Tobacco is the common name of several plants in the genus Nicotiana of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. Tobacco is normally consumed in a variety of ways which include smoking bidi, cigarette, hand-rolled cigarette, pipe, cigar, hookah, water pipe and some other forms like chutta, dhumti and chillum. Smoking leads to disease and disability and harms nearly every organ of the body.
Use of tobacco is a serious public health issue in India having devastating impact. Tobacco consumed either as smoke or smokeless is perilous to the human body. Globally, around six million people are killed every year due to tobacco related diseases which is more than tuberculosis (TB), HIV/AIDS and malaria combined. Today India is the second largest producer of tobacco after China in the world. India is also the second largest consumer of tobacco in the world.
As per Global Adult Tobacco Survey, 28.6 percent (266.8 million) of people in India aged 15 and above currently use tobacco in some form. Among the adults 24.9 percent (232.4 million) are daily tobacco users and 3.7 percent (34.4 million) are occasional users. The prevalence of current tobacco use among men was 42.4 percent and among women it was 14.2 percent. Every third adult (32.5%) from rural areas and every fifth adult (21.2%) from urban area reported current use of tobacco.
Tobacco is deadly in any form or disguise. Scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. In addition to this, passive smoking contributes to approximately 41,000 deaths among non-smoking adults and 400 deaths in infants each year.

Tobacco in Jammu and Kashmir
In the Union Territory of Jammu and Kashmir, tobacco use whether smoking or non- smoking is very common. As per Global Adult Tobacco Survey, 20.8% of all adults in the Union Territory smoke tobacco of which 35.2% are men, 5.1% are women. There is additionally a lot of populace that consumes smokeless tobacco. Nearly 4.3% among all adults consume smokeless tobacco. Cigarette, hukkah and bidi are the three most commonly used tobacco items with 10.4%, 6.3% and 6.2% of adults using them, respectively. The mean age at initiation of tobacco use has increased from 17.2 years in GATS 1 to 18.0 years in GATS 2. The survey further reveals that 57.5% of all adults who worked indoors were exposed to second-hand smoke at their workplace while as 35.3% of all adults were exposed to second-hand smoke at any public place.

Measures Taken
National Tobacco Control Program (NTCP) began in the Union Territory of Jammu and Kashmir towards the end of 2016. Under the programme capacity building training for Chief Medical Officers, Pharmacists, Nurses and Asha workers has been conducted both at divisional Level as well as at district levels. The programme has also focussed on various awareness programmes for the youth with a view to sensitise them regarding health hazards associated with the use of tobacco. J&K government in May 2016 enforced a complete ban on the sale of loose cigarettes, loose bidis and loose tobacco in J&K with immediate effect in consonance with section 7 of Cigrattes And Other Tobacco Products Act, 2003. Besides this, a complete ban on e-cigarettes has also been placed in the Union Territory. For effective implementation of COTPA-2003, Challan mechanism has also been initiated to prevent violations under the Act. As per the data available under NTCP, 966 persons have been counselled, 79 challans have been issued to violators, and 6 training programmes have been organised up to June 2019.

Loopholes
Despite all these measures and a comprehensive legislation in place, consumption of tobacco in UT of J&K has largely remained unaffected which has posed increased health risks for the populace. According to Health of the Nation’s States Report prepared by Indian Council of Medical Research, 3,039 disability adjusted life years (DALY) are lost to tobacco use in Jammu and Kashmir. This is one of the highest among all the states and even compared to national average. The Union Territory has a 16-18% prevalence rate for COPD which again is higher than the national average of 5-7%. The practice of sale of loose cigarettes continues in the Union Territory. In addition to this, sale of imported cigarettes has also gone up. These cigarette packets are not structured according to the laws in India and either have no pictorial admonition or fewer ones. The biggest reason for this seems to be the ineffective implementation of National Tobacco Control Programme.
District Tobacco Control Cells under the programme have been established only in two districts (Budgam, and Jammu) of the Union Territory which is a measure loophole. Apart from this there are only two Tobacco Cessation Centres functional in the Union Territory. The data also depicts that none of the tobacco users from district Bandipora and Pulwama were counselled as of June 2019. Organisation of School Programmes pertaining to awareness about tobacco has also been on lower side. In fact, only 6 programmes have been conducted since the inception of the NTCP in 2016.

Way Forward
Tobacco use among young individuals, as well as among school pupils, should be viewed as a serious challenge that demands a holistic approach. Special attention should be paid to ensuring successful implementation of Cigarette and Other Tobacco Products Act, 2003 (COTPA) and National Tobacco Control Programme in the UT of Jammu and Kashmir. For this purpose, Central and State coordinating mechanisms should be set up to monitor and to enhance the effective implementation of tobacco control legislation. The NTCP must be extended to all the districts of the UT. Massive awareness programmes must be launched in schools, colleges, universities, villages, towns to sensitize people about health risks associated with tobacco consumption.

The writer is a research scholar at Aligarh Muslim University. [email protected]

AJAZ AFZAL LONE