By Ngozi Nwoke
There have been repeated campaigns, warning and awareness programmes by health experts, advocacy groups, non-governmental organizations and government agencies against tobacco consumption due to its adverse health effects.
Despite all these, millions of smokers in Nigeria have refused to yield to the warning, while tobacco companies and distributors still smile to the bank with huge profits from the tobacco trade.
With over 20 billion sticks of cigarettes consumed annually in Nigeria, many smokers pay with their health, as reports from the World Health Organization (WHO) and other resource centres indicate that millions of smokers die annually in Nigeria from tobacco-related ailments.
Reports from the Dun and Bradstreet website, a global provider of Nigerian business data and analytics shows that Philip Morris Limited generates US$26.89 million yearly from sales revenue, while British American Tobacco Nigeria Limited generates US$6.12 million annually from sales revenue. Also Gozie Nwaogu Nigeria Limited generates an annual sales income of US$26.89 million, as well as other tobacco-producing and distribution companies.
According to medical experts, second-hand smoke is responsible for an estimated 166,000 child deaths each year worldwide. There is also third-hand smoke, which is the result of chemical residue on surfaces where smoking occurred. Experts say that this type of smoke has adverse effects on the liver and lungs. Research shows that healthy living is the greatest gift one could give to one’s self.
According to the Canada Heart and Stroke Foundation (CHSF) tobacco smoking is a leading risk for disability and premature death. Tobacco is made from leaves of tobacco plants. It contains nicotine, which is an addictive drug. When tobacco is smoked in cigarettes or pipes most frequently, the body absorbs toxic and cancer-causing chemicals that affect the health.
At a Tobacco Harm Reduction Conference held in Nairobi, Kenya, a renowned oncologist, who is also a Professor of Surgery at the Cancer Institute in Senegal, Prof. Abdoul Kassé, stressed the need for putting harm reduction at the center of all public health development strategies, adding that harm reduction is a powerful public health tool that has the potential to reduce cancer by 30%. The award winning health expert further stated that tobacco enlightenment campaigns should be enforced as a preventive measure in tobacco control.
“When we talk about smoking,” Kassé said, “we mean tobacco misuse, which has increasingly become a public health issue in many states of Nigeria. Awareness creation and education apply to areas where there is a need to reduce the harm associated with a practice or consumption of a substance that is overused in society leading to increased morbidity and mortality.”
He expressed the view that such conferences will continue to gain traction in view of the devastating effect of tobacco smoking and the fact that cessation or outright quitting has continued to prove impossible for most smokers.
While canvassing the view that innovative initiatives on tobacco harm awareness and education will help to keep more Africans alive, Kassé observed that Tobacco harm awareness initiatives, including the use of popular e-cigarettes, nicotine patches and chewing gums, have continued to generate misunderstanding in both the public health community and in the media. Like other health experts, he believes that there is evidence that the use of potentially less harmful alternatives than cigarettes for those who are not willing or cannot give up smoking with currently approved methods may be a solution, not necessarily the best for everyone but by far better than continuous smoking.
In view of the trend in tobacco smoking and its health implications, experts also estimate that at least half of lifetime tobacco smokers will die before they reach 70, even as a smoker loses about 10 years to smoking. Reports also indicate that over 25 million Nigerian children and adolescents are at the risk of tobacco use or smoke exposure.
According to Senegal-based advocate, Mr. Amadou Mahtar Alioune, co-founder of All Africa.com and CEO, African Media Initiative (who also spoke at the Nairobi conference), the government should reduce the risks of cigarette smoking by enforcing laws that restrict tobacco consumption in public places and encourage the most viable alternative use of vaping.
Alioun submitted that burning tobacco produces more than 4,000 chemicals, including nicotine, carbon monoxide and tars. He said: “Cigarette smoking boosts increased mucus production, clogging of the airways, increasing susceptibility to infections, pneumonias, development of chronic obstructive pulmonary disease (chronic bronchitis and emphysema), irritation and destruction of lung tissue, exacerbation of asthmatic attacks and lung cancer.”
His submission is based on the finding that the use of vaping, heated tobacco, oral nicotine and smokeless tobacco is certified 95 percent safe because of their smokeless nature which drastically reduces risks associated with tobacco smoke. Vaping is gaining traction with reports indicating that as of 2021, there were 82 million vapers worldwide.
Health authorities say Vape is considered to be a tool that has the potential to reduce cancer by 30% and should be made affordable, accessible and available for people who smoke as a public health development strategy. That is why Alioun agrees that harm reduction has already benefited many people in public health and is the most viable alternative in tobacco control.
Despite efforts to persuade smokers, the use of alternative products has been met with stiff opposition from stakeholders, including the WHO, which has continued to insist on total cessation.
On his part, Mr. Kgosi Letlape, an ophthalmologist and president of Africa Medical Association as well as the president of the Association of Medical Councils of Africa, who was also at the conference, urged African countries to heed the advice of health experts on the use of tobacco products and accept other safer alternatives.
He said: “We have a responsibility to make smokers aware of the alternative product available, which is vaping, so they can conveniently make informed decisions. Tobacco cessation is a key factor in the prevention of cardiovascular diseases and cancer. Abstinence from tobacco smoking is one of the primary goals for health promotion and management globally but it is unachievable in a huge number of cases. This task remains unaccomplished despite extensive public campaigns on the health dangers of tobacco smoking.”
Similarly, Vivian Manyeki, a Nairobi based medical doctor, expressed the views that about a million of smokers believe in the myths rather than the facts of tobacco smoking. She said many smokers are unable, or at least unwilling, to achieve cessation through complete nicotine and tobacco abstinence.
According to her, “they continue smoking despite the very real and obvious adverse health consequences and against the multiple public health campaigns. Conventional smoking cessation proposals should be complemented with alternative but more realistic options through Harm Reduction. The most dangerous form of tobacco use and the leading cause of preventable diseases, including cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease.”
Laying more emphasis on the alternative use of vapes as recommended by health experts, the New York Times reported that most western countries such as Canada, America, United Kingdom, etcetera, have legalized the sale of vaping products with nicotine as a less harmful option for smokers. E-cigarettes, or vapes, are battery-operated devices that heat and vaporize a liquid that users inhale or vape to imitate the smoking experience. The liquid usually contains nicotine in a mixture of propylene glycol, vegetable glycerin, water and flavoring agents. However, evidence has emerged about the toxic effects of e-cigarette vapor on the cells that line the mouth, nose, lungs and blood vessels. Vaping is also linked to respiratory injury and an increase in blood pressure.
“The nicotine in e-cigarettes is addictive and most users of e-cigarettes want to quit. For these and other health reasons, smokers who are trying to quit are advised to use medically approved nicotine replacement therapies (NRT) and/or apply counseling therapy. There is strong evidence to show that NRTs are effective aids for smoking cessation.”
The experts also warned that it is dangerous to use e-cigarettes and regular cigarettes together (dual use). They disclosed that dual use can be more harmful than either smoking or vaping alone, adding that E-cigarettes should not be used by young people, by non-smokers or by ex-smokers who have quit altogether.
A Lagos based health expert speaks on the adverse effects of dual smoking. She said: “Daily dual use may increase your risk of a heart attack five times more than if you did not use either vapes or cigarettes. The best approach is to stop smoking. Speak to your healthcare provider if you have tried quitting without success. Programs and medically approved cessation aids will increase your chances of success. Many people find it hard to quit smoking. It is often a physical and psychological addiction. Many use smoking to manage unpleasant feelings such as stress, depression, loneliness and anxiety. Some feel that smoking helps them to concentrate or control their appetite.”
Ahmed further explained that “within three years of quitting tobacco smoking, your risk of having a stroke will be nearly that of a non-smoker; within 10 years, your risk of dying from lung cancer is cut in half; and within 15 years your risk of heart disease will be similar to someone who never smoked at all.”
Going further, the reporter had a chat with a patient who was admitted in a private hospital in Lagos (name withheld) for lung cancer as a result of excessive smoking. The patient, who identified as Chukwuma Nnadi, revealed that he had been a chain-smoker for 25 years, until he began to vomit blood and was later rushed to the hospital where he was diagnosed with the deadly disease.
When asked if he was not aware of the health risks caused by tobacco smoking, he said: “I am an addictive smoker, even on this sick bed, I still feel the urge to smoke cigarettes. I cannot help my situation. But kidney cancer has helped me to stop. I always know that smoking too many cigarettes is bad. I have seen it on the television, I read the warnings in the newspapers and hear doctors saying it is bad. But I just could not stop smoking. I feel sorry for my situation and pray to God for healing. Now I am the one to warn people who are smoking to stop smoking because of the situation I find myself in.”
Another cigarette user, simply known as Tobi, narrated how he became addicted to the substance and reasons why he is not willing to quit the habit, “I have been smoking for five years now and whenever I smoke cigarettes or weed, it gives me a feeling of greatness. I love the feeling. I cannot explain it. It also helps me to relax my brain and my nerves. I get inspiration to think well when I take it.
“As a bricklayer, I get more energy and stamina to do my work, that is why I take it before I start my work and, in the night, to sleep well. I have heard that smoking cigarettes is bad for my life, but I believe that it is only when you smoke it too much and you don’t eat good food that it will disturb you. So, I don’t see myself stopping it anytime soon because of the benefits I get from it.”
In his opinion, Rivers State Commissioner for Health, Chike Princewill Rewhuamwhu, added that tobacco smoking cannot be stopped in Nigeria as it is impossible to control smokers. However, the Rivers State ministry of health dwells more on advocacy programmes that creates awareness on the dangers of excessive tobacco smoking in rural communities of the state.
He said: “The challenge about tobacco smoking is that it doesn’t only affect the person smoking the cigarette. Anyone close or around the smoker is also at risk. That is known as second-hand smoking. The reality is that it is impossible to ban or stop persons who smoke. Even if we succeed in stopping public smoking of cigarettes, how about those who smoke in their private spaces or houses?
“However, what we do as a health ministry is to carry out more advocacy campaigns on the dangers associated with excessive tobacco smoking. We carry out radio jiggles, place newspaper adverts and billboards with the aim to sensitize people on what to expect if they continue. We also collaborate with advocacy groups and healthcare centers to reach those in the rural communities who are at greater risk to this harmful substance, since most of them are not privileged to education and enlightenment. This is the most we can do as it concerns tobacco smoking.”