Saying No to Smoking – Moving Towards a Tobacco-Free Ireland

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This post is a little bit of a different topic from those you might be used to my blog, but smoking and tobacco-related harms comprise a major public health issue, and I wouldn’t be a public health advocate if I didn’t address it on my platform! Now, this article is not about shaming smokers, past or present. It’s about raising awareness about the current prevalence of smoking in Ireland, the extensive harms caused by smoking (both to the smoker and those who are exposed to their second-hand smoke, which is known as environmental tobacco smoke (ETS)), and most importantly, the vast health benefits to be gained from smoking cessation, prevention of initiation of smoking, and reducing the chances of relapse during a quit attempt. Of course, I’ll also include the key resources available in Ireland for quitting smoking – for good!

One in every two long term smokers will die from a tobacco related disease.

Did you know that? I don’t think many do, but it’s a pretty shocking statistic to digest. I actually don’t know if I’ve ever seen a social media post or much chat at all about smoking on Instagram (my main social media platform), which is maybe because there’s more of a focus on diet and exercise nowadays as the big lifestyle factors people want to get on top of. However, smoking, despite the hard work of public health officials and the many anti-smoking policies and legislation in Ireland now (such as the landmark workplace smoking ban implemented in Ireland in 2004), hasn’t gone away. The prevalence of smokers in Ireland is currently 18.8%, which is thankfully on a slow but steady downward trend (22% in 2017, 23% in 2016 and 2015). There’s a greater proportion of males smoking than females in Ireland (21.1% versus 16.6%), and we also know that those of lower socio-economic status are more likely to be smokers than those in middle to upper classes. The goal in Ireland is to bring that number right down to less than 5% by 2025 – 6 years away. It’s an ambitious but neccessary and appropriate target.

So the obvious next question is – why? Why do we, as public health doctors, advocate for a ‘tobacco-free’ Ireland? Let’s break down the (numerous) reasons, keeping the stark statistic I shared above in mind! First, below you’ll see a great little infographic from the Smoking Facts Irish Health Service Executive webpage illustrating what is actually IN a cigarette, and where those components can be found outside of that. It’s not pretty.

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Cigarette smoke, as you can see, contains a wide range of toxic chemicals (over 4000, in fact), 69 of which are known to be carcinogenic. The main reason smoking is so addictive is, as many of you will know, due to the nicotine in cigarettes, which reaches the brain within SIX SECONDS of taking a drag from the cigarette.

I’m going to break down the effects of smoking into those that affect the smoker, those who live/work/socialise around the smoker, and finally the economic and healthcare burden that arises as a result of smoking-related harms. I’m not trying to scare-monger in this article – instead, I want to make you aware, whether for yourself or a family member or friend you know who you’ve seen attempt to quit in the past, of the potential adverse health effects of this habit – and I’ll finish with some great resources in Ireland to help those wanting to quit for good.

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Tobacco use is THE leading cause of preventable death in Ireland, accounting for 19% of all deaths, which translates to over 5000 deaths each year. The breakdown of these deaths is as follows – cancers (44%), circulatory diseases (30%), respiratory diseases (25%) and digestive diseases (1%). Smoking is also the leading cause of premature death in the WHO European Region, accounting for 1.6 MILLION deaths per year.

For the smoker, the health effects are serious and affect many organ systems in the body. Importantly, many of the potential diseases that can result from smoking are often silent until at a very late stage. I’ve put some of the most common diseases in bullet points below, and these are the ones we have very solid evidence based on decades of research:

  • Lung Cancer: The best known example is lung cancer, and it’s also the cancer with the most evidence behind it to say smoking is the leading risk factor for lung cancer. In fact, 90% of lung cancers are due to smoking! There is also what is known as a dose-response relationship seen, meaning that the longer you smoke for, and the greater the number of cigarettes you smoke per day, the greater your lung cancer risk is.
  • Other cancers: After lung cancer, the strongest evidence exists for smoking as a risk factor for oral and throat cancers. However, smoking is a risk factor for MANY other cancers, including oesophageal (your food-pipe), pancreatic, bladder, kidney and cervical.
  • Circulatory Disease: Smoking is a lead risk factor for coronary heart disease, and peripheral vascular disease, meaning it puts you at greater risk for heart attacks, strokes and poor peripheral circulation (i.e. the blood vessels all around the body).
  • Lung Disease: Smoking is responsible for 80% of cases of a condition known as COPD (Chronic Obstructive Pulmonary Disease) which is an inflammatory disease of the airways in your lungs.
  • Other: Some of the lesser known but important health effects for the smoker include quicker ageing, skin damage, staining of the teeth and gums, dulled taste, and increased risk of thinning of the bones (known as osteoporosis). I haven’t mentioned cost yet, as I will touch on it in a later section, but clearly, cigarettes are expensive, and their price is increased year on year to discourage people from buying them. A regular smoking habit takes up a LOT of disrectionary income.
  • A shorter life: By virtue of smoking itself, it’s effects on the rate of ageing of the body and the adverse health risks I’ve just described, long-term smokers are estimated to have their life expectancy shortened by approximately TEN to FIFTEEN years.

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A key part of why smoking is such a big public health issue is the adverse impact second-hand smoke (SHS) has on those in the environment of the smoker. SHS causes 600,000 premature deaths globally per year! Even if you don’t smoke, the SHS we may inhale from smokers we live, work or socialise with contains the same toxic chemicals and potent carcinogens as described above. So, while the health harms from SHS exposure are somewhat less strong as we don’t inhale the smoke directly from the cigarette, there is good evidence to say exposure to SHS causes increased risks for the following:

  • Lung cancer
  • Coronary Heart Disease
  • Respiratory Disease
  • Sudden infant death syndrome (there are also other potential negative effects to the health of infants and children who are exposed to SHS, including increased risk for respiratory infections and ear infections)

So if you’re a smoker, even if the implications for your own health don’t frighten you that much, or enough to want to quit the habit, it’s worth thinking about the effects on those around you, because they’re not to be sneezed at, and can be devastating.

Finally, let’s touch on the burden smoking places on society. It’s no secret that smokers cost the health service (and therefore the economy) a significant amount of money, wich increases year on year. In fact, a estimate of this cost from 2013 reported Irish health expenditure on smoking-related diseases was approximately 466 million euro per year! In the U.K., given the greater population size, this number is significantly higher, with smoking-related diseases estimated to cost the NHS between 3.1 – 6.0 billion euro per year.

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Now, that’s some figures for the cost burden to society from smoking. And I’ve described the personal health cost that smokers risk from this habit. There’s also a major monetary cost to the smoker from actually buying cigarettes, the price of which is increased year on year in Ireland, simple because we know from the evidence that increasing the price of cigarettes reduces the likelihood that someone will buy them. Quitting smoking removes that expense and releases a big fraction of discretionary spending that you (or the smoker you know) could use for so many other things in life.

Okay. To finish, let’s talk about the HOW to STOP. To Quit Smoking. For good. As from the health risks you’ve read about above, here’s some extra fast facts about the health GAIN to be got from quitting, which I’ve taken from the really helpful Irish Health Service Executive ‘Quitting Smoking’.

  • After one month: Your skin will be clearer, brighter and more hydrated.
  • After three to nine months: Your breathing will have improved, and you will no longer have a cough or wheeze. Your lung function may have improved by up to 10%.
  • After one year: Your risk of heart attack and heart disease will have fallen to about half that of a smoker.
  • After 10 years: Your risk of lung cancer will have fallen by half.
  • After 15 years: Your risk of heart attack and heart disease will be the same as someone who has never smoked.
  • Research into smoking shows that people who quit smoking before age 35 have a life expectancy that is only slightly less than people who have never smoked.

However, quitting smoking for good is tough. While the majority of smokers, when surveyed, do want to quit, the success rate is very low. About 4 in 10 smokers try to quit each year, and of those, just over a third succeed on their first attempt. Over half succeed on their second attempt! The symptoms you may experience as a result of withdrawal can be tough too, and include the following – cravings, irritability, anxiety, disturbed sleep and concentration, possible weight gain (usually this occurs when a person replaces the smoking habit with an increase in dietary intake), and changes to energy levels. It’s important to remember all of these symptoms are temporary and are a result of the physical dependence that develops from nicotine use.

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So, let’s talk about the steps to quit! You need to consider these steps involved, and ensure you’re armed with the right physical and psychological supports to succeed on your journey. In the bullet points below, I’ve shared some key steps on the path to success, and again, the Health Service Executive website here as well as Quit.ie are fantastic resources to get you started.

  • Motivation: This is so SO important as a starting point. As with anything in life, when you’re making a big change, especially one requiring breaking habits and addictions (which smoking is), you have to know your why. As you’ve read above, that might be your health, that of your family/friends, the expense of smoking, or a combination. Write those reasons down, somewhere you can reference back to easily, for the times when you want to give up on quitting. When you write those down, below it write the day/date/time you’re going to quit, ideally a time when you know you won’t be under stress!
  • Prepare: TELL those who are your social supports at home and at work your quit date, so that they can be ready to help you on your journey. It’s also important to consider what physical supports you might want – these will be in the next bullet point, but they include Nicotine Replacement Therapies, as well as non-medication lifestyle behaviours that might help (e.g. exercise, mindfulness and meditation, taking up a new hobby!)
  • Ask the Expert: Chat to your local G.P. and/or Pharmacist about your options for Nicotine Replacement Therapy (NRT). Many of you will be familiar with the ‘Nicorette’ patches/lozenges/gum/inhaler etc, and there are also medications available for NRT too. The medications must be prescribed by your GP, while you can get the patches/lozenges/gum/inhaler from your pharmacy.
  • Plan, Plan, Plan: It’s vital to consider (and maybe write down) the times when you resort to cigarettes the most – whether that’s stressful situations at home or at work, or with work colleagues on breaks, the time of day, or in social situations such as nights out. By being mentally prepared for those situations, you’re giving yourself the best chance at resisting temptation and having alternatives to hand, such as the NRT lozenges or gum if you’re using them!
  • Don’t Go It Alone: As I said in an earlier point, make sure your close social network of family, friends and work colleagues know when you’ve started your quitting journey. Self-motivation is absolutely crucial, but equally important is the motivation you can find from the kind words of those around you, helping you on your journey, especially early on!
  • Cravings: The 4 D’s are what I have learnt from my Health Promotion and Behaviour Change training, which is a little step-wise path through those 3-5 minutes you’ll experience when a craving rears its ugly head. They are as follows: Delay (for those few minutes and feel the urge subside) – Distract (keep as busy as you can to distract your thoughts from that of a cigarette) – Drink (water, a cup of tea, even juice, or a suck on a mint, just something to replace that ‘hand to mouth’ habit of smoking) – Breath Deeply – Inhale, exhale, slowly, as the craving passes.
  • Positivity and Progress: Focus on one day at a time, one craving at a time, and remember it’s progress, not perfection that’s the focus. A positive mindset, and positive healthy lifestyle behaviours will also help in a big way. Believe that you will succeed in quitting, and tell yourself that every day! Getting in regular exercise (a daily walk is a fantastic starting point!), sticking to a healthy diet, and remember how much money you are saving from not smoking too! Maybe put that money you would have spent towards something you can look forward to – a dinner out with family/friends, a trip away, or something you’ve wanted to treat yourself to for ages!

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Okay gang. I really hope this article was helpful, made you more aware of the harms associated with smoking (for the smoker, those around them and society), and most importantly, showed you that quitting IS possible, and more than worthwhile, in the short and long term. I’ve re-linked the Irish smoking cessation online resources again below. As always I would love your feedback on this article – drop me an email, a comment or a message/Tweet – I’m @theirishbalance on Instagram/Twitter/Facebook!

Ciara 🙂 x

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