Recent findings from the first nationally representative study of smoking in India found that this country is in the grip of a smoking epidemic likely to cause nearly a million deaths a year starting in 2010. There are 120 million smokers in India, half of them younger than 30, the study found. India has a larger population of smokers than any other country in the world except China. The research was conducted across the country by a team of 900 field workers from India, Canada and Britain and the results published online in the New England Journal of Medicine last week.    The study found that more than half of smoking-related deaths would be among poor and illiterate Indians. It also offered some medical surprises about the way smoking worsens diseases, researchers said. According to the findings, for example, 40 percent of tuberculosis cases in India were due to smoking, since smoking converts the disease in the lungs more quickly.   "Please don't smoke in your movies," Ramadoss said recently on CNN- IBN,  "India should be very, very concerned about 14-year-olds now starting to smoke. We have data which show that 52 percent of children have their first puff of a cigarette because of movie celebrities." Recently, a movie star from Tollywood, the Tamil-language film industry, quit smoking and began talking to high school and college students about doing the same.

The king of Bollywood, actor Shah Rukh Khan, said in an interview that the thing he hated most about himself was his inability to stop smoking. "I know I have to. I know as a role model I shouldn't be sending that message," he said. "It's a horrible habit. I have to work harder to stop."

In the year 2010 alone, smoking will cause close to a million deaths in India, and 70% of those deaths will occur in men and women ages 30 to 69, according to Prabhat Jha, M.D., of the Center for Global Health at the University of Toronto, and colleagues, who made those predictions in a special article published online by the New England Journal of Medicine.     Dr. Jha and colleagues studied smoking in a nationally representative sample of 1.1 million Indian households. They compared the prevalence of smoking among 33,000 deceased women and 41,000 deceased men with the prevalence of smoking among 35,000 living women and 43,000 living men.  . Typically Indians smoke bidis, a sort of mini-cigarette wrapped in the leaf of another plant and which  contains only about 25% of the tobacco in a U.S. cigarette. In the U.S., tobacco use accounts for at least 30% of all cancer deaths and 87% of lung cancer deaths, according to the American Cancer Society. In 2007, about 168,000 (or one in three) cancer deaths will be caused by tobacco use, the society added.  Tobacco use was responsible for nearly one in five all-cause deaths per year, an estimated 440,000 deaths in the U.S., during 1997 through 2001, according to the society.    Among the findings in India:    Roughly 5% of women ages 30 to 69 were smokers as were 37% of men in that age group. For women ages 30 to 69, smoking was associated with a doubling of the risk of death from any medical cause (risk ratio 2.0, 99% CI 1.8 to 2.3) and for men in that age group, smoking was associated with a 70% increase in the risk of death from any medical cause (RR 1.7, 99% CI 1.6 to 1.8).    The most likely cause of excess mortality among smokers was tuberculosis (RR 3.0, 99% CI 2.4 to 3.9 for women and 2.3, 99% CI 2.1 to 2.6 for men).    Smoking was associated with an eight-year reduction in median survival for women and a six-year reduction in median survival for men.    Assuming the associations between smoking and excess mortality were mainly causal, smoking among people ages 30 to 69 is responsible for one in five deaths in men and one in 20 deaths in women.    In 2010, smoking will cause 930,000 adult deaths in India.    Moreover, "tobacco use and alcohol are strongly correlated, so residual confounding by the use of alcohol could explain some of the excess mortality among smokers."    And smokers tend to live with other smokers, which could "have inflated the rates of smoking among control subjects."     The authors acknowledged that "the tubercle bacillus is obviously a cause of all deaths from tuberculosis." But they said that smoking could contribute to tuberculosis deaths because subclinical infection is widespread and "smoking could facilitate the progression to clinical disease."    The study was funded by grants from the John E. Fogarty Center of the National Institutes of Health, the Canadian International Development Research Center, the Canadian Institute of Health Research, the Li Ka Shing Knowledge Institute, the Keenan Research Center, Cancer Research U.K., and the United Kingdom Medical Research Council. Dr. Jha reported no potential conflict of interest.      Indian health authorities want tobacco companies to print grisly images of tobacco-related diseases on packets of cigarettes and beedis, but face opposition from politicians keen to protect the jobs of tobacco workers.

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