Tobacco and Public Health - TCSC Indonesia

PRAKASH C. GUPTA AND CECILY S. RAY 257
hookah smoking and for chewing. Thereafter, bidi and cigarette smoking increased
tremendously with bidis becoming the predominant tobacco habit, (Sanghvi 1992).
In recent years India has been witnessing a resurgence of smokeless tobacco consumption
in industrially manufactured forms, especially amongst the young. By far most
tobacco products consumed are produced in the country.
Prevalence in the general population
Surveys conducted by the National Sample Survey Organisation (NSSO) during
1999–2000 found that at least one person in 62% of households consumed tobacco.
These data indicate that the north-eastern states have the highest prevalence of tobacco
use, other northern states the next highest, and the southern states the lowest. The
exception in the north is Punjab, showing the lowest prevalence, because of a high proportion
of Sikhs, whose religion forbids tobacco use. The lower income groups generally
prefer smokeless tobacco, the low to middle income groups favour bidis and higher
income groups prefer cigarettes, in order of the cost of the product.
The most accurate information on tobacco use prevalence comes from house-tohouse
surveys carried out in individual areas. In these studies, conducted over a 40-year
time span in different parts of India, the percentage using tobacco among men (>15 years
age) ranged from 19 to 86% and among women from 7 to 77% (Table 14.1). Overall,
tobacco use prevalence is higher in rural areas. Gender-wise, chewing habits are
practiced about equally by men and women, while most smokers are men. The prevalence
of chewing in men varied from 11 to 55% and in women from 10 to 39%. Smoking
prevalence varied from 8 to 77% in men and 2 to 12% in women with some exceptions.
In a few regional pockets where certain indigenous forms of smoking have been practiced,
women may smoke at equal or higher rates compared with men (Table 14.1).
In one study in rural Srikakulam, Andhra Pradesh, ‘reverse’ chutta smoking was practiced
by 59% of women and 35% of men. In rural Darbhanga, Bihar, smoking was
practiced by nearly 11.4% of men and 21.8% of women—mainly hookah smokers
(Mehta et al. 1971). Also, in an area of Orissa 85% of women smoked chuttas, compared
to 30% of men (Jindal and Malik 1989). Among school personnel in rural and
urban Bihar, 47.4% of men and 31% of women reported smoking (Sinha et al. 2002).
In a few areas, like Mumbai, both men and women tobacco users prefer chewing
(Gupta 1996). In some parts of Gujarat, like Bhavnagar and Ahmedabad, chewing of a
new product called mawa became very popular among young men during the 1980s
and ‘90s. During a survey carried out in 1993–94 in Bhavnagar, the prevalence of mawa
use was 19%, whereas in 1969 it was around 4.7% (Mehta et al. 1971; Sinor et al. 1992;
Gupta 2000).
Overall, tobacco use in India is inversely related to educational level except for cigarette
smoking (Gupta 1996). For example, nearly a third of highly educated men in
Delhi and Chandigarh reported smoking (Bhattacharjee 1994; Sarkar et al. 1990).