The single biggest cause of death by far in the world each year is cigarette smoking. For many years, public policy aimed at cigarette smoking relied almost entirely on public education. This has certainly not solved the problem, although it has had a limited effect.
Increasingly, more and more active interventions are being made against smoking, e.g. banning of advertising in certain media, prohibition of smoking in certain public places etc.
Also, in the developed world, cigarette smoking is becoming more and more socially unacceptable.
Regular cigarette smoking is an addiction. However, not nearly enough is known about either the psychology or the pharmacology of addictive behaviour. Much work remains to be done before addictive behaviour is properly understood, and this knowledge may take a long time to acquire. In the meantime society must continue to strive to solve the problem of cigarette smoking and other damaging addictive behaviours.
The smoking of cigarettes places a massive burden on human health each year. About 2.5 million people die each year from all diseases caused by tobacco. The World Health Organisation has estimated that the number of deaths due to tobacco is equivalent to that which would result from 20 jumbo jets crashing every day!
Every year in Ireland there are approximately 7,500 deaths from cancer. Twenty to 25 per cent of these deaths are from lung cancer, mainly attributable to cigarette smoking. Another effect of smoking is to make the smoker more susceptible to damage from other inhaled pollutants such as asbestos, compared to the non-smoker. It is also known that smokers are more at risk from the ubiquitous natural radioactive gas, radon, than are non-smokers.
Furthermore, large numbers of non-smokers suffer something of an increased risk of lung cancer, heart disease and other related ailments through passive smoking. Inhaled tobacco smoke contains hundreds of toxic substances and therefore almost all smokers suffer from some form of tobacco-induced disorder. No one can be resistant or immune to all of these substances.
A large-scale Japanese study, followed up over 17 years, showed that not only is the cigarette a powerful cancer causing agent, but it also speeds up the ageing process. The ageing of tobacco smokers was estimated to be increased by five years on average among adults.
The global environment is also degraded by cigarette smoke. The World Health Organisation has said tobacco cultivation causes soil degradation and pollution by pesticides. Tobacco is one of the main causes of deforestation because tobacco leaf must be dried by locally available fuel.
Twelve per cent of trees cut down each year are used as fuel for curing tobacco. Because of this, smoking makes an important contribution to enhancing the Greenhouse Effect.
Cigarette smoking is so closely related to cancer of the lung, larynx (voice box) and bladder that there can be no reasonable doubt that they are cause and effect.
If there was no cigarette smoking, the total number of cancers would fall by about one-third. The most obvious method for avoiding cancer is therefore never to smoke, and, if you have started to smoke, to stop. If you do smoke, your risk of contracting lung cancer increases roughly in direct proportion to the number of cigarettes you smoke per day.
Cigarette smoking became really popular during the 1940s and 1950s. At that time it wasn't really considered to be a harmful activity and about 55 per cent of all adults smoked cigarettes. The connection between cigarettes and disease was then established, following which large government-sponsored programmes of public education on the dangers of tobacco were launched. Today nobody doubts that smoking cigarettes is a deadly pastime but, nevertheless, 34 per cent of adults persist in smoking.
Even more depressing is the high proportion of youngsters who take up smoking - in Ireland 30 per cent of teenagers smoke cigarettes.
Public education on its own has clearly not solved the smoking problem. Amazingly, in spite of the obvious toxicity of the product, cigarette manufacturers are still allowed to advertise in the printed media. Cigarette manufacturers also supplement somewhat flagging sales at home by exporting to Third World countries where cigarette smoking is booming.
An established cigarette smoker has an addictive habit of some potency. Some studies claim that the smoking habit is as addictive as cocaine, although I find that difficult to accept. It can be difficult to stop smoking once the habit is well formed. Nevertheless, it is not too difficult to stop smoking. Ordinary people do it every day. I stopped smoking many years ago and found the withdrawal only mildly disagreeable.
If you are currently smoking and find that you either cannot or do not want to stop the habit, then remember that you will greatly improve your chances of retaining good health by drastically cutting down on the number of cigarettes you smoke per day.
Instead of lighting up every time the idea pops into your head, practise postponing the pleasure and enjoying the anticipation. With only mild efforts and self-discipline, most heavy smokers could reduce to less than 10 per day, while moderate smokers could make do with two or three cigarettes per day.
It is to be hoped that when sufficient is learned about the psychology and pharmacology of addictive behaviour simple foolproof methods can be devised to effectively wean people off the smoking habit.
In the meantime what is to be done? Banning cigarettes would be worse than useless. The still reasonably high degree of social acceptability is a major factor in maintaining smoking at its present level. Social acceptability is declining fairly steadily, however, and this development represents a very powerful form of attack on the smoking habit.
Casual general observation in recent years has convinced me that far more young women are smoking than young men. This was confirmed by a study carried out by UCG and reported on July 11th, 1997, in The Irish Times. Young fashion-conscious females make up the highest percentage of smokers among Irish adults. It isn't hard to predict the motivation that causes this behaviour. Keeping weight down and having a `cool' image figures prominently on the agenda. All of these young people know that smoking is bad for their health, but they ignore this fact.
The type of public education we have had about smoking has only been of limited effectiveness. It is time for a new approach.
William Reville is a senior lecturer in Biochemistry at UCC