This year’s NoTobacco Day is fundamentally important for Kashmir. Pertinently, because thisyear’s theme “Tobacco and lung health”resonates well with the rise of lung cancer in valley. A study conducted bySKIMS In 2017-18 concluded that at least 507 new cases of lung cancer wereregistered, claiming to be highest among other forms of cancer prevalent in thevalley.
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℅ofmen and 40.7%of women who tried to use tobacco in any form during the past 12months and this unhealthy trend is scary given the precarious rise of womentobacco users in any form is on rise in state. The involvement of women in useof tobacco is not only shocking but an alarming predicament that is detrimentalto society at large and lack of gender based tobacco control policies have madeit a silent misery that has gone unnoticed and has been ignored by healthagencies.
Another literature study concluded that the causalrelationship between lung cancer and tobacco smoking concerning cigarette andin Kashmir valley hookah smoking widely prevalent in rural Kashmir has beennoted as commonest form of smoking amongst lung cancer (Altaf et al, TID,2018).
With More than hundreds of deaths from tobacco use everyyear, a figure that is predicted to grow yearly without intensified action. TOBACCO is acting as a living Frankensteinthat has existed now over the years that has vehemently deteriorated all fabrics of human society. The use andconsumption of tobacco in any consumable form is detrimental to every fractionof human dwelling.
Tobacco usage in form of Smoking is most apparent human selfinfuriating practice that has left more deaths than any other knowncatastrophe. Tobacco use costs national economies enormously through increasedhealth-care costs and decreased productivity,besides causing emotional andphysical dependence, mental and health deterioration and finally death orsomething 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 faroutstrips the national monthly expenditure averages. While nationally, smokersaged 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 tobaccoforms
Also People especially parents are wrongfully assuming that youngergenerations are not smoking cigarettes anymore because of the recent popularityof vaping or e cigarettes which is still under consideration of High courtscrutiny.surprisingly cigarette smokingin 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 insome way, whether it be cigarettes, chewing tobacco or cigars.
The problem starts with social smoking. Although studentsmay not be smoking every single day, succumbing to peer pressure enforces a badhabit and exposes them to an addictive substance.
Even though Jammu and Kashmir government has banned sale ofloose cigarettes, ‘beedis’ and tobacco in the state with immediate effect in abid to discourage consumption of tobacco products especially among the youths.
The decision has been taken under section seven of theCigarettes and Other Tobacco Products (Prohibition of Advertisement andRegulation of Trade and Commerce, Production, Supply and Distribution) Act,2003
The DM Srinagar recently constituted committee forimplementation of COPTA after expressing anquish over staggering amount of 131crore being spent on tobacco consumption in Srinagar ,highest among any otherdistrict of state.
This positive development however shall also evoke a sense of urgency, adequaterobust implementation and cross check the social awareness that many agenciesclaim 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 toquit smoking is underlined below.
5 A’s ofintervention
1.ASKING – Askingpatient to describe their smoking status that will enable to check his level ofsmoking dependence.in our valley
2. ADVISE then Provide him clear,strong advice to quit withpersonalized messages about the impact of smoking on health; urge every tobaccouser to quit.
3.ASSESS – Assess his willingness to make a quit attemptwithin 30 days. • Access his willingness to make a quit attempt in the next14-40 days and offer medications accordingly.
4. ASSIST – Recommend Him use of approved pharmacotherapy.weas dental surgeons would prescribe NRT NICOTINE REPLACEMENT THERAPY for patientsto give up smoking dependence. But it is to be done Under your professionalguidance to prevent dependence on drugs.
5.ARRANGE – arrange future engagements with the patients andreinforce these above steps to help him quit smoking.
5 Rs’ of motivation
1. RELEVANCE: Makingpatient to know about how quitting may be personally relevant viz . Longer andbetter quality of life • People you live with will be healthier • Extra money • Decrease chance of heartattack, 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 perceivedbenefits/rewards for quitting tobacco use. •
4.ROADBLOCKS: Helpingpatient to know about perceived roadblocks to quitting. •
Withdrawal symptoms: • weight gain, • depression ,• fear of failure, • lack of support fromfamily, • 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 concludesas cancer of oral cavity.
Why Tobacco Cessation?
Both smokers and smokeless tobacco users have substantialbenefits from cessation. Smokers who quit before 50 years of age reduce theirrisk of dying in the next 15 years to half that of a continuing smoker. Eventhose who quit at 60 years of age reduce their risk of dying by 10% comparedwith regular smokers. Smoking cessation is known to produce an immediatedecline in the blood carbon monoxide levels, normalization of pulse rate, bloodpressure, and restoration of sense of taste and smell. Cessation of smokelesstobacco use is associated with reduced risks of oral cancer and precancerouslesions, cardiovascular diseases, and dental problems.
In JK state as per GATS records current cigarette smokerswho 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 withtheir lives while smoking tobacco there is little time to fend for miseries andcomprehend this dreadful trail
So a lot of positive response and follow up programme needto be organised to make the policiessuccessful. It needs to be collective social effort ,engaging actively allwalks of life and take on this ragingbull by its horns.
Dr Tahir Ahmad is Oral and maxillofacial surgeon