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Tobacco: Deadly in any form or disguise
Prof. Dr. N Islam

          TOBACCO is currently responsible for the death of one in ten adults worldwide, about 5 million deaths each year. If current smoking patterns continue till 2020, it will cause some 10 million deaths each year. Half the people who smoke today will eventually be killed by tobacco.
With current smoking patterns, 500 million people alive today will eventually be killed by tobacco use. More than half of these people are now children and teenagers.
By 2030 tobacco is likely to be the single biggest cause of death worldwide, according to a World Bank report of 1999. In the world as a whole, tobacco already kills 1 in 10 adults. By 2030 it is likely to kill one in six, or more than 10 million deaths a year. Majority of these deaths will be in low-income or middle-income countries.
To discourage smoking and to create awareness about the fatal effects of smoking in this country ADHUNIK (we prevent smoking) was established in 1987 and the first World No Tobacco Day was observed in 1988 highlighting a theme of the WHO -- "SMOKING OR HEALTH: CHOOSE HEALTH".
Since then ADHUNIK has been observing the World No Tobacco Day every year. The function includes rally comprising students, nurses, doctors, members of the medical profession, representatives of the country-wide branches of ADHUNIK and volunteers. A press conference is held to highlight the theme and enlighten the public about the significance of the day. The activities receive wide publicity in the national dailies and encourage many to quit tobacco and strengthen anti-tobacco movement in the country.
When Tobacco became a target for anti-tobacco lobbying, the researchers of the giant tobacco companies found alternatives. They put their attention to smokeless tobacco. People thought that these are harmless and safer than smoking.
In our South Asian sub-continent, smokeless tobacco enjoys popularity and social prestige. Even a poor man in the village would offer a guest in the house a pan (betel leaf) and supari (nut) with some jarda (tobacco leaf powder).
Cigarette smoking has some social inhibition in our sub-continent. A young boy or a junior would hesitate to smoke a cigarette before the seniors, which is considered as beyadobi or unpolite behaviour and is hated by parents and society. Consequently, children would never smoke before parents and teachers or else they would earn severe warnings and punishment. Hubble-bubble (Hukkha) is another form of smoking where tobacco powder is burnt.
Smokeless tobacco is equally addictive and harmful. The WHO has estimated that worldwide smokeless tobacco is used by up to 400 million people, causing about 100,000 deaths a year in men and 50,000 in women. Smokeless tobacco contains more than 2,000 chemicals, a number of which may be cancer-causing. Just as much nicotine is absorbed through it as in smoking.
In India, Bangladesh and Pakistan the use of oral tobacco is widespread. In some areas of these countries, it is popular among people of all ages, and in women as well as men. Its production was originally a peasant industry but oral tobacco is now being manufactured and widely advertised by industrial companies.
In some countries in Central Asia up to 20 per cent of adults use nass. Dry snuff contains powdered tobacco and additives inhaled in South Africa and Europe.
Many studies have shown the relationship between smokeless tobacco and cardiovascular diseases. In Sweden a large study showed a 40 per cent higher risk of cardiovascular mortality among smokeless tobacco users compared to non-users.
The amount of nicotine absorbed from smokeless tobacco has been found to be 10 times more than that found in one cigarette. Smokeless tobacco, therefore, exposes to higher dosages of nicotine and more heavily addictive. Consequently, it becomes more difficult for the users to give up this deadly habit.
Even though statistical figures are not available in Bangladesh social customs and freedom of use and ignorance make smokeless tobacco popular among women so much so in some rural areas that more than 60 per cent women use smokeless tobacco as a safe method of tobacco use. As a result in clinical practice, we come across patients with horrible look having the destruction of cheeks and gums due to long use of tobacco. It is estimated that these smokeless tobacco users face the same risk as the smokers as the toxic elements of tobacco are absorbed through the buccal mucosa and carried to the different parts of the body as the smoking of tobacco.
It is, therefore, evident that no form of tobacco and no method of use of tobacco is safe. Smokeless tobacco is more or as harmful as smoking tobacco because of the presence of chemical ingredients absorbed through the buccal mucosa in case of smokeless tobacco and through lungs in case of cigarette smoking. The misconception and social freedom for smokeless tobacco is a great hindrance and people use it with a sense of safety.
From all available scientific data it may be concluded that smokeless tobacco is by no means safer than tobacco use in other forms. It has been well said that smokeless tobacco is not harmless. It is equally or more addictive and harmful than smoking. We must all appreciate that tobacco is a killer in any form of its use. The crux of the theme of the WHO for this year's World No-Tobacco Day -- TOBACCO: DEADLY IN ANY FORM OR DISGUISE is, therefore, scientific, correct and proven. We must all work together towards creation of greater awareness of the message of the WHO theme of the WNTD for the health and welfare of mankind.
The writer is a national professor, reputed medical practitioner, Founder-Vice Chancellor, USTC and Founder-President of the ADHUNIK


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