Tobacco is a shadow that stretches across nations,
economies, and generations. While often discussed in the context of smoking, a
more insidious and varied threat has taken deep root, particularly in
developing nations like India: smokeless tobacco. This book, *Beyond Smoke:
Youth, Slums and Shadows of Tobacco*, is an attempt to sound an alarm and
dismantle a public health crisis unfolding in plain sight—the targeting of adolescents
in urban slums with addictive, carcinogenic products.
The journey of this research began with a simple, disturbing
observation: the sight of younger and younger children with small, colourful
sachets of gutkha and pan masala, products marketed like candy and priced like
it, too. Despite legislative bans, such as the landmark five-year prohibition
in Maharashtra in 2002, these products continued to flow freely into the hands
of children, facilitated by pocket money, peer pressure, and a startling lack
of awareness about their devastating health consequences.
This book is the culmination of a year-long, intensive
cross-sectional study conducted among 1800 adolescents in an urban slum of a
major Indian metropolis. We sought not only to quantify the prevalence of
smokeless tobacco use but to understand the intricate web of factors that
enable it—socio-demographic backgrounds, family dynamics, knowledge levels, and
the powerful influence of marketing and peer networks.
Our findings are a clarion call. A prevalence rate of 13.9%
among adolescents is not just a number; it represents hundreds of young lives
embarking on a path toward addiction, oral lesions, and potentially, cancer.
The data reveals that initiation begins as early as 13-14 years, often motivated
by a quest for enjoyment or a need for social acceptance. Perhaps one of our
most counterintuitive findings challenges traditional assumptions: users often
hail from better socio-economic backgrounds, have educated parents, and receive
unsupervised pocket money—primarily from their mothers—which is then used to
purchase their daily dose of poison.
Perhaps most disheartening is the discovery that while most
adolescents know tobacco is harmful, a significant knowledge gap exists
regarding the specific dangers of its smokeless forms. This critical disconnect
between knowledge and practice, combined with easy availability and social
acceptability, creates a perfect storm for addiction to thrive.
This work would not have been possible without the participation
of the 1800 adolescents who shared their stories and experiences. I am deeply
grateful for their honesty and trust. I also extend my sincere thanks to the
community health workers, the institutional ethics committee, and my
professional colleagues for their unwavering support and guidance throughout
this endeavour.
On a personal note, this work stands on the foundation of my
family's unwavering support. My deepest gratitude flows first to my wife, Dr.
Vibha, not only for her patience but for her invaluable insights as a
psychiatrist, which helped me weave the crucial psychological perspective into
this research. I am eternally grateful to my father-in-law, Mr. Anil, whose
wisdom as a scholar and academician provided much-needed guidance through the most
challenging phases of this journey. My elder brother, Dr. Rahul Gajbhiye,
deserves special credit for being the catalyst who first ignited my passion for
rigorous inquiry and shaped me into a researcher. To all of them, and to my
entire family for their boundless encouragement and faith, I owe a debt I can
never fully repay.
It is my earnest hope that this book will serve as a
valuable resource for public health policymakers, medical practitioners,
educators, and non-governmental organizations. By understanding the patterns
laid bare in this book, we can begin to craft interventions that are not just
policies on paper, but lifelines extended into the heart of these communities.
The future of a generation depends on our collective will to act now and shield
them from the long, dark shadow of tobacco.
Author(s) Details
Dr. Anand R. Bhide
Department of Community Medicine, Maharashtra Institute of Medical
Education & Research (MIMER), Talegaon Dabhade, Pune, Maharashtra, India.
Dr. Balaji D. Almale
Department of Community Medicine, Dr. Vasantrao Pawar Medical College,
Hospital & Research Centre, Nashik, Maharashtra, India.
Dr. Amrut A. Swami
Department of Community Medicine, Dr. S. S. Tantia Medical College,
Hospital and Research Centre, Sri Ganganagar, Rajasthan, India.
Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-88417-47-1
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