“The tobacco epidemic is one of the biggest public health threats the world has ever faced”
Why do we start smoking?
The nicotine rush
Some of us are biologically addicted to nicotine while others remain unaffected. The sudden rush of dopamine in our brain brings about a burst of connections lighting up. We feel amazing, happy and full of energy. Although this feeling is short-lived.
Genetics
Scientists have now discovered that our genes play an important role in determining who will become a smoker. Individuals with particular gene characteristic termed SLC 6A9-3 are significantly less likely to be a smoker. These people are less likely to start smoking before the age of 16 and more likely to quit smoking than people without the gene type.
Psychological and Cognitive bias
Cognitive ability is our thinking process and our ability to reason out our judgments. They hold inaccurate perceptions about the risk of smoking. They know smoking causes harm to their body but tend to underestimate these risks. They also tend to minimize the perspective relevance of the risk- they do not think that their health is affected as much as the other addicted smokers or others suffering from side effects.
Cultural Risk
One study showed that Asian participants perceived smoking to be less risky than African, American and white participants.
Circle of competence
One of the reasons is our friend's circle who provokes us to smoke. Try at least one time, what’s there in that. But this turns out to be very addictive. Friends often take this as a competition: like alcohol, what is your capacity to smoke. The competition of capacitance turns into chain-smoking.
Depression
The stress we take around, the daily routines we have, tiredness and all these lead to smoke more- to escape the reality of depression, to relax ourselves, to end stress, pressure and routines. But in the long run stress, frustration, boredom increase.
Coolness
In fact, most youngsters start smoking to get an edge over other people. Thinking having hookah, smoking makes us cooler. When he is desperate to blend in with the coolness, he is sacrificing his own body for this. Doing what everybody is doing is not cool- doing the right thing even if nobody is doing is cool.
Relationship
This can be friends, spouses, relatives, everyone. The terms of this relationship make you who you are. In times of toxic relationships, breakups- eventually lead to depression. The chances of girls starting to smoke in this stage are quite high to overcome the pressure (provided boys are already into smoking).
Stamina
Some believe smoking increases their stamina to stay longer during the night especially when you’re working on a project or studying. Adding to this, smoking makes me go potty, in the morning to get energy and many more. But this is one of the biggest myths. The truth is smoking lowers your stamina, laziness increases, energy decreases: in that second you might get a kick but not for long.
Movies
Who is not fond of movies. Brad pit on the screen smoking cigarette, Scarlet Johansson smoking one: how cool is that. These people are our role models, these millionaires. Nothing is happening to them when they smoke, they are living normally, then what’s the problem us smoking one. These influencers are the one influencing us to start smoking one. They aren’t real heroes; they are showcasing themselves as real heroes. So, whom do you want to be: A showcasing hero or an actual hero?
Religion
There are some religions that prohibit drinking. For example, Islamic tradition restricts people to consume alcohol. This is a good principle. But since alcohol and smoking are the ones where we get the dopamine rush, people turn towards smoking. What they couldn’t cover up in alcohol, they will cover up in smoking. Thus, increasing their chances of having more cigarettes each day.
Climate
We have seen in many countries, especially colder countries where it snows and the temperature will be very low. The people in these areas smoke to keep their bodies warm, this is the thought process but in reality, smoking doesn’t keep your body warm. On the contrary, people in hot regions, to escape the frustration of heat, start smoking. The sudden rush of dopamine relaxes them and gives temporary relief from the grueling hot weather.
“If you have one cigarette, there is a 90% chance smoking will turn out to be addictive”
What does a cigarette contain?
Cigarettes have almost 600 different ingredients. When you light up a cigarette, these ingredients mix up to form 4000 different chemicals. And at least, 69 of these chemicals are known to cause cancer. And a lot of ingredients in these cigarettes can be found in our consumer products like rat poison and cleaning products.
Benzene: Benzene is found in rubber, cement, gasoline and is used in making dyes. It is also linked to leukemia.
Hexavalent Chromium: It is used in textile dyes, wood preservation, anti-corrosion products, color in paints, inks and plastic. It is carcinogenic which can lead to lung cancer.
2-Naphthylamine: It is used in making dyes which is also a carcinogen.
Cadmium: It is found in battery acid and painting. This is linked to cardiovascular diseases, osteoporosis and cancer. The cigarettes have cadmium because the tobacco plant absorbs heavy metals like cadmium from the soil. Thus, smokers have 4-5 more cadmium levels in their blood than a non-smoker.
4-aminobiphenyl: This is responsible for bladder cancer in humans and dogs by damaging their DNA. The production of this chemical stopped in the 1950s in the United States, but it’s still in your cigarettes.
Vinyl Chloride: A gas with a sweet smell, highly flammable, toxic and carcinogenic.
Ethylene oxide: This is the main component of explosives. They put this in tobacco leaves to mature more quickly and kill the fungi.
Arsenic: This is used in commercial products like rat poison. One of the most harmful substances and is classified as a group A carcinogen.
Nickel: Used in batteries, metal surface treatments and pigments. This is related to lung cancer and workers exposed to nickel have a higher risk of lung cancer and lung infections.
Polonium 210: This is a radioactive substance known to cause cancer. It is used in artificial satellites and in atomic bombs.
Beryllium: This is found in coal slag, atomic bombs. This is listed as a category 1 carcinogen.
Formaldehyde: This is a disinfectant and is used to preserve dead specimens. This is also linked to lung cancer.
Tar: Tar is carcinogenic. When you inhale tobacco, tar is the dark color that is left in the lungs.
Acetone: This is found in nail polish remover.
Cyanide: This is a deadly poison used to suicide. Cyanide was used as mass murder in the holocaust in the gas chambers.
Acetic acid: It is an ingredient in hair dye.
Ammonia: It is a common household cleaner used to clean windows and toilets. Ammonia is added so that your lungs can absorb more nicotine, so that our brain will get more dopamine rush.
Butane: Butane is a gas used in a lighter fluid such as cigarette lighter and portable stoves.
Carbon monoxide: This is found in car exhaust fumes and is a poisonous gas as well.
Lead: Lead is used in car batteries and is poisonous in high doses.
Naphthalene: This is used in mothballs, used in black smoke and is linked to cancer.
Methanol: This is the main component of rocket fuel.
Toluene: This is the main ingredient used to manufacture paint.
DDT: A banned insecticide because it’s linked to liver cancer.
Methyl isocyanate: This is the gas that killed 1000’s of people in the 1984 Bhopal gas tragedy.
Will filters make cigarettes healthier?
In the initial days, cigarettes were unfiltered. This was made mainly to allow all the flavors to come through. But through time, people started to find out cigarettes cause cancer and they got worried. So, to keep up the sales, the tobacco companies started to put filters in cigarettes to prevent some chemicals.
But this makes the cigarettes bitter. In order to avoid this, they added even more chemicals so the filter does not make cigarettes any bitter. Thus, cigarette filter doesn’t make it any healthier and they don’t remove nearly enough tar and chemicals. The filter is a marketing play to keep you hooked up to smoking.
How does smoking a cigarette affect our body?
While the effect of smoking is not immediate, the complication and damages can last for years. With each inhalation, smoke brings more than 5000 chemical substances into our bodies.
In the beginning, Tar begins to coat our teeth and gums, damaging tooth enamel and causing tooth decay. Over time, it damages nerve endings in the nose causing loss of smell.
Inside our lungs, smoking increases chronic diseases like bronchitis and emphysema. It damages the cilia- whose job is to keep the airway clean. The alveoli get filled up with this smoke. The alveoli are tiny air sacs that help to enable the exchange of oxygen and carbon dioxide between lungs and blood. As we smoke, toxic gas: carbon monoxide gets exchanged through these alveoli thereby binding with the hemoglobin displacing the binding of oxygen. This leads to oxygen deprivation and shortness of breath.
Within seconds of smoking, our bloodstream carries a stimulant called nicotine to the brain, this releases dopamine and endorphins in the brain that trigger pleasure sensation making it highly addictive.
This nicotine and other chemicals cause narrowing of blood vessels, damaging their delicate endothelial lining, restricting blood flow. This leads to the thickening of blood vessel walls and enhances blood platelet stickiness- causing the formation of clots triggering heart attack and stroke.
Many other chemicals inside cigarettes can trigger dangerous DNA mutation that turns it into cancer form. Arsenic and Nickel disrupt the process of DNA repair, compromising our body’s ability to fight cancer.
FACT: One in every 3 cancer deaths in the United States is a result of smoking. This is not just lung cancer, but a wide variety of other cancer diseases.
Additionally, smoking damages eyesight, weakens our bones. It makes it harder for women to get pregnant, erectile dysfunction in men. It also has toxic effects on the child of pregnant women causing stillborn, abortion, premature delivery, sudden infant death syndrome (SIDS), ectopic pregnancy, orofacial clefts in infants, low birth weight.
Smoking increases the risk of:
Coronary heart disease by 2 to 4 times.
Stroke by 2 to 4 times
Men to develop lung cancer by 25 times
Women to develop lung cancer by 25.7 times
More likely to die (12 to 13 times) from COPD (Chronic Obstructive Pulmonary Disease) than non-smokers.
Smoking reduces men’s sperm count, reducing fertility and increasing the risk for birth and miscarriages for women. Female smokers tend to enter menopause earlier than non-smokers, which also leads to an increase in hot flashes.
The risk for developing diabetics is 30-40% higher for active smokers than non-smokers. It increases the amount of insulin resistance in our bodies. It also causes inflammation and decreased immune function. Smoking damages our airway and causes “smokers cough”- a dry uncontrolled cough.
Smoking lowers your HDL (good) cholesterol and increases your LDL (bad) cholesterol level. It also increases the total cholesterol triglycerides which are fats in your blood.
Children whose parents smoke are more prone to coughing, wheezing, and asthma attacks. They also tend to develop pneumonia and bronchitis.
Smoking changes the structure of your skin increasing the risk of developing squamous cell carcinoma (skin cancer). It also increases the chance of fungal and nail infections. It also increases hair loss, balding and greying of hair.
Smoking can lead to a decreased sex hormone levels in both males and females thereby decreasing sexual desire. This decreases their sexual performance and their ability to reach orgasm.
What happens to our bodies once we quit smoking?
There are a lot of immediate and long-lasting physical benefits the moment you stop smoking.
Just 20 mins after the last cigarette, our heart rate and blood pressure begin to return to normal.
After 12 hours, carbon monoxide levels stabilize thereby increasing our blood’s oxygen-carrying capacity.
A day after, heart attack risk begins to decrease.
After 2 days, the nerve ending in our nose starts to recover, bringing back our sense of smell and taste.
One month down the line, our lungs start to recover and become healthier leading to less dry cough and less shortness of breath.
In about 9 months, Cilia in our airway and lungs start to recover and begin to restore themselves to their full capacity.
By one year to quitting smoking, heart disease risk plummets to half as blood pressure starts to stabilize and improve its function.
By 5 years, the chances of clot-forming and risk of stroke dramatically reduce.
By 10 years, the chances of developing lung cancer reduce by half as our body’s ability to recover DNA is once again restored.
By 15 years, the likelihood of developing coronary heart disease is the same as that of a non-smoker.
By 20 years, the risk of death from smoking-related causes drops to the level of a person who has never smoked in their life.
How do we quit smoking?
Quitting smoking can be tough and at times can lead to anxiety and depression from nicotine withdrawal. This means breaking the cycle of addiction and rewiring our brains to stop craving nicotine. Quitting needs a systematic plan and approach to stop triggers and cravings. The faster we quit smoking the better it is.
In order to think about quitting, we need to change the way we look at habits. So, you need to know in which stage are you presently in:
Pre-contemplation stage: You are not really thinking about quitting smoking. About 75% want to quit and 25% are not interested.
Contemplation stage: You are thinking about it but you are not ready to act. You have the desire to quit but just haven’t thought about it.
Preparation stage: You have tried to quit before. You now know what has worked in your favor and what hasn’t and what made you come back.
Action stage: This is the time you are ready to make your move. You have plans and strategies and gaps to fill in on how to quit smoking.
Maintenance stage: Here you become a non-smoker and you try to stay this way.
One of the reasons you start to smoke is the triggers that trigger you to do so. Like:
Getting up and smoking in the first 15 mins
Before breakfast and meals
Coffee/Tea routine
A friend calls you for a walk/smoke
Throwing out an ashtray, especially in your car
Alcohol and parties (Double the risk)
Want something in my hand
Certain hangout spots
If you could avoid these triggers by making a distraction, you can stop the act of smoking. This will lead to a big change in your daily routine and habits., but it will be worth it.
“Now it’s time to start some healthy relationships for a healthier life”
There are 3 main treatments available to reduce your level of nicotine intake:
NICOTINE REPLACEMENT THERAPY (NRT)
This is a medically approved way to treat people with tobacco use disorder by taking nicotine in other means other than tobacco. This therapy increases the chance of quitting tobacco use by 55%.
Researchers have shown that NRT in combination with Cognitive Behavioural Therapy can increase the chances of quitting. This includes motivational interviewing, transtheoretical model of behavior change and social cognitive therapy.
There are 5 types of Nicotine Replacement Therapy (NRT).
Nicotine patch:
This is a transdermal patch (to give a specific dose of medication through the skin) which releases nicotine into your body through the skin. It is used to treat anxiety, depression and inattentiveness and late-life depression. These patches are typically worn for 16-24 hours. Nicotine patches are available over the counter and come in Nico dermal patch strength (nicotine content) of 7mg, 14mg and 21 mg. Common side effects experienced by people using nicotine patches are cough, headache, nausea, insomnia, sweating, shortness of breath and skin irritation at the site. In some cases, diarrhea, dizziness, vomiting and coldness in limbs are observed.
Nicotine Gum:
This is a type of chewing gum that delivers nicotine to your body. The nicotine is delivered to the bloodstream via absorption by the tissues of your mouth. The gums are available in individual foil packages and come in various flavors. The nicotine content is usually either 2mg or 4mg per chewing gum. Popular brands include Nicotex, Nicorette, Nicogum, Nicotinel and Zonnic.
The side effects include making our hearts harder to pump blood, stress on blood vessel walls, chronic vascular injury, coronary heart disease, stroke, peptic ulcer disease and oesophageal reflux. Nicotine may cause wounds to heal more slowly and is associated with reproductive toxicity.
Nicotine Lozenge:
Nicotine Lozenge is a tablet that contains a dose of nicotine that dissolves slowly in the mouth to release nicotine over the course of 20 to 30 minutes. Nicotine Lozenge is commonly found in 2mg and 4mg strength. The nicotine is absorbed through the lining of the mouth and enters the bloodstream. Some of the side effects include Nausea, mouth irritation, sore throat, hiccups, heartburns, restlessness, difficulty in concentrating, etc.
Nicotine Nasal Sprays:
These are used to deliver nicotine medication locally in the nasal cavities. The nicotine from the spray is being absorbed through the blood vessels in the nasal passage. This is used as 2-4 sprays per hour and after 4 weeks, your doctor may advise lowering the dose. Some of the side effects include nose irritation, running nose, watering eyes, sneezing, coughing, throat irritation.
Nicotine Inhaler:
The nicotine inhaler is available under the brand name Nicotrol. The device is designed to initiate the act of smoking but in a less harmful way. One shot of inhaler delivers 4mg of nicotine. The inhaler is not approved for people who are younger than 18 or pregnant. Some common side effects include mouth and throat irritation, cough, hiccups, runny nose, headache, upset stomach.
MEDICATIONS
These are prescription drugs that have been shown to help people quit tobacco. If you are using drugs, it is mandatory to talk with your health care provider about exactly where to start and how to use the medication. These are drugs such as Varenicline (Chantix), Bupropion (Zyban), Nortriptyline, Clonidine, Naltrexone.
Some of the side effects of using drugs include Nausea, vomiting, headache, skin irritation, seizures, heart or blood vessel problems, constipation. A person who uses less than 15 cigarettes a day (mild smoker) is advised to use other NRT’s while heavy smokers (>23 cigarettes per day) are advised to look into medication as well.
BEHAVIOURAL AND COGNITIVE THERAPY (CBT)
CBT is a psychotherapy technique that focuses on identifying negative thoughts and developing new ways of thinking about situations. This combines two approaches: Cognitive and Behavioural therapies.
Cognitive Behavioural Therapy means talking about what’s on your mind and learn ways of coping with feelings. Some people work individually with a therapist while other work in group sessions. Participants learn how to deal with stress and avoid unhealthy thoughts and behaviors. It also helps people deal with a number of emotional health and behavioral issues, including depression, anxiety, phobias, substance abuse, mood disorder.
The therapy also doesn’t carry the side effects of certain medication-based treatments. The goal is to change your thought patterns replacing your old unhealthy thoughts, habits and unrealistic beliefs.
“It’s going to be a challenge now, it’s going to be a challenge 5 years down the line, then why not just do it now?”
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