Resident GP Dr Zak Uddin on the chances of a smoke-free future
Despite strenuous progress towards reducing tobacco use and preventing second-hand smoke among non-smokers, the number of smokers has increased, now reaching 1.1 billion people worldwide. The majority of them are concentrated in just 10 countries, with a staggering third in China alone.
This is disheartening news as the devastating effects of tobacco use become widely publicized. There were 90,000 smoking-related deaths in the UK last year, 10,000 more than those from COVID-19. Cigarettes and related products are the leading preventable cause of cancer and heart disease, the two leading causes of death worldwide.
So, against this huge body of evidence, why do people continue to smoke? A recent study published in the Lancet very effectively argues that the age at which people are able to legally buy tobacco is the reason why the number of smokers has increased rather than decreased.
Two-thirds of smokers start before the age of 20, and almost 90% start to smoke before the age of 25. Addiction occurs quickly, often followed by a lifetime of unsuccessful attempts to quit smoking. The authors argue that if you haven’t started smoking by the age of twenty-five, you probably won’t start at all, which is certainly supported by the numbers above. By raising the legal purchasing age to 21, in the first year alone, it could prevent 100,000 people from becoming smokers around the world.
87% of deaths among current smokers are due to smoking, compared to just 6% among those who quit 15 years or more previously, demonstrating not only the need to quit, but also the importance of quitting early. Even if you are lucky enough to avoid cancer, smoking for a lifetime will wreak havoc on every organ in the body.
The UK’s goal is to be smoke-free, which means less than one in 20 smokers, by 2030. Currently, around 1 in 6 smokes, compared to 1 in 2 adults in the 1970s. other countries are even more ambitious; New Zealand is aiming for this goal by 2025.
Is it possible ? Several initiatives have seen the number of smokers in many countries decline steadily. People’s views on smoking have also hardened, shifting from an annoying vice to an act of antisocial behavior, even harmful to the environment. A recent petition in Spain, with nearly 300,000 signatures, was presented to their Minister of Health, calling for a ban on smoking on all beaches. It has been argued that not only are cigarette butts unsightly, but chemicals leaching into the sand are an environmental hazard.
Even though, in an ideal world, no one would ever start smoking, encouraging smoking cessation remains an important goal. All health professionals are encouraged to answer the question and offer their support at any time, a concept known as “positive health promotion”.
While the majority of smokers want to quit according to questionnaires and surveys, many do not. Commonly cited factors are lack of motivation or having the necessary support. On top of that, there’s the massively addictive nature of nicotine, the almost instant fix it provides, as well as the often unpleasant immediate effects of withdrawal. Fortunately, these are usually short lived.
Often there has to be a goal to stop, whether it is the desire for better health, to get rid of an unpleasant habit, or the cost that can reach several thousand a year. A clear plan with a specific stop date is often necessary. Withdrawing from heavy tobacco use does not present the same life threatening health risks as the acute transition from heavy alcohol consumption to no alcohol consumption altogether, so there are fewer arguments in favor of a gradual reduction. There is also the temptation to increase your smoking if you experience unexpected stress.
Getting rid of smoking paraphernalia, including that “emergency cigarette pack”, will hopefully reduce any desire or desire after the date you decide to quit.
The NHS has smoking cessation services that remain operational and there is good evidence that professional support helps many people quit and stay quit. Some people may simply quit smoking and never touch another cigarette, but these remain in the minority.
Electronic cigarettes are now firmly established as a cessation aid, and while significantly less harmful than cigarettes, they are not completely harmless. Ideally, they should be viewed as a way to make quitting easier, rather than an alternate method of obtaining nicotine.