Second-hand Smoke Is An Invisible Killer: Vaishakhi Mallik, Vital Strategies

In an exclusive interaction with BW Healthcare World Vaishakhi Mallik, Associate Director, South Asia, Policy Advocacy and Communication, Vital Strategies, spoke on the usage of tobacco, second smoke, impact on younger generation and the solutions which can reduce the tobacco usage

What is the state of tobacco usage in India and around the world?

Tobacco use is a leading, but preventable cause of premature death and disease in India and around the world. Nearly 5 trillion cigarettes are consumed each year globally, contributing to more than 8 million deaths and nearly US $2 trillion in economic damage. According to the latest available data from the Tobacco Atlas India is among the top three countries with the highest number of smokers globally, with approximately 130 million smokers ages 15 and above. The most common form of tobacco use in India is smokeless tobacco and commonly used products are khaini, gutka, betel quid with tobacco, and zarda. Smoked tobacco products include bidi, cigarette, and hookah. Although globally more people overall are being protected by effective regulatory interventions including tobacco taxes, smoke-free public areas, access restrictions and education, these efforts must be much more robust to contend with an industry whose gross profits climbed to at least US $60 billion in 2020.

According to WHO Southeast Asia is home to 22 percent of the world's adult smokers which includes India. Do you think tobacco usage has gone up in the last couple of years or has it come down?

India has made progress in reducing the prevalence of use of both smoked and smokeless forms of tobacco. The prevalence of tobacco use among people aged 15-24 has reduced from 18.4% in GATS-1 (2009-10) to 12.4% in GATS-2, which is a 33% relative reduction. While some states have been successful in achieving a decline in tobacco use prevalence, others need to undertake more aggressive efforts for effective tobacco control. The current levels of tobacco use are still very high across the country, which calls for urgent and sustained efforts at all levels and multi-sectoral coordination to bring down tobacco use across all sections of the population.

How does tobacco usage impact the health of individual consumers?

The health harms associated with smoking and tobacco use are vast. As per WHO tobacco use is a major risk factor for the four main non-communicable diseases (NCDs) -- cardiovascular disease, cancer, chronic lung disease, and diabetes. Smoking is a powerful cause of asthma symptoms, irritating the lining of the airways. Smokeless tobacco can cause oral cancer and can also affect one’s gums and lead to several gum-related diseases. Also, secondhand smoke – known as an invisible killer - causes numerous health problems in infants and children, including more frequent and severe asthma attacks, respiratory infections and ear infections.  The exposure of unborn children to maternal smoking or second-hand smoke is linked to birth defects, stillbirths, preterm births, and infant deaths. Given the correlation between COVID-19 and tobacco, ending tobacco use has never been more critical.

How is tobacco usage impacting the younger generation?

Today more than 50 million 13 to 15-year-olds smoke cigarettes or use smokeless tobacco products, as per the reports of The Tabacco Altas. Tobacco use during adolescence and early adulthood is consistently linked to heart disease, cancers, and premature mortality and has profound public health implications. According to the Global Youth Tobacco Survey (GYTS-4), India, 2019, which was released by Union Health Minister Mansukh Mandaviya in 2021, 8.5% of students – 9.6% of boys and 7.6% of girls in India use any tobacco product. The survey also points out that 7.3% of students use smoking tobacco products, while 4.1% use smokeless tobacco products. The positive portrayal of tobacco in the media – particularly social media - is partly to blame. Our recent report, Selling Death on Social Media: How Bidis Are Reaching Consumers Online shows that Facebook hosts at least 30 distinct pages for bidi companies, and many of these companies are utilizing the social media platforms to facilitate sales.

How well are we fighting the war against tobacco?

India has made successful progress in reducing the prevalence of use of both smoked and smokeless forms of tobacco between 2009 and 2016 thanks to strong tobacco control efforts like anti-tobacco messages on tobacco packs are more visible, which prompt more tobacco users to think of quitting. Efforts by National Tobacco Control Programme (NTCP) and the Government of India, which aim to create awareness about the harmful effects of tobacco consumption, reduce the production and supply of tobacco products, and ensure effective implementation of the Cigarettes and Other Tobacco Products Act 2003 are a step in the right direction, though successful quitting remains low across populations and more needs to be done.

Vital Strategies has supported the Government of India with varied public education campaigns on tobacco control. Various mass media campaigns like 'When You Quit’ and 'I Don't Believe' have been launched to discourage tobacco use. We also recently launched a digital campaign The Tobacco Enforcement and Reporting Movement (TERM), which provides a digital tool to monitor and track tobacco marketing via online conversations regularly, news, social media, and media coverage.

What is secondhand smoke & what are the effects it has on the consumers?

Second-hand smoke is an invisible killer. It is the smoke that fills enclosed spaces when people burn tobacco products such as cigarettes, bidis, and water pipes, according to the WHO. It is one a major culprit of ill health, and most Indians face it whether they smoke tobacco products themselves or not. Long-term exposure to secondhand smoke causes lung cancer, coronary heart disease, and cardiac death. Currently Vital Strategies, in partnership with State Health Departments of Karnataka and Maharashtra, Tata Memorial Centre and Cancer Patients Aid Association, is running an interactive billboard campaign with QR code-enabled billboards raise awareness and make people rethink tobacco use, given how harmful secondhand smoke can be to people’s health. Multi-sectoral efforts like this one are critical to let people know about the harmful impacts of secondhand smoking on health and environment.

What should be done to reduce the tobacco usage in India and around the world?

Every death from tobacco is preventable, and every government has the power to reduce the human and economic toll of the tobacco epidemic. There are a number of proven, life-saving policies governments can adopt to stem the epidemic and improve the lives of hundreds of millions worldwide. These include raising tobacco taxes, better enforcement of smokefree policies especially at public places, and stronger marketing restrictions both offline and online to curb youth initiation, amongst others. Though cessation efforts are key to have more and more people quit tobacco use, stronger supply side policies are crucial to prevent tobacco use. 

Since 2007, Vital Strategies has been working with the Government of India, as a technical partner, to deliver evidence-based population-level campaigns and build media capacity to raise awareness about the dangers of tobacco. Our campaigns encourage quitting, delay initiation, and support policy goals, such as smoke-free environments and tobacco tax increases. The faster countries can regulate tobacco and prevent youth from starting, the more lives that can be saved. 

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