On 31 May 2023, the World Health Organization (WHO) and numerous international organizations are focusing attention on the hazards of tobacco by commemorating World No Tobacco Day.
Despite the wealth of information amassed over recent years, the compelling anti-smoking advertising campaigns, and prevention messages targeting young people, too many individuals still initiate or continue smoking.
According to WHO statistics, over 8 million people succumb to tobacco-related deaths each year. Meanwhile, 1.3 billion people persist in smoking, with a staggering 80% of them residing in low- and middle-income countries. Men constitute the majority of smokers1.
US data indicate that 90% of adult smokers began smoking before turning 18, and 8% of young adults aged 18 to 25 smoke regularly2.
In recent years, (young) smokers’ habits have subtly shifted with the introduction of electronic cigarettes (e-cigarettes), which may help reduce tobacco consumption. For some, e-cigarettes represent a significant stride toward mitigating tobacco addiction and the risk of tobacco-related diseases. For others, this new type of cigarette merely shifts the addiction problem among youths and adults.
According to several recent scientific studies, the benefits of using e-cigarettes remain a matter of debate. While toxicological analyses reveal clear benefits for e-cigarettes (absence of tar derivatives or other toxic substances), other studies indicate detrimental effects on the respiratory system, such as airway irritation, an increase in inflammatory markers, and a local cytotoxic effect3.
However, the question remains: if people understand that smoking is harmful to their health and can lead to severe illnesses and health complications, why do young people initiate smoking, and why do individuals persist in smoking?
Several possible explanations have long been explored and debated in the media. Regarding young people, many teenagers are navigating complex lives, seeking their place within their family and society. Straddling childhood and adulthood, they often aspire to emulate role models. This is the primary reason behind recent prohibitions on the portrayal of tobacco use in cinema, television, and other advertising platforms – to prevent the projection of a ‘cool’ image that might influence young people to start smoking.
As for adults who continue smoking despite knowing its health implications, doctors witness this phenomenon almost daily. Patients consult them due to heart or lung issues or, more critically, early signs of cancer. Yet, even in the face of these dire circumstances, many patients persist in smoking. According to a 2017 study, 30% of patients who have developed cardiovascular problems (heart failure, heart attack, stroke, etc.) continue to smoke despite medical advice4.
Why?
Several reasons underpin why people persist in smoking despite a clear understanding of the risks or the presence of existing medical complications:
- Addiction: Nicotine, a chemical substance in tobacco, interacts with certain brain areas, resulting in addiction. Tobacco functions as a real drug, and like all drugs, quitting can become immensely challenging. Smoking stimulates neural circuits associated with pleasure and well-being.
- Habits: Once established, habits can be difficult to break. Many ‘tricks’, such as chewing gum or using other oral substitutes (like toothpicks), can help change this habit.
- Social influence: Existing in a familial or social environment where others continue to smoke can complicate the decision to quit. This is evident in families where both partners smoke, making it difficult for one member to quit if the other continues to smoke.
- Denial: Most adults who continue to smoke understand it’s harmful to their health. Yet, they persist, often due to a psychological defense mechanism known as ‘denial’. One study suggests that between 30% and 50% of individuals who use illicit substances exhibit some form of denial. This denial interferes with the recognition of the problem, either by minimizing it (e.g., “I’m not a heavy smoker”) or by disregarding it entirely (e.g., “it doesn’t concern me”)5.
- Dependence and Craving: Nicotine, like all drugs, leads to a form of addiction in the brain circuits, and interrupting this cycle results in physiological symptoms known as craving. These symptoms can manifest as nervousness, irritability, sleep disturbance, aggression, depression, etc., depending on the individual.
Quitting smoking is not easy, and tobacco should be treated as a real drug. While not as immediately dangerous as cocaine or heroin, its potential for disastrous long-term health complications cannot be understated. Remember, tobacco is a leading cause of lung cancer and is associated with various other cancers and cardiovascular and lung diseases.
It remains essential to continuously highlight these issues, particularly to young people, and to promote discussions with specialists trained specifically to address this subject.
References:
1. https://www.who.int/news-room/fact-sheets/detail/tobacco
2.https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index. htm
3. Patricia Marques, Laura Piqueras et al. An updated overview of e-cigarette impact on human health. Respir Res. 2021 May 18;22(1):151. doi: 10.1186/s12931-021-01737-5.
4. Yoo Kyoung Lim, Dong Wook Shin et al. Persistent smoking after a cardiovascular event: A nationwide retrospective study in Korea. PLOS one. 2017. Oct 19. doi.org/10.1371/ journal.pone.0186872
5. Andy C Dean, Milky Kohno et al. Denial in methamphetamine users: Associations with cognition and functional connectivity in brain. Drug Alcohol Depend. 2015 Jun 1;151:84-91. doi: 10.1016/j.drugalcdep.2015.03.004.
