'Alarming' rise in tobacco consumption in J&K, reveal studies

'Alarming' rise in tobacco consumption in J&K, reveal studies

''38.2 % men addicted to some kind of tobacco; state fast turning into smoking capital of India’

The union health ministry recently directed for changing pictorial health warnings on tobacco packs, in an attempt to deter people from consuming tobacco products. Showing graphic pictures of throat and mouth cancer, these warnings, the ministry hopes will bring down prevalence of smoking. However, in Kashmir, the number of people addicted to smoking is growing at alarming rate. As per the latest National Family Health Survey (NFHS-4), 38.2 percent men in J&K are addicted to some kind of tobacco. Though the NFHS has not bifurcated smoking and smokeless tobacco use, it has been discussed in the latest Global Adult Tobacco Survey (GATS). This international survey puts J&K at serial no number 6 among all states in Indian in terms of tobacco smoking. The only states which have a higher prevalence of smoking than that of J&K are five north-eastern states of Mizoram, Meghalaya, Arunachal Pradesh, Tripura and Manipur. Although in terms of use of smokeless tobacco products (chewable), J&K is at tail end of the list, the “mammoth abuse” of tobacco has the potential to make it smoking capital of India. It is generally assumed, given the intensive anti-tobacco campaigns in media and other platforms, that people are well-versed with impact of smoking on health. However, last week, the World Health Organisation (WHO) made some astonishing remarks. Based on GATS analysis, it said, over half of adults in India were unaware of the fact that smoking causes heart disease and stroke. “Most people know that using tobacco causes cancer and lung disease, but many people aren’t aware that tobacco also causes heart disease and stroke, the world’s leading killers,” Dr Tedros Adhanom Ghebreyesus, WHO director-general was quoted as saying on commemoration of No Tobacco Day on May 31. This brings into discussion the huge burden of heart disease that Kashmir has been facing. Indian Council of Medical Research (ICMR) recently estimated that in J&K, 3,039 disability adjusted life years (DALYs) are lost to tobacco use, one of the highest among all states. The only two states, where DALYs attributable to tobacco use are higher than J&K are Mizoram and Uttrakhand. At all-India level, an average 2081 DALYs are lost to tobacco, much less than figures for J&K. The DALY is an estimate of how many life years are lost to disease or death due to a certain factor or disease. One DALY can be explained as one lost year of "healthy" life per 1000 population. This ICMR report titled ‘Health of Nation’s States’ makes it clear that J&K has one of the highest incidences of chronic obstructive pulmonary disorder (COPD). A study carried out by noted pulmonologist Prof Parvaiz A Koul at Sher-e-Kashmir Institute of Medical Sciences (SKIMS) has found that one in six individuals in Kashmir have decreased performance of lungs. “The COPD is highly prevalent in Kashmir, and seems to be related to the high prevalence of smoking,” Prof Koul said. According to the ICMR the Ischemic heart disease in Kashmir is leading cause of death. No wonder J&K features at serial no 4 in terms of most lives lost and disability due to smoking, giving rise to the questions that what are healthcare and allied systems in State doing towards bringing down the incidence of smoking. Experts believe that very little is being done in J&K to make tobacco products inaccessible to people below age of 18, as mandated under Cigarettes and Other Tobacco Products Act (COTPA) laws. At most vending outlets, there is no display of warnings that declares tobacco sale to children below 18 years of age as illegal. In addition, cigarettes are sold right outside the schools, with no fear of prosecution. Moreover, although sale of loose cigarettes is banned, the practice continues in the state. In Kashmir, sale of “imported cigarettes” has also gone up. These cigarette packets are not designed as per the laws in India and either have no pictorial warning or smaller ones. In the past, the COTPA units have seized and destroyed such cigarettes but, more needs to be done. The COTPA enforcing unit of Kashmir is the same one that looks after the food safety. But this understaffed, overburdened and ill-equipped unit has not been able to ensure compliance to tobacco control laws. A source in this unit candidly admitted that due to lack of support from enforcing agencies like police, ensuring strict adherence to the laws becomes difficult. “Our staff has faced wrath of people many times and there is no support from any allied department for carrying the enforcement drives,” the source said. The fallouts of this laxity have been documented by a study carried out at Government Medical College (Srinagar). As per the survey “Tobacco Use in School Going Adolescents of District Srinagar of Kashmir”, published in International Journal of Science and Research found that 23 percent of adolescents were smokers and 18 percent of the studied population had started smoking when they were 14-15 years old. “Half of the currently smoking adolescents indicated that they would be able to stop smoking if they wanted to do and only half of them received help or advice that encourage them to quit smoking,” the researchers noted. “Cigarettes and other tobacco products can be purchased by anyone in Kashmir, whatever the age,” said Prof S Saleem Khan, head department of community medicine at GMC Srinagar. Experts believe it would take many departments and the society as a whole to come forward in order to discourage younger generation from becoming addicted to smoking. Director health services Kashmir, Dr Saleem ur Rehman, whose department has the mandate of generating awareness about smoking said that it was not just government’s job to create awareness about health hazards due to smoking. “It would take a lot of dedication from all stakeholders to ensure that anti-tobacco laws are not flouted. But unfortunately, not much is being done in this direction,” he said. Till Kashmir wakes up to these issues, the new pictorial warnings on the cigarette packets may not yield much results.