Quit smoking or die trying: 50% of young men smoke

Today, smoking is considered to be one of the biggest public health threats that the world is facing. Around six million people are killed every year because of tobacco smoking. Mauritius is not spared either. News on Sunday reports on this scourge... Nearly one in five Mauritians smoke (19.3%) according the Non Communicable Diseases Survey 2015. However, more men are into this ‘habit’ than women, 38% for men as compared to 3.9% for women. Tobacco smoking is one of the highest causes of cancer and death. The most worrying aspects of these figures is that half (50%) of young men aged between 19 and 24 smoke! The NCD estimates that Mauritius has more young smokers than old ones, however, the older a person, the less likely he is to smoke. The main implication of smoking rates among the younger population is that to curb the trend, measures will have to be initiated quickly and effectively. In line with this objective, the Minister of Health, Anil Gayan, has this week announced that the authorities are considering the implementation of plain packaging for cigarettes. Even though the percentage of the population who smoke has dropped from 21% to currently stand at 19%, according to the NCD coordinator Dr Rughoo, more youngsters are picking up the habit resulting in a rising trend of young smokers. According to the Global Youth Tobacco Survey (GYTS) 2008, a school-based survey, school children as young as 13 are smoking. The authorities have been working on various programs to reduce the number of smokers. One of the main programs includes sensitisation campaigns in schools, universities and work place. A second program is the tobacco cessation clinic set up since 2009, in regional hospitals to help people quit. At the clinic, initially there is a psychological assessment. The person then has to follow some therapy for three to four weeks before being given medication. The nicotine replacement therapy follows thereafter.

[[{"type":"media","view_mode":"media_large","fid":"18849","attributes":{"class":"media-image wp-image-32300 alignleft","typeof":"foaf:Image","style":"","width":"302","height":"253","alt":"smoking2"}}]]Leading cause of death

According to the World Health Organisation (WHO), nearly 80% of the more than 1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. “Tobacco users who die prematurely deprive their families of income, raise the cost of healthcare and hinder economic development. In some countries, children from poor households are frequently employed in tobacco farming to provide family income,” the report highlights. Smoking can be very dangerous for a pregnant women as it can lead to birth defects, premature births, stillborn infants, low birth weight, spontaneous abortion, and long term effects on children. Dr Rughoo explains that smoking affects a person’s body from his hair to his toe. “Tobacco contains around 4,000 chemical products among which 300 are poisonous and 50 are cancer causing agents. And youngsters whose organs are still developing are taking such poisonous substance. It will surely be detrimental to his health. Adult smokers are vulnerable to a wide range of diseases starting from hair problems to various types of cancer,” he says. The WTO warns people of second hand smoke which is equally dangerous. “There is no safe level of exposure to passive smoking. Almost half of children regularly breathe air polluted by tobacco smoke in public places. Second-hand smoke causes more than 600 000 premature deaths per year,” the report debates. Dr Rughoo avers that passive smokers are also at risk to various health issues like asthma attacks, bronchitis, ear infection and sinus infections. Rajen Suntoo, sociologist: “Smoking has a huge impact on society”

Sociologist Rajen Suntoo explains that the tobacco has harmful effects not only on the individual but on society as well. “The smoker is not only harming his health, but is health of others simultaneously. The youth are getting trapped in this scourge as many of them are following in the steps of their elders. Many youngsters are picking this habit from their parents and are transmitting it to their peers.” According to him, what is more surprising is the increasing number of young girls smoking nowadays. “Girls are adopting the same style like boys, hanging out, smoking and drinking. Smoking is causing huge expenditure to the health services. “Society has to pay for the health cost of these persons. Parents need to assume their responsibilities. They need to educate their children about the harm tobacco can do.”

The number of cigarettes imported by year

• 2015: 986 480 000
• 2014: 995 540 000
• 2013: 978 520 000
• 2009: 1 306 406 000

Health problems caused by smoking:

• Cataracts and loss of eyesight
• Periodontal disease (gums, breath, teeth)
• Cancers (lung, mouth, kidney, pancreas, bladder, throat, esophagus)
• Reduced fertility (impotence, erectile dysfunction, early menopause, irregular and painful menses)
• Chronic obstructive pulmonary disease (bronchitis, emphysema)
• Ulcers
• Cardiovascular disease (coronary thrombosis, heart attack, cerebral thrombosis, stroke, high blood pressure)
• Ageing and facial wrinkles
• asthma
• reduced life expectancy
• atherosclerosis

Benefits of quitting smoking

Quitting smoking has a major and immediate health benefits for men and women of all ages. “Within 20 minutes, a person heart rate and blood pressure drop. Within 12 hours, the carbon monoxide level in a person’s blood drops to normal. In 2-12 weeks, the circulation is improved and lung function increases. Within a year, the risk of coronary heart disease is about half that of a smoker,” explains Dr Ruggoo. Smoking is very expensive! If 20 cigarettes per day costs Rs 100, then every year, the amount goes up to Rs 36,000. You can spend this money wisely in things like technology, food, travel and leisure. Besides, smoking has a negative impact on the environment as well. At least 4.5 million non biodegradable filter tips are deposited annually somewhere in the world.

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According to Dr Deawan Mohee, President of VISA association and Executive Director of African Tobacco Control Alliance, the country has made extensive progress in the fight against tobacco. However, he trusts that there is great room for improvement and that there are additional measures that should de adopted.

Dr Deawan Mohee: “Cigarette is a drug”

“What we need is a well calculated strategy that will holistically tackle the issue. For example we should continue educating our youth about the dangers of tobacco smoking, it should be completely banned in public places. Advertising should be banned and promotion of tobacco should not be done at all, illicit trade should be prevented, among others. We also need collaboration between the different stakeholders and countries around the world. Then we will be able to have an efficient program to curb tobacco smoking,” says Dr Deawan Mohee.

Banning imports of tobacco products won’t solve the issue, he says. “Cigarette is a drug. When you are not getting your dose, you will find a way to get it even if it is illicit. There are a lot of smuggling going on that you will definitely get hold of cigarettes or smuggled ones. Sometimes, you may even shift to other drugs to satisfy your craving. The only country which has banned the importation of cigarettes is Bhutan. If it was the real solution, organisations such as WHO and UN would not have set up the Framework Convention on Tobacco Control. This document is the cornerstone of anti-tobacco policies of 180 countries around the world,” he explains.

Dr Deawan Mohee says that the campaign against smoking requires time and action. He supports the plain packaging measure. “It is one of the most effective measures. It has known much success in other countries such as Australia where a significant decrease in tobacco consumption has been noted. Cigarette packages are often colourful, with various logos and designs to attract people, especially the youth. Besides the sanitary pictures, the plain packaging will only have the trademark of the product in small characters. People, especially the youth, will thus find it not appealing to buy.”

However, he adds that there are many other issues related to smoking that should be tackled with much urgency. “According to research carried out by the University of Waterloo, Canada, in association with the Mauritius Institute of Health (MIH), cigarettes are affordable in Mauritius. This indicates that taxes on cigarettes could be raised. According to the UN, increase of taxes is also one of the most effective measures. In South Africa, the consumption of cigarettes has decreased following the increase in taxes.”

Nevertheless, Dr Deawan Mohee highlights that the major problem is the enforcement of measures implemented. Among the issues he highlights are: existing laws are not sufficiently enforced. For example, in public places such as buses or taxis, the ‘No Smoking’ sign is often missing. In addition, the ‘No Smoking’ sign is not displayed in public places. Smoking in nightclubs is not controlled. This is against the law. Others illegally sell cigarettes to minors.

“Another big issue is the mushrooming of Shisha (Hooka) bars around the island. This is also illicit and we do not understand how these small businesses get their licence. Shisha smoking is as dangerous as cigarette smoking as it contains tobacco. According to the law, we do not have the right to import and produce Shisha tobacco in Mauritius. Thus, authorities have to react and absolutely make sure that laws are respected and implemented as they should,” says the anti-smoking campaigner.

Ajay Nundoochan, Officer in Charge, WHO (Mauritius): “Plain packaging is working well in Australia”

What will be the effectiveness of the plain packaging?

WHO recommends that plain packaging be implemented as part of a comprehensive approach to tobacco control. Plain packaging is a suitable policy for any country implementing a comprehensive approach to tobacco control. Developed countries have taken the lead in designing and implementing plain packaging measures and other countries, including developing countries, will benefit from their experience. There are strong evidence base which supports implementation of plain packaging. Overall, this evidence tends to conclude that plain packaging:

• reduces the attractiveness of tobacco products restricts use of the pack as a form of advertising and promotion
• limits misleading packaging, and
• increases the effectiveness of health warnings.

Australia was the first country to implement plain packaging. Evidence from Australia shows that the plain packaging is working well. During the first 34 months following implementation of plain packaging there, more than 100,000 smokers managed to quit smoking without any relapse. A recent study published in the British Medical Journal found that plain packaging reduced the appeal of smoking and encouraged smokers to consider quitting.

[[{"type":"media","view_mode":"media_large","fid":"18850","attributes":{"class":"media-image wp-image-32301 alignleft","typeof":"foaf:Image","style":"","width":"266","height":"433","alt":"cigratte"}}]]What could be done to curb the smoking trend in Mauritius?

The WHO Framework Convention on Tobacco Control (FCTC) is the first international treaty negotiated under the auspices of the World Health Organisation. Mauritius ratified the convention on 17 May 2004. Through the different successive National Action Plan on Tobacco, Mauritius has been implementing the different articles contained in the convention. This should be sustained.

Furthermore, the WHO has developed and introduced a package of six policy measures, known as MPOWER. A study released in 2013 evaluated the impact in adopting at least one of its measures in 41 countries, including Mauritius. In these 41 countries, the estimated number of smokers dropped by 14.8 million from 2007 to 2010. It is estimated that some 7.4 million deaths would be averted by 2050. This demonstrates the considerable impact of cost effective measures for demand reduction.

What are the implications for the public sector health?

For every cent that we invest in tobacco control, studies have shown that we have a return of 50 cents through healthcare cost savings.

A study by the Royal College of Physicians in 2000 found that nicotine is highly addictive. Should smoking be treated as an addiction instead of a habit?

Nicotine is addictive. It is acquired through the habit of smoking/tobacco use. The approach to smoking cessation is addressing the addiction to nicotine. WHO, as well as the Royal College of Physicians, and the American Psychiatric Association (APA), have supported the conclusions of a 1988 report by the Surgeon General of the United States that cigarettes and other forms of tobacco are addictive and nicotine causes addiction.

In Mauritius, all eight tobacco cessation clinics are managed on evidence-based clinical guidelines with tobacco dependence treatment which provides the use of approved medications to treat physical withdrawal and behavioural coaching to help change habits. Healthcare workers provide behaviour change support.