Say NO to Tobacco

This year’s  No Tobacco Day is fundamentally important for Kashmir. Pertinently, because this year’s  theme “Tobacco and lung health” resonates well with the rise of lung cancer in valley. A study conducted by SKIMS In 2017-18 concluded that at least 507 new cases of lung cancer were registered, claiming to be highest among other forms of cancer prevalent in the valley.

Cancer of any organ is evil, nefarious and pitiless predisposition to miseries. Total sufferings per year from this dreadful disease is beyond human contemplation. Unusual to say that the time one takes to consume a cigarette is equivalent and proportional to the whimpering pain that one takes in fighting this disease for rest of their lives.

Startling figures on kashmir

As per NFHS part 4, Kashmir witnessed a increase of 39.5℅of men and 40.7%of women who tried to use tobacco in any form during the past 12 months and this unhealthy trend is scary given the precarious rise of women tobacco users in any form is on rise in state. The involvement of women in use of tobacco is not only shocking but an alarming predicament that is detrimental to society at large and lack of gender based tobacco control policies have made it a silent misery that has gone unnoticed and has been ignored by health agencies.

Another literature study concluded that the causal relationship between lung cancer and tobacco smoking concerning cigarette and in Kashmir valley hookah smoking widely prevalent in rural Kashmir has been noted as commonest form of smoking amongst lung cancer (Altaf et al, TID, 2018).

With More than hundreds of deaths from tobacco use every year, a figure that is predicted to grow yearly  without intensified action. TOBACCO is acting as a living Frankenstein that has existed now over the years that has vehemently deteriorated  all fabrics of human society. The use and consumption of tobacco in any consumable form is detrimental to every fraction of human dwelling.

Tobacco usage in form of Smoking is most apparent human self infuriating practice that has left more deaths than any other known catastrophe. Tobacco use costs national economies enormously through increased health-care costs and decreased productivity,besides causing emotional and physical dependence, mental and health deterioration and finally death or something that will cripple you for rest of life (cancer).

With Global Adult Tobacco Survey, (GATS) figures  that J&K’s  monthly spending on smoking tobacco as far outstrips the national monthly expenditure averages. While nationally, smokers aged 15 and above spend Rs 399.20 a month on cigarettes and Rs 93.40 on bidis, those in J-K spend Rs 513.60 and Rs 134.20, respectively, on these tobacco forms

Also People especially parents  are wrongfully assuming that younger generations are not smoking cigarettes anymore because of the recent popularity of vaping or e cigarettes which is still under consideration of High court scrutiny.surprisingly  cigarette smoking in college students has picked more pace and is  extremely prevalent among college students of our state.

One-third of college-aged students use tobacco products in some way, whether it be cigarettes, chewing tobacco or cigars.

The problem starts with social smoking. Although students may not be smoking every single day, succumbing to peer pressure enforces a bad habit and exposes them to an addictive substance.

Even though Jammu and Kashmir government has banned sale of loose cigarettes, ‘beedis’ and tobacco in the state with immediate effect in a bid to discourage consumption of tobacco products especially among the youths.

The decision has been taken under section seven of the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003

The DM Srinagar recently constituted committee for implementation of COPTA after expressing anquish over staggering amount of 131 crore being spent on tobacco consumption in Srinagar ,highest among any other district of state.

This positive development however  shall also evoke a sense of urgency, adequate robust implementation and cross check the social awareness that many agencies claim to be working on,besides being hall of shame for developing smart city.

As maxillofacial  practioner the procedure and the method advised for smoker’s who want to quit smoking is underlined below.

5  A’s of intervention                                                                                                                                           

1.ASKING  – Asking patient to describe their smoking status that will enable to check his level of smoking our valley                                                                                                                                                               

2. ADVISE then Provide him clear,strong advice to quit with personalized messages about the impact of smoking on health; urge every tobacco user to quit.                                                                                                          

3.ASSESS – Assess his willingness to make a quit attempt within 30 days. • Access his willingness to make a quit attempt in the next 14-40 days and offer medications accordingly.                                                                       

4. ASSIST – Recommend Him use of approved pharmacotherapy.we as dental surgeons would prescribe NRT NICOTINE REPLACEMENT THERAPY for patients to give up smoking dependence. But it is to be done Under your professional guidance to prevent dependence on drugs.                                                                                    

5.ARRANGE – arrange future engagements with the patients and reinforce these above steps to help him quit smoking.                                                                                                                                                                                   

5 Rs’ of motivation                                                                                         

 1. RELEVANCE: Making patient to know about how quitting may be personally relevant viz . Longer and better quality of life • People you live with will be healthier •  Extra money • Decrease chance of heart attack, stroke or cancer • If pregnant, improves chance of healthy baby.                                                           

2.RISKS: short term health risks like (Acute breathing, problems asthma, risks in premature pregnancy oral diseases ) • Long-term (heart, lungs, oral cancers)                                                                                        

3. REWARDS: Making patient to know about perceived benefits/rewards for quitting tobacco use. •                                                                                                                                                         

4.ROADBLOCKS:  Helping patient to know about perceived roadblocks to quitting. •

Withdrawal symptoms: • weight gain, • depression ,•  fear of failure, • lack of support from family, • enjoyment of tobacco from peers                                                                                                                                                                            

5. REPETITION: Respectfully repeat 5 R’s each visit, providing motivation and information.

Besides getting routinely checked for any developing ulcer ,or growth in any part of oral cavity which if ignored persists and concludes as cancer of oral cavity.

Why Tobacco Cessation?

Both smokers and smokeless tobacco users have substantial benefits from cessation. Smokers who quit before 50 years of age reduce their risk of dying in the next 15 years to half that of a continuing smoker. Even those who quit at 60 years of age reduce their risk of dying by 10% compared with regular smokers. Smoking cessation is known to produce an immediate decline in the blood carbon monoxide levels, normalization of pulse rate, blood pressure, and restoration of sense of taste and smell. Cessation of smokeless tobacco use is associated with reduced risks of oral cancer and precancerous lesions, cardiovascular diseases, and dental problems.

In JK state as per GATS records current cigarette smokers who thought about quitting because of warning label on cigarette packet  is 55.4% higher than previous record of  33.7%

After one finds little things that have gone wrong with their lives while smoking tobacco there is little time to fend for miseries and comprehend this dreadful trail

So a lot of positive response and follow up programme need to be organised  to make the policies successful. It needs to be collective social effort ,engaging actively all walks of life and take on  this raging bull by its horns.

Dr Tahir Ahmad is Oral and maxillofacial surgeon