Not only are the bans against advertising of tobacco products and their sales ineffective, new, insidious ways of pushing tobacco sales are coming up.

 

Ahmedabad: It is not easy for a 13-year old studying in Class 8 to admit he is addicted to tobacco, but after several rounds of discussion on the harmful effects of tobacco, in a government school in Ahmedabad, young Nitin (name changed) came up to the counsellor after school hours and surrendered four packets of miraj, a tobacco based intoxicant that comes in small packets for Rs 5 and Rs 10. He confessed he was consuming two packets a day, after mixing it with lime, which comes in a semi-liquid form in a tube.

In an urban slum area of Ahmedabad, while trying to improve the diet of a malnourished three-year-old migrant girl, health workers of NGO CHETNA found she was picking up small pieces of chemically soaked supari from her father’s daily supply. She stopped eating supari after the intervention, but when the team saw her again after a break of two months, she was back to eating small pieces from her mother’s packet along with the prescribed nourishing bowl of porridge. When parents, both father and mother, eat paan masala, mava, khaini, gutka and other tobacco-based intoxicants, it is difficult to stop children from imbibing it. It is easily available in their homes and they pick up the habit without knowing the consequences.

Contrary to popular perception, consumption of tobacco seems to be on the increase, which is why health, education and nutrition specialist CHETNA, with support from the Salaam Mumbai Foundation, has taken on the challenge of making 823 government schools tobacco free in Ahmedabad villages and city. Based on their experience with the three-year-old, it has decided to integrate anti-tobacco inputs into all its activities. The tobacco free schools programme, started in 2016, was slated for Gandhi Nagar district too. In fact it started in 10 secondary schools, but there was so much resistance from school principals, teachers and traders that it had to be dropped.

According to Malav Kapasi, working with the tobacco free schools programme, 34.5% of children below 18 in Gujarat consume tobacco in some form—smoking or anti-smoking. Gutka ban was imposed in 24 states and three Union Territories in May 2013. In Gujarat the production and sale of gutka was stopped even earlier, from September 2012. However, the Global Adult Tobacco Survey (GATS) of 2016-2017 in Gujarat showed that the prevalence of tobacco use among 15 to 17 years has decreased from 6% in 2009-2010 (GATS-1) to 3.5% in GATS-2. However smokeless tobacco use in the 15 to 24 age group is much higher than smoking.

It is also a fact that despite the ban on advertising of cigarettes and tobacco products, many Bollywood stars promote pan masala and other products on radio and TV. It is difficult for young minds to reconcile to the advice of the counsellors and social workers when they see the products being promoted by big guns of Bollywood.

CHETNA’s programme focuses on adolescents of 10 to 19 years and tries to ensure implementation of the 11 criteria given by the Central Board of Secondary Education for making schools tobacco free. These vary from display of a tobacco free school board on boundary wall of school to no sale of tobacco within a radius of 100 yards of the school to no smoking/chewing of tobacco inside the school by students, teachers, other staff and visitors. Schools have also to carry posters giving information on the harmful effects of tobacco and should have a tobacco control committee.

While implementing the tobacco free schools programme, it was found that principals as well as male teachers in many schools are addicted to tobacco chewing. They confessed it was a habit that they had from childhood and since it was socially accepted to meet friends and share tobacco, they did not try seriously to shake off the habit. More alarming was the realisation that teachers sent out children to pick up their preferred sachets of tobacco.

In the first round of counselling, teachers were convinced not to send children to buy tobacco for them and not to chew it in school. In Umedpura primary school, Detroj block, it took five months to get the principal and five teachers out of the tobacco chewing habit. Changes were evident after three months of intervention but the team persisted till they were sure the habit had been broken. The principal was a heart patient and it could be due to tobacco chewing, the social worker pointed out.

There is discussion and audio visual presentation on the side effects of tobacco. Breathlessness, hand tremors, unsteady gait while walking, impaired hearing, TB and cancer could all be due to tobacco chewing. It is estimated that 210 of a 1 lakh population in Gujarat has tuberculosis. In 2015, it was 180 of a 1 lakh population that had TB. In 2016, 211 of a 1 lakh of tobacco consumers suffered TB.

To ensure that the 11 criteria for tobacco free schools are adhered to, CHETNA works closely with the Education Department of Gujarat. The problem is evident from Class 9 onwards, though there was the case of an Class 8 student, who was addicted to a particular brand of tobacco. Forty-three teachers have been upgraded to master teachers for implementing the tobacco free schools programme. The master teachers in turn have trained 600 block level teachers.

In many schools there is brief discussion on the ill effects of tobacco after the morning assembly. Interesting snippets of information are prepared by CHETNA’s workers and shared with children who make the presentation. Sometimes a play on the impact of tobacco is staged at the schools.

There is also a move to felicitate children who motivate their parents to give up tobacco with the title of Ahmedabad Padma Shri, Padma Bhushan and Padma Vibhushan on the lines of the national awards.

However, the battle against tobacco seems endless. Not only are the bans against advertising of tobacco products and their sales ineffective, new, insidious ways of pushing tobacco sales are coming up! E-cigarettes are the new fad among upper and middle class adolescents in metros (not in Gujarat as yet) who can afford the smokeless cigarettes that could cost Rs 300 apiece. They are available at stationery, paan and cigarette shops as well as online. E-cigarettes have a battery which releases nicotine slowly into the bloodstream with each puff. This in turn releases the hormone dopamine which makes the smoker feel good. E-cigarettes can lead to nicotine addiction and increased risk for addiction to other drugs.

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