Cigarette Smoking: Risks factors, Addiction, Quitting & Treatment

According to the WHO, 6 million people die because of tobacco smoking and an estimated 600,000 individuals lose their lives due to second-hand smoke globally each year. A recent study found that smoking is related to about 20% adult mortality around the world. It is projected that smoking will cause the death of 8 million people every year by 2030 and 80% of these deaths will occur in low- and middle-income countries. Smoking is associated with increased risk of cardiovascular and chronic respiratory diseases, stroke, and cancers of many organs of the body such as mouth, larynx, lungs, kidneys, cervix, and pancreas.

Of the more than 6 million tobacco-related deaths every year across the world, one-sixth occur in India alone. Experts see the total tobacco-related deaths rising to 8 million by 2030.In India alone, every third adult consumes some form of tobacco. Bidis are the most commonly consumed tobacco product and are primarily consumed by the poor. Bidis alone contributed to 5.8 lakh deaths in the country in 2011. Tobacco causes 1 death every 6 seconds yet India is the second leading consumer.

Tobacco doesn't harm the individual alone, but also affects national economies through increased healthcare costs and decreased productivity. It worsens health inequalities and exacerbates poverty.

Some chemicals in cigarette are:

• Ammonia - commonly used in toilet cleaners.
• Cyanide - used as rat poison.
• Formaldehyde - used in laboratories for preservation of dead specimens.
• Nicotine - "the Hook", habit forming, addictive drug

Diseases caused due to smoking:

• Cancer: Lung cancer, cervical cancer, cancer of mouth and throat, bladder, pancreas, kidneys and stomach. Cancer of the bone marrow. It helps cancers multiply in many other parts of the body.
• Coronary heart disease and stroke: Respiratory illness including chronic obstructive pulmonary disease, pneumonia, bronchitis and emphysema.
• Infertility: This is caused n both men and women. Damages blood vessels in the penis, which may make men impotent.
• Osteoporosis: Smoking places women at the risk of developing cancer of uterus, vulva, and liver colon, gastric ulcers, breast cancer. Smoking is a known risk factor of osteoporosis.
• Peripheral Vascular Disease (PVD) - Poor circulation leads to gangrene
  Nicotine in cigarettes increase heart rate and blood pressure, Heart works much harder and needs more oxygen.

Passive Smoking

Smokers not only put themselves at risk of serious health problems, people around them are also exposed to the toxic chemicals in tobacco. There are 3 different types of tobacco smoke:

1. Mainstream smoke - smoke directly inhaled by smoker
2. Exhaled mainstream smoke - smoke breathed out
3. Side stream smoke - smoke drifting from burning end of cigarette.

There is no safe level of exposure to tobacco smoke.

If you are a non-smoker being exposed to tobacco smoke is dangerous. Passive smoking is linked to lung cancer, breast cancer, nasal sinus cancer, heart disease, stroke, lung disease and asthma. Passive smoking during pregnancy increases risk of SIDS (sudden infant death syndrome) and miscarriage and affects baby's birth weight and development of infant lungs.

Babies and children exposed to smoke are at risk of childhood cancers, middle ear infections, decreased lung function, onset of asthma, bronchitis. It is estimated that tobacco smoke causes 450,000 lower respiratory tract infections in infants & young children needing 25,000 hospitalizations. Children of parents who smoke are more likely to try cigarettes in their teenage years and become regular smokers. Parents are role models for their children.

Third Hand Smoke:

It is not new that second-hand smoke is harmful to your children. So maybe you turn down the windows in your car. Research has highlighted the dangers for non-smokers exposed to smoke in cars.

Contrary to common belief, opening the window does not eliminate dangers of tobacco smoke. Clothes and hair pick up the toxins too. In fact besides the smoker and the passive smoker who is inhaling the smoke there is a 3rd category called "3rd hand smoker "smokers leave traces of their smoke along with the harmful chemicals on curtains, clothes, bed sheets, sofas which are harmful to the 3rd hand people who use the same room/bed. A small child crawling in the room picks up tobacco particles in this way. It may lead to cognitive deficits in children. There is no gradual process or "tomorrow".

After 24 hrs of quitting smoking the levels of CO in your blood drops dramatically. Within 5 days of quitting smoking all nicotine products leave your body. The taste buds come alive again. Your breath, hair, fingers, teeth and clothes will be cleaner. At 1-week cilia of lungs start cleaning mucus again. After 3 months your lung's cleansing system will be working normally. Blood is less thick and sticky and blood flow improves. After 10-15 years your risk of death from all causes, including lung cancer, will be close to that of someone who never smoked.

What can we do?:

1. Build Public Opinion against Tobacco. Understanding and Awareness work better than a Ban, though drastic action invites thoughtful discussion.
2. Schools & Colleges are ideal settings for thoughtful awareness programmes.
3. Withdraw all privileges to tobacco companies; lifestyle products that strengthen the Brand must be banned. It was public outcry that removed Tobacco sponsorship of Sports.
4. Study the Tobacco Control Act, and its provisions.
5. Enforce existing legislation stringently.
6. Demand utilization of Tobacco taxes to set up detox quit programmes, and a coherent anti-Tobacco policy.
7. Put anti-smoking Quit products (Nicotine patches, Gum, etc) side-by-side with Tobacco products, in kiosks, not Chemist shops

The COVID-19 pandemic has led to millions of tobacco users saying they want to quit. Commit to quit today and sign the pledge.

(Dr. Nitish Ranjan Acharya, Consultant Surgical Oncology, HCG Panda Cancer Centre)