Smoke & Mirrors: Exposing the Tobacco Industry’s Playbook for Hooking Kids

Dr. Manorama Bakshi

Annually, over 8 million people die from tobacco-related causes, including around 1.2 million non-smokers exposed to second-hand smoke.

Tobacco use remains a critical public health issue worldwide, contributing significantly to disease and death. According to the World Health Organization (WHO), tobacco use accounts for 25 per cent of all cancer deaths globally. It is directly linked to various types of cancer, respiratory diseases, cardiovascular diseases, and other severe health problems. Annually, over 8 million people die from tobacco-related causes, including around 1.2 million non-smokers exposed to second-hand smoke.

The Indian Scenario

In India, the situation is equally alarming. Data from India’s fifth National Family Health Survey (NFHS-5) reveals:

Gender Disparity: 38 per cent of men and 9 per cent of women consistently show higher tobacco use across all age groups and educational levels compared to women.

Educational Influence: Tobacco consumption is also significantly higher among those with less education and lower economic status. For instance, 58 per cent of men with no schooling use tobacco compared to 21 per cent in the educated quintile

Rural vs. Urban: Usage is higher in rural areas (43 per cent for men and 11 per cent for women) compared to urban areas (29 per cent for men and 6 per cent for women)indicating potential socio-economic or cultural influences.

Common Types of Tobacco Use in India

The types of tobacco products used in India are diverse and include:

  1. Cigarettes
  2. Bidis (small, hand-rolled cigarettes wrapped in a tendu leaf)
  3. Cigars
  4. Pipes
  5. Hookah
  6. Gutkha (a mixture of tobacco, areca nut, and slaked lime)
  7. Paan masala with tobacco
  8. Khaini (a form of chewing tobacco)
  9. Other chewing tobacco
  10. Snuff

Health Impact of Tobacco Use: Tobacco use affects nearly every organ in the body, leading to a range of serious health issues

Immediate and Long-term Effects

  1. Cancer: Smoking causes lung, oral, throat, esophageal, and several other types of cancer. Chewing tobacco is particularly linked to oral cancers.
  2. Cardiovascular Diseases: Smoking increases the risk of heart disease, stroke, and hypertension. It causes plaque build-up in arteries, leading to atherosclerosis.
  3. Respiratory Diseases: Chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis are common among smokers.
  4. Reproductive Health Issues: Smoking can cause infertility, complications during pregnancy, and adverse outcomes for newborns.
  5. Diabetes: Smokers have a higher risk of developing type 2 diabetes.
  6. Immune System: Tobacco weakens the immune system, making smokers more susceptible to infections and diseases.
  7. Other Conditions: Tobacco use is linked to vision and hearing loss, osteoporosis, periodontal disease, and gastrointestinal disorders.

Impact on Non-Smokers

Second-hand smoke is a major concern, especially for children and pregnant women. Non-smokers exposed to second-hand smoke are at risk of developing lung cancer, cardiovascular diseases, respiratory infections, and reduced lung function. Children exposed to second-hand smoke are more likely to develop asthma, middle-ear infections, and other health issues.

Benefits of Quitting Tobacco as per WHO

Screenshot 20240602 1033212

Role of Family, Community, Society, and Government

Families play a crucial role in preventing tobacco use among children and adolescents through parental guidance, setting a tobacco-free example, and maintaining a smoke-free home environment, along with open communication about the dangers of tobacco. Communities support tobacco cessation via educational programs, support groups, and tobacco-free public spaces, with schools, Village Panchayats, and community centres providing resources and education. Societal attitudes towards tobacco need to shift to stigmatize smoking, with media campaigns and public health messages significantly changing social norms and behaviour’s related to tobacco use. 

Government of India Stand

Governments have a critical role in regulating tobacco products and protecting public health. India became a Party to the WHO Framework Convention on Tobacco Control on February 27, 2005. Policies such as higher taxes on tobacco products, comprehensive bans on tobacco advertising, promotion and sponsorship, plain packaging, and graphic warning labels are effective in reducing tobacco use. Implementing strict regulations on the sale and distribution of tobacco products, especially to minors, is essential.

Smoke-Free Places

Smoking is completely banned in many public places and workplaces such as healthcare, educational, and government facilities and on public transport. The law, however, permits the establishment of smoking areas or spaces in airports, hotels having 30 or more rooms, and restaurants having seating capacity for 30 or more. With respect to outdoor places, open auditoriums, stadiums, railway stations, bus stops/stands are smoke-free. 

Tobacco Advertising, Promotion, and Sponsorship

Advertising through most forms of mass media, including online curated content, is prohibited. There are some restrictions on tobacco sponsorship and the publicity of such sponsorship.

Tobacco Packaging and Labeling

Health warning labels are pictorial and text; they cover 85 percent of the front and back panels of the tobacco product package parallel to the top edge; and are rotated every 12 months. Misleading packaging and labeling, including terms such as “light,” and “low-tar” and other signs, is prohibited.

Cigarette Contents and Disclosures

The law does not grant the authority to regulate the contents of cigarettes. The law does not require that manufacturers and importers disclose to government authorities information on the contents and emissions of their products.

Sales Restrictions

The law prohibits the sale of tobacco products via vending machines and within 100 yards of any educational institution. In addition, several states ban the sale of single cigarettes and gutkha and other forms of smokeless tobacco. There are no restrictions on internet sales or the sale of small packets of cigarettes or other tobacco products. The sale of tobacco products is prohibited to persons under the age of 18.

E-Cigarettes

The law prohibits the production, manufacture, import, export, transport, sale, distribution, and advertising of e-cigarettes. There are no restrictions on the use of e-cigarettes.

Heated Tobacco Products

The sale of heated tobacco products (HTPs) is prohibited. Existing smoking restrictions apply to HTPs. The law bans the direct and indirect advertisement and promotion of both tobacco inserts and devices.

The Tobacco Industry

The tobacco industry continues to grow despite the governments restrictions and awareness campaigns due to the exploiting the addictive nature of nicotine and targeting vulnerable populations, including children and adolescents. Companies often use deceptive marketing practices to create a perception that smoking as well as chewing tobacco masala is glamorous and desirable. Despite regulations, the industry finds ways to market their products, including through sponsorship of events and indirect advertising.

Celebrity Influence

Many A category starts often endorse different brands of tobacco products like cardamom pearls , which are typically surrogate products for tobacco pan masala and gutkha brands. These endorsements can significantly influence young people’s habits, contributing to the normalization of tobacco use. The Elaichi Pearls often do not even exist and are merely seen in advertisements, further exemplifying the deceptive practices of the tobacco industry.

The Economic Impact

While the tobacco industry generates significant revenue, the costs associated with tobacco-related diseases and lost productivity far outweigh these profits. Tobacco use burdens the global economy with an estimated USD 1.4 trillion in healthcare costs and lost human capital annually. However, the health and social costs of tobacco use are immense.

Recommendations for Stakeholders

Families

  • Educate children about the dangers of tobacco use.
  • Set a tobacco-free example.
  • Create a smoke-free home environment.

Communities

  • Promote tobacco-free public spaces.
  • Provide educational programs and support groups.
  • Engage in public awareness campaigns.

Society

  • Change societal attitudes towards tobacco use.
  • Support policies and initiatives aimed at reducing tobacco use.

Government

  • Implement and enforce comprehensive tobacco control policies.
  • Increase taxes on tobacco products.
  • Ban tobacco advertising, promotion, and sponsorship.
  • Introduce plain packaging and graphic warning labels.
  • Ensure access to tobacco cessation programs and support.

Tobacco Industry

  • Adhere to regulations and stop targeting vulnerable populations.
  • Support public health initiatives and contribute to the costs associated with tobacco-related diseases.

The theme of World No Tobacco Day 2024, “Protecting children from tobacco industry interference,” underlines the critical need to safeguard our youth from the harmful influences of the tobacco industry. Despite the encouraging signs of a decline in tobacco use, significant challenges remain. By focusing on protecting children, promoting education and awareness, and implementing effective policies, we can continue to reduce tobacco use and move towards a healthier, smoke-free future. All stakeholders, including families, communities, society, and governments, must work together to achieve this goal and ensure a healthier future for all.

The author is Public Healthcare Expert, Consocia Advisory.

The article was first published in BW Healthcare World as ‘Shielding Our Youth: Exposing Tobacco Promoting Tactics & Celebrity Influence’ on May 31, 2024.

Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.

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Acknowledgment: This article was posted by Ankita, a Research intern at IMPRI.

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