Smoking Epidemic Foreseen Causing Millions of Deaths
By Emily Wax
Washington Post Foreign Service
Thursday, February 21, 2008
NEW DELHI, Feb. 20 -- Lounging in a smoke-filled cafe, Purvi Ahuja, 20, and her hip friends like their text messages to be fast, their cappuccinos to be milky and their cigarettes to be plentiful.
"I know it's so bad. My skin is even gross, my lips are black because of it," sighed Ahuja, her ashtray filled with cigarette butts. Her friends, a pilot and a writer, took long drags on their cigarettes, exhaled puffs of smoke and agreed that it's just not easy to stop smoking.
Young Indians, especially young women like Ahuja, represent one of the cigarette companies' largest markets. Because they are so heavily targeted, they are also at particular risk of smoking-related death, according to health officials.
Recent findings from the first nationally representative study of smoking in India found that this country is in the grip of a smoking epidemic likely to cause nearly a million deaths a year starting in 2010. There are 120 million smokers in India, half of them younger than 30, the study found. India has a larger population of smokers than any other country in the world except China.
The research was conducted across the country by a team of 900 field workers from India, Canada and Britain and the results published online in the New England Journal of Medicine last week.
The study found that more than half of smoking-related deaths would be among poor and illiterate Indians. It also offered some medical surprises about the way smoking worsens diseases, researchers said. According to the findings, for example, 40 percent of tuberculosis cases in India were due to smoking, since smoking converts the disease in the lungs more quickly.
Only 2 percent of smokers in India quit the habit, and usually only after falling ill.
"The health risks are much bigger than previously thought," said Prabhat Jha, director of the Center for Global Health Research at the University of Toronto in Canada and one of the report's authors.
He said Indians tend to start smoking later and smoke fewer cigarettes per person than Westerners. "But as it turns out, those factors don't make a difference. The study found there were no safe levels of smoking. I think the message has to be smoking is not cool. It's deadly."
Anti-smoking activists say the government needs to launch a more aggressive campaign about the dangers of smoking and mandate grisly visual warnings -- photos of cancerous lungs, for example -- for those who can't read. Taxes on cigarettes also need to be raised, they say, since the current tax amounts to pennies.
Indian Health Minister Abumani Ramadoss called last week's report "alarming" and told journalists that the government is committed to tackling the issue.
Since January, Ramadoss has been publicly pressing cafes, college campuses and even Bollywood movie stars to take steps to curb smoking.
"Please don't smoke in your movies," Ramadoss said recently on CNN-IBN, one of the country's largest news channels. "India should be very, very concerned about 14-year-olds now starting to smoke. We have data which show that 52 percent of children have their first puff of a cigarette because of movie celebrities."
Recently, a movie star from Tollywood, the Tamil-language film industry, quit smoking and began talking to high school and college students about doing the same. The so-called king of Bollywood, actor Shah Rukh Khan, said in an interview that the thing he hated most about himself was his inability to stop smoking. "I know I have to. I know as a role model I shouldn't be sending that message," he said. "It's a horrible habit. I have to work harder to stop."
Smoking in India is as omnipresent as chili flakes and onions in food. Almost all restaurants and cafes permit smoking, and most smoking sections often dribble into nonsmoking sections, without enforcement.
In cosmopolitan cities like the capital, smoking is seen as a sign of rebellion against overbearing families that have traditionally exerted tight control over young people's activities. But some young smokers say they are starting to acknowledge the dangers.
After the report was released, an anti-smoking squad at Delhi University traveled around campus buildings nabbing those who were smoking in classrooms.
Many working-class Indians smoke bidis, or small, cheaply made cigarettes rolled in leaves that cost the equivalent of 50 cents for a pack of 25.
Even smoking one to seven bidis a day raised the mortality risk by a third, Jha said.
Om Prakash, a 43-year-old resident of New Delhi, went to a roadside dealer for his bidi fix the other day. The dealer was operating from a tree, with cigarette cartons stuck in the trunk.
Prakash has smoked both bidis and cigarettes for 26 years.
"I want to stop. I know it's bad for my health," he said with a raspy cough. "I do tell my 12-year-old boy to never smoke. He likes to imitate me taking drags of my bidis."
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