“Main zindagi ka saath nibhata chala gaya, har fikr ko dhue mein udata chala gaya…” sang Dev Anand in the movie Hum Dono , while Zeenat Aman and her friends crooned “Dum maro dum, mit jaye ghum…” in Hare Rama Hare Krishna , leaving the audience swaying in ecstasy. The smug look on Dev Anand's face conveyed that he could rid himself of all fikr (worries) by just blowing smoke rings in the air. In the Chikni chameli song from Agneepath , a small bottle of country liquor dangles from Katrina Kaif's slender waist as she sings “…beedi chillum jalaane aayee...”

A study of about 4,000 students from 12 schools across New Delhi conducted by non-profit organisation Health Related Information Dissemination Amongst Youth (HRIDAY) suggests that adolescents exposed to tobacco use in Bollywood films are more likely to become tobacco users. The study's lead author, Dr Monika Arora, head of Health Promotion and Tobacco Control and Adjunct Assistant Professor at the Public Health Foundation of India (PHFI), says the odds of ‘ever tobacco use' (using once or more in a lifetime) among students exposed to images of tobacco use in Bollywood films were found to be more than double compared to those with little exposure. She underscored the need for strengthening rules prohibiting images of smoking and tobacco use in Indian films.

HRIDAY sent actor Shah Rukh Khan a nicotine replacement therapy kit and tips to quit smoking after he announced he would give up cigarettes after the release of his film Don 2 . However, he was subsequently seen smoking during an IPL cricket match at a Jaipur stadium.

There are other actors, however, who have successfully kicked the habit. Hrithik Roshan has said he stopped smoking after reading Allen Carr's book The Easy Way to Quit Smoking . Carr, the deceased smoker from the UK, became an anti-smoking expert with his Easyway method of quitting, and Hollywood actors such as Anthony Hopkins and Ashton Kutcher have endorsed his books. HRIDAY commended actor Aamir Khan for his efforts to address the influence of tobacco use in movies. Meanwhile, Bollywood continues to smoke on screen.

Harm in every puff

Smoking has long been associated with the incidence of lung cancer, heart disease and compulsive obstructive pulmonary disorder, but new research also points to many other maladies including cancer of the urinary bladder, prostate, oral cavity and stomach. Women smokers are prone to breast and cervical cancer, and scientific evidence shows smoking aggravates asthma and could cause eye diseases, fertility problems, peptic ulcers and impotence.

A growing number of women and children are exposed to environmental tobacco smoke (ETS) at home. The risk of sudden infant death syndrome, asthma and ear infections is higher among children exposed to ETS compared to those who live in smoke-free homes. Even pets are not spared from the ill-effects of smoking, with evidence pointing to incidence of lung and nasal cancer in dogs and lymphoma in cats.

Yet another World No Tobacco Day will be observed on May 31, marked by anti-smoking rallies and meets to encourage smokers to quit at least for 24 hours. Launched by the World Health Organisation in 1987, the day is meant to draw global attention to the health risks of smoking. This year's theme is “tobacco industry interference”, focusing on tobacco marketing strategies.

Dr Prakash C. Gupta, director of the Healis Sekhsaria Institute for Public Health, observed that “despite a complete ban on tobacco advertising, the tobacco industry continues to target adolescents.”

Unhealthy haze over India

A World Heart Federation-commissioned report released at the World Congress of Cardiology in Dubai showed that India has 138 million smokers, and 28 per cent of its population aged 15-49 consumes tobacco in some form or the other, with beedis being the most popular (48 per cent), followed by smokeless tobacco products (38 per cent) and cigarettes (14 per cent).

Although smoking has been banned in public places since October 2, 2008, enforcement has been lax with little or no fines imposed on violators.

Calling for strict enforcement of the law and outlawing tobacco sale to minors, Dr Gupta expressed concern over the growing popularity of hookah parlours among teens. Pointing to the popularity of beedis in rural areas owing to the cheaper price, he suggested integrating more de-addiction centres into existing health centres in small towns and villages.

Dr Monika of PHFI called for increasing the size of pictorial health warnings on tobacco products to cover 80 per cent of the pack surface, from the 40 per cent at present. As tobacco control is a multi-sectoral issue, all the ministries involved should work in tandem to ensure success, she said.

India ratified WHO's Framework Convention on Tobacco Control in 2004. The treaty calls for raising tobacco taxes; ban on smoking in public places; regulating contents of tobacco products; regulating packaging and labelling; launching public awareness programmes; restricting tobacco advertising, promotion and sponsorship; and addressing tobacco dependence and cessation.

Awareness at the grassroots

The National Tobacco Control Programme was launched in 2007 on a pilot basis in nine States, with the second phase extending to 11 more. In addition, the PHFI in partnership with Andhra Pradesh and Gujarat governments is implementing a project funded by the Bill and Melinda Gates Foundation. The “Strengthening of Tobacco Control Efforts through innovative Partnerships and Strategies” (STEPS) is active in 12 districts in Andhra Pradesh and six in Gujarat.

Dr Monika says the funding has helped take tobacco control efforts to the grassroots level.

The project imbibes components of the WHO's MPOWER (Monitor tobacco use, Protect from tobacco smoke, Offer help to quit, Warn about dangers, Enforce marketing bans, and Raise tobacco taxes) strategy.

Dr Gupta of Healis Sekhsaria credits support from the Bloomberg Initiative to Reduce Tobacco Use and the Bill and Melinda Gates Foundation for advancing tobacco control policies, especially in low- and middle-income countries. He points out that there is no safe level of tobacco use and all tobacco products are harmful and can cause cancer.

“Quitting smoking is easy, I've done it a thousand times,” said Mark Twain, summing up smokers' difficulty. But a combination of cessation aids such as nicotine replacement therapy and counselling promise to help turn it into a decision of a lifetime.

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