Following an upward rise in the number of young people now falling prey to the injurious impacts of smoking at an early age this year’s theme of Protecting Children from Tobacco Industry” on No Tobacco day( May 31) is specially relevant to Sri Lankan youth with recent studies showing that even school children are now being enticed to cigarette smoking.
The main obstacle to reducing the smoking population in the country was found to be a lack of motivation to quit rather than knowledge since recent studies had shown that the majority were well aware of the harmful effects it had on the human body.
The Sunday Observer spoke to Senior Registrar, National Teaching Hospital Welisara Dr. Chanurdi Wickramathunga to find out how Sri Lankan youth could be motivated into abstaining from taking that first puff of tobacco smoking which has long lasting impacts on their growing bodies.
Excerpts
Q: The theme for this Year’s No Tobacco Day is Protecting Children from the Tobacco industry. How does this impact Lanka?
Dr. Chanurdi Wickramathunga
A. “No Tobacco Day 2024” organised by World Health Organization (WHO) aims to provide a platform for the youth to speak up against predatory tobacco marketing tactics. This campaign is relevant to Sri Lanka for several reasons. First, Sri Lanka’s smoking population remains high despite sustained regulatory and economic deterrence. The most recent Global Adult Tobacco Survey (GATS) conducted in Sri Lanka by the National Authority on Tobacco and Alcohol (NATA) in 2020 found that 36 percent of Sri Lankan males and 5 percent of females over the age of 15 were smokers despite 94 percent of the smoking population being well-aware of the harmful effects of smoking.
Secondly, there is evidence that tobacco smoking starts young, and that those who had picked up the habit early ended up as heavier smokers. In Sri Lanka, a study in 2015 led by Prof. Katulanda found that the mean age-group to start smoking was 14-16, who had parents and close friends or partners who smoked, as well as involvement in school sports underlying the need to equip young persons to withstand peer pressure offering alternative role models.
Q: What are the 1) short term and 2) Long term health consequences of tobacco smoking on the human body, in general?
A. Smoking injures many organs of your body – not just your lungs. In the short-term it raises your heart rate and blood pressure, because the stimulation of the nicotine neurochemical pathway leads to the release of epinephrine (adrenaline) and norepinephrine (nor-adrenaline), triggering the “fight-or-flight response.” This burden on the heart is exacerbated by the increase of Carbon Monoxide in the bloodstream, causing fatigue and low-energy in the short-term, and by blood vessel inflammation and damage in the long-term.
By damaging the nasal membrane lining, smoking weakens your immune system, and makes you more susceptible to infection. Progressive exposure to smoking leads to elevated long-term risk of lung diseases such as lung cancer and Chronic obstructive pulmonary disease (COPD) and heart diseases. Smoking can also harm your social life by inducing infertility by hormone-disruption, and weakening hair follicles, collagen-production and calcium uptake, resulting in osteoporosis and premature ageing.
Q: What are the ingredients in cigarettes or any other device containing tobacco that makes it so additive to young people?
A. The addictive nature of smoking is a result of natural ingredients of tobacco as well as artificial additives used in processing traditional and e-cigarettes. The most addictive component of smoking is nicotine itself, which stimulates dopamine – the neurotransmitter associated with pleasure sensations. This dopamine-boost is further sustained by monoamine oxidase inhibitors (MAOIs) present in cigarette smoke which slows down the body’s natural breakdown of dopamine. Processing additives to cigarettes such as Ammonia quicken the delivery of nicotine to the brain, while artificially added flavours to traditional/e-cigarettes mask some of the distaste produced by smoking, and make them more alluring to young people. The natural ingredients of tobacco and these artificial pre-processing treatments make smoking more addictive, and challenge withdrawal efforts.
Q: Could you list some of the most harmful and dangerous ingredients that a single cigarette for example contains?
A. Cigarette smoke is full of injurious chemicals, and cigarettes have structural modifications that aggravate this harm. For example, Polycyclic Aromatic Hydrocarbons (PAHs), formaldehyde, benzene, and nitrosamines are carcinogenic by-products of burning tobacco, and there is some research to indicate the composition of cigarette paper may affect the diffusion of hydrogen cyanide. There is also evidence to suggest that metals such as Lead and Cadmium may be absorbed by tobacco plants and the burning of these may contribute towards cancer and organ damage. In addition to the chemicals mentioned, deposits of tar, which is produced by burning tobacco, progressively damage lung tissue.
The US Food and Drugs Administration (FDA) has cautioned that the sugars used as flavours in cigarettes/ e-cigarettes can turn carcinogenic when burned.
Q: As a Senior Registrar in Respiratory Medicine, tell us what adverse impacts smoking has on the respiratory system?
A. Smoking constitutes a multifaceted assault on your respiratory system. First, carcinogens released by smoking damage lung cells and their DNA, and are the leading cause of a range of cancers including Non-Small cell lung cancer (NSCLC) and the rarer but more aggressive Small Cell Lung Cancer (SCLC) as well throat, larynx and mouth cancers. Secondly, smoking reduces lung functioning due to airway inflammation and narrowing, resulting in COPDs such as Emphysema when lung sacs, known as alveoli, are damaged, or Chronic Bronchitis, when the overproduction of mucus clogs the airway. Scarring of the lung-tissue may also lead to pulmonary fibrosis and the damaged lung-lining makes you more susceptible to respiratory infections, such as pneumonia and bronchitis.
Q: Does smoking affect the Heart? Eyes, Ears? If so, how?
A. Smoking is considered a major risk factor for heart attacks, as it damages blood vessels and causes inflammation. It also induces oxidative-stress resulting in increased levels of oxidised Low-Density lipoproteins (or LDL/ “bad cholesterol”). Smoking has been implicated in almost 40 percent of aneurysms, or the abnormal bulging of blood vessels.
It also affects the eyes, causing eye irritation and doubles the risk of cataracts, while increasing the risk of Age-related Macular Degeneration (AMD) and Diabetic Retinopathy. The effect of smoking on ears is still under study, but there is evidence to suggest an increase in ear infections, especially among children.
Q: Are passive smokers also at risk of health issues if they were constantly exposed to the smoke of a close relative ?
A. Passive smokers, or those exposed to second-hand smoke – are well-known victims of smoking. Research indicates that continued exposure to second-hand smoke increases lung cancer by 20-30%. Passive smoking poses increased risk of chronic respiratory diseases such as COPD. Cardiovascular diseases and stroke risks are also elevated in passive smokers. Pregnant women and children are especially vulnerable to second-hand smoke. For expectant mothers, smoking increases the risk of heart and lung diseases, while foetuses may suffer from premature birth, and ensuing developmental complications. Furthermore, second-hand smoke significantly raises the risk of Sudden Infant Death Syndrome (SIDS), a leading cause of death in infants from one month to one year old. Second-hand smoke exposed children are prone to Asthma, Infections in the respiratory system and middle ear, as well as problems with focusing, learning disabilities, and behavioural problems. As noted earlier, they are more likely to pick smoking.
Q: What are effective ways to quit smoking?
A. The National Authority on Tobacco and Alcohol (NATA) maintains a Hotline: 1948 which can support your journey towards being addiction-free.” Even though nicotine’s addictive nature makes quitting difficult in the short-term, given time, the body will adjust to new dopamine baselines. Individual circumstances such as economic conditions, severity of addiction, family support and personality differences all determine quitting strategies and their effectiveness. Identifying what triggers you, and avoiding triggers is crucial, be it in social settings, or in stressful situations. Distracting yourself when you are vulnerable, by chewing on a fruit, or by scribbling may be useful in these times, as is self-talk and delayed gratification. Support groups and behavioural therapy can also be helpful, and surrounding yourself with loved ones, helps replace the pleasure sensations from cigarettes. Nicotine replacement therapy such as patches and gums, and prescribed medication can support withdrawal and help manage cravings. Finally, it is crucial to know that you can easily relapse if you drop your guard, and therefore you should resist social pressure, or internal urges to have “just one,” because that often leads to a degeneration of willpower and recidivist smoking.
Q: What about vaping as an alternative to smoking? What are the pros and cons?
A. Currently the medical community does not recommend using e-cigarettes or vaping as a means for quitting smoking due to several factors. The long-term effects of vaping are still being studied, and the jury is still out on whether vaping is effective in quitting smoking, or if it’s merely a crutch that prolongs nicotine dependence. The major advantage that vaping provides is eliminating tar and reducing some known carcinogenic exposure of cigarettes. However, as I noted earlier, uncertainty remains on the health effects of the alternative chemicals, including some of the flavourings added to e-cigarettes. These chemicals can produce lung and respiratory irritation, and there may be more effective alternatives available to you if you wish to quit smoking.
Q: What are your Dos and Don’ts to avoid second hand smoking?
A. Avoid second-hand smoking especially if you are pregnant or have small children who may be exposed. Stay as far as possible from smoking areas and check beforehand when you visit public places such as restaurants where smoking is allowed. Do not rely merely on air-purifiers as they do not completely cut down risk. In social gatherings, excuse yourself politely while smoking is going on, and re-join the group after the activity is over. Be aware of the risks of passive smoking, and do not compromise your safety or that of your children.
Q: If you stop smoking will you be able to recover from the withdrawal symptoms completely? If so, how long will this take?
A. Yes – there are many successful case studies of quitting. Most of these studies note that if resisted, withdrawal symptoms such as heightened anxiety, irritability, craving for food, and the loss of focus, dissipate over time, with withdrawal symptoms starting to recede in as little as 2-4 weeks complete recovery from withdrawal symptoms within the first six months or less. The National Health Service of the UK (NHS) provides a useful guideline (https://www.nhs.uk/better-health/quit-smoking/What happens when you quit?) which shows how quickly you can recover. However, it is crucial to avoid relapsing. Data indicate that about 10 percent of those who had successfully quit smoking, relapse annually, with stressful periods being the primary trigger for resuming smoking.
Q: Do you have a message for all our young readers on the verge of taking their first puff a cigarette smoking?
A. Smoking might seem like a cool way to fit in, but remember that your true friends will respect you for making choices that are best for you.
