During the decade beginning 2010, a new study says smoking will cause about 930,000 adult deaths in India annually; of the dead, about 70 per cent will be between the ages of 30 and 69 years.

"People should know smoking is a huge killer and the cause of 10 per cent of all deaths in India. A male cigarette smoker will lose 10 years of his life compared to a non-smoker. A female beedi smoker will lose 8 years of life while a male beedi smoker will die about 6 years earlier," says Dr Prabhat Jha, Director, Centre for Global Health Research, University of Toronto, and the principal investigator of the study on smoking and death in India.

What is alarming is that smoking is responsible for about 1 in 20 deaths in women and 1 in 5 deaths in men between the ages of 30 and 69 in India. About 5 per cent women and 37 per cent men in India between the ages of 30 and 69 years are smokers. In this age group, smoking was associated with an increased risk of death from any medical cause.

120 million smokers -- almost 10 per cent of the world's smokers -- live in India.

While smoking has been on the rise in India, in most Western countries it has declined as a result of high taxes, strong warning labels, effective ban on advertisement and smoke-free work places and public places.

"The Indian public does not know, especially the poor and illiterate, and neither manufacturers nor the government is telling them anything about the consequences of tobacco use," says Dr Prakash C Gupta, Director, Healis-Sekhsaria Institute for Public Health, Mumbai, and one of the co-authors of the report.

"The price of tobacco products in real terms (adjusted for inflation) has gone down. Even though direct advertisements of tobacco products are banned, surrogate advertisement and promotional activities have increased tremendously," he says.

Though awareness is higher among the educated and smoking in this group is comparatively lower, studies reveal the educated are also not convinced anything will happen to them.

"The risk is much higher in middle aged smokers. Even anything as small between 1 to 7 cigarettes a day increases the risk. Among those who smoked only 1 to 7 cigarettes a day, smoking-associated excess deaths accounted for almost half of the deaths from any medical cause," Dr Jha told rediff.com on the telephone, while on a visit to India.

Dr Jha, a Rhodes Scholar, served at the World Bank and the World Health Organisation before joining the Centre for Global Health Research, Toronto. His family migrated to Canada [Images] from Ranchi in 1971.

India passed a law to print pictorial warnings on cigarette packs in 2003 as recommended by the World Health Organisation -- particularly to spread awareness in rural India -- but legal wrangles have delayed the measure so far. The law, which was to be implemented in 2006, has not come into force yet.

"Unfortunately, this measure is getting postponed and weakened for nearly two years without implementation. First, the skull and bones sign was made so-called 'optional' and now pictures are being revised because one of our ministers thinks they were 'repulsive'," Dr Gupta said in an e-mailed interview.

In countries like South Africa, picture warnings have worked and anti-tobacco activists feel it would have a similar impact in India.

The new study is the first nationally conducted survey and made world headlines when it was published on February 13 in the New England Journal of Medicine. For the research 900 field workers traveled to 1.1 million homes in all parts of India. The smoking habits of 74,000 smokers who died between 2001 and 2003 was compared to 78,000 existing smokers. The study was carried out by a team of 12 doctors from India, Canada and Great Britain.

The reason why there is such a high rate of deaths in India in spite of the fact that Indians start smoking later than American and Europeans is because Indians have a high rate of TB in rural areas and heart attacks in urban areas that accounts for deaths due to smoking.

"Stopping smoking can be highly effective but only 2% adults quit smoking in India," says Dr Jha. "The best way forward is for people to understand the risk. People should support tobacco control."

For more information on the report go to Centre for Global Health Research