Get ready for plain packaging

Dr. Sushil Kumar Sharma
Every year.  On 31st May, WHO and Partners mark World NO Tobacco Day , highlighting the health risks associated with Tobacco use and advocating for effective policies to reduce tobacco consumption. The Theme of No Tobacco Day 2016 Get Ready For plain packaging.
Plain packaging is a measure that restricts or prohibits the use of logos, colors, brand images or promotional information on tobacco packaging other than brand names and product names displayed in a standard color and font style. According to WHO, it is an important demand reduction measure that reduces the attractiveness of tobacco products, restricts use of tobacco packaging as a form of tobacco advertising and promotion, limits misleading packaging and labeling, and increases the effectiveness of health warnings.
Background
Tobacco is a product of the fresh leaves of nicotiana plants. It is used as an aid in spiritual ceremonies and a recreational drug. It originated in the Americas, but was introduced to Europe by Jean Nicot, the French ambassador to Portugal in 1559. It quickly became popular and an important trade crop.
Medical research made it clear during the 1900s that tobacco use increased the likelihood of many illnesses including heart attacks, strokes, Chronic Obstructive Pulmonary Disease (COPD), emphysema and many forms of cancer. This is true for all ways in which tobacco is used, including:
* Cigarettes and cigars.
* Hand rolling tobacco.
* Bidis and kreteks (cigarettes containing tobacco with herbs or spices).
* Pipes and water pipes.
* Chewing tobacco.
* Snuff.
* Snus (a moist version of snuff popular in some countries such as Sweden).
* Creamy snuff (a paste consisting of tobacco, clove oil, glycerin, spearmint, menthol, and camphor sold in a toothpaste tube popular in India).
* Gutkha (a version of chewing tobacco mixed with areca nut, catechu, slaked lime and other condiments popular in India and South-East Asia).
Prevalence
* Tobacco kills up to half of its users.
* Tobacco kills around 6 million people each year. More than 5 million of those deaths are the result of direct tobacco use while more than 600 000 are the result of non-smokers being exposed to second-hand smoke.
* Nearly 80% of the world’s 1 billion smokers live in low- and middle-income countries.
* Unless we act, the epidemic will kill more than 8 million people every year by 2030. More than 80% of these preventable deaths will be among people living in low and middle income countries. Approximately one person dies every six seconds due to tobacco
* 56.4% of cancers in men and 44.9% of cancers in women are caused by Tobacco in India. India has the largest number of the mouth cancer cases in the world due to tobacco use.
* Smoking causes about 30% of all cancer deaths , 17% of all heart disease deaths and atleast 80% of deaths from bronchitis and emphysema
*Over one in two people in India are exposed to second hand smoke at home and 29% in public places.
* If current smoking patterns continue, it will lead to about 10 millions deaths each year by 2020.
* In some countries, children from poor households are frequently employed in tobacco farming to provide family income. These children are especially vulnerable to “green tobacco sickness”, which is caused by the nicotine that is absorbed through the skin from the handling of wet tobacco leaves.
WHAT IS SMOKING –
Tobacco was first brought to Britain from America in the 16th century by Sir Walter Raleigh. Cigarettes as we know them were introduced in the late 19th century , and by the turn of the 20th century largely replaced other forms of tobacco use such as snuff, chewing tobacco and cigars. There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 60 of  these substances are known or suspected carcinogens.
The Three main poisons in tobacco smoke are:
1) Tar – A solid irritant, tar coats the lungs, blocks the airways and causes emphysema and lung cancer.
2) Nicotine – Nicotine is a highly addictive toxic substance which diffuses into the blood stream very quickly , providing a quick fix for the smoker .One Cigarette contains about 1mg of nicotine, which if taken intravenously could be fatal. Nicotine has a variety of adverse effects , many of which contribute to the development of CHD.
3) Carbon Monoxide ( CO) – Carbon Monoxide is absorbed via the lungs into the blood stream where it binds to hemoglobin, replacing oxygen. The level of CO in the smoker’s body depends on the number of Cigarettes smoked and how they are smoked. Carbon Monoxide causes heart and arterial diseases.
Other Poisons in Tobacco smoke include formaldehyde, ammonia and benzene.
Second-hand smoke kills
Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes, bidis and water-pipes. There is no safe level of exposure to second-hand tobacco smoke.
* In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death. In pregnant women, it causes low birth weight.
* Almost half of children regularly breathe air polluted by tobacco smoke in public places.
* Second-hand smoke causes more than 600 000 premature deaths per year.
* In 2004, children accounted for 28% of the deaths attributable to second-hand smoke.
Every person should be able to breathe tobacco-smoke-free air. Smoke-free laws protect the health of non-smokers, are popular, do not harm business and encourage smokers to quit.
Over 1.3 billion people, or 18% of the world’s population, are protected by comprehensive national smoke-free laws.
Harmful effects of Smoking
Smoking increases the risk of CHD seminal studies linking smoking and Heart Diseases appeared by the middle of 20th century. The 1964 Surgeon General report reaffirm the epidemiologic relation and by 1983 The Surgeon General had firmly established cigarette smoking as the leading avoidable cause of CVD. Smoking doubles the incidence of CHD and Increases CHD mortality by 50% and that these increase risk with age and the number of Cigarette smoked. Women incur similar increases in the relative risk for CHD. Smoking rates continues to rise worldwide with the greatest increase in the developing world. Among smokers 35yrs of age or older who die of smoking related causes 33% die of CVD.
Smoking has also been linked to
* Cancer of the mouth
* Larynx
* Esophagus
* Bladder and Pancreas
* Stroke
* COPD
More recently published research has found links to premature menopause, complications in pregnancy, impotence, premature ageing and reduced fertility.
Ad bans lower consumption
Bans on tobacco advertising, promotion and sponsorship can reduce tobacco consumption.
* A comprehensive ban on all tobacco advertising, promotion and sponsorship could decrease tobacco consumption by an average of about 7%, with some countries experiencing a decline in consumption of up to 16%.
* Only 29 countries, representing 12% of the world’s population, have completely banned all forms of tobacco advertising, promotion and sponsorship.
* Around 1 country in 3 has minimal or no restrictions at all on tobacco advertising, promotion and sponsorship.
Environment Effect : Tobacco causes destruction of forests by cutting of trees to create a space for tobacco farming and to get wood for curing of tobacco .About 7000 Cr  Tonnes of paper is used every year for wrapping Cigarettes. Tobacco growing depletes soil nutrients at a much faster rate than many other crops and reduces the soil fertility. The land used for tobacco farming becomes useless for other crops. Smoke from tobacco products and that exhaled by smokers causes air pollution.
Benefits of Intervention – Observational studies demonstrate clear benefits of smoking cessation .Smokers who quit reduce their excess risk of 50%  within  first two years of cessation with much of this gain in the first few months this period is followed by more gradual decline , with the risk of former smokers approaching that of never smokers after 3 – 5 years .The gain in life expectancy are large and the earlier in life an individual stop smoking the larger the potential gain, A 35 yrs old male smoker for example May add 3 yrs to his life expectancy on cessation.
In order to help smokers to quit smoking , combination of multiple counseling  session in addition to  medication  increase the success rate .Seven first line pharmaco therapies that reliably increase long time smoking abstinence were also identified  such as sustain release bupropion  hydrochloride , five Nicotine replacement therapies ( Gum patch, Inhaler, Nasal spray and lozenges) and Varenicline.
World No Tobacco Day is an attempt to draw public and Government attention on the need to take effective measures to prevent tobacco consumption which contaminates the air we live in . So. If your dream is to live in a pollution free environment then Give up Smoking and consumption of other tobacco products for Life.
(The author is MD, DM FACC,  Head Deptt. of Cardiology GMCH Jammu)
feedbackexcelsior@gmail.com

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