New studies have warned against complacency in efforts to tackle cigarette smoking by urging governments to enact policies that prioritise public health above economic interests, reports Associate Editor ADEKUNLE YUSUF.
Evidence abounds in the medical parlance that cigarette smoking harms nearly every organ of the human body, causing many diseases and reducing smokers’ health in general. That is why tobacco epidemic is regarded as one of the biggest public health threats the world has ever faced.
According to World Health Organisation (WHO), smoking kills more than eight million people a year. More than seven million of those deaths are results of direct tobacco use while around 1.2 million deaths are results of non-smokers being exposed to second-hand smoke. The latest WHO figures also suggested that around 80 per cent of the 1.1 billion smokers worldwide live in low and middle income countries, where the burden of tobacco-related illness and death is heaviest.
Tobacco users, who die prematurely, deprive their families of income, raise the cost of healthcare and hinder economic development, experts said. In some countries, children from poor homes are frequently employed in tobacco farming to feed their families. These children are especially vulnerable to “green tobacco sickness”, which is caused by the nicotine absorbed through the skin from the handling of wet tobacco leaves.
Latest findings have confirmed the dangers inherent in cigarette smoking. Three research papers, published by The BMJ recently, examined smoking and efforts to deal with health hazards associated with it, and highlighted the importance of continued investment in international tobacco control, particularly in the more vulnerable low and middle-income countries. The first study by Professor Steven J. Hoffman and colleagues examined how patterns in international cigarette consumption have changed since 1970.
Using data from 71 countries, representing over 95 per cent of global cigarette consumption and 85 per cent of the world’s population, the study showed that cigarette consumption fell in most countries over the past three decades, but trends in country specific consumption were highly variable. For example, China consumed 2.5 million metric tons (MMT) of cigarettes in 2013, more than Russia (0.36 MMT), United States (US) (0.28 MMT), Indonesia (0.28 MMT), Japan (0.20 MMT), and the next 35 highest consuming countries combined. The US and Japan achieved reductions of more than 0.1 MMT from a decade earlier; whereas Russian consumption plateaued out, and Chinese and Indonesian consumption increased by 0.75 MMT and 0.1 MMT, respectively.
The authors said the findings “underscored the need for more robust processes in data reporting, ideally built into international legal instruments or other mandated processes.” Using this data, the second study by Professor Steven J. Hoffman and colleagues found no significant change in the rate at which global cigarette consumption had decreased after the adoption of WHO’s Framework Convention on Tobacco Control (FCTC), an international treaty adopted in 2003 that aimed to reduce harmful tobacco consumption.
After 2003, high income and European countries showed a decrease in annual consumption by more than 1000 cigarettes per adult, whereas low and middle income and Asian countries showed an increased annual consumption by more than 500 cigarettes per adult. Although causal associations cannot be stated with certainty, the quasi-experimental designs used in the study provided robust evidence of shifting patterns in global cigarette consumption, which the researchers said “should motivate greater implementation of proven tobacco control policies” and “encourage more assertive responses to tobacco industry activities”.
The third study examined differences in vaping and smoking among adolescents in Canada, England and the US, using online surveys of 16 to 19 year olds in 2017 and 2018. Prevalence of vaping (past 30 days, past week, and 15 days or more in the past month) increased among 16 to 19 year olds in Canada and the US, and smoking also increased among Canadian adolescents, while little change was seen in England. The use of JUUL (a nicotine salt based electronic cigarette) increased in all countries, particularly the US and Canada.
Despite some study limitations, the authors said vaping among adolescents increased in Canada and the US “in parallel with the rise of nicotine salt based vaping products and the introduction of more permissive vaping regulations in Canada”. Fewer changes were seen among adolescents in England, where there are stronger marketing restrictions and maximum nicotine limits, they concluded. “Taken together, these new studies emphasise the value of comparative research for tobacco control across different countries,” wrote Professor Linda Bauld at the University of Edinburgh in a linked editorial. “They also warn against complacency in our attempts to address smoking, now and in the future.”
She argued that continued investment in international tobacco control is more important than ever, particularly in low and middle income countries with limited capacity to combat industry’s attempts to delay or derail public health policies. In Nigeria, there are two major tobacco companies, the British-American Tobacco (BAT) and Phillip Morris International (PMI), which is one of the largest in the world, with headquarters in Lausanne, Switzerland. State-owned tobacco companies in China and Japan are at odds with their countries’ commitments to reducing the immense toll of disease and death caused by tobacco.
In Nigeria too, the Federal Government, under pressure form civil society and health organisations such as the Environmental Rights Agenda (ERA) has been nudged to enforce some tobacco control laws. But it would seem the tobacco lobby in the country is very powerful. Despite efforts by the successive governments in making legislation against tobacco smoking in public places, more Nigerians, especially the youths, are taking up the bad habit.
Tobacco is a product prepared from the leaves of the tobacco plant by curing them. The plant is part of the genus Nicotiana and of the Solanaceae (nightshade) family. While more than 70 species of tobacco are known, the chief commercial crop is N. tabacum. The more potent variant N. rustica is also used around the world. Tobacco contains the alkaloid nicotine, which is a stimulant, and harmala alkaloids. Dried tobacco leaves are mainly used for smoking in cigarettes, cigars, pipe tobacco, and flavored shisha tobacco. They can also be consumed as snuff, chewing tobacco, dipping tobacco and snus, a type of moist powdered tobacco, typically held in the mouth between the lips and gums.
Tobacco use is a risk factor for many diseases, especially those affecting the heart, liver, and lungs, as well as many cancers. In 2008, the WHO named tobacco as the world’s single greatest preventable cause of death. Why do some Nigerians still smoke despite the negative health and economic implications? Several studies have identified poor implementation and enforcement of policies and legislations against smoking in public places, and advertising of tobacco products.
Also, producers are not giving up. They are developing newer versions and are still raking in huge profits with estimated 20 billion sticks of cigarettes valued at over N200 billion being consumed annually in Nigeria. According to “a systemic review of tobacco use in Nigerian youth”, published in the journal Plos One, peer influence was the most common risk factor described. The researchers said this is consistent with one study among South African adolescents that showed that peer smoking had the strongest influence on smoking lifestyle.
Also, family conditions such as low parental education, polygamy, not living with parents; having a parent who smokes and having divorced or separated parents, were additional risk factors. Stress, loneliness and depressive symptoms were the most common psycho-social risk factors for tobacco smoking, consistent in one study that focused on tobacco smoking among adolescents in seven African countries.
The Plos One review identified that young people, who abuse other substances such as alcohol and marijuana, or who consume other forms of tobacco, excluding smoking, were at risk of tobacco smoking. Since psycho-social problems among young people are usually due to physical, emotional and sexual abuse and neglect, they usually resort to tobacco smoking or other forms of substance abuse as a coping mechanism to ameliorate their condition.
Smoking cigarettes can have many adverse effects on the body. Some of these can lead to life-threatening complications. In fact, according to studies, smoking cigarettes increases the risk of dying from all causes, not just those linked to tobacco use. Smoking cigarettes affects the respiratory system, the circulatory system, the reproductive system, the skin, and the eyes, and it increases the risk of many different cancers.
According to a study published in Elixir International Journal, as at December 31, 2016, the prevalence of tobacco use in Nigeria by youths was 15.4 per cent while adult tobacco smoking and smokeless tobacco use stood at 5.6 per cent and 1.9 per cent respectively. The study titled: “Tobacco Control Legislation and Policy in Nigeria: Much Barking Without Biting”, was conducted by Festus Ukwueze, Chukwunweike Ogbuabor and Ebele Okiche of the Faculty of Law, University of Nigeria, Enugu Campus, Enugu State.
The Plos One study noted that the lowest prevalence values of tobacco smoking in Nigeria was 0.2 per cent, in a rural setting across Osun State, and the highest prevalence was 32.5 per cent in an urban population in Lagos. According to WHO, smoking is responsible for over two thirds of lung cancer deaths globally, and second-hand smoke increases the risk of developing lung cancer for non-smokers.
As WHO Director-General, Dr. Tedros Adhanom Ghebreyesus said, tobacco kills at least eight million people every year; while millions more live with lung cancer, tuberculosis, asthma or chronic lung disease caused by tobacco. “Healthy lungs are essential to living a healthy life. Today – and everyday – you can protect your lungs and those of your friends and family by saying no to tobacco,” Ghebreyesus said.
In 2017, tobacco killed 3.3 million users and people exposed to second-hand smoking from lung-related conditions, including: 1.5 million people dying from chronic respiratory diseases; 1.2 million deaths from cancer (tracheal, bronchus and lung); and 600,000 deaths from respiratory infections and tuberculosis. More than 60,000 children aged under-five die of lower respiratory infections caused by second-hand smoke. Those who grow into adulthood are more likely to develop chronic obstructive pulmonary disease (COPD) later in life.
According to Medical News Today, smoking cigarettes can damage the heart, blood vessels and blood cells. The chemicals and tar in cigarettes can increase a person’s risk of atherosclerosis, which is the build-up of plaque in the blood vessels. This build-up limits blood flow and can lead to dangerous blockages. Smoking also increases the risk of peripheral artery disease (PAD), which occurs when the arteries to the arms and legs start to narrow, restricting blood flow. Research showed a direct link between smoking and developing PAD. Even those who used to smoke face a higher risk than people that never smoked.
Having PAD increases the risk of experiencing: blood clots; angina, or chest pain; a stroke; and heart attack. Smoking cigarettes can damage a female’s reproductive system and make it more difficult to get pregnant. This may be because tobacco and the other chemicals in cigarettes affect hormone levels. In males, the more cigarettes a person smokes and the longer they smoke, the higher the risk of erectile dysfunction. Smoking can also affect the quality of the sperm and therefore, reduce fertility. Indeed, many doctors are of the opinion that should the government fail to act on tobacco use in Nigeria, the nation may be headed for another health crisis of unimaginable proportions.
