Stubbing out smoking

It’s a short trip from adventure to addiction. For many, it begins with the thrill of trying at a young age something that is prohibited. When did you light your first cigarette? The memory of the first drag stays for long: mine is somehow linked to the iconic 1976 Bollywood film Kabhi Kabhie. Every time I listen to its memorable songs or watch clips, they remind me of the first furtive attempt to smoke. A close friend and I had gone to the Children’s Park in Panaji, Goa, one afternoon after school, when few people would be around, to try out a menthol-tipped cigarette amidst the anonymity afforded by the tall, lush green trees. But we soon found ourselves facing that film’s shooting: many of the trees were being set on fire with cotton bales on branches, agitated horses were being calmed, instructions were being yelled out, as actors Amitabh Bachchan, Shashi Kapoor, Rishi Kapoor, Neetu Singh and others got into action, shooting the climax of the film. The dense smoke from the fire on the trees disturbed us. We tried to light the cigarette, but gave up as nerves took over, and soon fled the scene before anyone could spot us and report us home.

Fortunately, that first failed attempt at smoking did not lead to addiction over the years and whatever little I indulged in stopped completely long ago. But we would never have been able to buy that cigarette we thought was ‘cool’ if the kind of laws announced last week by New Zealand were in force. Under the novel law, those aged 14 and below are to be banned from purchasing tobacco, and the legal smoking age is to increase every year, to ultimately create a smoke-free generation by 2025.

Widely termed as ‘historic’, New Zealand’s Smokefree 2025 Action Plan takes state intervention to a new high. Says Ayesha Verrall, associate minister of health: “We want to make sure young people never start smoking so we will make it an offence to sell or supply smoked tobacco products to new cohorts of youth. People aged 14 when the law comes into effect will never be able to legally purchase tobacco. We are also reducing the appeal, addictiveness and availability of smoked tobacco products. New laws will mean only smoked tobacco products containing very low levels of nicotine can be sold, with a significant reduction in the number of shops who can sell them. Preventing people from starting to smoke and helping those who smoke to quit means we are covering both ends of the spectrum. We know it’s really tough to break the habit and some people who smoke will understandably need lots of support leading up to these changes taking effect.”

Power of effective messaging

The action plan made headlines across the globe, and also raised some doubts. The effort is to cut the current number of 13 per cent of New Zealand’s smoking adults to 5 per cent by 2025, but there are fears that the new law could create a black market for cigarettes, with criminal gangs filling the gap in demand. There is also the issue of vaping: the law excludes e-cigarettes, which produce a vapour that delivers some nicotine to the user. Seen as a substitute to help give up smoking, e-cigarettes are not harmless, since they contain hazardous cancer-causing substances.

Debashish Munshi, professor of management communication at the University of Waikato, New Zealand, supports the ‘path-breaking’ ban, but says: “The exclusion of vaping from the otherwise innovative plan is a worry. A recent survey of secondary school students conducted by the Asthma and Respiratory Foundation New Zealand showed that a rapidly growing number of teenagers are taking up vaping and being exposed to its toxic effects. The government argues that vaping is less dangerous than smoking and that vaping can be a means to quit smoking. But vaping too has harmful effects, many e-cigarettes have high nicotine content, and there are far too many unknown risks with the potential for a new form of addiction. Studies show that many teenagers who pick up vaping have never smoked before. The key to a totally smoke-free environment lies in aligning stricter regulations around vaping for young people with the smoking ban. Effective messaging about the harms of toxic substances and resourcing to attract youth to healthier pastimes would be very useful too.”

A range of bans and restrictions is in place in various countries, the most common include a ban on smoking in workplaces, curbs on advertising and displays in retail shops, and health warnings on packs with gory images of ailments linked to smoking (such as in Australia and Canada). Michael Bloomberg, when he was mayor of New York, financed anti-smoking campaigns in Indonesia and elsewhere. Several countries have jacked up prices, making it dearer to buy cigarette packs. From the time when smoking was fashionable, even considered therapeutic — King George VI was advised to smoke to relax his throat to help deal with his stammering — it is now widely accepted as a no-no and the cause of hundreds of thousands of premature deaths. ‘Thanks for not smoking’ is a common message in public spaces. The World Health Organisation has launched a Tobacco Free Initiative to strengthen tobacco control and monitor use in the western Pacific region, which has an estimated 386.5 million adult smokers, or about one-third of the world’s smokers.

The act also inspired a popular phrase: ‘smoking like a chimney’. But it remains a matter of debate whether the bans and restrictions are followed and implemented, since the discourse of smoking runs against the lure of hundreds of billions of dollars in taxes that the tobacco industry brings to state coffers across the globe, besides providing employment to a large number of people (read voters) — best exemplified in ‘The Smoke Screen’, one of the episodes of the BBC’s ever popular political sitcom, Yes Prime Minister. Many smokers dismiss calls and campaigns to quit, calling it a ‘true life pleasure’, and cite several reasons why they smoke — including giving something for hands to do and give the illusion of doing something — how it helps them fit in with peers, or see them through various moods, phases of creativity and stages of life. Winston Churchill, who was often seen with his favourite Cuban cigar, once said: “I drink a great deal. I sleep a little, and I smoke cigar after cigar. That is why I am in two-hundred-percent form.”

Death of a smokin’ hot romance

While state-driven initiatives can help, many smokers give up when health issues catch up after years and decades of smoking, when the act no longer brings the romance and pleasure it once did. Says Rakesh Bhatnagar, senior Indian journalist: “I started smoking in 1970. After nearly 50 years, I had to stop in 2018, but while it lasted, I enjoyed it, saw it as a source of strength, often smoked continuously to relieve stress. If cigarettes are easily accessible, you will definitely find more people smoking, so reducing the access can be one of the ways of preventing new smokers emerging and adding to the large number of patients suffering from smoking-related issues. I had to quit smoking, when it seemed to choke me. Besides, I was detected with lung issues, including reduced lung power. I suffered enormously due to my long smoking innings, but now I cannot stand the smell.”

In Britain, the number of smokers has fallen dramatically over the decades: from 70 per cent men and 40 per cent women smoking in 1962, to 45 per cent in 1974, to 14.1 per cent in 2019. Over 6 million adults still smoke in England, with almost 75,000 preventable deaths a year. A ban on smoking in all enclosed workplaces came into effect in 2007. The government’s ambition is for England to be smoke-free by 2030 and to reduce stark disparities in smoking rates.

Since 2012, millions have joined a mass quitting attempt called ‘Stoptober’, held annually in October. The campaign is based on research that if smokers can make it to 28 days smoke-free, they are five times more likely to quit for good. During the first ‘Stoptober’, 1 in 5 adults smoked (19.3 per cent), which has now fallen to 1 in 7 in England (13.9 per cent). The campaign offers a range of free quitting tools, including the National Health Service (NHS) Quit Smoking app, Facebook messenger bot, Stoptober Facebook online communities, daily emails and SMS, and online Personal Quit Plan, which helps people find a combination of support that is right for them, including expert support from local Stop Smoking Services and aids.

Britain’s health authorities acknowledge the risks associated with e-cigarettes, but say properly regulated products can go a long way to help kick the addiction. For the first time, in October this year, officials announced that e-cigarettes could be prescribed on the NHS, making it the first country in the world to prescribe it as a licensed medical product. Manufacturers can approach the medicines regulator to submit their products to go through the same approvals process as other medicines available on the NHS.

A medicinally licensed e-cigarette would have to pass even more rigorous safety checks. If a product is approved, clinicians could then decide on a case-by-case basis whether it would be appropriate to prescribe an e-cigarette to help patients quit smoking. It remains the case that non-smokers and children are strongly advised against using e-cigarettes. E-cigarettes are not risk free, but expert reviews from the UK and US suggest that regulated products are less harmful than smoking.

The official advice is that smokers should switch to vaping products to help them quit smoking, but non-smokers should not take up vaping. E-cigarettes were the most popular aid used by smokers trying to quit in England in 2020, shown to be highly effective, with 27.2 per cent of smokers using them compared with 18.2 per cent using nicotine replacement therapy products such as patches and gum. Some of the highest success rates are among people using an e-cigarette to kick their addiction alongside local Stop Smoking services, with up to 68 per cent successfully quitting between 2020 and 2021. Says health secretary Sajid Javid: “This country continues to be a global leader on healthcare, whether it is our Covid-19 vaccine rollout saving lives or our innovative public health measures reducing people’s risk of serious illness. Opening the door to a licensed e-cigarette prescribed on the NHS has the potential to tackle the stark disparities in smoking rates across the country, helping people stop smoking wherever they live and whatever their background.”

Prasun Sonwalkar is a journalist based in London

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