World No Tobacco Day - Facts & Figures

Dr Pravin Valsalan
Consultant Pulmonologist
Aster Medcity
Kochi

According to WHO, the global tobacco epidemic kills more than 7 million people each year, of which close to 900 000 are non-smokers dying from breathing second-hand smoke. Nearly 80% of the more than 1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use and exposure are associated with a wide range of debilitating diseases including various types of cancers including oropharyngeal and lung cancer, coronary heart disease, obstructive pulmonary diseases, peripheral vascular disease, stroke and acid peptic disease. In addition to the above diseases, tobacco affects almost all organs in the body.

According to the Global Audit Tobacco Survey – 2 (GATS – 2), which is a global standard for systematically monitoring adult tobacco use, prevalence of tobacco use (both smoking and smokeless) has decreased by six points from 34.6% in GATS -1 study to 28.6% in GATS – 2 in 2016 – 17. Three in every 10 adults who work indoors were exposed to second hand smoke at their work place and 23% of adults were exposed to second hand smoke in public. Survey has found that tobacco use in Kerala has come down to 12.7% in 2016-17 from 21.4% in 2009-10. Estimates show smoking increases the risk for coronary heart disease by 2 to 4 times, for stroke by 2 to 4 times, of men developing lung cancer by 25 times, of women developing lung cancer by 25.7 times. Smoking can cause cancer almost anywhere in your body. Smoking can affect the health of the bones leads to osteoporosis, causes cataracts, affects fertility low birth weight babies and still birth, preterm labour, reduces the immunity,

When you inhale tobacco, you get exposed to more than 7000 chemicals of which many of them are carcinogens. The mainstream smoke emerging from the mouthpiece of a cigarette is an aerosol containing about 10 10 particles/mL. Polycyclic aromatic hydrocarbons are the most studied carcinogens in cigarette smoke of which benzo[ a ]pyrene (BaP) is the most extensively studied compound, and its ability to induce lung tumors upon local administration or inhalation is well documented.  

The tobacco-specific N -nitrosamine NNK is a potent lung carcinogen. Nickel, chromium, cadmium, and arsenic are all present in tobacco, and a percentage of each is transferred to mainstream smoke. All these carcinogens are well documented in environmental tobacco smoke (ETS). Sidestream smoke, the material released directly into the air from the burning tip of a cigarette plus that which diffuses through the cigarette paper, constitutes the major portion of ETS. While sidestream-mainstream ratios are generally greater than 1, dilution with ambient air is such that passive uptake will be far less than uptake in a smoker, and the risk for lung cancer is accordingly less.

Cigarette smoke is also a tumor promoter. The majority of the activity seems to be due to uncharacterized weakly acidic compounds. Substantial levels of cocarcinogens are also present in cigarette smoke.

Every year, on 31 May, WHO and partners mark World No Tobacco Day (WNTD), highlighting the health and other risks associated with tobacco use, and advocating for effective policies to reduce tobacco consumption. This year the “World No Tobacco Day 2018 focus is "Tobacco and heart disease." where in it intends to increase the awareness of tobacco on cardiovascular diseases. Despite the known harms of tobacco to heart health, and the availability of solutions to reduce related death and disease, knowledge among large sections of the public that tobacco is one of the leading causes of cardiovascular diseases is low.

Cardiovascular diseases (CVD) kill more people than any other cause of death worldwide, and tobacco use and second-hand smoke exposure contribute to approximately 12% of all heart disease deaths. The campaign will increase awareness on the link between tobacco and heart and other cardiovascular diseases (CVD), including stroke, which combined are the world’s leading causes of death and feasible actions and measures that key audiences, including governments and the public, can take to reduce the risks to heart health posed by tobacco.

The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is a treaty adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003. The treaty came into force on 27 February 2005. This agreement seeks "to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke" by enacting a set of universal standards stating the dangers of tobacco and limiting its use in all forms worldwide.  

To assist countries to implement effective strategies for selected demand reduction related articles of the WHO FCTC, WHO introduced a package of measures under the acronym of MPOWER. These measures include:

- Monitor tobacco use and prevention policies;
- Protect people from exposure to tobacco smoke by creating completely smoke-free indoor public places, workplaces and public transport;
- Offer help to quit tobacco (cost-covered, population-wide support, including brief advice by health care providers and national toll-free quit lines);
- Warn about the dangers of tobacco by implementing plain/standardized packaging, and/or large graphic health warnings on all tobacco packages, and implementing effective anti-tobacco mass media campaigns that inform the public about the harms tobacco use and second-hand smoke exposure.
- Enforce comprehensive bans on tobacco advertising, promotion and sponsorship; and
- Raise taxes on tobacco products and make them less affordable.

The Global Audit Tobacco Survey has said that there is a need for further reducing the use of tobacco for which the government has to come out with more awareness programmes. Despite tall claims of being tobacco free in public places, we still have miles to go before Kerala stubs the cigarette. Kerala became the first Indian state to ban smoking in public places, back in 1999. Smoking in any public area, including restaurants, bars, pubs and discotheques, is banned and punishable except in designated smoke free zones.

We have “Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003" which is a comprehensive Act encompassing key aspects of tobacco control, regulation and enforcement.Anti-smoking messages are ubiquitous — on TV, movie theatres, online and print campaigns, social media and even cigarette packages. The question that must be asked is how far these steps go in discouraging people from the habit.Public smoking has reduced over the years. But low visibility does not imply that Indians don’t smoke — putting a stop on the habit will require far more holistic measures.

Taxation and pricing is a concern. It is also important to take all forms of tobacco consumption into consideration. The GST has not covered beedis (indigenous cigarettes comprising tobacco wrapped in leaf). Considering that beedi is a leading cause for tobacco-related deaths in India and exceptionally affordable, activists and beedi workers have demanded for its inclusion under the GST slab. Legislation and messages do play a role, but it’s intention should not be to judge or instill fear among smokers but to motivate and provoke the idea of making healthier life for them as well as for their dear ones and the whole of humanity.