Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional surveyBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39311.550197.AE (Published 13 September 2007) Cite this as: BMJ 2007;335:545
All rapid responses
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
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
Locum Consultant in Public Health Medicine
Dr S Ramaiah
Director of Public Health
Walsall teaching Primary Care Trust, Jubilee House,
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;
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:
Competing interests: No competing interests