Dr Nikhil Mehta Surgical Oncologist, HCG Cancer Centre, Jaipur
The first puff of a cigarette is often accompanied by curiosity, peer influence, or the illusion of relief. For many, it feels like a fleeting moment, harmless, even forgettable. Yet, from that very first inhalation, the body begins to undergo subtle but significant changes. What may seem like a casual experiment can quietly set off a chain reaction that affects nearly every organ system, laying the groundwork for long-term health consequences.
When tobacco smoke enters the lungs, it delivers a complex mix of thousands of chemicals, including nicotine, tar, and carbon monoxide. Nicotine, the addictive component, reaches the brain within seconds, triggering the release of dopamine—the “feel-good” chemical. This rapid reward mechanism is what makes smoking highly habit-forming. Even at this early stage, the body starts adapting to repeated exposure, gradually building dependence while masking the underlying damage.
The Global Adult Tobacco Survey (GATS) 2 – 2016–17 found 266.8 million adults still using tobacco in some form. The WHO’s 2025 Global Tobacco Report shows adult smoking prevalence rising again, to 9.3% in 2024 from 8.1% in 2020.
No Tobacco is Safe
India is the world’s second-largest consumer of tobacco, with over 267 million adults, approximately 29% of all adults, using tobacco in some form. Smoking is one part of this crisis. Smokeless tobacco, including khaini, gutkha, and zarda, accounts for much of the rest. Among 270 million tobacco users in India, roughly 200 million consume smokeless products without a second thought.
Our body’s response to consumption is what connects all these. From the first use, tobacco introduces over 4,000 chemicals into the body and more than 250 of which are known to be harmful. There is no safe level of tobacco exposure and the damage accumulates across organs and over years.
From Minor to Mortal: The Harm Spectrum
Cancer is the most critical end of the spectrum but it is far from the only consequence.
The impact begins with subtle change including yellowed teeth, persistent cough, reduced lung capacity, and chronic fatigue. The respiratory system is the first to bear the burden; smokers experience higher rates of bronchitis, recurrent infections, and aggravated asthma.
As exposure continues, the risks escalate. Tobacco is a primary driver of the four largest non-communicable diseases: cancer, cardiovascular disease, respiratory illness, and diabetes. Bidi and cigarette smokers in India die six to ten years earlier than their non-smoking counterparts (Jha et al., NEJM, 2008). Tobacco accounts for 27% of all cancers diagnosed in India including cancers of the lung, mouth, throat, oesophagus, stomach, bladder, and cervix (ICMR-NCRP, 2021). Smokeless tobacco alone is responsible for nearly 90% of oral cancers in the country.
Smokers also face a significantly elevated risk of heart attacks, strokes, and chronic obstructive pulmonary disease (COPD). For individuals living with tuberculosis, smoking nearly doubles disease severity and treatment failure rates.
The Non-Smoker Who Pays the Price
The harm of tobacco does not respect the boundaries of who lights the cigarette. Secondhand smoke carries the same toxic cocktail and they carry a 20–30% higher risk of developing lung cancer. Children are among the most vulnerable. Secondhand smoke exposure increases their risk of respiratory infections, asthma, and ear infections. In infants, it is linked to sudden infant death syndrome (SIDS).
Families Pay the Hidden Cost
The economic burden of tobacco in India is staggering and inequitable. According to the Tobacco Atlas 2025, the annual cost-of-illness attributable to smoking now stands at INR 1.97 trillion, covering direct healthcare expenditures and indirect losses from premature death and lost productivity. For individual families, this means catastrophic out-of-pocket expenses including hospital visits, long-term treatment, and, in many cases, loss of the primary earner.
On average, a smoker in India spends 8.43% of GDP per capita to sustain a 100-pack-a-year habit (Tobacco Atlas 2025). For lower-income households, where tobacco marketing is disproportionately concentrated, this diverts money from food, education, and essential healthcare. Tobacco related deaths are not mere statistics. They are fathers, mothers, and siblings lost to a preventable addiction.
Early Recognition, Timely Action
The good news is that tobacco-related diseases are among the most preventable. Detection and treatment at any stage of life, even after decades of use, deliver measurable health benefits, and cancers detected early respond far better to treatment. The human body has a remarkable ability to recover within hours of quitting. Blood pressure drops, circulation improves, and lung function begins to restore. Over years, the risk of cancer and heart disease declines significantly, and the individual is able to live a healthier life.
Tobacco users with a persistent cough, unexplained weight loss, blood in sputum, mouth ulcers that do not heal, or difficulty swallowing require immediate medical attention.
On World No Tobacco Day, every individual must look honestly at their relationship with tobacco. Always know that help is available, that treatment works, and that the best time to quit is always no
