The tobacco epidemic is growing in India


E-cigarettes and harm-reduction products remain banned for almost three years in India, while legal sales of cigarettes, bidis and other tobacco products continue.

There are serious arguments about what this means for the country’s public health policy. But Health Ministry officials are simply unwilling to engage in discussions.

We can only write about the pros and cons of this company.

It is therefore clear that India has a major problem with tobacco, the South Asian giant is the world’s second largest consumer of tobacco behind China. It’s a $30 billion bazaar. The tobacco epidemic has indeed reached alarming levels. Nearly 267 million adults (15 years and older) in India (29% of all adults) are tobacco users. Tobacco use is higher in rural areas, among those with lower socioeconomic status, and among those with low levels of education. The prevalence of smoking is also significantly higher among men (43%) than among women (14%). Smoking prevalence varies widely across states, ranging from almost 10% in Goa to almost 70% in Tripura.

The most common form of tobacco consumption in India is smokeless tobacco and commonly used products are khaini, gutkha, betel quid with tobacco and zarda. The forms of smoking tobacco used are bidi, cigarette and hookah.

Yet, although harm reduction alternatives are available to smokers, these have yet to be effectively integrated into tobacco control policies to complement traditional measures such as taxation and graphic warnings on cigarette packaging.

The Department of Health and Family Welfare has issued an advisory seeking to ban the manufacture, distribution and sale of e-cigarettes, instead of regulating the category to potentially reduce smoking rates and improve outcomes in public health.

This, experts say, is a worrying development and needs to be seriously reconsidered.

So let’s take a realistic look at the studies circulating on the market. It says electronic nicotine delivery systems (ENDS), such as e-cigarettes and vaping devices, represent only a small fraction of the risks of smoking, as they crucially eliminate combustion from the process.

World-renowned public health organizations such as Public Health England, The Royal College of Physicians, American Cancer Society and National Academy of Sciences, Medicine and Engineering have recognized the low potential for harm from e-cigarettes. Furthermore, these are supported by the Heart Care Foundation of India, which has prepared a consensus statement on the harms of tobacco which has been signed by eminent Indian doctors.

A series of studies carried out in India demonstrated that toxic chemicals such as class 1 carcinogens, respiratory toxins and carcinogenic metal ions were present in significantly higher amounts in conventional cigarettes compared to ENDS vapor. For example, cadmium, a heavy metal that is a Class 1 carcinogen, respiratory toxin, and reproductive and developmental toxin, was found to be about 1,400 times higher in cigarette smoke than in vapour. of electronic cigarette. Similarly, lead and chromium, which are probable class 2b carcinogens, were 12 and 13 times more common in cigarette smoke than in e-cigarette vapor, respectively. Other carcinogens such as polycyclic aromatic hydrocarbons which are abundant in tobacco cigarette smoke, are completely absent from e-cigarette vapor.

Yet Health Ministry officials are not flinching.

Vaping, experts say, suffers from myths propagated by interest groups. Tobacco harm reduction must be debated scientifically based on rigorous evidence. Worse still, there is also a general inability to tell the difference between e-cigarettes and combustible tobacco cigarettes. As a result, the same restrictions are often imposed on both. And then many try to classify e-cigarettes as tobacco products because of the nicotine extracted from tobacco.

Department of Health officials need to realize that this is totally unreasonable and has no scientific basis.

Tobacco harm reduction is based on the absence of combustion, a process that creates almost all of the toxins a smoker inhales, leading to a high risk of illness and death. Electronic cigarettes have no combustion and do not contain tobacco. Available scientific evidence indicates that e-cigarettes are far less harmful than smoking. In fact, they fit the definition of tobacco harm reduction perfectly.

Researchers often misinterpret the data and make a hash of everything. For example, another myth associated with ENDS is that they are a gateway to combustible cigarettes. Even though ENDS does correlate with later smoking – remember, this has never been proven – its contribution to smoking prevalence is minimal. Now, ENDS are far more appealing to smokers, making them a perfect tool to distract them from tobacco cigarettes.

Health Ministry officials must have realized for many years that the use of ENDS is believed to have increased among young people, primarily among those experimenting with e-cigarettes. So what happened? The prevalence of smoking has dropped significantly. In the United States, for example, during the period when ENDS became popular (2011-2017), the prevalence of smoking among young people decreased by more than 50%.

ENDS offers a significantly less harmful, yet still satisfying, alternative to millions of smokers who have been unable or unwilling to quit. Banning them amounts to the Ministry of Health’s violation of basic human rights.

The consumer must have the right to choose, and the government must allow him to do so because the consumer will do so with his common sense.



The opinions expressed above are those of the author.



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