Interminable tobacco epidemic in India

Tobacco causes six million deaths globally every year and India accounts for one-sixth of the world’s tobacco-related deaths.^[1] The issue of tobacco control is complex in India, due to its cultural lineage and ease in availability. Tobacco control law in India (COTPA) was enacted in the year 2003,^[2] and yet, tobacco use has reached epidemic proportions. This pernicious problem is largely due to the fact that tobacco industries target the youth as they are easily influenced by the urban culture and peer pressure. Therefore the youth are prone to be reckless and exhibit risk taking behaviours. Greater than 50% of India’s population is below 25 years, and nearly 37% of children in India initiate tobacco use at the age of 10 years.^[3] Furthermore, the proportion of Indians taking up tobacco habit grows by 2–3% every year.^[4]

According to COTPA, the sale of tobacco products is banned for up to 100 yards from an educational institution, and sale to minors is prohibited; yet, the percentage of youth taking up tobacco habit in India is skyrocketing. We conducted an IRB approved shoe leather survey to document the density of tobacco retailers within 100 yards from educational institutions in Chennai metropolitan city. A total of 57 retailers around 27 random institutions were surveyed and 94.7% of them sold smoked and smokeless tobacco, of which 31 were shops, 15 were cafes, and 8 were temporary settlements meant only for the sale of tobacco. About 73% of point of sale were located within 10 m from the institutions. Surprisingly, only one institution displayed tobacco ban and only one retailer had a ban on tobacco sale to minor signage which is mandatory for all schools and vendors according to the government of India. Tobacco industry is primarily targeting the youth in developing countries where the global burden of tobacco is concentrated. The present alarming trend of tobacco use is estimated to cause 10 million deaths globally by 2020–2025, of which 70% are expected in the developing world.^[5] India already contributes to one-sixth of global tobacco burden, and if sufficient measures are not adopted by the authorities, it surely will be an immutable problem by 2025.^[1] Globally 1.1 billion people smoke, of which 182 million are Indians.^[4] Retailers are the terminal end to the tobacco distribution system; and a downstream approach adopted by the regulatory body without curbing the upstream flow is a serious flaw in the tobacco trade regulation. In conclusion, the unrestricted availability and enactment nonfeasance of tobacco control law around educational institutions in Chennai shed light on the deterring hope in reversing the prevalent tobacco epidemic among youth in India. As a signatory to the FCTC, it is high time the government of India takes appropriate action to effectuate anti-tobacco legislation to lower the tobacco burden in India and thereby reducing it globally.