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Tobacco Menace and What can Be Done About It

Tobacco is perhaps the most common addiction all over the world, and a leading carcinogen producer .

Alarmed by the devastating impact of tobacco in its various forms on human health, the World Health Organization is calling for stringent regulations on smoking.

Tobacco generates about Rs.7,964 crore annually but spends for treatment of tobacco related diseases is about Rs.27,661 crore, according to WHO estimates.

The results of a recent survey are really alarming. The total losses in high-income countries are $451 billion whereas in low-income countries it is $13 billion.

It uses up more minerals and nutrients from soil hence other crops don't grow around and the wood used for curing tobacco causes deforestation.

Effects on the health:

Cancer is the commonest cause of tobacco related deaths after IHD and CVA. The smoke contains all forms of chemical carcinogens of all stages.

Tobacco smoke contains over 4,000 chemical compounds, which includes at least 60 different carcinogenic substances. They in turn cause a variety of chronic pulmonary and cardiovascular diseases besides damage of the central nervous system leading to Alzheimer's disease and the like.

Diseases due to Tobacco in India, 1996

Disease Entity Total Number in India Cases due to tobacco use
Tobacco related cancers 209,810 154,320
Coronary artery disease(Prevalent cases) 15,700,000 4,200,000
Chronic obstructive lung diseases (Prevalent cases) 14,000,000 3,700,000

Ecological Observation of Smoking Prevalence and various cancers showed a definite strength of association as represented by an increase in relative risk ranged from 3.8 to 14.2, specificity as represented by demonstration of chemical carcinogens off all stages (initiation progression till loss of apoptosis) and coherence as demonstrated in many of the epidemiological studies.

1. The Consistency of the Association: In 1984 surgeon general's report, 29 retrospective and 7 prospective studies have all demonstrated an association between cigarette smoking and lung cancer. Similar findings had thus reported from a large number of studies by different investigators, using different methodological approaches, and in different populations and different diseases.
2. The Strength of the Association: In men, the relative risk ranged from 3.8 to 14.2. In women, the relative risk ranged from 2 to 5 for CVA and IHD. Men and women who smoked one of more packs per day experienced a 25 to 30-fold increased risk of dying from various cancers when compared with non-smokers.
3. Dose-Response Relationship: The existence of a dose-response relationship between smoking and various diseases constitutes further evidence of a causal relationship. Many studies have demonstrated a dose-response relationship between cigarette smoked per day, years of smoking and pack-years of smoking with all tobacco related disorders.

4. Specificity of the Association: As measured by the attributable risk, all the above mentioned studies found a definite association and increased risk for the diseases in smokers.
5. Temporal Relationship: The average latency for the development of COPD is 5-12 years, and for various malignancies it is ranging from 8-5 years.
6. Coherence of the Association: The distribution of cigarette smoking among sexes, among rural and urban residents, and among different socioeconomic classes was similar to the distribution tobacco related health diseases among these groups.

Types and burden of tobacco consumption:

There are two types of tobacco species that are commonly used. N. tabacum- commonly used for the cigarettes, cigars, bidi, hookas etc.. And N. rustica- used for the snuff and hooka (high class). The consumption can be broadly dealt in smokeless tobacco and smoking. It is estimated that 57% of the Indian populating aged less than 15 years consume some form of tobacco. Of which 80% users are smokers and remaining use smokeless forms of tobacco (20%).

Smokers:

Since its entry, till World War 1, cigarette represented a small proportion, but from then over next five decades, it became the dominant form of tobacco. From 1995, cigarette consumption declined dramatically. Though it is a good sign, the other side of coin that is worrying is an increased trend in other forms as well as more number of females and young population joining the list of consumers. The global trends show 1.1 billion smokers of which 80% are in low- and middle income countries (1 in 3 adults) and the trends are expected to raise up to 1.6 billion by 2025. The major forms are chuttta (villagers), Cigar, cigarette, dhumti (Goa, Konkani), hooka (Muslims, and gujaratis) Reverse Chutta (srikakulam of AP) Bidi (poor man cigars) and chillum (eastern India).

Smokeless tobacco:

Though the relative contribution of it for the tobacco consumption is low (20%), its role in the causation of oral malignancies is highest. An estimated 50-70% of all oral malignancy patients use this form tobacco, and 75-90% will use some form of tobacco. The various forms are pan masala(all over India), Manipuri tobacco (UP), mawa (Gujarat), Tobacco lime preparation (bihar, Maharashtra), Pure tobcco(southern India).

Prof. PP Bapsy, Director of the Kidwai Centre, Bangalore, who has done extensive study of tobacco-related problems points to problems in tobacco control such as:

Unemployment, want of better alternatives to farmers in drought prone areas, addiction and a singular lack of motivation among those charged with the task of combating the evil.

Unless each one of these problems is addressed with earnestness, thousands will keep falling victims to a range of tobacco related diseases, she warns, bleeding the economy white.

She also suggests suitable legislation to curb sale and promotion of all tobacco products and also effectively banning smoking in public places.

An equality effective tool could be taxation. Tax increases raise prices and it is estimated that a 10% price increase reduces consumption by 4% in developed countries and 8% in developing countries.

Poor and youth are more price-sensitive and high prices deter youth from starting to smoke.

But at the end of the day what is required is political will to rid humanity of this terrible scourge.


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6. Tobacco smoke increases the levels of Cox 2.
7. Aggressive Tobacco taxation policy can reduce cigarette smoking
8. Role Of Tobacco In Development Of Oral Cancer And Heart Disease
9. Women More Prone To Risk of Colorectal Cancer from Tobacco
10. WHO Intensifies Anti-Tobacco war
11. New Zealand Researchers Call For Tobacco-Free Society
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