Why you shouldn't smoke!

New African, Apr 2004 by Bull, Genstacia

Why you shouldn't Smoke!

Ever heard of this before: "There is oral tobacco in the form of sweets mainly used by children. The earlier children start smoking, the more likely they are to continue smoking throughout life, to smoke heavily and to die from a smoking-related disease." Genstacia Bull reviews John Crofton and David Simpson's new book, Tobacco: A Global Threat.

This is an ideal book that politicians and health officials would find very useful. It is also relevant to smokers and non-smokers alike as it highlights the risks and consequences of smoking and acts as a preventive measure for potential smokers.

The book opens by stating that as richer countries have begun to learn the grim lessons of suffering and death from tobacco, they are gradually abandoning the habit - but sadly not in poor countries, including those in Africa.

Tobacco consumption is now decreasing in the rich countries. As a result, the multinational tobacco companies are increasingly concentrating on creating vast new markets in Asia, Africa and Latin America (as well as in Central and Eastern Europe).

The book describes tobacco as an epidemic. In the world as a whole, tobacco already kills one in 10 adults. By 2030, it is expected to kill one in 6, or more than 10 million a year. At least 7 in 10 of these deaths will be in low-income or middle-income countries.

A survey in 1990 showed that in 44 industrialised countries, smoking caused an average of 24% of all male deaths - but 35% of deaths in middle aged people (35-69). It also caused 7% of all female deaths. In the USA, where a high proportion of women smoke, it was 17%. The average loss of life in smokers is 8 years. For those who die in middle age, it is as much as 22 years.

In high-income countries, most smokers start smoking in their teens. In poorer countries, they mostly start in their early 20s. But the peak of the starting-age is getting younger.

In most countries, there is already more smoking among the poor than the rich. Smoking makes the poor poorer; money is spent on tobacco instead of food or other family needs. In short, their health is doubly threatened. That tobacco is a menace to health, is amply illustrated by Crofton and Simpson in their book, using several case studies, like the one below.

It can't happen to me

Mrs Tsuli was a schoolteacher. When she was young, few women in her country smoked. However when she was at her teacher training college, smoking became popular as a sign that educated women were now becoming more "liberated", sophisticated and "Westernised".

Though she did well in her career, became an assistant head teacher, and married happily, she continued to smoke. She began to have attacks of bronchitis, which kept her off work, sometimes for several weeks. She got rather more breathless.

At the age of 48, one of Mrs Tsuli's bronchitis attacks developed into a severe pneumonia with fever and pain in her left chest. This was treated with antibiotics. The fever subsided but she continued to cough. She still had pain in her left chest and felt generally unwell. Her doctor sent her to hospital. X-rays showed a shadow in her left lower lung, and there was a gap in the bone shoulder of one of her left ribs where she had had the pain.

Examination with bronchoscope confirmed a cancer. The obstruction of the bronchus by the cancer had led to infection beyond. This had caused her pneumonia. The gap in the rib showed that cancer cells had spread there through the bloodstream and were destroying part of the rib. No curative treatment was possible.

Mrs Tsuli died a few months later. She spent much of the last few months of her life trying to persuade all her smoking friends to quit and so save themselves from the same fate. In her later years, she became aware that cigarettes were dangerous. But like many smokers, she felt psychologically that "it can't happen to me" - until it did. To her great credit, while she felt that it was too late for anyone to help her, she felt she could help her friends to avoid the same tragedy.

This book covers the whole gamut of tobacco types targeted at different user groups, especially women and children. For instance, "there is oral tobacco in the form of sweets mainly used by children. The earlier children start smoking, the more likely they are to continue smoking throughout life, to smoke heavily, and to die from a smoking-related disease."

The younger they take up smoking, on average the younger they are when they suffer from heart attacks or lung cancer. Children who smoke are also less fit athletically - they are slower both at sprints and endurance running. This is partly an effect of lung function.

In all people, the efficiency of the lungs decline with age, but the lungs of children who smoke "age" much faster than those of their non-smoking peers. For example, a 16-year-old who smokes 20 cigarettes a day might in effect have the lungs of a 28-year-old non-smoker.

According to the book, the increase in smoking among women is associated with the development of "feminised" cigarettes-filter tips to reduce tar staining. There are also milder, less pungent tobaccos, and cigarettes made longer and thinner.