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Tobacco, cigarettes: kick their butt?

Published in Health

A major scientific study published in November 2016 confirmed the horrific damage cigarette smoking can cause to human health.  Cigarette smoking is associated with 17 different types of cancer and is estimated to claim more than 6 million lives each year.

Those risks are bad enough, but then there are many more which can affect both the smoker and people around the smoker who share the smoker's environment, whether indoors or outside.

Across Europe, banning smoking in public places seems to have done much to reduce the incidence of smoking. However, not so in Croatia, which joined the European Union in 2013. Yes, there is a law limiting the use of tobacco products (Zakon o ograničavanju uporabe duhanskih proizvoda), and the earliest version of it in 2008 established that there should be a mandatory programme to warn school children about the health dangers of smoking (Article 22).Croatia signed the World Health Organization's 'Framework Convention on Tobacco Control' on June 2nd 2004, and was fully accepted as a participant on October 12th 2008. On January 11th 2011 Croatia presented its first report on the prevalence of smoking in the country, albeit using data from 2001, showing shockingly high figures for all age groups. However, the law to curb tobacco use has gradually been strengthened.

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Tobacco advertising and sales

Tobacco companies are banned from advertising their products directly or indirectly through any kind of promotional material or sponsorship (Article 9); youngsters under 18 may not buy cigarettes or any other products used for smoking; tobacco products may not be sold via the internet or in vending machines (Article 11); smoking when making a public presentation is not allowed, although an exception is made for films and artistic works; the media (television or the press) are not allowed to show people smoking for promotional purposes (Article 12); smoking is banned in all enclosed public places; smoking is banned within 20 metres of the entrance to any medical premises; smoking is banned in any place of childcare and education (Article 13).

In 2015 new rules governing cigarette packaging were introduced, in line with EU directives. Whether warnings like 'Smoking kills' have any real effect on consumers is questionable, but at least cigarette packets are not allowed to be dressed up to look attractive. 

Smoking areas

Smoking is permitted in designated smoking areas in psychiatric hospitals and prisons (Article 13). In public places, where the premises are large enough, smoking is allowed in designated rooms which are separated from other areas so that smoky air cannot reach them. The smoking area must be not less than 10m2, and should constitute not more than 20% of the total area of the premises (Article 14). Smoking areas have to be equipped with special ventilation equipment with a system for measuring that air is being delivered according to the regulations (Articles 16-20). The smoking area itself should be completely enclosed, with self-closing sliding doors. The area should be clearly marked with a  sign stating 'Smoking area' over the entrance. In case of breakdown of the ventilation system, a sign saying 'Smoking forbidden because the ventilation system is out of order' should replace the 'Smoking area' sign (Article 15). For smaller cafes and bars where only drinks are served, without food, the owner can decide whether to make the premises smoking or non-smoking. If smoking is allowed, there should be a sign at the entrance saying so, and an adequate filtered ventilation system should be in place providing ten changes of air per hour. There should also be warnings about the harmful effects of smoking in posters or leaflets (Article 20a).  

Enforcing the law

Ensuring that there is no-smoking areas are respected is the responsibility of the owner of the premises. Enforcement of the law is the responsibility of the hygiene inspectors, health inspectors, educational inspectors, work inspectors and business inspectors within their legal remit (Article 25). There are fines of 30,000 up to 150,000 kunas for infringements of the law by business concerns. Individuals who allow smoking in cafes or restaurants where it is prohibited face fines of 500 up to 1,000 kunas (Article 28), while anyone offering or smoking cigarettes in no-smoking public areas can be fined 1,000 kunas (Article 29).

The Tobacco Law in practice

The incidence of smoking in Croatia is extremely high. Surveys have shown that young Croatians in particular smoke cigarettes and drink alocohol at levels above the European average. It is obvious that young people have not been deterred from taking up smoking, even competitive sports players. Bizarrely, many members of Jelsa's handball team - a sport which is taken very seriously in Croatia - will sit smoking and drinking beer while waiting for transport to their match.

On Hvar Island at least, but I suspect also across Croatia, the restrictions on smoking are more honoured in the breach than in the observance. It is commonplace to find restaurateurs turning a blind eye to smoking on their premises. In some restaurants, chefs and waiters even smoke in the kitchen. Cigarette smoke all too often mars public entertainments indoors, whether lectures, concerts, plays or films. Mostly it originates from smokers standing by the open doors to the theatre or hall. In some venues it even permeates the auditorium from backstage, where of course smoking is not allowed.

Tobacco strategies

Measures to limit and restrict tobacco use are still being devised across the world. In Europe, Ireland is leading the way with a highly ambitious plan to make the country tobacco-free by 2025. The programme is being implemented step by step. Following the initial Public Health (tobacco) Act of 2002, a ban on smoking in the workplace was introduced in 2003. Ten years later, in 2013, new measures were proposed including a ban on smoking in parks and on beaches, or anywhwere near childcare facilities and schools. Ireland has a Tobacco Control Centre in Dublin which monitors smoking habits in the country on a regular basis within the programme to create a tobacco-free society. Although most governments agree that tobacco is harmful and costly to health services, so that its use should be curbed if not totally outlawed, anti-tobacco legislation is at different stages in different parts of the civilized world. ASH (Action on Smoking and Health) is a global campaigning group aiming to improve health through reducing smoking and curbing the influence of the tobacco companies. In Australia, Tasmania had the strictest anti-smoking regulations for the workplace, while some of the other states are classified as 'poor', according to ASH Australia, which coordinated a campaign for 'SmokeFree Australia' from 2002 until ASH Australia closed down in December 2013. In the United Kingdom, the Department of Health has promoted actions to reduce smoking and build towards a 'smokefree future', in line with the UK government's anti-smoking policies based on the 1998 white paper 'Smoking Kills'. In 2008, marking the tenth anniversary of the ground-breaking white paper, ASH UK published its document 'Beyond Smoking Kills', with the aim of further protecting children from smoking addiction. Also in the UK, in February 2010 the National Institute for Health and Care Excellence (NICE) published its guidelines on 'School-based interventions to prevent smoking'.

While the World Health Organization published an upbeat report on the global tobacco epidemic in 2013, claiming success for anti-smoking campaigns and legislation, there is reason to believe that progress in curbing tobacco use is not so straightforward. A major hindrance to the introduction of anti-tobacco legislation is the enormous influence wielded by the leading tobacco companies. For instance, in the UK in 2013 there was widespread concern among health campaigners when it emerged that two important 'thinktanks', the Adam Smith Institute and the Institue for Economic Affairs, which publish papers on tobacco issues and are thought to have an influence on government policy, had received significant payments from the tobacco industry.

Opponents of anti-smoking legislation claim that people have the right to choose, and that revenue from taxes on tobacco products is a big part of any national budget. Both true statements. But there are counter-arguments.

Health risks from tobacco are expensive

The health costs of tobacco-related diseases are high - higher than many people think, because tobacco is a factor in so many different illnesses, whether life-threatening, crippling or simply debilitating. Smoking is most obviously linked with lung diseases such as lung cancer and emphysema among many others. As any physiotherapist can tell you, the fluid expectorated from the lungs of a smoker with chronic bronchitis is not a pretty sight. The lungs are not the only parts of the human body to be adversely affected by tobacco - all the organs can suffer, with particular danger to the heart and the brain. The World Health Organization has stated that tobacco kills up to half of its users, and was responsible for the deaths of 100 million people in the 20th century. The United States Department of Health and Human Services estimates that in the U.S. there are 8.6 million people living with a serious illness caused by smoking.

The right to choose

Any adult of sound mind has the right to choose to do what he or she wants within the laws of his or her country. Smokers invariably overlook the discomfort and harm their habit does to those around them. Time was when a smoker would ask if those around minded before lighting up. Nowadays smokers mostly take the view that if smoking is permitted in a public place, for instance a cafe terrace, the fact that there are other people there who might object or be disturbed is of no consequence. Thus they annul the right of the non-smoker to choose a smoke-free environment. Outdoor areas where smoking is permitted are blighted, smokers underestimating or ignoring the fact that their smoke carries. For instance, on the Jadrolinija ferries, smoke from the corridors outside the saloons often wafts into the supposedly smoke-free areas, while on the open decks the fresh sea air is mostly overridden by tobacco smoke when the weather is fine. A smoker standing at the door of a non-smoking room can pollute the room's air in a matter of seconds. Passive smoking is known to be dangerous. Adults can mostly choose to move away from the immediate pollution, although as smoke is so pervasive, they may not be able to escape completely. The real victims of the situation are the children who cannot choose. It is especially distressing to see how many young Croatian women smoke during pregnancy and how many parents smoke right over their baby, with no awareness of the terrible potential damage they might be causing. Alongside the expected problems affecting the breathing system, children can suffer an increased risk of Legg-Calvé-Perthes disease (a potentially serious hip condition) through passive smoking.

Smoking and the environment

Tobacco smoke lingers in the environment. The walls of a room used by smokers become blackened and the smell remains embedded in furniture. Discarded cigarette butts retain their smell for many months, despite rain and wind. Smokers discard cigarette stubs with careless abandon. They are tucked into crevices in stone walls or between rocks on beaches. They are thrown on to earth around plants or into the sea. They are disgorged en masse from car ashtrays. They make an immense mess, and are a major fire risk in hot climates when they are not stubbed out properly. Fag-ends are also toxic, especially to fish. Research carried out in 2010 showed that cigarette butts could in fact be put to good use in preventing corrosion in one type of steel, but this does not seem to have led to any practical application as yet. The nicotine in tobacco itself has been used at least since the 1800s as a natural pesticide, which would be a much better use of it than humans poisoning themselves.

Progress and room for improvement

Attitudes to smoking have changed, sometimes for the better, sometimes not. In the early 20th century, smoking was widespread, especially among men, whereas women were expected to smoke less, if at all, and preferably not in public. Cigarette advertising was everywhere, flaunting images of health, happiness, sophistication, masculinity, femininity, physical fitness and personal freedom - ironically the opposite of what tobacco addiction actually brings. In the 1960s, cigarette sponsorship became commonplace in sports as diverse as tennis and Formula One motor racing. Again ironical: smokers are at a disadvantage in most sports through reduced lung capacity, specifically losing about one third of the capacity by smoking within two hours before taking part in physical activity. Putting a stop to such blatantly misleading product promotion has been the one major success of anti-tobacco legislation.

Alternatives to cigarettes have been developed, such as smokeless tobacco, chewing tobacco and e-cigarettes, but they all have drawbacks and health risks. Concerns about e-cigarettes have grown rapidly: a ban on smoking them in National Health Service hospitals is being introduced in April 2015 by twelve of the thirteen Scottish health boards. It is a sad reflection on human society that substances which are so obviously harmful to self and others are so widely used, without a thought to the possible consequences. Even sadder that the force which drives the continued marketing of tobacco products is the profit motive.

There are numerous possible reasons why people take up smoking, and many factors dictating whether they become addicted and whether they succeed in giving up if they want to. Very often, for young people the key factor is peer group pressure, the desire to be one of the in-crowd, whatever it takes. We can probably only expect fundamental change in smoking habits when the fashion tide seriously turns against the habit, and young people in particular stop seeing it as a cool, mature-looking, self-affirming activity. Smoking creates a negative and unacceptable environment of stale air, dirty ash, toxic fag-ends, with multiple consequences of ill-health. To win the battle for a better quality of life, a new reality needs to be established:

IT'S COOL TO BE CLEAN! 

© Vivian Grisogono 2013, updated 2016

Useful links:

Tobaccofreelife, a user-friendly website offering comprehensive and well-reasoned advice on how to stop smoking. Most importantly, it gives guidelines on how to make the choices which suit the individual, rather than promoting any particular method as a 'cure-all0,

QuitDay, an organization in the United States which helps smokers with the daunting task of giving up the habit / addiction. But be warned: it advocates vaping, which has been associated with its own health risks (With thanks to Amy Elliott for the information, February 2016.)

Reference: Alexandrov, Ludmil B.; Ju, Young Seok; Haase, Kerstin; Loo, Peter Van; Martincorena, Iñigo; Nik-Zainal, serena; Totoki, Yasushi; Fujimoto, Akihiro; Nakagawa, Hidewaki; Shibata, Tatsuhiro; Campbell, Peter J.; Vineis, Paolo; Phillips, David H.; stratton, Michael R. 2016. Mutational signatures associated with tobacco smoking in human cancer. Science. Vo. 354, issue 6312, pp 618-622 (04 November 2016)

 

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