UP IN SMOKE

Smoking is injurious to health” is a very familiar warning we have been exposed to for ages. It is widely mentioned on cigarette packs along with dreadful pictorial warnings, posters, leaflets and even in the literature that talks about the negative impacts of smoking or consuming tobacco in any form. Showing a person smoking in a TV play or a movie is also prohibited in many countries and it is suggested that if it is an unavoidable demand of the scene the same warning must also appear on the screen. Furthermore, advertising of cigarettes in any form is prohibited in the country and there are strict rules and regulations aimed at stemming their use.

Despite all this, it is a pity that the goal of bringing down tobacco use in the country has not been met. The cigarette manufacturing companies, especially the multinational ones, are growing leaps and bounds and the government seems addicted to the taxes they pay. This is a matter of embarrassment for the country at the international level as well because Pakistan has signed the World Health Organization’s (WHO’s) Framework Convention on Tobacco Control (FCTC). Under the terms of this convention, Pakistan is supposed to regularly increase taxes on cigarettes so that they become expensive and out of reach of people but somehow the industry uses its influence and gets tax relief in the annual budget.

As per the figure of the country’s federal health ministry, the annual financial burden of the diseases caused by tobacco consumption is around Rs 192 billion – much higher than the taxes paid by the tobacco industry. No doubt, one of the major reasons for failure on this count is that the implementation part of anti-tobacco laws is weak and the tobacco industry is too powerful and influential.

Researches have shown that women in Pakistan are taking up smoking but they aren’t as visible as men because of the social taboos. A girl or a woman seen smoking in public is charged with ‘indecency’. Therefore, it is believed that women smoke mostly when they aren’t in public places.

Tobacco consumption harms all alike but most of the times it is the men who are in focus. Latest researches and surveys have shown that women in Pakistan are fast taking up smoking but they are not as visible as men because of the social taboos associated with it. A girl or a woman seen smoking in public is charged with indecency and many a time her character is also brought to question. Therefore, it is believed that women smoke mostly when they are not in public places. Today, women can be seen smoking in cafes, ice cream parlours, sheesha bars, tea houses etc that remain open late into night, private parties and so on. Being adults, they cannot be stopped from doing this if they smoke in designated areas as per the laws in place.

This article largely highlights the health hazards that women face due to tobacco use and points out that in certain cases women are more vulnerable to different diseases and health complications than men. Interestingly, they are sometimes vulnerable even if they are not smoking cigarettes but exposed to the smoke exhaled by smokers, which is called passive smoking.

So to start with, we talk about the dangers of inhaling secondhand smoke which many women do as the male members of their families are regular smokers. When the male members smoke, the females are exposed to hazardous particles they exhale. These women can’t often resist because men are mostly in a position of command and leaving the premises in protest is not easy. Dr Ziauddin Islam, Incharge, Tobacco Control Cell (TCC) at the Federal Ministry of Health shares with You! that when a smoker exhales smoke he/she retains only 15 per cent of the harmful particles and releases the remaining 85 per cent in the air. These 85 per cent harmful particles are enough to cause havoc to passive smokers’ health, many of whom are women. Besides this, he says, there is third-hand smoke as well in the form of traces of hazardous chemicals released during smoking on clothes, surfaces, bed sheets, doorknobs and so on.

The findings of a WHO study need to be mentioned here, which state that “even brief exposure to secondhand smoke can have an immediate effect on the cardiovascular system, causing blood platelets to stick together, damage to blood vessel walls, and other cardiovascular effects which increase the risk of heart attack. Irritants in second-hand smoke, when breathed in, can trigger asthma attacks in asthmatic people even upon brief exposure.”

Besides, mothers who smoke with young children or infants close to them put their health and life in danger. The same WHO study states that children, whose bodies are still developing, are especially sensitive to the toxicants in second-hand smoke. It adds, children exposed to secondhand smoke are at a 50 per cent to 100 per cent higher risk of acute respiratory illness and are more likely to suffer from asthma, middle ear infections, behavioural disorders, and sudden infant death syndrome.

No doubt, the female smokers face almost all the risks that male smokers face but expecting mothers pass these on to the babies in their wombs. There is sufficient medical evidence that smoking in pregnancy can result in complications such as miscarriage, stillbirth, premature birth, and low birth weight which exposes the child to chronic diseases later in life.

WHO warns that smoking during pregnancy “increases the risk of developmental conditions such as cleft lip, limb reduction, or congenital heart defects. Heavy smoking during pregnancy can result in the child being born with nicotine dependence. Paternal smoking can also affect child development, as it affects sperm quality and can increase the child’s risk of suffering from postnatal health problems such as childhood cancer, genetic disorders, sudden infant death syndrome, and physical malformations. Despite these risks, smoking in pregnancy remains the leading cause of poor pregnancy outcome and prenatal death in the European Region.”

Afshan Bajwa, Chairperson, National Commission for the Rights of the Child, says she has observed during her visits to schools that girls and boys are equally addicted to smoking. The situation, she says, is worse at elite private schools where the students think that smoking is cool and something glamorous. Afshan says if there are children who do not follow others and refrain from smoking, they face immense peer pressure and become outcasts. She tells You! that she has often seen male and female students smoking cigarettes in upscale restaurants while in their uniforms which is very disturbing and must be discouraged. Her point is that if girls are not seen smoking openly, it does not mean that female smokers do not exist in large numbers. What is worrisome is that in elite class smoking by girls is not even considered a bad habit, she adds.

Amid this alarming situation, a new menace has raised its head which is leading to introduction of nicotine among people many of who are not earlier exposed to it, says Malik Imran from Tobacco Free Kids (TFK). He shares that a new flavoured oral nicotine pouch, introduced by the British American Tobacco in Pakistan has been widely advertised and made available to youth across the country. The product comes with a disclaimer that it is only sold to consumers above 18 years old and contains nicotine, an addictive chemical. He says the product marketing has been aggressively targeting young people through internet and social media. Nicotine is a highly addictive substance with elevated toxicity, especially for the youth. Imran shares that many of these products contain high nicotine levels, so they are very addictive and can negatively affect health and impair adolescents’ brain development.

Imran demands that the government of Pakistan must consider banning these addictive products to save future generations from nicotine addiction. It shall also bring oral nicotine pouches under the anti-tobacco laws to prohibit its promotion and availability to young people.

Dr Ziauddin Islam, Incharge, Tobacco Control Cell (TCC), calls for launching of awareness campaigns to discourage smoking among women. He shares that the last survey on tobacco consumption in Pakistan was carried out in 2014 by the Federal Ministry of Health in collaboration with WHO according to which 22.2 per cent men and 2.1 per cent were women smokers. The ratio of women consuming non-smoking/chewable tobacco, he says, was much higher. “It was 11.1 per cent among men and 3.7 per cent among women.”

Dr Ziauddin shares it with You! that a similar survey was due but could not be carried out because of Covid-19. There are plans to go ahead with this survey soon so that the latest figures of male and female smokers and the details of the latest trends can be documented. But before this is done, he says, special campaigns must be launched by the government, anti-tobacco campaigners, health professionals, civil society to discourage smoking among men and especially women – who are normally not targeted in such campaigns.

The author is a staffer and can be contacted at shahzada.irfan@gmail.com