The alarm bell on rising tobacco use in Northeast

 The incidence of cancer due to the use of tobacco products is the highest in the northeastern region of India. The seizure of huge quantities of illicit cigarette sticks smuggled across the India-Myanmar border in the recent period is only the tip of the iceberg of an alarming rise in tobacco use in the region. While the illicit market is causing huge revenue losses to the government, growing tobacco consumption has put more people in the region at risk of cancer. Industry estimates put the share of illicit cigarettes in India’s tobacco market at 30%. There is no alternative to building awareness about the harmful effects of tobacco use. More and more youth in the region using both smoke and smokeless tobacco raises questions about the effectiveness of the current awareness drive. Sights of school- and college-going students smoking cigarettes are becoming more common on the streets of Guwahati and other capital cities and towns. This calls for urgent intervention by the government and society before they become addicted to tobacco use and become vulnerable to developing cancer, heart disease, or stroke. Ironically, two decades have elapsed since India ratified the World Health Organisation (WHO) Framework Convention on Tobacco Control in 2004 and the Protocol to Eliminate Illicit Trade in Tobacco Products in 2018. The Global Audit Tobacco Survey, conducted jointly by the Tata Institute of Social Sciences in Mumbai and the Ministry of Health and Family Welfare, highlighted that while overall tobacco use in the country declined during the period between 2009–2010 and 2016–2017, Assam, Tripura, and Manipur registered a rise in tobacco use during this period, and prevalence in other states in the region was also much higher than the national average. The survey also brought to the fore another disturbing trend: minor children in three states—Arunachal Pradesh, Nagaland, and Sikkim—starting to use tobacco when they are not even 16 years old. Available data and various survey findings give a clear idea of the magnitude of the problem, but the challenge of controlling tobacco use has become tougher than perceived or anticipated. Preventing adolescents and youth from smoking or chewing tobacco requires multi-pronged approaches. Parents and teachers play a crucial role in guiding adolescents and youth to overcome peer pressure to initiate any harmful activities like smoking or tobacco use. They must encourage children to share whenever their peers pressurise them to indulge in anything that they perceive to be dangerous or wrong. When they share about such pressure, the parents and teachers can teach them how to say no to their peers or to stay away from their negative influence. If the children do not feel confident enough to share their experiences with their parents or teachers, they can be easily influenced by their peers. Parents or elders smoking in front of their children and asking them not to smoke will only increase curiosity in adolescents and teens to experience what they see. Besides, many smokers are not aware of how they are also putting non-smoking members in the family at health risk through passive smoking. The sale of tobacco products to and by minors under 18 years of age is prohibited in the country, but the increase cigarette smoking among minors clearly reflects that there have been no serious attempts to enforce the prohibition. Smoking in public places is prohibited and is a punishable offence, but more people smoking in public places shows that these prohibitions are merely on paper. Displaying the pictorial warnings on tobacco product packages is mandatory, but when retailers sell one or two sticks of cigarettes to smokers, including minors, the warning is not seen, and the purpose of the mandatory use of statutory warnings on the harmful impact of smoking is not achieved. Amending the current anti-tobacco laws to curb the loose sale of cigarettes and enforcing the prohibition of the sale of tobacco products to minors can significantly reduce smoking initiation among minors. The Parliamentary Standing Committee on Health and Family Welfare recommended a ban on the sale of loose cigarettes. Wider public opinion in support of this recommendation will prompt the government to rethink the existing policies and implement them to achieve the objectives of the anti-tobacco laws in force. States in the northeastern region can take the lead by making the sale of loose cigarettes illegal. Lessons must be learned from the tobacco control programme and an effective enforcement mechanism must be put in place when the government decides to implement the recommendations of the parliamentary standing committee as well as other ohibitions. The states in the region shy away from enforcing various prohibitions aimed at controlling tobacco use, which will only lead to a cancer burden of unmanageable magnitude. Both awareness and enforcement under the National Tobacco Control Programme need equal attention. It is time states in the region undertook serious efforts to ensure that awareness and enforcement do not remain symbolic.