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On March 20-24, 2012 the 13th World Conference on Tobacco or Health will take place in Singapore, which is the premier, international conference on tobacco control. It is organized once every 3 years, and involves thousands of delegates from more than 100 countries. This year’s theme is “Towards a Tobacco-Free World: Planning Globally, Acting Locally”. The leaders of the conference declared: “We recognize that concerted efforts are critical in the fight against tobacco” (WCTOH website, 2012). Smoking has become one of the most burning issues of public health and all possible efforts should be taken to convince smokers to quit this harmful habit. Smoking was chosen as the topic for this paper, because it is no longer the problem of one country, but the problem of the whole world. This paper overviews the scale of the issue, the measures applied globally and possible recommendations for further activity.
Tobacco is the second leading cause of mortality in the world. Among the preventable causes of death, tobacco smoking takes the first place in the world, however from 3.5 to 5.4 million people die each year due to health problems caused by smoking. In developed countries (e.g. USA) life expectancy among smokers is on the average 13 years shorter than among non-smokers. If current trends in smoking persist, in 2030 tobacco will lead to an annual 10 million deaths. Half of the people that smoke today (about 650 million people) will be eventually killed by tobacco. According to World Health Organization, on the average, one person dies every six seconds of a disease related to tobacco smoking (Quitsmoking.about.com website, 2012).
Since the inhaled smoke burns the mucous membranes and contains a large amount of harmful substances (benzpyrene, nitrosamines, carbon monoxide, soot, etc.), smoking (regardless of the product) increases the risk of developing of lung, mouth and respiratory tract cancer, chronic obstructive pulmonary disease, mental health problems, cardiovascular and other diseases. The researchers noted a correlation of smoking with impotence. Currently, the most common long-term consequences of smoking are the occurrence of COPD and the development of various tumors in the respiratory system; 90% of cases of lung cancer are associated with smoking. Smoking or passive inhalation of tobacco smoke can cause infertility in women. Atrophy and demyelination (destruction of the white matter of the brain and spinal cord) with multiple sclerosis is more pronounced in patients who have smoked for at least 6 months during their lifetime compared to patients who have never smoked.
Addiction to smoking can be both psychological and physical. Having psychological addiction, people reach for a cigarette when smoking in the company or under stress and nervous tension to stimulate mental activity. A certain habit is created such as a ritual of smoking without which man cannot live a full life. With physical addiction the nicotine dose is required by the body so much that all the attention is focused on the search for cigarettes; the idea of smoking becomes so intrusive that the majority of other needs (work, satisfaction of hunger, rest, sleep, etc.) go to the background. It becomes impossible to concentrate on anything other than cigarettes. Frequent symptoms are apathy and unwillingness to do anything.
Nicotine is one of the substances with strong addictive potential. During smoking most of the nicotine is pyrolyzed, but even the remaining small amount is enough to cause physical and psychological effects, including formation of chemical addiction. Investigations show that nicotine is more physically addictive than caffeine and marijuana, but less than alcohol, cocaine and heroin. But nicotine is more than other substances likely to cause psychological addiction (even counting alcohol, the strongest agent of somatic action, which can cause severe forms of mental illness).
Most smokers smoke regularly. Nicotine dependence in adolescents occurs within five months after the beginning of smoking. Addiction develops incredibly quickly: among those people who have symptoms of addiction 10% developed it in two days after the first cigarette and 25-35% during the next month. Several large-scale studies of youth show that 25% of the symptoms appear after smoking of one to four cigarettes (Quitsmoking.about.com website, 2012).
The reason for the fight against smoking is a violation of the inalienable rights of nonsmokers to the highest attainable standard of health. This right is recognized by Article 12 of the UN International Covenant on Economic, Social and Cultural Rights, Convention on the Rights of the Child, Preamble of the World Health Organization Charter.
On May 21, 2003 World Health Organization adopted a document entitled “WHO Framework Convention on Tobacco Control”. By the present moment it was signed by 168 states and 151 states ratified it. The Convention is not an instrument of direct action, but only determines the strategy of government regulation of the tobacco industry.
Since that time in many countries smoking in public places has been prohibited by law. In November 2004, Bhutan became the first country which prohibited the sale of tobacco and tobacco products. Tobacco products imported for personal use are subject to a 100% duty. Today, smoking is prohibited in public places in many countries of the world.
Tobacco producers are often involved in funding and carrying out programs that, according to them, prevent smoking among children and adolescents, positioning tobacco as a product for adults. According to anti-smoking organizations, such programs are at best useless and at worst acts as a hidden propaganda of smoking. Thus, the very idea of cigarettes as a product for adults can encourage young people, who want to grow up quickly, to smoke. Such programs include activities ineffective to combat teenage smoking, but creating the appearance of such combat (educational programs, training of students’ conscious choice, programs for tobacco vendors, etc.). For example, when creating anti-tobacco campaign materials for teens they use only the images of students (mostly causing irritation for teenagers), and never use images of famous athletes that are engaged in advertising of tobacco for adults. Trainings for salesmen teaching them to refuse to sell cigarettes to adolescents have no practical significance, because in reality most sellers are selling cigarettes to minors knowing that otherwise it will be done by competitors.
These programs allow tobacco companies to improve their image, to conduct marketing of their products among adolescents and ruin really effective measures against smoking (e.g., a complete ban on smoking in schools and at locations for both children and adults, or a total ban on tobacco advertising).
For a long time antismoking efforts at both state and national levels have applied numerous media campaigns that concern adolescents and adults. As a matter of fact, these campaigns (e.g., the American Legacy Foundation’s “truth”) did contribute to a decrease in the adolescent smoking rate, but the rate still is unacceptably high (about 20% according to the US Department of Health and Human Services).
As a matter of fact, enactment of smoke-free legislation is the only measure which has obvious positive impact. According to Robert Friis (2011), the rates of smoking dropped in the U.S. and other countries where smoke-free legislation was approved. Thus, the “prevalence of smoking in Ireland dropped from 27.0% prior to the bans to 23.6% four years after the bans and continues to decline at a steady rate” (p. 58).
A complete prohibition of tobacco products is a frequently pronounced idea. Though it may seem impossible, apparently, this is the only way to solve this issue.