The World Heart Federation calls on all countries to set a target year to end tobacco use

At the Tobacco End Game Conference in New Delhi, India this week the World Heart Federation (WHF) signalled to all countries worldwide to set a target year to end tobacco use in their country. Ending tobacco use implies reducing population smoking levels to five percent or below.

Some countries have already taken the lead and have announced their “target year” to reduce tobacco consumption. These include Finland (2030), Scotland (2034), New Zealand (2025) as well as a few Pacific Island States (2025).  

The Risks

Previous Blogs, “Raising Awareness for Lung Cancer” and “Smoking – a big turn off”  have highlighted the negative impacts of smoking on health, and the evidence continues to affirm that tobacco use is one of the main risk factors for heart disease and is the cause of millions of premature deaths each year worldwide.

Smoking is estimated to cause nearly ten percent of cardiovascular disease (CVD) and is also the second leading cause of CVD after high blood pressure. Further more, it is not just smokers who bear the consequences of tobacco smoke, passive smokers are also placed under unnecessary risk.

Figures indicate that nearly six million people die from tobacco use or exposure to second hand smoke worldwide, every year. By 2030 is it believed that tobacco-related deaths will increase to over eight million deaths a year.

With strong evidence available to the public on the adverse effects of smoking and the efforts to promote these facts, the statistics on tobacco related deaths remain shocking!  

Thus, important questions arise about what else we need to be doing to reduce smoking in adults and prevent children from starting.

Could further changes in marketing be the answer?

Over the past decades the UK has witnessed some significant changes to how tobacco is advertised and this began in the early 1990’s but took greater affect after the millennium.  The 1990 and 1996 Broadcasting Acts prohibited tobacco marketing on broadcast media (television and radio). However, it was the Tobacco Advertising and Promotion Act 2002 (TAPA) that banned most forms of tobacco advertising. This included a ban on print media and billboard advertising (2003) and advertising at the point of sale (2004).

As the UK is a Party of the Framework Convention for Tobacco Control (FCTC) they were bound by agreement to implement the framework into national policy.  The drive to improve population health coupled with the requirement to integrate further restrictions on tobacco advertising, saw a new national tobacco control strategy emerge in 2008 by the Labour Government and later reinforced by the Coalition Government in 2011. The consultation included a ban on the display of tobacco in shops and a ban on tobacco vending machines (2011) both of which were included in the Health Bill.

Since April 2012 it has become illegal to display tobacco products at the point of sale in large stores and this ban will come into force in smaller stores from 2015. Although in 2010 the Coalition government agreed to review the evidence for plain packaging as part of its national strategy, this has still not come into affect, despite pressing evidence that branding of tobacco packets and higher consumption rates exists. Read the RSPH press release here on our disappointment of not introducing standardised packaging on tobacco products.

“Research shows that Point of Sale (PoS) display has a direct impact on young people’s smoking. In 2006, almost half (46%) of UK teenagers were aware of tobacco display at PoS and those professing an intention to smoke were more likely to recall brands that they had seen at the point of sale.”

Tobacco companies invest large amounts of resources in branding their products and making them appear as attractive as possible. They know that brand imagery is much more important to younger age groups, thus standardised packaging would reduce brand appeal and reduce the inclination to smoke.

Next Steps

Clearly, measures have been made to reduce smoking in the UK, tighter restrictions on tobacco advertisement and the implementation of the smoking ban in public spaces 2007/2008 have sought to reduce appeal for smoking. However, there remains more to be done to ensure we are able to align ourselves with the World Heart Federations’ aim to reduce tobacco use below 5% and prevent thousands of avoidable deaths a year (in England the current ambition is to reduce smoking prevalence to 18.5% or less by 2015; to 12% or less among 15 year olds by 2015). 

The World Heart Federation President Professor K Srinath Reddy said: "There is no hiding from the deadly effects of tobacco on heart health....There are many countries across all incomes making great strides in tobacco control and it should be possible for each of these nations to further bolster their tobacco control efforts by setting themselves a target year for reducing tobacco use below 5%. So the World Heart Federation would hope to see these countries, followed by those around the world, following the brave lead set by the countries that have announced target dates."

Visit RSPH Training Solutions to see programmes and courses that can give you the confidence and skills to help people make key lifestyle choices to improve their health.

For further information on UK regulations click here to read the ASH Briefing: UK Tobacco Control Policy and Expenditure.

For more information on the negative effects of tobacco use and how to quit please click here and NHS Choices website. 

Raising Awareness for Lung Cancer

This November in the UK is Lung Cancer Awareness Month aimed at raising awareness of the signs and symptoms of the disease, to encourage people at risk to visit their GP’s and seek medical help.

The Facts

Worldwide, lung cancer is the most common cancer in the world with an estimated 1.61 million new cases diagnosed in 2008.  With the highest rates of lung cancer for men in Central and Eastern Europe, and for women in Northern America.

In the UK, lung cancer is the second most common cancer diagnosed after breast cancer.  Around 41, 000 people were diagnosed with lung cancer in 2008, that is, 112 people every day.

The Survival Rates

As with most cancers, the earlier the diagnosis, the higher the chance of survival.  Currently however, more than two-thirds of lung cancers are diagnosed at a late stage and so survival rates for these patients remain lower.

Overall, the statistics show that less than 10 percent of lung cancer patients survive the disease for at least five years after diagnosis.

Death From Lung Cancer

Worldwide around 1.38 million people died from lung cancer in 2008 and in the European Union more than a quarter of a million people died in the same year.

In the UK, lung cancer has been identified as the most common cause of cancer death, resulting in more than 1 in 5 deaths.

The latest figures from 2008, highlight that around 35,260 people died from lung cancer, that is 95 people every day. 

Causes of Lung Cancer

It has long been established that tobacco and cancer are strongly linked.  Evidence has revealed that smoking causes 90 percent of lung cancer deaths.  The recent figures show that in Britain 1 in 5 adults smoke cigarettes, that is 9.5 million people.

Living with someone who smokes, also increases the risk of lung cancer in non smokers by a quarter and it is estimated that exposure to passive smoke in the home causes around 11,000 deaths every year in the UK.

It has also been recognised that lung cancer can also be caused by heavy exposure to industrial carcinogens and numerous air pollutants, but this accounts for a small proportion of cases.

Despite the known facts and the strong correlation between lung cancer and tobacco, why is it that so many people continue to smoke?  Why do people ignore the health signs and fail to seek medical support? 

We can all help to reduce the risk of lung cancer and potentially save ourselves, a loved one or someone we know.  This month is dedicated to raising awareness about lung cancer and ensuring that people are educated about the disease and know where to find and access help.

For further information on supporting the campaign and raising awareness on lung cancer please click here 

For information on symptoms and lung cancer please visit the NHS Choices website by clicking here  

For information on quitting smoking click here

Shish' of a Time? The Health Implications of Waterpipe Smoking

“Every human being is the author of his own health or disease” Buddha

Smoking through a waterpipe, otherwise referred to as shisha, attracted attention in this weeks BBC health news: 'Shisha pipe smoking among young 'rising in Leicester'. The article expressed concern over the recent increase in Shisha users and once again challenged the misconception that Shisha smoking is safer than cigarettes. There is clearly a need for more to be done to get the health message across that smoking, in any form, is dangerous.

Over the past two decades tobacco smoking using waterpipes has become a massively popular and fashionable pastime among younger people. An activity normally shared with friends in homes, restaurants and cafes, shisha smoking has become socially accepted and widely regarded as a relaxing and an enjoyable experience. However, the rise in shisha smokers gives cause for concern because of the multiple associated health risks, of which people are either unaware or choose to ignore.  A report conducted in 2006 by the World Health Organisation (WHO) entitled, "Tobacco use in Shisha: Studies on waterpipe smoking in Egypt", claims that waterpipe smoking represents both a "modern renaissance of an old public health threat and the emergence of a new tobacco epidemic". 

Tobacco consumption has been linked to a high death rate worldwide (5 million deaths each year) and is considered to be the second major cause of death in the world that is completely preventable. With this statistic in mind, it raises the question; why do so many continue to smoke? 

The studies carried about by the WHO examining the effects of waterpipe smoking have all concluded that it is hazardous for our health. However, its growing popularity as a social, glamorous and harmless activity means much of the research has been overshadowed by people's misconceptions. Shisha smokers are thus left ill-informed and ignorant of the risks.

Dr Alan Shidaheh of the American University in Beirut says; "The historical lack of evidence has unfortunately allowed many Shisha users to believe that the practice was safe, or at least safer than other forms of tobacco use. We have recently learned otherwise.”

The History

The 2005 WHO Study Group on Tobacco Product Regulation "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions" found that shisha has been smoked by people in Africa and Asia for at least four centuries. It is believed that a waterpipe was invented in India by a physician named Hakim Abul Fath who suggested that tobacco would be rendered less harmful if smoke was passed through a small receptacle of water. Thus, this widespread and unsubstantiated belief held by shisha users today - that the practice is safe - is as old as the waterpipe itself. 

Since the 1990s waterpipe smoking has become increasingly popular and is no longer dominated by older males in Middle Eastern countries.  Shisha smoking appears to have spread to new populations such as college students and young persons in the United States, UK and other European countries. 

Health Awareness - Battling the misconception

Although waterpipe smoking has not been studied as intensively as cigarette smoking, the preliminary research claims that it is associated with many of the same risks as cigarettes, and may in fact involve unique health risks.

The evidence affirms that the smoke that emerges from a waterpipe contains numerous toxicants which are responsible for causing oral cavity cancer, heart disease, tuberculosis and respiratory diseases. 

Waterpipe smoking, compared to cigarettes, is characterised by less frequent exposure (one to four sessions per day) but with a much more intense exposure per session, which can typically vary between 15 and 90 minutes. The uptake of tobacco nicotine is equivalent to 2-12 cigarettes per portion of tobacco used (hagar) and one person usually smokes several hagar per session. This translates into a nicotine intake equivalent to more than one pack of cigarettes per session. However, the waterpipe produces more smoke than cigarette smoking and thus overall smoke exposure could be as much as 100-200 cigarettes per session.

In addition, the temperature of burning tobacco in waterpipes is much lower than that in cigarettes, and the force needed to pull air through the high resistance of the water pathway, causes the smoke to be inhaled very deeply into the lungs. This is likely to cause patterns of cell injury in the oral and respiratory tracts. Smoking has also been shown to cause an accelerated decline in lung function.    

While it has been noted that the water does absorb some of the nicotine, waterpipe smokers can be exposed to a sufficient dose of this drug to cause addiction. Nicotine level intake in a standard session is similar to a single cigarette, yet the tar intake is 20 times greater. It is likely that the reduced concentration of nicotine in waterpipe smoke may result in smokers inhaling higher amounts of smoke and thus exposing themselves to higher levels of cancer-causing chemicals, alongside higher levels of arsenic, chromium and lead, as well as hazardous gases such as carbon monoxide.   

Professor Mostafa Mohamed, Professor of Community Medicine in Cairo and author of the 2006 WHO report stated that, “Heat sources that are commonly used in Shisha pipes to burn the tobacco are likely to increase the health risks because when they burn they produce their own toxins".

The report also points out that waterpipe smokers are exposed to a large number of genotoxicants via ingestion, respiration or absorption through the skin. Tobacco has been linked to mutations in the p53 tumour suppressor gene which leads to uncontrolled cell division and is found in over 50% of all human tumours.   

The study found that people who were waterpipe smokers were significantly more prone to develop hypertension and have higher blood pressure than non-smokers. The report also identified that waterpipe smokers are prone to repeated infections due to lowered immunity, and the habit of sharing waterpipes heightened the chance of contracting communicable diseases such as tuberculosis and hepatitis. There was ample evidence which showed that people who smoked were more likely to experience sleep disturbance. Thus the perception that smoking will help them relax and elevate their mood is, in fact, incorrect. 

The report highlighted that although further research needs to be done, there is strong viable evidence that exposure to waterpipe smoking is as harmful as the exposure to cigarette smoking, if not more so. 

Professor Mohamed affirmed that "Waterpipe smoking is growing epidemic. Any intervention programme to prevent this new threat must disabuse the public notion that waterpipes are less risky than cigarettes."  

What can we do?  

Changing our behaviour and habits is hard. Many people are reluctant to give up something they enjoy, particularly if its a social activity with friends. Hence it is easier to ignore the facts and live for the "now" rather than thinking about the consequences of our actions or wrongfully assuming that "it won't happen to me". 

We have to remember that our health is paramount and making sensible choices now can prevent unnecessary suffering later. 

Both the studies by the WHO point out that despite the strong evidence of health risks associated with waterpipe smoking, there remains few published studies on its negative effects. This has created an ambivalent and misguided picture of Shisha smoking.  More needs to be done to ensure people are educated about the dangers so that its reputation as a harmless and glamorous pastime gets demoted to unfashionable and unsafe!   

  

Education of health professionals, regulators and the public at large is urgently needed to make information more available. The WHO researchers stressed, “Waterpipes should be subjected to the same regulations as cigarettes and other tobacco products and should contain health warnings". 

RSPH  

The Royal Society for Public Health offer a course on Understanding Health Improvement Level 2 designed to provide knowledge and understanding of the benefits of good health and well being, and of the barriers to making a change of lifestyle.  For further information please contact Gina Mohajer. 

       

Smoking - The Main Reason Why Men Die Sooner Than Women

In a report published by Tobacco Control "Contribution of smoking-related and alcohol related deaths to the gender gap in mortality: Evidence from 30 European countries" found that smoking continues to be the most important cause for gender differences in mortality across Europe.  

Since the 1990's emerging evidence has revealed that women outlive men in all countries of the world.  Historical records demonstrate that in England, Wales and some of the Nordic countries, the life expectancy of women has exceeded that of men since the mid to late 18th Century.  Currently in the UK women are estimated to live four years longer than men.  There has been a great deal of speculation as to why this appears to be the case.  Many expects claim that simple biology or the fact that women seek medical help more readily than men are the reasons for the disparity in life expectancy.

However, as the report discovers, smoking is the main cause followed by alcohol, which accounts for 20 percent of the difference. 

The report which studied the data extracted from the World Health Organization database, looked at thirty European countries.  It found that in all countries death from all causes were higher for men than for women.  However, the report also noted that there continues to be a considerable variation in the extent of gender difference in contemporary Europe.  The gender gap in all-cause death rates varied from 188 excess deaths per 100,000 in Iceland and the UK, to over 800 in Ukraine and Lithuania.    

Despite the variations, the researchers discovered that smoking-related deaths alone contributed to around 40 to 60 percent of the gender gap in all countries, excluding Denmark, France and Portugal where it is considerably lower, and Malta where it is higher at over 70 percent. 
The data demonstrated that in the UK, smoking-related diseases such as lung cancer and heart disease caused 60 percent of the excess male deaths. 

The researchers highlighted that, "It is no surprise that two of the most important health behaviours, smoking and hazardous drinking continue to account for substantial proportions of the gender gap in mortality because health behaviours have long been a powerful way of portraying gendered identities." 

Thus the report makes clear that there is an "ongoing need for public health measures to reduce health damaging behaviours". 

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said: "It is never too late to give up smoking so it's important we invest in support services to help people quit the habit as well as ensuring our young people don't start smoking in the first place.”

Men's Health Week 13 - 19 June
-To Raise awareness of preventable health problems among men and boys -

In light of Men's Health Week this year, the RSPH will be hosting a one day Men's Health course on May 13th.  The purpose of the event is to facilitate men’s access to information, empower them to be more aware and access health leisure services, in order to improve key lifestyle behaviours.
For further information or to book onto the course please contact Nicolette Smith.