The old American anthropological literature quotes that, tobacco was given to a star boy, ancestor of the Absarokas, to make everyone in his family strong and free. There are many other such fascinating stories related to the origin and use of tobacco in ancient society. It is necessary to dig the stories a little to understand the socio-cultural meaning of tobacco use among people, especially the ethnic and tribal groups. The origin of tobacco use was not for recreational use, but, for medical and cultural use and had sacred and religious beliefs attached to it. People used to burn raw tobacco in open ceremonies, sprinkled the tobacco water as an offering to sprit, and many other forms of occasional use have existed until the Europeans introduced its recreational cigarette form. However, today it has become a part of our contemporary lifestyle leading to a global public health challenge.
According to WHO estimates, tobacco kills 6 million people across the world every year. The GATS survey (2016-17) shows that 28.6% of adults in India use tobacco (in any form), and the current users of smokeless tobacco are 25.9%. As per the latest tobacco atlas, India ranks third in the top 20 female smoking populations across the globe. Nearly 45% of all cancers in males and 17% in females and more than 80% of oral cancers in India are directly related to tobacco use.1
Tobacco consumption is higher among socioeconomically vulnerable groups, especially the tribal population (52.1%) compared to general populaion.2-4 A study conducted in the indigenous population of Kerala found that a whopping 73.8% of the individuals used some form of tobacco and 82% of the use was in the smokeless form.5Another study conducted in tribal population of 9 major states of India recorded a high prevalence of hypertension in Indian tribes. The same study reports a significant association between substance abuse and hypertension.6 Despite the interventions exercised by the WHO and the government of India to control tobacco consumption, the prevalence of tobacco use is rising at a disturbing rate, especially among the children and the adolescents.3 To make any meaningful gains, it is important to understand why the interventions are challenging and unsuccessful in the tribal communities.
Ethnic groups (Tribes) are among the most vulnerable populations that constitutes 8.6% (census 2011) of the Indian population. They possess a very distinct culture and a unique way of living. They maintain a particular community structure and power relations that keep them culturally and socially united. Therefore, any health interventions targeted at the tribal populations should be culturally appropriate and acceptable. Often, the meaning we attribute to many practices and habits are not the same in the tribal context. Therefore, it is very critical to explore the tribal meaning assigned to tobacco consumption as well. Family influence is a crucial factor that motivates tribes to adopt tobacco consumption.5 When parents consume tobacco commonly, adolescents perceive it as a normal practice and start using it. According to the local tribal leaders of the Nigiris, “some people use tobacco to confront poverty and hunger as they believe it will reduce the appetite, enabling them to work longer.” While others use tobacco as a remedy to toothache, and a few use it to alleviate bad breath.5 “People even start chewing tobacco to get rid of boredom”, mentioned a community worker from the paniya tribe of Nilgiris. This factor could be associated with unemployment or lack of any healthy recreational activities in tribal communities. They also had a practice of using tobacco to ward off the insects and leeches from legs while working in the field.
We might find these facts as shallow but are critical in determining the behavioural change in sensitive populations. It is essential to address the underlying problems that motivate them to consume tobacco. Understanding this context will also support the policymakers to design specific and tailored tobacco cessation programs for the tribal community. Many times, policymakers generalize populations while designing programs. They miss the critical factors that are important for cultural acceptance. As a result, conventional mundane programs reach the community without acceptance of the people it was designed for. Therefore, awareness programs should be led by the people from the community, as community ownership models have reported to have acceptance in tribal populations. The content of the program must be sensitive to the socio-cultural context. It should address the underlying issues identified by the community. Intersectoral coordination and support of panchayat raj institutions will help to deliver the program effectively. Precisely we should address the community’s perceived needs in a community acceptable way by community ownership model.
Reference
1. NCRP-Consolidated Report of Hospital Based Cancer Registries 2007-2011, National Cancer Registry Programme (Indian Council of Medical Research), Bangalore, 201
2. Mohan S, Sarma PS. NFHS – 3 (2005-2006). Available at: http://www.whoindia.org/Link Files/Tobaccofree _Initiative _nfhs3.pdf. Accessed on 7 January 2017.
3. Mohan S, Sarma PS, Thankappan KR. Access to pocket money and low educational performance predict tobacco use among adolescent boys in Kerala, India. Prevent Med. 2005;41(2):685–92.
4. Jayakrishnan R, Sreekumar C, Sarma S. Tobacco use and Smoking Dependency among the District Tribal Population of Kerala State. Available from: http://www.sctimst.ac.in/amchss/Smoking_depende ncy.pdf. Accessed on 14 March 2016.
5. Prevalence and Dependency of Tobacco Use in an Indigenous Population of Kerala, India
6. Socio-economic & demographic determinants of hypertension & knowledge, practices & risk behaviour of tribals in india, Tobacco uses in the world