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Asia is smoking and so are the women!

September 28, 2007
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Apparently, Asians are ‘culturally disposed’ towards smoking and this includes Asian Americans! Well, it is well known that tobacco companies target the developing world to increase their market shares…and that they are succeeding. I wanted to find out just how much Asians smoke as compared to the rest of the world and an interesting article in a recent issue of The Economist satisfied my curiosity to some extent. Take a look at this graph.

China, Japan, India and Thailand are in bad shape. And in contrast, the percentage of smokers in developed nations is falling. In the UK for example the numbers have been falling since the late nineties, a trend that seemed to have started in the eighties, when about half of the British population smoked. By 2002, there were only 26% smokers in the UK!

Smoking declined in America as far back a decade ago, with only about quarter of the adult population smoking! Even now the rates are well below 30 percent. In Germany about 27 percent of the population smokes.

Indian women take in a lot of tobacco!
The percentages are high in India and not all of it is due to the efforts of the tobacco companies! What struck me was the number of Indian women who smoke – about 17-18 percent of all women in the country, only lower than women in Bangladesh and that is the second highest percentage in Asia. A large percentage of American women smoke as well, almost equal to the men, and this seems to be a pattern in developed countries. Smoking patterns there are more socio-economic rather than based on gender.

Inverse link between education and smoking
This link has been well established and in fact in America highly educated men and women smoke less as compared to those in the general population. In India this holds true as well. It’s the illiterate women who take in the most tobacco.

Cigarettes account for an estimated 20% of tobacco consumption; about 50% of tobacco is consumed in the form of bidis, that is, traditional, leaf-wrapped unfiltered cigarettes…in general, men in India smoke as well as chew or apply tobacco, whereas women generally chew or apply tobacco, with the exception of the few areas where prevalence rates of smoking among women are high…more than 150 million men and 44 million women in India use tobacco in various forms

However, “cigarette smoking rates have been shown to increase with increasing education.” This must be because people want the so-called a ‘modern’ lifestyle. A lifestyle which is contributing to about 635000 deaths in India due to tobacco each year. Tobacco chewing on the other hand has been a habit here for a long time.

Tobacco companies targeting not just Asia, but also Asian Americans!
I was surprised to read that tobacco companies have been targeting the Asian American population as they find them less resistant to smoking! Why are Asian Americans more amenable to smoking? After all they are an educated lot. The reasons given are:

1) High prevalence of smoking in countries of origin
2) High purchasing power of the Asian immigrants
3) Cultural predisposition to smoking
4) Opportunities afforded by the high proportion of retail businesses under Asian ownership
5) Tobacco control initiatives in this group have been slower to develop than in other targeted ethnic groups

I am a little confused as to why Asians supposed to be ‘culturally disposed’ towards smoking and wonder why even after living in a developed country Asian Americans have been slow to develop tobacco control initiatives.

Related Reading: Tobacco causes cancer

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25 Comments leave one →
  1. Shefaly permalink
    September 28, 2007 12:00 pm

    Amongst the factors driving tobacco companies to developing nations are the following practices in the developed countries:

    1. Stringent and harshly enforced anti-smoking laws in public buildings, spaces and means of transport; These laws are framed as employer responsibility laws. So an employer is duty-bound to protect his staff from the effects of second-hand smoking. This is a tricky ‘tedhi ungali’ tool but nonetheless very powerful.

    One side effect was you saw many smoking employees smoking in front of the office building. Offices are cracking down – from an image perspective – and making it disallowable to smoke in front of the buildings, so smokers are often forced to consider quitting.

    2. Considerable effort made into promoting the “smoking kills” message; the latest in the UK is the use of pictures of diseases lungs etc on the packs. The use of fear appeal is a powerful tool in advertising to desist from certain behaviours (I had a full scale MBA marketing project on this many years ago when I was at IIM Ahmedabad)

    3. Taxation – every year in the budget, taxes on tobacco go up. Some argue this is a regressive tax because it affects the poor more than it does the rich, but it is hopefully reducing some purchases.

    4. De-addiction support: One of the key qualities of cigarettes is the addictiveness of tobacco. The National Health Service in the UK offers a lot of help towards smoking cessation, which also helps.

    This year, all 4 nations comprising the UK and NI went no-smoking in public establishments and in early uptaker Scotland and Wales, health benefits are already being reported.

    Now as to the puzzle why AAPI were targeted: This has to be seen in a temporal context. The BMJ paper covers practises during the mid1980s to mid 1990s. In the US, the tobacco industry was facing a growing threat to their usual means of promotion. At the same time, this was a time when the income of the AAPI community was growing. This was a smart exercise in segmentation. Many ethnic minorities often consume different ‘media’ (different from non-mainstream ones) so the segmentation based advertising could target specific groups and these hitherto-ignored-in-mainstream-brand-marketing groups being given attention could then be induced to buy more.

    The growth markets for tobacco are increasingly in developing countries. I have a friend who works in BAT in marketing and his travels over the last 10 years have moved from Central and Eastern Europe to Bangladesh/ Sri Lanka to now China. This to me is a great indicator of the movements.

    This is for many reasons:

    1. poor health awareness in the general population and co-existing with poor literacy, poverty and so on (John Reid, one time Health Minister in the UK, recently said smoking was one of the pleasures poor people could still afford. There was an uproar but most people knew this was true, esp in the extremely expensive UK)

    2. lack of legal frameworks which prohibit advertising and above the line marketing of tobacco products BUT pressure from more regulated countries could change that; e.g. China has weaker laws so one of the F1 teams can still use their tobacco sponsor’s logo in the Beijing F1 race. Now they are under pressure to get rid of it because the race is beamed globally and into many countries where it is illegal to advertise tobacco on TV! There is also pressure on Phillip Morris to withdraw their sponsorship from the team

    3. legal mire regarding targetting minors: THIS is the most morally dubious practice! They hook them young and the children stay addicted. This may explain why the said friend in BAT is now scrambling to change jobs – with little success, as his brilliant marketing skills are now tainted by association with a pariah industry – since he had a daughter in summer!

    This is a very important health issue and one which many countries have done well at managing. Developing countries need to clean up their act fast…

    • Aakarsh permalink
      October 14, 2011 2:32 am

      Hey Shefaly,
      Can you share your statistics concerned with current smoking trend in India?

  2. Shefaly permalink
    September 28, 2007 12:05 pm

    The European nations where smoking is still rife, it is a large % of women who smoke. This has its roots in rather delayed liberation of women so this is a kind of delayed ‘You have come a long way, baby’ effect

    BTW that Virginia Slims ad affected mamy girls in India too as Gabriela Sabatini was one of the models for it – hence the strong crackdown on celebrity endorsement in tobacco advertising in western nations..

  3. September 28, 2007 12:19 pm

    Shefaly, thanks a lot for that detailed comment!! This increased my understanding of what happens there a great deal. I see we have something in common, an academic bent of mind!
    p.s why don’t you type in your url in the comment box because that is what links your name to your blog.

  4. Shefaly permalink
    September 28, 2007 12:35 pm

    Nita.

    I am pleased you found it useful. I study policy now and being the curious kind, I do not confine myself to one area… The engineer in me means I follow policy developments in telecoms and social media and the Internet. The policy person in me makes me consider health policy with all its social implications. The MBA in me can see motives and driving factors where some policy makers not educated similarly can miss vital signs🙂 I am 3 weeks away from submitting my PhD so I am house-bound and my only window on the world is this virtual one…

    I read your blog in the morning standing in the kitchen as I make tea. I am impressed how you can keep the discipline of a post a day. I am very indisciplined. I wrote 4 yesterday and am unlikely to write something today unless something gets up my nose.. In the past I have thought of setting a programme like blogging about the best Lancet paper as I get my new issues on Friday, or something similar. Cannot schedule creativity, I find🙂

    PS: This is a WordPress problem. If I am logged in as admin on my WordPress blog, it does not show my URL on the post I have commented on. As they say in the US, go figure!😎

  5. September 28, 2007 1:18 pm

    Writing a post a day is tough and at times I really feel like catching up on that movie I missed! But I like the discipline it imposes on me and in a way its like having a full time job besides all the housework and other things one has to do.
    when I am logged in as admin of my blog, which is always, i don’t have a problem. i am surprised why the problem is there on your blog…strange! but i know wordpress has glitches, my custom header had disappeared for a day!
    so you mean to say you signed out and then commented when you made that second comment (which you asked me to delete)

  6. September 28, 2007 2:38 pm

    Hi, Nita!
    Smoking is one of the very few issues that bothers me really. And the situation is getiing better here in the West. However I am very distrustfull towards all kinds of smoking-relevant studies – who pays them??
    It would be great not only to read all that statistics, but also to hear what your personal impression of smoking in India (especially that of women) is – what do you actually see in your society?
    thanks a lot!!

  7. Karthik permalink
    September 28, 2007 2:45 pm

    my salt worth …….. in india its the other way round… these was a lot of poor and uneducated women who used to chew / smoke bidis….. but there is a definate increase in the no of women whom smoke from the educated class… who attribute to the so called BPO culture… and I have tried to speak to a lot of youngsters who have got into smoking… esp the girl crowd…. its sheer peer pressure and a status symbol… so your conclusion that education plays a role is far from accurate… we might reach that stage in a couple of years when the so called educated realise… till then for those women…. its a status symbol and trying to feel on par with men

  8. September 28, 2007 2:46 pm

    Axinia, tobacco chewing is rampant all across India amongst the poor. We have the highest rate of oral cancer in the world. From my own observation, almost 70 percent of adults from a certain socio-economic class ingest tobacco either in the form of bidis or eating it in paan. that is why we have a tremendous spitting problem.
    Just in the last few months, two workers where I live (gardener, labourer) both women died of oral cancer. Tobacco eating is not a western fad here amongst the poor, they have been at it for years. Even the woman who looked after me when I was a child (nanny) chewed tobacco and my mom finally told her that she had to quit the job or quit tobacco!

  9. September 28, 2007 2:52 pm

    Karthik…er, it is not my conclusion. Its an established fact. However your point about educated women doing it is something that I have mentioned…with reference to cigarettes only. Let us remember that cigarettes and chewing tobacco is equally bad and both are tobacco. The graph takes into account smokeless tobacco (chewing) and if it didn’t probably not even one percent of women would be found to be smoking!
    Also if you want to take it percentage wise, you will find that a LOT more uneducated women ingest tobacco than educated women. We are talking of sheer numbers here.
    But it is true what you said, smoking is catching on amongst the educated too, thats the whole point of this post.

  10. September 28, 2007 4:25 pm

    Nita: Another thing. No Smoking laws could reduce smoking but not other forms of tobacco consumption. In Norway there is a growth category in Snus. This is not different from the tobacco chewing in India but it is more potent and comes in a bag that looks like a little tea bag which one places at the back of one’s mouth to sate the withdrawl. I have a Norwegian friend who uses this hence my detailed knowledge and interest.

    To see how this market is likely to grow in Europe, consider this document:
    http://www.euromonitor.com/Tobacco_in_Norway

  11. September 28, 2007 5:19 pm

    // This is not different from the tobacco chewing in India but it is more potent and comes in a bag that looks like a little tea bag which one places at the back of one’s mouth to sate the withdrawl.//

    In india also this product was launched by a top swedish company by brand name “Click ” Rs. 5 per pack .. I guess it was 5 years back… but failed here very soon..

    Read this: http://www.hindu.com/thehindu/lf/2002/02/26/stories/2002022600030200.htm

  12. September 28, 2007 5:50 pm

    Shefaly, that snus article was interesting, had never heard of it!
    Bharath, how did you manage to find that??? Can’t imagine the thing came and went in India! Well, it looks like chewing tobacco itself is a long standing tradition in Scandinavian countries, just like in India. I wonder whether the tea bag paper might help reduce the incidence of oral cancer. That news report says that they haven’t found a connection between oral cancer and snus. but its been established that tobacco chewing directly does cause the cancer.
    snus will also take care of the spitting. The govt. should sell it here!! Just joking…

  13. September 28, 2007 6:16 pm

    Nita, They did considerably good marketing here.. Atleast in B’lore n Mumbai I saw many of their ads on billboards.. I wonder how you didn’t catch it!!! I tasted it twice.. Not to avoid smoking but to see what it is?

    My review is (negatives):

    1) It’s very very strong in taste as it’s like raw tobbacco chewing.. tea bag paper is too thin.. so I’m sure it causes cancer

    2) It sucks lot of water.. I mean you feel horribly thirsty after chewing it..

    3) It’s not convienient to chew

  14. September 28, 2007 6:46 pm

    Massachusetts in the US is one of the many states that have passed laws to make the workplace smoking-free (including bars and clubs). Other states are following suit. Sure, there was some hue-and-cry but that has quietened down. I think it was/is a step in the right direction, given all the PR psychological propaganda and smoke-and-mirrors used by the tobacco industry to obfuscate the link between cigarette smoking and cancer.
    One reason women tend to smoke (at least in the West) is to keep their weight down. Virginia Slims anyone?🙂

    Excerpted/paraphrased from “Toxic Sludge Is Good For You“:

    The tobacco company used slogans like “Reach for a Lucky instead of a sweet” to market cigs to women. It’s also associated with freedom/women’s lib and a sublimation of oral eroticism. Edward Bernays staged a publicity event where he hired attractive women to march in NY’s Easter parade, each waving a lit cigarette and proclaiming it a “torch of liberty.” He made sure that publicity photos of his smoking models appeared world-wide.

    The book has a whole chapter devoted to tobacco industry called “Smokers’ Hacks” that explores the hazy ethics involved. I wonder if India has something similar to a PR Watch yet.

  15. September 28, 2007 7:08 pm

    Nita: I doubt that it will help reduce the incidence of oral cancer. It is placed at the back of the jaw, between the jaw and the cheek. Which is not very different from (I think) gutka or khaini in India.

    You may want to look up smokeless tobacco products on Google. You will be amazed by how much is written about India’s smokeless tobacco consumption.

    The smoke is visible; the silent chewing is not. We need to pay attention to overall tobacco consumption given our predilection for smokeless products..

  16. September 28, 2007 8:26 pm

    @ Amit: That tie-in with weight? Altogether another drama altogether, no? I research obesity and it is more fascinating by the day.

    @ Nita: Sorry to send so much stuff your way. But this just in from my public health feeds:

    QUOTE:
    Fourteen to 18-year-old adolescents are at an increased risk to initiate smoking when they start to work, according to researchers from the Johns Hopkins Bloomberg School of Public Health. Investigators found that adolescents who worked more than 10 hours per week also started smoking at an earlier age than their peers. The study authors recommend that the workplace be considered as a location for smoking prevention programs or policies. The study is published in the November 2007 issue of the American Journal of Public Health.

    “Our findings highlight the importance of working on smoking behaviors of adolescents, which is an area that has not received much attention in current efforts to reduce youth smoking,” said Rajeev Ramchand, PhD, lead author of the study. The research was completed while Ramchand was a PhD candidate in the Bloomberg School of Public Health’s Department of Mental Health.

    Using data from the Baltimore Prevention Intervention Research Center (PIRC) studies, the researchers analyzed work and smoking patterns of the study participants, of which 55 percent were male and 85 percent were African American. The adolescents have been followed since the first grade, which allowed the study authors to review multiple years’ worth of data.

    During year 10 of the PIRC studies, 26 percent of the adolescents worked. One year later, close to 40 percent of the adolescents were employed as babysitters, fast food restaurant staff, store clerks and in other retail positions. Tobacco use during this time increased from 13 percent at year 10 to 17 percent at year 11. Adolescents who worked during two consecutive study years and those who started to work during the tenth and eleventh year of the PIRC study were over three times more likely to report tobacco use initiation when compared to their non-working peers.

    Adolescents who worked more than 10 hours per week were 13 years old when they first smoked. Surprisingly, adolescents who didn’t work started smoking at 14 and adolescents who worked less than 10 hours each week started smoking at 15.

    The study authors also examined other risk factors for smoking—high levels of aggression in first grade, as well as reductions in parent monitoring during late childhood and changes in affiliations with peers who used drugs.

    The study results coordinate with the previously published precocious development theory which states that adolescents seek out the rewarding aspects of adulthood ahead of their counterparts by assuming social roles and adult-like behaviors.

    “There is a clear relationship between working for pay and adolescent tobacco use. Ensuring that adolescents work in smoke-free environments may be a promising way to prevent some kids from starting to smoke. However, more research is needed to systematically evaluate what features about the workplace, or about working, are most closely linked with adolescent smoking,” said Ramchand, who is now an associate behavioral scientist with the RAND Corporation.

    UNQUOTE

  17. September 28, 2007 8:55 pm

    Shefaly, I worked in public health area for a while (obesity, chronic disease) and some of the surveys from schools in MA regarding diet, exercise and weight etc. indicated that one of the reasons girls/females smoke cigarettes is to control their weight. I also have anecdotal evidence from a couple of women friends and according to them, it works – apparently, smoking cigs somehow kills the desire to eat (more). But I have no idea about the biological workings of that.

  18. September 28, 2007 10:38 pm

    So will the cigarette companies stop targeting kids and now start targeting Asians and Asian-Americans?

  19. September 29, 2007 1:06 am

    Abarclay12: If I may.. That BMJ paper link about Asian Americans and Pacific Islanders is about mid 1980s to mid 1990s.

    Tobacco companies are targetting anybody and everybody in countries which have lax regulations regarding smoking.

  20. September 29, 2007 4:28 am

    Interesting statistics – a friend of mine says there is a special place in Hell for cigarette manufacturers and I like to believe he might be on to something.😉

    Malcolm Gladwell had an interesting opinion on the rise of Teenage Smoking in America in his book “The Tipping Point” where he explored how cultural fads can spasm out of control and turn into epidemics – whether it’s a new hairdo, bell bottoms or lighting up cancer sticks.

    I once wrote a post after reading his analysis and I think I agree with him. From what I have seen, the majority of new smokers are teenagers and young adults. Very few people start smoking after their mid-twenties and the reasoning he gave – that young people are more likely than grown-ups to jump on to lifestyle fads (that are perceived as image-enhancers) – is right on.

    http://noumankhan.wordpress.com/2007/05/01/smoking-isnt-cool-smokers-are/

  21. September 29, 2007 4:30 am

    Bharath, thanks for sharing that personal experience with snus!

    Amit, I have heard about this smoking to keep the weight down thing. In India its more lifestyle related, though I am sure this weight thing is also a part of it…being thin is very much a desired thing nowadays and if smoking can give you the ‘image’ and keep your weight down, why not!!

    Shefaly, no its not to much stuff at all. One of the things I want my site to be is a place where people can look up information on various subjects and there is just so much I can do myself! So all the info is welcome.

    But about the targeting of Asians, do you feel that tobacco companies have stopped focusing on Asian Americans? That they do not think of them as a vulnerable group anymore? Do you think there has been a change? Are tobacco prevention measures now in the Asian American group similar to the mainstream Americans?

    abarclay12, I think kids will always be a vulnerable group…unless there are laws to ban it, companies will continue to do it!

    Nouman, cancer sticks describes it aptly!

  22. Nil permalink
    October 1, 2007 7:34 pm

    I remember seeing a documentary on India where billboards across the big cities kind of glamourise smoking, as they are endorsed by the stars and it gives the ordinary man an idea that it’ll make them more socially accepted among peers.

    From a semi-personal experience, my family in Kerala told me of a neighbour who was kicked out by his wife because of a tobacco addiction which was costing them so much money. Every night u could hear him screaming for, apparently more tobacco. He sadly died by the next time we visited.

    A dangerous habit.

  23. March 28, 2008 8:50 pm

    nice post… i think the primary reason is
    5) Tobacco control initiatives in this group have been slower to develop than in other targeted ethnic groups

    why can’t people learn from other peoples mistakes, why does it always have to be from their own:-/

    Perhaps it’s just a lack of control over themselves! – Nita.

  24. January 20, 2009 3:17 pm

    And what is wrong with smoking?

    why Asians supposed to be ‘culturally disposed’ towards smoking

    I wonder which Asia you are talking about. Are you talking of the same India in which there is a small nation with HUGE population and a name India? I wonder if you have heard something about villages of India.

    Almost 52% of village women in MP, UP, who never heard of America, who knows nothing about Paris Hilton, Hillary Clinton, Obama or Bush, do smoke.
    India is a nation where smoking afeem is traditional and historical. Bhang is a common drug used by Indians since eons of ages and it is considered as the “Prasad of Bhole Nath” that phallus god of all virgins, who get the personified god in their husband after marriages, and hence husband becomes their real god, an image of the virtual God Bhole Nath.
    There were some great songs about bhang and bholenath too, like “Jai jai ShivShankar kanta lage na kankar”, and “Bhang ka rang jama ho chakachak fir lo paan chabaye” etc.
    In the villages where I visit often for my construction projects, I see a freedom in women out there; they are freer than Indian city dweller women are. They can bath well in open near a well in a “jheeni see sari” wo bhee all wet showing off all their cleavages and men just don’t stare, they do not get infuriated. Their estrogens don’t push them to rape women just because women are exposing.
    While in cities, Indian youth may well eve-tease a girl just because she is wearing cloths she prefers. I am sure many Indians are aware of the eve-teasing sequences on New Year night.
    In villages, women not only smoke, they engages themselves in the small scale industry of making Bidis, and hence they earn a respectful living independent of their husbands, and provides their children a little better life, not only that, it makes them feel self-confident too.

    why can’t people learn from other peoples mistakes, why does it always have to be from their own:-/
    Perhaps it’s just a lack of control over themselves!

    umm I am sorry, but may I say that “perhaps some people are too much addicted for preaching?”
    One of them is our health care minister the jerk Ramodas.
    Total Number of people in India died of by smoking or related diseases in last 30 years is less than number of people killed in last single year in a single city Delhi by road accidents.

    So, should people learn that using roads kills people hence they should not use roads?
    There is no sense in that.

    (Please don’t take it as an offense.)

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