“Smoking is injurious to health” – Myths, facts and risks
Myths
• Roll-your-own cigarettes are more natural than factory made ones (both are equally harmful)
• Air pollution is the cause of lung cancer and not cigarettes
• If you quit smoking, you will gain weight (with a good diet and exercise plan, you won’t)
• Smoking a couple of cigarettes a day isn’t harmful
• Cigarettes help people de-stress (it is the harmful substances in cigarettes that relaxes a smoker)
• Expensive cigarettes are not as harmful as cheaper ones or beedies
• Cigarettes are safer than chewing tobacco
• It is safe to smoke menthol, or low-tar cigarettes (smokers who use these tend to smoke more cigarettes)
Facts
• A cigarette contains 4800 chemicals, 69 of which are cancer triggers
• One person dies every six seconds due to tobacco
• India has 12 crores of tobacco users (includes smokers and tobacco chewers)
• Every 9th Indian uses tobacco
• One third of those who die due to tobacco are children who have been exposed to passive smoke
• Medical costs of treating tobacco related diseases are about 90 crores a year
Pictorial health warnings
Large pictorial or graphic health warnings, including plain packaging, with hard hitting messages can persuade smokers to protect the health of non-smokers by not smoking inside the home, increase compliance with smoke-free laws and encourage more people to quit tobacco use. Studies show that pictorial warnings significantly increase people's awareness of the harms from tobacco use. Mass media campaigns can also reduce demand for tobacco by promoting the protection of non-smokers and by convincing people to stop using tobacco.
Tobacco advertising
Comprehensive bans on tobacco advertising, promotion and sponsorship can reduce tobacco consumption. A comprehensive ban covers both direct and indirect varieties of promotion:
- Direct forms include advertising on television, radio, print publications, billboards and social media platforms.
- Indirect forms include brand sharing, brand stretching, free distribution, price discounts, point of sale product displays, sponsorships and promotional activities masquerading as corporate social responsibility programmes.
Taxes
Tobacco taxes are the most cost-effective way to reduce tobacco use and health care costs, especially among youth and low-income people, while increasing revenue in many countries. The tax increases need to be high enough to push prices up above income growth. An increase of tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and about 5% in low- and middle-income countries.
Tax avoidance (licit) and tax evasion (illicit) undermine the effectiveness of tobacco control policies, particularly higher tobacco taxes. The tobacco industry and others often argue that high tobacco product taxes lead to tax evasion. However, experience from many countries demonstrate that illicit trade can be successfully addressed even when tobacco taxes and prices are raised.
Quitting tobacco
When tobacco users become aware of the dangers of tobacco, most want to quit. However, nicotine contained on tobacco products is highly addictive and without cessation support only 4% of users who attempt to quit tobacco use will succeed. Professional support and proven cessation medications can more than double a tobacco user's chance of successful quitting.
Novel and emerging nicotine and tobacco products
Heated tobacco products (HTPs)
HTPs are, like all other tobacco products, inherently toxic and contain carcinogens. They should be treated like any other tobacco product when it comes to setting policies. HTPs produce aerosols containing nicotine and toxic chemicals upon heating of the tobacco, or activation of a device containing the tobacco. The aerosols are inhaled by users during a process of sucking or smoking involving a device. They contain the highly addictive substance nicotine, non-tobacco additives and are often flavoured.
In recent years, HTPs have been promoted as reduced harm products or products that can help people quit conventional tobacco smoking. HTPs expose users to toxic emissions, many of which cause cancer and currently there is not enough evidence to suggest that they are less harmful than conventional cigarettes. There is also insufficient evidence at present on the effects of second-hand emissions produced by HTPs, though the emissions from these products contain harmful and potentially harmful chemicals (2).
E-cigarettes
Electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS), commonly referred to as e-cigarettes, are devices which heat a liquid to create an aerosol which is then inhaled by the user. These may or may not contain nicotine. The main constituents of the solution by volume are propylene glycol, with or without glycerol, and flavouring agents. E-cigarettes do not contain tobacco but are harmful to health and are not safe. However, it is too early to provide a clear answer on the long-term impacts of using them or being exposed to them.
E-cigarettes are particularly risky when used by children and adolescents. Nicotine is highly addictive and young people’s brains develop up to their mid-twenties.
ENDS use increases the risk of heart disease and lung disorders. They also pose significant risks to pregnant women who use them, as they can damage the growing fetus.
Advertising, marketing and promotion of ENDS has grown rapidly, through channels which rely heavily on internet and social media (3). Much of the marketing around these products gives rise to concern about deceptive health claims, deceptive claims on cessation efficacy, and targeting towards youth (especially with the use of flavours).
ENDS/ENNDS should not be promoted as a cessation aid until adequate evidence is available and the public health community can agree upon the effectiveness of those specific products. Where ENDS and ENNDS are not banned, WHO recommends that the products be regulated in accordance with 4 key objectives:
- prevent initiation of ENDS/ENNDS by non-smokers, minors and vulnerable groups;
- minimize health risks for ENDS/ENNDS users and protect non-users from exposure to their emissions;
- prevent unproven health claims being made about ENDS/ENNDS; and
- protect tobacco control from all commercial and other vested interests related to ENDS/ENNDS, including interests of the tobacco industry (4, 5).
WHO response
The scale of the human and economic tragedy that tobacco imposes is shocking, but it’s also preventable. The tobacco industry is fighting to ensure the dangers of their products are concealed, but we are fighting back. In 2003, WHO Member States unanimously adopted the WHO Framework Convention on Tobacco Control (WHO FCTC). In force since 2005, it has currently 182 Parties covering more than 90% of the world’s population.
In 2007, WHO introduced a practical, cost-effective way to scale up implementation of the main demand reduction provisions of the WHO FCTC on the ground: MPOWER.