Who does not know that smoking and non-smoking tobacco causes cancer? Tell a smoker this and he/she will simply shrug it off. Cancer seems a remote possibility to a teenager. His immediate concerns are looking macho. Like it was for Prakash* who began smoking at 17 for just this reason. Six months later his body was addicted to the nicotine and today at 30, he smokes 10 cigarettes a day.

Reality sinks in as one gets old, as it has for Govindrao Shinde. ``I started chewing tobacco at 18 without giving it any thought.'' Today at 73 he is undergoing treatment for oesophoegal cancer at the Morbai Cancer Institute. Cancer takes years to become apparent. Risk of cancer is calculated in `pack years and where one pack year is equivalent to smoking 20 cigarettes a day for one year. ``It generally takes 20 pack years to be prone to cancer,'' says Koppikar. ``Cigarettes smoke destroys the cilia, which is part of the natural defence system of the lungs that helps to throw out harmful substances. Besides the smoke also affects the genetic code of an organ. Suppressor genes are destroyed, thus making one susceptible to diseases like cancer.''

Though not all smokers get cancer, 100 per cent suffer from bronchitis, commonly known as smoker's cough. Chewing tobacco, gutka and other such addictive substances affect the mucous membrane or the soft tissue in the mouth. Says Koppikar ``Doctors see a rise in gutka cancer which particularly affects people in their twenties. They develop sub-mucous fibrosis where the person cannot open his mouth because soft tissues inside the mouth get hardened.'' In fact one afflicted with this condition finds eating and drinking difficult. What's worse is that doctors can barely treat it as they cannot look inside the mouth to see where the problem lies.

Besides cancer, tobacco is known to causes several conditions like cardio-vascular diseases, impotence, low birth weight babies, abortions, asthma, peptic ulcers, strokes, osteoporosis, cataract and others. That's not all. Passive smokers inhale not just other people's smoke from the cigarette's burning end but also environmental smoke (that which is released when a smoker exhales).

Maternal smoking is the cause for low birth weights, one fourth of Sudden Infant death syndrome and causes birth defects(Royal College of Physicians in Smoking and the Young). Smoking fathers expose children to the risk of lower respiratory tract infections. Passive smoking has shown to trigger and aggravate about 200,000 to 10 lakh asthamatic attacks in children a year in the US (Cecil textbook of Medicine).

In fact if a non-smoker is near a person who smokes 20 cigarettes a day, the exposure is comparable to smoking 10 cigarettes a day.(Family Physician edition, Medical tribune). Passive smoking also doubles the risk of coronary heart disease.(Circulation, 1997).

Why does tobacco continue to be used? The reasons vary. On a personal level, it is peer pressure and social custom account for 50 percent of this addiction, according to the P&SM department B.J. Medical college. ``Besides there is the lack of a proper policy on tobacco control.'' says Koppikar. Though tobacco advertising is banned in state-controlled electronic media, it flourishes in the print media and on billboards and video cassettes. According to the Cigarette Act 1975, all cigarette and pan masala packs have to carry a statutory warning. But often warnings on the non-smoking tobacco packs are in fine print. Taxes on tobacco products too vary. Taxes represent 75 percent of the retail price of cigarettes.

But they are much lower on packaged chewing tobacco and rarely collected on bidis and unpackaged tobacco products. With the absence of mandatory health education in schools and colleges, youngsters will find it that much harder to make an informed choice about tobacco use. Instead they may fall prey to the advertising efforts that portray chewing tobacco or smoking as necessary to achieve success. While litigation is seen as a major deterrent to tobacco companies in the United States of America, the proceedings of an international symposium published by the Tata Institute of Fundamental Research, shows its possibility in India as well.

In the M.C. Mehta v/s Union of India 1987, the Supreme Court ruled that ``If an enterprise is permitted to carry on a hazardous or an inherently dangerous activity for its profit, the law must presume that such permission is conditional on the enterprise absorbing the cost of any accident arising on account of such hazardous or inherently dangerous activity, as an appropriate item of its overhead.'' But are the tobacco manufacturers listening?