In several countries, the government has provided tobacco alternatives to deal with nicotine use and addictions
The Constitution asks citizens to develop a scientific temper and this could well be their greatest contribution to health. The Covid-19 has been an eye-opener to the importance of modern science. Many understand diseases better and that knowledge helps to combat it through vaccines, prophylactics and medical treatment.
That same scientific temper is lacking when it comes to tobacco use. More than a third of the Indian male population uses tobacco. The situation is particularly grim in rural India, where 42 per cent of men use tobacco products. It is time to employ science to combat death and disease by tobacco.
The data is culled from the National Family Health Survey, which is an important vehicle to understand the status of India’s health. The most recent one, NFHS-5, was carried out in 2019-21.
The data from the NFHS on the consumption of tobacco in India has thrown up shocking data. There has been a little change in patterns of tobacco use amongst the Indian population despite advertising ill-effects.
There are graphic images on tobacco pouches and cigarette packets yet these seem to have little effect. The data on tobacco use also throws up several scary observations on the smoking population, which is quite high. But the message is not percolating down to the smokers, particularly in rural areas.
The study of tobacco consumption also shows that the prevalence of smoking decreases with increased exposure to schooling. The NFHS-5 reports that 39 per cent of men and nine per cent of women age 15 and over currently use any tobacco products. This percentage is less than reported in the NFHS-4 (conducted in 2015-16) which had shown that tobacco use amongst 45 per cent of men and seven per cent of women in the 15-49 age group.
However, it is far from ideal in the modern world. Those who smoke in a family are not smoking alone. The NFHS-5 survey revealed that, in 25 per cent of Indian households, at least one person smokes tobacco on a daily basis, exposing others to passive smoking and its ill-effects. This is down a few notches from 29 per cent in NFHS-4.
The percentage of men aged 15 years and above who use any kind of tobacco exceeds 40 per cent in most parts of Madhya Pradesh, Uttar Pradesh, Odisha, Jharkhand, West Bengal, Bihar, Chhattisgarh, Northeastern states, northern part of Maharashtra, western Gujarat, and southern Rajasthan.
Use of tobacco is also high (30–40
per cent) in Ladakh, Uttarakhand, most parts of Maharashtra, Karnataka,
northern parts of Rajasthan, and northwestern Gujarat.
The lowest kind of tobacco use (below 30 per cent) is mostly observed in Punjab and southern states. The five states with the highest tobacco use in rural population are Mizoram (73.1), Andaman & Nicobar Islands (58.7), Manipur (58), Meghalaya (57.8), Tripura (57.2). For women, it’s Mizoram (61.7), Tripura (50.5), Manipur (43.3), Andaman & Nicobar Islands (31.2), and Meghalaya (28.3).
The data shows that these five states have the highest percentage of tobacco users for both men and women. These five states are also the top five states of India with the highest tobacco consumption in rural areas.
The NFHS-5 shows that tobacco consumption is much higher in rural India than urban. Among women, there are 5.5 per cent tobacco users in urban areas and 10.5 per cent (or nearly double) in rural areas. For the men, there are 28.8 per cent tobacco users in urban areas and 38 per cent in rural areas.
Indians both smoke and chew tobacco. The smokers consume bidis and cigarettes and account for around 20 per cent of tobacco users in the country. The rest
use different forms of chewing tobacco.
The chewing or buccal
consumption of tobacco is a
traditional practice that was once rooted in consumption of paan. Traditionally, tobacco (zarda, kimam, patti) was added to betel leaves along with betel nuts, ground limestone and other
natural substances. That has undergone a sea change in recent years. Most chewing tobacco
consumers prefer gutka, or
packets of readymade paan-like products. Previously, these came in two varieties: a benign one
without tobacco and one with tobacco pre-mixed into it. Following changes in regulations, all manufacturers were asked to sell packets of tobacco separately with the risks of cancer advertised through graphic images on tobacco pouches, same as on cigarette packets.
The paan is a perishable item but the gutka packets are convenient to buy and store for long periods. The result is that there are different grades available and their quality is subject to manufacturing standards and preservatives may be added to make them last longer. This means that inorganic substances are added to preserve the tobacco or betel nuts in the packets.
Another popular form of chewing tobacco is khaini—raw tobacco mixed with limestone and stored in the cavity between the gums and the cheeks for the buccal absorption of nicotine.
Indian law prohibits the sale of tobacco to minors. But, when was the last time you saw a tobacco seller asking for proof of age? The NFHS-5 survey was conducted amongst those who are aged 15 and above. This itself is an indicator that minors in India are using tobacco products. Most minors use tobacco secretly and away from the gaze of their parents and guardians. There is no evidence that minor tobacco users have scientifically explained the consequences of using tobacco, that it leads to an addiction and attracts a range of diseases.
The NFHS report says: “Tobacco use is associated with a wide range of diseases, including several types of cancers and heart and lung diseases, diabetes, eye disease, and rheumatoid arthritis. Studies have shown that in addition to sharing the same health risks as men, women who use tobacco experience difficulty in becoming pregnant and are at an increased risk of infertility, pregnancy complications, premature births, low birth-weight infants, stillbirths, miscarriages, and infant deaths.”
Earlier, some doctors would ask smokers to cut down during the course of ailments or treatments and would tell them to quit in case of some conditions. Now, doctors advise all smoking patients to quit smoking.
This is regardless of whether the patient has a lifestyle disease, a life-threatening one or one that directly affects the lungs. Even for bone or muscle injuries, physiotherapists and orthopaedic doctors advise quitting smoking because tobacco use can delay/stunt the healing time and process.
The NFHS-4 survey had found that around 50 per cent of all tobacco users were asked by a doctor to quit smoking tobacco in the 12 months before the survey. Where does science come in?
Creating regulations and following the bare minimum will also reap the bare minimum results. A sea change in attitudes is required and this is only possible with sustained, aggressive drives to create awareness amongst the Indian population.
In several other countries, the government has provided tobacco alternatives to deal with nicotine use and addictions. These alternatives have to be pushed especially amongst the rural population amongst India, where the numbers of tobacco users is increasing.
The celebration by a healthy, tobacco-free nation will be the biggest tribute to the republic.
(The author is a data journalist with experience in reporting health and science)