1. The document discusses smoking habits in India, including the types of tobacco smoked as well as health risks. It provides statistics on smoking prevalence and related deaths in India. 2. Smoking is responsible for several diseases and premature death in India, killing over 900,000 people per year according to one study. Certain forms of smoking like bidis are associated with greater health risks than others. 3. The study found high smoking rates among Indian men, with over 60% of male smokers expected to die between ages 30-69, compared to 41% of non-smoking men. Female smoking rates were also linked to over 60% mortality for smokers versus 38% for non-smokers between ages 30-

1. Chapter I
Introduction
Smoking refers to the inhalation and exhalation of fumes from burning tobacco in cigars, cigarettes
and pipes. Smoking is one of the most common forms of recreational drug use. The history of
smoking can be dated to as early as 5000 BC, and has been recorded in many different cultures
across the world. Early smoking evolved in association with religious ceremonies; as offerings to
deities, in cleansing rituals or to allow shamans and priests to alter their minds for purposes of
divination or spiritual enlightenment.
Smoking tobacco has been used in India since ancient times. The most common method of smoking
today is through cigarettes, primarily industrially manufactured but also hand-rolled from loose
tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs,
vaporizers, and bongs In particular, the practice of smoking hookah, which is smoked using a single
or multi-stemmed water pipe (also known as a hookah), has been part of Indian culture for
centuries.
Smoking is the most common method of consuming tobacco, and tobacco is the most common
substance smoked. Smoking is responsible for several diseases, such as cancer, long-term (chronic)
respiratory diseases, and heart disease, as well as premature death. It also attacks the heart, liver
lungs, with a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease
(COPD) (including emphysema and chronic bronchitis), and cancer (particularly lung cancer,
cancers of the larynx and mouth, and pancreatic cancer).
Smoking kills 900,000 people every year in India according to a study published in the ‘New
England Journal of Medicine’ and conducted by scientists from India, Canada and the UK. The
study warns that without action, the death toll from smoking will climb still further. It predicts
smoking could soon account for 20% of all male deaths and 5% of all female deaths between the
ages of 30 and 69. The researchers have calculated that on average, men who smoke bidi - small
hand-rolled cigarettes common in India - lose about six years of life. Men who smoke full-size
cigarettes shorten their lives by about ten years and for women bidi smokers the figure is about
eight years. The figures are based on a survey of deaths among a sample of 1.1 million homes in all
parts of India carried out by about 900 field workers. It is estimated that there are about 120 million
smokers in India. The study found that, among men, about 61% of those who smoke can expect to
die at ages 30-69 compared with only 41% of otherwise similar non-smokers. Among women, 62%
of those who smoke can expect to die at ages 30-69 compared with only 38% of non-smokers.
Professor Amartya Sen, of Harvard University, said: "It is truly remarkable that one single factor,
namely smoking, which is entirely preventable, accounts for nearly one in 10 of all deaths in
India.”

2. Tobacco use is the greatest potentially remedial problem throughout the world, and it is the number
1 preventable cause of death in the developed world. Clinicians have a particularly important role as
patient advocates in health promotion, discouraging smoking initiation, encouraging and assisting
smoking patients to quit, and participating in social efforts designed to curb smoking at various
levels. The gains in understanding the neuropathology of nicotine addiction have already opened
new frontiers, including effective nicotine replacement therapy (NRT) and oral therapy. Greater
therapeutic advances are anticipated in the years to come.
A critical component of treatment is educating patients about the benefits of smoking cessation and
the cessation process. Provide a description of the expected withdrawal syndrome. Continue with a
discussion of the possible cessation methods, which include counseling, NRT, antidepressant
medications, behavioral training, group therapy, hypnosis, and quitting “cold turkey.” Successful
cessation is confirmed by measuring cotinine or carbon monoxide levels. More than 90% of
patients who attempt to quit smoking stop cold turkey. Professional group therapy or counseling
achieves an initial cessation rate of 60-100% and a 1-year cessation rate of approximately 20%.
Hypnosis and acupuncture are popular programs that might encourage renewed attempts by people
for whom other techniques have failed, but these modalities have not been shown to be any better
than placebo.
The use of smokeless tobacco products constitutes a small but growing segment that requires
special considerations in the design of treatment interventions. NRT does not increase smokeless
tobacco quit rates; however, of the pharmacologic options, varenicline shows early positive results.
Patients who quit smoking tend to gain weight; therefore, patients should be encouraged to follow a
low-calorie diet and exercise regimen during and after cessation. In patients attempting smoking
cessation, exercise has been shown to help curb long-term weight gain and to help alleviate nicotine
withdrawal symptoms.
Interventions designed specifically for weight-concerned smokers (e.g, an on-site exercise program)
improved smoking abstinence rates and delayed weight gain. Cognitive-behavioral therapy to
reduce weight concerns improved smoking cessation success and reduced weight gain. Smoking
may begin as a voluntary habit, but eventually it becomes an addiction. Health professionals can
contribute powerfully to motivating their patients to attempt and sustain cessation by offering
encouragement, advice, and assistance.

3. Chapter II
Review of Literature
According to Dr C. Kolappan, (Epidemiology Unit, Tuberculosis Research Centre, Chetput,
Chennai 600 031, Tamil Nadu, India) in his Article ‘Tobacco smoking and pulmonary
tuberculosis’ said “Tobacco smoking is a common habit among men in India. Two types of tobacco
smoking are prevalent among the study population—cigarettes and “beedi”. “Beedi” consists of
flaked tobacco rolled in a rectangular piece of dried Tendu leaf (Diospyros exsculpta). The Tendu
leaf is odourless and tasteless when smoked. Because of its smaller size, “beedi” may produce less
smoke than a cigarette……..Tobacco smoking is a common habit among men living in both rural
and urban parts of India, being generally more common in urban than in rural areas”
According to, Manju Rani( Indian Administrative Services, N-30, Bajaj Nagar Jaipur, India ) in
her Article ‘Tobacco use in India: prevalence and predictors of smoking and chewing in a
national cross sectional household survey.’ said “ In India, tobacco consumption is responsible for
half of all the cancers in men and a quarter of all cancers in women, in addition to being a risk
factor for cardiovascular diseases and chronic obstructive pulmonary diseases. India also has one of
the highest rates of oral cancer in the world, partly attributed to high prevalence of tobacco
chewing. Forms of tobacco chewing include pan (piper betel leaf filled with sliced areca nut, lime,
catechu, and other spices chewed with or without tobacco), pan-masala or gutkha (a chewable
tobacco containing areca nut), and mishri (a powdered tobacco rubbed on the gums as toothpaste).
The World Health Organization predicts that tobacco deaths in India may exceed 1.5 million
annually by 2020. However, considerable research is required to comprehend the actual trends.
Nationally representative and reliable prevalence data on tobacco consumption are scarce.
Similarly, the socio demographic predictors of tobacco smoking and chewing are poorly
understood. The existing studies on prevalence of tobacco use are based on non-representative
sample surveys or have been conducted in localised—mostly urban—geographical areas as
reviewed in table 1 WHO estimated a prevalence of tobacco consumption of all forms at 65% and
33%, respectively, among men and women, based on small scale studies conducted in the past”.

4. Chapter III
Objective of the study
The purpose of this research is to survey and analysis associations between individual smoking
habits in people living in different parts of the world and to assess to which extent smoking habits
are related to
- smoking policies
- knowledge of the health consequences of smoking
- attitude toward preventive practices related to smoking, alcohol, diet and exercise
- smoking habits (use, addiction, dependence, tolerance)
For testing the relationship, the following null hypotheses are formulated:
1. There is no relationship between smoking habits and smoking policies
2. There is no relationship between knowledge of health consequences of smoking, smoking
habits and smoking policies
3. There is no relationship between smoking habits, attitude and smoking policies
4. Smoking habits are same all over the world

5. Chapter IV
Sampling and Methodology
Research will be done on population in Kolkata slums, town and rural parts in India, in people age
from 18-70 years, both sexes(male and female)
Tools:
For screening: CAGE questionnaire (I).
For assessing nicotine addiction: modified Fagerström questionnaire will be used (II).
For the attitude towards smoking: Attitude questionnaire, Beliefs questionnaire, yes/no statements
Smoking policies will be provided from the Governmental websites
Design:
Multilevel analysis of cross-sectional data from surveys and questionnaires
Location:
Kolkata
Time frame:
Project should take approximately 3 months to complete field work and around a further 3 months
for data analysis and proposals.
Problem of Data Collection

6. Chapter V
Major Findings.
Table No 1
Age and Sex Distribution
SL. No Age Male Female
1 18- 20 years 150(15.51%) 10(30.0%)
2 21- 25 years 199(20.57%) 20(60.6%)
3 26- 30 years 272(28.12%) 0
4 31-35 years 76(7.85%) 0
5 36-40 years 46(4.75%) 2(6.06%)
6 41- 50 years 120(12.40%) 1(3.03%)
7 51 years old or older 104(10.75%) 0
Total 967 33

7. In the table no 1 the age and gender distribution of the respondents is shown. Out of 1000
respondents, it is seen that 967 is male and 33 is female. Between the age group of 18- 20 years
male is150(15.51%) and female is10(30.0%), followed by 21- 25 years male 199(20.57%) and
female 20(60.6%), 26- 30 years male is272(28.12%), 31-35 years male76(7.85%), 36-40 years
46(4.75%) male and 2(6.06%)female, 41- 50 years 120(12.40%)male and 1(3.03%)female , 51
years old or older104(10.75%) male. The table is shown in graph no 1
Table No2
Education
SI. No Level of Education Respondents
1 Primary 45(4.5%)
2 Secondary 326(32.6%)
3 Higher 349(34.9%)
4 Technical 187(18.7%)
5 Student 0
6 Prefer not to answer 93(9.3%)
Total 1000

8. The table 2 shows the level of education of the respondents. 45(4.5%) respondents have primary
level of education, 326(32.6%) have secondary level of education, 349(34.9%) have higher level of
education, 187(18.7%) have technical level of education where as 93(9.3%) did not prefer to answer
the question. The graph is shown in Fig No 2
Table No 3
Screening on Dependence
SI.
No
Types of
Dependency
Yes No No answer
1 Need to cut
down or
control
smoking but
had difficulty
264(26.4%) 708(70.8%) 28(2.8%)
2 Get annoyed
or angry with
people who
criticize your
smoking or
tell you ought
to quit
smoking
213(21.3%) 754(75.4%) 33(3.3%)
3 Felt guilty
about your
smoking
135(13.5%) 837(83.7%) 28(2.8%)

9. 4 Smoked
within half an
hour of
waking up
223(22.3%) 749(74.9%) 28(2.8%)
Table 3 indicates the types of dependency the respondents have with regard to their smoking habits.
264(26.4%) respondents said yes they need to cut down or control smoking but have difficulty,
708(70.8%)respondents said no, and 28(2.8%)respondents did not answer the question.
213(21.3%)respondents said yes they get annoyed or angry with people who criticize their smoking
or tell them ought to quit smoking, 754(75.4%)said no, and 33(3.3%)did not answer the question.
135(13.5%)said yes they feel guilty about your smoking, 837(83.7%)said no, and 28(2.8%)
respondents did not answer the question.
223(22.3%) respondents smokes within half an hour of waking up, 749(74.9%) respondents do
not smoke within half an hour of waking up, and 28(2.8%)respondents did not answer the
question.
Table No 4
Score obtainedin respect ofintensityof smoking(Maximumlimit: 10, Minimumlimit:0)
Sl. No. Score Obtained Respondents
1. 0 points 758(75.8%)
2. 1 points 55(5.5%)

10. 3. 2 points 31(3.1%)
4. 3 points 7(0.7%)
5. 4 points 39(3.9%)
6. 5 points 64(6.4%)
7. 6 points 20(2%)
8. 7 points 16(1.6%)
9. 8 points 10(1%)
10. Total 1000
In the table no 4 the score obtained in respect of intensity of smoking of the respondents(Maximum
limit: 10, Minimum limit: 0) is shown. 758(75.8%) respondents obtained 0 points,
55(5.5%)obtained 1 point, 31(3.1%)obtained 2 points, 7(0.7%)obtained 3 points, 39(3.9%)obtained
4 points, 64(6.4%)obtained 5 points, 20(2%) obtained 6 points, 16(1.6%)obtained 7 points, 10( 1.%)
obtained 8 points.
Table No 5
Beliefs of the respondents
Sl.
No.
Types of
thinking
Respondents
Yes No Don’t Know
1. You have to
smoke if you
are with friends
who smoke
144(14.4%) 375(37.5%) 481(48.1%)
2. My parents
(spouses,
employers…)
should not
allow me to
smoke
290(29%) 315(31.5%) 395(39.5%)

11. 3. Teachers
(doctors,
nurses) should
not be allowed
to smoke
268(26.8%) 301(30.1%) 431(43.1%)
4. Advertising of
tobacco should
not be
permitted
345(34.5%) 312(31.2%) 343(34.5%)
5. Cigarettes
should be more
expensive to
stop the young
from smoking
453(45.3%) 200(20%) 347(34.7%)
6. Smoking
should not be
permitted at
public places
408(40.8%) 259(25.9%) 333(33.3%)
The table no 5 points out the facts about the smoking habits of the respondents. 144(14.4%)
respondents said yes they have to smoke if they are with friends who smoke, 375(37.5%) said no,
481(48.1%) said they don’t know.
290(29%) respondents said yes their parents (spouses, employers…) should not allow them to
smoke, 315(31.5%) said no, 395(39.5%) said they don’t know.

12. 268(26.8%) respondents said yes teachers (doctors, nurses) should not be allowed to smoke,
301(30.1%) said no, 431(43.1%) said they don’t know.
345(34.5%) said yes advertising of tobacco should not be permitted, 312(31.2%) said no,
343(34.5%) said they don’t know.
453(45.3%) said yes cigarettes should be more expensive to stop the young from smoking,
200(20%) said no , 347(34.7%)said they don’t know.
408(40.8%)said yes smoking should not be permitted at public places, 259(25.9%)said no,
333(33.3%)said they don’t know.
Table No 6
Attitude of the respondents
Age of starting smoking.
Serial No Age in years Respondents
1 Younger than 15 75(7.5%)
2 Between 16-20 242(24.2%)
3 Between 21-25 93(9.3%)
4 Between 26-30 0
5 Between 31-35 0
6 Between 36- 40 0
7. Between 41- 50 0
8. Older than 50 0
9. Prefer not to answer 590(59%)
Total 1000

13. In table No 6 the age of the respondent when he/she first started smoking. is noted. 75(7.5%)
respondents started smoking when he/ she was younger than 15 years, followed by 242(24.2%)
between 16-20, 93(9.3%) between 21- 25 years, whereas 590(59%) preferred not to answer the
question.
Table No 6/a
Cause of starting smoking
Serial No Probable Causes Respondents
1. Peer Pressure 152(15.2%)
2 Rebel against authority 24(2.4%)
3 To appear more adult 47(4.7%)
4 Because it is “cool” 24(2.4%)
5 Close family member is smoking 0
6 My idol is smoking 121(12.1%)
7 Other (specify) 0
8 No answer 632(63.2%)
Total 1000

14. In No 6/a the respondents have cited the probable causes for starting smoking which is as follows.
632(63.2%) respondents did not give any answer when the question was asked, 152(15.2%) said
peer pressure, 121(12.1%) said they smoke because their idol smokes, 47(4.7%) said they smoke
because they want to appear more grown up, 24(2.4%)respondents said, they smoke to show rebel
against authority whereas 24(2.4%) said it is “cool” to smoke. The table is shown in Fig No 6/a.
Table No 6/b
Getting from Smoke
Serial
No
Particulars Respondents
1 It relaxes me 160(16%)
2 It helps me concentrate 100(10%)
3 It gives me something to do with my hands 8(0.8%)
4 It an excuse for approaching interesting
people
1(0.1%)
5 It gives me confidence boost 88(8.8%)
6 I don’t know 643(64.3%)
7 Other 0
Total 1000

15. The Table No 6/b lists out the answers of the respondents stating their responses what they get
when they smoke. 643(64.3%) respondents listed their response as “I don’t know”, 160(16%) said it
relaxes me, 100(10%) said it helps me concentrate, 88(8.8%) said it gives me confidence boost
8(0.8%) said it gives me something to do with my hands, 1(0.1%) said it an excuse for approaching
interesting people. The table is graphically shown in Fig No 6/b.
Table No 7
Why people start smoking
Serial No Answers Received Respondents
1 Concentration 48(4.8%)
2 Don’t Know 558(55.8%)
3 For Experiment 24(2.4%)
4 For style 22(2.2%)
5 Out of interest 16(1.6%)
6 It is a personal matter 22(2.2%)
7 For idle time pass 5(0.5%)
8 Peer Pressure 76(7.6%)
9 Relaxation 111(11.1%)
10 To feel like a hero 54(5.4%)
11 To feel mature 64(6.4%)
Total 1000

16. The above table No 7 enlists different answers of the respondents on their views why people start
smoking. 558(55.8%) respondents said don’t know, 111(11.1%) said for relaxation, 76(7.6%) said
for peer pressure, 64(6.4%) said to feel mature, 54(5.4%) said to feel like a “ Hero”, 48(4.8%) said
for concentration, 24(2.4%) said for experiment, each of 22(2.2%) said style and it is a personal
matter respectively, 16(1.6%) said out of interest, 5(0.5%) said it is an idle time pass. The table is
represented in Fig No 7.
Table No 8
Frightening about smoking
Serial No Answers Received Respondents
1 Breathing Problem 64(6.4%)
2 Cancer 744(74.4%)
3 Don’t Know 120(12%)
4 If my family knows about it 16(1.6%)
5 Loss of energy 14(1.4%)
6 Throat Disease 42(4.2%)
Total 1000

17. Table no 8 shows the responses of the respondents stating their frightening about smoking.
744(74.4%)respondents are scared of cancer, followed by 120(12%)respondents stating don’t know,
64(6.4%)said they are scared of having breathing problems, 42(4.2%) said throat disease, 16(1.6%)
said if my family knows about it, 14(1.4%) said they are scared of loss of energy. The table is
shown in Fig No 8.
Table No 9
Some body died of smoking
Serial No Somebody died of smoking Respondents
1 Yes 283(28.3%)
2 No 717(71.7%)
Total 1000

18. In the Table No 9 it is seen that 283(28.3%) respondents have said yes whom they know have died
from smoking. 717(71.7%) respondents said no they do not know anyone who died of smoking.
The table is shown in Fig No 9.
Table No 9/ b
Relationship with the person
Serial No Relationship with the person Respondents
1 Office Colleague 96(33.92%)
2 Grand Father 64(22.61%)
3 Uncle 45(15.90%)
4 Father- in-law 31(3.1%)
5 Teacher 14(1.4%)
6 Brother- in Law 33(3.3%)
Total 283
The table no 9/b states the responses of the respondents 283(28.3%) who said Yes they know
someone who have died from smoking. 96(33.92%) respondents said office colleague, 64(22.61%)
said grand father, 45(15.90%) said uncle, 31(3.1%) said father- in –law, 14(1.4%) said teacher,
33(3.3%) said brother-in law. The table is shown in Fig No 9/b.

19. Table No 10
Government smoking prevention and cessation policy.
Serial
No
Government Policy Respondents
1 Reducing tobacco use initiation 54 (5.4%)
2 Increasing tobacco use cessation 44 (4.4%)
3 Reducing exposure to environmental tobacco
smoke
29 (2.9%)
4 Restricting minor’s access to tobacco products 67 (6.7%)
5 Decreasing tobacco use among workers 20 (2%)
6 Other(please specify) 0
7 Do not know 319 (31.9%)
8 Government Policy 1,2,3 383 (38.3%)
9 Government Policy 2,3,1 60 (6%)
10 Government Policy 3,4,2 17 (1.7%)
11 Government Policy 4,5 7 (0.7%)
Total 1000

20. Table No 10 shows the responses of the respondents citing their knowledge on various government
smoking prevention and cessation policies. 383 (38.3%) respondents are aware of government
policy on reducing tobacco use initiation, increasing tobacco use cessation, reducing exposure to
environmental tobacco smoke. 319 (31.9%) said they do not know, 67 (6.7%) only know about
restricting minor’s access to tobacco products, 60 (6%) know about increasing tobacco use
cessation, reducing exposure to environmental tobacco smoke, reducing tobacco use initiation, 54
(5.4%) only know about reducing tobacco use initiation policy, 44 (4.4%) only know about
Increasing tobacco use cessation, 29 (2.9%) only know about reducing exposure to environmental
tobacco smoke, 20 (2%) only know about decreasing tobacco use among workers, 17 (1.7%) said
reducing exposure to environmental tobacco smoke, restricting minor’s access to tobacco products,
increasing tobacco use cessation, 7 (0.7%) know about restricting minor’s access to tobacco
products and decreasing tobacco use among workers. The table is given in Fig No 10.
Table No 10/ a
Thoughts about the policy
Serial No Think about the policy Respondents
1
It will help
2
I support it
3
I am a participant
4
It is useless
5
No opinion
6
Other(please specify)
Total

21. Table No 11
Know about any school activities /working place in smoking prevention
Serial
No
Governmental Policy Respondents
1 Delineation of areas for a smoke- free
2 Development of a written policy to be considered by the
relevant authorities
3 Education and signage of any new policy or procedures
4
Expansion of cessation programs
5
Consideration of how the policy would be applied
during special events held on school
6
Consideration of employee groups and residence halls
7
Creation of a culture of compliance
8 Other(Please specify)
Total

22. Table No 11/a
Think about the policy
Serial No Think about the policy Respondents
1
It will help
2
I support it
3
I am a participant
4
It is useless
5 No opinion
6 Other(please specify)
Total

23. Web References
1. http://thorax.bmj.com/content/57/11/964.full
2. http://tobaccocontrol.bmj.com/content/12/4/e4.full
3. www.inforesearchlab.com/smokingdeaths.chtml
4. indiafacts.in/facts/30-cancer-deaths-in-india-due-to-tobacco-use
5. http://en.wikipedia.org/wiki/Smoking
6 http://news.bbc.co.uk/2/hi/health/7239722.stm
7 http://environment.about.com/od/healthenvironment/a/smoking_deaths.htm
8 . http://emedicine.medscape.com/article/287555-treatment