The nation needs a strategy to reduce the death and disability caused by use of tobacco products. That strategy may develop out of a renascent public debate about tobacco control policies that has intensified over the past three years.

Media coverage of these events and revelations of hitherto secret files and depositions from former tobacco firm employees has been intense. These and other developments have resulted in a vigorous national debate about tobacco control among the various groups with a stake in tobacco policy--tobacco firms, attorneys general and health officials, public health groups, tobacco growers, tobacco control advocates, and others. Attention now focuses on the Pakistan Government and the executive branch, which are seriously considering federal legislation.

Although public debate has intensified, tobacco use among youths has escalated. Smoking rates among youths have increased for four years in succession (1993-1996), as measured by the largest national survey, the University of Karachi.

"Smoking cigarette is part of enjoyment while hanging out," says Roheela.

"I smoke to stay slim,"Sadia tells.

"I smoke to stay relax and relieve any stress," Lubna comments.

Mumtaz, 23, student of Karachi University said, "It was my willpower and support from my friends and teachers that helped me to stop smoking." Though I am facing problems like headache, irritation, fever and craving after quitting 10 years old smoking habit, yet I can't relapse because I don't want to shatter their trust".

These are the general statements given by the females of our society who are indulged in smoking as this trend among women is on the rise in Pakistan.

A survey supervised by the Karachi University showed that eight percent of women are frequent smokers. Researchers found out that the reasons for smoking among women are different from those prevailing in men. The most general reason of women smoking is gender discrimination within and outside family. Women find smoking an act of rebellion against social pressures to be feminine, perfect and nice.

"I dress like boys, I behave like them and I smoke because I want to show my parents that I am not inferior than my brothers", said Tania who is smoking for the last 10 year. She said if boys are free to smoke, why not girls?

Among children’s, smoking is viewed as a sign of being independent and bold and is considered as a label for acceptance among peers. Psychological factors like depression, anxiety and a sense of insecurity are also well known risk factors. Furthermore, dieting is another common reason for women smoking. A team of doctors analyzed association between dieting and smoking. Their aim was to see if the desire to lose weight play a role in the decision to start smoking and it was found that teenage girls who start dieting are nearly two times more likely to take up smoking regularly, compared with teenage girls who are not dieting.

Apart from that, cigarette advertising on mass media and images portrayed convince females to identify themselves as glamorous through smoking. It's a fact that heavy smoking is extremely injurious for health. Although equally bad for males, women who are frequent or habitual smokers are at risk. For example, smoking during pregnancy can cause serious health problems for both mother and child. It accounts for 20 to 30 percent of low-birth-weight babies, up to 14 percent of preterm deliveries and about 10 percent of all infant deaths.

Mothers who smoke can pass nicotine to their children through breast milk. Cigarette smoking not only passes nicotine on to the fetus; it also prevents as much as 25 percent of oxygen from reaching the placenta. When mother smokes, carbon monoxide, the baby that inhibits the unborn baby from getting the food and oxygen needed to grow inhales a poisonous gas.

According to the World Health Organization (WHO), report, "by the year 2030, mortality from smoking related disease is expected to rise 10 millions and over 70 percent of these deaths will be in the developing countries like Pakistan where smoking is rising day by day."

Passive smoking has now been directly linked with some sort of cancers. WHO links smoke with 25 cancers like, uterine, kidney, lungs, cervix, pancreas, head and neck etc. For women, smoking also increases the risk of stroke and heart diseases. In fact it adds fuel to the fire; chances for heart related diseases get ten-fold if they are taking birth control pills side by side.

There are only three basic ways to reduce the death toll: to prevent the initiation of tobacco use, to get current users to quit, and to reduce exposure to tobacco toxins. The vast majority of those who use tobacco start doing so in childhood or youth, so prevention efforts must focus there. Individuals of all ages can quit using tobacco, and the cessation of tobacco use is associated with immediate economic and health benefits from reduced cardiovascular disease and long-term reductions in the likelihood of developing cancer. Reduced exposure to tobacco toxins has followed from bans in public places.

Preventing the initiation of tobacco use among children and youths remains the preeminent long-term goal, but cessation of tobacco use by individuals in all age groups is also essential. The projection that 10 million people will die of tobacco-related illness in the year 2030 is mainly based on the number of current users. This enormous health toll will thus drop only if current users quit and are not replaced by other users, and if tobacco exposure is reduced. The worldwide health consequences also clearly indicate that national tobacco control policies must look beyond national borders.

RAISE PRICES TO REDUCE USE:

Raising the prices of tobacco products is a proven way of reducing tobacco use in the short and medium terms. Price hikes both encourage cessation and thwart initiation. Higher prices have the added benefit of reducing use among people not yet addicted to nicotine, including young people, whose level of tobacco consumption may be more sensitive to price. There are many ways to raise prices. A federal excise tax is simple and direct and would create a revenue stream that could be used for research and tobacco control measures. Goals for reducing tobacco use among youths and children’s.

TOBACCO CONTROL EFFORTS:

Current attention to tobacco control follows many years of innovative work and local levels initiated by governments and private organizations. City such as Karachi and Lahore have mounted effective public education campaigns, supported research, encouraged local nonsmoking ordinances, restricted some forms of advertising and promotion, and implemented other tobacco control measures. These efforts are funded by increases in city excise taxes on tobacco products.

The federal government must support city and local infrastructure for tobacco control Many increases in nonfederal excise taxes and restrictions on advertising, promotion, and levels of exposure to environmental tobacco smoke depend on the actions of state and local governments. Bans on smoking in public places and in workplaces not only reduce environmental tobacco exposure to nonsmokers, but have also proven to be powerful interventions to enhance cessation and to reduce the dose exposure among smokers. The vast majority of progress on this front has taken place at the city and local levels. Counter advertising and public education have also been largely city and local efforts, although they would likely be more effective if implemented nationally. All of these are elements of tobacco control efforts and complement federal measures.

HELP CURRENT USERS QUIT:

More than 10 million Pakistani use tobacco products regularly, including 44 million who smoke cigarettes or cigars or who use spit and snuff tobacco. Approximately 70 percent of smokers express a desire to stop smoking. Half attempt to quit each year, but only 2.5 percent succeeds. At present, approximately 3,000 children and youths start to smoke each day, contributing 1 million new smokers annually. Even if prevention efforts reduce this figure by 60 percent, the goal stipulated in the settlement each year, the nation will have 400,000 new smokers each year, the majority of whom will become addicted and have difficulty stopping. On top of these compelling public health reasons, there is also a moral reason to intensify cessation efforts: Current tobacco users will be paying the increased prices, and some fraction of that revenue should redound to help them directly.

Government health programs and private insurance and health plans should cover treatment programs for tobacco dependence.

Coverage for tobacco use cessation programs and services should be required under all health insurance, managed care and employee benefit plans, as well as all Federal health financing programs. Many who quit do so only after repeated attempts, so effective coverage cannot be a one-time benefit but must recognize the cyclical nature of quitting, and health programs must provide coverage for repeat attempts at cessation.

Treatment Programs For Tobacco Dependence Should Be Incorporated Into Quality Of Care Measures.

Assisting smokers with smoking cessation is a powerful intervention for promoting health and reducing dramatically the risk of cancer, heart disease, lung disorders, and other medical conditions. Instruments used to evaluate the quality of health plans and the adequacy of insurance coverage should include an indicator of whether tobacco cessation services are covered. When coverage is included, the effectiveness of the cessation methods needs to be continually measured and reported. This will require ongoing research to improve smoking cessation methods and to assess their cost-effectiveness.

Programs and norms outside the medical care system must also support prevention, cessation, and harm reduction.

Many tobacco users succeed in quitting without a cessation program and without formal care in the medical system. In recent years, nicotine gum and patches have been approved for sale without prescription. And nicotine nasal sprays, lozenges, and aerosols are in the pipeline. Ironically, the market for smoking cessation means that firms making cessation products may apply sophisticated marketing and promotion techniques to entice tobacco users to quit. Similar to those tobacco firms have used to lure people into taking up tobacco use in the first place. Competition among cessation product manufacturers and service providers also appears to be intensifying. This has the potential to increase public education, encourage a social norm friendly to cessation, and reduce the costs of cessation products and services.

SUPPORT RESEARCH:

The federally funded ASSIST and IMPACT programs have augmented the innovation at the state level noted previously. As more states implement higher intensity tobacco control measures, the value of information to guide those efforts will increase. Any funding derived from new taxes or settlement payments will further increase the need for information to guide tobacco control efforts. Leadership on the research to help guide national tobacco control efforts should come from federal health research agencies.

Recommends governments consider the international implications of tobacco control policies or settlements with the tobacco industry, and to ensure that:
Such measures do not contribute to an increase in the worldwide epidemic of tobacco-related death and disease. The legal rights of those not party to any agreement or policies are fully protected; Such measures do not inhibit full public scrutiny on the past, present, and future activities of the tobacco industry and that

The tobacco industries pay the costs of damage caused by tobacco. The extent with which smoking in general and women smoking in particular, is increasing in Pakistan, it has become inevitable for the country to enforce laws against the increasing threat. Despite of producing more fashionable forms of tobacco to entice teenage girls and Youth by portraying celebrities and film stars in tobacco ads, selling cigarette should be discouraged. Smoke free environment at schools colleges, universities and work places should be ensured to guarantee a healthy and smoke free life.

Data on Youth Tobacco Use from the University of Karachi