World No Tobacco Day: 4.4% of children in India between 13 and 15 years addicted to smoking, says survey

Smoking is a risk factor for weak bones and the deterioration can start as early as the teen years, say orthopaedic physicians on World No Tobacco Day.

There’s yet another reason to educate children and teenagers about the perils of tobacco: experts say smoking can actually have an effect on bone formation in young people. If they begin smoking in school and college, it can hamper bone deposition, hence stunt bone growth. Plus, it can set them up for bone degeneration much earlier in life than non-smokers.

As per World Health Organization (WHO) statistics, worldwide, 82,000 to 99,000 young people start smoking every day. The Global Youth Tobacco Survey, of which India is a part, is a school-based survey conducted in 137 countries, indicates that 46.8% of children who did not smoke themselves were exposed to cigarette smoke within the home and 47.8% were exposed outside the home. In India, the survey produced representational data that implied 4.4% of children in India between 13 and 15 years smoked cigarettes. 

“Peak bone formation, which is the maximum buildup of bone in the skeletal mass, happens between 20 and 25. This is the point at which the bones are at their highest strength and density. Look at growing bones in children and young adults as a bone bank. You are adding to the bank with various factors, like diet, exercise and sun exposure. This mainly takes place upto the 20s. After this, there tends to be more withdrawals on the bone bank, in terms of depletion,” said Dr Maninder Singh, an orthopaedic surgeon. 

He added, “However, smoking inhibits bone deposition, and so overall skeletal strength is reduced. Besides, in case of a fracture, there is an impact on bone healing—it may not be as efficient as a non-smoker.” 

Smoking decreases calcium absorption and reduces levels of vitamin D in the blood stream (the vitamin that facilitates bone building). Besides, the constriction of blood vessels that takes place in smokers, decreases blood supply, hence nutrition to the bone is compromised, hampering skeletal health. Cigarette smoke causes the circulation of free radicals in the body, killing bone-building cells. It also raises cortizol that adversely affects bones. The wrist and the neck of the femur are most prone to injuries, making a child more vulnerable to playground injuries, said Dr Singh. 

Further, experts say that young people who smoke are more likely to be adult smokers, setting them up for the early onset of osteoporosis, or decreased bone density. 

Dr. Samir Parikh, Director mental health and behavioral science at a leading hospital explained further, “Adolescent substance use has become one of the major areas of concern in India, with an estimate of 50% boys having tried at least one substance by the ninth grade (1991). Moreover, according to a recent study in India, easy availability and relief from tension were the most frequent reasons reported for the continuation of substance use, with media being stated as the most frequent source of information (Tsering et al, 2010). Further, adolescents have been found to be the most vulnerable population to initiate tobacco use (Chadda & Sengupta, 2003).” 

In addition, one of the factors responsible for tobacco addiction is experimental attitude. The teen years are a critical period of development and adolescents are given to be experimental with many risk taking behaviors including the use and abuse of drugs and alcohol. “Within this phase, the youngsters have a simple curiosity, and are keen to experiment all options as they have a need to explore the consequences for themselves. In the process, an addictive behaviour is likely to gradually increase, as there is a very thin line between casual use and drug abuse,” added Dr Parikh. 

If a parent does find out that their child has begun smoking, then counselling is the way forward, not just for the child, but for the parents too. However, in addition, it is a good idea to take your child to an orthopaedics specialist to understand if any supplements are needed, to reverse the damage done. A diet rich in calcium and vitamin D may also be advised.