Dr Bhat raises an important and pertinent point of health education regarding stopping smoking, especially among those in rural areas1. However, some issues should be considered before embarking on such an exercise.
The rural scenario is different from the urban. Although many Indian rural people may be poor and illiterate, they are still receptive to new ideas that are presented in the right way. Regarding their illiteracy or low level of education2, pictorial warnings would be more effective than using written text. Further, legislation could assist passive smokers by preventing their exposure to second-hand smoke, providing bans on smoking in 'No smoking' zones were strictly enforced.
Another issue to consider is the preparedness of our health professionals to counsel smokers about quitting the habit, or even to deliver the health education message? Published reports suggest that few doctors are capable of this3. Attention should be given to the training of medical students, with health education built into the curriculum, before we deputise them to teach the public.
Most important is the example of those who are educated and the informed. In rural India, people hold their doctors in high esteem, offering an opportunity for those doctors to lead by example. However, sadly, there is evidence that doctors and future physicians are tobacco smokers themselves, and that they find it difficult to quit4-7. We need to kick the butt before we ask others to do so. Unless we do so, any amount of education, warning and pictorial depiction will fail miserably. Before we start to preach, some introspection might reveal whether we are prepared to answer the questions: 'Doc, why do you ask me to stop/ not to take up smoking when you yourself smoke?' or 'Why are you not able to quit?'
Animesh Jain, MBBS, MD
Department of Community Medicine
Kasturba Medical College,
1. Bhat M. Health message for smokers in the rural and remote areas of the developing world. Rural and Remote Health 7: 813. (Online) 2007. Available: http://www.rrh.org.au (Accessed 3 September 2007).
2. Indian Government. Literacy rates in India. Census 2001. Available: http://www.indiabudget.nic.in/es2001-02/chapt2002/chap106.pdf (Accessed 3 September 2007).
3. Crofton JW, Freour PP, Tessier JF. Medical education on tobacco: implications of a worldwide survey. Medical Education 1994; 28: 187-96.
4. Behera D, Malik SK. Smoking habit of undergraduate medical students. Indian Journal of Chest Diseases & Allied Sciences 1987; 29: 182-184.
5. The Times of India. Smoking among medical students high: survey. Available: http://timesofindia.indiatimes.com/articleshow/1865981.cms (Accessed 2 September 2007).
6. Sachdeva V. 40% Indian docs are chain smokers. Available: http://www.ibnlive.com/news/40-indian-docs-are-chain-smokers/40597-17.html (Accessed 3 September 2007).
7. Nawaz H, Imam SZ, Zubairi AB, Pabaney AH, Sepah YJ, Islam M et al. Smoking habits and belief of future physicians of Pakistan. The International Journal of Tuberculosis and Lung Disease 2007; 11: 915-919.