Dr. K.S.

Reddy
Hony Executive Director, HRIDAY
CIGARETTE SMOKE CONTAINS
4000 POISONS
 WHAT IS AT STAKE?

1 tobacco related death

every 6 seconds

= 10 million annual
deaths by 2030

1 Billion deaths in 21st Century

 Global Tobacco Toll
Tobacco toll rising globally: 5 million in 2002 to 10 million
in 2030- WHO
Developing Countries increasingly vulnerable: 7 million
deaths in 2030- WHO
700 million children worldwide are forced to passively
breathe tobacco smoke
1.69 million due to cardiovascular diseases
1.47 million due to all tobacco related
(0.83 million due to lung cancer)
1 million due to chronic obstructive pulmonary disease.
 Health Consequences of Tobacco Use
 Tobacco chewing in its various forms is directly responsible for cancers
of the oral cavity, oesophagus, pharynx, cervix, penis.
 Beedi and cigarette smoking cause oral, pharyngeal, oesophagael,
laryngeal, lung, stomach, gallbladder, urinary bladder and penile
cancers.
 Tobacco use is a major known risk factor for cardiovascular diseases.
 Tobacco smoking is responsible for over 82% of chronic obstructive
pulmonary disease.
 Tuberculosis is a major cause of death in India and it is three times as
great among smokers than non smokers.
 Men who smoke have a lower sperm count and poorer sperm quality
than non smokers
 Tobacco use is also associated with oral precancerous lesions such as
leucoplakia and other oral mucosal lesions.
TOBACCO AND CANCERS
 Lung

 Mouth (oral)
 Throat (Pharynx &
Larynx)
 Food Pipe (Oesophagus)

 Urinary Bladder

 Other Sites
CARDIOVASCULAR RISKS OF SMOKING

100% Increase in Risk

Stroke; CHD; Impotence
300% Increase in Risk
Death from undiagnosed CHD
> 300 % Increase in Risk
Peripheral Arterial Disease
400 % Increase in Risk
Aortic Aneurysm
 OTHER DISEASES
 Chronic Bronchitis
 Emphysema

 Asthma

 Cataract

 Tuberculosis

 Diabetes

 Still Birth and Low Birth Weight

> 25 Diseases
 PASSIVE SMOKING (ETS)
 Second Hand Smoke increase risk of
– Cancer by 30%
– Heart attack by 25%
in spouse of the smoker

 Increased risk of asthma and lung

disease in children
 Economic Effects of Tobacco Use
 The total social costs of tobacco products exceed the direct outlay
on them, owing to morbidity, mortality and negative externalities
associated with the consumption of tobacco products.
 
 The costs inflicted by tobacco consumption extend much beyond
the direct users to cover secondary smokers as well as non-users.
 
 The recognition of the costs of tobacco has been obfuscated and
made opaque by the unethical tactics and practices by the tobacco
lobbies.
 
 Worldwide recognition of the perils of the pandemic of tobacco
have led to the recognition of tobacco as a demerit good, i.e. a
public ‘bad’.
 
Cost of Tobacco related Cancer
 ECONOMIC COSTS OF TOBACCO

Health Care: Just for 3 diseases

(Coronary Heart Disease; Cancer;
Chronic Lung Disease)

Health Care cost in 2002 – 2003 was

Rs. 308.33 Billion (USD 7.2 Billion)

Tobacco also has: Environmental costs

& Social costs
 Prevalence Of Tobacco Use Among
The Youth - INDIA
Global Youth Tobacco Survey (GYTS) conducted among
school going youth (aged 13-15) during 2000-2004 in
India:
 Ever tobacco use : 25.1%
 Current tobacco use: 17.5%
 Current smokeless: 14.6%
 Current smoking: 8.3%
 Current cigarette smoking: 4.2%

Results support the need to prevent youth from initiating tobacco

habit and provide the evidence base for the provisions of Indian
Tobacco Control Act, 2003
Differences in prevalence of tobacco use between
sixth-grade and eighth-grade students
(n=11642) : MYTRI STUDY
Sixth grade Eighth grade Ratio p
(n=6165) (n=5477)

Ever use to tobacco

Chewing tobacco % 19.0 6.8 2.8:1 <0.0001

Smoking bidis % 11.9 3.4 3.5:1 <0.0001

Smoking cigarettes % 12.5 4.7 2.7:1 <0.0001

Any kind of tobacco 24.8 9.3 2.7:1 <0.0001

Current use of tobacco

Chewing tobacco % 4.5 1.6 2.8:1 <0.0001

Smoking bidis % 2.0 0.9 2.2:1 0.0001

Smoking cigarettes % 2.0 0.9 2.2:1 0.0001

Any kind of tobacco 6.7 2.9 2.3:1 <0.0001

- (The Lancet, 2006; 367: 589-594

 Government Initiatives towards
Tobacco Control Laws to Curb the
Problem
• Cigarettes Act is passed with first statutory health warning, 1975
• States like Delhi, Goa and a few more had created their own tobacco control
laws
• Kerala High Court and Supreme Court had given momentous decisions in
favour of tobacco control policies

• Prevention and Control of Pollution Act included smoking in the definition of

air pollution, Motor Vehicles Act of 1988 made it illegal to smoke in a public
vehicle and Cables Television Network Amendment Act of 2000 prohibited
the transmission of tobacco commercials on cable TV across the country.
• The Cigarettes and other Tobacco Products (Prohibition of Advertisement
and Regulation of Trade and Commerce, Production, Supply and
Distribution) Act, 2003 (COTPA), a comprehensive tobacco control
legislation, comes into force on 1st May 2004

• India ratified FCTC on 5th February 2004.

The Cigarettes and Other Tobacco Products
Act, 2003: Significance to Public Health
Section 4: Ban on Smoking in Public Places

 Secondhand smoke (passive smoking) of smoke causes many

diseases like lung cancer, respiratory diseases, heart disease,
breast cancer, asthma, bronchitis. In some cases, it can trigger
severe, even life-threatening reactions in individuals.
 Children are the worst affected. It causes sudden infant death
syndrome.
 People working, especially in the food service industry are
affected.
 Ban on smoking in public places would prevent damage to the
health of non smokers and smokers
 Contd..
Section 5: Ban on Advertisements of Tobacco Products

 In India children and the youth have been greatly influenced by tobacco
advertisements, especially those for cigarettes and gutka which definitely harms
their health.
 Advertisements and placing of the product at a low height and next to candies
at points of sale is a strategy they use to give undesirable exposure and access to
children.
 A study found that children who had seen sports events being sponsored by a
tobacco company were more likely to start smoking. This was during the period
when a cigarette company sponsored cricket matches.
 Many tobacco industries are promoting tobacco products to target women.
 This provision would prevent women and children from being influenced by
glamorized advertisements of tobacco products.
TRENDS IN WEIGHTED CIGARETTE CONSUMPTION
PER CAPITA IN COUNTRIES WITH A
COMPREHENSIVE BAN COMPARED WITH NO BAN

1750
Annual cigarette consumption

Ban
1700 No Ban
1650
per capita

1600

1550

1500

1450
1981 1991
Year

Source: World Bank Report, 1999

 Contd..
Section 6: Prohibition of Sale of Tobacco Products to
and by Minors

 Many children in India experiment with tobacco at an early age and

become addicted thereafter.
 Individuals who use tobacco from a young age are more likely to
suffer from serious diseases earlier than others and die prematurely
 Sale by a minor gives a message to that child, as well as to other
children, that it may be all right to use tobacco.
 Adolescents out of school are more likely than other youth to sell
tobacco.
 This would restrict access of tobacco products to youth and children
 Contd..
Section 7: Specified Health Warning Labels on all
Tobacco Products
 Images help smokers visualize the nature of tobacco-related diseases and
convey health messages in a clearer way.
 Pictorial health warnings are intended to serve as visual cues to prompt
smokers to take action to quit. They are designed to shock people into
realizing that smoking kills and causes serious illness.
 Pictorial warnings also make the health warnings accessible to those who
are illiterate.
 They are effective tool in conveying health risks to the tobacco users. It
also has an impact on intention and ability to quit.
 In countries like Brazil, Canada and Thailand many pictorial warnings
have helped in decreasing consumption of tobacco products
 Contd..
Section 7(5): Every tobacco package to have nicotine
and tar contents along with the maximum permissible
limits

 Nicotine and tar are carcinogens

 Nicotine and tar contents along with permissible limits
should mentioned on the packages
 Having them on the package would help people making an
informed choice
 Contd..
Increasing Tax and Price of Tobacco Products

 Price and tax measures are an effective and important means of

reducing tobacco consumption by various segments of the
population, in particular young persons.
 Implementing tax policies and price policies, on tobacco
products would contribute to the health objectives aimed at
reducing tobacco consumption.
 This measure acts as a demand reduction measure for tobacco
products.
 PRICE INCREASE OF 10%
IMPACT ON SMOKERS ALIVE IN 1995

Change in Change in
Grouping number of smokers number of deaths
(millions) (millions)

Low/middle -36 -9
Income
High Income -4 -1
World -40 -10

Source: World Bank Report, 1999

POWER OF POLICY
FOR CHRONIC DISEASE PREVENTION

TOBACCO
Evidence is available from many
countries (including LMIC) that

‾ Taxation
‾ Ad Bans
‾ Smoke Free Policies
‾ Health Warnings
ARE EFFECTIVE
48.1% of mortality averted in UK (1981-2000) is attributable to
reduced smoking (Unal B et al. Circulation 2004)
TOBACCO CONTROL POLICIES WORK

 Ban on smoking in bars: 80% reduction in salivary

cotinine levels of bar staff
(BMJ 2005; 331:1117-22)

 Graphic warning labels have impact on smoking

cessation
(Tobacco Control 2003; 12:391-95)

 Reduced incidence of admissions for myocardial

infarction after public smoking ban
(BMJ 2004; 328:977-80)