Quit smoking on independence day: Questions and Answers by Dr Srikant Sharma

Q1. What is the history of Tobacco?

A. Tobacco leaf use was introduced to Columbus by Native Americans, spreading to Europe and thereafter all over. Until 1590 tobacco cultivation was unknown to Indian farmers. Portuguese brought this plant to India in an early 17th century and cultivated in Gujarat. Mughal Emperor Akbar was also presented with Hookah (Chillum) for smoking tobacco during the 17th century. A decade thereafter tobacco was available to general people.
Tobacco as cigarettes became popular in the twentieth century. Nicotine being the principal constituent for addiction. Acidic pH of smoke inhibits its nicotine absorption in the mouth, hence is inhaled in lungs. Hence deposits smoke in lungs leading to lung disease/ heart diseases.

Q2. Who are the producers of Tobacco?

A. The tobacco industry in India is 2nd largest in the world next only to China. India shares 10.2 % of world tobacco production whereas China has a 36.7% share.

Q3. What is the prevalence of Tobacco smoking?

A. Commonest drug misused, with 15 billion cigarettes being sold on a daily basis. It is predicted that by 2030, smoking will kill 1 in 6 person Globally (WHO).

Q4. How many people consume tobacco in India?

A. The latest national average for tobacco consumption according to National Family Health Services(NFHS-4) is 44.5% for men and 6.8% for women, which is lower than 2005-06 figures. Tobacco use has fallen in India–by 12.5 percentage points for men and four percentage points for women–over last decade. But India is still the second highest producer and consumer of tobacco, according to the National Tobacco Control Program. Nearly 200 million tobacco consumer is present in India. Approximately, 13% consume it as Cigarettes, 54% as bidi, rest as raw or Gutka.
Tobacco consumption in India is highest in the six north-eastern states; of Mizoram, Meghalaya, Manipur, Nagaland, Tripura, and Assam: On average, 70.7% men here use tobacco in some form or the other, according to data from the NFHS-4. This figure is 26 percentage points higher than the national average.
Mizoram tops the north-east list, with 80.4% men and 59.2% women between 15 and 49 years of age consuming tobacco. When ranked for men using tobacco, it is followed by Meghalaya (72.2%), Manipur (70.6%), Nagaland (69.4%), Tripura (67.8%) and Assam (63.9%). At 37.7%, the female average for tobacco users in Manipur, Tripura, Meghalaya, and Nagaland was way above the national average of 6.8%.

Q5. What is the demographic distribution of tobacco use in India?

A. More rural Indians use tobacco. Both men and women (between 15 and 49 years of age) use more tobacco in India’s villages than in cities. Among urban women, 4.4% use it compared to the 8.1% of women in villages. For men in villages, the figure is 48% and in cities, 38.9%.

Q6. Which states in India are leading producers of tobacco?

A. Andhra Pradesh leads the Indian states in terms of tobacco production. It is closely followed by Assam and Bihar in 2 nd and 3 rd places respectively. Other major tobacco-producing states are Chhattisgarh, Gujarat, Karnataka and Madhya Pradesh.
Majority of cigarette is manufactured in Andhra Pradesh & Karnataka, while Bidi in Gujarat. And Hookah in Bihar, Maharashtra, Odisha, Uttar Pradesh, Tamil Nadu.

Q7. How is smoker risky?

A. There is 10 times higher risk of lung cancer, 2 times for fatal heart disease. Data also shows that 85% of COPD patients, 90% of peripheral vascular disease patients (non-diabetic), 50% of Aortic Aneurysm patients and 10% of stroke patients are smokers.

Q8. Tobacco kills how many persons?

A. Within 24 hours of your reading this, 2,739 people will lose their lives due to cancer caused by the use of tobacco and other tobacco products. WHO predicts that on an average, smokers die 10 years earlier than non-smokers. Mortality in smokers is 3 times higher than non-smokers. Tobacco kills 7 million people per year, more than 6 million by direct tobacco and around 890,000 as a result of passive smoking exposure to second-hand smoke.
In India, The north-eastern states report a higher risk for cancer–112 men and 60 women of 1,000 die of cancer, while the national average is 47 for men and 44 for women, according to the 2012 Lancet.

Q9. What financial burden does tobacco use cause on the nation?

A. The study was done by MOHFW for the year 2011, Indians using tobacco products between age 35-70years had to spend Rs1.05 lakh crore in total for getting treatment for diseases caused due to tobacco use. And this is 12% more than the combined state and central government expenditure on healthcare of 2011.

Q10. What are the problems that occur due to tobacco smoke?
A. The cigar has 600 chemical ingredients; when burnt produces 7000 chemicals; out of which 69 are proven to be Carcinogenic. Nicotine is responsible for habit-forming, energizer and craving. Due to smoking immune system weakens which may be linked with the heart attack, stroke, and cancer. Again Immune system weakening leads to autoimmune diseases. Healing process gets delayed since nicotine tightens blood vessels (Vasoconstrictor), leading to a decreased flow of blood to wound and hence healing decreases. Similarly, muscle fiber tires faster due to lack of oxygen. Since steroid (Stress) decreases nicotine levels; at stress, a person needs more nicotine. Hence the need for nicotine or smoke increases gradually.

Q11. What damage is done by smoke to the various systems of the human body?

A. In the eye: Tobacco smoking develops Macular degeneration, cataract, and poor eyesight.

Respiratory: The toxin filtering capacity of the lungs decreases. Hence smoke is trapped in lungs; leading to increase in infection (Flu and Cold). Also, the lining of the respiratory tubes gets destroyed leading to emphysema/ COPD disease and lung cancer. Children of smokers develop Bronchial asthma, Pneumonia and ear infection due to inhalation of secondary smoke known as passive smoking.

Heart: Nicotine being a Vasoconstrictor, decreases blood flow to peripheral blood vessels. Smoking decreases HDL, increases blood pressure, hence increase in atherosclerosis, leads to heart attack and paralysis (Stroke).

Skin and teeth: Ageing wrinkles increase, yellow-brown teeth staining increases.

Cancer: Smoking damages DNA - hence cells grow out of control - leading to cancers; of mouth, throat larynx, Oesophagus/kidney/ pancreas/cervix.

Q12. What if a female smokes?

A. Female - Smoking decreases Estrogen, which leads to dry skin, thin hair, reduced memory, early menopause.

Q13. What happens if a pregnant female smokes?

A. Tobacco intake, whether in active or passive form causes miscarriage, low birth weight, stillbirth, premature delivery, sudden infant death syndrome and placental complications.

Q14. What are the adverse effects of smoking on reproductive life?

A. With the increase in smoking infertility increases.

Q15. What is withdrawal?

A. The National Institute of Drug Abuse (NIDA) defines the concept of a withdrawal syndrome as a predictable group of signs and symptoms that result from either the sudden removal of or an abrupt decrease in the regular dosage of a drug. Thus tend to exaggerate the very processes and physical functions that were being suppressed by the drug, to begin with.

Q16. What are withdrawal effects of Tobacco?

A. Generalized withdrawal effects may be anxiety, headache, palpitation, sweating, ghabrahat, confusion, agitation, muscle ache, depression, anxiety, tremors, seizures.

Q17. How to successfully withdraw from any drug?

A. Drug withdrawal help begins with the help of professionals. For some people struggling with addiction, it would be quite difficult and inadvisable for them to attempt to successfully navigate a withdrawal period at home by themselves. For many, the uncomfortable symptoms of withdrawal and
even the fear of them occurring leads to continued drug use and hinders the decision to begin recovery.

Q18. Why is quitting so hard?

A. Smoking tobacco is both a physical addiction and a psychological habit. The nicotine from cigarettes provides a high addictive effect. Eliminating that regular fix of nicotine causes your body to experience physical withdrawal symptoms and cravings. Because of nicotine’s “feel good” effect on the brain, many of us smoke as a way of coping with stress, depression, anxiety, or even boredom. Quitting means finding different, healthier ways to cope with those feelings.
Smoking is also ingrained as a daily ritual. It may be an automatic response for you to smoke a cigarette with your morning coffee while taking a break at work or school, or on your commute home at the end of a hectic day. Or maybe your friends, family, or colleagues smoke, and it’s become part of the way you relate to them.
To successfully stop smoking, you’ll need to address both the addiction and the habits and routines that go along with it. But it can be done. With the right support and quit plan, any smoker can kick the addiction—even if you&'ve tried and failed multiple times before.

Q19. How to quit smoking?

A. Approximately 60- 80% of smokers want to quit but only 4% are successful without professional help.

Some helpful guidelines are:-

Start your stop smoking plan with the START

S = Set a quit date.
Choose a date within the next two weeks, so you have enough time to prepare without losing your motivation to quit. If you mainly smoke at work, quit on the weekend, so you have a few days to adjust to the change.

T = Tell family, friends, and co-workers that you plan to quit.
Let your friends and family in on your plan to quit smoking and tell them you need their support and encouragement to stop. Look for a quit buddy who wants to stop smoking as well. You can help each other get through the rough times.

A = Anticipate and plan for the challenges you'll face while quitting.

Most people who begin smoking again do so within the first three months. You can help yourself make it through by preparing ahead for common challenges, such as nicotine withdrawal and cigarette cravings.

R = Remove cigarettes and other tobacco products from your home, car, and work.

Throw away all of your cigarettes, lighters, ashtrays, and matches. Wash your clothes and freshen up anything that smells like smoke. Shampoo your car, clean your drapes and carpet, and steam your furniture.

T = Talk to your doctor about getting help to quit.
Your doctor can prescribe medication to help with withdrawal symptoms. If you can&'t see a doctor, you can get many products over the counter at your local pharmacy, including nicotine patches, lozenges, and gum. BUT, you may re-addict again, while quitting these products. Hence may consult your doctor.

Other helpful tips include:

● If nicotine replacement needs to be done then it should be in the morning.
● Smoker should keep himself busy to distract from craving
● Try to get out of the house and spend time with non-smokers
● Smokers should keep their hands busy. Chew, candy if required.
● Relax by deep breathing exercises, watching movies etc. Read, write, go for dinner to relax and
keep busy.
● Think of quitting, for hours to days, and add up time stretch time not to smoke as possible.

Q20. What are the trigger factors to be avoided?

A. Avoid people who smoke, and places where usually smokes get stimulated.
. Tiredness is a trigger so take adequate rest.
. Review previous quitting attempt; what helped or led to smoking again, so that situation can be avoided.
. Tell your friends about your quitting, and for help (so that they will not offer Cigar to you).
A majority can quit by general awareness, lifestyle modification, healthy dietary habits, maintaining environment hygiene, good sleep, seeking professional help and last but not positive thinking.

Q21. How to prevent Secondary smoking (re-smoking)?

A. Abstinence - Even a single puff should not be allowed. Alcohol is associated with relapse. Other household smokers to stop smoking simultaneously.

Q22. What are sources for obtaining supplementary materials on quitting smoking?

A. National Cancer Institute and agency for health care policy and research helps in providing knowledge materials on quitting smoking.

Q23. What are the long-term benefits of quitting smoking?

A. Although carcinogen-induced gene mutation persists for years despite cessation of smoking still, after 20 years of cessation of smoking, the risk of cancer equalizes with non-smokers. After 1- 2 years of smoking cessation, lung function become equal to non-smokers and 15 years after cessation of smoking, a risk for heart disease become the same as a non-smoker.

Q24. What steps has the Indian Govt. taken against the tobacco menace?

A. COPTA (Cigarette and other tobacco product act) act came in 2003, says prohibition of smoking in public places, prohibition of advertising, prohibition of sale to minor, health warning on tobacco product pack, Nicotine, and tar content should be displayed on the pack.

Q25. What is the world's responsibility?

A. World "No tobacco day" is observed on 31st May, to increase awareness about tobacco, so that people can quit tobacco. Now 13 billion people consume tobacco in the world. 100 million premature deaths by 2020 can be saved by this campaign.