There is the need to legislate on passive smoking for smokers to quit; if not for his own health, but for the family. OYEYEMI GBENGA-MUSTAPHA writes.
When Idayat, a 28-year old sewing mistress got married to 30 year old Segun Ikuomola, a commercial driver that smokes, she looked forward to a happy matrimonial experience. But barely two years into the marriage, with her losing four pregnancies, one still birth and the last pregnancy ending in low birth weight baby, was she fed up. Yet gynecologists at the private hospital she enrolled in said she had no problem with reproduction, her husband as well.
Her mothe
r in-law then suggested she moved her case to the public hospital. Idayat complied and registered with the Lagos University Teaching Hospital (LUTH), Idi Araba, Lagos.
During one of the ante-natal clinics, she listened to a seminar on roles environment plays on health, especially fumes and smokes.
After the talk she found audience with the nurses who gave the talk. And narrated her past experiences. Her file was fished out and she was referred to a Consultant (name withheld).
After many interactions with the Consultant, it was established there was a link between her miscarriages, premature births and low birth weight babies.
Idayat was shocked that her husband’s habit of smoking had caused her these much anguish. But she was not to be blamed. She did not know nor her husband that there are health risks for expectant mothers and foetus who are exposed to passive smoking.
She was not the only woman who had been at the receiving end of effects of passive smoking. Mrs Ngozi Okafor, a 32 year old receptionist had lost two children to same passive smoking. Her two children died as a result of increased risk of sudden unexpected death in infants (SUDI), sudden infant death syndrome (SIDS) and fatal sleep accidents.
Passive smoking means breathing in other people’s tobacco smoke. Exhaled smoke is called exhaled mainstream smoke. The smoke drifting from a lit cigarette is called side stream smoke.
Second-hand smoke (SHS) is a common indoor pollutant in the home, making passive smoking a serious health risk for both those who smoke and those who do not. Children are particularly at risk of serious health effects from second-hand smoke. In Victoria, US, it is illegal to smoke in cars carrying children who are under 18 years of age and in enclosed workplaces. But Nigeria has no such law. Though smoking in public places is restricted by the Federal Government, only Lagos State has passed a law to illegalize smoking in public places.
According to a Consultant Public Health physician, Department of Community Health and Primary Care, College of Medicine CMUL), University of Lagos, Idi Araba, Dr kemi Odukoya, SHS, also known as passive or environmental tobacco smoke (ETS), is a combination of main stream smoke that is exhaled by smokers and side stream smoke given off by the burning end of a cigarette, cigar, or pipe. “SHS is a mixture of air-diluted side-stream smoke from the burning tip of the cigarette, and exhaled mainstream smoke that has been initially inhaled and then exhaled by the smoker. The proportions of side-stream and exhaled mainstream smoke can differ but side-stream smoke is usually the larger constituent. An open window doesn’t provide enough protection against the chemicals found in second-hand smoke. These chemicals linger long after the smoke has disappeared, and can be absorbed by carpets, furnishings and walls in the home, increasing your risk of exposure.
“Harmful particles in mainstream smoke include tar (itself composed of many chemicals), N-Nitrosamines, benzene, benzoicpyrene, dioxins and heavy metals including chromium, lead and cadmium. Harmful gases include carbon monoxide, ammonia, sulphur-dioxide, dimethylnitrosamine, formaldehyde, hydrogen cyanide and acrolein,” said Dr Odukoya.
According to Dr O
dukoya, SHS is a serious health hazard, approximately causing close to 50,000 deaths per year, globally. “It can cause a wide range of adverse health effects, including lung cancer, respiratory infections and asthma. Nonsmokers exposed to secondhand smoke at work are at increased risk for adverse health effects. SHS exposure causes disease and premature death in children and adults who do not smoke. There is need for the government at all levels to pass a law to save mothers and children from the evil effects of passive smoke.”
Facts
Intrigued to find out how expectant Nigerian women are affected by passive smoke, a researcher at LUTH, Mrs Grace E. Oyekan, decided to carry out an investigation.
Titled: “Second hand tobacco smoke exposure among pregnant women: Knowledge, attitude and associated factors in patients attending Ante-natal clinic in Lagos University Teaching Hospital (LUTH)”, she established that there is urgent need for the government to save expectant mothers and their babies from the harmful effects of SHS because, “based on my study I found out that the pregnant women’ knowledge of second hand smoke was 19.3 per cent good. About the attitude, 50.3 per cent had positive attitude while 49.7 per cent had negative attitude. I also found out that among the respondents 29.4 per cent were exposed at home while 32.7 per cent were exposed at other places other than their homes, these percentages of the respondents that exposed were significant enough as there is no safe level of exposure to SHS. I recommend as a matter of urgency that health talk should be done at the ante-natal clinics nationwide to inform the pregnant women about the dangers associated with second hand smoke. There should be the passage of tobacco smoke free law in homes, and Passage of tobacco smoke free law in public places, as was done in Austria.”
Other sources equally affirmed that globally, SHS is a serious health hazard causing close to 50,000 deaths per year; approximately 3,400 deaths from lung cancer and 22,700 to 69,600 deaths from heart disease each year. It can cause a wide range of adverse health effects, including lung cancer, respiratory infections and asthma. Nonsmokers exposed to secondhand smoke at work are at increased risk for adverse health effects. SHS exposure causes disease and premature death in children and adults who do not smoke.
SHS is especially harmful to young children. It is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalisations in the United States annually. Secondhand smoke exposure may cause buildup of fluid in the middle ear, resulting in 790,000 physician office visits per year and it can also aggravate symptoms in about 1,000,000 children with asthma.
Mrs Oyekan, an operative theatre nurse found out that SHS harms not only the mother-to-be, but her unborn child as well. It increases both her and her baby’s risk of developing lung cancer, heart disease, emphysema, allergies, asthma, and other health problems. “When a pregnant woman is exposed to secondhand smoke, the nicotine she inhales is passed on to her unborn baby and as such they have a higher rate of miscarriages and stillbirths as well as have an increased risk of low birth weight infants. The children born also have greater risk of sudden infant death syndrome (SIDS) and decreased lung function.
“Nicotine in the blood of a pregnant woman exposed to second-hand smoke can decrease the blood flow to the unborn baby. This can affect the unborn baby’s heart, lungs, digestive system and central nervous system. Carbon -monoxide in smoke can affect the baby’s growth and may lead to low birth weight. Exposure to cigarette smoke in utero whether via maternal smoking or maternal exposure to secondhand smoking is associated with a number of adverse pregnancy outcomes. It is a source of severe oxidative stress in the unborn child and can have detrimental effects on the fetal growth, neurodevelopment, neuro behaviour as well as cardiovascular regulation that predispose the fetus to a number of adverse health outcomes.”
On the effects on the foetus, Mrs Oyekan said: “SHS harms not only the mother-to-be, but her unborn child as well. It increases both her and her baby’s risk of developing lung cancer, heart disease, emphysema, allergies, asthma, and other health problems. When a pregnant woman is exposed to secondhand smoke, the nicotine she inhales is passed on to her unborn baby and as such they have a higher rate of miscarriages and stillbirths as well as have an increased risk of low birth weight infants. The children born also have greater risk of sudden infant death syndrome (SIDS) and decreased lung function.”
Further damages
The Consultant, Dr Odukoya said men are not the only source of passive smoke, ‘some women smoke too. Maternal tobacco use is also likely to expose infants and children to SHS and serves as a role model for children’s use of tobacco. Intervening during pregnancy is also important because of the health risks to the woman who potentially has many years of remaining life. For cigarette smoking, these health risks include lung and other cancers, coronary heart disease and stroke, and chronic obstructive pulmonary disease; health risks from smokeless tobacco products include oral and pancreatic cancer.”
Mrs Oyekan said, “Active maternal smoking during pregnancy can increase the risk of a range of conditions, including impairment of fetal growth and development. However non-smoking mothers who are exposed to SHS may also risk similar effects on fetal and reproductive health, although the risk is smaller than that of smoking mothers. A foreign research indicates that almost 19,000 babies exposed to passive smoke during gestation are born with low birth weight each year in the UK. Latest figures from Scotland suggest an annual decline in the numbers of mothers reporting smoking at first booking and first visit, though the percentage of women recorded as ‘not known’ has increased. 18.8 per cent of women were active smokers at booking (first antenatal appointment); a decrease of nine per cent on 2005 figures. Maternal smoking rates at first visit from a health visitor were 18.1 per cent for the same period (a fall from 22.2 per cent in 2005). Though not conclusive, some studies have argued that maternal passive smoking may reduce fertility, increase fetal and perinatal mortality and increase the risk of some congenital abnormalities.”
Further facts
The researcher said: “Mothers’ avoidance behavior of SHS plays a critical role in the exposure of children to SHS. If mothers do not take adequate precautions to avoid exposure to such SHS hazards, they and their children may be susceptible to a series of negative health effects. Of the 585 non-smoking adults in a study done in two cities in Nigeria, 38.8 per cent had regular exposure to SHS; mostly, in public places (24.4 per cent). More men were exposed at public places when compared with women (27.0 per cent versus 19.5 per cent). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95 per cent confidence interval (CI), 3.08-9.42]; and in men, it was lack of home smoking restriction (PR ratio-6.35; 95 per cent CI, 4.51-8.93). Among men, SHS exposure at any location was associated with lack of secondary school education, residing in slum apartment (house with many households), living with a smoking family member (non-spouse), lack of home smoking restriction, and alcohol intake. Among women, SHS exposure at any location was associated with having a smoking spouse, residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health.”
It is of concern to Dr Odukoya that children of smoking parents are not taken into cognizance on the effects on them and the Government is seemingly doing nothing to prevent the children, because the home is a predominant location for smoking, children are exposed to tobacco smoke as they go about their daily lives, i.e. while eating, playing and even sleeping.
“The exposure at home may be added to exposure at school and in vehicles. Consequently, in a country like ours, children cannot avoid inhaling tobacco smoke. Data on the exposure of children to secondhand tobacco smoke are limited. In perhaps the most comprehensive cross-sectional study to date, researchers examined exposure to secondhand tobacco smoke in 17, 448 children aged one to 10 years in the USA. Exposure varied considerably according to socio-economic status- 41 per cent of children of lower socio-economic status experienced daily exposure to secondhand tobacco smoke in their home, whereas only 21 per cent of children of higher socioeconomic status were exposed daily.
“People who have never smoked who live with people who do smoke are at increased risk of a range of tobacco-related diseases and other health risks, including: increase in the risk of heart disease. There is consistent evidence that people who do not smoke, who live in a smoky household, have higher risks of coronary heart disease than those who do not. Passive smoking makes the blood more ‘sticky’ and likely to clot, thereby leading to increased risk of various health conditions, including heart attack and stroke. There is evidence that passive smoking can cause levels of antioxidant vitamins in the blood to reduce.”
The Consultant said just 30 minutes of exposure to SHS can affect how your blood vessels regulate blood flow, to a similar degree to that seen in people who smoke. “Long-term exposure to passive smoking may lead to the development of atherosclerosis (narrowing of the arteries). People who do not smoke who suffer long-term exposure to second-hand smoke have a 20 to 30 per cent higher risk of developing lung cancer. There is increasing evidence that passive smoking can increase the risk of stroke, nasal sinus cancer, throat cancer, breast cancer, long- and short-term respiratory symptoms, loss of lung function, and chronic obstructive pulmonary disease among people who do not smoke,” she stated.
Call to action/ Recommendations
The 2010 publication of the National Institute for Health and Clinical Excellence (NICE) titled, “Quitting smoking in pregnancy and child birth” guidance aimed at stopping smoking in pregnancy and following childbirth recommended that midwives should identify pregnant women who smoke through discussion and the use of CO tests to assess their exposure to tobacco smoke. This would help identify levels of exposure through both active and passive smoking. The NICE guidance also recommended that partners and other smokers in the household should be offered help to stop smoking, as well as information and advice on the risks of passive smoking on the mother and baby.
Smoking among fathers is another concern of particular interest, as the women and young children who live with them are especially vulnerable to SHS at home. Smoke-free legislation has been effective in protecting both non-smoking adults and children in public places. In July 2007, the “promote smoking control” law, which included the aim of preventing second-hand smoke in public places, was introduced in Taiwan. However, as of 2009 such Taiwanese governmental legislative protection had not been enforceable in private homes, which is still the primary source of SHS exposure for women and children.
Special Adviser to the Lagos State Governor on Public Health, Dr Yewande Adeshina had also advocated the need for Nigerians to cultivate the healthy habit of not smoking actively or passively, in order to reduce the incidence of preventable diseases.
Adeshina opined that tobacco smoking is an unhealthy habit with every puff taken, about 4,000 dangerous chemicals and 400 compounds such as tar, carbon monoxide and the highly addictive nicotine are released into the bloodstream. “When there are children in a house where someone smokes, they are seriously affected leading to the development of asthma. In school, such children do less well in reading and mathematics. The list of these problems caused by tobacco is almost endless, staying away from the habit could prevent all these problems’’.
The Special Adviser advised Nigerians to shun the advertising gimmicks of tobacco producers which often advertised their products by presenting people who took tobacco in the adverts with the image of successful personalities as if it was tobacco that took them to such height just. She urged them to shun concerts and parties that have been supported by the tobacco industry.
Adeshina admonished tobacco industry on the need to intensify their efforts in changing the perception of people especially the unsuspecting and impressionable youth who are easily influenced to cultivate smoking habit.
These findings justify the urgent need for the government to take action on the passage of the National Tobacco Control Bill. Tobacco is the bedrock of SHS, and its use in Nigeria is projected to have devastating consequences, even on unborn innocent babies. For Civil organisations and non governmental organisations (NGO) to have pushed for the passage of the National Tobacco Control Bill is an indication of the seriousness of the situation and the government should not lag in initiating a legislative process to combat this social ill, by passage of the bill.
These findings by the researcher, and the consultant justify the urgent need for the government to take action on the passage of the National Tobacco Control Bill (NTCB). Tobacco is the bedrock of SHS, and its use in Nigeria is projected to have devastating consequences, even on unborn innocent babies, paediatrics, and women. In fact everybody. For Civil organisations and non governmental organisations (NGO) to have pushed for the passage of the National Tobacco Control Bill (NTCB) is an indication of the seriousness of the situation and the government should not lag in initiating a legislative process to combat this social ill, by passage of the bill.
