Quit Smoking and Run For Your Life!

To The Editor: The World Health Organization promotes the World No Tobacco Day on May 31.

This draws global attention to the tobacco epidemic and to the preventable death and disease it causes. Tobacco use is one of the leading preventable causes of premature death, disease, and disability throughout the world [1]. Cigarette smoking is the most common form of tobacco consumption. Alarming statistics have recently emerged. An estimated 1.2 billion people worldwide are smokers. In developing countries, half of all males smoke. The WHO projects a global smoking population of 1.6 billion by the year 2030 [2]. An estimated 5 million deaths annually can be attributed to tobacco use. By 2030, estimates based on current trends indicate that this number will increase to 10 million, with 70% of deaths occurring in low-and middle-income countries. The artificial passion for smoking killed 100 million people in the 20th century. Without significant public health interventions, this health hazard threatens to lure, seduce, and kill another one billion in this century [3]. The impact of public health awareness in combating this disease is evident from the fact that tobacco-attributable deaths are projected to decline by 9% between 2002 and 2030 in upper-income countries, yet they are expected to double from 3.4 million to 6.8 million in lower- and middle-income countries [4]. It has also been reported that from 1970 to 2000, tobacco leaf production decreased by 36% in developed nations, but more than doubled in developing countries [5]. The negative health effects of pipe, cigar, and water pipe smoking (WPS) as well as other forms of tobacco use such as chewing tobacco and moist snuff deposited between cheek and gum are on par or above that of cigarette smoking [6]. A recent study of high school students in the United States revealed that both Arab American youths and nonArab youths are experimenting and using WPS regularly, which underscore the importance of assessing non-traditional forms of tobacco use [7].

Nicotine, carcinogenic compounds, other toxic components, chemical additives, and carbon monoxide all form a deadly “aerosol cocktail” in cigarette smoke which contribute to its lethal effects. Medical research has proved that tobacco smoking causes coronary heart disease, respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma, emphysema, and cancer (in particular lung cancer and cancers of the larynx and tongue) [6]. It has been reported that 20 to 30% of coronary artery disease and approximately 10% of occlusive cerebrovascular disease are caused by cigarette smoking. In the non-diabetic population, 90% of peripheral vascular disease and 50% of aortic aneurysms are attributed to cigarette smoking [6]. The increased incidence of COPD worldwide is an index of the rising consumption of tobacco products, especially in low-income countries where more than 80% of current smokers can be found [8].

Tobacco also has the dubious distinction of being the world's leading cause of cancer. Its incidence is on the rise in many regions of the world including the Middle East, where rates for both men and women are on the rise due to increased tobacco use combined with other factors [9]. Complications of pregnancy, increased risk of osteoporosis, senile cataracts, delayed healing of peptic ulcers, and male impotency is some of the other manifestations of cigarette smoking [6]. The WHO Framework Convention (WHO FCTC), is the first international health treaty for tobacco control. It was initiated on February 27, 2005, and as of May, 2008, more than 150 countries are parties to the treaty. Libyan Arab Jamahiriya has also signed this treaty which was ratified on June 7, 2005 [10]. The treaty urges countries to develop action plans for public policies such as banning direct and indirect tobacco advertising, instituting tobacco tax and price increases, promoting smoke–free indoor work places, public transport, and as appropriate, other public places to prevent passive smoke related illnesses, and placing health messages on tobacco packaging. In a recent report involving six Western –European countries, it was observed that such policies are very effective in reducing smoking especially among socio-economically disadvantaged groups [11]. In South Africa a strong and consistent lobbying to persuade the government to implement an effective tobacco control strategy has paid rich dividends in reducing tobacco consumption [12]. In India, sale of tobacco in any form is forbidden to minors and there is a ban on advertising tobacco products at sports and cultural events [13]. New Zealand is another shining example of a country getting tough on tobacco and reducing consumption [14]. Several Western countries have also put restrictions on cigarette advertising. In the United States, all television advertising of tobacco products has been prohibited since 1971. In Australia, the Tobacco Advertising Prohibition Act of 1992 prohibits tobacco advertising in any form [15]. Several countries such as the Republic of Ireland, Latvia, Estonia, France, Finland, Norway, Canada, Australia, Sweden, Singapore, Italy, Indonesia, India, Lithuania, Chile, Spain, Iceland, United Kingdom, Slovenia, and Malta have legislated to eliminate smoking in public places, often including bars and restaurants [15]. The positive impact of this ban in the European Union (EU) member states suggests that it should be considered a priority against the tobacco epidemic to help reduce the gap between literature recommendations and actions [16]. Mental disorders, especially depression have been linked to excessive smoking. In the United States, 44.3% of cigarettes are consumed by individuals with mental illnesses [17]. Hence mental illness deserves a prominent focus to allow our public health goal of reducing the prevalence of smoking.

The incidence of smoking–related diseases is proportionately greater in younger than older smokers, particularly for coronary artery disease and stroke [6]. The Global Youth Tobacco Survey (GYTS) developed by the WHO, CDC, and the Canadian Public Health Association (CPHA) is the most comprehensive youth tobacco surveillance system ever developed, implemented, and maintained [18]. Since 1999, the GYTS has been conducted in 140 countries and 11 territories across all six WHO regions. The study was conducted among all students aged 13–15. The GYTS, 2000–2007 has been published. The important findings are summarized below [18]:

1. Gender is irrelevant when it comes to tobacco. The level of cigarette smoking, prevalence of smoking, use of other tobacco products, and susceptibility to initiate smoking among those persons who have never smoked was found to be similar for both boys and girls.

2. Passive smoking is a significant problem in our society. Approximately half of the students were exposed to passive smoking in public places during the week preceding the survey. Approximately eight in ten favored a ban on smoking in public places.

3. The role of tobacco companies marketing tobacco to minors was evident since two in ten students own an object with a cigarette brand logo on it, and approximately one in ten have been offered free cigarettes by a tobacco company representative.

4. The lure of nicotine is well known. The good news is that approximately seven in ten students who smoked reported that they wanted to quit. However, approximately seven in ten students were allowed to purchase cigarettes from a store during the month preceding the survey.

5. Finally, the glaring lack of education of children in our schools against tobacco became evident when approximately only six in ten students reported having leanred in school about the harmful effects of smoking during the year preceding the survey.

The GYTS report summary of Libyan students is as follows [17]:

1. A total number of 1243 students (49.9% girls and 51.1% boys) were included in the study

2. Students who currently smoked cigarettes totalled 4.6% (7.7% boys and 0.9% girls)

3. Students who currently used tobacco products other than cigarettes were 7.2% (8.6% boys and 5.6% girls).

4. Students who had never smoked but were susceptible to products other than cigarettes were 18.5% (22.1% boys and 15.0% girls)

5. Students exposed to smoke from others at home during the week preceding the survey were 37.8%.

6. Students exposed to smoke in public places during the week preceding the survey were 41.5%.

7. Students who favoured banning smoking in public places were 77.1%.

8. Students who had an object with a cigarette or tobacco logo on it were 11.3%.

9. Students who reported being offered a free cigarette by a tobacco company representative were 8.6%.

10. Students who usually bought their cigarettes in a store were 14.1%.

11. Students who were taught about the dangers of smoking in school during the year preceding the survey were 48.7%.

From these results it is evident that although extensive knowledge exists about the harmful effects of smoking and other forms of tobacco use, dissemination of the best practices and adaptation and implementation of recommended policies are still in its rudimentary stages. The GYTS report reveals the need for effective programs to be developed and implemented soon. If this does not occur, future morbidity and mortality attributed to tobacco use is likely to increase. The question is: do we care about the next generation? If we do, it is imperative that we act to make tobacco use history. The Tripoli Marathon is being held on May 31, 2008 to mark the World No Tobacco Day. The caption of the marathon is eye catching and says “Quit Smoking and Run”. However with all due regard to the organizers of this noble event we would like to say:

Quit smoking and run for your life.