Tobacco in any form is hazardous to health. Tobacco smoking produces more problems in the lungs and respiratory tracts. Where as smokeless tobacco produces more problems in the oral cavity and oropharynx. Smoking related problem can be slow like lung cancer. Smoking can trigger acute events like blood clotting, heart attack or stroke, which may be life threatening. By smoking, a person is inviting death - How and when depend on the topography of smoking which includes the number of cigaratte smokers per day, year of smoking, pattern of smoking, type of cigarattes smoked etc. Tobacco smoke is mixture of numerous toxic chemicals. The damage caused by tobacco smoking can be local or widespread. Locally, it can damage the respiratory tract and lungs and make this more prone for various infections. Smoking can cause respiratory disease known as chronic obstructive pulmonary disease (COPD) for which currently there is no cure. Progressive disease leads to deterioration in the health due to reduced air reaching body tissues. It is commonly observed that diseases like pneumonia and respiratory problems are more common in smokers compared to non-smokers. Smoking can be harmful for the person with known asthma. In these people, smoking can trigger a severe attack of asthma. Nicotine in tobacco is addictive which increases urge for taking it regularly. From the lungs, these chemicals reach blood through which they go to all parts of the body. Smoking causes damage to the blood vessels. Regular smoking causes ongoing trauma to cells in the body. The immune system of the body is adversely affected due to regular smoking as it has to keep constantly fighting against the damage caused by smoking. Smoking can cause abnormalities in the blood lipid levels ie; increase bad cholesterol and lower good cholesterol. If you are not diabetic, smoking can increase the risk of developing diabetes. If you are diabetic, smoking will add to your problems. Smoking makes control of diabetes more difficult which eventually will result in more complications such as heart disease, kidney disease, eye disease, nerve related problems or increased risk of amputation (cutting a part or whole of the limb). In non-smokers, diabetes is easier to control than those in smokers. In both men and women, tobacco smoking can reduce fertility. Smoking during pregnancy can result in complication in babies too. Smoking during pregnancy can results in delivery of babies with low birth weight or delivery before full term, proving smoking dangerous. Smoking can cause cancer not only of the lungs but at other places in the body too. For example, smoking can cause cancer of mouth, throat, food pipe, stomach, kidney, urinary bladder, pancreas etc. Passive smoking is also harmful. Six lakhs people die every year due to passive smoking. It is a fact that a smoker not only kills himself, but push others also into the well of death. Smoking can be said to be a 'Slow Suicide Attempt' because it is a preventable risk factor for many diseases which increase the risk of death. Save yourself and others by not smoking. Quit smoking regardsless of your age and duration of smoking. Let us join hands to fight for a tobacco free India. 

From  1988,  ‘World,  No  tobacco  Day’  is  being  observed  globally,  as  per  the directive  of  the  World  Health  Organisation.  Every  year  WHO  comes  out  with  a befitting  theme  for the  occasion.  This  year’s  theme  is  “protect the  environment” by avoiding  tobacco.  Those  individuals,  institutions  and  NGOs  engaged  in  tobacco control activities join together, discuss and decide on a regional plan of action for the next one year, for effective tobacco control.

Let  us  examine  the  theme  of  the  current  year.  Tobacco  growing,  processing, manufacturing of products, use of these products and discarding the remains after use; all these activities in the life cycle of tobacco are damaging the environment.

Economist considers tobacco as a “Demerit good”. That means however much is earned by tobacco cultivation and trade, much more has to be spend to diagnose and treat tobacco related diseases.   So,  there is no logic in  cultivating tobacco. Why the conventional tobacco growers do not change to more beneficial and economic crops? This is mainly due to the readily given advances and loans to the agriculturists by the multinational tobacco tycoons.

Tobacco Plant needs heavy manuring and pesticides for growth and protection. The continuous use of chemical manures weakens the soil. The pesticides used remain for long, polluting the environment.

Usually  timber  is  used  to  ‘cure’  tobacco.  35  million  hectors  of  forest  is destroyed  every  year  globally  for  preparing  new  agricultural  land  and  for  obtaining timber. 90% of this deforestation is occurring in developing countries. It is estimated that annually 84 mega tones of carbon dioxide or similar gases are expelled in to the atmosphere by tobacco use, which damages the Ozone layer.

The  health  hazards  of  tobacco  are  well  known.  Tobacco  prematurely  kills nearly 80 lakhs of its users annually. Habitual tobacco use accounts few more than 2 dozens of diseases. The passive smokers also get many of these diseases against their will. Smoking or passive smoking by pregnant mother result in a good number of still births or abortions and neonatal diseases in their newborn.

It is important to note that covid-19 infection will be more severe and fatal in habitual smokers than their non smoking counterparts. The same is true for pulmonary tuberculosis patients.

The cigarette buds thrown after smoking increases the level of micro plastics in the  environment.  The  plastic  or  metal  foil  covers  of  smokeless  tobacco  products remains in the environment for generations. That is why the Hon. Supreme Court has recently banned packing of smokeless tobacco products like Pan masala in plastic or foil jackets.

India is the second largest grower, exporter and user of tobacco. The strategies of tobacco control are: Creation of tobacco awareness, Legislations to restrict tobacco use, Increase in the tax of tobacco products and Establishment of network of tobacco cessation  clinics  throughout  the  country.  Many  tobacco  cessation  clinics  in  famous institutions are run by Dental Surgeons.

The WHO conducts “Global Adult Tobacco Survey” (GATS) once in ten years. It was noted that in the GATS 2015-16, the member of tobacco users have decreased compared  to  the  number  of  users  in  the  2005-2006  Survey.  It  is  mainly  due  to implementation of the “Control of Tobacco Product Act 2003”, by the Govt. of India. Kerala State showed the highest number of Quilters in the GATS.

It   is   welcoming   to   see   that  Indira Gandhi Institute of Dental Sciences, Kothamangalam and other dental colleges in the state   as well as   professional organizations  like  KSOMP,  ASMIK  etc are  taking  innovative  steps  in tobacco control activities this year. Wish all the tobacco control activists good luck!

The idea that someone is protected from the effects of cigarette smoke because they’re not directly exposed to second-hand smoke is not the case.

- Drew Gentner

“Doctor… He is a kid.. My son never smoke.. no pan chewing.. nothing.. But still..” Mr. Suresh*  was trying hard to control his tears in front of his family. This was during the first month of my Head and Neck Residency. I was taking case history of Sanju*, a 21 year old engineering student who was diagnosed with tongue cancer. Mr. Suresh was asking a very genuine question. How did Sanju got cancer without any habits? We still face similar questions from the patients and their relatives. I often find it difficult to give a convincing answer to them.

Around 5-10% of oral cancer occur without any definite cause. Is it genetic? Hereditary? Or just bad luck..? We don’t know. But there is a silent assassin. It is Third Hand Smoke, fact which most of us are less aware or is overlooked. The term Third Hand Smoke became popular in 2009 when it was used by Jonathan Winickoff, an associate professor of pediatrics at Harvard Medical School to emphasize its harmful effects on children.

Third hand smoke - How is it formed?

Third-hand smoke (THS) is the long-lasting residue resulting from second-hand smoke that accumulates in dust, in objects and on surfaces in indoor or outdoor environments where tobacco has been smoked. When cigarettes are regularly smoked in an indoor environment like home, office, car etc, a significant amount of the emitted tobacco smoke pollutants can accumulate and cling to clothes, furniture, drapes, walls, bedding, carpets, dust, vehicles and other surfaces long after smoking has stopped. Children and nonsmoking adults might be at risk of tobacco-related health problems when they inhale, swallow or touch substances containing thirdhand smoke. Infants and young children are at a higher risk of exposure to third hand smoke due to their tendency to mouth objects and touch affected surfaces. But quantifying the risk from thirdhand smoke is difficult, and data on its effects are still scarce.

Components of THS

THS contain highly carcinogenic tobacco-specific nitrosamine, toxic metals like lead, cadmium etc, nicotine, polycyclic aromatic hydrocarbons and other various volatile organic compounds. Apart from this, the compounds of THS undergo ageing and chemical reactions to produce more toxic agents. Nicotine can react with common air pollutants or the gases emitted from LPG cylinders of vehicles to create Nicotine-derived Nitrosamine Ketone (NNK), which is highly carcinogenic. Efforts to diffuse the smoke, like opening windows or using a fan, don’t prevent thirdhand smoke from forming or keep it from being inhaled. The residue may give off harmful chemicals for months or even years. Normal cleaning methods also aren’t effective against the pollutants

How Third hand Smoke affect our children?

Children spend more time indoors. Hence they are more exposed to Third Hand Smoke. They are more vulnerable due to their immature immune system as well. Children living with parents who smoke can be exposed, through physical contact with pollutants on the clothes and body of a smoker, playing with polluted toys, and through house dust in carpets and on furniture. The levels of Third Hand Smoke pollutants stay elevated for months after smoking has ceased.

Coming back to Mr. Suresh’s genuine doubt. After completing the case history, I found that though Sanju doesn’t have any habits, his father is a smoker and he regularly smokes at home. But he was “conscious enough” to not smoke in front of his kids.

Although no research has been conducted yet on the effects of thirdhand smoke on humans, studies have shown that mice exposed to thirdhand smoke have a greater chance of developing lung cancer. The important thing to know is that there is a risk, and this risk could predispose people to health issues, including cancer.

A large number of our kids are being exposed to third hand smoke. Bus stations, hotels, trains, movie theatres are all contaminated. Home is supposed to be their safest environment. But are we responsible enough to provide our kids a safe and healthy environment to grow? Unless we find  a cure to Third Hand Smoke, people like Mr. Suresh keep asking the same question. How did my son got cancer? He never smoke…

(* the names used in this article are not real in order to protect the privacy of the patient)

References:

1.    Tobacco and its environmental impact: an overview; ISBN 978-92-4-151249-7; World Health Organization 2017

2.    A. Burton; Does the Smoke Ever Really Clear? Thirdhand Smoke Exposure Raises New Concerns; Environ Health Perspect. 2011 Feb; 119(2): A70–A74.

3.    Winickoff JP, et al. Beliefs about the health effects of “thirdhand” smoke and home smoking bans. Pediatrics. 2009;123(1):e74–e79.

Tobacco use is a major preventable cause of premature death and disease, currently leading to over five million deaths each year worldwide.

Despite, the wide knowledge and the existing legislative, service, and preventative efforts by various agencies and NGOs at both national and state levels, tobacco continues to be a major threat to the health and wellbeing of the user and others around (passive smoking).

India is the world's third-largest tobacco-growing country and the second-largest consumer of tobacco products in the world. India accounts highest tobacco-related mortality with about 7,00,000 annual deaths attributable to smoking in the last ten years, with an expected rise to one million in the coming decade.

More than one-third (35%) of adults in India use tobacco in some form, 21% of adults use smokeless tobacco, 9% only smoke tobacco, and 5% smoke as well as use smokeless tobacco. It is estimated that annual oral cancer incidence among Indian males is as high as 10 per 100,000.

Passive smoking in the form of Second hand, thirdhand, and Fourth hand smoking is a major concern.

Tobacco cessation can be effectively done through a two-pronged approach:

·         large scale promotions to educate the people about the harmful effects of tobacco use and benefits of quitting

·         providing adequate facilities to those who want to quit.

What is the need for a health care professional intervention in tobacco cessation?

·         Tobacco causes addiction – Nicotine being the cause of addiction

·         Withdrawal symptoms associated with sudden stoppage of tobacco use make it difficult to quit the habit

Various methods are available for quitting and most people who want to quit are not aware of the means available to them. Tobacco cessation measures are now a regular part of the healthcare delivery system.

PROCESS OF TOBACCO CESSATION – INTERVENTIONAL STRATEGIES

Three types of interventions in tobacco cessation

1. Behavioural/Non pharmacological

2. Pharmacological

3. Combination

Tobacco cessation counselling during the routine dental visit

The dental clinic forms a conducive environment for tobacco cessation counseling. Dentists play an important role in promoting tobacco cessation. Being the health professionals, dealing with an oral cavity – a mirror to general health, dentists are in a unique position to educate and motivate patients concerning the hazards of tobacco to their oral and systemic health, and to provide intervention programs as a part of routine patient care. Dentists assume multiple roles and responsibilities in tobacco cessation which include that of a clinician, educator, counselor, researcher, role model, academician, leader, opinion, and policy builder.

The use of tobacco in any form manifests in the oral cavity as various signs and symptoms including staining of teeth, bad breath, abrasions, pigmentation of tissues, changes in the palate, gums, and tongue, red and white lesions, difficulty in mouth opening, burning sensation in the mouth, ulcers, etc. A routine oral examination by a dentist can reveal most of these at an early stage and early intervention can prevent serious sequelae.

Once the tobacco user is identified,

·         A Detailed case history will be taken to assess the level of nicotine addiction/dependence and a detailed oral examination for 'red flags'. 

·         Proper communication regarding the methods available for quitting tobacco and necessary treatment can be provided by the dentist.

·         Interaction with the family members may be necessary to assess the effect of passive smoking (second, third and fourth hand smoking), which is a serious consequence of tobacco smoking.

·         Various indices (as multiple-choice questions) are used to assess nicotine dependence and these indices can be used to assess the progress of the tobacco cessation program.

·         A five-to-fifteen-minute communication with the dentist in the form of a 5A and 5R approach has been proved to be a successful tool in assisting the patient with tobacco cessation.

·         Five A’s of tobacco cessation include

1. ASK – The dentist/health care provider asks all patients about tobacco use and exposure to second hand or third-hand smoke

2. ADVISE – The dentist persuades all the users that they need to quit. They advise the user to quit in a strong, clear, and personalized manner. They relate to the demographics, social factors, health concerns, and economic implications associated with tobacco use. They advise those exposed to secondhand and thirdhand smoke to avoid it.

3. ASSESS – The dentist assesses the readiness of the patient to quit. If willing to quit or have had failed attempts to quit, the dentist then ASSISTS the patient in quitting. If NOT willing to quit, a 5R approach (mentioned below, will be adopted)

4. ASSIST – The dentist assists in quitting through counseling sessions, with developing a quit plan. Use of nicotine replacement therapies for assisting in combating nicotine dependence and use of approved medications (pharmacotherapy) may be needed as appropriate.

•  A STAR method may be used to facilitate and help to develop a quit plan: 

§  Set a quit date ideally within two weeks.

§  Tell family, friends, and coworkers about quitting, and ask for support.

§  Anticipate challenges to the upcoming quit attempt.

§  Remove tobacco products from the patient’s environment and make the home smoke free

•   For Passive smokers, a MAD-TEA method may be employed

§  Meet their friends at spaces in the community that are smoke free

§  Ask family members and visitors to smoke outside

§  Declare their home and personal spaces  to be smoke free

§  Talk to family members and people they work with about the risks of secondhand smoke

§  Encourage family members, friends, and workmates who smoke to stop

§  Advocate comprehensive smoke-free laws or regulations in workplaces and public places.

5. ARRANGE – Scheduling of follow-up contacts – in person or through telephone.

•    During the follow-up, the dentist

§  Identify problems encountered and anticipate challenges.

§  Remind patients of social support.

§  Assess medication use and problems.

§  Schedule next follow-up contact.

§  For patients who are abstinent - Congratulate them on their success.

For patients who have used tobacco again

§  Remind them to view relapse as a learning experience

§  Review circumstances and elicit recommitment.

§  Link to more intensive treatment if available.

·         The 5R’s of tobacco cessation include (for those who are not willing to quit)

1. RELEVANCE – Tries to make the patient understand the relevance of quitting – how it is important for the person himself and his/her family.

2. RISKS -  Identification of risks to the patient and family, which include - Shortness of breath, exacerbation of asthma, increased risk of respiratory infections, harm to pregnancy, impotence, infertility, heart attacks and strokes, lung and other cancers (e.g. larynx, oral cavity, pharynx, esophagus), chronic obstructive pulmonary diseases, osteoporosis, long-term disability, and need for extended care.

3. REWARDS – Identification of potentially relevant rewards of quitting - improved health, improved sense of smell and taste; saving money, feeling better, the breath will smell better; setting a good example for children, having healthier babies and children, performing better in physical activities; improved appearance, including reduced wrinkling/aging of the skin and whiter teeth.

4. ROADBLOCKS – Identification of roadblocks/barriers that interfere with counseling, which may include withdrawal symptoms, fear of failure, weight gain, lack of support, depression, enjoyment of tobacco, being around other tobacco users, limited knowledge of effective treatment options.

5. REPEAT – Repetition of the motivational interventions and advice in every visit.

OTHER NON-PHARMACOLOGICAL/BEHAVIORAL INTERVENTIONS

1. Self-help programs – Printed pamphlets and other education materials. These materials are widely available on the internet and various hospitals that are customised and in vernacular languages.

2. Exercise and yoga - Aerobic exercise has shown promise as an aid to smoking cessation because it improves affect and reduces nicotine withdrawal symptoms.  Yoga is an alternative to traditional (Western) aerobic exercise that may have promise as a complementary treatment for smoking cessation.  Pranayama, breathing exercises that involve regulation of breath and conscious deep breathing stimulates pulmonary stretch receptors similar to the deep inhalations associated with smoking and thus aid in quitting smoking.

3. Social media and apps (mCessation) – A wide range of mobile applications are available that can be downloaded and be used for effective quitting.

A national toll free Quit Line number can be used for personalized counselling and help in quitting. The Ministry has started National Tobacco Quit Line to provide tobacco cessation counseling services to the community through a toll-free number (1800-112-356)

The mCessation programme launched by Government of India is a very effective in assisting tobacco cessation. Ministry of Health & Family Welfare, in partnership with World Health Organisation and the International Telecommunications Union, has started this initiative for utilising mobile technology for tobacco cessation. WHO-ITU’s ‘Be Healthy Be Mobile’ initiative, aims to reach out to tobacco users of all categories who want to quit tobacco use and support them towards successful quitting through constant text messaging on mobile phones. You can register to the mCessation programme by giving a missed call on 011-22901701 OR register at the website https://www.nhp.gov.in/quit-tobacco

4. Alternative foods – Foods such as cinnamon, ginger, milk, fruits and vegetables, dark chocolate, cheese, herbal teas and sugar free chewing gums and candies have proven benefits that help in quitting the habit.

PHARMACOLOGICAL INTERVENTIONS

1. Nicotine replacement therapy

         a. Slow and sustained release – transdermal patches – applied to skin

         b. Acute dosing forms – Chewing gums, Nasal spray, Inhalers, Sublingual tablets, Lozenges, e – cigarettes

         c. Nicotine vaccines

2. Non-Nicotine therapy

         a. Varenicline

         b. Bupropion SR

         c. Cytisisne

         d. Nortryptiline

         e. Anxiolytics and antidepressants

It is advised that these pharmacological interventions are to be taken after consultation with health care provider only, as the dosages and mode of delivery can vary from person to person.

Dealing with Cravings

Once you quit, you may have times when you really want to smoke. Sometimes, you may be “triggered” by a memory or a routine where you used to smoke. These are called cravings. Cravings typically last 4-5 minutes and can be managed several ways. Some medications help a lot with cravings, but there are things you can do to help you get through the rough spots.

The 4 Ds can help!

1. DELAY – Do not act on your urge to smoke. It will pass in a minute or two. Do not give in – use your willpower!

2. DEEP BREATHING – Take slow, deep breaths to relax you. Breathe in slowly and deeply through your nose and release the breath through your mouth. Keep breathing until you relax and forget about the urge to smoke.

3. DRINK WATER – Drink water. It helps to flush the toxins from your body and gives you something to do with your hands and mouth.

4. DISTRACT – Take your mind off smoking. Get up and move around. Take a walk. Call a friend. Listen to music. Start a new hobby. Meditate. Pray. Chew gum. Brush your teeth

Tobacco cessation represents the single most important step that people who use tobacco can take to enhance the length and quality of their lives. Quitting is hard, but you can increase your chances of success with adequate help of the health care professionals. Make every day a ‘No Tobacco Day’.

   The nocturnal flies get attracted to the flames in a lamp, jumps into it not only extinguishing the lamp but also killing the flies themselves. Similarly, a smoker is indirectly committing suicide and at the same time inflicts upon others the menace of passive or secondhand smoking. 

     Although the parents and friends are not supposed to be a perilous or unhealthy model to a young person, quite paradoxically many youngsters irrespective of their gender get attracted to smoking either from his or her father, brother or friends. It gives them an illusion that smoking helps to ease their mind or soothe tension arising from adverse situations.  Even some of them consider cigarette as a friend for consolation. Old as well as new generation movies show actors smoking and using alcohol as if to project them as smart and stylish. This invariably gives a wrong message to the younger generation. A poor man never thinks that he is contaminating his internal organs with the poisonous gas and murderous chemicals. Unfortunately, the internal organs could clearly express their perilous state only at an irreversible and disastrous stage. 

      With the advancement in medicine, now we are aware that the smoking 

causes oral and lung cancer, atherosclerosis, heart disease, stroke, lung diseases etc.  and also creates problems of the immune system. 

      Even if counselling and social education has succeeded in reducing the number of smokers in cities and towns, many people in rural areas are still unaware of the consequences and continue smoking. I know a person who refused to take the advice not to smoke in public by a police constable arguing that it is none of the business of police. When the constable fined him for the insolence he smiled and showed his empty pocket. This is the sad state of many of our elderly population. They feel that interference with their personal behaviour is an infringement of their liberty. They believe that they have every right to inflict any harm on their body and have no idea about the dangerous effects of secondhand or passive smoking.

      In our experience many people have stopped smoking just because of fear more than anything else. Thinking about death is not the real villain for them. It is getting incapacitated due to a stroke or amputation of limbs due to Deep Vein Thrombosis etc and not being able to perform even the basic biological necessities without the help of others. Educating the public clearly, making them aware of the perils and the aftereffects of smoking and including it in the primary class curriculum also may help in reducing this bad habit.

 Instead of advocating a gradual stopping of the smoking habit it is advisable to make the smoker abruptly quit this bad habit altogether.  His dangerous addiction to the Nicotine could be reduced by other methods.  It is also essential to prevent the use of alcohol or any other drug instead of smoking especially among the young people. In this context it is advisable to completely prevent the sale of tobacco and connected items near the educational institutions once and for all.

World No Tobacco Day is a poignant reminder of the ongoing battle against tobacco use and its devastating impact on public health. This year, the focus is on protecting children from tobacco, an essential step in safeguarding our future generations from the myriad harms associated with tobacco exposure. As we delve into this crucial topic, it becomes evident that preventing children from falling prey to tobacco addiction is not just a public health imperative but a moral responsibility.

The Alarming Reality of Tobacco Exposure in Children

Tobacco use remains one of the leading causes of preventable deaths globally. According to the World Health Organization (WHO), tobacco kills more than 8 million people each year. Alarmingly, a significant number of new smokers are children and adolescents. In fact, most adult smokers begin smoking during their teenage years. This early exposure is often influenced by factors such as peer pressure, aggressive marketing by tobacco companies, and a lack of awareness about the dangers of tobacco.

Children exposed to secondhand smoke are also at risk. Secondhand smoke contains over 7,000 chemicals, hundreds of which are toxic and about 70 can cause cancer. Children exposed to secondhand smoke are more likely to suffer from respiratory infections, sudden infant death syndrome (SIDS), and developmental issues. This exposure not only endangers their immediate health but also increases the likelihood that they will become smokers themselves.

Strategies to Protect Children from Tobacco

1. **Education and Awareness Campaigns**:

Raising awareness about the dangers of tobacco is vital. Schools, parents, and communities must collaborate to educate children about the health risks associated with smoking and secondhand smoke. Effective education programs can empower children to make informed decisions and resist peer pressure to try tobacco.

2. **Legislation and Policy Enforcement**:

Governments play a crucial role in protecting children from tobacco. Implementing and enforcing strict laws that prohibit the sale of tobacco products to minors is essential. Additionally, banning tobacco advertising, promotion, and sponsorship can reduce the visibility and appeal of tobacco to young people.

3. **Creating Smoke-Free Environments**:

Establishing smoke-free zones in public places, especially areas frequented by children, such as schools, playgrounds, and parks, is an effective way to minimize their exposure to secondhand smoke. Smoke-free policies also help denormalize smoking behavior, making it less likely for children to view smoking as acceptable.

4. **Parental Involvement**:

Parents are powerful influencers in their children's lives. By setting a positive example and maintaining open communication about the dangers of tobacco, parents can discourage their children from starting to smoke. Parents who smoke should seek support to quit, not only for their own health but also to protect their children from the harms of secondhand smoke.

5. **Access to Cessation Support**:

Providing resources and support for tobacco cessation is crucial for both adults and adolescents who are trying to quit. Schools and communities should offer counseling, support groups, and access to nicotine replacement therapies to help those struggling with addiction.

The Path Forward

Protecting children from tobacco is a multifaceted challenge that requires a concerted effort from individuals, communities, and governments. By implementing comprehensive strategies that combine education, legislation, environmental changes, and parental involvement, we can create a society where children are free from the harms of tobacco.

As we observe World No Tobacco Day, let us renew our commitment to this vital cause. By working together, we can ensure that our children grow up in a world where they can thrive, free from the dangers of tobacco. This is not just a health issue; it is a matter of securing a healthier, brighter future for generations to come.

The tobacco epidemic is one among the biggest public health threats that the world faces almost killing over 8 million people a year. More than 7 million of those deaths are the result of direct tobacco use while around 1.3 million are the result of non-smokers being exposed to second-hand smoke. All forms of tobacco are harmful, and there is no safe level of exposure to tobacco. Cigarette smoking is the most common form of tobacco use worldwide. Other tobacco products include waterpipe tobacco, cigars, cigarillos, heated tobacco, roll-your-own tobacco, pipe tobacco, bidis and kreteks, and smokeless tobacco products.

Around 80% of the 1.3 billion tobacco users worldwide live in low- and middle-income countries), where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco. This spending behavior is difficult to curb because tobacco is so addictive

NEED FOR TOBACCO MONITORING:

Good monitoring tracks the extent and character of the tobacco epidemic and indicates how best to tailor policies. Most population are regularly asked about their tobacco use in nationally representative surveys among adults and adolescents.

PASSIVE SMOKING :

Second-hand smoke is the smoke that fills restaurants, offices, homes, or other enclosed spaces when people smoke tobacco products. There is no safe level of exposure to second-hand tobacco smoke. Second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer, and kills around 1.3 million people prematurely every year.

Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can double a tobacco user's chance of successfully quitting. Currently however, only 23 countries provide comprehensive cessation services with full or partial cost-coverage to assist tobacco users to quit. This represents just 32% of the world's population.

Health professionals have the greatest potential of any group in society to promote the reduction of tobacco use. Studies show that few people understand the specific health risks of tobacco which include lung cancer, heart disease and stroke.  Brief advice from health professionals can increase quitting success rates by up to 30%, while intensive advice increases the chance of quitting by 84%. 

Under WHO’s Framework Convention on Tobacco Control (FCTC), countries are mandated to treat tobacco use and dependence. WHO provides capacity building and training packages to help governments establish or strengthen their national tobacco cessation systems including integrating brief tobacco interventions into their primary care systems, developing national toll-free quit lines and mCessation projects. Offering help to quit is also one of the five key interventions in the MPOWER package of technical measures and resources which WHO introduced in 2007.

TOBACCO BURDEN IN INDIA:

India faces a dual burden of tobacco use in the form of smoking and smokeless tobacco. According to the Global Adult Tobacco Survey (GATS) conducted in 2016–17, the overall prevalence of smoking tobacco use is 10.38% and smokeless tobacco use is 21.38% in India. Of all adults, 28.6% currently consume tobacco either in smoke or smokeless form, including 42.4% of men and 14.2% of women. The Demographic Health Survey, known as the National Family Health Survey (NFHS) is one of the largest health surveys conducted in India providing disaggregate estimates of several health and demographic indicators. It has been a major source for planning policies and programs for different aspects of health among the Indian population. As NFHS and GATS are nationally representative household surveys using multistage sampling design with an overall response rate of 90%; they produce enough sample size for reliable estimates to be made, at least at state level, for comparison. 

The prevalence of tobacco use among men has declined in most states, except Sikkim, Goa, Bihar, Gujarat, Himachal Pradesh, and Mizoram. In the case of women, the prevalence has declined in almost all states except Mizoram and Sikkim. The prevalence of tobacco use in rural areas is higher than in urban areas. There is a clear urban rural divide.  The absolute number of tobacco users in India is still very high due to its huge population, which has a high risk for developing various chronic diseases. The tobacco control programs need more targeted interventions for specific groups in the population. Despite all cessation policies, people are still consuming tobacco in both forms in India. The tobacco users should be strongly encouraged to quit tobacco to eliminate long-term detrimental effects on their health. The decline in tobacco use definitely shows some positive signs for tobacco prevention and cessation programs in India, but it is yet far from achieving the goal of a tobacco-free India.

         Smoking continues to be a public health problem around the world. India is the third largest tobacco producer and consumer in the world. The overall prevalence of tobacco use in India is 10.38%. The prevalence of exposure to indoor tobacco smoke has increased in India from 4.1% to 52.7%. During the last 10 years the prevalence of indoor exposure to tobacco smoke has risen thirteen times in children under the age of 5 years. Secondhand smoke kills around 1.2 million people every year and 65,000 of these preventable deaths are children and adolescents under 15 years. Children with caregivers who smoke are almost 70% more likely to try smoking by the age of fifteen. Smoking in school children has increased in the last decade.

Most people know that smoking causes health problems including cancer in adults. Tobacco smoke contains a deadly mix of more than seven thousand chemicals. There is no safe level of exposure to tobacco smoke. Tobacco is a child right issue and tobacco control is a cost-effective intervention for a healthy child. Per World Health Organization (WHO) sixty-two countries have adopted comprehensive smoke free policies to improve chances of healthier future for children.

During pregnancy exposure to secondhand smoking or smoking causes serious problems. Smoking during pregnancy leads to preterm delivery, small babies, birth defects, and stillbirths. Smoking affects a baby’s brain and lungs. The damage caused due to smoke exposure during pregnancy can last through childhood and into teen years. Exposure to secondhand smoke during pregnancy is relevant to low- and middle-income countries where few women smoke but many men do smoke. Smoking/exposure to secondhand smoking causes birth defects including cleft lip, palate, or both. Babies born to mothers who smoke/secondhand exposure to smoking during pregnancy and babies exposed to cigarette smoke after birth have a higher risk of sudden infant death. Preventing secondhand smoke exposure or quitting smoking during pregnancy protects the health of pregnant women and the unborn child.

Sudden infant death syndrome (SIDS) is the unexplained death of a baby younger than a year of age. There are risk factors that can increase the risk of SIDS. Secondhand smoking is oneof the risk factors that can cause SIDS. The risk of SIDS increases even more if a parent who smokes shares a bed with a baby. Studies have shown chemicals in secondhand smoke affect babies’ brain and their breathing. Secondhand smoking can cause bronchitis, frequent ear infections, pneumonia, and frequent severe asthma attacks needing hospital admission. Children exposed to tobacco smoke in early life often experience behavioural problems and do not do well in school. Research has shown babies who die from SIDS have higher concentrations of the drug nicotine, a chemical present in tobacco products.

It is important to remember not to smoke during pregnancy or be around someone who smokes. It is important to not smoke around your baby or allow others to smoke near your baby. Children are more susceptible to effects of secondhand tobacco exposure than adults because of their immature immune system. Having smoke-free outdoor and indoor spaces, playgrounds, outdoor dining areas, parks and beaches protect children from exposure to secondhand smoke.

Studies have shown that exposure to media messages regarding tobacco has a significant influence on children. Advertising and promotion of tobacco products attract children's attention, lures children through glamorous and deceptive promotional stunts. Advertisements associate the brand name with idolized role models, legitimize the habit in young minds and project the use of tobacco as being socially acceptable. To reduce the health risks associated with tobacco exposure and ensure a healthier future for generations to come it is important to have laws against smoking and safeguard children and their health.

            According to the centers for disease control and management in the US, every day almost 2,500 children under 18 years of age try their first cigarette, and more than 400 of them will become new, regular daily smokers.  Half of them will ultimately die from their habit. Tobacco use is a leading cause of preventable deaths world over, more so in developing countries. In India alone, nearly 1 in 10 adolescents in the age group 13-15 yr have smoked cigarettes and almost half of these reports initiating tobacco use before 10 yr of age.Tobacco is used as cigarettes, cigars, hookah, nicotine gels, pipe tobacco, roll-your-own tobacco, smokeless tobacco products, vapes, electronic cigarettes (e-cigarettes), hookah pens, and other electronic nicotine delivery systems. With the changes in the dynamics of societies, the prevalence of smoking among children has increased many folds and is at present a significant public health problem. 

          Use of tobacco leads to cancer, respiratory problems, heart diseases, diabetes, infections, dental problems, hearing loss, vision loss, fertility problems, osteoporosis etc. to name a few. The role of family, peer influence, promotion by tobacco companies, easy availability psychological and emotional factors play a significant role in tobacco use among children.   Considering the enormous health complications associated with tobacco use, it is of utmost importance to understand the factors leading to the use of tobacco and related products, plan effective measures to curb its use.