Cigarette smoking has been the number one health villain for a long, long time. Never mind the stories of people who smoked a pack a day till they were well into their 70s. Never mind that you may have been a happy smoker for many years. The truth is: smoking is a dangerous habit; and you may not be able to give it up merely by saying, "That's it, I quit."
The facts are ominous. Medical research has already proved - and is still proving - that passive smoking is more dangerous than thought earlier. According to the World Health Report 2001 (published by World Health Organization), there are 1.2 billion smokers worldwide, or one in three adults. Of these, half are likely to die prematurely from cancer, heart disease, emphysema or other diseases.
The report predicts that tobacco-attributable deaths will rise from 4 million annually in 1998 to an estimated 8.4 million in 2020. The increase in mortality is not evenly distributed. Deaths in developed countries are expected to rise by 50 per cent - from 1.6 to 2.4 million, while those in Asia will almost quadruple from 1.1 million in 1990 to 4.2 million in 2020. This proves what anti-smoking lobbies have been saying: That, faced with aggressive anti smoking lobbies in the west, tobacco companies are targeting the relatively vulnerable developing countries.
Almost everybody knows that the risks of smoking are higher for women. Men who smoke could suffer a heart attack seven to eight years earlier than non-smoking males; whereas for women, a heart attack could occur 16-19 years earlier than for non-smoking women. The risk of a heart attack or a stroke is 20 times greater for women-smokers on oral contraceptives. Babies born to women who smoked during pregnancy are more likely to be underweight or premature. According to the National Sample Survey of India, over 4.4 per cent of urban women consume tobacco, while over 8.8 per cent rural women are addicted to it.
Many women who smoke are less fertile than the non-smokers and are more likely to have a miscarriage. Based on a study of Canadian women, doctors found that women who started smoking in their teens are more likely to develop breast cancer than non-smokers and those who start smoking after the birth of their first child. When both parents smoke, there is a higher chance that the children will smoke.
Almost every smoker is familiar with aggressive, anti-smoking campaigns; and many urban smokers have tried to kick the habit at one point or another. Despite this, there are myths related to giving it up, that need to be challenged, says Dr Raj Kumar, a lecturer at the Anti-Smoking Clinic at the Vallabhbhai Patel Chest Institute (PCI), Delhi. Some myths: if you cannot quit the first time, you can never quit; the best way to quit is cold turkey; and, quitting is just a matter of will power.
Usually, expounds Dr Kumar, people make two or three attempts before they finally stop. Smoking is an addiction, and counseling and nicotine replacement therapy can make it easier to quit. The Anti-Smoking Clinic at PCI was set up in November 2001, with the support of the WHO, to assist those trying to give up smoking.
Registration at this clinic requires a person to respond to a detailed questionnaire - the Fagerstrom Test for Nicotine Dependence - which charts out a person's smoking habit and the extent of dependency. A Carbon Monoxide Monitor Test determines the CO level on the breath; it also shows whether a person has smoked in the past 24 hours. Counseling is provided in groups, and positive literature is distributed.
There is a time-table of benefits: After 20 minutes without a cigarette, your blood pressure returns to normal; after 48 hours, nerve endings start growing again; after 3 months, cilia in the lungs begins to recover; and after a year, the risk of lung cancer is reduced. And you are told - yet again - that smoking is an expensive habit.
Step by step practical advice follows after a person has set a "Quit Date" with the doctor's help. If the urge to smoke hits you, says Dr Kumar, hold out - usually the urge lasts for about five minutes.
At the National Chest Institute in New Delhi, Dr Rohit Sobti provides individual counseling for those trying to quit smoking. The main planks of his anti-smoking counseling are awareness, realization and strategies. He tries to make the facts hit home. For instance, 99 per cent of those suffering from lung cancer are smokers. "See that man panting desperately for breath in the corner. He smoked for 35 years and could not stop," he might say, and it has a very strong impact.
Anti-smoking pills (bupropion), nicotine patches, nicotine chewing gum and the like can only be adjuncts to anti-smoking efforts, according to Dr Sobti. Optimistic people do say, "Doc, I've heard there's a pill." But giving up smoking is not as easy as popping a pill. The process involves unlearning bad habits, behavioral therapy and strong motivation. As stress is often a trigger to restart smoking, confirmed smokers have to learn more positive coping behavior.
Doctors warn that the process of quitting is not pleasant. Withdrawal symptoms - for nicotine is a drug like any other - include irritability, fatigue, insomnia, coughing, dizziness, constipation, hunger and headaches. The ex-smoker needs to be ready for this. The remedy reads like the recipe for healthy living - easy to spell out, hard to do. Eat light, relax, take deep breaths, drink plenty of fluids and cut down on tea and coffee. Brisk walks and changes in diet will take care of weight gain associated with giving up the habit.
Incidentally, in the UK, the statutory warning on cigarette packs is to be revised - the plan is to print graphic photographs of lung cancer and yellow teeth to deter smokers.
Dizziness, nausea and getting fatter are not pleasant but one fact is unarguable. Giving up smoking is the single best step a smoker can take towards better health.
Read the writing on the wall or better still, believe the warning on the cigarette pack. It took a lot of effort to get it printed there. Think about it.