The statistics are eye opening. Only 20% of the total tobacco consumed in India is in the form of cigarettes, about 40% is in the form of bidis and the remaining 40% is consumed as chewing tobacco, pan masala, snuff, gutkha, masheri and tobacco toothpaste. These products contain putrefied tobacco, paraffin, areca nut, lime, catechu, and 230 permitted additives and flavours including known carcinogens.
WHO reports suggest that 65% of all Indian men use at least one form of tobacco. For women, the usage statistics differed from 15% in rural Gujarat to 67% in Andhra Pradesh, the overall prevalence being 3% for bidi and cigarette smoking. What is alarming is that fully one third of all women use at least one form of tobacco and in Mumbai, 57.5% of women use tobacco but solely in the smokeless form.
The habit has a high degree of social acceptability. A popular advertisement showed the parents of a bride and groom agreeing to greet guests with pan masala. People who would not dream of smoking, have no such qualms about consuming several packets of pan masala every day, simply because they are unaware of the dangers involved.
Most people have no idea that consuming smokeless tobacco is as dangerous as smoking and while packets of pan masala do bear health warnings, they are rendered almost invisible by the bright shiny
packaging and the small size of the warnings. Consequently, unlike smoking, which must be hidden from adults, children can openly consume pan masalas.
Shockingly, younger and younger children are being introduced into this habit, with the first introduction often being given at home by an elder who is unaware of the dangers he is exposing the child to.
The fact is that smokeless tobacco has been directly related to the incidence of oral cancer. The first signs are the appearance of patches and sores in the mouth or tongue, followed by submucous fibrosis and difficulty in opening the mouth fully. At this stage the signs are reversible, but if left untreated will almost certainly develop into cancer. A recent news item on BBC reported usage of pan masalas by the large ethnic Indian community in England. The abuse of smokeless tobacco resulted in cases of submucous fibrosis among patients who spoke of their ignorance of the dangers they had exposed themselves to.
Confronted with the vast problem of tobacco usage and its social acceptability, it is tempting to say that the problem of addiction is too deep rooted to attempt to fight and to focus attention instead on preventing young people from taking up the habit. However, this has been found to be unsuccessful unless it follows strong anti-tobacco sentiment in the adult community and high proportions of the population giving up tobacco usage. CPAA has therefore adopted a two-pronged approach. On the one hand, in a massive drive covering at least 50 schools in different localities in Mumbai, we are educating children in Standards 8, 9 and 10 in the dangers of tobacco dependency. At the same time, a series of advertisements are being visualized to educate adults on the harms of smokeless tobacco and advising them not to introduce their children to the habit.
"We never tell kids not to smoke or chew tobacco," says CPAA's Alka Kapadia. "Instead we educate them and offer our help in kicking the habit." The lecture begins with general information about the disease, the warning signs, symptoms, prevention through early detection. The schools being visited during the month of August, 1999 are St. Xavier’s High School, J.B. Wachcha, St. Anne’s High School, and Don Bosco.
"Our most depressing failures is with children from the lower income levels. It is difficult to convince them to give up tobacco. The habit helps them to deal with their daily lives, it kills the appetite and gives a kick that makes them happy for a while. It is cheaper to buy a packet of gutka than dinner. And it gives them the strength to face challenges of child labour including late night shifts. Sometimes it is their only source of happiness. In such cases, we advise them to pay attention to oral hygiene, to at least brush their teeth before sleeping so that the remnants of the tobacco do not attack the buccal linings overnight and to watch for patches which can be the first sign of cancer."