Save Nepalis from the tobacco epidemic

The tobacco epidemic is one of the biggest public health threats, responsible for more than eight million deaths per year around the world. It’s estimated there were 37,529 tobacco-related deaths in Nepal in 2019—19.4 percent of total deaths that year. Despite various efforts to reduce tobacco use in Nepal, the prevalence of tobacco has been consistently high in the last decade. According to the STEPS survey, the prevalence of tobacco use was 30.8% in 2012/13 and 28.9% in 2019. Recently, a survey conducted by Nepal Development Research Institute in December 2019 found that these prevalence rates are even higher, at 31.7 percent. The reason for the increasing consumption may be attributed to the numerous tobacco companies’ innovative and focused marketing methods and tactics as well as lax regulation on tobacco use. Numerous tobacco products are made, tobacco control regulations are not strictly enforced, and these products are readily available and reasonably priced, all of which contribute to the rising tobacco use among young people. The use of newer tobacco products, such as hookah and e-cigarettes, is rapidly increasing among youths. Young people are consuming new forms of tobacco products without realizing that they contain tobacco. Since almost all tobacco product use starts in adolescence or early adulthood, it’s crucial to prevent juvenile tobacco product use in order to reduce mortality.

All forms of tobacco are toxic to human health. There is no safe level of tobacco exposure. Hookah, also known as a water pipe, narghile, and shisha, is a common form of tobacco in many countries. Around the world, hookah smoking has increased recently, particularly among young people. Newer evidence suggests that children are experimenting with this form of tobacco as well.

There are concerns that young people in Nepal are also imitating this trend. Hookah comes in a variety of flavors (such as apple, mango, peach, lemon, mint, cherry, chocolate, coconut, watermelon, etc.) that are likely to appeal to young people. Nowadays, hookah smoking is frequently done in groups and is considered a part of socialization among youths. The expanding hookah market and its popularity among young people are serious concerns as hookah poses numerous health risks. Various studies have shown that hookah smoke contains at least 82 harmful substances and carcinogens. Carcinogenic poly hydrocarbons (PAH), carbon monoxide (CO), ultrafine particles, formaldehyde, nitrogen, nitric acid, nicotine, phenols, and phenol derivatives have all been found in shockingly high concentrations in water pipe tobacco smoke. Despite the smoke passing through water, the harmful, addictive compounds generated by tobacco are not eliminated. The burning of charcoal, which produces poisonous substances including carbon monoxide (CO) and polyaromatic hydrocarbons, is another source of one of the worst emissions (PAH) which possess additional health risks. Nicotine is a highly addictive chemical that has been related to a number of negative health consequences for the growing fetus if consumed during pregnancy and can have long-lasting negative impacts on adolescent brain development. Also, studies conducted around the world reveal that hookah contains considerable amounts of nicotine, tar, and heavy metals, and smoking has cumulative effects on cardiovascular disease that can be both acute and long-lasting. Increased heart rate, blood pressure, the prevalence of coronary artery disease, heart failure, myocardial ischemia, and worse outcomes, including mortality linked to these disorders are only a few of these impacts. It’s documented in some research that smoking tobacco with a water pipe for an hour emits the same amount of smoke as 100–200 cigarettes. Hookah smokers are 2.2 times more likely than non-smokers to experience long-term cardiovascular consequences. It has also been shown that hookah smokers are more likely to develop esophageal cancer than non-smokers. Because hookahs are shared by several smokers and come in direct contact with the mouth, infectious diseases related to the lungs, mouth, lips, and gums can be transmitted easily to other persons during a session. Contagious diseases such as flu and oral herpes, as well as more severe conditions like tuberculosis and hepatitis, can spread from hookah smoking. Also, second-hand smokers, such as employees at hookah restaurants and people who cohabit with hookah smokers, are at considerable risk of major health problems due to the smoke from hookahs and their hazardous compounds, some of which are present in higher concentrations than in cigarette emissions. In Nepal, Hookah flavors and accessories are easily accessible and available through online shopping. Hookah pipes are sold without age restrictions, and are available at coffee shops, public places, and households. The fact that it’s also quite cheap has contributed to increased hookah consumption among youth. Hookah establishments are targeted at adolescents and youth and have opened near educational institutes. It’s often considered that a restaurant without a hookah bar cannot attract people, so most restaurants and lounges in the city area have made arrangements to have a hookah bar. The directive on Printing Warning Messages and Pictures on Tobacco Product Boxes, Packets, Cartons, Parcels, and Packaging Materials, 2014 has made provision that health warnings on tobacco packs should cover 90 percent of the front and back of the pack. The message should include: ‘Cigarette smoke contains carcinogenic chemicals, including Benzopyrene and Nitrosamine’, ‘Stop smoking’ and ‘Nicotine, tar, and carbon monoxide in cigarette smoke can cause heart and lung problems’ in the left- and right-side panels. But the provision has not been made compulsory for hookah products in Nepal. The prevention and control of tobacco use have never been a priority among political parties in Nepal. There haven’t been any debates or on tobacco use in the lead-up to the federal election. Governments are willing to tolerate disease and death brought on by tobacco use just because tobacco products generate a substantial amount of revenue each year. Tobacco smoking has no benefit at all. All political parties in Nepal should look into curbing tobacco use. Tools such as taxing tobacco, and the implementation of tobacco control acts, policies, and regulations should be the priority of all political parties. The new government to be formed after this federal election must give special emphasis on saving Nepalis from the tobacco epidemic.