DR. JAGRUTI NADKARNI
Tobacco as a plant was cultivated and used by Native Americans for at least 5000 years, long before Columbus arrived in America. From America, the Europeans took it to Europe, and then its cultivation quickly spread to Asia. Starting with 1st World War, cigarettes became popular among Americans. Snuff, chewing tobacco, cigars, pipes, bidis and cigarettes are all used for pleasure.
Tobacco use kills nearly 6 million people worldwide every year. Nicotine which is the main ingredient of tobacco acts as a stimulant to think clearly and to improve alertness. It also acts as a relaxant to relieve anxiety so that the smoker “feels good”. Besides nicotine, cigarettes also contain tar. Tar is a brown and sticky substance used at the end of the cigarette filter after it has been smoked. Tar has more than 4000 dreaded chemicals, many of which are known to cause cancer. They include cadmium, hydrogen peroxide, benzene, toluene, arsenic, vinyl chloride and carbon monoxide. If the genetic material in the cell is damaged by these chemicals, when the cell replicates the next time, it may produce abnormal or cancerous cells.
The surgeon general’s report, which was published in the US in 1964, showed a clear relation between smoking and lung cancer. It said that the death rate due to cancers amongst the smokers was 1000 times more than that of non-smokers. The report provided legitimacy to the findings that smoking is harmful. However, the tobacco industry refuted this by saying that this finding was a “mathematical aberration”.
What is the scenario in our country?
India is the second largest consumer of tobacco globally, and accounts for approximately one-sixth of the world’s tobacco related deaths. India’s tobacco problem is very complex with wide variety of smokeless and smoking forms of tobacco being available in India. Bidi smoking is more common than cigarette smoking in India. Some researchers consider smoking bidis as more toxic than smoking cigarettes. India has one of the highest rates of oral cancers in the world with about 50 % attributable to smokeless tobacco use.
Due to the growing number of cancer related deaths due to tobacco, the Indian parliament passed a bill which became an Act on 18th May 2003. A few key provisions of this Act include- prohibition of smoking in the public places; prohibition of advertisements, sponsorship and promotion of tobacco products; prohibition of sales of cigarettes to minors less than 18 years of age and regulation of health warnings on tobacco product pack including displaying pictorial warnings.
What are the ill effects of tobacco smoking?
Ninety percent of all lung cancer deaths in men and 80% in women are caused by smoking. The “second hand smoke” (SHS) is more toxic than mainstream tobacco smoke. The toxic chemicals from SHS cling to clothes, food, furniture, rugs, even on fans and air filters and can recycle back in to the room. They coat the surface of the room and the smoker’s belongings are referred as “third hand smoke.” There is an evidence linking both, active and passive smoking, to an increased risk of heart diseases, lung cancers, asthma and other respiratory diseases such as tuberculosis in adults. Children who are exposed to smoke, have a greater chance of developing asthma, ear infections and sudden infant death syndrome.
Is Nicotine use just a bad habit?
The following may be simple warning signs that one is addicted to nicotine.
If one smokes within 30 minutes after getting out of the bed in the morning, one may be addicted, or if a person cannot resist smoking even if he is ill, then he is addicted.
If a person smokes more than a pack of cigarettes every day, or if he/she smokes more in the morning than at other times of the day or has a difficulty in refraining from smoking in areas which are designated as non smoking areas, then one probably is addicted.
How long does it take to become addicted to nicotine?
Historically, researchers believed that it took about two years of regular use before one became tobacco dependant. However, researchers now say that addiction can develop rapidly, especially in teenagers, after smoking only a couple of cigarettes for a few months. Moreover, sometimes smoking even 2 cigarettes a week can precipitate withdrawal symptoms once an attempt is made to stop smoking.
Why should one quit smoking?
Because once a person stops smoking, the benefits to one’s health and longevity are substantial. The body starts to repair itself immediately. Depending on the time one has smoked, some organs may take a long time to heal. It may take 10 years for a former smoker to reach the same risk level as that of persons who have never smoked.
What about the recovery from diseases including heart diseases, lung cancer and stroke?
We have to remember that these diseases can occur irrespectively whether or not someone smokes. They may be related to age, genetic factors, diet, activity, environmental factors, etc. Never having smoked is no guarantee one will avoid these diseases. Therefore, quitting smoking is no guarantee one will avoid these disease either. Smoking merely increases the risk and accelerates the course of the disease once someone has developed it. With that in mind, quitting smoking certainly lowers one’s risk and slows down the progress of disease.
When should I talk to my child about smoking?
Recommendations say that the parents should start talking to their children about smoking by the time they are 5 or 6. Many kids start experimenting with smoking during their teens and are already addicted by the time they are 18. The topic can be discussed in a simple language in a way the child understands.
It is also important to be a good role model. One should not smoke in front of the children and leave the cigarettes at places where they can be easily reached. One third of the children whose parents quit smoking are less likely to smoke.
What treatment is available for the people who want to quit?
Because of the chronic, relapsing nature of tobacco dependency, one needs to recognise smoking as a chronic disease just like diabetes and hypertension. Counselling and medicines are available to help smokers quit.
Many effective medicines are available in the market in the form of nicotine gums, nicotine patches and oral medicines. These have shown to reliably increase the abstinence rates when a person tries to quit smoking. The combination of counselling and medication, however, is more effective than either therapy alone. What if a person wants to quit smoking without using medicines?
Quitting on one’s own is hard but it can be done. One needs motivation and commitment. One can go “Cold Turkey” i.e. not use any quit aids. The withdrawal symptoms may be very distressing but the duration of withdrawal is generally short. Some people believe that they can quit using their will power alone while others may decide to consult their doctors to help them quit.
What’s the take home message?
No matter how old one is or how long one has smoked, quitting smoking definitely prolongs one’s life. Studies have shown that people who quit smoking even at 50 years reduce their risk of deaths in the next 15 years compared to the people who continue to smoke. The rewards for not smoking continue throughout the years after quitting. And hence, one is never too old to quit smoking.