The Union Health Ministry recently directed for changing pictorial health warnings on tobacco packs, in an attempt to deter people from consuming tobacco products. Showing graphic pictures of throat and mouth cancer, these warnings, the ministry hopes will bring down prevalence of smoking and use of tobacco. However, in Nagaland, though the number of people consuming tobacco has reportedly decreased to some extent, it continues to be high as per national average. According to the Global Adult Tobacco Survey (GATS), Nagaland status from being the second highest consumer of tobacco at 56.8% in the country has significantly improved and moved down to seventh rank at 43.3% in North East India and eight in the country. Still the prevalence rate of 43.3% is much above the national average of 28.6%. As per the GATS, 54% of men and 32% of women in Nagaland are addicted to some kind of tobacco. Nagaland has also the highest use of pan masala with tobacco at 21%, with 24% male and 18% female consuming it. GATS survey also showed that Nagaland has the 14th highest population of smokers and 6th highest population of smokeless tobacco users in the country. According to Dr Hotokhu Chishi, State Nodal officer, National Tobacco Control Programme (NTCP), with an average of 454 new cases detected each year, Nagaland has the highest number of nasopharyngeal cancer in the country. He reminded that the consumption of tobacco is one of the major factors for prevalence this cancer of head and neck. Now it is also generally assumed, given the intensive anti-tobacco campaigns in media and other platforms, that people are well-versed with impact of smoking on health. However, last week, the World Health Organisation (WHO) made some astonishing remarks. Based on GATS analysis, it said, over half of adults in India were unaware of the fact that smoking causes heart disease and stroke. “Most people know that using tobacco causes cancer and lung disease, but many people aren’t aware that tobacco also causes heart disease and stroke, the world’s leading killers,” Dr Tedros Adhanom Ghebreyesus, WHO director-general was quoted as saying on commemoration of No Tobacco Day on May 31. This also brings into discussion the huge burden of heart disease that Nagaland has been facing. At the same time, a worrying trend today is the rapid rise in the number of tobacco users among school going children in the State. Experts believe that very little is being done in Nagaland to make tobacco products inaccessible to people below age of 18, as mandated under Cigarettes and Other Tobacco Products Act (COTPA) laws. At most vending outlets, there is no display of warnings that declares tobacco sale to children below 18 years of age as illegal. In addition, cigarettes are sold right outside the schools, with no fear of prosecution. Moreover, there is no restriction on sale of loose cigarettes in the State. The fallouts of this laxity have been documented in a study named ‘Nagaland School Oral Health Survey 2013-14’, which found that 28.3% of all school going children between the age of 8-13 years consume tobacco, out of which 15% are smokers. The survey also showed an alarming rate of 41.2% of school going children are buying tobacco for their parents. It is a sad state of affairs that in Nagaland cigarettes and other tobacco products can be purchased by anyone, whatever the age. Experts believe it would take many departments and the society as a whole to come forward in order to discourage younger generation from becoming addicted to smoking. Chief Medical Officer (CMO), Dimapur, Dr Vikato Kinimi during the observation of World No Tobacco Day in Dimapur had said that though the National Tobacco Control Programme has recognized 107 tobacco free schools in Dimapur till now, there are reports of shops near the school selling tobacco, and he sought support from student bodies and authorities to take actions against such practices as NTCP cannot always regulate it. Indeed although the Department of Health & Family Welfare has the mandate of generating awareness about smoking, it is not just the Government’s job to create awareness about health hazards due to smoking. It needs a lot of dedication from all stakeholders to ensure that anti-tobacco laws are not flouted. Unfortunately, not much is being done in this direction. And till Nagaland wakes up to these issues, the new pictorial warnings on the cigarette packets may not yield much results.