Prevailing challenges of quitting smoking in India despite viable measures, ET HealthWorld

By Dr Chandrakant S Pandav

The resolve to quit smoking can go up in smoke sooner rather than later. This is because while struggling to quit smoking, smokers often must fight a huge psychological battle as they face a dual challenge: suppressing the cravings and strengthening the urge to withdraw at the same time. To overcome this intrinsic challenge, balancing behavioural support and alternative approaches that smooth the cravings has been recognised for a long time as an effective measure to help smokers quit without leaving shadows of side effects on their health.

Given the numerous interventions for quitting in place, the number of smokers continues to rise, as 80% of smokers continue to smoke one year after quitting. The latest WHO report shows that smoking tobacco results in an estimated 8 million deaths per year globally, which are mostly preventable. More so, of the estimated 1.1 billion smokers globally today, over 100 million are from India. And India is still projected to have more than 80 million smokers in 2025.

The rising number of smokers is due to the failure of administrations globally to implement tobacco control measures, which is predicted to result in one billion tobacco-related deaths in the 21st century. Though the WHO Framework Convention on Tobacco Control (FCTC) implements tobacco control policies such as price and tax increases, pictorial warnings, and prevention of smoking in public and workplaces, the reduction in smoking prevalence is quite low—a measly 1% per year, approximately.

The reason behind the sub-optimal result in quitting smoking is probably the lack of focus on health-related approaches to tobacco control, thus resulting in the failure to directly address smoking cessation and harm reduction strategies, which can enhance improvements in health outcomes.

According to the National Health Policy, India has set a target of reducing tobacco use by 30% by 2025. However, to achieve this target, besides other measures, the adoption of wide-scale tobacco harm reduction sounds most promising.

Quitting smoking is not an overnight exercise, as it’s a tough task for smokers. It has also been found that initially, those who want to quit tend to do so without assistance. But their initial efforts often fail to give the desired result because only 7% of quitters succeed, if reports are to be believed. However, the resolved quitters switch to alternate feasible solutions that satisfy their urges and simultaneously reduce the harm of smoking, eventually leading to cessation.

If we talk about switching to alternate feasible solutions, over the past decade, alternative nicotine products have evolved and are currently used by almost 100 million people. Other feasible alternatives for quitting include heated tobacco products (HTPs) or heat-not-burn (HnB) products, which are replacing combustible tobacco products in many countries and have resulted in a substantial decline in smoking rates. In Japan alone, cigarette sales have fallen by an unprecedented 42.4% since 2015, before the introduction of HTPs.

From across the world, the voice for harm reduction has been gaining ground. And the most recent Cochrane Review (September 2021) concluded that vaping with nicotine liquid was 53% more effective than nicotine replacement. In nicotine replacement therapy (NRT), such products supply low doses of nicotine. These products do not contain many of the toxins found in smoke. The most popular NRT products are nicotine patches, gum, lozenges, nasal sprays, and inhalators. However, these products haven’t borne the desired result for smokers to suppress the urge or kick the habit in India.

Despite concerted efforts towards quitting smoking, India still has the second-largest tobacco-consuming population in the world. Now is the right time for Indian policymakers to reimagine the existing policies and look at safer alternatives. The effective ban on safer tobacco alternatives in the current policy discourages millions of adult smokers who wish to choose safer alternatives to quit.

To revitalise the policies, the policymakers can initiate consultations at the ground level with consumers, public-health analysts, and researchers to develop a progressive and evolving regulatory framework. Likewise, running public education campaigns to counter nicotine risk misinformation is equally important. Legitimate inclusion of tobacco harm reduction (THR) in Indian national policies would also be one of the prudent and effective steps that will aid a larger chunk of the population in quitting smoking.

Dr. Chandrakant S. Pandav is a global public health expert and Padma Shri Awardee. He was the former Professor and Head of Department at the Centre for Community Medicine, AIIMS, New Delhi. Currently, Dr. Pandav is a member of the National Council on India’s Nutritional Challenges under the Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN ABHIYAN).

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