I know, no one wants to be sick or chooses to be sick, but as a person who did medicine mostly because she was talked into it, I often find myself wondering, is all our work as doctors truly necessary, was there anything that could be done to prevent the patient from becoming ill in the first place?

A lot of reading has led me to some conclusions. In general, most experts would agree that in order to be healthy, one should:

  1. Refrain from cigarette smoking
  2. Exercise
  3. Eat a healthy diet

As simple as it sounds, these three steps are actually quite complicated more in the execution part.

No 1, smoking prevention, is complicated and difficult because and only because there are people who make money out of the suffering of others.

Does smoking cigarettes have any benefits? I don’t know. Maybe.

Does smoking cigarettes have bad effects? Yes, and not only on physical health of the smoker. But everyone KNOWS this.

We know we are supposed to exercise, but we don’t. We know were supposed to eat more fruits and vegetables, but we don’t.

Today, this post will focus on prevention of smoking cigarettes. We’ll look at the other healthy lifestyle choices another day.

The biggest myth, so to say, surrounding cigarette smoking is the fact that it is not a choice per say. It is an addiction. The choice surrounds the picking up of the habit. Even so, addicts can remove the habit if they chose to.

Anyway, back to the subject at hand: can smoking cigarettes be prevented in the first place?

http://www.emedicinehealth.com/cigarette_smoking/page6_em.htm

I found the excellent article above which says that yes, it can be.

  1. Yes, it can be prevented by not taking up the habit in the first place. (Duh)
  2. Quitting is not easy.
  3. Most smokers start when they are teenagers.

Bingo! The most important fact to me in the three listed is the last part. I’m going to be forty soon (in about a years time), and I remember what it was like to be a teenager. To be honest, there were many things and decisions I did back then that I’m not particularly proud of today, but imagine being punished for something you did as a teenager, everyday for the rest of your life. That’s not fair, surely.

Teenagers are impressionable, teenagers do things mostly on impulse, they crumble to peer pressure, they really want to fit in, they want to impress others, they are very concerned about superficial things…anyone who has survived teen-hood should know what I’m talking about. Doctors can’t carry out any procedure on a teenager without parental consent, as in the ‘real world’, we know that teenagers are not corpus mentis, they cant make decisions like adults can. So is it fair to blame them if they chose to smoke? Whose fault is it when they do take up cigarette smoking? The parents or the tobacco industry?

As an adult, as a doctor, as a mother, as a parent, as a blogger, it is my responsibility to ensure that I can protect as many teenagers as possible from taking up this mistake (cigarette smoking) then I have done a great contribution not only to health and the environment but also to my religion and the economy.

http://www.emedicinehealth.com/cigarette_smoking/page6_em.htm

According to the article, it is the parents who are to be blamed.

I agree, monkey see, monkey do. If a parent smokes then hey, can you blame the kid if they do it? Doesn’t seem fair to me either, so parents, please stop smoking, for your child’s sake.

Whenever I am working in the community as I sometimes do, and a child comes into the clinic with cough, flu, fever, asthma attack, I always ask (but I subconsciously do this while avoiding eye contact with the father if he is present), “Does anyone smoke at home?” and lo and behold, the usual answer is yes.

Then I use that opportunity to give them the “Stop doing this to your own flesh and blood lecture, can’t you see what’s happening here. QUIT SMOKING! I can prescribe the gum or patch, choose”.

There’s a ton of research and articles on effects of second hand smoke on children, here’s an example:

http://no-smoke.org/document.php?id=212

Second hand smoke causes:

  1. Low birth weight
  2. SIDS
  3. Cognitive impairments
  4. Behavioural problems
  5. Respiratory problems
  6. Asthma
  7. Effect on health as adults due to exposure to second hand smoke as children

Well, Malaysians may not care so much about health (I’m sorry, I was really cynical here, but with good reasons and intention) but they really do are concerned with their children getting good grades in school, much to the delight of supplement sellers who market products which supposedly improve school grades. I know, I know, funny right, or maybe not. The fact that the market exists in the first place is a painful fact for many.

But did you know that second hand cigarette smoke actually impairs children’s academic ability?  Read no3 above again:

Cognitive impairments.

IN CHILDREN, not the elderly.

“Cognitive Impairments

  • Secondhand smoke exposure impairs a child’s ability to learn. It is neurotoxic even at extremely low levels. More than 21.9 million children are estimated to be at risk of reading deficits because of secondhand smoke. Higher levels of exposure to secondhand smoke are also associated with greater deficits in math and visuospatial reasoning. (Yolton, K. et al., “Exposure to Environmental Tobacco Smoke and Cognitive Abilities of U.S. Children and Adolescents,” Environmental Health Perspectives, 113(1): 98-103.)
  • The offspring of mothers who smoke one pack of cigarettes per day during pregnancy have an IQ score that is, on average, 2.87 points lower than children born to nonsmoking mothers. (Batty, G.D.; Der, G.; Deary, I.J., “Effect of maternal smoking during pregnancy on offspring’s cognitive ability: empirical evidence for complete confounding in the US National Longitudinal Survey of Youth,” Pediatrics118(3): 943-950, September 2006).

Shouldn’t this be a worry to any parent? Smoking makes your kids less smart. Please stop smoking. I beg you.

I know, I know, intelligence quotient isn’t the marker of success later in life, emotional intelligence matters more, but in Malaysia (and other countries around the world), IQ helps get you a place in university, so it is very important.

I was at the beach recently and it really made me angry when the fresh air was contaminated with the pungent smell of cigarettes. I turned around and surely, there was a man smoking, not only that, he kept blowing off the smoke in the face of his wife and the baby she was carrying in her arms. If not for being one of two supervising four kids, I would have gone over and gave him a piece of my mind and a prescription for gum or patches. Sigh.

So back to our problem, if parents who smoke are the only ones responsible, then we should just put them in jail until they stop smoking or prevent smokers from conceiving until they quit. Problem solved. Hahaha, kidding.

But it’s not completely their fault right if they too were tricked into picking up the habit as teenagers by none other than the evil tobacco industry.

In Malaysia we have the death penalty for drug dealers, I don’t understand why we cant impose the same on tobacco companies, they are after all, making profit based on an addiction and other peoples suffering. Allow me to continue.

Were back to the first article: http://www.emedicinehealth.com/cigarette_smoking/page6_em.htm

So, we all discovered that smoking is really bad for humans and decided about 30 years ago to ban all forms of tobacco advertising. Yes, that was partly genius, and, lets continue on.

I still remember the advertisements on TV as a child. There were a couple dancing on a mountain with trees in the background and the music “feeling fresh and bright, feeling so clean so right, a world of our very own, style that is ours alone, above it all”…I can even remember the lyrics for God’s sake, and that was like 30 years ago. I remember thinking what is this advert all about, perhaps years later when I began to understand what advertising meant. IT IS VERY POWERFUL but hello, I did not take up smoking. But I was lucky because my parents were not smokers either.

“According to the American Lung Association, the tobacco industry spent an estimated $12.49 billion on advertising in 2006”.

Aik? I thought advertising was banned?

Very slick eh, this tobacco industry.

Then a few years later…

“Some states place restrictions on the type and locations of tobacco advertising, and legislation enacted in 2009 gave the U.S. FDA strong authority to regulate tobacco products. The FDA requires prominent health warnings on all cigarette packaging and advertisements in the United States”.

Yeah, the packaging thing we definitely have in Malaysia…but is it effective?

The statistics are worrying.

An estimated five million Malaysians, or 22.8 per cent of the population, are smokers, according to the National Health and Morbidity Survey (NHMS).

Read More : http://www.nst.com.my/news/2016/06/149526/five-million-smokers-malaysia-survey-shows

I don’t know about you but, as a non-smoker, reading that, I’m still one of the MAJORITY 77.2% who does not smoke and I have rights to breath fresh, contaminated air, where ever I go.

“Deputy Health Minister Datuk Seri Dr Hilmi Yahaya said

  • 50 per cent of smokers are above 30-years-old
  • 40 per cent are above the age of 19
  • while the remaining 10 per cent are below 19″

“Although the number of smokers has reduced by 0.3 per cent compared to 23.1 per cent in 2011, the reduction is still not significant enough as more awareness and efforts must be taken to stop smoking,” he said.

Yay! So number are reducing albeit slowly, but is that because the smokers are dying from the smoking-related diseases or is it due to less people taking up the habit? Hmmm….

‘He said that

  • four out 10 or 7.6 million adults are exposed to secondhand smoke inside their houses,
  • four of 10 or 2.3 million adults at workplaces, and
  • seven out 10 or 8.6 million adults at public places like restaurants.

“The number is worrying as many non-smokers are also affected,” he said.

‘Hilmi said, according to the World Health Organisation (WHO),

  • about 600,000 people die every year from exposure to secondhand or passive smoking.
  • A total of 28 per cent of victims are children,” he added.’

Doing the math in my head (thankfully my parents didn’t smoke so I was pretty good at math as a child) that’s about 150,000 children. That’s very sad because it’s preventable.

More sad facts…

‘On efforts to quit smoking, he said

  • around 10,000 smokers have joined smoking cessation programmes conducted in 486 goverment clinics and hospitals every year.
  • “Although an average of only 22 per cent out of the 10,000 are able to quit smoking annually, but we are happy to help them kick the habit,”.’

So that means out of 5 million smokers, 10,000 join a program to quit which is 0.2% of all smokers. WOW. Only 0.2%. Well, maybe there are many others going cold turkey, who knows right?

Then out of the 0.2% who join the gov quit program only 22% succeed. So that means about 2,200 people quit smoking, hopefully forever. And the rest 7,800 continue to smoke. I really should join the tobacco industry (sarcasm here just in case you can’t decipher!)

It’s such a profitable product! Talking only from a business point of view. Once the customer is hooked, you’ve got them for life, pretty much.

Coming back to prevention of smoking, and the original article: http://www.emedicinehealth.com/cigarette_smoking/page6_em.htm

  1. “Studies have shown that youth are particularly susceptible to tobacco marketing campaigns.
  2. In the past, cigarette use by actors in popular films was a means to portray smoking as sophisticated and glamorous.
  3. Although denied by tobacco companies, the use of cartoon animals and the like in advertising campaigns appeals to youngsters.
  4. Counter-advertising by various antismoking advocacy groups may provide some balance, but their advertising budgets pale beside those of tobacco companies.
  5. Schools generally provide education on the use of tobacco, alcohol, and other substances, but their impact is unclear.
  6. Increasing the taxes on cigarettes, and hence their price, has been shown to reduce tobacco consumption, especially among adolescents”.

I’d like to dwell on point no two for a moment, just because I am a huge fan of movies and the cinema. When I was living in PJ the past five years, going to the cinema was a weekly event and I was most up-to-date with the latest ongoings, always posting spoilers on my facebook timeline (with warnings, of course).

Whenever I see a scene of cigarette smoking in the movies, it immediately hits me (I’m not sure if it does the same to others, maybe they are not as passionate about movies as I am, or maybe they don’t really care about their right as non-smokers to breath fresh air, I don’t know), WHY AM I SEEING THIS very good looking and attractive movie star lighting a cigarette? I mean, isn’t it some form of advertising? I’m not a smoker but I’m sure looking at that makes a person think of cigarettes and possibly even, for the young and impressionable who love movies (not implying anything directly to myself heh heh), think about giving it a try?

I’ll give two examples I can think of, sorry they are not very recent but they were huge hits at their respective times:

Titanic.

You know when Kate nearly jumps off the ship and was rescued and then as she and that loser walks off, Leonardo or Jack asks for a cigar from the creepy PA (personal assistant). Then he puts one in his mouth and takes another and puts it behind his ear.

Was that really necessary? I mean, if they removed that part, would it have any bearing on the story at all? ADVERTISING. It was an advertisement whether the viewer noticed it or not.

Another one.

Avatar

Loved that movie and watched it again and again. There was a smoking scene. I love Sigourney Weaver but why did she demand a cigarette? Couldn’t she have demanded for something else? Anything?

https://consumer.healthday.com/encyclopedia/smoking-and-tobacco-cessation-36/tobacco-and-kids-health-news-662/smoke-screen-smoking-in-the-movies-645323.html

‘When it comes to smoking, actors and actresses may be more influential role models than anyone else, including parents and peers, Sargent says. “John Travolta is tough when he smokes. Are everyday smokers tough? Sharon Stone is sexy when she smokes. Are everyday smokers sexy? Smoking in movies associates the behavior with all the things adolescents want to be.”‘

https://www.ncbi.nlm.nih.gov/pubmed/19336346

“In this sample of adolescents there was a strong, direct, and independent association between seeing tobacco use in films and trying cigarettes, a finding that supports the hypothesis that smoking in films has a role in the initiation of smoking in adolescents”.

“What is already known on this topic

Smoking is often depicted in films, and watching films is a favourite activity of adolescents

Adolescents whose favourite actors smoke in films are more likely to have tried smoking

What this study adds

Adolescents’ exposure to smoking in films varies widely

Adolescents with higher exposure are significantly more likely to have tried smoking, even when other factors linked with adolescent smoking have been taken into account

This study supports the hypothesis that depictions of smoking in films influence adolescents to smoke”

 

So what can we do about this?

If only movies were the problem then easy, just ban everything (cynical, don’t worry). All the movies are for adults only, and adults can make responsible decisions. Hopefully.

It would be easier to remove all smoking scenes for movies meant for general viewing but is that possible?

Remember the point no2 “In the past, cigarette use by actors in popular films was a means to portray smoking as sophisticated and glamorous”. I think it still is being used because recently, during the raya break, I finally got to watch Conjuring 2, (I know, its so painful when everyone else has seen it except you), and there it was, a smoking scene, and I thought what does this have to do with a horror movie? Parental guidance 13 was the rating in Malaysia anyhow. I know the child didn’t take a puff, the teacher found them, snatched the cig and then puffed on it when the kids (but not the audience) was out of sight.

To be continued…

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