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Q1. What is in Tobacco that makes it dangerous?

Ans: Tobacco contains more than 4000 chemicals; several can cause cancer and are dangerous to health. It includes -

  1. Nicotine: a severely addictive drug found in tobacco smoke. Nicotine increases heart rate and blood pressure, which makes the heart work harder. It also constricts blood vessels, reducing blood flow to many organs.
  2. Tar: Tar coats the lungs like soot in a chimney making it harder to breathe. Tar in tobacco contains dozens of chemicals that cause cancer.
  3. Carbon Monoxide: The presence of this gas in tobacco smoke makes the heart bat faster. The gas takes the place of oxygen in the blood. The ability of blood to deliver oxygen to various body tissues is thereby reduced.
  4. The poisons in tobacco smoke that are inhaled by both smokers and passive smokers include nitrogen oxides, hydrogen cyanide, arsenic (white ant poison), ammonia (floor cleaner), phenol (paints), naphthalene (mothballs), cadmium (car batteries), urethane, acetone (paint stripper), carbon monoxide (car exhaust), DDT (insecticide) and butane (lighter fuel).

      Q.2 How many deaths are attributed to tobacco globally?

      Ans: Presently tobacco contributes to 5 million deaths per year globally. According to the World Health Organization (WHO), tobacco kills more people annually than AIDS, alcohol, other addictions (drugs) and accidents put together. This figure is expected to rise to 10 million deaths per year by 2025.
      Tobacco use is the single largest preventable cause of death and disease.

      Q.3. Is the tobacco toll in India expected to rise?

      Ans: Tobacco kills between 8-9 lakh people each year in India! This will multiply many fold in the next 20 years.

      Q.4. What is the projected tobacco toll for teenagers who smoke?

      Of 1000 teenagers smoking today, 500 will eventually die of tobacco related diseases-250 in their middle age and 250 in their old age. Those who die earlier lose on an average 22 to 26 years of life compared to a non-smoker. Even those who die later will suffer ill health due to tobacco related diseases in the middle age.

      Q.5. Does passive smoking contribute to tobacco deaths?

      The WHO estimate that many children die of respiratory diseases induced by the tobacco smoke they are forced to breathe. Adults who are exposed to passive smoking may die of cancers, heart attacks or lung diseases.

      Smoking by the mother during pregnancy may lead to still birth or a low birth weight baby
      who is at higher risk of many health problems.


      100 male non-smoker deaths : 139 male cigarette smoker deaths

      100 male non-smoker deaths : 178 male beedi smoker deaths

      100 female non-tobacco user deaths : 135 female oral tobacco user deaths


      Q.6. What are the various ill effects of tobacco consumption on human health?

      Ans: It has been proved beyond doubt that tobacco use can lead to

      1. Cancer of
        1. Mouth
        2. Throat
        3. Lungs
        4. Larynx (Voice box)
        5. Oesophagus (food pipe)
        6. Urinary Bladder
        7. Kidney
        8. Pancreas
        9. Cervix
      2. Chronic Bronchitis and Emphysema

      3. Bronchitis and emphysema result from the breakdown of the cilia (hair like cells for cleaning) in the airways. The cilia become paralyzed or destroyed by cigarette smoke. This reduces their ability to remove phlegm and protect the lungs against infection. Affected persons cough frequently and are very short of breath. They sometimes turn blue because the blood does not have enough oxygen.

      4. Heart and Blood Vessel disease

        1. Artery clogging process (Atherosclerosis) is accelerated by tobacco products. Smoking damages the lining of blood vessels and leads to fat deposition.
        2. This artery clogging process is called atherosclerosis.
        3. This can lead to heart attack, stroke and peripheral vascular disease (narrowing of the leg arteries leading to blockage). Diseased arteries can also swell up (aneurysms) and burst.
        4. The younger one starts smoking the higher is the risk. Middle age smokers may be at 4 to 6 times excess risk of heart attacks, especially if they started smoking as teenagers.

      The largest number of deaths caused by tobacco occurs due to heart attacks

      1. Reproductive Problems
        1. Importance in men has been associated with smoking
        2. Male smokers have more abnormal sperms and a lower than average sperm count
        3. Women smokers are less fertile and may become sterile
        4. Smoking during pregnancy may result in a stillborn baby, low birth weight, premature birth and spontaneous abortion.
      2. Eye Problems
        1. Smoking has now been related to the risk of early cataracts and also for the degeneration of the retina (the screen in the eye, which helps us to see things). These may lead to partial or complete blindness.
      3. Cigarette smoking can also cause
        1. Bad Breath
        2. Smelly hair, clothes and hands
        3. Stained teeth and fingers
        4. Facial wrinkles, especially around the mouth and eyes.

      Tobacco has, over the years, been identified to be a risk factor for many other disorders and the list continues to increase each year.
      Not only cigarettes, but all forms of tobacco smoking are dangerous. In fact bidi is even more lethal than cigarettes. Even so called �low tar� cigarettes are also dangerous to health!

      Q.7. Does smoking a single cigarette have immediate health effects on the body?

      Ans: Smoking just one cigarette can have immediate health effects on the body. These include:

      1. Temporary increases in blood pressure and heart rate
      2. Constriction of blood vessels, which slows down blood flow around the body.
      3. Binding of carbon monoxide to haemoglobin in the blood stream. This reduces the amount of oxygen delivered to the tissues.




      Smokers vs. Non-smokers

      1. 20-25 times risk of developing lung cancer.,
      2. 2-3 times risk of having a heart attack.
      3. 3 times risk of sudden death.
      4. 30-60% more sick days.

      Both sexes are at risk of early heart attacks!

      Male : On an average, a male smoker suffers a heart attack 7 to 8 years earlier than a male non-smoker.

      Female : Among women smokers, heart attacks occur about 16-19 years earlier than in women who are non-smokers.

      Women have upto 20 times greater risk of heart attack and stroke if they smoke while taking oral contraceptives.


      Q.8. What is Second Hand Smoke?

      Second Hand Smoke (SHS) is the smoke produced from a burning tobacco product and the smoke exhaled by the tobacco smoker. If SHS is inhaled by non-smokers, it is called �passive smoking�.

      Q.9. Is Side Stream smoke dangerous?

      1. The �side stream� smoke that comes out of the burning end of the cigarette has a very high concentration of dangerous chemicals. These chemicals get diluted as they mix with the room air but the net intake by non-smoker is still high enough to put them at a considerable risk of suffering the many health disorders that smokers are afflicted by.
      2. A passive smoker breathes side stream smoke which contains three times more nicotine and tar and 50 times more cancer causing substances than mainstream smoke.

      Q.10. What are the ill effects of SHS/ Passive Smoking on health?

      Ans: SHS is a hazardous mixture which contains over 4000 chemicals such as cadmium, lead, arsenic, benzene, carbon monoxide, out of which over 50 are carcinogenic for humans. Apart from this, some of the chemicals in SHS are irritants and systemic toxins whereas some are reproductive and developmental toxins.

      1. SHS is a major cause of disease, death and disability among non-smokers
      2. Passive smoking has been shown to lead to an increased risk of cancers and heart attacks in the spouses of smokers.
      3. It can contribute to or worsen other people�s breathing problems and causes lung cancer and nasal sinus caner.
      4. ETS irritates the eyes, nose and throat.

      Q.11. How is a non-smoker affected by a smoker?

      Ans: It has been found out that a non-smoker living with a smoker who smokes about 20 cigarettes per day inhales the same quantity of tobacco smoke as if she herself has smoked 3 cigarettes per day.

      Studies have shown a 20% - 30% increased risk of fatal and non-fatal cardiac events in non-smokers living with smokers.

      Q.12. Is passive smoking especially dangerous for children and babies?

      Ans: Children are especially vulnerable, if adults smoke around them. It can cause the following:

      1. Low birth weight babies
      2. Sudden infant death syndrome (SIDS) � instances where babies suddenly stop breathing during sleep.
      3. Bronchitis and Pneumonia
      4. Middle Ear infections
      5. Additional episodes and increased severity of Asthma.
      6. Reduced rate of lung growth

      WHO estimates that nearly 700 million, or almost half of the world�s children, breathe air polluted by tobacco smoke, particularly at home.


      Q.13. What does the term �smokeless tobacco� mean?

      Ans: The term �smokeless tobacco� is used to describe tobacco that is consumed in an unburned form. Smokeless tobacco can be used orally or nasally. Smokeless tobacco in India is used as chewing tobacco, with or without lime. Guthka, Khaini, Zarda are all examples of such use. Snuff is an example of the nasally used form.

      Smokeless tobacco is highly dangerous as it causes a variety of cancers, majority of these being oral cancers.

      1. Is oral tobacco a common cause of cancers in India?
      2. Oral cancers account for 18-20% of cancers in India and are mainly tobacco induced.
      3. India has the highest number of oral cancer cases in the World.


      Q.14. Is it possible to quit the habit of tobacco use?

      Ans: Tobacco is an addiction, which is easier to avoid than to abandon. However, there are definite health benefits of quitting. It is possible to quit through will power. Counseling and social support are helpful. Sometimes, severe addicts may require temporary use of nicotine chewing gum or nicotine patches to help in the dead diction process.

      What are the benefits of giving up smoking?

      The benefits of giving up smoking are:

      1. the body starts repairing itself within 24 hours.
      2. one will get free from most of the nicotine in 7-10 days.
      3. the risk of a heart attack is greatly reduced within 2-3 years of giving up smoking.
      4. the risk of lung cancer may take up to 20 years to normalize to the level of non �smokers but the risk does get progressively lower during this period.
      5. appetite and taste improve.
      6. the disappearance of bad breath and odour of smoke from clothes and home is a refreshing change.
      7. relief from smoker�s cough is welcome to the smoker as well as others near him.
      8. family and co-workers are protected from passive smoking.
        1. Persons who quit the habit before 35 years of benefit the most but it is never too late to quit!
        2. A recent study from Finland revealed that a 50-years old male smoker who smokes about 20 cigarettes a day will gain 12 minutes of life for every cigarette he does not smoke!


      What is the effect of tobacco production on our environment?

      Tobacco is one of the major contributors to deforestation. This is because the �curing� of raw tobacco needs the burning of wood fuel. This requirement is large. For curing 1 hectare of tobacco, 1 hectare of trees are cut down and burnt.

      It has been estimated that for every 300 cigarettes smoked, some one somewhere has killed a tree!

      Tobacco is an environmental nightmare because of

      1. the paper consumed in the manufacture and packaging of cigarette products
      2. the large amount subsoil water drained by tobacco farming
      3. the extensive use of pesticides and soil erosion due to deforestation


      Why ban tobacco advertising?

      Advertisements use congenial settings and associations with popular individuals or event to create a mood in favour of tobacco use. These seductive images and associations outweigh the health warnings against tobacco and break the mental barriers against initial experimentation with tobacco. After this initiation has occurred, the addictive nature of tobacco takes a firm grip. A ban on advertising will reduce the number of new addicts by protecting nonsmokers from such false allure of misleading tobacco advertisements.

      Aggressive advertisement strategies of tobacco products include direct and surrogate advertising through sponsorship of sports, cultural and other popular events. These advertisements tempt youngsters to experiment with tobacco, by legitimizing and glamorizing the tobacco product logos.

      Smoking is extremely uncommon among sportsmen since smoking and fitness do not go together. Similarly, a good singer will stay far away from tobacco to protect the voice and the lungs. Yet, false associations are promoted with sports and culture to increase the acceptability of tobacco in young minds as well as to find a convenient vehicle for mass advertising of tobacco brand logos. Young people are often influenced by role models from sport or cinema, who do not themselves smoke but promote tobacco products or brand names for the sake of money.

      Ban on tobacco advertisement reduces tobacco consumption especially by preventing new addicts. There is clear evidence of this in countries which have imposed such a ban.


      What is the definition of smoke free public and work places?

      1. The concept of smoke free public places means that �everyone is protected from the hazards of second hand tobacco smoke, in all enclosed public and work places�.
      2. A �public place� means any place to which the public has access. A smoke free policy is applicable to all enclosed public places like offices, institutions, airports, cinema theatres, libraries, post offices and banks and some open spaces
        like open auditoria, railway platforms, bus stops etc.

      What is Second Hand Smoke? How is it harmful to health?

      1. Second Hand Smoke (SHS) is the smoke produced from a burning tobacco product and the smoke exhaled by the tobacco smoker. If SHS is inhaled by non-smokers, it is called �passive smoking�.
      2. SHS is a hazardous mixture which contains over 4000 chemicals such as cadmium, lead, arsenic, benzene, carbon monoxide, out of which over 50 are carcinogenic for humans. Apart from this, some of the chemicals in SHS are irritants and systemic toxins whereas some are reproductive and developmental toxins.
      3. SHS is a major cause of disease, death and disability among non-smokers.

      Why is smoke free a constitutional right?

      1. According to the Article 21 of the Constitution of India, nobody can harm other people to express their liberty.
      2. According to Article 39 and 47 of the Constitution of India, it is the duty of government to raise the level of standard of living and to improve the health of its citizens.
      3. It is the fundamental right of every citizen to claim clean air to breathe.
      4. It is the duty of the state to protect citizens from all types of harmful exposure like Second Hand Smoke emitted by smokers.

      What is the provision for Smoke-free under the Central tobacco Control Act,2003 in India?

      1. As per the section 4 of the COTPA, there is prohibition of smoking in public places.
      2. Rules for prohibiting smoking in public places notified on 25th February, 2004, vide notification No. G.S.R. 137. On 30th May, 2008 by a notification, the rules under Section 4 have been revised. These rules came into effect on 2nd October, 2008 all over the country.

      What are the salient features of revised rules?

      The owner, proprietor, manager, supervisor or in charge of the affairs of a public places shall ensure that-

      1. No person smokes in public places.
      2. There should be a board prominently visible in every entrance and every floor mentioning � �No Smoking Area � Smoking Here is an Offence� in any Indian languages as applicable.
      3. The size of the board should not be less than 60 cm/30cm.
      4. No ashtrays, matches, lighters or other things to facilitate smoking should be provided in any public place.
      5. The owner, proprietor, manager, supervisor or in-charge of the affairs of a public places shall notify and display prominently the name of the person to whom a complaint may be made if violation occurs.
      6. If the owner, proprietor, manager, supervisor or in charge of the affairs of a public places fails to act on a report of such violation then he/she will be liable to pay fine equivalent to the number of individual offences.

      What is the Penalty for violations by individual and business?

      A fine up to Rs.200/- for offences relating to smoking in public places can be imposed by any officer as authorized by the central/state government.

      Do businesses have a right to allow smoking?

      No. The safety of workers and the public is not a matter of choice for business owners.

      Are smoke free laws popular? Do they enjoy high compliance?

      1. A survey commissioned by Voluntary Health Association of India, Delhi, and Healis Sekhsaria Institute for Public Health, Mumbai, conducted by Synovate�s Global Omnibus, in four metropolitan cities of India including Delhi revealed that there is a near universal support for the new smoke free regulations that prohibit smoking inside all public places and workplaces in India.
      2. All over the world, smoke free laws are being enforced easily and winning popular support. They register high compliance. In New Zealand, support for smoke free bars, pubs, and nightclubs rose from 61% of adults in 2004 to 81% in 2006. In Ireland, the smoke free law was supported by 93% of the population in 2005, compared with 67% immediately before the law was introduced.

      Is smoke free a successful global practice?

      1. Smoke-free laws have been successfully implemented in several countries around the world, which include Scotland, France, Ireland, Sweden, UK, Uruguay, Italy, South Africa, Thailand, Australia, Hong Kong, Iran, New Zealand and Norway. It is based on the rational concept of protecting the health of those who smoke as well as those who do not smoke.

      Is there any safe limit of Second hand smoke?

      The scientific evidence shows that there is no safe level of exposure to secondhand smoke.

      Q-1 What is the mandate of the law that bans smoking at public places?

      Section 4 of COTPA prohibits smoking in public places. Any violation will be punished with a fine up to Rs. 200 .Technically; the process of reaching a compromise is called Compounding. Such offences, in which a compromise can be done and a trial can be avoided, are called Compoundable offences.

      Q-2 When did the ban take effect?

      The ban on smoking at public places came into effect from 1st May 2004 and subsequently from 2nd October, 2008 and is applicable all over India.

      Q-3 Which are the public places where the ban applies?

      The Ban is applicable to all public places where the public have access, as of right or not, but does not include any open space.

      1. auditoriums,
      2. hospital buildings,
      3. railway waiting rooms,
      4. amusement centres,
      5. restaurants including open space surrounding such premises
      6. bars,
      7. discotheques,
      8. refreshment rooms,
      9. banquet halls,
      10. canteens,
      11. coffee houses,
      12. pubs,
      13. airport lounges (airports can have a facility of providing separate smoking lounge)
      14. public offices,
      15. libraries,
      16. workplaces
      17. shopping malls
      18. cinema halls
      19. open auditoriums
      20. stadium
      21. railway stations
      22. bus stops
      23. public conveyances
      24. educational institutions,
      25. court buildings
      26. And the like which are visited by general public

      Q-4 Which opens spaces is covered under the Act as Public place?

      Ans: Open Auditorium, stadium, railway station, bus stop/stand, and such other such places.

      Q-5 What is to be done by Authorized officers/ Managers of Public Places to ensure that smoke-free laws are implemented in their jurisdictions?

      1. Display boards as per specifications in non smoking areas.
      2. Notify and display the name of a person to whom a complaint may be made, in case someone is found violating the law.
      3. Train and inform the persons within the institutions responsible for implementing the Act, including their duties, responsibilities under the law. The consequence of non-compliance should be spelt out. Also, train the enforcers about the mechanism of issuing challan / compounding of offences and imposing fine.
      4. Educate the staff about the provisions of the smoke-free rules.
      5. Constitute a core group/task force for regular monitoring, surprise checks to and ensure monitoring & compliance.
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