Cigarette smoking is waning across the world, due to a combination of laws preventing smoking in public places and offices, the increasing cost of cigarettes due to taxation, the increasing awareness among people of the ill-effects of tobacco smoking and the availability of less harmful options, such as e-cigarettes.
And yet, people, especially the young, do start smoking, usually due to peer pressure…once begun, it becomes difficult to stop. With tobacco smoking, it is best to have never started than to try and quit after starting.
So let’s just look at some simple questions related to cigarette smoking.
1. Why is cigarette smoking harmful?
Tobacco and the other substances use in cigarettes cause harm to the body and lead to increased mortality and morbidity.
a. Increased mortality: Smokers die 3 times more than non-smokers and lose approximately one decade  of their lifespan. This is because of cancers, chronic lung damage, increased cardiovascular risk (heart attacks, strokes, etc) and overall reduced immunity.
b. Increased morbidity: This means a reduced healthspan and living with disability. While most people with cancers typically die within 5 years of detection, those with chronic lung problems and heart and brain diseases often continue to pull on, living diminished lives, a burden to themselves and others.
2. What is the burden of disease caused by cigarette smoking in India?
There are around 1.2 to 1.3 million (12 to 13 lakh) deaths in India every year attributable to tobacco smoking. Almost 10% of all adults in India smoke tobacco, though this is down from 15% compared to the earlier decade . The poor smoke more, starting at a younger age along with a much lower quit rate. The North-Eastern and Eastern states have much higher rates of smoking, Tripura leading the pack, while Kolkata earns that dubious distinction when it comes to metros.
3. What is the collateral harm of cigarette smoking?
Globally, secondhand smoke from 52 smokers leads to one death in a non-smoker . The CDC site explains the risks, which are similar to those in smokers, with additional harm to babies, the young and pregnant women.
The other collateral damage is the expense incurred due to illnesses caused by smoking. India spends almost 1% of its GDP on costs related to tobacco use. If Rs. 100 is the tax amount that the Government gets from the sale of tobacco (in all forms), Rs. 816 is the cost incurred, making this a negative-sum game that actually drains the treasury . At an individual level, tobacco related illness leads to catastrophic expenditure and the poor, who smoke more and also often have no insurance, bear a larger economic burden and slide further into poverty.
4. How does one stop smoking?
It is not easy. Government bodies have poured billions of dollars into finding solutions. While laws have made it difficult for people to smoke, reducing the number of cigarettes smoked in a day, eventual cessation needs personal motivation. It helps if you move away from environments that encourage smoking, such as large stadium events, pubs and bars and friends and colleagues who smoke. Nicotine is addictive, and like alcohol, some people just find it impossible to stop and need a combination of nicotine analogues or replacements with counseling.
As I mentioned earlier, it is better to not start than to try to quit after having started.
5. Does vaping/e-cigarette use work as a less harmful alternative?
Yes. While the best option is to avoid nicotine, if vaping or e-cigarette use helps reduce cigarette smoking, it is a better alternative. There are controversies related to the amount of nicotine in e-cigarettes and the addiction caused, but overall, e-cigarettes are safer than regular cigarette smoking.
In short, our atmasvasth quest to live long, healthy means “not smoking”.
1. Jha P. The hazards of smoking and the benefits of cessation: a critical summation of the epidemiological evidence in high-income countries. Elife. 2020 Mar 24;9:e49979.
2. Lahoti S, Dixit P. Declining trend of smoking and smokeless tobacco in India: A decomposition analysis. PLoS One. 2021 Feb 25;16(2):e0247226.
3. Yousuf H et al. Estimated Worldwide Mortality Attributed to Secondhand Tobacco Smoke Exposure, 1990-2016. JAMA Netw Open. 2020 Mar 2;3(3):e201177
4. John RM et al. Economic Costs of Diseases and Deaths Attributable to Tobacco Use in India, 2017-2018. Nicotine Tob Res. 2021 Jan 22;23(2):294-301
Views expressed above are the author’s own.
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