Outside many of India’s offices, workers take a respite from work, chat with colleagues and smoke a cigarette. But as smoke drifts back inside buildings, their smoking doesn’t just affect them, but those around them.

According to the Global Adult Tobacco Survey for India released in 2016-17, around 11% of Indians smoke regularly – the bulk of whom are men (19% of male adults smoke compared to 2% of women) . Of the 22 countries surveyed as part of GATS, between 2008-13 India ranked 18th.


And even though the number of smokers is decreasing (prevalence of smoking fell from 14% in 2009-10 to 11% in 2016-17), Indians smokers are generating dangerous levels of second-hand smoke. Between 2008-13, 313 million Indians were exposed to second-hand smoke at home, the second highest figure in the world after China’s, which had 717 million adults that were exposed, according to the GATS Atlas released in 2015. GATS is a cross-country survey on tobacco use, exposure to secondhand smoke, conducted across 22 countries with the highest burden of tobacco use. In India, 74,000 adults were surveyed as part of GATS, which also monitors progress and opportunities for improvement of tobacco control policies across countries.

Based on the GATS India Report, 30% of Indian adults were exposed to secondhand smoke at workplaces and even more (39%) were exposed at home. This gap widens between rural and urban areas, with smoking inside homes allowed in 54% of rural in comparison to 38% of urban households. Some states though fare much worse than others. India’s North-East is home to the country’s heaviest smokers. The five states with the highest percentage of adult smokers are all in the North-East.


Unsurprisingly, when it comes to exposure to second-hand smoke, these are also the most vulnerable states. There can also be significant differences within regions. While more than half of all adults in West Bengal are exposed to secondhand smoke, in neighbouring Odisha and Bihar adults were exposed among the least in India.


Unsurprisingly, when it comes to exposure to second-hand smoke, these are also the most vulnerable states. There can also be significant differences within regions. While more than half of all adults in West Bengal are exposed to secondhand smoke, in neighbouring Odisha and Bihar adults were exposed among the least in India.

Exposure to secondhand smoke can have significant health effects. Scientific evidence has shown that there is no safe level of exposure to second-hand tobacco smoke. Second-hand exposure is linked to cardiovascular diseases, chronic respiratory problems, and increased risk of lung cancers. Among children, it is a leading cause of respiratory illness such as asthma, pneumonia and bronchitis, low birth weight, and middle ear disease. All these health risks have driven the enactment of clean indoor air policies in several parts of the world.

Several countries now have comprehensive clean indoor air laws at the national or sub-national level. Uruguay was the first Latin American country to implement national legislation for having smoke-free restaurants, bars, and workplaces. New Zealand, Norway, Ireland are some of the countries that have been at the forefront in enacting comprehensive clean indoor air laws.

The effect of these policies in terms of lowering smoking prevalence, without hurting businesses, has been well-established. Clean indoor air laws and having comprehensive smoke free laws at home, workplaces, restaurants and bars, and public transportation have contributed to the denormalization of smoking. Denormalization of smoking refers to changes in social norms, attitudes through a series of policy measures. This includes having 100 percent smoke-free workplaces, not allowing any indoor smoking areas at restaurants, bars, hotels, airports and in certain places this also extends to pubs and casinos.

India remains one of the signatories to the Framework Convention on Tobacco Control – a global treaty to reduce the burden of tobacco use and exposure in various forms. Yet, many Indian restaurants, bars, airports, and hotels continue to be exempted from clean indoor air laws. Many of these places, including airports which have millions of visitors in a year, have designated smoking rooms. However, smoking rooms do not effectively control secondhand exposure. A study assessing second-hand smoke at international airports, with a large number of designated smoking areas in Thailand, found that the concentrations of PM_2.5 varied at hazardous levels between 348.5 to 1793. 5 in the airport smoking rooms. Even in some of the rooms adjacent to smoking rooms, the exposure to second-hand smoke remained high . Other studies have documented that main entrances are critical sources of carrying PM_2.5 into the buildings and halls and should be considered in promoting a smoke-free environment.

If an ounce of prevention is worth a pound of cure, then India investing in preventive health by promoting smoke-free homes and environment would be a move in the right direction.

Priyanka Vyas is a postdoctoral fellow at the Center for Tobacco Control Research and Education at the University of California, San Francisco

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