Smoking has been a prevalent habit for centuries, captivating millions of individuals worldwide. However, behind the allure lies a dark truth—cigarettes are laden with toxic substances that pose grave threats to our health. According to the World Health Organization (WHO), tobacco kills more than 8 million people each year. This figure includes around 7 million smokers and approximately 1.2 million non-smokers exposed to second-hand smoke. Smoking-related healthcare costs and productivity losses amount to trillions of dollars worldwide each year. This financial burden affects individuals, families, and societies as a whole. Smoking is responsible for roughly one in three cancer-related deaths and is the leading preventable cause of premature deaths globally. The Member States of the World Health Organization created World No Tobacco Day in 1987 to draw global attention to the tobacco epidemic and the preventable death and disease it causes. It is observed on May 31st each year. The theme for world no tobacco day 2023 is “We need food, not tobacco”. It aims to raise awareness about the harmful effects of tobacco growing on food security, health and environment. It also urges governments to end subsidies for tobacco growing and support farmers to switch to sustainable crops. It exposes the tobacco industry’s interference with crop substitution efforts.
The Anatomy of a Cigarette
A cigarette may seem like a simple combination of tobacco and paper, but its contents are far more complex and hazardous. Let's dissect a typical cigarette:
Tobacco: At the core of every cigarette is tobacco, a plant native to the Americas. Nicotine, an addictive alkaloid, is present in tobacco leaves and acts as the primary agent that keeps smokers hooked on cigarettes. It raises blood pressure, constricts blood vessels, and increases heart rate, putting undue strain on the cardiovascular system.
Additives: Tobacco manufacturers use a range of additives to enhance the flavour, aroma, and burn characteristics of cigarettes. These additives include sugars, flavours, and ammonium compounds. By altering the taste and sensory experience, additives contribute to the addictive nature of smoking.
Paper and Filters: The outer wrapping of a cigarette is made of paper, which is typically composed of cellulose fibres. Filters are often incorporated to reduce the amount of tar and particulate matter that reaches the smoker's lungs.
Tar: Tar is a sticky brown residue that accumulates in the lungs of smokers. It contains numerous toxic chemicals, including polycyclic aromatic hydrocarbons (PAHs) and carcinogens such as benzene and formaldehyde. Tar coats the lung tissues, impairing their ability to exchange oxygen and leading to chronic respiratory problems.
Carbon Monoxide (CO): CO is a poisonous gas present in cigarette smoke. When inhaled, it binds to haemoglobin in the bloodstream, reducing its ability to carry oxygen. Prolonged exposure to CO can lead to tissue damage and increase the risk of cardiovascular disease.
Volatile Organic Compounds (VOCs): Cigarette smoke contains VOCs, such as benzene, toluene, and formaldehyde. These compounds have been linked to various health issues, including respiratory irritation, lung damage, and an increased risk of cancer.
Heavy Metals: Cigarette smoke contains toxic heavy metals like lead, cadmium, and arsenic. These metals are absorbed by the tobacco plant from the soil and subsequently released into the smoke when the cigarette is burned. Chronic exposure to these metals can lead to organ damage and increase the risk of cancer and other diseases.
Health Hazards of Smoking
The health hazards of smoking are both immediate and long-term, affecting every system of the body. Smoking damages the lungs, leading to chronic obstructive pulmonary disease (COPD), bronchitis, and lung cancer. It also exacerbates asthma symptoms and increases the risk of respiratory infections. Smoking significantly elevates the risk of heart disease, stroke, peripheral vascular disease, and hypertension. The toxic chemicals in cigarettes can damage blood vessels, leading to atherosclerosis and restricted blood flow. Smoking is a leading cause of various cancers, including lung, throat, mouth, esophageal, pancreatic, kidney, bladder, and cervical cancer. The carcinogens present in cigarettes can initiate DNA mutations and promote the growth of malignant cells.
Second-hand and Thirdhand Smoke: Unveiling the Invisible Dangers
The harmful effects of smoking extend beyond the individual who smokes. Secondhand smoke and the lesser-known concept of thirdhand smoke pose significant health risks to those exposed, even in the absence of active smoking.
Second-hand smoke (SHS) refers to the combination of smoke exhaled by a smoker (mainstream smoke) and the smoke emitted directly from the burning cigarette (sidestream smoke). It contains over 7,000 chemicals, including 70 known carcinogens, toxic metals, and irritants. SHS exposure increases the risk of numerous health problems, including respiratory infections, asthma exacerbation, reduced lung function, heart disease, stroke, and certain cancers. Children, pregnant women, and individuals with pre-existing health conditions are particularly vulnerable. Spending time in enclosed spaces, such as homes, cars, and public areas where smoking is permitted, exposes individuals to higher concentrations of SHS. The duration and intensity of exposure play significant roles in determining the health risks. Non-smokers inadvertently inhale SHS, leading to the absorption of toxic chemicals into their bloodstream. This exposure can have both immediate and long-term health consequences.
Thirdhand smoke (THS) is a concept that has gained attention in recent years. It refers to the residual tobacco smoke contamination that remains on surfaces and in the air even after visible smoke has dissipated. When tobacco smoke settles on surfaces, it forms a thin layer of toxic residues. These residues contain harmful chemicals, including carcinogens, and can persist for weeks, months, or even years. Examples of affected surfaces include furniture, carpets, clothing, and walls. Over time, the chemical composition of THS can change as the residues react with other compounds present in the environment. When these surfaces are disturbed or exposed to heat, such as during cleaning or through the use of heating appliances, THS chemicals can be reactivated and re-emitted into the air. Individuals can be exposed to THS by touching contaminated surfaces and then touching their mouths or ingesting particles through dust inhalation. Infants and young children are especially vulnerable as they crawl, play, and put objects in their mouths.
Increased awareness is crucial in safeguarding public health and implementing effective policies and practices to protect individuals from these hazards. Establishing and enforcing comprehensive smoke-free policies in public places, workplaces, and homes can significantly reduce exposure to SHS and THS. Public health campaigns should focus on educating individuals about the dangers of SHS and THS, promoting smoke-free environments, and encouraging smokers to quit. Improving ventilation in indoor spaces can help reduce the concentration of residual smoke particles and enhance air quality.
Breaking Free from the Grip of Addiction
Nicotine dependence is a complex addiction that poses significant health risks. While quitting smoking can be challenging, medical interventions have proven to be effective in supporting individuals on their journey towards nicotine independence.
Nicotine Replacement Therapy (NRT) provides controlled doses of nicotine to the body, reducing withdrawal symptoms and cravings associated with quitting smoking. Available in various forms such as patches, gum, lozenges, nasal sprays, and inhalers, NRT allows individuals to gradually wean themselves off nicotine. It is important to follow the recommended dosing guidelines and duration of treatment. Bupropion is a drug originally developed as an antidepressant. It has shown efficacy in aiding smoking cessation. It works by reducing cravings and withdrawal symptoms. It is typically prescribed for a specific duration and requires medical supervision. Varenicline is a newer drug that acts on nicotine receptors in the brain, reducing the pleasurable effects of smoking and easing cravings. It also helps alleviate withdrawal symptoms. Varenicline is usually taken for a prescribed duration and may require close monitoring due to potential side effects. Combining pharmacological treatments with behavioural support can enhance success rates in smoking cessation. Cognitive-Behavioural Therapy (CBT) focuses on identifying triggers and developing coping strategies to manage cravings and change smoking-related behaviours. Combining CBT with pharmacotherapy has shown promising results in smoking cessation. Motivational Interviewing approach involves a collaborative conversation between healthcare professionals and individuals seeking to quit smoking. It aims to enhance motivation, build confidence, and explore personal reasons for quitting.
Engaging with healthcare professionals is essential for effective medical management of nicotine dependence. They can provide personalized guidance, prescribe appropriate medications, and monitor progress. Healthcare professionals can also help individuals understand the potential side effects of medications and tailor treatment plans to suit individual needs. Successfully quitting smoking requires long-term maintenance and relapse prevention strategies. Adopting a healthy lifestyle that includes regular physical activity, a balanced diet, stress management techniques, and adequate sleep can help individuals maintain their smoke-free status. Continuing to engage in support groups, counselling sessions, or quit-line services after quitting can provide ongoing support and motivation, reducing the likelihood of relapse. Practicing mindfulness techniques, such as deep breathing exercises, meditation, or yoga, can help individuals manage stress and cravings, minimizing the risk of relapse.
While the battle against nicotine dependence is arduous, contemporary management options provide hope for smokers looking to reclaim their health and well-being. Combining pharmacological treatments, behavioural support, and long-term maintenance strategies can significantly enhance success rates and improve overall health outcomes. By raising awareness, providing resources, and fostering supportive environments, we can collectively strive towards a smoke-free future and a healthier society.
(Dr. Padmavathy R is Senior Consultant Pulmonologist, Meitra Hospital, Calicut)
