Every year on May 31st, the world observes World No Tobacco Day, led by the World Health Organization (WHO). The goal is to raise awareness about the serious health risks of tobacco use and push for stronger policies to reduce its impact. Thanks to the efforts of such health organisations, NGOs and government bodies, today, people are more aware of the wide-ranging health impacts of tobacco use and smoking, such as cancer, heart disease, COPD and emphysema.
However, tobacco consumption continues to be one of the leading causes of preventable diseases and deaths globally, affecting millions worldwide. Further, there are also lesser-known but equally grave consequences of tobacco that affect mental health, skin, and overall well-being. Many individuals also grapple with the challenges of quitting tobacco, facing not only the physical addiction but also the psychological struggles that come along with it.
Along with the health burden, tobacco usage also causes a huge financial burden on the society and country at large. The economic cost of smoking is huge and includes the medical costs associated with the diseases and also the lost productivity.
Why is tobacco bad for health?
Tobacco is consumed in various forms. The most common method is ofcourse – smoking, which includes cigarettes, cigars, bidi, pipes, and hookahs. Smokeless tobacco forms are also common – such as chewing tobacco, snuff, gutka, khaini, snus etc. Additionally, electronic nicotine delivery systems (ENDS), including e-cigarettes, vape pens, mods, and pod systems, have gained popularity recently as alternatives to traditional smoking. All forms of tobacco use are associated with severe health risks, including cancers, respiratory diseases, cardiovascular diseases, and oral health issues.
Tobacco contains a variety of toxic chemicals that significantly contribute to its harmful effects on health. Notably, it includes nicotine, which is the primary addictive component in tobacco, leading to dependence and making it difficult for users to quit. Nicotine affects the nervous system, increases heart rate and constricts the blood vessels (vasoconstrictor). As the blood vessel constricts and reduces its diameter, the pressure of the blood inside increases leading to hypertension (high BP) and associated complications. Cigarette smoke also contains ammonia, which enhances the absorption of nicotine thereby worsening its addiction.
Further, the tar from the cigarette smoke contains many cancer causing agents that can accumulate in the lungs and cause lung cancer. For example – apart from nicotine and ammonia, cigarette smoke also contains formaldehyde and acrolein which are well-known carcinogens and respiratory irritants. Tobacco smoke also contains benzene, a Group 1 carcinogen as per the International Agency for Research on Cancer (IARC) that can cause severe oxidative stress and damage the bone marrow, leading to a decrease in red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia).
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The list of cancer-causing components in tobacco goes on – hydrogen cyanide, nitrosamines, polycyclic aromatic hydrocarbons (PAHs), toluene, acetaldehyde, and heavy metals such as cadmium, lead, and arsenic are all highly dangerous to various organs including lung, heart, kidney, bones, and the nervous system. Yet another toxic by-product of tobacco smoke is carbon monoxide, a gas that reduces our body’s oxygen-carrying capacity and increases the risk of heart diseases.
Not just smoking, even chewing tobacco also poses significant risks to health – especially oral health. Apart from oral cancer, it can cause inflammation of the gums (periodontitis), tooth decay, oral lesions, altered sense of taste and smell and reduced ability to enjoy food and detect odours.
Are e-cigarettes (vaping) a less risky option?
E-cigarettes work by heating a liquid often called e-liquid or vape juice that contains nicotine, flavourings, and other chemicals. This creates an aerosol that looks like vapour, which the user inhales. This process is known as vaping.
For smokers who are unable to quit, vaping may be a slightly better alternative to traditional cigarettes because it usually contains fewer harmful chemicals and carcinogens. However, this does not mean vaping is safe. It still carries serious health risks, especially for young people.
Many teenagers and young adults mistakenly believe that vaping is harmless, and this misunderstanding has led to a rise in vaping among youth. In reality, most e-cigarettes contain nicotine, which is highly addictive. Regular use can affect brain development in teenagers and young adults, especially areas linked to attention, learning, and mood regulation. The nicotine in the e-cigarettes can also cause severe damage to nerves and blood vessels and lead to many chronic health conditions. It also harms the heart and lungs, and increases the risk of cardiovascular issues and lung inflammation. Some vaping products have even been linked to serious lung injuries.
In short, while vaping might be less harmful than smoking for current smokers, it is NOT SAFE, particularly for non-smokers and young people. It should not be seen as a risk-free habit.
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Steps to Successfully Quit Tobacco
There is no single right way to quit tobacco. However, here are some steps that one can follow to achieve that goal. Whether trying to quit smoking or chewing tobacco, the first step is to decide to quit. This decision must come from a personal commitment; reflect on the reasons for quitting, such as concerns about health, financial savings, and improved quality of life. Write down these reasons in a book or a diary; it will be a powerful reminder and motivation throughout the quitting process.
The next step is to set a specific ‘Quit-Day’. Do not choose a day within the next 3 or 4 days, as the chances of failure are very high – especially if you have been a smoker for several years. This is important, to manage the withdrawal symptoms that can be psychologically very daunting. At the same time do not choose a quit-date more than a month away to ensure you remain committed, without procrastinating.
Mark this date on your calendar (possibly with a red ink pen) and inform some of your close friends, family, and colleagues about your plan. Start by removing all tobacco products from your environment and stocking up on substitutes like sugarless gum, carrot sticks, pickled radish etc. Seeking professional help if required, in terms of therapy support.
Practice delaying the urge to use tobacco and thus cut down on the number of cigarettes or the amount of smokeless tobacco used daily. Identify the triggers that prompt cravings and find coping mechanisms. For example, the urge to smoke immediately after a meal is a very common trigger for many. Chewing gum immediately after meals to change the taste in the mouth or taking a short walk can perhaps distract from that urge.
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Being around friends or colleagues who smoke can be yet another trigger. Inform them about your decision to quit and request their whole-hearted support. Choose smoke-free environments or no-smoking zones for socialising or when taking a quick break from work.
As you reach the quit day, refrain from using tobacco entirely and keep busy with activities that distract from cravings. Stay hydrated, avoid alcohol, and change your routine to break the association with tobacco use. Practice deep breathing, drinking water, and engaging in different activities to overcome strong urges. A comprehensive approach, combining planning, support, and behaviour modification, can all help to successfully quit tobacco.
Avoiding Rationalisation
To overcome urges or cravings, it is important to recognise and acknowledge rationalisations as they arise. Rationalisations are deceptive thoughts that may seem plausible at the moment but are not grounded in reality. Entertaining such thoughts, even briefly, can serve as a justification for using tobacco.
“This is the last one I will smoke”, “I will quit tomorrow”, “Air pollution is more harmful than smoking”, “My uncle used to smoke all his life and he lived past 90”, “I need tobacco to wade through this rough patch” etc are some examples of rationalising thoughts.
Rationalisations can be dangerous and can fail you in your No-Tobacco journey. It is helpful to document these rationalisations as they surface and acknowledge them for what they are – i.e tempting thoughts that lead one back to smoking or chewing tobacco.
Managing Tobacco Withdrawal
Withdrawal from tobacco occurs when the body, having become dependent on nicotine, experiences a range of physical and psychological symptoms upon stopping its use. This dependency develops due to nicotine’s actions on the brain’s reward pathways (mesolimbic pathway) associated with pleasure and reinforcement.
When we consume tobacco, nicotine binds to nicotinic acetylcholine receptors, triggering the release of neurotransmitters like dopamine, which creates feelings of pleasure and reinforces tobacco use behaviour. Over time, the brain adapts to this regular nicotine intake by reducing the number or sensitivity of receptors, requiring more nicotine to achieve the same effects.
When tobacco use is stopped suddenly, nicotine levels plummet, leaving these receptors unoccupied and resulting in withdrawal symptoms as the body seeks to restore balance. Common withdrawal symptoms include intense nicotine cravings, irritability, mood swings, difficulty concentrating, increased appetite, sleep disturbances, physical discomfort, anxiety and even depression. These symptoms arise due to the neurotransmitter imbalances caused by the sudden absence of nicotine.
As dopamine levels decrease, individuals may experience heightened feelings of irritability and depression along with impaired cognitive functions, sleep patterns, and appetite regulation. Reducing and managing withdrawal from tobacco involves a combination of strategies to address both the physical and psychological aspects of dependence.
Using Nicotine Replacement Therapy (NRT) products such as nicotine patches, gum, lozenges, nasal sprays, or inhalers can help reduce withdrawal symptoms by providing a controlled dose of nicotine. The dosage of NRT must be tapered down gradually to facilitate the weaning process and reduce dependence. Certain medications, such as bupropion and varenicline, can help reduce cravings and withdrawal symptoms by changing the brain chemistry. However, these medications should be used only under the guidance of a medical doctor. Your doctor may prescribe these medicines only if there is a severe nicotine dependence after proper diagnosis.
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Seeking support through counselling can also help in emotional support, coping strategies, and encouragement throughout the quitting process. Behavioural therapies can help to identify triggers, develop coping skills, and reinforce positive behaviours to stay away from tobacco.
Adopting a healthy lifestyle with regular physical activity, a balanced diet, adequate hydration, and sufficient sleep can help manage withdrawal symptoms apart from improving overall well-being.
As the world observes World No Tobacco Day, we should reflect on the impact of tobacco use on individual health and well-being, and the families it has broken. Despite widespread awareness of its harmful effects, tobacco consumption continues to be a menace that requires a multifaceted approach to tackle. This includes stronger public policies, better access to therapy and support, ongoing education, and lifestyle interventions. Real change happens not just through laws and regulations, but by helping people make informed and healthier choices – one step at a time.
