What begins as a gratification of innocent curiosity or an act of revolt usually ends in death or disability! Yet you always inevitably assume that indulging in tobacco usage of any form will affect the other person and 'not you'! And if you were thinking that you are safe because you did not smoke, think again. The person next to you – he may be your father, brother, friend or a complete stranger – causes as much harm by smoking in your presence. Studies carried out by leading organisations around the world in the healthcare sector say that globally tobacco-attributable causes of death was 100 million in the 20th century. Unchecked, the toll will rise up to one billion in the 21st century. Tobacco kills nearly 6 million people each year, out of which more than 5 million are users or ex-users and more than 600,000 are non-smokers exposed to second-hand smoke. What is more saddening is the fact that in 2004, children accounted for 28% of the deaths attributable to second-hand smoke. And there is more to add to the story. Ecologically tobacco cultivation heavily contributes in deforestation, depletion of soil nutrients and destruction of indigenous flora and fauna. It is believed that meteors were responsible for wiping out entire life species like dinosaurs from the face of the earth some millennia ago. If stories of the impending Judgment Day are to be believed, we won't need a shooting star – tobacco is enough to make us extinct!
Statistics suggest that globally more than 40% children have at least one smoking parent. Also, unless urgent action is taken, the annual death toll for tobacco-attributable causes could rise from 6 million to more than 8 million by 2030. Estimates suggest nearly 80% of the world's 1 billion smokers live in developing and under-developed countries. Apropos of that and based on current trends and estimates, the World Health Organisation (WHO) has predicted that India will have the fastest rate of rise in deaths attributable to tobacco in the first two decades of the 21st century. Statistics throughout the world are an overwhelming pointer to the power of ignorance and human stupidity. Studies reveal that there are more than 4000 chemicals in tobacco smoke, of which 250 are known to be harmful and more than 50 are known to cause cancer. Yet we choose to remain blind and indifferent to the tragic predicament. Thousands of scientific investigations have also confirmed the association of smoking with various other diseases, and have provided additional evidence implicating cigarette smoking as a cause of coronary artery disease, stroke, obstructive airway disease, peripheral vascular disease, pregnancy complications including intra-uterine growth retardation and a variety of neoplasms including cancers of oral cavity, larynx, oesophagus, urinary bladder, kidney, stomach, pancreas, cervix and more recently of haematopoietic system. Incidentally, tobacco is also harmful without being smoked or chewed. Green Tobacco Sickness (GTS), an acute form of nicotine toxicity that results from absorption of nicotine through the skin ails workers engaged in tobacco cultivation.
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Turning the focus back to India, the prevalence of tobacco smoking has been reported to be high among men (exceeding 50%) from almost all parts of India. The incidence is high in rural areas as compared to the urban areas. Amongst women, the use of smokeless tobacco has been reported to be more prevalent across India with figures varying from 15% to 60%. Percentage of school- going children aged 13-15, using any tobacco product vary from 3.3% in Goa to 62.8% in Nagaland. Consequently, the cost of tobacco-attributable burden of just three groups of diseases – cancer, heart disease and lung disease has increased from Rs. 277.611 billion (US$ 6.5 billion) in 1999 to Rs. 308.33 billion (US$ 7.2 billion) in 2002-2003. Cohort studies from rural India suggest that the relative risk of death is 40% to 80% higher for tobacco use of any type. The relative risk of dying was more than 50% higher for smokers and 15% higher for smokeless tobacco users, as reveled by a cohort study in Mumbai. Whereas in Chennai, a case-control study found that the relative risk of dying for smokers was slightly higher than two-fold. Overall, smoking currently causes more than 700,000 deaths per year in India.
With greater awareness of the dangers posed by the tobacco spread, nations across the world have resolved to fight the war against the tobacco threat by forming campaign strategies and comprehensive plans. Governments are legislating laws prohibiting the use of tobacco and NGOs and other independent organisations are executing awareness campaigns. But in spite of all that, the onus lies with us as individuals to be more conscious of the serious nature of the threat posed by tobacco. The prerogative for preventing an untimely death – whether it concerns us directly or indirectly – through regular checkups and timely remedial measures also rests with us. And it is for the future only to tell whether we will remain blind and perish or wake-up and make the right choice and take the right decision. Until then …