A US-made campaign to curb cigarette smoking among young people in India has become entangled in the cultural aspects of the country’s attitudes to tobacco.  

 
A chewing mixture is known as paan – a blend of powdered tobacco, spices and areca nut, wrapped in a betel leaf – is contributing to the rapidly escalating tobacco problem in the sub-continent.
 
The World Health Organisation is unsure of the prevalence of tobacco use, but estimates range from between 30 and 70%. Chewing tobacco makes up a large proportion and its use among young people is increasing rapidly.
 
Over 5,000 are estimated to start using tobacco products, and experts are predicting that by 2020, tobacco will account for 13% of deaths across the subcontinent.
 
With these shocking figures in prospect, prevention efforts have been weighing on the minds of researchers, policy makers and advocacy groups in India and abroad.
 
In 2004 Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India) was set up as a collaboration between prevention scientists at the University of Minnesota and an Indian NGO (Health-Related Information Dissemination Amongst Youth). The objective was to translate and test expertise in tobacco prevention imported from the US.  
 
Outcomes after two years, recently published in Cancer, Epidemiology, Biomarkers and Prevention, show that young people receiving the programme have proved to be less likely to smoke, but the reductions do not translate to reductions in tobacco use in regions where paan chewing is widespread.