Around 70 million women in India aged 15 years and above use smokeless tobacco (SLT) and one factor influencing them to consume it is the desire to suppress hunger while performing laborious tasks, a new report today said.
"Currently, 70 million women age 15 and older use SLT. Easy availability and low cost of SLT are key factors promoting SLT use by women. One factor influencing SLT use among disadvantaged women is the desire to suppress hunger while performing difficult and laborious tasks," the report said.
The Health Ministry in collaboration with WHO, Public Health Foundation of India, Healis-Sekhsaria Institute of Public Health, Centers for Disease Control and Prevention, and National Cancer Institute, US released the country's first comprehensive report on the impact of smokeless tobacco consumption in the country.
Terming cancers of the oral cavity and pharynx as an important health problem in India, the report said that nearly 85,000 new cases among men and 34,000 among women are reported each year with at least 90 per cent of them caused by tobacco use in some form and more than half are caused by SLT use.
Referring to the The Global Adult Tobacco Survey (GATS) conducted in India in 2009-2010 among those 15 years or over, the report said that SLT was the most common form of tobacco used as the prevalence of SLT use was 26 per cent (33 per cent men and 18 per cent women).
The report was released Seventh Session of the Conference of Parties (COP7) to World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) which India is hosting for the first time.
The report said that using SLT during pregnancy results in 70 per cent higher risk of anaemia in pregnant women, 2-3 times higher rate of low birth weight and 2-3 times higher rate of stillbirth.
"The relative risk of oral cancer among women SLT users is 8 times higher than that for men, and the relative risk of cardiovascular disease among women SLT users is 2-4 times higher than in men. Relative risk of all-cause mortality due to SLT use is higher among women than among men," the report said.
The SLT industry in India has grown "exponentially" mostly in the unorganised sector, the report said and asserted that about 14 per cent of land under tobacco cultivation is used for growing SLT varieties and one-fifth of total tobacco production is used for SLT.
"The cumulative tax rate, 76 per cent, is similar across all SLT products. Excise revenue from chewing tobacco has increased 15-fold in 10 years, from Rs 722 million in 1990-1991 to Rs 10,532 million in 2010-2011," the report said.
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The report said that from 1991 to 2010 the value of SLT exports from India increased ninefold, from Rs 181 million to Rs 1,648 million and over 70 per cent of SLT exports from India go to the Eastern Mediterranean Region, followed by the Western Pacific and American Regions.
The report assumes significance as India had said that it will push for incorporating smokeless tobacco as an agenda of the ongoing crucial global tobacco control conference.
"India is the first country to prohibit the sale, storage and manufacturing of smokeless tobacco products like gutkha across all states. However, stronger measures are required for effective implementation of the law.
"The report outlines all facets of smokeless tobacco use including their determinants, economic costs and health consequences, along with advocacy, policy and judicial measures that can be utilised to curb its impact," said Amal Pusp, Director, Union Health Ministry.
The Global Youth Tobacco Survey, 2009 also highlights that 9 per cent of 13-15 year olds use smokeless tobacco products and India India ranks highest in prevalence of smokeless tobacco use among both boys and girls in the four most populous countries for which comparable estimates are available.
"In 2009, Global Youth Tobacco Survey (GYTS) found that nearly one in ten students in India aged 13-15 years used some form of SLT (9.4 per cent overall, 10.7 per cent boys and 7.5 per cent girls).
"The most important factors affecting SLT use by youth in India are advertisements, promotions, and price, all of which can be influenced by policy. Surveys conducted in India in 2006 and 2009 showed that seven in ten students between 13-15 years were exposed to SLT advertisements," the report said.
Noting that a dual tobacco user uses both smoking and smokeless forms of tobacco, the report while referring to the GATS India 2009-2010 said that the prevalence of dual tobacco use was 5.3 per cent (men 9.3 per cent and women 1.1 per cent), amounting to 42.3 million adults while the North-East region had the highest prevalence (9.8 per cent).
"SLT is a risk factor for stroke (40 per cent-70 per cent higher risk), and in association with hypertension, SLT use markedly increases the risk of stroke.
"In a few studies from India, chewing tobacco, like smoking, was also found to be associated with higher risks of high blood pressure and dyslipidemia," the report said.
