Wednesday, 6 June 2012

Tobacco: not now; not ever

Official picture and logo of the United Nations for World No Tobacco Day


By Anna Joseph.
Anna is the Communications Officer at the Centre. 

Imagine yourself an average xteen-year-old at your favourite hang-out. 

Your bosom pal/hot stranger/class mate/casual friend sitting next to you passes you your first fag – a lit one.
Would you take a drag?

If you think you would, then you also know why there are so many smokers all over the world.
If you think you won’t, you probably still know why there are so many smokers;
if not, then is it because you feel smokers are weak and indecisive, and most of all, totally irresponsible when it comes to their own health and that of their loved ones?

Assuming that you fall into the third category, let’s try to understand why people who normally would not play with fire, taunt poisonous snakes, expose their children to dangerous situations or jump off cliffs … would deliberately choose a path spiraling down to certain illness or near-certain death.

The making of a smoker 

It's common knowledge that cigarettes contain nicotine, a highly addictive substance. Addiction, it is important to know, is not a bad habit that has not been dealt with.
Addiction involves physiological dependence, with its conditions of tolerance and withdrawal. (In fact, some research suggests that dependence on nicotine may be even more than what heroin can induce.) 
Once you get there, your body and your mind will actually punish you if you deny yourself. This is because the loss of nicotine causes feelings of anxiety, high irritability and depression.  And why it is so easy to give in is because just one cigarette is the quick-fix solution to those punishing feelings.

It is this simple though vicious cycle that has created millions of smokers around the world.

Giving up smoking is the easiest thing in the world. I know because I've done it thousands of times. – Mark Twain

How bad is it, really?

More than half the people who keep smoking will die as a direct result of the addiction. And half of those who die will die middle-aged.
That’s how bad it is.  

The Evidence
Mortality in relation to smoking: 50 years' observations on male British doctors 

The global burden 

Tobacco is the number one cause of preventable death in the world today. According to World Bank statistics, presently, the annual number of deaths due to tobacco-related illnesses around the world is more than 5 million – approximately one in ten adults.

The big, bad wolf 

The big, bad wolf is Big Tobacco which refers to the five big tobacco companies - four are publicly traded companies - that make most of the cigarettes sold around the world.
They are British American Tobacco, the China National Tobacco Company, Imperial Tobacco, Japan Tobacco and Philip Morris International.
Reports for 2008 show that the collective revenues of these companies exceeded $300 billion and of this amount, more than $160 billion was paid as taxes.

Developing countries – soft targets

While tobacco use is decreasing in developed countries because of strong campaigns against smoking and strict regulations, it is increasing in developing countries. Within a few decades, 80% of tobacco-related deaths will occur in developing countries.
This is partly because of the global industry’s marketing strategy of targeting young people and adults in these countries. While India and China, the big gaming grounds, are out of bounds for Big Tobacco because of their protective measures for local firms, Indonesia (where one in four children between the ages of 13 and 15 smokes) and Philippines are ready markets because of their growth potential and relative lack of regulation.

Freud committed suicide because of oral cancer. (Photo courtesy Wikipedia) 

Ground Zero 

The body of the smoker is a site devastated by that powerful weapon, the cancer stick, ordinarily referred to as the cigarette. Tobacco smoke contains more than 60 known cancer-causing chemicals and more than 4,000 other harmful substances. These wreak havoc on almost every organ in the body. 

Hence, a smoker is at risk for various lung diseases, heart and circulatory system problems, diabetes, infertility and incompetence, premature aging and weakening of the senses, pregnancy and newborn complications, cold, flu and other bronchial illnesses.

The Evidence
Does giving people who smoke feedback about the effects of smoking on their body help them to quit?

Would less than five cigarettes a day be okay?

It has been scientifically proven that smokers of less than five cigarettes per day still have almost three times the risk of dying from heart disease, and a higher risk of death from tobacco-related diseases than non-smokers. And if you up the number to less than ten, the risk for lung cancer is around four to five times.

The Evidence
Health consequences of smoking one to four cigarettes a day 

Second-hand or passive smoking  

Second – hand smoke is smoke which a smoker exhaled or that which emanates from the burning tip of the cigarette.

Can smoke that you can’t see or smell harm you? 

The answer is yes.
Smoke can stay in the air for up to two and a half hours, ie much longer than the time when you are able to see it and smell it. Especially in small, enclosed places like cars, smoke may still be present in large amounts even after the person has stopped smoking.

Why children are most vulnerable 

When there is cigarette smoke in the air, young, developing lungs get a higher concentration of inhaled toxins than do older lungs.  This is because till around five years old, the respiratory rate is pretty fast – usually 20 and 60 breaths per minute. For adults, this is only around 14 to 18 times a minute; and if it is a newborn, the rate could even be 60 per minute.

•    Babies whose mothers smoked during pregnancy are at an increased risk for developmental issues such as learning disabilities and cerebral palsy. They often weigh lesser than other babies as well.
•    Fetuses exposed to chemicals in cigarettes through the placenta are thought to have an increased risk for SIDS.
•    Passive smoking may also be responsible for thousands of new cases of asthma, bronchitis and pneumonia every year. It also worsens the condition for those children who already have the illness.
•    Passive smoking may also lead to hearing loss in children. Inhaled cigarette smoke irritates the Eustachian tube, and the subsequent swelling leads to infections. Such infections are the most common cause of hearing loss in children.
•    Risk of meningitis and frequent coughs and colds.

The numbers for young passive smokers 

The UN Global Youth Tobacco Survey (a school-based survey conducted in 137 countries using a standardized method) found that approximately half of children between the ages of 13 and 15 surveyed were exposed to secondhand smoke both inside and outside of the home.
Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke 

Passive to active smoker

And what’s worse, children who grow up with a parent or family member who smokes are also about twice as likely to start smoking later in life.

"Teenage smoking is one of the great, baffling phenomena of modern life. The anti-smoking movement has never been louder or more prominent. Yet all signs suggest that among the young, the anti-smoking message is backfiring…. The lesson here is not that we should give up trying to fight cigarettes. The point is simply that the way we have tended to think about the causes of smoking doesn’t make a lot of sense. What if smoking, instead of following the rational principles of the marketplace, follows the same kind of mysterious and complex social rules and rituals that govern teen suicide? If smoking really is an epidemic like Micronesian suicide, how does that change the way we ought to fight the problem?" - Malcolm Gladwell 

The Evidence
Community interventions for preventing smoking in young people 

Is South Asia doing anything about it?

Bangladesh, India, and Sri Lanka have enacted legislations banning smoking in public places such as schools, hospitals and workplaces. Bhutan, Maldives and Nepal have orders and decrees to protect people from second-hand smoke. Since December 2004, Bhutan has also banned the selling of tobacco, the first country in the world to do so.

The Evidence
Does legislation to ban smoking reduce exposure to secondhand smoke and smoking behaviour?