Smoking is still a public health issue in Sri Lanka although the number of smokers has dropped following government interventions. Recent hospital data has revealed that most patients in hospitals today suffer from diseases related to cigarette smoking, such as lung cancer, heart problems, hypertension and stroke. The number of school children and youth being lured into this habit has recently prompted the Cabinet to ban sales of cigarettes within a radius of 500 metres from schools.
Despite warnings many young people still don’t realise the extent of poisonous chemicals in cigarettes that lead to serious health impacts on their bodies.
Emeritus Prof of Forensic Medicine and Toxicology, University of Colombo and Senior Prof of Forensic Medicine, General Sir John Kotelawala Defence University, Prof Ravindra Fernando, explains what these poisons are and how they impact on their bodies.
Excerpts …
Q. Cabinet approval has been given for plain packaging of cigarettes and steps taken to ban sales of cigarettes within a radius of 500 metres of any school. Do you think this is a good thing?
A. It is a commendable decision to have plain packaging in Sri Lanka. It would standardize the appearance of cigarette packages by requiring the removal of all brand imagery, including corporate logos and trademarks. Packages would display a standard background colour and manufacturers would be permitted to print only the brand name in a mandated size, font and position. Other government-mandated information, such as health warnings, would remain.
The prohibition of cigarette sales within a periphery of 500 metres from schools is a correct step to prevent young people being lured into this dangerous trend.
Q. At a discussion at the Sri Lanka Medical Association (SLMA) to mark ‘No Tobacco Day’ recently, National Authority on Tobacco and Alcohol (NATA) Chairman Dr. Palitha Abeykoon was reported to have said that some 14.5 % or 1.2 million Sri Lankans are smokers and if this number could be reduced to 10 % it would no longer be a public health issue. Do you agree?
A. The problem is how to reduce the number of smokers to 10%. A recent study has shown that with legal and illicit tobacco products combined, Sri Lanka’s annual tobacco consumption in 2018 will be around 8.57 billion sticks; up 16% over last year’s figure of 7.38 billion. At the moment, male smokers’ percentage in Sri Lanka is 26 percent.
Various interventions by the state would be necessary to reduce smoking in the next few years.
Q. SLMA President Dr. Anula Wijesundera was quoted as saying that at present 20,000 Lankans die of various health diseases caused by smoking. This was endorsed by the Consultant Chest Physician Dr. Saman Kapilawansa, who reportedly said that 90% of patients warded in state hospitals had fallen ill due to smoking tobacco. Your comments?
A. Tobacco kills half of its users, with smoking and smokeless tobacco killing nearly six million people worldwide. According to the WHO, tobacco use has killed 100 million people in the 20th century and could increase to one billion in the 21st century! Hospital medical wards have patients with coronary heart disease, strokes, chronic obstructive pulmonary disease (COPD) and cancer caused by smoking.
Q. What is the largest category of smokers in Sri Lanka?
A. Adults.
Q. What is it in tobacco that attracts people?
A. Smoking is not simply a bad habit. It is an addiction. The drug inside tobacco that people are addicted to is called nicotine. Just like with other addictions, those addicted to cigarettes have a compulsive need to smoke. Their body craves for regular doses of nicotine.
When someone smokes, it often leads to changes in their brain and nervous system. These are real physical differences, and the brain will now be dependent on the nicotine, and has ‘rewired’ itself. Withdrawal from smoking and nicotine is often uncomfortable. It has many physical symptoms and some people are not able to handle these feelings. They may also find the cravings for nicotine too hard to resist.
Q. Tobacco is said to have some 4,000 chemicals of which 400 are harmful to our health and about 50 chemicals which are carcinogenic. Can you elaborate?
A. Tobacco smoke is both toxic and addictive. It contains around 7,000 chemicals! Many of these are poisonous and over 60 are known to be cancer causing (carcinogenic). Apart from nicotine, there is tar. ‘Tar’ is the term used to describe the toxic chemicals found in cigarettes.
It’s a sticky brown substance that forms when tobacco cools and condenses. It collects in the lungs and can cause cancer. In addition there is carbon monoxide. When it is inhaled it enters the blood stream and interferes with the working of the heart and the blood vessels.
Up to 15% of a smoker’s blood can be carrying carbon monoxide instead of oxygen. Other chemicals include arsenic, ammonia, acetone, toluene, methanol and pesticides. A number of pesticides (toxic chemicals used to kill pests, usually insects) are present in cigarette smoke. These pesticides find their way into cigarettes because they’re used on tobacco plants as they are growing.
Q. What are the most significant health risks posed by cigarette smoking? I understand ten top priority areas have been listed by the WHO? What are they?
A. They are lung damage, heart disease, fertility problems, pregnancy complications, type two or adult type diabetes, weakened immune system, vision problems, poor oral hygiene, unhealthy skin and hair and cancers
Q. What is the effect of cigarette smoking on our respiratory system?
A. Smoking affects lung health because a person breathes in not only nicotine but also a variety of additional chemicals mentioned above. Cigarettes are responsible for a substantial increase in the risk of developing lung cancer and are linked to developing emphysema and chronic bronchitis. They can also trigger or exacerbate an asthma attack.
Q. How does it impact on our lungs?
A. Smoking causes lung disease by damaging the airways and the small air sacs (alveoli) found in our lungs. Some changes such as colds and pneumonia are sudden, lasting just a short time. More chronic changes like emphysema happen slowly and can last a lifetime.
When you smoke, the cells that produce mucus in your lungs and airways grow in size and number. As a result, the amount of mucus increases and thickens. Lungs cannot effectively clean out this excess mucus. So, the mucus stays in our airways, clogs them and makes us cough. This extra mucus is also prone to infection.
Q. Can it harm our Reproductive System?
A. Smoking can damage the female reproductive system and make it more difficult to get pregnant. This may be because tobacco and the other chemicals in cigarettes affect hormone levels.
In males, there is a higher risk of erectile dysfunction. Smoking can also affect the quality of the sperm and therefore reduce fertility.
Q. Cause of COPD?
A. Smoking is the leading cause of Chronic Obstructive Pulmonary Disease (COPD) and a trigger for COPD flare-ups. Smoking damages the air sacs, airways, and the lining of the lungs. Injured lungs have trouble moving enough air in and out, so it is hard to breathe.
Q. Affect the skin and eyes?
A. Smokers prematurely age, have wrinkled skin and a higher risk of skin cancer, especially on the lips. Smoking can cause hair loss and balding.
Q. The heart?
A. Smoking can damage the heart, blood vessels and blood cells. The chemicals and tar in cigarettes can increase a person’s risk of atherosclerosis, which is the buildup of plaque in the blood vessels, which limits blood flow and can lead to dangerous blockages.
Q. Is there a safe level for smoking?
A. No. Even low-intensity smokers are at increased risk of early death.
Q. What about second hand smoking?
A. There are two types of secondhand smoke; side stream smoke comes directly from the burning tobacco product and mainstream smoke is the smoke the smoker inhales. The smoke that burns off the end of a cigarette or cigar actually contains more harmful substances than the smoke inhaled by the smoker, as there is no filter it must pass through.
Q. How long does cigarette smoke remain in the environment?
A. Cigarette smoking causes environmental pollution by releasing toxic air pollutants into the atmosphere.
The cigarette butts and toxic chemicals seep into soils and waterways causing soil and water pollution respectively affecting animals and plants that absorb toxic substances. Additionally, the pesticides, fertilizers and other chemicals used in the cultivation of tobacco hamper the fertility of the soil making it unsuitable for supporting any other crop.
Q. Penalties? How effective are they?
A. Raising taxes on tobacco and thereby increasing its price is one of the most effective ways to reduce tobacco use.
Q. Your advice to those on the verge of taking their first smoke?
A. Educating them on the harmful health effects of smoking is essential and parents play an important role here.