A diligent medical professional, Dr. Dharminder graduated as a doctor from Mysore University in 1995 and worked as a doctor in UK between 1995 & 1998. He also holds M. Phil in Hospital & Health System Management from Birla Institute of Technology & Science, Pilani.

With every puff of cigarette, a smoker inhales 7000 chemicals, of which up to 70 are known carcinogens. When these dangerous chemicals enter the blood stream, they have the potential to alter the DNA and expose the smoker to a heightened risk of multiple types of cancers. Apart from being responsible for almost nine of every 10 cases of lung cancer, tobacco can cause cancer almost anywhere in the body. According to estimates, up to 16 types of cancers can be directly attributed to tobacco consumption (smoke + chewable). World Health Organization estimates that tobacco kills more than seven million people each year, up to half of its users.

According to data of the Indian Council of Medical Research (ICMR), cancer incidence doubled in India over the past 26 years, with breast, cervical, oral cancer, and lung cancers, together constituting 41 percent of the cancer burden. Tobacco smoking causes cancers of the lung esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach and cervix. Oral tobacco causes oral, esophageal and pancreatic cancers. Tobacco is the also single most known and preventable cause of cardio-vascular deaths.

The good news is that tobacco which constitutes a major risk factor for cancer is a completely preventable risk factor. Bad news is that despite a series of campaigns and introduction of pictorial warnings on tobacco products, tobacco consumption remains rampant in India. Almost a third of Indians, 57 percent of all men and 11 percent of all women consume some form of tobacco, and many also use more than one type of tobacco product.

Pictorial Warnings & Public Smoking Ban
Over the past 10 years, India has taken a series of welcome measures to curb the use of tobacco. These include a ban on tobacco related advertisements, a ban on smoking in public places as well as making sale of tobacco products to minors an offence. Similarly, despite protests by artists and film makers, it was made mandatory for scenes depicting smoking in movies to tag along a disclaimer about its harmful impact.

One of the most significant interventions has been the introduction of 85 percent pictorial warnings on the packaging of tobacco products. A report released recently by the Canadian Cancer Society, which documents global progress on tobacco package warnings, ranks India fifth in the global list of countries that have pictorial health warning on tobacco products. Graphic & pictorial warnings are known to have an impact on the minds of tobacco users, especially those

who are illiterate and cannot read the written health warning. Studies carried out in Brazil, Canada, Singapore and Thailand has provided clear evidence that pictorial warnings significantly increase people's awareness of the harms of tobacco. Graphic pack warnings also discourage children from beginning smoking.

While the introduction of all these measures in the face of protests by the tobacco industry underline the government’s commitment to curb tobacco consumption, much more needs to be done in India which houses the world’s second largest population of tobacco users after China.

Graphic & pictorial warnings are known to have an impact on the minds of tobacco users, especially those who are illiterate and cannot read the written health warning

Scale Up Tobacco Taxes
Tobacco taxes have been an area of much debate and discussion. High taxes on tobacco products are a cost-effective way to reduce tobacco use, especially among young and poor people. A tax increase that raises tobacco price by 10 percent decreases tobacco consumption by about four percent in highincome countries and about five percent in low and middle-income countries. Studies of price elasticity in India find that a 10 percent increase in tobacco prices is estimated to reduce bidi consumption by 9.1 percent and cigarette consumption by 2.6 percent. Since tobacco is an addictive product, taxes should be high enough to raise the retail price by a large margin. WHO recommends that the taxes should be at least 70 percent of the retail price. However, despite their inclusion in the GST demerit list of highest tax slab,taxes on tobacco products are still much below the WHO recommendation. Bidis which constitute the most common tobacco product used in India continue to remain affordable. The government must fight-off pressure from influential tobacco lobbies to impose a high tax rate on all tobacco products cigarettes, bidis and gutka to discourage consumers from purchasing them.

Offer Institutional Help in Quitting
Recently, India became the first country in the SAARC region to start printing a Quit-Line number on tobacco products. A highly welcome step, this complements the pictorial warnings by offering help to people who want to it. However, it is not enough. Since tobacco is an addiction, its users require help to kick the habit. We must provide greater institutional support to help users kick the butt. This must include ‘Quit Tobacco’centres at colleges, hospitals as well as offices to provide professional help and advice to people seeking to quit tobacco use. Involving primary healthcare physicians in this endeavor can help reach out to a large number of tobacco users.

‘Smoking is NOT COOL’campaigns
Mass media campaigns are effective in reducing tobacco consumption and influencing youth to stop using tobacco. The government must rope in influential youth icons cricket and Bollywood stars to act as influencers in its campaign to cut tobacco use. At the same time tobacco campaigns must focus on informing the youth that smoking is not cool and is hardly a sign of machismo, often perceived by them.