Is a smoke free future possible?

Despite aggressive strides toward a reduction in tobacco consumption and preventing non-smokers from second hand smoke, the number of smokers has increased, now standing at 1.1 billion individuals worldwide. The majority of these are concentrated in just 10 countries, with a staggering one third in China alone.

This is disheartening news when the devastating effects of tobacco consumption are heavily published. There were 90,000 smoking related deaths in the UK last year, 10,000 more than those due to COVID-19. Cigarettes and related products are the leading avoidable cause of cancer and heart disease, the two main causes of death worldwide.

So, against this massive body of evidence, why do people continue to smoke? A recent study published in the Lancet argues very effectively that the age at which people are first able to legally purchase tobacco is the reason the number of smokers has risen rather than dropped.

Two thirds of smokers begin before the age of 20, with almost 90% commencing the habit by the age of 25. Addiction occurs rapidly, often followed by a lifetime of failed attempts to kick the habit. The authors argue that if you haven’t started smoking by the age of twenty-five, you probably won’t start at all, which is certainly supported by the above figures. By raising the legal age of purchase to 21, in the first year alone this may prevent 100,000 becoming smokers worldwide.

87% of deaths in current smokers are due to smoking, versus only 6% in those who quit 15 or more years previously, demonstrating not only the need to stop, but also the importance of quitting early. Even if you are lucky enough to avoid cancer, a lifetime’s consumption of tobacco will wreak havoc on every organ in the body.

The UK’s aim is to be smoke-free, meaning less than one in 20 smokers, by the year 2030. Currently around 1 in 6 smokes, down from 1 in 2 adults in the 1970s. Other countries are even more ambitious; New Zealand has aimed for this by the year 2025.

Can it be done? Several initiatives have seen the number of smokers in many countries steadily reduce. People’s perspective on smoking has also hardened from viewing it a troublesome vice to an act of antisocial behaviour, and even harmful to the environment. A recent petition in Spain, with almost 300,000 signatures, was presented to their health minister, urging smoking to be banned on all beaches. It was argued that not only were cigarette butts unsightly, but that chemicals leeching into the sand were an environmental hazard.

Although in an ideal world no one would ever start smoking, encouraging smoking cessation remains an important goal. All healthcare professionals are urged to address the question and offer support at any opportunity, a concept known as “positive health promotion”.

While the majority of smokers do wish to stop according to questionnaires and polls, many fail to achieve this. Commonly cited factors are lack of motivation, nor having the necessary support. On top of this is the massively addictive nature of nicotine, the almost instant fix it provides, as well as the often-unpleasant immediate effects of withdrawal. Thankfully these are usually short lived.

Often there has to be a goal in quitting, be that the desire for better health, to rid oneself of an unpleasant habit, or the cost which may run into several thousand per year. A clear plan with a definite stop date is often needed. Withdrawal after heavy tobacco consumption does not have the same life threating health risks as acutely going from significant alcohol consumption to not drinking at all, so there is less of an argument for gradually cutting down. There is also the temptation to increase your smoking if you encounter an unexpected stress.

Getting rid of smoking paraphernalia, including that “emergency pack” of cigarettes will hopefully reduce any longing or desire after the date you decide to stop on.

The NHS has smoking cessation services that remain up and running and there is good evidence that professional support helps many in stopping and staying stopped. Some individuals will be able to just quit and never even touch another cigarette, but these remain in the minority.

E-cigarettes are now firmly established as an aid to cessation, and although significantly less harmful than cigarettes, are not completely harmless. Ideally, they should be viewed as a way of making stopping easier, rather than an alternate method of obtaining nicotine.