Narayana Medical Journal Vol 1: Issue 2 Review: World no tobacco day Gowrinath K Published online: Oct 2012 Tobacco smoking is the single most important preventable cause of sickness and premature death. Globally, about 1billion men and 250 million women use tobacco. More than 85% smokers are in the developing countries. In India, about 275 million people use tobacco and 110 million of them are smokers. Each year, global tobacco epidemic kills nearly 6 million people including 6 lakhs due to passive smoking. If current trend of smoking continues, 8 million people may die by 2030. Every year, 9,00,000 die in India due to tobacco related diseases. In India, 35% of adults use some form of tobacco; 21% use smokeless tobacco, 9% smoking tobacco and 5% use both forms of tobacco. Bidies are more popular products than cigarettes and are used by Karanam Gowrinath, MD,DNB Department of Pulmonology, Narayana Medical College- Nellore Nellore 524003, A.P. drkgowrinath@gmail.com 48% compared to 14% smoking cigarettes. India is the second largest consumer of tobacco and tobacco growing country in the world. Tobacco has become rich source of revenue generation from taxation of tobacco products, an easy way to earn foreign exchange and rural employment. The states of Maharashtra, Andhrapradesh and Karnataka are major tobacco growing states and about 26 millions (More than two-thirds in rural area) work in tobacco industry. Tobacco provides about 10% of India s total excise revenue; 88% from cigarettes. The sale of smokeless tobacco products have increased by over 25% in India between 2005-10. What happens when you smoke tobacco? Within seconds after inhalation of tobacco smoke, nicotine in the tobacco reaches the brain and enhances concentration, alertness, memory and decreases tension and anxiety. Nicotine in the tobacco is the cause of addiction. Nicotine in
tobacco controls smoker s behaviour in such a way that once tobacco use is stopped, withdrawal symptoms develop within 12 hours. The nicotine withdrawal symptoms include frustration, depressive mood, anxiety, restlessness, poor concentration and increased appetite. The degree of nicotine addiction may be mild to severe. Every year about 70% smokers attempt to quit smoking but only 2-3% succeed. During smoking along with nicotine large number of other toxic and carcinogens are inhaled and deposited in the airway and alveoli and get absorbed. Diseases caused by smoking are not due to nicotine but by other chemicals in the inhaled smoke.those who are near smoking individuals are also forced to inhale tobacco smoke (Passive smoking) from the cigarette in between puffs resulting in more respiratory problems and increased risk of getting cancer and heart diseases. Health effects of smoking Tobacco used in any form whether it is smoked or chewed is harmful. Bidies deliver twice the amount of tar and seven times the amount of nicotine compared to cigarettes. Bidies are far more addictive than cigarettes. Tobacco causes 50% of all cancers and 40% of all health problems. Tobacco smoking is most important risk factor of chronic obstructive pulmonary disease (COPD) and responsible for 80-85% cases of COPD. History of long term smoking can be elicited in nearly 85% cases of lung cancer. Smoking causes or contributes to over 20 diseases including lung cancer of lung, mouth, throat, oesophagus, larynx, bladder, kidney, pancreas and stomach, COPD, heart diseases, stroke, pregnancy and birth complications, gastric/duodenal ulcers, peripheral vascular diseases, impotence, sterility, osteoporosis, hearing and tooth loss, cataract and other eye problems, gray hair and hair loss, facial wrinkles. It increases the risk of cardiovascular diseases and worsens asthma. Smokers die earlier than nonsmokers. Smoking affects the function of the immune system and may increase the risk of respiratory and other infections. Campaign against tobacco use The initial idea of observing no tobacco day was to spend 24 hours without tobacco use. The first world no tobacco day was observed in 1988 in the month of June by the World Health Organization (WHO) and from 1989 onwards every year on 31 st of May. The aim was to create and extend awareness on the harmful health effects of tobacco use. Mass media campaign comprises display of posters and distribution of hand bills highlighting the harmful effects of tobacco use. In 1998, WHO established the tobacco free initiative (TFI) an attempt to focus international resources and attention on the global health epidemic of tobacco. In 2008,WHO
called for nationwide ban on all tobacco advertising, promotion and sponsorship. As a result, tobacco advertisements and sponsorship of sporting events has been banned in many countries. In 2012, Tobacco industry interference is the chosen theme of World No tobacco day. Tobacco industry interference is a constant threat to tobacco control efforts. The idea is to raise awareness about tobacco industry interference with tobacco control policies and to focus on the need to expose and counter the tobacco industry s aggressive attempts to undermine the WHO framework convention on tobacco control (WHOFCTC) meant to avoid serious danger they pose to the public health.the tobacco industry works for monetary benefits against public health.tobacco industry wants people to experiment smoking or chewing tobacco and become addicted to it. The tobacco industry opposes people s fundamental right to breath clean air, opposes ban on smoking in public places and opposes at efforts to protect children and infants from breathing tobacco smoke. The tobacco industry has many allies and third parties through which it works to block implementation of effective tobacco control legislations. One in 10 school children have been offered free samples of tobacco products and equal numbers of students were given bags, T-shirts etc with brand logos of tobacco products as per global youth tobacco survey. The material of WHO against tobacco use is MPOWER. 1.Monitor tobacco use and prevention policies. 2.Protect people from tobacco smoke. 3. Offer help to quit tobacco use. 4. Warn about dangers of tobacco. 5.Enforce ban on tobacco advertising, promotion and sponsorship. 6. Raise taxes on tobacco. The no tobacco use campaign will educate policy makers and the general public about the tobacco industry nefarious and harmful tactics. Tobacco advertizing is well organized, planned, deliberate and often highly researched attempt to promote smoking. One can advertise a brand of cigarette without simultaneously recommending smoking itself. The advertisements associated with smoking include luxury, excitement, travel, sexuality, companionship, relaxation etc. In every country, tobacco products are among the most easily available consumer products. Anti smoking events are less common compared to other public issues in the magazines, news papers and TV programmes. Unless wide spread campaigning and information is given by the mass media and educational institutes,
the awareness about harmful effects of smoking cannot be spread. Why people start using tobacco? Smoking is an artificially induced habit that has its social, developmental and cultural basis. In some societies. smoking is considered as a normal sign of having attained adulthood. Smoking is the result of child and adolescent nature of doing things disapproved by the parents. Experimental smoking is also common in children. Smoking is also a part of the process of male socialization. Smoking is started as style with gestures, postures and rituals. spouse, siblings, a peer group, a social network and a set of workmates are powerful predictors of smoking. Why tobacco use is high? When there is little media discussion of smoking as health hazard and when tobacco products are cheap and easily available, the use of tobacco is naturally high. In countries where advertisement for tobacco use is allowed to flourish and the government does not encourage/run public awareness and education programmes against tobacco use, majority of public does not have opportunity to know the harmful health effects of tobacco use. If medical professionals do not warn against tobacco use as a serious problem,smokers will not have motivation or influence to quit smoking. Smoking will continue to be high if unrestricted and not banned at least in public places, hotels, public transport. Can smoking be stopped? Most smokers mistakenly believe that lot of willpower is needed to stop smoking. Willpower is necessary but not enough to stop smoking. It has been found that only about 45% of smokers were advised to quit smoking by their doctors during consultation. Chest specialists have special responsibility to treat tobacco addiction as much of the health problems due to smoking affects lungs only. Now drugs are available in the market to treat tobacco addiction. In 2003,electronic cigarettes were introduced into market which operate on battery and release smoke with each puff similar to cigarette but without any harmful effect on health. Now nicotine chewing gums and skin patch are available to treat nicotine addiction. In some hospitals special clinics like smoker s clinic is being run exclusively for those who want to quit smoking. References: 1.http://www.who.int/tobacco/wntd/2009/ en/index.html. 2.FriedonT, Bloomberg M. How to prevent 100 million deaths from tobacco. Lancet 2007; 369:1755-61.
3.http://www.who.int/tobacco/wntd/2012/ announcement/en/index.html 4.http://www.who.int/tobacco/fctc/about/ en/index.html 5.World Health organization 2010. Tobacco free initiation(tfi). http://web.ebscohort.com.libproxy.wnstl. edu/ehost/develop? 6.http://www.who.int/tobacco/about/en/in dex.html