To smoke or not to smoke...

Carolyn Kavita Tauro - CNS
'Tobacco kills nearly half its consumers'! “That can't be possible,” exclaimed Tesh (name changed) as his friend read out one of the new posters pasted at a bus stop. In most countries No Tobacco Day went by just like any other day, with probably just as many smokes up in flames. How much do we know about this much used substance Tobacco? 

Types of Tobacco consumption

The different forms of consuming tobacco around the world include the cigarette, cigar, cigarillo and little cigar, dissolvable tobacco, electronic cigarette, beedi, roll your own, hookah, kreteks, the pipe, the french inhale and vaporiser, passive smoking and other forms of smokeless tobacco including paan, gutkha, mawa, chewable tobacco, snuff, snus, spit tobacco and dips among others.

Although familiar with many forms of tobacco smoke, its contents may be unfamiliar to many. There are 4000 chemicals in tobacco smoke. 250 of these are known to be harmful while over 50 are known to cause cancer. An alternative form that is quickly picking up as something that will help quit smoking is the electronic cigarette (e-cigarette). E-cigarettes are devices powered by battery with flavoured cartridges. These refillable and reusable cartridges are filled with nicotine, flavors like cherry and menthol and other chemicals. Although there are cartridges which have been claimed to have no nicotine, the US Food and Drug Administration (FDA) has conducted studies which prove that they do. Also, according to the World Health Organization (WHO), there have been no studies which prove the product's safety or effectiveness as a safe nicotine replacement therapy. On the contrary, the FDA has conducted studies which show that these contain known carcinogens and toxic chemicals which are harmful to the user.

Although smoking is the most common form of tobacco consumption in the developed countries, countries such as India, Nepal and Bangladesh have a high proportion of smokeless tobacco bring consumed. From those over the age of 15 years, 32.9% males and 18.4% females in India, 31.2% males and 4.1% females in Nepal and 26.4% males and 27.9% females in Bangladesh use smokeless tobacco.  In India, Beedi smoking is the most common form of smoking, especially in rural areas. Overall, about 7 beedis are smoked for every cigarette in the country.

Status on Smoking

Every year tobacco kills about six million people. While five million of these are due to direct tobacco use, more than 600,000 people who die are nonsmokers who had been exposed to second-hand smoke. This death toll has been estimated to rise to more than eight million by 2030.

An online survey was conducted recently with 50 respondents from Australia, Canada, Germany, India, Qatar, United Arab Emirates and United States. The mean age group of respondents was between the ages of 16 and 25 years and about 42% of these had ever smoked a cigarette. About 20% of the respondents thought that the age group of 21-25 was a safe age to smoke while more than 59% felt there was no real safe age for smoking. From the 43 people who responded to this question, 88.37% felt that consuming tobacco was not good for health and 9.30% felt that was only so if consumed in excess. When asked whether they thought any of the following diseases could be caused or aggravated by the smoking the percentage of those who thought in the affirmative were: Hypertension (21.6%), Heart disease (25.6%), Infertility (15.2%), Tuberculosis (14.4%) and Asthma (22.4%).

In adults, apart from those mentioned above smoking attributes to disease such as lung cancer, strokes (which are a result of hypertension/high blood pressure), blindness and oral cancer. While smoking increases the risk of heart disease and strokes by 2-4 times, it increases the risk of having lung cancer by 23 times in men and 13 times in women. The kinds of cancers smoking can cause include Acute Myeloid cancer (a kind of blood cancer), bladder cancer, cancer of the cervix, cancer of the oesophagus (food pipe), kidney cancer, cancer of the larynx (voice box), cancer of the oral cavity (mouth), pancreatic cancer, cancer of the pharynx (throat) and stomach cancer. It also has adverse effects and increases risks of infertility, preterm delivery, stillbirth and low birth weight. Second hand smoke too causes respiratory and cardiovascular diseases.

People who do not smoke are not immune to these diseases. Second hand smoke too causes respiratory and cardiovascular diseases. While 19% of the 31 respondents said they smoke in public areas, about 70% said they didn't in enclosed pubs where smoking was not banned. 83% did not smoke in their homes or at their workplaces, and 25% would not move away from others who did not smoke while about 18% would only move away if the others who did not smoke objected. Air polluted by tobacco smoke in public places affects not only adults but almost half of all children while over 40% children are known to have at least one smoking parent. In the year 2004, 28% deaths in children was attributable to second-hand smoke.

For the last year and a half, India has declared new regulations on depiction of tobacco products in films and on television. Anti-tobacco messages should be shown during all films and programmes and anti-tobacco health warnings must be displayed during any scene depicting consumption of tobacco. It has also prohibited the promotion of any brand of tobacco product in any films or program. The online survey revealed that about 59% of the respondents agreed that banning advertisements which promoted tobacco while about 13% of the respondents felt that it was people's rights to know their tobacco products and so these advertisements were required. 51% thought increasing taxes could discourage people from consuming tobacco while 23% felt it would not. “Taxes to cigarettes have significantly increased in Mexico and Brazil over the last three years. More examples of successful tobacco control policies exist, but what’s more important is the challenging future to protect people from the dangers of tobacco: Brazil will give a fight against tobacco industry to become the first country in the world to ban all additives to cigarettes”, said Mirta A Molinari, Director, Regional Coordinator (Tobacco Control), International Union Against Tuberculosis and Lung Disease (The Union). While markets in developed countries have reached saturation and smoking is decreasing there, tobacco MNCs have been targeting markets in softer areas especially in asia, where people are less aware about health. Surrogate advertisements during fashion shows and bravery award shows sponsored by large tobacco companies only makes them more visible to the market despite the disguise.

Why smoke? Why quit?

Smokers are aware that smoking can be dangerous to health. 18% of the respondents on the online survey had attempted and succeeded quitting smoking while about 40% had attempted several times but had resumed smoking. Common methods used to quit smoking mentioned were nicotine patches or gum, exercise, staying away from smoking zones and thinking of family. So why is it so difficult to stop smoking? Tobacco companies make sure that their buyers cannot easily give up smoking - they are several patented ways of increasing the nicotine content to the tobacco after it is harvested. Another few more ways of advanced technology ensure the manipulation of nicotine levels and new chemical variants. With each cigarette containing 2mg of nicotine it isn't about smoking a pack, as much as it is about getting 250 hits of nicotine to the brain in that one pack.

According to 65% of the respondents, apart from the components of the Framework Convention on Tobacco Control which state heavy taxes, fines for violations and health education at schools, one could be discouraged from smoking if shops that offered these products were banned but mostly through programs where people would meet and talk to those suffering from illnesses due to tobacco consumption and their families. Many felt that strong family support and monitoring could help one quit smoking while staying away from friends who smoked also helped a great deal. While there may be more than one way to tackle this, de-addiction centres established in various countries may be a good place to get professional help.

In all this, the most common reason for smoking is found to be peer influence. Being part of a fashion statement or just 'to be cool' has been a reason to start smoking and one does not realise when this becomes part of the air one breathes. Looking back at the eight years of the FCTC and anti-smoking campaigns one cannot help but remember Gary Lawyer's song “A cigarette in my hand”, which became part a very famous anti-smoking campaign held about 18 years ago by Bombay hospital. Decades have passed and yet we strive to put off the flames.

Carolyn Kavita Tauro, Citizen News Service - CNS
June 2013