Many of us probably grew up with a parent, an aunt or uncle or a grandparent who smoked, and have seen the significant impact that this had on the lives of people around us. Well-known smokers include Winston Churchill, who famously said, “My rule of life prescribed as an absolutely sacred rite smoking cigars and also the drinking of alcohol before, after and if need be, during all meals and in the intervals between them,” and Albert Einstein, who said “I believe that pipe smoking contributes to a somewhat calm and objective judgment in all human affairs.”
There has been an important mindset change over the past generations, but more needs to be done. May 31 was established as World No Smoking Day in 1987, with the aim of drawing global attention to the tobacco epidemic as well as to the resulting disease and death associated with it.
In a statement released on May 30, European Commissioner for Health and Food Safety Stella Kyriakides said: “Tobacco use is the single largest avoidable health risk. It is the leading cause of preventable cancer, with 27% of all cancers attributed to tobacco. With Europe’s Beating Cancer Plan, we are proposing bold and ambitious actions on prevention to reduce the use of tobacco. We have set a very clear objective – to create a smoke-free generation in Europe.” This statement supports the theme of the 2021 World No Smoking Day, “Commit to Quit.”
One of the observations made during the COVID-19 pandemic was that millions of tobacco users indicated that they would like to stop smoking, but that only 30% of the global population has access to quality tobacco cessation services. Currently, only 23 countries provide comprehensive cessation services to help tobacco users to quit.
It is estimated that 1.3 billion people worldwide use some form of tobacco, with more than 80% residing in low- and middle-income countries. One of the challenges is that this contributes to poverty by diverting household income and spending from basic needs to tobacco. China is the country with the largest number of tobacco users (>300 million), followed by India (approximately 275 million). It is said that Brunei is the country with the smallest number of smokers. The worldwide cost associated with tobacco use is $2 trillion and 7 million deaths per year.
The prevalence rate of tobacco smoking in Africa is only 14% – indeed much lower than in the Americas (23%) and Mediterranean countries (31%) – but the growth is alarming. A Lancet report report published in 2010 indicated that Mozambique has seen a 220% growth in cigarette consumption over the past 16 years.
Women seem to be more susceptible to the health effects associated with smoking: lung cancer is now the leading cancer among women in the US; they may develop severe obstructive airway disease earlier in life, have an increased risk for developing different cancers, double their risk for developing coronary heart disease and be more susceptible to lower bone density.
The Tobacco Atlas provides an overview of the situation globally.
It is also important to mention smokeless tobacco products in the conversation; these include gutkha, pan masala, snus, chew, etc. There are definite correlations between the use of smokeless products and the development of cancers of the head and neck. There also needs to be more attention paid to the dangers associated with the use of waterpipes (hookah or shisha).
Finally, a few words on e-cigarettes. The use of e-cigarettes is on the increase and with this, a higher awareness of potential health issues. Flavors used in e-cigarettes are thought to be as safe as food additives, but there is limited or no data available about their impact on the respiratory system. The CDC published very specific guidance in which it is stated that e-cigarette aerosol is NOT harmless “water vapor” and that the aerosol can contain numerous potentially harmful substances, including nicotine, ultrafine particles that can be inhaled deep into the lungs, flavorings such as diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals and heavy metals such as nickel, tin and lead.
So much more can be said and written about tobacco use and its impact on our health. The linked resources provide good information in case you would like to read more.
King James I of England said, “Smoking is a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is bottomless.”
Sources:
- https://www.who.int/news-room/fact-sheets/detail/tobacco
- https://tobaccoatlas.org/
- https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2430796 https://journals.physiology.org/doi/full/10.1152/ajplung.00389.2017%40apsselect.2018.5.issue-10
- https://www.timeanddate.com/holidays/un/world-no-tobacco-day
- https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_women_smoking_508.pdf
- https://pixabay.com/photos/cigarettes-ashtray-ash-smoking-83571/ (image - cigarettes)
- https://pixabay.com/photos/vape-vaping-nicotine-cigarette-2441608/ (image - vaping)