Illness
SMOKING AND HEALTH
It seems that smoking tobacco is declining in the developed world, but increasing in developing countries1.
However, in the United States, where smoking has declined, there is a reported increase in the use of smokeless or chewing tobacco. In Croatia, smoking remains widespread. Laws restricting smoking in public places were introduced, only to be watered down within a few months. Croatia signed the World Health Organization’s ‘Framework Convention on Tobacco Control’ on June 2nd 2004, and was fully accepted as a participant on October 12th 20082. Croatia’s first report on the prevalence of smoking in the country, submitted on January 11th 20113, but using figures from 2001, shows shockingly high figures for all age groups4.
Anti-social delusions
It can be difficult for smokers to realize that cigarette, cigar and pipe smoke can be both offensive and damaging to non-smokers. Some smokers simply close their minds to the fact that their habit is polluting the air for all around them. Some delude themselves into thinking that it doesn’t matter.
Self-delusion always plays a big part in addictions. Many smokers think that the ill effects of smoking are exaggerated by the anti-smoking brigade. One chain smoker told me recently that smoking wasn’t nearly as harmful to the health as stress, although his reasoning was vague. Some smokers think the harm is limited to the risk of lung cancer, and point with misplaced triumph to the cases where non-smokers die of the disease. Tobacco use is a major risk factor in heart attacks, strokes, emphysema and most if not all cancers, especially of the lungs, pancreas, bladder, mouth and larynx.
In fact, nicotine is so poisonous that tobacco has been used as a pesticide from the 15th century up to modern times.
Negative effects
A major problem regarding smoking and its ill-effects is the cost of healthcare for smoking-related diseases. One bizarre, not to mention inaccurate counter-argument is that smokers tend to die earlier than others with healthier habits, so they do not incur the costs of long-term care in old age. For healthcare workers, it is frustrating when smokers seek treatment for smoking-related problems, without being prepared to give up the cause of the problem, or at least to try. There’s probably nothing more futile than applying chest physiotherapy to a patient with chronic obstructive lung disease who prepares for the session by smoking (‘helps me cough up better, dear’); and nothing sadder than a patient puffing away on cigarettes while travelling to a chemotherapy session for lung cancer (‘helps me relax’).
Passive smoking
It’s one thing to risk damaging one’s own health. The biggest problem with smoking is its unavoidable effect on others. Parents smoke over their babies and small children without a thought for the dangers of passive smoking. Yet it is well established that passive smoking can contribute to various major and minor illnesses, especially affecting the lungs, but also including an increased risk of osteoporosis and bone fractures5,6, diabetes7 and hip development problems (Legg-Calvé-Perthes condition)8 in the young. In 2010 the Lancet published online an analysis of the effects of passive smoking, which concluded that in 2004 it caused some 603,000 deaths, with children accounting for 28%9.
Social effects
Attitudes to smoking have changed. In the early 20th century, smoking was widespread, especially among men. Restrictions reflected social attitudes: in ‘polite society’, especially in the UK, ladies were expected to smoke less, if at all, and certainly not in public. Cigarette advertising was rampant, awash with images of health, happiness, sophistication, manliness, femininity, physical fitness and limitless freedom... In the 1960s cigarette sponsorship of sport became commonplace. At tennis tournaments in the UK, cigarettes were freely available, a tactic that seems like a cynical investment, as every person who got hooked would be paying dearly for the freebies over many years.
In Hvar Town there is an old tradition that on the feast of Candlemas (2nd February) young people can smoke their first cigarette by the little chapel of Gospa Kruvenice (Our Lady of the Flag), after a due number of prayers. Very gradually the custom is evolving, so smoking now takes second place to lighting a symbolic fire of purification.
Manners have changed over the years, and politeness is arguably less common than it used to be. Smokers used to ask if those nearby minded them lighting up. Now they assume that if smoking is permitted (and sometimes even if it isn’t) they don’t need to ask, non-smokers must just put up with it. The modern scourge of littering is made up of a high proportion of cigarette packets and butts. The Croatian shipping line Jadrolinija has notices asking people not to throw litter into the sea, and particularly not fag-ends, as the discarded filters are known to be harmful to fish10,11 .
Changes, Government restrictions
The WHO Framework Convention on Tobacco Control, which came into force in 2005, aims to limit the spread of tobacco use worldwide, by encouraging countries to promote the health message, and to take steps to curb tobacco use, while still allowing each country freedom to choose if or how it implements the terms of the Convention: ‘Signature of a convention indicates that a country is not legally bound by the treaty but is committed to not undermine its provisions’.
Events can force change. The major fire at Kings Cross Underground station in London in 1987, which killed 31 people, was started by a cigarette butt setting fire to rubbish under an escalator. This led to a ban on smoking throughout the Underground network, which, surprisingly, was largely respected. Later UK legislation banning smoking in restaurants, pubs and the workplace also seems to have succeeded, despite fierce opposition in some cases.
Croatia’s measures to restrict smoking reflect the ambivalence governments show towards unpopular legislation which might undermine a source of national revenue. The 2011 Report states: ‘...smoking is prohibited in all closed public areas in Croatia. Smoking is only permitted in special areas reserved for smokers, designated for accommodation of guests, marked as areas where the smoking is permitted, but the serving of food and drinks is not permitted. The smoking areas must cover less than 20% of the overall public places, they are reserved for smokers only, with special ventilation system, automatically closing door etc.
According to the Act on Amendments to the Act on Restriction of the Use of Tobacco Products (OG 119/09) the exception are the facilities serving only drinks, which are not able to to fulfil the conditions for smoking areas and are designated as smoking area by the owner or the facility user, but with special ventilation system and obligation of having promotional material on the harmful effects of tobacco products.’
In practice, the law is flouted in government offices, hotels, restaurants and cafés alike, to the discomfort and frustration of non-smokers. Cigarettes are relatively cheap in Croatia, but not that cheap in comparison to the average wage, income or pension.
Freedom for all
We all have the right to live as we choose, within reason. By minimizing the negative impact we have on people around us, we create a happier and healthier society. Smoking is a negative contributor with no positive factors going for it.
Discouraging and restricting smoking is not about removing smokers’ freedom to choose what they do. The aim is to prevent their unhealthy habit from affecting others, particularly children.
Advice to smokers
* Remember that your cigarette smoke has a harmful effect on those around you.
* Your cigarette smoke travels a long way: try not to smoke anywhere in your home, especially if you have children.
* Choose smokeless or chewing tobacco rather than cigarettes.
* When in company, always ask if those around you object to you smoking.
* Be prepared to refrain or go elsewhere if they do.
* Respect no-smoking areas.
* Respect the environment: dispose of cigarette butts and packets in a responsible way.
* Do not encourage others, especially children, to smoke.
* If you do sport, avoid smoking for about 2 hours before exercising: that can increase your lung capacity by about a third.
Quitting
If you ever feel like quitting smoking, persevere. It is a difficult addiction to overcome, but not impossible. Even if you fail a few times, try to regain the motivation. Look up all the possible tactics for giving up the habit, and experiment until you find the one that works for you. It helps if you are supported by people close to you, but only you can solve the problem. Weigh up all the cons and any pros you can think of, then make the resolution.
References:
1 WHO Report on the Global Tobacco Epidemic 2008
http://www.who.int/tobacco/mpower/mpower_report_full_2008.pdf
2 http://www.who.int/fctc/signatories_parties/en/
3 http://www.who.int/fctc/reporting/party_reports/cro/en/index.html
4 http://www.who.int/fctc/reporting/party_reports/croatia_annex1_prevalence_figures.pdf
7 Houston T K, Kiefe C I, Person S D, Pletcher M J, Liu K, Iribarren C, 2006. Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study. BMJ 332 (7549) 1064-1069. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/16603565
8 Garcia Mata s, Ardanaz Aicua E, Hidalgo Ovejero A, Martinez Grande M, 2000. Legg-Calvé-Perthes disease and passive smoking. J.Pediatr.Orthop. 20 (3) 326. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/10823599
9 Online: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61388-8/abstract. Published in the journal (8th January 2011): Oberg M, Jaakkola M S, Woodward A, Peruga A, Pruss-Ustun A, 2011. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet, vol.377, issue 9760, pp 139-148
10 http://universe.sdsu.edu/sdsu_newscenter/news.aspx?s=71209.
11 Slaughter, Elli 2010. Toxicity of cigarette butts and their chemical components to the marine and freshwater fishes, atherinops affinis and pimephales promelas. Master’s degree thesis, Faculty of San Diego State University.
http://sdsu-dspace.calstate.edu/xmlui/bitstream/handle/10211.10/599/Slaughter_Elli.pdf?sequence=1
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