year. Over six million deaths are a result of direct consumption, whereas 890 000 are the result of passive smoking. Nearly 100 million premature deaths have been recorded in the 20th century and the figure is set to increase to one billion by the 21st century.
Smoking kills over one million people in India annually and is the fourth leading cause of non-communicable diseases (NCD), such as cancer and heart diseases, which account for 53 percent of all deaths in India.
This year, the theme to mark 'World No Tobacco Day' is 'Tobacco threatens us all,' which reinforces the fact that tobacco consumption compromises the health and economic well-being of all citizens in a country, from children to older people, be it men or women.
Dr Surender Dabas, director, Head, Neck and Thorax Surgical Oncology, Fortis Memorial Research Institute, presents some key facts and prevalent trends around tobacco consumption in India.
# 34.6 percent of adults (out of which 47.9 percent is males and 20.3 percent is females) are smokers;
# 14 percent adults (out of which 24.3 percent males and 2.9 percent females) use smoking tobacco;
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# 25.9 percent adults (out of which 32.9 percent males and 18.4 percent females) use smokeless tobacco;
# The absolute number of male smokers has grown from 79 million in 1998 to 108 million in 2015;
# According to the National Family Health Survey (NFHS-4) 2015, Government of India, among the 13 States surveyed, tobacco use among men has fallen from 50 per cent in 2005-06 to 47 per cent in 2015. At least 11 of the 13 states in the report have reported a decline in the numbers between 2005-06 and 2015-16;
# In Sikkim, there is up to 20 percent dip in tobacco use. The only two states that showed increase in consumption were Manipur and Meghalaya;
# Haryana specifically has a 32 percent prevalence of tobacco usage, with about 3.2 million smokers in the year 2015;
# Smoking cessation remains uncommon as only about five percent of men aged 45-59 years are ex-smokers.
- Trends in Tobacco use:
# Cigarettes are replacing bidis, among young men and also illiterate men.
# Among the upper class, cigarettes are being replaced by cigars which have a high concentration of tobacco-specific nitrosamines (TSNAs) that are the most potent cancer causing substances.
- Smoking tobacco hazards:
# Tobacco smoke is made up of thousands of chemicals, including at least 70 known to cause cancer. These cancer-causing chemicals are referred to as carcinogens. Some of the chemicals found in tobacco smoke include Hydrogen cyanide, formaldehyde, lead, arsenic, benzene, ammonia and radioactive elements.
# Many of these cause cancer and some can cause heart disease, lung disease, or other serious health problems, too. Most of the substances come from the burning tobacco leaves themselves, not from additives included in cigarettes (or other tobacco products).
# Nicotine, the addictive drug that is the key stimulant people are looking for is one of the harshest chemicals in tobacco smoke.
- Smokeless tobacco hazards: These include snuff and chewing tobacco placed in the mouth or nose but is not burned like cigarettes or cigars. Still, smokeless products contain a variety of potentially harmful chemicals, including high levels of TSNAs.
There are also other cancer-causing agents in smokeless tobacco, such as benzo[a]pyrene and other polycyclic aromatic hydrocarbons (PAHs). These carcinogens are absorbed through the mouth and are linked to oral cancers. Like other forms of tobacco, smokeless tobacco also contains radioactive substances.
-Tobacco-related diseases:
# The most common, nearly half of all, are cancers of the lung and oral cavity in men, and of the breast and cervix in women.
# The rate of occurrence of lung cancer is 11 per 1, 00,000 individuals and of oral cavity cancer, 10.1. The rates of occurrences of breast and cervical cancers are 25.8 and 22.0 per 1, 00,000.
- Which is riskier? Smokeless tobacco or cigarette smoking?
# Smokeless tobacco products are less deadly than cigarettes. On an average, they kill fewer people than cigarettes. Smokeless products are often promoted as a less harmful alternative to smoking, but they are still linked with cancers, especially oral and are deadly. And they have not been proven to help users quit.
- E-cigarettes and Electronic Nicotine Delivery Systems (ENDS):
# E-cigarettes and other electronic nicotine delivery systems (ENDS) are used as substitutes for cigarettes or other tobacco products. Marketers of e-cigarettes and other ENDS often claim the ingredients are safe.
# But the aerosols these products contain addictive nicotine, flavorings, and a variety of other chemicals, some known to be toxic or to cause cancer. The levels of many of these substances appear to be lower than in traditional cigarettes, but the nicotine and other substances in these products can vary widely because they are not standardized. The long-term health effects of these devices are not known, but they are being studied.