Times of India
20 October 2010
By Umesh Isalkar
Pune, India

Nicotine addiction is ingrained among Indians, so says a report of the first Global Adult Tobacco Survey (GATS) – India 2010. Sample this: Among daily tobacco users in the country, 60.2 per cent consume tobacco within half an hour of waking up. Among other startling revelations, the average age of tobacco initiation in the country was found to be 17.8 with 25.8 per cent of females starting tobacco use before the age of 15. Experts say that the report throws light on the hurdles in mankind’s hitherto unsuccessful battle against tobacco.

"This is definitely shocking. This shows how the addiction has become so deep seated. It only means that we are sitting on a time bomb. If this holds true and continue to be so for the next couple of years, then we are likely to lose 5,000 lives a day as against 2,000 lives which we lose every day now due to health hazards caused by tobacco consumption," said anti-tobacco crusader and chest physician Nitin Abhyankar.

The report underlines the urgency in preventing tobacco addiction even before the first exposure to tobacco or cigarettes. And this is best addressed by counselling children who are just getting into their teenage. Improving overall awareness about the menace of tobacco will go a long way in preventing this addiction, he added.

The Pace Foundation has been formed in Pune by doctors who have started going to schools with multi-media contents including films to sensitise children about tobacco and its health-hazards.

"Our foundation is in the process of making a film. The objective is to stimulate the thought process among children about dangers of tobacco. Our ambition is to reach every school going child in the city over the next one year," said Abhyanakar.

The survey was conducted under the stewardship of the Ministry of Health and Family Welfare, Government of India, with the International Institute for Population Sciences, Mumbai, an autonomous organisation acting as the nodal agency. Technical assistance was provided by the Centers for Disease Control and Prevention (CDC), the World Health Organisation (WHO), the Johns Hopkins Bloomberg School of Public Health, and Research Triangle Institute (RTI) International.

The report provides information on both, tobacco smoking and use of smokeless tobacco along with varied dimensions of tobacco use including use of different tobacco products, frequency of use, age at the time of initiation and the like. Additionally, the report throws light on the other aspects of tobacco use like, exposure to second-hand smoke; cessation; the economies of tobacco; exposure to media messages on tobacco use; and knowledge of health impact of tobacco use.

Blaming tobacco companies for the widespread addiction of tobacco across all age groups in the country, anti-tobacco crusader physician Kalyan Gangwal said, "What makes it difficult is that we crusaders are fighting against large tobacco manufacturers who promote their products as status symbols."

The GATS survey is unique in terms of its large sample size of 72,000 households and key survey activities having been carried out in 19 languages. The standard GATS questionnaire was adapted to Indiabased format on the prevailing pattern of tobacco use in the country and experiences from previous surveillance. This is the first time that hand-held computers were used for conducting the survey.

Sharad Agarkhedkar, president of the city chapter of Indian Medical Association, "The report assumes significance as it has added to our knowledge the status of tobacco use in the Indian population. It will be a valuable source of information for strengthening and modifying tobacco control policies and tobacco control and prevention programmes in the country."

Highlights Of The Report

• Current tobacco use in any form: 34.6% of adults; 47.9% of males and 20.3% of females
• Current tobacco smokers: 14.0% of adults: 24.3% of males and 2.9% of females
• Current cigarette smokers: 5.7% of adults: 10.3% of males and 0.8% of females
• Current bidi smokers: 9.2% of adults: 16.0% of males and 1.9% of females
• Current users of smokeless tobacco: 25.9% of adults: 32.9% of males and 18.4% of females
• Among daily tobacco users, 60.2% consumed tobacco within half an hour of waking up
• Average age at initiation of tobacco use was 17.8 with 25.8% of females starting tobacco use before the age of 15
• Among minors (age 15-17), 9.6% consumed tobacco in some form and most of them were able to purchase tobacco products
• Five in ten current smokers (46.6%) and users of smokeless tobacco (45.2%) planned to quit or at lease thought of quitting
• Among smokers and users of smokeless tobacco who visited a health care provider, 46.3% of smokers and 26.7% of users of smokeless tobacco were advised to quit by a health care provider
• About five in ten adults (52.3%) were exposed to second-hand smoke at home and 29.0% at public places(mainly in public transport and restaurants)
• About two in three adults (64.5%) noticed advertisement or promotion of tobacco products
• Three in five current tobacco users (61.1%) noticed the health warning on tobacco packages and one in three current tobacco users (31.5%) thought of quitting tobacco because of the warning label

Recommendations

• In view of the high prevalence of tobacco use in the country, there should be a national effort to prevent any further increase in the prevalence of tobacco use, especially among the vulnerable groups such as women, youth and children
• There should also be targeted programmes addressing different types of tobacco use and different user groups with special focus on cessation
• There is a need to further strengthen the implementation of Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003, at national, state and sub-state levels
• Establishment of a comprehensive implementation and regulatory structure at the national and state level is required
• Tobacco control strategies need to be mainstreamed with other national health programmes, within the overall framework of the National Rural Health Mission (NRHM)