NUR3101 S2 2019: Prevalence of Smoking Tobacco Use in India

This report analyzes the prevalence of smoking and tobacco use in India, highlighting its significant public health burden. It examines the various forms of tobacco consumption, including cigarettes, beedis, and smokeless tobacco, and presents statistical data from the Global Adult Tobacco Survey (GATS). The report delves into the social determinants of health, such as income, occupation, and education, and their impact on tobacco use, particularly among low-income communities. It discusses the National Tobacco Control Program (NTCP) implemented by the Indian government, outlining its objectives, implementation strategies, and the roles of different levels of government and healthcare professionals. Furthermore, the report emphasizes the role of nurses in addressing tobacco use through awareness campaigns, cessation programs, and culturally competent approaches. It also explores the impact of tobacco use on health outcomes, including cancers, cardiovascular diseases, and respiratory illnesses, as well as the importance of epidemiological studies and interventions to combat this public health challenge. The report stresses the need for ongoing efforts to reduce tobacco use and improve public health in India.

Prevalence of Smoking Tobacco Use in India
The intake of tobacco in India is practised in different forms. Some include cigarette and beedis
(dried tobacco leaves wrapped using a paper) smoking. They also consume smokeless tobacco
which comprises of chewing pan (a combination of lime, portions of areca nut, and other flavors
enfolded using some leaves) among others. The highest number of global tobacco users are from
India both in number and relative share. It is one among the few global nations with a high
incidence of various forms of tobacco usage. The Global Adult Tobacco Survey (GATS) (2017)
28.6% of the Indian population are tobacco smokers of any form with smoke accounting for
10.7% and SLT (21.4%), Khaini 11%, and beedis at 8% (Singh, & Ladusingh, 2014). This high
burden of tobacco use has been linked to a high death rate. As a result, the Indian Government
launched the National Tobacco Control Program (NTCP)
National Tobacco Control Program (NTCP)
The aim of initiating NTCP by the Indian government is to safeguard its citizens; young and old
from the harmful health, social and ecological effects of tobacco use and exposure. NTCP
achieves this goal by creating greater awareness regarding the devastating consequences of the
use of tobacco and regarding the laws regulating tobacco and their actualization. NTCP is
responsible for implementing COTPA 2003, offering training on the tobacco prevention
strategies, designing school programs on tobacco cessation among others. The entity has
partnered with a world health organization, public health foundation among other volunteers
The major areas of implementation of NTCP include:
 Training of health and social workers, non-governmental organizations, school tutors,
and enforcement officers.
 Offering information, awareness, and communication events
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 Institutional programmes
 Regulation of tobacco control laws
 Planning with Panchayati Raj Institutes for activities in remote areas
 Establishing and promoting cessation centers in addition to offering pharmacological
treatment centers at different levels.
The programme is actualized in three phases namely central level, state level and district level.
Overall, NTCP is under implantation in 36 states with over 600 districts distributed across the
nation.
i. Central Level
The National Tobacco Control cell (NTCC) is implemented at the district level and it oversees
the general formulation of policy, organization, coordination, overseeing and assessment of the
varying activities as prescribed in the NTCP.
ii. State Level
The State Tobacco Control Cell (STCC) is implemented at the state level with activities such as
seminars on State Level Advocacy, offering training services to the trainers of DTCC, refresher
training to employees, training on ceasing of tobacco use among healthcare providers
iii. District level
District Tobacco Control Cell (DTCC) is implemented at the district level with the responsibility
of implementation and overseeing of tobacco control efforts. Trainings on various stakeholders,
oversight role on tobacco control laws etc (National Tobacco Control Programme (NTCP, n.d.).
The use of tobacco in whatever form affects the quality of health of both the smokers and the
non-smokers exposed to the smoke. Epidemiological studies on the social determinants of health
have cited multiple determinants that affect smoking or tobacco use. The specific social
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determinants of health that affect smoking or tobacco use in the context of India include income,
occupation, social class and gender.
Rampant tobacco use and smoking has been reported among those from the lower-income
category. According to Palipudi et al. (2012), poor households which are characterized by low
income have a high occurrence of tobacco use because of the negative correlation between
poverty and influence regarding policy formulation, thus leaving the virtually ignored. Lower-
income is also associated with illiteracy or lack of education. Studies have examined the
association between education and smoking found that the habit was more prevalent among
those with lower education. The study by Bhawna (2013) on the impact of tobacco consumption
in India found out that the retired and unemployed were the most common users of tobacco
(46.8%) compared with the employed. Thakur et al. (2013) also found out that the low
socioeconomic status Indians were 1.6 times higher to smoke compared to the wealthy class.
Education and income have been found to influence smoking because of the higher the education
the higher the chances of being employed and securing higher income and better health services
in the lifetime. Moreover, high literacy levels increase accessibility to information on healthy
practices and thus enabling one to avoid unharmful health practices such as smoking (Palipudi et
al., 2012).
The control of tobacco uses and smoking have been perceived to be a social justice issue due to
its rather high prevalence among the low socioeconomic communities. Tobacco control
programs are often focused on the high economic class and yet the marketing promotions on the
use of tobacco are usually exposed to an equal measure to both high and low economic classes.
Some of the social injustice practices used by the tobacco-producing companies in their
marketing include the production of poor brands for low socioeconomic community and
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marketing luxury images to the most vulnerable. Additionally, the companies offer discounts at
the point of sale to individuals from low socioeconomic status (Greaves, 2015).
Tobacco smoking and use in India is ranked second on a global scale. The population of India
stands at approximately 300 million according to the 2017 report of UNDP. 28.6% of the Indian
population use tobacco in different forms, 21.4% chew it, 10.7% smoke. The consumption of
tobacco in any form increases by 2% annually (Mohan, Lando, & Panneer, 2018).
Approximately 6.2 cigarettes are smoked each day. India is both a high- and low-income
country, and tobacco use and smoking are highly prevalent among those of the lower
socioeconomic class. Several determinants have been attributed to increasing tobacco use and
smoking in India.
According to Pawar et al. (2014), 14% of the population smoked tobacco and approximately
6.2% of cigarettes are smoked by Indians each day. The beedis form of smoking is used by the
largest proportion more so among the lower socioeconomic group which is ten times more than
cigarette smoking. Such rampant use of tobacco has been linked to a high death rate. According
to the World Health Organization (2013), approximately six million people succumb due to the
smoking of tobacco, and it is predicted to increase to eight million people annually by 2030.
Most of the premature deaths in India are attributed to smoking with the working class of 15-59
years being affected the most. The high Smoking/tobacco use incidence in India necessitates the
need for more studies to help determine the aetiology and epidemiology of the public health
problem and the potential role of registered nurses in addressing the issue.
The study conducted by Singh and Ladusingh (2014) on the intake of tobacco found out that the
least educated, low socioeconomic status, listed tribes and castes were the highest consumers of
any form of tobacco. The nexus between poverty, less education and tobacco use and smoking
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have been attributed to ignorance on the negative health effects of using tobacco and the fact that
they are likely to find themselves in circumstances that increase the risk of them being initiated
behaviours that are devastating to their health (Thakur, Prinja, Bhatnagar, Rana, Sinha, & Singh,
2013). The rather high consumption of tobacco among the low socioeconomic class in India is
aggravated by the existing social inequalities and injustice. Any attempt to stop quit smoking
among the poor is likely to be unsuccessful because of minimal community and government
support, limited motivation, psychological issues like lack of self-efficacy and constant
marketing promotion (Thakur et al., 2013). Research has also clearly shown that active smoking
affects the reproductive system and may lead to barrenness in women or impotence in men.
Epidemiological studies have attributed the use of tobacco to almost 50% and 25% of all cancers
in men and women respectively (Shah, Dave, Shah, Mehta, & Dave, 2018). Moreover, tobacco
smoking is a predisposing factor for cardiovascular disorders and acute pulmonary diseases.
Tobacco chewing is also primary cause of oral cancer in India (Mohan et al., 2018). The
mortality rate caused by tobacco is likely to be over 1.5 million yearly by 2020 (Bhawna, 2013).
Nurses a significant role in the control of tobacco use in India by promoting healthy lifestyles.
Reports have documented evidence of increasing tobacco dependence and chronic diseases thus
necessitating the need for continuous evaluation and a circle of intervention. Nurses can be
effective in such scenarios by offering advice on the consequences of smoking and the urge to
cease smoking. Studies have shown that advice from healthcare experts such as nurses improves
the cessation rate among their patients (Varghese et al., 2012)
Nurses can also offer to educate tobacco addicts on the effects of tobacco use and exposure on
health and also respond to their questions. Nurses can also raise awareness regarding the long-
term and short-term benefits of stopping tobacco use at an earlier age. A community-based mass
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approach was found to be effective in controlling and ceasing tobacco smoking in India (Mishra
et al., 2014). The National Tobacco Program in India utilizes nurses to facilitate its
implementation and create greater awareness of the hazardous effects of tobacco smoking.
Nurses are responsible for creating awareness at hospital and community level.
Additionally, they can also offer tobacco dependence treatments such as Nicotine Replacement
therapy which aims at addressing nicotine withdrawal symptoms and minimize the desire of the
smoker to go back to smoke. In the study by Varghese et al. (2012) on tobacco cessation in India,
2362 tobacco smokers were administered with nicotine replacement therapy by nurses and over
50% ceased smoking and never went back
Cultural competence approaches to the prevention of drug abuse are interventions that seek to
involve the community members in fighting drug abuse and increase the capacity of the local
community in being involved in prevention activities. This approach is much more effective
because it first considers the community profile such as beliefs, cultural practices, age, gender
and other factors that may influence the rate of tobacco use. Then the approach is tailored to
address the predisposing factors (Palmer et al., 2013). For instance, some communities in India
associate tobacco smoking with their religious practices and therefore any intervention aimed at
tobacco cessation is received with a lot of resistance (Bhagyalaxmi, Atul, & Shikha, 2013). The
elements of a cultural competence approach include community involvement coalitions and the
use of nurses from that particular community or lay health advisors. One of the major
contributors to such an approach is building the capacity of local organizations to establish
culturally tailored tobacco prevention programs. The approach also involves the community
members in the program to effectively contest the promotional methods of the tobacco industry,
increase community awareness of the devastating effects of tobacco use, and offer innovative
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solutions to the households and society suffering from the disorders brought about by the use of
tobacco.
Nurses also can play significant roles in promoting cessation of tobacco use through a culturally
competent approach by promoting access to healthcare services. This can be carried out by
recruiting different and culturally competent nurses i.e. from different caste systems or
socioeconomic status. This approach is likely to eliminate any patient perception of the use of
tobacco in the community. Additionally, the mingling of people from different social-economic
statuses will remove any wrong perception about the prevalence of tobacco use in the
community.
The high prevalence of tobacco uses and smoking in India is attributable to the poor health status
of the country especially among those from low socioeconomic status. This high prevalence in
India is attributable to different social determinants of health such as low socioeconomic status,
poverty and literacy levels. It is the major cause of cardiovascular disease, respiratory diseases
and all cancers. Despite the existence of multiple interventions for the prevention and control of
tobacco use in India, there is still no significant change in the use of the drug. However, nurses
play critical roles in the prevention and control of tobacco use in India including the creation of
awareness, offering advisory role, offering preventive and cessation therapies among others.
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References
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