The key to fighting the tobacco menace is engaging the youth at the forefront of the battle, with youth focused tobacco control programs as well as policies and youth-led health advocacy. According to the World Health Organization, nearly 80 percent of the all adult smokers begin before 18 years of age. In India, 5500 youth initiate smoking every day. Of 1000 teenagers smoking today, 500 will eventually die of tobacco related diseases – 250 in their middle age and 250 in their old age. The most susceptible time for initiating and experimenting with tobacco use in India is during adolescence and young adulthood, between 15-24 years of age. Estimates from the Global Tobacco Youth Survey (GYTS) show the growing concern of tobacco use by youth in both developed and developing countries. Nearly 15 % of Indian youth use tobacco in one form or the other — smoking or smokeless forms.
Tobacco is the single largest preventable cause of death world over and a growing public health concern for present and future generations. Tobacco is a cause of various non-communicable diseases (NCDs) and a risk factor for 6 of the 8 leading causes of death in the world. The burden of the tobacco epidemic is greater in developing countries. By 2030, developing countries will account for 70% of all tobacco deaths. Many of these deaths will occur during the productive years of life.
With youth tobacco use reaching epidemic proportions and the tobacco industry on the prowl aiming directly at vulnerable sections like the youth, it is imperative that youth and young adults are made conscious of the public health threat that is tobacco. Therefore, inculcating ‘refusal skills’ or the ability to say ‘No’ to tobacco offers and helping them become vigilant towards industry strategies are vital for sustaining tobacco control efforts world over. In fact, research shows that when children have the opportunity to practice saying ’No” to offers of tobacco, before the offer occurs they are much better prepared to resist such offers.
A study conducted by HRIDAY (Health Related Information Dissemination Amongst Youth) in 2008 to assess the receptivity and exposure to tobacco marketing amongst youth found that tobacco advertising is positively related to tobacco use amongst youth, especially girls. The predatory nature of tobacco marketing influences consumer behaviour and reaches out to users and potential users in an attractive and deceptive manner. Tobacco industry messages present tobacco as glamourous and ‘cool’ — giving boys a false perception of style and girls, a false sense of freedom and emancipation. Although India has banned all forms of direct and indirect advertising, promotion and sponsorship under the Indian tobacco control law, Cigarettes and Other Tobacco Products Act (COTPA), 2003, the tobacco industry continues to employ clandestine yet aggressive ways to reach out to its target — the youth.
Apart from marketing various types and flavours of tobacco in colourful packaging, tobacco companies spend millions of rupees on sponsoring sports events, teams, and sports stars. Whether cricket or motor sporting like Formula One, these companies invest in imagery, suggesting a strong relationship between sporting excellence and tobacco use.
Tobacco companies are also harnessing the growing popularity and reach of social networking sites like Facebook and Twitter. They also host promotional activities, games and videos on their company websites.
Bollywood and other regional films glamorise tobacco use on screen. Many teenagers light their first cigarette or use tobacco after watching their favourite actor smoke or use tobacco on screen. Tobacco companies also tie up with filmmakers to have their products strategically placed in movie scenes. Studies in India and across the world show a strong link between tobacco use in films and youth tobacco use. Â India has been recognized and commended for becoming one of the first countries to introduce strict regulations on depiction of tobacco use in films. Yet, the film fraternity continues to violate these rulings through rampant tobacco use representations on screen and promotional materials on grounds of creative freedom.
The tobacco industry also sponsors various events like talent contests at the school and college level, bravery awards, and fashion events to enhance its social quotient. Â Tobacco companies sponsor contests which often require the purchase of tobacco products to enter competitions. Prizes are attractive and include cash, gold, key chains and cars among others. In India, tobacco companies also distribute free samples of tobacco products in public places such as shopping malls, rock concerts and discos to attract new users.
To counter these powerful tactics of the tobacco industry, youth must be informed about the various dangers of tobacco use during their formative years. One successful measure in this regard has been HRIDAY’s school-based tobacco use prevention program Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India). Project MYTRI’s two-year school intervention, based on social cognitive theory, involved four primary components including (i) classroom curricula; (ii) school posters; (iii) parent postcards; and (iv) peer-led health activism. Among its major findings, Project MYTRI concluded that the rate of current tobacco use among students who participated in the intervention program reduced by 17% Â vis-Ã -vis students in the control schools where current tobacco use increased by 68%. As the only successful and scientifically evaluated school-based tobacco use prevention program in India, MYTRI supported the inclusion of school health programs in India’s National Tobacco Control Program (NTCP) in 2007. In fact, the recently released US Surgeon General’s Report 2012, which focuses on ‘Preventing Tobacco Use Among Youth and Youth Adults’ cites and recognizes the effectiveness of programs like Â MYTRI as successful school-based multi-component tobacco interventions.
One of the key components of MYTRI was imparting life skills and peer-leadership training for youth to voice their health priorities. Youth advocacy is integral to the success of tobacco control not just in India but world over. Along with bringing in energy and creativity to the movement, youth engagement provides an opportunity to young people change social norms and affect change by voicing concerns to improve the policy environment.
For instance, youth-led advocacy efforts on banning tobacco advertising and calling for stronger pictorial health warnings have been recognized by the Government. Â Youth involvement in tobacco control efforts also reinforces the need to strengthen tobacco control policies, especially restrictions on youth access to tobacco.
India’s tobacco control law — COTPA (Control of Tobacco Products Act) — includes provisions to restrict youth access to tobacco, including bans on advertising and sale to and by minors. The law also prohibits sale of tobacco within 100 yards of all educational institutions. Yet, implementation of these provisions is far from effective. Therefore, there is also a need to monitor and report such violations to law enforcers for immediate action. Engaging youth in such monitoring exercises is also important and effective. Â Strategies to curb a global epidemic like tobacco use require an integrated, multi-disciplinary understanding of its varied determinants along with multi-sector interventions for a positive influence. While the success of the global tobacco control movement must be attributed to the development of a broad platform of stakeholders and the identification of specific action areas for targeted advocacy such as smoke-free public places, ban on tobacco advertising, raised tobacco taxes and effective pictorial health warnings, investing in youth engagement is central to building a sustainable movement to safeguard the health of millions at present and in the future. Protecting youth from the hazards of tobacco requires the combined effort of Government, parents, teachers, media and civil society.
WHO has announced ‘Tobacco Industry Interference’ as the theme of this year’s World No Tobacco Day’ to be observed on May 31st. Mounting evidence of a strong tobacco lobby in India and across the world serves as a clarion call to strengthen efforts for effective implementation and regulation, through coalition of stakeholder groups and the spirit of youth.