Ravi Mehrotra and Kavita Yadav
The fourth round of the Global Youth Tobacco Survey (GYTS-4) was conducted in 2019 by the International Institute for Population Sciences under the Ministry of Health and Family Welfare of India. These data provide a useful cross-sectional picture of youth tobacco use, and repeat surveys at regular intervals provide useful data over time which can be used to evaluate the impact of youth-focused interventions. The 2019 results have brought a glimmer of hope for all tobacco control professionals in India. However, several factors need to be considered before prematurely celebrating this success story.
Although the national figures show a decline in the use of tobacco with a 42% reduction in tobacco use among 13-15 year olds in the last decade, some state-specific figures are still alarming with North-eastern states like Arunachal Pradesh and Mizoram each reporting 58% of students (aged 13 and 15) regularly using tobacco. On the other hand, states like Himachal Pradesh and Karnataka fared better with only 1.2% of students using tobacco.[2] These data could help policy-makers to concentrate their efforts in the high-prevalence states and apply the lessons learnt from the better-performing states.
Challenges
A point of concern is that the survey reported the “ever use” of e-cigarettes among the students to be 2.8%. However, e-cigarettes have only been banned in the country since 2019, and the results of the survey may have pre-dated the ban. This should be explored further to ascertain when and how the e-cigarettes were procured by students. This would not only reveal the most common sources of procurement but also shed light on whether the e-cigarette ban has been effectively implemented across the country or not.
Another cause of concern is that 38% of cigarette, 47% of bidi smokers and 52% of smokeless tobacco users initiated this use before their 10th birthday. This suggests that tobacco companies are still succeeding in luring the youngest of their clients, even before they reach double figures.
Another concerning finding was that 45% of young cigarette and 47% of bidi smokers were able to buy bidis and cigarettes in shops when they ought to have been refused because of their age. (As per law, the sale of tobacco to minors is a punishable offence). This raises a question on the effective implementation of the tobacco control laws. However, this is a slight improvement since 2009, where 56.2% of minors were able to buy cigarettes/bidis underage.
It is also disheartening to report that 29% of students still get exposed to second-hand smoke in 2019 vis-à-vis 36.6% in 2009.
Successes
Data on quitting attempts bring a sigh of relief as 27% of current users of smokeless tobacco tried to quit the habit in the past 12 months and another 25% wanted to quit. As India is the largest user of smokeless tobacco products, these results are encouraging. It is hoped that these figures increased further recently when strict COVID-19 regulations prohibited spitting in public places to attempt to curb the spread of the virus.
Nearly 52% of students noticed anti-tobacco messages in the mass media which is a testament to the success of such campaigns. This is in contrast to only 18% of students who noticed advertisements promoting tobacco use at points of sale, this could be either due to indifference or due to gaps in the implementation of the tobacco control guidelines.
These findings represent the success and failures of the ongoing tobacco control activities in India. The highs and lows reveal that though considerable progress has been made, there is still much to be achieved. Nevertheless, the results to date encourage, bolster their morale and bring a smile to the faces of those who work tirelessly in the world of tobacco control.
Prof Ravi Mehrotra, MD, DPhil is CEO and Founder of the CHIP Foundation. Dr Kavita Yadav, BDS, MPH, is a Public Health Researcher at the CHIP Foundation.