Cigarette and beedi smoking negatively impact your healthspan and lifespan.
Thankfully, cigarette smoking is waning across the world, due to a combination of laws preventing smoking in public places and offices, the ever-rising cost of cigarettes due to taxation, the increasing awareness among people of the ill effects of tobacco smoking and the availability of less harmful options, such as e-cigarettes.
And yet, people, especially the young, do start smoking, usually due to peer pressure. Once begun, it becomes difficult to stop. With tobacco smoking, it is better to have never started than to try and quit after starting.
So let’s just look at some simple questions related to cigarette smoking.
Why is cigarette smoking harmful?
Tobacco and the other substances used in cigarettes cause harm to the body and lead to increased mortality and morbidity.
a. Increased mortality. Smokers die three times more than non-smokers and lose approximately one decade (1) of their lifespan. This is because of cancers, chronic lung damage, increased cardiovascular risk (heart attacks, strokes) and overall reduced immunity.
b. Increased morbidity. This means a reduced health span and living with a disability. While most people with cancers typically die within five years of detection, those with chronic lung problems and heart and brain diseases often continue to pull on, living diminished lives, a burden to themselves and others.
What is the burden of disease caused by cigarette smoking in India?
There are around 1.2 to 1.3 million (12 to 13 lakh) deaths in India every year attributable to tobacco smoking. Almost 10% of all adults in India smoke tobacco, though this is down from 15% compared to the earlier decade (2). The poor smoke more, starting at a younger age along with a much lower quit rate. The North-Eastern and Eastern states have much higher rates of smoking, Tripura leading the pack, while Kolkata earns that dubious distinction when it comes to metros.
What is the collateral harm of cigarette smoking?
Globally, secondhand smoke from 52 smokers leads to one death in a non-smoker [3], with risks that are similar to those in smokers, with additional harm to babies, the young and pregnant women.
The other collateral damage is the expense incurred due to illnesses caused by smoking. India spends almost 1% of its GDP on costs related to tobacco use. If Rs 100 is the tax amount that the Government gets from the sale of tobacco (in all forms), Rs. 816 is the cost incurred, making this a negative-sum game that actually drains the treasury [4]. At an individual level, tobacco-related illness leads to catastrophic expenditure and the poor, who smoke more and also often have no insurance, bear a larger economic burden and slide further into poverty.
How does one stop smoking?
It is not easy. Government bodies have poured billions of dollars into finding solutions. While laws have made it difficult for people to smoke, reducing the number of cigarettes smoked in a day, eventual cessation needs personal motivation. It helps if you move away from environments that encourage smoking, such as large stadium events, pubs and bars and friends and colleagues who smoke. Nicotine is addictive, and like alcohol, some people just find it impossible to stop and need a combination of nicotine analogues or replacements with counselling.
As I mentioned earlier, it is better to not start than to try to quit after having started.
Do vaping/e-cigarette use/nicotine patches work as less harmful alternatives?
Yes.
Nicotine per se is not carcinogenic. It is the other substances in tobacco smoke that cause cancer. This has led to nicotine-based approaches to wean smokers away from cigarettes with nicotine replacement therapy (NRT) in the form of nicotine patches, nicotine chewing gum, and such. Nicotine smoking delivery systems also called e-cigarettes (ECs) are another solution to shift people away from a highly carcinogenic regular cigarette to a non or minimally carcinogenic e-cigarette.
While the government of India has banned the sale of ECs, with a white paper from ICMR in 2019 [5] explaining the reasons, new data shows that ECs do help smokers stop smoking and the harm from ECs is far less than previously perceived [6]. It is perhaps time for the government to re-examine its stand on ECs and let them compete with cigarettes in the marketplace.
Does it matter when one stops smoking?
The earlier the better. However, there is no upper limit. While smokers have three times the risk of early death compared to those who don’t smoke, people who stop smoking before the age of 45 drop their risk by 90%, while those who stop between the ages of 45 and 64, drop their risk by 66% [7].
Smoking has always been portrayed as a “cool” thing to do, especially in movies and advertisements of the prior millennium. The harms of smoking however far outstrip any apparent benefit (there is none) and it is clear now that smoking, both at an individual level and for society at large leads to significant health risks and challenges.
For a long health span, don’t start smoking. If you are smoking, stop– it doesn’t matter at what age. The best time to stop is when you stop.
Footnotes
1. Jha P. The hazards of smoking and the benefits of cessation: a critical summation of the epidemiological evidence in high-income countries. Elife. 2020 Mar 24;9:e49979.
2. Lahoti S, Dixit P. Declining trend of smoking and smokeless tobacco in India: A decomposition analysis. PLoS One. 2021 Feb 25;16(2):e0247226.
3. Yousuf H et al. Estimated Worldwide Mortality Attributed to Secondhand Tobacco Smoke Exposure, 1990-2016. JAMA Netw Open. 2020 Mar 2;3(3):e201177
4. John RM et al. Economic Costs of Diseases and Deaths Attributable to Tobacco Use in India, 2017-2018. Nicotine Tob Res. 2021 Jan 22;23(2):294-301
6. Auer R et al. Electronic Nicotine-Delivery Systems for Smoking Cessation. N Engl J Med. 2024 Feb 15;390(7):601-610. doi: 10.1056/NEJMoa2308815.
7. Thomson B et al. Association Between Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex Among US Adults. JAMA Netw Open. 2022 Oct 3;5(10):e2231480.
Dr Bhavin Jankharia’s new book “Atmasvasth” available online, dives deeper into this concept. He can provide references for all statements of fact and can be reached at bhavin.mm@gmail.com