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Pulmonary & Critical Care Bulletin
Vol. VII, No. 3, July 15, 2001
In this issue :
From Editor's Desk
Tobacco Control - Problems & Strategies
Smoking is an addiction rather than a harmless `habit'. Nicotine, the chief component of tobacco has all the characteristics of an addictive substance similar to other agents such as alcohol, marijuana and opium. These are : 1, Immediate pharmacologic reward (the `Kick)'; 2, Rapidly increasing tolerance to this effect (provokes increasing consumption over time); 3, Definite-withdrawal symptoms on leaving and thus having a strong tendency to reuse. Over the last 20 -30 years, different approaches have evolved for control of tobacco consumption: (i) Group or clinic based programmes usually with an education and / or behavioural modification approach; (ii), Individual treatment, which might include psychotherapy, behavioural modification or hypnosis; (iii), Information dissemination by mass media; (iv), Drugs which help or reduce the withdrawal symptom; and (v), Self help.
Broadly, tobacco control has several aspects such as socio - behavioural, economic, medical and political. On socio - behavioural front, every effort should be made to decrease the social acceptability of smoking at home, at work places or at social gatherings. This requires a concerted effort by each member of society aided by the governmental policies and laws. Happily, some welcome steps have been taken up by several state governments in enacting laws to ban smoking in enclosed public areas such as cinemas, buses, educational institutions and hospitals etc. Indian Airlines currently does not allow smoking on all its domestic flights. Any advertisement on tobacco is banned on All India Radio and Door Darshan. More educational programmes, specially focussed on the target young non user population, are required through a patient, extensive and persuasive compaign. The mass media, voluntary agencies, women's organizations, educational and religious bodies can play important role in this matter.
Tobacco plays as important part in our economy and has several positive as well as negative aspects. In 1987, 75240 million cigarttes were produced. Bidi industry outweighs the organized sector cigarette manufacturing with estimated bidi production around 7-8 times that of cigarettes. Tobacco earned whopping Rs. 15515 million in revenue to Government and also Rs. 1711 million in foreign exchange as exports in 1986-87. Tobacco production is a major industry in India with estimated gross product value of approx. Rs. 3600 crores (US $ 2117 million). There are around 20 factories manufacturing cigarettes (Source : Directorate of tobacco development, Ministry of Agriculture: Tobacco in India, In: A handbook of Statistics, Govt. of India, Madras, 1989).
While the gains are clear in terms of employment generation and revenue collection, the losses in terms of costs incurred in providing health care to people having tobacco related diseases, and loss of productivity caused by disease and death related to cancers is enormous. Use of wood in tobacco curing also has implications in the form of environmental degradation. It has been estimated that the costs of providing health care, setting up diagnostic and therapeutic facilities far outweigh the apparent economic benefits from tobacco industry.
Besides the above mentioned socio- economic aspects of tobacco control, another important factor in tobacco control is helping the individual smoker to quit smoking. Once appropriately motivated by socio - behavioural interventions, a smoker needs extra help to come out of this addiction. Nicotine has definite withdrawal symptoms varying from smoker to smoker, such as bradycardia, irritability, anxiety, lack of concentration and mood abnormalities, increase in appetite, weight gain and insomnia. The `craving' for nicotine is the most common cause of failure of smoking cessation. Most of these symptoms would subside in about 2 week's time, should a person continue to refrain from smoking again.
Some other forms of medical aids in smoking cessation programmes are also available.
1. Smoking deterrents : These substances produce an unpleasant taste in mouth in conjunction with tobacco. Silver acetate is one such established substance available in a chewing gum form in the West.
2. Nicotine substitutes : Nicotine chewing gums and intra dermal implants are available to help relieve the withdrawal symptoms. They are probably less harmful as they are devoid of other toxic components of tobacco smoke.
3. Several other drugs have been used to reverse the withdrawal symptoms, but all of them have limited roles. It is well said that reducing withdrawal symptoms does not necessarily imply a successful smoking cessation; a smoker may continue to smoke because he gets rewarding effects from smoking and not because he experiences withdrawal symptoms after stopping.
Lastly, a strong administration and political will is required to effectively control the tobacco-use. One must recognize and be convinced of the magnitude of tobacco related problems. Moreover, the non smokers' rights have to be protected in face of now established harmful effects of "Passive Smoking",
Dr. Dheeraj Gupta, MD, DM, FCCP
Dr. Dheeraj Gupta
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