How to quit smoking, by experts

*Explain why more people turning to habit despite reported harm to health
*NHF urges govt to establish cessation centres in 36 teaching hospitals in Nigeria

Worried about the health implications and disease burden associated with smoking tobacco, medical experts have made recommendations on how to quit the habit.

The medical experts on the occasion of World No Tobacco Day (WNTD) warned that smokers face 50 per cent higher risk of developing severe disease and death from COVID-19 as well as cancers, infertility, abnormalities in babies born by smokers, lungs disease such as Chronic Obstructive Pulmonary Disease (COPD) and premature death.

The theme for this year’s WNTD is “Commit to Quit.”

Also, a new study suggests there were a record 1.1 billion smokers worldwide in 2019, and nearly eight million related deaths. Researchers warn progress against the prevalence of smoking tobacco use has slowed in the last 10 years in many countries, and population growth is resulting in an increasing number of smokers.

Study authors wrote: “Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens.”

Findings published in The Lancet stem from data on 204 countries and territories as part of the Global Burden of Diseases 2019 study. While the WHO ignited positive change in the decade following 2005 through its Framework Convention on Tobacco Control (FCTC) – recommending tools like dropping affordability through taxation and green-lighting smoke-free laws — study authors said, 15 years later, “a large implementation gap remains.”

Cardiovascular Health Physician and Executive Director, Nigerian Heart Foundation (NHF), Dr. Kingsley K. Akinroye, told The Guardian that the number of smokers is still not coming down, especially in developing countries like many sub-Saharan African countries including Nigeria due to the following: “The level of awareness about the health risks of tobacco is still very low unlike in economically developed countries where the level of awareness continue to grow steadily. In addition, the promotion of tobacco smoking by the tobacco industry continue to grow due to giant funding from the tobacco industry; support for research on tobacco in developing countries is poor.

“The lack of support for smokers willing to stop smoking is inadequate and there are few cessation – smoking centres available in most countries. In Nigeria, there are only three established smoking cessation centres where patients can go for therapy including counselling and drug therapy. For example, in Finland over the last 12 months, about 10,000 Finns have quit smoking due to increased awareness of risks of tobacco smoking during COVID-19 pandemic while about 30 per cent of the studied population have tried to quit smoking during the pandemic.”

Akinroye said exposure to tobacco smoking during COVID-19 have been associated with health risks. “And it is not true that tobacco smokers are protected from COVID-19,” he said.

The cardiologist said Nigeria is a signatory to the WHO Framework Convention on Tobacco Control and has also passed the Smoke – Free law in public places while several states in Nigeria (Lagos, Osun, Federal Capital Territory/FCT/Abuja, Ekiti, Kano, Nasarawa, Bauchi etc.) have domesticated and passed the Smoke-Free Law in public places in the State Assembly, but, the implementation of the law is very weak.

Akinroye said the advertisement of tobacco in electronic, print and billboard has been effective in Nigeria but the smoking of tobacco on television by actors and actresses is still unabated.

He said NHF is unaware of the global budget available for tobacco control and that e- cigarettes and use of pipes are dangerous to health.

Akinroye said the Federal Government of Nigeria needs to empower the regulatory agencies to ensure the enforcement of the Nigerian Tobacco Control Act and also support the respective states that have domesticated the Tobacco Smoke-Free Law by supporting the Non Communicable Diseases (NCD) Division in Federal Ministry of Health and the NCD unit in the states ministries of Health, Federal Ministry of Environment and State Ministry of Environment to enforce the law through impactful Budgetary lines and support for initiatives on enforcement of the Law.

He said NCD Alliance Nigeria, Nigerian Heart Foundation, Nigerian Cancer Society, Nigerian Thoracic Society should be empowered by Federal Government of Nigeria for effective partnership and collaboration for effective regulation and enforcement.

Akinroye said government at all levels; especially the Federal Government should demonstrate commitment to enforcement of the FCTC and establish Tobacco Cessation Centres in at least 36 Teaching Hospitals in Nigeria, and with adequate funding. He said each of the states that domesticated the Smoke-Free law should come out with practical initiatives to enforce the law. “Lagos state, developed an initiative about six years ago to enforce the Smoke -Free law in public places and this needs to be re-visited and a model that other States can start with,” he said.

A cancer expert at University of Nigeria Teaching Hospital (UNTH) Enugu, Prof. Ifeoma Okoye, told The Guardian that tobacco causes eight million deaths every year from cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension.

Okoye said most people are already addicted, and erroneously see smoking as a stress relief strategy and hold on to the perceived pleasure they get from the high that nicotine gives.

The oncologist said regulation, oversight and enforcement of regulations have always been a challenge in Nigeria, likely because of poor structures, in place, to mitigate this enforcement, inadequate budgetary allocation to support operationalisation of these robust structures capable of providing effective oversight, and lack of engagement of the lay public with the details/implications of the regulations

Okoye said tobacco usage is such a profound threat to cardiovascular health that NHF has embarked, on a Cessation of Tobacco Smoking Campaign and is supporting creation of Tobacco Cessation Centres.

She said that given the well-established harms associated with tobacco use and second-hand smoke exposure; WHO recommends that tobacco users stop using tobacco. The radiologist said Nigerian government should embark on sustained public enlightenment campaigns/ awareness and enforce proven interventions to help users quit, such as; free quit lines (access to counsellors/tobacco Cessation Centres, by provisions of Help Lines, mobile text-messaging cessation programmes, nicotine replacement therapies and other approved medications.

Okoye said introduction of a ‘punitive/painful sin tax’, officially by the Federal Government and ensuring engagement of public, vigilant oversight and enforcement are certainly veritable ways to achieve huge impact and cause positive disruptions in current narrative that, despite the ban on smoking, the number of smokers worldwide, continue to soar to the tune of 1.1 billion!

On why more people still turning to smoking despite the reported harm to health, a consultant pharmacist and medical director, Merit Healthcare, Dr. Lolu Ojo, told The Guardian: “It is a social defiance. People want to have a free choice on what to do with their lives. They derive pleasure in smoking. The active component is Nicotine, which is powerful stimulant.

“The harmful effect of smoking does not manifest immediately. It takes time and years of smoking before the harmful effects set in. There is a tendency to believe that nothing will happen.”

On the association of smoking with COVID-19, Ojo said: “Smokers are at a high risk of the movement of fingers to the lip. Both the cigarette and the fingers may be contaminated. This is also true for the vappers.

“Smoking compromises the capacity of the lung to function and cope with COVID-19 attack.”

The pharmacist said there is no strong evidence to support the claim that smokers are protected from COVID-19. “The most reasonable option is to dismiss this claim because it is false. As at today, the WHO recommendation is that smokers should quit as part of the fight against COVID-19,” Ojo said.

Ojo said the problem in Nigeria is not making legislation but it is all about enforcement. “We will have no worries for new legislation if the existing rules are enforced,” he said.

On why people still smoke in public places despite banned, Ojo said: “We can add ignorance. There is also poor enforcement of regulations. People are not afraid of the law enforcement agents because they can be easily compromised.

On the yearly global budget for tobacco campaign, the pharmacist said: “In 2019, the big tobacco companies spent $8.2billion on tobacco adverts and campaigns. In the USA, anti smoking campaign gulped $54m.

He said E- cigarettes may be less harmful compared to cigarette smoking but it is still harmful.

Ojo said regulation and enforcement against smoking and use of tobacco in Nigeria weak due to corruption and lack of vision.

President, African Fertility Society (AFS) and Medical Director, Medical Art Centre (MART) Maryland, Ikeja, Prof. Oladapo Ashiru, told The Guardian: “Most people lack insight because of their addiction to smoking even when they know it hampers their health system. We should also remember we have two cadres of smokers, passive and active smokers, active smokers are known for their addiction, and there’s nothing any agency or government can do unless they are willing to give up smoking and go for rehabilitation.

“One cannot also over-emphasise the role of peer pressure to smoking during the schooling period. Addiction mostly starts at this time. Passive smokers are the most vulnerable set of class that can come down with lung cancer.”

Ashiru, who is also the joint pioneer of In Vitro Fertilisation (IVF) in Nigeria, said a regulation should be put in place to prevent that from happening. “For instance, there’s a place in many countries set aside for smokers in the airport lounges, in the bars and other social areas, to avoid contact with nonsmokers, which I know we can Institute here in Nigeria.

“There should be a place inside bars and lounges designed for smokers in other to protect nonsmokers. Most government especially in the United States of America has banned smoking in public areas,” he said.

Ashiru said a good knowledge of the serious health consequences and hazard of smoking would make anyone to run away from smoking. “Such hazards include infertility, abnormalities in the babies born by smokers, lungs disease such as Chronic Obstructive Pulmonary Disease (COPD), cancer, and premature death,” he said.

What is the association of smoking with COVID-19? Ashiru said: “Normally, the body’s immune system declines gradually during smoking, and If such an individual gets infected with Coronavirus. The virus then attacks the lungs. Its first mission is to weaken the immune system then deposit its antigen, which will trigger the release of cytokines and interleukins (body defense mechanism). This reaction is energy-dependent which is depleted in smokers. As a result of these cascade reactions, the function of the lungs regarding the exchange of gases responsible for breathing begins to decline, which can be fatal and could lead to death.”

Are tobacco users/smokers protected from COVID-19? “I do not think they are protected because smoking alone hampers the functionality of the lungs, and that is the main organ the virus invades. It harms the environment where there is low immunity then further establishes itself to cause more damage,” Ashiru said.

Does Nigeria have enough or somewhat effective legislation against smoking? “Yes, we have enough and effective Legislation in Nigeria. We need more agency to help in passing out the correct information and in enforcing the laws,” he said.

Smoking in public places is banned, especially in Lagos, yet people still smoke in public. Why? “I guess because there are no effective agencies to curb the act. Laws without enforcement and proper notice is not going to have 100 percent compliance.”

Ashiru urged the government to put a measure in place that will enforce the populace not to smoke in public not to affect the non-smokers, make it a law for bars and lounges to have space with vent designated for smokers. “To Nigerians, I know you can’t stop smoking because you have the right to freedom but remember, smokers are liable to die young. You can still stop today,” he said.