Tobacco is increasingly becoming the major cause of death in india, which has risen to six million people per annum globally. The number of premature deaths in 20th century globally were 100 million and according to world health organization (WHO) estimates it is supposed to reach 1 billion in 21st century.
Smoking cigarette is not the only leading cause of death in countries like india and Bangladesh , in fact around one third of people in india use smokeless form of tobacco (Gupta and Ray, 2003). In Accordance to the 2010 report of Global Adult Tobacco Survey (GATS), 60% of tobacco consumers in India at present use only smokeless tobacco and in addition 15% of consumers are mixed users, that is, they use both smokeless tobacco and smoked tobacco (GATS INDIA, 2010). In india , we have a varied range smokeless tobacco which differ across country. These include forms like chewing, holding in mouth or applying over teeth and gums. It is not uncommon of females and youth to use tobacco in country. Numerous diseases, both, fatal and non fatal are caused by the use of tobacco. Type of tobacco use may vary from rural to urban areas.
In a large city like Mumbai, Maharashtra, use of bidi (traditional form of cigarette) and cigarette smoking was found to be equal.a relatively higher risk of disease was exhibited by bidi smoking. Mortality rates of women that used smokeless tobacco were age specific in this location. A study showed highest risk of death in extremely thin people who smoked bidi.
One of the studies conducted in Delhi aimed at examining the westernization of use of tobacco and its products among youth. It also stated that influences of western culture are rising high enough and normalizing the use tobacco in city. In Bihar, highest prevalence of tobacco use was seen among students. One of the contributing factors of this issue was the lowest literacy rate in the country. Also it showed that the initiation of the habit started before 10 years of age. In a country like India where smoking tobacco by adolescent girls is not culturally acceptable, still over 8% of girl students presented with the habit. Chewing Gutka was the most common form of tobacco in the state. With either one or both parent addicted to tobacco in the house makes tobacco easily available for the children. Also kids are exposed to the smoke from cigarettes or bidis at a very early age. Thus, increasing the incidence of oral cancer among younger population.
In Bhavnagar , Gujarat , prevalence of chewing tobacco (especially mawa) went from 4.7% in 1969 to 19% in 1994-95 among younger generations. (Gupta PC & Ray CS, Smokeless Tobacco Health in India and Southeast Asia, Respirology (2003)8, 419-31)
In Chennai , Tamil Nadu , studies showed stasticically significant relation between tobacco use and age. Use of tobacco was found more in males than females. Also most tobacco consumers were from the slum areas when compared to non-slum areas.A significantly higher proportion of males resorted to tobacco smoking (28.4%) and smokeless tobacco (11.1%) when compared to the same (0.1%) and (4.9%) respectively among females (P value ,0.001. seventy seven percent of smokers in the city used cigarettes over bidi. (http://repository.ias.ac.in/110617/1/journal.pone.0076005.PDF)
Other than cigarettes , smokeless tobacco forms like gutka , khaini and gul manjan that are locally available are the prevalent in Lucknow, Uttar Pradesh. Bidi also was the coomon modality of smoking in states like Karnataka and uttar Pradesh. There was significant evidence that showed use of tobacco by men first was before 10 years of age. Family income in collaboration with education had association with ever-use of tobacco. In both sexes people with lesser level of education were more prone to use tobacco. Prevalence of tobacco use was less among persons with a higher family income.
The prevalence of tobacco use was reported to be much higher in the North-eastern states compared to other parts of India according to the second National Family Health Survey (NFHS-2) (International Institute for Population Sciences (IIPS) and ORC Macro, 2000. National Family Health Survey (NHFS-2), Mumbai, India 1998-99.) The highest percentage of young people currently using any tobacco product in the North-eastern states of India was in Nagaland (63%) and the lowest (which is very high by any standard) in Assam (36%). The need of tobacco after getting up in the morning is one of the major criteria for tobacco dependence. This criteria was fulfilled by almost three fourths of cigarette smokers and around half of the smokeless tobacco in almost all north-eastern states of india.
Tuibur and hidakphu are watery tobacco products made by passing tobacco smoke through water. This tradition is commonly seen in Mizoram and Manipur with high integration of misconceptions regarding the tobacco water. Even in less concentration , tobacco water does contain nicotine making it equally addictive as to the amount of it being consumed is more.
In Goa tobacco is smoked mainly in the form of cigarettes or bidis (tobacco rolled in a tendu leaf). Seven out every eight people in goa are non smokers.
The most advanced Indian state in terms of social development measured by the health indicators and literacy levels is kerala. Apart for its well known higher literacy rate , use of tobacco was also found to be much higher in the state showing a negative correlation. Much use of tobacco was seen in students for which peer pressure attributed as a contributing factor.
Smoked tobacco or smokeless tobacco , both equally contribute to the mortality rate in the country. The key to tobacco control efforts is the awareness of the health risks of tobacco. These studies and evidences from around the country show an increasing risk of tobacco on one’s life. Advocation of tobacco control program and tobacco ceasation council (TCC) must be implanted in all the states in country.