The Tobacco Epidemic: The Summation Continues

It is estimated that this year tobacco is the cause of 12% of all deaths worldwide. Therefore, it is necessary to prevent its consumption in the population, especially among the youngest.

Smoking is the main preventable public health problem in developed countries. It is also the leading cause of preventable death worldwide. Eight million people die annually from diseases related to tobacco consumption (one person every four seconds), of which 1.2 million were not active smokers but passive smokers, that is, were exposed to cigarette smoke.

In the world, the age of onset of cigarette consumption is 13 years old, while in Mexico, data from the National Survey of Drug, Alcohol and Tobacco Consumption 2016-2017 indicates that it is 14.3 years old, with an average of 5.8 cigarettes per day and a global prevalence of smoking among adolescents of 4.9% (women 3% and men 6.7%). These figures must be reduced to prevent smoking from creating an addiction and from continuing into adulthood.

The National Survey of Drug, Alcohol and Tobacco Use 2016-2017 indicates that 20.1% of adults between the ages of 18 and 65 are current tobacco smokers, of which 31.3% are men and 9.8% women. The most common product is the conventional cigarette, which they acquire mainly in grocery stores or supermarkets. An average of 7.8 cigars are consumed daily by men and 6.4 by women, and more are smoked in urban areas than in rural areas. It is noteworthy and reflective that 98.5% of smokers are aware of the toxic consequences of tobacco and recognize that it causes serious illnesses such as cancer and respiratory diseases. However, less than 15% are willing to quit this habit, because nicotine is a legal drug as addictive as cocaine and heroin.

Nicotine is the main active component of tobacco and is a psychoactive stimulant drug that induces tolerance and chemical dependency with strong addictive power. The same applies to electronic cigarettes in which the liquid added to them also contains nicotine. In only seven to ten seconds it reaches the brain and increases the release of dopamine, which generates the sensation of pleasure and alertness, but the effect disappears after a few minutes, so it is necessary to continue smoking. Besides nicotine, tobacco smoke contains more than seven thousand compounds, of which several are toxic and at least 69 are carcinogenic.

Exposure to cigarette smoke is related to the development of respiratory tract diseases, various types of cancer, and cardiovascular diseases. In 2016, chronic obstructive pulmonary disease (COPD) was among the top ten causes of hospital mortality at the Institute of Security and Social Services for State Workers (ISSSTE), and in Sonora, it caused 388 deaths (rate of 15.5 per 100,000 inhabitants). In that same year, 6,717 cases of malignant tumors of the trachea, bronchus, and lung were registered in the country, with an accentuation in the ages of 15 years onwards.

Carbon monoxide from tobacco smoke and nicotine alter the inner wall of blood vessels by causing small erosions that favor the formation of plaque. This is the accumulation of substances found in the blood, such as lipoproteins and cholesterol. As time passes, the plaque hardens and obstructs the flow of blood. In addition, nicotine causes an increase in blood pressure, which leads to the heart working harder.

Smoking is also linked to other conditions such as insulin resistance, diabetes, impaired kidney function, and obesity. In women, it is also associated with osteoporosis and early menopause. Tobacco consumption not only affects the health of smokers, but also the economy of their families, and it also means an expense in health care.

The cost that smoking represents for public health institutions is very high. An example of this is the annual attention of a patient with acute myocardial infarction in a delegation of ISSSTE, which costs an average of 301,789 pesos, while lung cancer is treated at the National Institute of Cancerology in Mexico has an average cost of 1'073,191 pesos per year. In addition, the medical care costs of acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease, and lung cancer are estimated at 43,000 million pesos.

The unnecessary additional expense of smoking prevents this resource from being used for other priority needs in the household. Therefore, strict public policies and strategies are required to help reduce this problem as much as possible.

The report on the global tobacco epidemic reports progress since the adoption of the World Health Organization (WHO) Framework Convention on Tobacco Control. Many challenges have been met and obstacles have been overcome, both by the tobacco industry and by policymakers. Thus, five billion people around the world have been protected by at least one tobacco control measure. However, there is still work to be done to avoid the risks of the damage that tobacco use causes to health and the economy.

The WHO's global tobacco control strategies that are effective are: monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit, and warning about the dangers of tobacco. Also, enforcing bans on tobacco advertising, promotion and sponsorship, and increasing tobacco taxes.

While recognizing the work and commitment made by the government, failures persist in controlling the media and smoke-free environments. There are also unquantified recruitment practices, commented on by youth, such as the free distribution of cigarettes at mass events.

All of the above highlights the complex and, in some aspects, little explored problem of the smoking habit, an important risk factor to control to achieve and maintain good individual and population health.

By María del Socorro Saucedo Tamayo and Adriana Verónica Bolaños Villar, researchers of the Nutrition Coordination of CIAD.