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Smoke Screen
April 11, 2013 COMMENT comment
     
Smoke Screen
By Priyanka Chakrabarti
Why Indian Women are Lighting Up Younger and Faster
 
Whether it's the language of rebellion or a way to get into the big boys' club in workplace corridors, women are taking to smoking younger and are outpacing men quickly in this deathly race. What's going on behind the puff? Tobacco usage amongst Indian women has doubled in the last five years alone and the rate of cigarette smoking per day by women is now higher than that of men: 7 per woman versus 6.1 per man.
 
Dressed smartly in crisp formals, 26-year-old Rhea stands below her office stairway, mindlessly swirling puffs of smoke into the thick, dusty air of corporate Gurgaon. She exudes confidence and a certain sense of rebellion. "Smoking is such a great stress-buster and I don't really care about what others think of me – it's my life and I am no less than a man. If someone gives me a judgmental look, they can talk to the hand!" she says in a stern self-assured tone that seems to covers up for acute, unaddressed insecurity.

In another part of the country, Debbie, a 40-something solo traveller, stands in a small smoking chamber at Bangalore airport, diagonally across two younger male smokers who seem to be checking her out. She has a look of studied indifference as she puff s away, mindful of the stares she is getting from her smoking companions and from all the other nonsmoking passengers passing by outside the glass cubicle. She is uneasy, but she is damned if she is going to leave until she has smoked the last grain of nicotine on the stub.

Indian women have taken to smoking with a vengeance in the past decade. According to the Global Adult Tobacco Survey (GATS), tobacco usage amongst women in India has doubled in the last five years alone. The survey revealed that the rate of cigarette smoking per day by women is now higher than that of men: 7 per woman as compared with 6.1 per man. And cigarettes are not their only source of getting a nicotine kick: One in five women in central India and one in three women in eastern India consume tobacco in the form of hookah or water pipe, bidi, or chewing tobacco (better known as paan masala).

Despite the obvious health risks, social ostracism, and procurement challenges and expenses, women seem to be increasingly drawn to their packs of smoke as moths to a flame. What kind of fatal attraction is this?

PASSIVE TO ACTIVE
"Shedding inhibitions and changing attitudes, amongst other reasons, have developed in the high-income groups and given rise to smoking," opines Dr Samir Parikh, director, department of Mental Health and Behavioural Sciences, Fortis Healthcare, Delhi. According to him, the percentage of women smokers was relatively less about six decades ago in India. "However, with changing socio-cultural patterns, women are exposed to more peer groups than before. Young women start correlating smoking with a means of stress relief. The portrayal of smoking as a ‘hip' culture by the entertainment and media industry plays a big role too. Also, at times, when your boss or someone you really look up to smokes, you attempt to follow them too," he adds.

He is of the opinion that smoking is no longer taboo for women as it was earlier, which perhaps explains its wider appeal. Besides, more and more establishments now offer separate smoking zones where women can light up in peace, and even come across as elitist and trendy. Be it coffee shops, bars, nightclubs or restaurants, it is far more acceptable now for a woman to be seen with a fag. "In fact, many girls find it easier to smoke after drinking because it helps them shed their inhibitions," says 30-yearold Kolkata-based journalist Maya Narayan who quit smoking after eight years.

Dr Vimal Grover, senior consultant, Obstetrics and Gynaecology, Fortis La Femme, Delhi avers, "With Western influences mixing up with Indian culture, lifestyles have changed 360 degrees and women feel empowered and at par with men. So with the new set of socio-cultural and economic patterns, smoking amongst women has become a conventional way of life." Many women confess that they got used to the whole dynamic of smoking because of severe exposure to passive smoking that previously used to bother them. "My dad is a chain smoker and I hated the smell of cigarettes since childhood.

I grew up seeing my mother argue with my dad on his addiction and in the process I developed a strong mindset against smoking – I despised it," admits 24-year-old Neha Rane (name changed), an engineer in Pune, adding, "But as I stepped into college, I realised that pretty much every girl in our hostel smoked. In fact, if you were a non-smoker, you were tagged as ‘un-cool'. I had my first drag in our ragging session and then – from half a cig to a pack of cigs a day – it's been a weird and self-contradictory journey so far."

FASTER, YOUNGER, LONGER
With the dawning of this millennium, a rapid boom in the call-centre industry led to armies of young girls, some right out of high school and a majority from college, grabbing jobs at BPOs. Being relentlessly surrounded by seasoned smokers, they eventually got either tempted or pressurised to take to this slow poison themselves. Peer pressure is certainly one of the most vital reasons why women in the age group of 17–25 get hooked but, frequently, smoking is associated with escapism; in this case, an escape from detrimental corporate pressure.

The figures, however, are inescapable. A report by medical journal Lancet found that an average Indian woman is taking up smoking at 17.5 years of age as opposed to 18.8 years among men. Dr K Srinath Reddy, president of Public Health Foundation of India, has been quoted saying, "While tobacco use among men has dipped from 51 to 48 per cent, it has actually doubled among women from 10 to 20 per cent." The latest Tobacco Atlas states that India ranks third in the top 20 female smoking populations across the globe. Only USA with 2.3 crore female smokers and China with 1.3 crore are worse off .

Published by the American Cancer Society and World Lung Foundation, the Atlas made another stern observation – female smokers in India die an average eight years earlier than their nonsmoking counterparts.

A DEATHLY DRAG
Smoking kills; it doesn't spare any gender. On the whole, 25 per cent of all smokers die and many more fall ill during their most productive years. It is an addiction that hits a person's fundamental living organ – the lungs. But women are even more vulnerable because of their reproductive stature. Dr (Prof ) Suneeta Mittal, director and head of department, Obstetrics and Gynaecology, Fortis Memorial Research Institute, Gurgaon, explains, "If a pregnant woman consumes tobacco in any form, she harms the unborn child in severe ways. Tobacco consumption reduces birth weight of the foetus, decreases their gestational age leading to premature babies, increases the risk of still births and heightens the chances of anaemia among adult pregnant women."

Tobacco is also, of course, connected directly to various forms of cancer, especially that of the breast and lungs, and passive smoking is equally damaging. "Smoking can lead to repeated abortion cases and sudden infant death syndrome, right after birth. When a pregnant lady smokes, her child could be born with cleft lip, cleft palette, eyes defects, behavioural issues and child leukaemia," warns Dr Mittal.

She also adds that a large number of women work in the tobacco industry, rolling bidis. "They inhale tobacco dust all day long. These women have higher chances of getting cancer, asthma and eye problems, to name a few, and their unborn foetuses invariably suffer." Smoking can also lead to heart disease, strokes, serious breathing problems (emphysema and chronic bronchitis) and issues with early menopause besides others like osteoporosis.

SEXY MAMA
Over the years, tobacco companies had targeted men with macho ads. But, with the unexpected shift in the consumer list, the ad industry is now also wooing women with low-tar or ‘light' versions (which are equally harmful). "I feel that holding a cigarette adds to my sex appeal and that men find women smokers to be quite seductive," says Shruthi Prasad, a social worker from Mangalore. Many women strongly have faith in this myth that cigarettes make them sexier and more desirable but this is merely an illusion of verve, liberation, superiority and sexual magnetism.

The truth is that the primary factor that leads women to fag is depression. "The work pressure at office, less time to spend with husband and children, and family issues rattle me. I find solace in smoking," confesses Akriti Bhatia, a Delhi-based media professional.

Women's smoking in public as a symbol of emancipation and parity goes back to the twenties. Smoking became a symbol of women's liberation in the West a decade later. During World War II, as the involvement of women to the war effort began to ascend, so did smoking amongst them: It was concurrent to women going out to work, to self-rule, and nationalism.

The Tobacco Epidemic, a film produced by WHO, showed that smoking is no longer taboo among women even in traditional societies. Underprivileged Indian women smoke bidis or infuse their beetle leaf with tobacco. Educated, upper-class, urban women smoke because they associate the imagery of smoking with their profession. These are occupations where pressure and anxiety are channelled into the work structure, and a public image that spells aggression is a necessity. Women then smoke because they think they should, not because they want to.

Smoking amongst women of the affluent and meagre classes in India is a second-generation pattern because they have either one or both parents smoking. In contrast, middle-class women are usually first-generation smokers because they just fabricate a habit that they regard to be a status symbol.

SMOKY PATH AHEAD
The Indian government has come up with various public awareness campaigns (pictorial warnings on cigarette packs) but it hardly has much effect. And though smoking has been banned in public since 2008, and the sale of tobacco products is prohibited with in 100 yards of educational institutions, rules are seldom enforced and young smokers have only burgeoned in number. The earlier one starts smoking, the more the number of years one smokes, and the more number of cigarettes one smokes each day – all these add to the risk of disease or death.

The solution may lie in sterner legislation and higher pricing of cigarettes. The Indian government also needs to come up with more public awareness campaigns, especially amongst the younger populace. Experiences around the world have shown that the more difficult the access to cigarettes and spaces to smoke them, the sooner people kick the butt. If Chandigarh and Shimla have gone completely smoke-free, other cities can do it too.

Quitting smoking is no doubt difficult; it may require multiple attempts to finally kick the butt. Smokers often get discouraged because of rising stress levels, weight gain, and with drawal symptoms, including mood swings, hot temper, fretfulness, difficulty in concentrating and increased appetite. But as an alternative to death, those may just be the lesser devils to make peace with .

UP IN SMOKE
Smoking may soon account for 20 per cent of all male deaths and five per cent of all female deaths among Indians between the ages of 30 and 69.
Bidi-smoking women shorten their lives by about eight years on average.
One cigarette takes away eight minutes of your life.

Nicotine Replacement Therapy (NRT):
Nicorette patches are worn continuously for 16 hours; the nicotine in the patches is absorbed continuously through the skin and into the bloodstream (Habitrol Nicotine Patches, Rs 2,525). Nicotine nasal spray requires a doctor's prescription. It is recommended for a minimum of three to a maximum of six months (Nicotrol NS, Rs 1,750). Nicotine gum or lozenges can be bought over the counter (2 mg or 4 mg). It can be used for 12 weeks (Nicotex, 10 tablets for Rs 45).

The average Indian woman takes up smoking at 17.5 years versus 18.8 years among men.

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