Combatting Tobacco and Its Deadly Effects in India

Tobacco-control is making headlines – and headway – in India.  And CECHE has been there from the get-go.

In 2004, CECHE partnered with Indian nonprofit Roshni to launch a Tobacco Control Communications Program in Pattur, a South Indian village near Chennai with a high prevalence of smoking and reliance on tobacco trades.  The primary goal of the project was to create an awareness of the health hazards of smoking among the village population and to train selected members, especially women, in skills suitable for non-tobacco trades. Six years in, progress is palatable, with the program providing vocational training and job placement, as well as incentives to refrain from tobacco-related activities and self-help groups to train Pattur families in smoking cessation, nutrition, health and hygiene.  Meanwhile, smoking rates in Pattur have plummeted by 60 percent.

A health camp in Pattur is an extension of the smoking-cessation activities that are an integral part of the CECHE-Roshni program in South India.

A success story in its own right, the CECHE-Roshni program is a harbinger of recent national action on the tobacco-control front that has India, and Indians, taking bold steps to scale back tobacco impact and use.

In October 2008, the South Asian power became the largest country in the world to implement a nationwide smoke-free law when it enacted a national ban on smoking in all public places, including workplaces, hotels, restaurants, bars, shopping malls, cinemas, hospitals, railway stations and educational institutions.  The action saw India join the ranks of a dozen other countries, several Canadian provinces and Australian territories, and 24 U.S. states that have already adopted and successfully implemented similar strong and comprehensive smoke-free laws.

Campaign for Tobacco-Free Kids President Matthew L. Myers called the ban “a historic step to protect the health of the nation’s more than 1.1 billion citizens.”  And given the country’s more than 120 million smokers and its annual 700,000 tobacco casualties, the law could, in Myers’ words, be “a significant step toward reducing the devastating toll of tobacco use and secondhand smoke in India.”  Meanwhile, polls conducted in Mumbai, New Delhi, Chennai and Kolkata prior to enactment of the ban found near-universal support for the nationwide legislation.  Overall, 97 percent of Indians surveyed expressed support for the smoke-free law, with 92 percent expressing strong support. 

The Indian people also appear to be equally supportive of the nation’s newest tobacco-control regulation: pictorial warnings covering at least 40 percent of the front of cigarette and tobacco packs.

India’s health minister has estimated that 40 percent of the country’s health problems stem from tobacco use, and this new rule, which was passed in December 2008 (but didn’t go into effect until May 2009 because of government laxity) is aimed at discouraging new smokers and lowering tobacco use among adolescents, which, according to the Global Youth Tobacco Survey, stands at 13 percent among Indian children between age 13 and 16.  Under the pictorial warnings rule, each district in India will receive Rs.2.2 million (about USD $47,300) to run school and community-based tobacco-control programs. Smoking cessation clinics in 100 medical colleges and district hospitals will also be set up to help people kick tobacco addiction.

Source: World Health Organization. The number of smokers per country was estimated using adjusted prevalence estimates (see Technical Note II and Appendix III). A limitation of this approach is that adjusted estimates used to estimate the number of smokers are sometimes derived from limited country data, and for some countries large adjustments are needed. In these cases the adjusted estimates can be different from actual surveys reported by countries. Brazil prevalence data were obtained from VIGITEL 2006.

Warning graphics in Canada have led to a 3 percent drop in smoking. “With 250 million tobacco consumers in India, a similar percentage drop would mean 6 million people giving up smoking,” pointed out Sanchita Sharma in a September 9, 2008 Hindustan Times article on the anticipated warnings.

This would be a good thing, because, as a team of Indian researchers recently reported, smoking, and in particular, smoking bidis (small, unfiltered cigarettes), substantially increases the risk of lung cancer.  In fact, “[s]mokers of rolled tobacco are nearly four times more likely to develop lung cancer than non-smokers,” Dr. Padmavathy Amma Jayalekshmy and colleagues wrote in the September 2008 issue of International Journal of Cancer (as reported by Reuters Health) after interviewing more then 70,000 households and analyzing the incidence of lung cancer among 65,829 males age 30 to 84 in the Kerala region of India over a seven-year period, from 1997 to 2004.

According to the team’s research, the relative risk of lung cancer was 3.9 times greater among bidi smokers as compared to those who had never smoked bidis or cigarettes – and the risk remained for up to 10 years after cessation.  Meanwhile, smoking bidis for 45 years or more and smoking 25 bidis or more per day increased the relative risk of lung cancer to 4.1 and 5.1, respectively.  Starting to smoke before age 17 also heightened the risk of cancer significantly; however, cigarette smoking increased the risk of lung cancer only 1.4 times, much lower than reported in the West, the researchers reported.

"From the point of view of preventing cancer associated with smoking...bidi smoking is at least as hazardous as cigarette smoking," they concluded. "Immediate measures should be taken to stop bidi smoking."

Meanwhile, CECHE and the Chennai-based Roshni have been working to combat the production and consumption of bidis in South India for years through their Tobacco Control Communications Program in Pattur, where prior to 2004, all 2,500 families supported themselves by rolling bidis. 

With the help of the skills training, job placement and awareness-building activities offered through the program, from 2005 to 2007, more than 200 individuals and 20 Pattur families left bidi production for garment design, tailoring and embroidery, leather goods production and grocery/shop businesses. In fact, the rate of bidi-rolling in the village was reduced by 50 percent in 2006, to 10 percent of what it was five to six years earlier, and by the beginning of 2008, the companies collecting bidis had dropped from five to three, and bidi smoking in Pattur had been halved. During this time, the partners also facilitated the enforcement of laws against smoking in public places.

Now, with comprehensive national enforcement and graphic warnings on their side, the CECHE-Roshni partnership is seeing the fruits of its labors multiply 440,000-fold, as the whole of India begins to see the light, instead of asking for one. 

Read More:
Lead Article: The New Face of Tobacco Control in the United States
CECHE News: Combatting Tobacco and Its Deadly Effects in India
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