Adult tobacco use falls in Sikkim, but youth consumption raises concern

NITESH R PRADHAN

GANGTOK, October 28: A quiet public health battle is unfolding – one that pit strict State enforcement against deep-rooted social habits. As health authorities intensify border surveillance, market raids and school zone checks under National Tobacco Control Programme, their primary target is clear: stopping youth initiation before it takes hold. Yet, with steep terrain making healthcare access a challenge and tobacco products remaining widely accessible, officials face an uphill task.

Sharing key insights on ground realities, Dr. Tempo Gyaltsen Tsechutharpa, Director of Health Services and State nodal officer for National Tobacco Control Programme (NTCP), stated: “National survey data highlights a striking contrast between adult and youth habits in Sikkim. According to the Global Adult Tobacco Survey from 2016 to 2017, adult tobacco consumption in the State stands at 17.9 percent, which marks a dramatic drop from the earlier baseline of 41.6 percent.”

However, Tsechutharpa pointed out that the Global Youth Tobacco Survey from 2019 shows nearly a quarter of students aged 13 to 15 – about 24.6 percent – are using tobacco. “While that youth figure remains high, it actually reflects a major long-term decline from the 54.7 percent recorded back in 2001. Teenagers usually pick up the habit because of peer pressure, seeing family members smoke or chew tobacco, and general cultural norms, rather than any single trigger,” he explained.

These social triggers are echoed by individuals struggling with addiction. “I was barely fourteen when my school friends handed me my first pinch of khaini behind the grounds, and before I knew it, it became a daily habit I couldn't shake,” shared a local youth seeking counseling in Gangtok. Another long-time user from a nearby village recalled how normalized the habit was at home, noting, "Growing up, everyone in my family offered paan masala with tobacco during social gatherings, so it never felt like something dangerous until my health started slipping."

Tsechutharpa also spoke about how usage habits vary depending on where people live, observing, "In urban areas, people tend to consume a wide range of products like cigarettes, bidis, khaini, e-cigarettes, vapes, hookahs, and gutka. In rural areas, however, usage centers mostly around traditional items like khaini, bidis, cigarettes, gutka, and tobacco-laden paan masala."

To restrict access and cut off illegal supplies, Tsechutharpa stated, "State and district tobacco control cells are actively enforcing public smoking bans along with strict limits on advertising and store displays. Authorities are paying special attention to schools, where sales are strictly banned within a 100-yard radius under Section 6(b) of the law." To keep school premises tobacco-free, designated nodal teachers and administrative officers are monitoring campuses directly. “High-level teams, including the State Level Coordination Committee headed by the chief secretary and district committees led by district magistrates, are regularly meeting to coordinate joint raids against cross-border smuggling of banned smokeless tobacco."

Addressing the clinical picture, Tsechutharpa detailed, “While tobacco-related cancers make up a serious portion of Sikkim's health burden, they are not actually the most dominant type in the State. Data from major facilities like STNM Hospital and Central Referral Hospital shows that stomach and gastrointestinal cancers remain the top concern overall." Even so, he warned, "Oral cancers from smokeless tobacco like khaini and gutkha, alongside lung and laryngeal cancers from smoking, continue to require major medical intervention."

To help people quit, Tsechutharpa shared that comprehensive tobacco cessation services – offering both counseling and medications like nicotine replacement therapy – are up and running at district hospitals in Namchi, Singtam, Mangan and Gyalshing, as well as STNM Hospital. For many users, these services offer a crucial lifeline. “You tell yourself you can stop whenever you want, but the cravings always pull you back," admitted a patient undergoing nicotine replacement therapy at STNM Hospital. Having counselors guide you through the withdrawals and getting patches locally makes a massive difference.”

To make sure residents in isolated, hilly villages do not get left behind, Tsechutharpa confirmed, "The Health department is rolling out a phased expansion plan to bring these cessation services directly to Community Health Centres, Primary Health Centres, and local health sub-centers across the State."