You may not smoke! However Tobacco still endangers you and your loved ones!

Nonsmokers breathe in the same toxic chemicals in tobacco smoke as the smokers do, with similar, although smaller effects. The smoke nonsmokers breathe is known as secondhand smoke and the process of breathing secondhand smoke is called involuntary smoking or passive smoking.

The smoke contains thousands of toxic chemicals, including benzene, cyanide, cadmium, lead, radioactive polonium, benzo(a)pyrene, ammonia, carbon monoxide, and nicotine. These chemicals cause many diseases.

Secondhand smoke (or ETS) is a very serious form of indoor air pollution. For example, in the USA secondhand smoke causes about 3,000 lung cancer deaths a year, compared to less than 100 lung cancer deaths per year from traditional forms of outdoor air pollution.

Secondhand smoke causes and aggravates asthma and other breathing problems, particularly in children. It is also an important cause of sudden infant death syndrome (SIDS).

While most discussion about passive smoking have concentrated on lung cancer and breathing, the effects on heart disease are more important. The chemicals in secondhand smoke poison the heart muscle, interfere with the ability of blood vessels to adjust themselves to control blood pressure and flow, increase the buildup of blockages of blood vessels (which lead to heart attacks), and make blood stickier. The net effect is that there are about 15 times more deaths from heart disease caused by passive smoking – 35,000-62,000 deaths annually in the USA – as lung cancer.

While the tobacco industry continues to claim that the evidence that passive smoking causes disease – particularly lung cancer – is controversial, every independent authoritative scientific body that has examined the evidence has concluded that passive smoking causes many diseases. Moreover, the evidence that passive smoking causes disease is not new.  Source : https://www.who.int/tobacco/research/secondhand_smoke/about/en/

How tobacco endangers the lung health of people worldwide

The multiple ways that exposure to tobacco affects the health of people’s lungs worldwide include:
 

Lung cancer. Tobacco smoking is the primary cause for lung cancer, responsible for over two thirds of lung cancer deaths globally. Second-hand smoke exposure at home or in the work place also increases risk of lung cancer. Quitting smoking can reduce the risk of lung cancer: after 10 years of quitting smoking, risk of lung cancer falls to about half that of a smoker.

Chronic respiratory disease. Tobacco smoking is the leading cause of chronic obstructive pulmonary disease (COPD), a condition where the build-up of pus-filled mucus in the lungs results in a painful cough and agonising breathing difficulties. The risk of developing COPD is particularly high among individuals who start smoking at a young age, as tobacco smoke significantly slows lung development. Tobacco also  exacerbates asthma, which restricts activity and contributes to disability. Early smoking cessation is the most effective treatment for slowing the progression of COPD and improving asthma symptoms.

Across the life-course. Infants exposed in-utero to tobacco smoke toxins, through maternal smoking or maternal exposure to second-hand smoke, frequently experience reduced lung growth and function. Young children exposed to second-hand smoke are at risk of the onset and exacerbation of asthma, pneumonia and bronchitis, and frequent lower respiratory infections.

Globally, an estimated 60 000 children die before the age of 5 of lower respiratory infections caused by second-hand smoke. Those who live on into adulthood continue to suffer the health consequences of second-hand smoke exposure, as frequent lower respiratory infections in early childhood significantly increase risk of developing COPD in adulthood.

Tuberculosis. Tuberculosis (TB) damages the lungs and reduces lung function, which is further exacerbated by tobacco smoking. The chemical components of tobacco smoke can trigger latent infections of TB, which around a quarter of all people are infected with. Active TB, compounded by the damaging lung health effects of tobacco smoking, substantially increases risk of disability and death from respiratory failure.

Air pollution. Tobacco smoke is a very dangerous form of indoor air pollution: it contains over 7 000 chemicals, 69 of which are known to cause cancer. Though smoke may be invisible and odourless, it can linger in the air for up to five hours, putting those exposed at risk of lung cancer, chronic respiratory diseases, and reduced lung function. 

How to Improve Lung Health ?

The most effective measure to improve lung health is to reduce tobacco use and second-hand smoke exposure. But knowledge among large sections of the general public, and particularly among smokers, on the implications for the health of people’s lungs from tobacco smoking and second-hand smoke exposure is low in some countries. Despite strong evidence of the harms of tobacco on lung health, the potential of tobacco control for improving lung health remains underestimated.

Call to action

Lung health is not achieved merely through the absence of disease, and tobacco smoke has major implications for the lung health of smokers and non-smokers globally.

In order to achieve the Sustainable Development Goal (SDG) target of a one-third reduction in NCD premature mortality by 2030, tobacco control must be a priority for governments and communities worldwide. Currently, the world is not on track to meeting this target.

Parents and other members of the community should also take measures to promote their own health, and that of their children, by protecting them from the harms caused by tobacco. Actionable points could be as follows :-

• Do not allow any form of tobacco within your house.
• Get your Office / Society to ban smoking in “Public Places”.
• Display “No Smoking” signs as per specifications.
• Designate Smoking areas for those unfortunate people who are enslaved by tobacco.
• Encourage your friends and relatives to quit smoking completely. Always keep in mind that there is no such thing as cutting down on smoking. You have to QUIT.

The time to act is NOW!

Did you know that India is a signatory to the Framework Convention for Tobacco Control Read more here…… https://www.who.int/fctc/about/en/

The Govt of India has issued various public notices on the promulgation of various Tobacco Control legislations, since 2004. (available from http://www.tobaccocontrollaws.org/legislation/country/India)  The provisions of the relevant Act and the various Rules thereto are intended to safeguard the health of the general non smoking public, as it is scientifically proven that passive smoking is as dangerous (if not more) than smoking itself.

As per the various laws in India, there is : –

• Prohibition of smoking in public places.
• Prohibition of advertisement of cigarette and other tobacco products.
• Prohibition of sale of cigarette and other tobacco products to a person below the age of eighteen years.
• Prohibition of sale of tobacco products near educational institutions.

Vide various Gazette of India Notifications, smoking is strictly prohibited in a public place, which is defined as any place to which the public has access, and include auditoria, hospital buildings, educational institutions, restaurants, public offices, libraries, public conveyances, open auditoria, railway stations bus stops, etc.

Tobacco products under the Act include cigarettes, beedis, pipes tobacco, hookahs and chewing tobacco.  Snuff, pan masala, gutkha and tooth powder containing tobacco are also listed.

We all are aware that the consumption of tobacco in any form is extremely harmful to the health of an individual directly , and secondarily to those in his immediate surroundings, i.e women and children of the family. This passive smoking affects all Non-smokers, with women and children being the most affected by this indirect smoke pollution.

For the reader’s information, it is mandatory to display at all public places including community facilities, a board of a minimum size of 60 cm x 30 cm in English or Hindi as applicable, with the warning “No Smoking Area – Smoking Here is an Offence”.

This board should also contain a circle of no less than 15 cm outer diameter with a red perimeter, of no less than 3 cm width, with a picture in the centre of a cigarette or a beedi, with black smoke, and crossed by a red band. The width of the red band across the cigarette shall be equal to the width of the perimeter.

While smoking or consumption of tobacco is an individual’s choice, hence it is presently not banned in a democratic system. However smoking indiscriminately is what is banned, i.e in front of others (who may not have a choice in inhaling the smoker’s second hand smoke). This is in the public’s interest. We must understand this nuanced statement. A non smoker has a right to breathe clean and untainted air!

Hence the approach that we should advocate is that simultaneous with the banning of public smoking, specific areas in office complexes, community facilities etc be designated for smokers to use, and signposted as such. These sites are not to be near thoroughfares or be common rooms frequented by others or be near AC / cooler fitted windows. As a strict rule, all air-conditioned spaces are to designated as “No Smoking areas”.    

It must also be appreciated that the masses consume copious amts of gutkha, which is far more harmful to their health. As it is, further to dirn of the  Supreme Court, it is illegal to sell gutkha in plastic sachets, which is still the norm. Hence we do periodically read news reports of seizures of large consignments of this banned item.

It is requested that the readers of this post may please reach out to those in their circles of influence and solicit their participation in the “Say No to Tobacco” initiative currently underway in the country in the interests of promoting of health of our people and their families, both the smoker minority and the non smoker majority.

SMOKING : THE ROLE OF THE HEALTHCARE PROFESSIONAL

For those of you who are medical practitioners, please know that when it comes to tobacco use, health professionals have the opportunity to help people change their behaviour. Their involvement is key to successfully curbing the tobacco epidemic. For example, if dentists warned all their patients that smoking causes excess plaque, yellowing teeth and contributes to tooth decay, as well as a five-fold increased risk of oral cancer, the impact on smoking would be dramatic.

Studies have shown that even brief counselling by health professionals on the dangers of smoking and importance of quitting is one of the most cost-effective methods of reducing smoking. Please refer to Cochrane Reviews website for the meta analysis based recommendation on this. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000165.pub4/full

“Does advice from doctors encourage people who smoke to quit

Advice from doctors helps people who smoke to quit. Even when doctors provide brief simple advice about quitting smoking this increases the likelihood that someone who smokes will successfully quit and remain a nonsmoker 12 months later. More intensive advice may result in slightly higher rates of quitting. Providing follow‐up support after offering the advice may increase the quit rates slightly.”

Ideally, health professionals should lead by example and should act as role-models for their patients, by ceasing to smoke, and by ensuring their workplaces and hospitals are smoke and tobacco-free.  The message to be conveyed to all patients in clear terms is :-  “If you use any form of tobacco ….QUIT. If you don’t, then don’t start”.

Doctors and Dentists must utilize every opportunity afforded to convey the “SAY NO TO TOBACCO” message, and must endeavour to question every patient about tobacco usage and offer advice and counseling on giving up tobacco during every professional interaction, irrespective of the nature of reason for seeking healthcare.

A simple model for interventions applicable in all patient care settings to be adopted by healthcare professionals  is the “4 A approach” https://www.nature.com/articles/4810266

• Ask for tobacco use  (at every med consultation)
• Assess degree of tobacco use
• Advise on cessation (at every patient contact)
• Assist / Arrange in quitting (when patient requests)

If you are a Doctor, go on, Ask your patient and help him / her!

If you are an interested individual, what are you waiting for ? Go ahead change the world one person at a time.

If you are in the Corporate environment, you can get in touch with me at drcariappa@deltazuluconsultancy.com to help you design and develop a customized workforce oriented Company level Tobacco Impact Mitigation Policy that is aligned with International Best Practices and fully compliant with the law of the land.