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Smoking Dons
- Shalini Pooransingh, Sam Ramaiah, Director of Public Health (17 September 2007)
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Shalini Pooransingh, Locum Consultant in Public Health Medicine Walsall teaching PCT, Jubilee House, Bloxwich Lane, Walsall, WS2 7JL, Sam Ramaiah, Director of Public Health
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Dear Sirs, Every week we read with interest about smoking related issues (1). At the same time we welcome the increasing emphasis and importance being afforded to tackling health inequalities by the Department of Health (2). In Walsall West Midlands, a spearhead Primary Care Trust (PCT) we face many challenges not least of which is smoking among the South Asian population (Bangladesh, India and Pakistan) which comprises the largest minority ethnic group in the borough. Our minority population of 14% increases to around 40% in certain wards. A lifestyle survey of a sample of South Asians in Walsall (Response rate = 71%) found that men and Bangladeshis reported the highest smoking prevalence. Chewing tobacco which has a role in oral cancer (3) is in use among Walsall South Asians (4% admitting to using betel nut with tobacco, 2% use chewing tobacco on its own while 4% use paan with tobacco)(4). When respondents were asked what would influence their decision to quit smoking, illness and disapproval from family and friends were cited as major influences. Bush et al (5) report that a survey of a UK Bangladeshi and Pakistani community revealed that religion and culture influence smoking behaviour; that particularly among Bangladeshis, smoking was part of being a man along with the macho image which was reinforced by Indian films. The influence of on-screen smoking on smoking uptake in adolescents has been well documented (6). We were therefore surprised to see in the recent re-make of the Bollywood movie Don (2006), the character playing Don, arguably the biggest icon in Bollywood was shown smoking cigarettes. Indeed there are also images of him chewing paan. The Indian movie industry is a huge business. Many South Asians in South Asia and those forming the diaspora are regular Bollywood movie - viewers. Anecdotally, 20 million tickets were sold for Bollywood movies in the UK last year. India also has a huge proportion of smokers. Given the evidence to support the influence of on-screen smoking on smoking uptake among teenagers and that there is a captive audience in Bollywood movie-goers it seems sensible to tackle the film industry. However, more realistically and practically we urge health promoters to be aware of the influences on smoking uptake in certain groups and to address this locally during their health education sessions to encourage self efficacy and empowerment which would have benefits in areas such as drugs, alcohol and teenage pregnancy in addition to tobacco control. Dr S Pooransingh
Dr S Ramaiah
Walsall teaching Primary Care Trust, Jubilee House, Bloxwich Lane, Walsall WS2 7JL References 1. Akhtar P, Currie D, Currie C, Haw S Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke free legislation in Scotland: national cross sectional survey BMJ 2007; 335:545-9 2. Department of Health Tackling health inequalities A Programme for Action Crown Copyright 2003. 3. Hashibe M, Sankaranarayanan R, Thomas G et al Body mass index, tobacco chewing, alcohol drinking and the risk of oral submucous fibrosis in Kerala, India Cancer Causes Control 2002;13 (1):55-64. 4. Pooransingh S, Kumar J, Ramaiah S Walsall’s Asian Lifestyle Survey 2000 Walsall PCT. 5. Bush J, White M, Kai J, Rankin J, Bhopal R understanding influences on smoking in Bangladeshi and Pakistani adults: community based qualitative survey BMJ 2003; 326: 962-67. 6. Dalton M, Sargent B, Beach M et al Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study Lancet 2003; 362: 281-85. Competing interests: None declared |
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