Cigarette smoking and health
Cigarette smoking is the greatest epidemic facing humanity and use of
tobacco is the second major cause of death in the world.
Cigarette smoking is currently responsible for the death of one in
ten adults worldwide (about 5 millions deaths each year according to
World Health Organisation (WHO) website 2002).
Every eight seconds, someone dies from tobacco use. If current
smoking pattern continues it will cause some 10 million deaths each year
by year 2020.
Half the people that smoke today, that is, about 650 million people
will eventually be killed by tobacco. 15 billion cigarettes are sold
daily or 16 million every minute and the total number of cigarettes is
enough to send 3 million smokers to the grave annually.
This includes both passive and active smoking. Smoking is becoming
one of the important risk factors not only in the industrialised
countries but also in the developing countries such as Sri Lanka.
In 1974, N. J. Wallooppillai and D. P. Atukorale carried out a
research project (sponsored by Sri Lanka Science Council) to find out
the common causes of myocardial infraction (heart attacks) among the
young Sri Lankans (i.e. those below the age of 40 years) and we came to
the scientific conclusion that smoking is the commonest coronary risk
factor in the young infarcts.
I have come across thousands of young widows (and their school going
children) thanks to the good work of the cigarette industry. Like other
more developed countries, these widows should take legal action against
the cigarette companies for the damages.
About 12 times more British people have died from smoking than from
World War II. Cigarettes cause more than one in five Americans deaths.
Great effort has been made to reduce the number of smokers in the
developed countries, for example the percentage of the population that
smokes in England has been reduced to 9% and in United States to 25%.
However, the number of smokers has been increasing in developing
countries. The percentage of population who are smokers is about 22% in
the Asiatic countries, and 42% in the African Countries.
The economic costs of tobacco use are equally devastating. In
addition to high public health costs of treating tobacco caused
diseases, tobacco kills people at the height of their productivity,
depriving families of breadwinners and nations of a healthy workforce.
Tobacco users are also less productive while they are active due to
In 1994, W.H.O. report estimated that the use if tobacco resulted in
an annual global net loss of U.S. 200 billion dollars, a third of the
loss being in developing countries. (Reference B. M. J. 1994, 309,
Mortally in relation to long term smoking: 40 years observation of
male British Doctors by R. Doll, R. Peto, K. Wheatley, I. Sutherland.
A prospective study of mortality in relation to smoking habits was
assessed for male British doctors from 1951-1991.
A large regiment of 34,439 British male doctors who replied to a
postal questionnaire in 1951 of whom 10,000 had died during the first 20
years and another 10,000 died during the second 20 years.
The death rate ratio during 1951-1991 (comparing continuing cigarette
smokers with life long non-smokers) was approximately threefold at age
group 45-54 and twofold at ages 65-84. The excess mortality was chiefly
from diseases that can be caused by smoking.
Positive association with smoking was confirmed for death from
cancers of mouth, esophagus, pharynx, larynx, lung, pancreas and larynx,
bladder, from chronic obstructive pulmonary disease, from vascular
diseases; from peptic ulcer and (perhaps because of confounded by
personality and alcohol use) from cirrhosis, suicide and poisoning.
Those who stopped smoking before middle age subsequently avoided all
the excess risk that they would otherwise have suffered and even those
who stopped smoking in middle age were subsequently at less risk than
those who continued to smoke. It now seems that about half of all
regular cigarette smokers will eventually be killed by their habits.
Pipe and cigar smokers
Mortality of pipe and cigar smokers who had never regularly smoked
cigarettes has been found to be higher than the nonsmokers but less than
The causes of death in pipe and cigar smokers are cancer of lung and
other respiratory sites (such as pharynx and larynx), cancer of
oesophagus, chronic obstructive lung disease, pulmonary tuberculosis,
pulmonary heart diseases, non-syphilitic aortic aneurysms. But these
were less than in cigarette smokers though greater than non-smokers,
while their mortality from other causes was similar to that of
non-smokers. Upper respiratory cancers include cancer of mouth (other
than salivary gland), pharynx (other than nasopharynx) and larynx,
cancer of lung; esophagus, bladder and pancreas were all clearly related
Out of above, mortality rates of cancers of upper respiratory sites,
lung and esophagus were at least 15 times that of non-smokers.
Cancer of bladder and pancreas were about 3 times more common in
heavy smokers than in non-smokers. Cancer of stomach showed a marginally
significant relation with the amount smoked.
Chronic obstructive lung disease which includes chronic bronchitis
and emphysema showed a relation almost as strong as that for cancer of
the lung. Pulmonary tuberculosis shows a moderately close relation with
A statistically highly significant relation with smoking was observed
for pancreas. Asthma mortality was more than double that of non-smokers.No
death was observed in men under 25 years of age. Total number of deaths
observed at 25-34 years was small.
Under 35 years, the mortality was higher in current smokers than in
non-smokers. Overall mortality was twice as great in continuing
cigarette smokers compared to life-long non-smokers throughout middle
and early old age.
Active smoking is a well established major preventable risk factor
for coronary heart disease (C.H.D.). Many studies have reported that
passive smoking is also associated with increased risk of C.H.D. (Law MR
et al, B. M. J., 1997, 315, 315-80).
Generally such studies have compared the risks of non-smokers who do
or do not live with cigarette smokers (Hirayama T, N. Z. Med J. 1990,
103, 5) though few have also considered occupational exposure. Passive
smoking may also be related to risk of stroke (Bonita R.et al, Tob.
Control, 1998, 8, 156-60).
Living with someone who smokes is an important component of exposure
to passive smoking. A person may also get exposed to passive smoking in
work places and public places such as restaurants.
Thirty years ago scientific committees and national organisations
concluded that exposure to environmental tobacco smoke (also called
passive smoking) is a cause of lung cancer. A woman who has never smoked
has an estimated 24% greater risk of developing lung cancer if she lives
with a smoker.
There is a dose response relation between a non-smoker's risk of
getting a lung cancer and the number of cigarettes and years of exposure
to the smoker. Tobacco specific carcinogens are found in the blood and
serum of non-smokers exposed to environmental tobacco smoke. All the
available evidence confirms that exposure to environmental tobacco smoke
causes lung cancer.
I have come across a significant number of young wives who have
developed heart attacks and angina following passive smoking (second -
hand smoke) due to their husbands smoking at home. I always advise young
women to get married to smokers if they want to be young widows!
British heart study
This is a prospective study of cardiovascular disease in 7735 men
aged 40-49 years selected from 24 towns in England, Wales and Scotland.
According to above study passive smoking is associated with an increase
in risk of coronary heart disease. (C. H. D.) of 20-25%. Passive smoking
may also increase the risk of stroke though information is limited.
According to above study, high concentrations of cotinine (which is a
nicotine product) among non-smokers are associated with excess risk of
coronary heart disease of about 50-60%.
High overall exposure to passive smoking seems to be associated with
a greater excess risk of C. H. D. than partner smoking and widespread in
non-smokers that the effects for passive smoking have been
under-estimated in the past.
Weight of evidence using serum nicotine concentrations suggests that
exposure to passive smoking is a public health hazard and should be
minimized (Peter H. Whincup et al, B. M. J. 2004, 329, 200-205).
Among young teens (aged 13 to 15) about one in 5 smokes worldwide.
Between 80,000 and 100,000 children worldwide start smoking everyday,
roughly half of whom live in Asia. Evidence shows that 50% of those who
start smoking in adolescence go on to smoke for 15 to 20 years.
Peer-reviewed studies show that teenagers are heavily influenced by
The number of smokers among school students in still high. There are
many factors influencing, these students to start smoking; for example
socio-economic status, parents, friends and siblings who smoke and
social environment. In developing countries like Sri Lanka, smoking
among children and adolescents has not yet received much attention.
It has been found that most common age for starting smoking was
between 15 years and 19 years. The main sources of the first cigarette
were relative or neighbour (25% school friend). Close relative i.e.
father or sibling accounted for 20.9%, and friend outside school
The first cigarette for those who smoked before 10 years of age was
predominantly given by a relative or neighbour followed by close
relatives (mainly father). For those who started smoking between 10
years and 14 years the main sources were relatives or neighbours, school
friend or close relative (father or sibling). For those who smoked
between 15 years and 19 years the main sources were friends.
The first cigarette was usually smoked at home, followed by on the
way to or from school and these at the house of a friend or relative.
The reason of starting smoking was usually to see what it was like
i.e. curiosity followed by to imitate others and because of
encouragement by others. The idea that smoking makes people elegant was
not a common reason given for starting smoking.
Currently there are more than 70 countries in the world which have
official anti-smoking programmes and activities including campaigns to
protect individuals from tobacco smokers and promoting a healthy
Work environments and other public places should be tobacco smoke
free in order to reduce the adverse effects on people's health. In this
respect we should appreciate the good work done by Ministry of Health
and Nutrition to make our hospitals and Ministry of Health and Nutrition
smoke free areas.
All Sri Lankans should be very grateful to his Excellency the
President, the J.H.U. and all other political parties who supported the
recent Anti-Smoking and Anti-Alcohol Bill in the Parliament.
Half of long term smokers will die from ill-effects of tobacco. Every
cigarette smoked cuts at lest 5 minutes of life on average about the
time taken to smoke it.
Smoking is the single largest preventable cause of disease and
premature death. It is a prime factor in heart diseases, stroke and
chronic lung diseases including lung cancer.
More than 4000 toxic or carcinogenic chemicals have been found in
tobacco smoke. Smoking related diseases cost the United States more than
150 billion US$ a year.
Smoking is mainly a problem of young and adult males in Sri Lanka.
Fortunately smoking is rare among females in our society. It is likely
that social norms and traditions have greater influence on females than
males in our society.
There is a misconception among some Sri Lankans that vehicle fumes
and other industrial gases contain nicotine and that chemicals present
in these fumes cause heart attacks. As far as I am aware to-date there
is not a single case of a documented heart attack due to vehicle fumes
and industrial gases in Sri Lankan medical literature.
Cigarette smoke contains more than 4000 toxic chemicals which include
nicotine which is the most poisonous alkaloid (C10 H14 N2) found in all
parts of the tobacco plant, especially in the leaves.
Smoking cigarettes, cigars, beedis, pipes and chewing cigars tobacco
(with betel leaves) and inhaling tobacco snuff (which is popular among
females in the Western and Southern Province especially in Beruwala) are
injurious to health. As far as I am aware only tobacco plant (especially
the leaves) contains the very toxic alkaloid nicotine.
"Tobacco companies possess the knowledge that consuming their product
is so imminently dangerous that it must in all probability cause death
or cause such bodily injury as is likely to cause death and since
tobacco companies commit such crimes without any excuse or
justification, in all means they are murderous" (Swarna Hansa
It is noteworthy that people attached to tobacco industry including
those working in their distribution outlets in Sri Lanka, (as far as I
am aware) don't smoke cigarettes.
Cigarette smoking should be banned in our 'Big Matches' as these are
school events and not adult events.
Anti-smoking campaigns should be started in all our schools and the
school syllabus should include ill-effects of smoking and alcohol
The age-old practice of offering betel leaves with tobacco leaves (Bulat
dunkola) to elders during the festive seasons such as April Sinhala and
Hindu New Year should be improved and tobacco leaves should never be
offered to your elders as these leaves contain nothing but poisons.
Psychological difficulties in motherhood
These days there is no stigma attached to being childless, and many
women have other, often very interesting options what females want to do
with their lives. But meanwhile, a woman's biological clock is ticking
louder than ever.
A study appeared in 2002, in the journal Human Reproduction
suggesting that the decline in female fertility starts earlier than
previous thought, at age 27. Woman who once put off a decision about
children now feel pressure to start at least thinking about it earlier.
In Sri Lanka, the accepted norm is to have a child with in the first
two years of getting married. This is the thinking of most Asian
countries. The husband's parents and their relations tend to think that
there is some fertility problem of the wife, if she does not produce a
child within the first two years of married life.
It is complicated for single women, too. In their parent's
generation, the choice was pretty much made for them. But these days,
even if they decided not to marry - or no one has come along that they
want to marry - then in eastern countries like Sri Lanka still it is bit
difficult to live a single life. But in western countries like United
States or Canada, there is no stigma attached of being single or being a
There is even a U.S. organisation, Single Mothers by choices, for
women having children outside marriage.
Many books have been written both on the joys of motherhood and in
support of the child - free choice for those women asking themselves if
they want children. But in the last decade there have been very few that
take no stand on the subject that simply want to help women think about
At the same time, the reasons to have children - or not have gotten
more complicated. Most of the females who are working are living away
from their parents. They don't have an extended family to talk to. Their
mothers and grandmothers did not think much about whether they would
have children or not. That was the married women did.
But today's women are not just considering motherhood in terms of
when, but if. Over the past couple of decades, society has grown more
accepting of women's choice not to have children. But advances on
medicine also have made it possible for older women to conceive, leaving
motherhood a question to contemplate much later in life.
In the present society most women have so many questions before
becoming a mother. Questions like - Do I want to have a child? - How
will children affect my career?
What will pregnancy do to my health? - What does it cost to have a
child? How does we raise a good person?
It is feelings of regret that much cross the mind of almost any woman
who chooses not have a child. What if? But on the other hand, what if I
give up or put on hold, a great career? What if I don't like being a
mother? In the end, it may be just a leap of faith.
According to psychologists, motherhood is an automatic response based
on millennia of knowing that if you did not have children, something was
wrong. Since the advent of the Pill in the early 60s childbearing has
been an individual decision.
Most of the psychologists say that it is a good idea for a couple to
visit their obstetrician before conceiving. Women also need to think
about how motherhood will change their image of themselves. They also
should be willing to take a new identity.
Beliefs and attitudes need to be taken into consideration. A couple's
differing faiths may become important for the first time, and role
changes need to be thought out.
Dr. R. A. R. Perera, Consultant Psychologist, Ontario, Canada.
Emotional recovery helpful to heart attack patients
Emotional recovery from heart attacks is vital to a patient's health,
according to a new study published in the Mayo Clinic Women's Health
The study said that people who develop depression after a heart
attack are more likely to require hospital care within a year for a
heart-related problem than heart attack survivors who aren't depressed.
Heart attack survivors with depression are also three times more
likely to die of a future heart attack or other heart problems, the
These differences in health outcomes may be partially due to a lack
of follow-up care, the study said, adding that people who are depressed
are less likely to take medications and follow the advice of their
The study said depression, fear and anger are common reactions after
a person has had a heart attack, but doctors' follow-up care can ease
depression and fear in patients.
The article offered some tips from experts to help heart attack
patients with their emotional recovery:
* Discuss your feelings openly and honestly with your doctor, family
members and friends;
* If you think you may be depressed, seek treatment; - Talk to your
doctor about joining cardiac rehabilitation programs, many of which
offer counselling and support groups;
* Get regular exercise as directed by your doctor as exercise not
only boosts heart health, it may also help relieve anxiety and
* Try to resume the activities and hobbies you enjoyed before the
heart attack so as to keep you in a positive mood.
Doctors ignore sleep problems of elderly
Doctors rarely note the sleep problems of older patients, although
two-thirds of them report these complaints, according to a new study.
Researchers at the U.S. Northwestern University studied 1,503
patients aged 60 and older who visited their primary-care doctors.
They surveyed the patients about sleep problems and found that 69
percent of the patients had at least one sleep complaint, and 40 percent
had two or more. Forty five percent of the patients said they had
"difficulty falling asleep, staying asleep, or being able to sleep."
The study, published in a recent issue of the American Journal of
Geriatric Psychiatry, said despite the high rate of sleep complaints
among the patients, a sleep complaint was only reported by the doctor in
the patient's chart 19 percent of the time, even when the patient
indicated sleep problems in all five sleep questions on the survey.
This is important, since previous research has linked sleep disorders
in the elderly to poorer mental and physical health and quality of life,
the study noted.
"A doctor may not think that it's very important to ask the patient
about sleep. We (the researchers) hypothesize that doctors think that
sleep problems are a normal part of aging, and there's not much they can
do about it," study author Kathryn Reid, a research assistant professor
of neurology at Northwestern's Feinberg School of Medicine, said.
But while some sleep problems, including a reduction in deep sleep,
tend to occur with age, sleep disturbances are not an inevitable part of
aging. In fact, a recent study found that among older people with
exceptionally good health, only 1 percent had sleep difficulties.
"Now, a lot of studies show that not getting enough sleep can lower
your metabolic function; be associated with cardiovascular problems,
cancer and breast cancer in women; and increase our mortality.
Sleep deprivation also increases your sensitivity to pain," Reid
said. Treatment options for sleep disorders may include meditation,
exercise and bright light or evening activity. Climate crisis: Killer
diseases spread North Health officials fear global warming will bring
more tropical illnesses, such as West Nile, here to Canada.