COLUMN | The great harm: Tobacco use by Adolescents

COLUMN | The great harm: Tobacco use by Adolescents

Hrishikesh Sarma | February 09, 2019 13:59 hrs

Adolescents are the most vulnerable population to initiate tobacco use. It is now well established that most of the adult users of tobacco start tobacco use in childhood or adolescence. There has been a perceptible fall in smoking in the developed countries after realization of the harmful effects of tobacco. The tobacco companies are now aggressively targeting their advertising strategies in developing countries like India. Adolescents often get attracted to tobacco products because of such propaganda. There has been a rapid increase in trade and use of smokeless tobacco products in recent years in the country, which is a matter of serious concern to the health planners. It is important to understand various factors that influence and encourage young teenagers to start smoking or to use other tobacco products. The age at first use of tobacco has been reduced considerably. However, law enforcing agencies have also taken some punitive measures in recent years to curtail the use of tobacco products.

Tobacco use in children and adolescents is reaching pandemic levels. The World Bank has reported that nearly 82,000 - 99,000 children and adolescents all over the world begin smoking every day. About half of them would continue to smoke to adulthood and half of the adult smokers are expected to die prematurely due to smoking related diseases. If current smoking trends continue, tobacco will kill nearly 250 million of today’s children. India is the second most populous country in the world. It is a secular country but the Hindus form the majority. Hinduism traditionally advocates abstinence from all intoxicants. Even then, India is the third largest producer and consumer of tobacco in the world. The country has a long history of tobacco use. Tobacco is used in a variety of ways in India; its use has unfortunately been well recognized among adolescents. Tobacco addiction of a large number of adults has been initiated during the adolescence.

India has a distinct tradition of enforcements against tobacco use being initiated by the past kings (like Jahangir) and the religious leaders at different times in the history. The great Indian Sikh Guru Gobind Singh prohibited smoking for the members of the Sikh community. He said, “Wine is bad, Indian hemp (bhang) destroys one generation, but tobacco destroys all generations.” Tobacco use has been considered a religious taboo by the Sikhs since then. However, despite historical attempts to legally ban tobacco, its use has continued to grow in popularity as a non-productive pastime.

In modern medicine, its harmful effects have been recognized over the last 4 decades. Although its use has declined in developed nations in the recent years, it continues to be popular in developing countries.

Beedi, Hooka, Hookli, Chutta, Dhumti and Chillum are some of the smoking tobacco. Tobacco is used in a number of smokeless forms in India, which include betel quid chewing, mishri, khaini, gutka, snuff, and as an ingredient of paan masala.

Adolescents and children are the prime targets of the tobacco industry when adding new smokers. About 20 million children of ages 10-14 are estimated to be tobacco-addicted according to a survey done by the National Sample Survey Organization of the Indian government. To this astounding figure, about 5,500 new users are added every day, making two million new users every year. Adolescents typically become addicted to nicotine while still being teenagers. The usual interval between the first cigarette consumption and daily smoking is 1-2 year(s). More than half of the adolescent smokers try to quit smoking every year with fewer than 20% being able to quit for a month. The majority of adolescent smokers report withdrawal symptoms when they try to quit. During the last three decades, a number of epidemiological surveys have been conducted in different parts of India to study the prevalence of tobacco use by adolescents. The study populations have included school and college students, medical students and street children.

The prevalence of smoking has been found to vary from 6.9 to 22.5% among the male school and college students. Among the girls, the prevalence is considerably lower varying from 0-2.3%. In fact, tobacco use, especially smoking, is a relatively new habit among the female students, noticed only during the last 10-15 years. The prevalence figures vary according to the criteria used to define tobacco use habits. More than 40% of children have started the habit between 10-15 years of age. There was no rural-urban difference. Being of male gender, having an age above 15, smoking by a close relative (father, mother, sister/brother) or friends were significantly associated with smoking by the adolescent children. Both the smokers and non-smokers were well aware of the adverse health effects of smoking indicating that mere provision of information on hazards of smoking may not be enough to reduce the prevalence of smoking. The girls had a very low (1.1%) prevalence of tobacco use. Most boys who were using tobacco were smokers (86%).

India has probably the largest population of street children in the world. The metropolitan cities like Delhi, Mumbai, Kolkata and Bangalore have each around 100,000 of street children. The majority of them maintain tenuous ties with their families, but many have no families at all, having an extremely stressful life. Drugs of abuse give these kids excitement and relief from the all-pervasive gloom of street life and serve to suppress hunger and helplessness. Tobacco-based products stimulating the CNS to improve alertness are used by these children to get relief from insomnia due to long working hours. The usual pattern of drug abuse by male and female kids of ages 5 to 10 is through chewing tobacco (gutka and khaini) mixed with other drugs as adulterants, followed by beedis and cigarettes. Older children of ages 15-16 use nicotine along with other hard drugs.

Advertisements of various tobacco products are very common in all forms of media including the print media, television and the roadside hoardings and banners. Tobacco advertising and promotion effectively target the young people with images of smokers as trendy, sporty and successful. Characters in the movies or television serials often demonstrate cigarette smoking as a routine of daily life. They sometimes even show cigarette lighting ways using different tricks. These scenes often attract the impressionable mind of the adolescent to use similar tricks or adopt similar behaviour. For a child or an adolescent growing in a stressful home, television show and movies are a means of finding out what a normal life is about. He or she is likely to begin smoking after watching such visuals.

Humans have used tobacco in many forms for several centuries. Its use often starts early in life. In recent years, there has been a rising trend in tobacco use, more in smokeless forms in India. It has been observed that a large number of adolescents pick up this habit from their family members or the peers. Advertisements of tobacco products and promotional campaigns by the manufacturers also play an important role in initiation of the habit by adolescents. This has attracted the attention of health professionals, media and law enforcement agencies. The local governments are also taking steps in putting curbs over the sales of tobacco products to children, and in regulating tobacco advertisements.

So, regarding this problem parents should be very conscious on their children and for this problem our government should take serious steps against it.

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