Times of India
01 June 2010
By P C Gupta

Women must wake up to the harmful effects of tobacco use
More and more women are participating in activities dominated by men until recently. Much of this can be considered progressive except for one activity – smoking. World No Tobacco Day having been marked on May 31, it is worth noting that there is some epidemiological and considerable observational evidence that smoking is increasing among girls and young women in India.

Teenagers are known to try new behaviour patterns and activities to feel grown up. Some boys consider experimenting with tobacco and alcohol as a sign of maturity, probably because these habits have been seen as symbols of manhood. Girls too are known to smoke and drink to remain part of the group and avoid being left out. It’s known that girls with boyfriends who smoke are more likely to try smoking than other girls.

Many young women who smoke occasionally tend to view the habit as harmless for being occasional. Yet, with the passage of time, many such women have been found to become daily smokers.

Though daily smoking of a few cigarettes may still seem trivial, scientific evidence points to elevated risks for women who smoke even a few cigarettes a day, just like for men. Once a person becomes a daily smoker, she is rarely able to stick to one or two cigarettes a day, as addiction sets in with loss of control over the amount smoked. Teenagers who experiment with smoking run a much higher risk of addiction.

Hookahs represent another form of smoking converted into a social activity by today’s youth. Many boys and girls, even minors, frequent hookah parlours to enjoy hookahs in fruit–andnut, icecream and candy flavours. But the scientifically proven fact of the matter is that hookah smoke contains more tar and carbon monoxide than cigarette smoke. Unfortunately, taken in by seemingly harmless fruit–flavoured smoke, few people know about that.

Smokeless tobacco products seem to have grown in appeal in recent years. Unlike smoking, their use tends to be socially acceptable among women. Pan chewing has been a part of our culture for millennia and the newer products are simply modern versions. Pan masala advertisements on buses (advertised as not containing tobacco) show happy couples, attractive and young or homely and middleaged, all enthusiastic about the product, purported to have breath–freshening and energising qualities. The tobacco–containing variant, usually called gutka and sometimes pan masala with tobacco, is normally available at pan or tobacco shops while the advertised non–tobacco product may not be. Even young women are seen purchasing pan masala or gutka from such vendors, where mainly men purchase all kinds of tobacco products.

Young women across the world seem a special target of the tobacco industry. In developing countries, they are highly vulnerable. In India, the problem is more acute because of multiple products and multiple segments of the industry targeting them.

Women addicted to smoking or smokeless tobacco products find it difficult to give up tobacco use even when pregnant. This puts their babies at high risk. Even if a pregnant woman gives up smoking, she often reverts to it after delivery, putting not only herself at a higher risk of diseases but also her infant at greater risk of Sudden Infant Death Syndrome, respiratory infections and middle ear infections. Prolonged smoking also leads to premature facial wrinkling, yellowing of teeth and gum disease, apart from lung cancer, heart disease and stroke. Of all smokeless tobacco products, gutka is most advertised and addictive. If used during pregnancy, it seems to exert higher risk of adverse outcomes. It can cause oral submucous fibrosis, a painful debilitating condition that constricts the opening of the mouth. With no well–accepted cure, this has a very high risk of developing into mouth cancer.

Smoking among young women is greatly encouraged by cigarette manufacturers’ marketing strategies. Before the Cigarettes and Other Tobacco Products Act, 2003 went into force, cigarette ads almost always included women in the company of men. In the current legal climate where direct tobacco advertisements are banned, cigarette manufacturers attract customers through point of sale signboards and displays. Signboards test and stretch the limits of the law, with oversized boards, images of cigarette packs, backlighting and descriptions like "light" or "mild" designed to suggest relative product safety, which appeals to women.

Cigarette manufacturers also indulge in television advertising of products with the same brand name as cigarettes through fashion shows, clothing stores and ads for soaps, shampoos and perfumes, mostly catering to women. They have also come up with household products like packaged flour and readymade dishes, agarbatti sticks, bath soaps and shampoos. On all these products, the manufacturer’s logo is prominently displayed.

Manufacturers of cigarettes and gutka are increasingly targeting the new social realities and aspirations of young women. Educated young women are society’s role models; their behaviour influences women in all levels of society and walks of life. If current trends continue, smoking will increase among women across social classes in years to come. This is exactly what happened in the industrialised countries of the developed world a few decades ago. Young women need to be warned about the harmful effects of tobacco products before it is too late.

The writer is director, research, Healis–Sekhsaria Institute for Public Health.