Smoking India 

• As a result of stringent tobacco control initiatives by the developed countries, the tobacco industry has shifted its base to the developing countries like India. India is the world’s second largest consumer and third largest producer of tobacco.¹

• Union Health Minister Ghulam Nabi Azad called for a ”jihad” against tobacco use after releasing the first Global Adult Tobacco Survey in India which identified India as the world’s second largest consumer of tobacco.¹  The sample size was of 72,000 households and the survey was carried out in 19 languages.¹

• An estimated 275 million Indians consume tobacco. Nearly 900,000 tobacco-related deaths occur in India annually as compared to 5.5 million worldwide. More Indians die from tobacco related diseases every year than the combined deaths resulting from tuberculosis, HIV, AIDS, and malaria.¹

• The survey was conducted under the supervision of the Health Ministry by the International Institute for Population Sciences, Mumbai, an autonomous organization of ministry. Technical assistance was provided by the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Johns Hopkins Bloomberg School of Public Health, and RTI International.

• 35% of Indian adults use tobacco; 48% of males and 20% of females; the use of smokeless tobacco is as high as smoking.¹ 14% of adults are current tobacco smokers with marked gender difference (24 % males and 3% females). Goa had the lowest smoking rates at 5%.

• Current cigarette smokers: 10 % of males and 0.8% of females. Current bidi smokers:  16% of males and 2% of females. Current users of smokeless tobacco: 26% of adults: 33% of males and 18% of females.

• Among daily tobacco users, 60% consume tobacco within half an hour of waking up.¹

• Average age at initiation of tobacco use was 18 years  with 26% of females starting tobacco use before the age of 15.¹

• Further, the report revealed widespread tobacco use among the youth, with more than 15 percent of children less than 15 years of age, and nearly 25 percent of those between 15 to 17 years consuming tobacco.

• The exposure to second-hand smoke in the country is as high as 29 percent. Nearly 26 percent non-smokers were exposed to second-hand smoke at work and 52% at home. The highest exposure was in public transport and restaurants. ¹

• The mean age of starting tobacco use was found to be 18 years for boys and 17 years for girls. 40 percent tobacco users in the bracket of 20 to 34 years started using tobacco on a daily basis before the age of 18. Among adults who visited a restaurant, 16 percent observed someone smoking in a designated non-smoking area. ¹

• Three in five (61 percent) tobacco users notice the health warning on tobacco packages. The ban on smoking in public spaces too seemed to have little effect.¹ People belonging to the low socioeconomic strata were 3 times more likely to use tobacco.²

• A study of medical students in Malaysia, India, Pakistan, Nepal, and Bangladesh showed smoking prevalence of 13%. The current smoking was 23% among male  and 4% for females overall but 14 % in Indian males and zero for Indian female.³

• “We must provide alternative livelihoods, as we must encourage farmers cultivating tobacco to change to other cash crops,” Azad said.¹

• Smoking in the south Asian population overall is the similar or lower than in Europid men  low in south Asian women. ⁴ There are differences between groups, however, with 44% of Bangladeshis, 26% of Pakistanis and 23% of Indians smoking cigarettes, compared  to 27% of men in the general population in the UK ⁴ Tobacco use among Indian Diasporas varies widely according to place of origin and religion, with extremely low rates in North Indian Sikh men.^{5, 6}

• Other studies have shown significantly greater prevalence of multiple CVD risk factors such as obesity, resting tachycardia, hypertension, high total and LDL-C, and low HDL-C  and electrocardiographic changes in tobacco users (chewing or smoking), as compared-to tobacco non-users. ^{7, 8}

• Chewing tobacco is associated with similar cardiovascular risk as smoking. ^{7, 8} 29% of the school teachers use tobacco giving the wrong example to the children⁹.

Sources

1. Azad  GN. First Global Adult Tobacco SurveyNew Delhi, India: Ministry of  Health & Family Welfare, Govt. of India. ;2010.

2. Subramanian S V, Nandy S, Kelly M, Gordon D, Davey Smith G. Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey. Bmj. Apr 3 2004;328(7443):801-806.

3. Sreeramareddy CT, Suri S, Menezes RG, et al. Self-reported tobacco smoking practices among medical students and their perceptions towards training about tobacco smoking in medical curricula: A cross-sectional, questionnaire survey in Malaysia, India, Pakistan, Nepal, and Bangladesh. Subst Abuse Treat Prev Policy. 2010;5:29.

4. Barnett AH, Dixon AN, Bellary S, et al. Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia. Oct 2006;49(10):2234-2246.

5. Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian heart journal. Jul-Aug 1996;48(4):343-353.

6. Pinto  RJ, Bhagwat AR, Loya YS, Sharma S. Coronary artery disease in premenopausal Indian women: risk factors and angiographic profile. Indian heart journal. 1992;44(2):99-101.

7. Pednekar MS, Gupta PC, Hebert JR, Hakama M. Joint effects of tobacco use and body mass on all-cause mortality in Mumbai, India: results from a population-based cohort study. Am J Epidemiol. Feb 1 2008;167(3):330-340.

8. Gupta BK, Kaushik A, Panwar RB, et al. Cardiovascular risk factors in tobacco-chewers: a controlled study. J Assoc Physicians India. Jan 2007;55:27-31.

9. Sinha DN, Gupta PC, Dobe M, Prasad VM. Tobacco control in schools of India: review from India Global School Personnel Survey 2006. Indian journal of public health. Apr-Jun 2007;51(2):101-106.