World No Tobacco Day; Health risks of Shisha and other tobacco products.

May 31st is World No Tobacco Day and thus an important date on the World Health Organization and Ministry of Health, Uganda calendar.

The extent of the human and economic burden that results from tobacco use is jaw dropping. Globally, tobacco kills more than 8 million people per year with over 7 million of these deaths resulting from direct use of tobacco and approximately 1.2 million as a result of exposure to second-hand smoke by non-smokers.

In the African region, approximately 146,000 adults aged 30 years and above die every year from tobacco-related diseases. About 80% of the 1.3 billion tobacco users globally reside in low and middle-income countries, these are countries where tobacco-related illnesses and deaths are heaviest. 

According to the WHO Global Health Observatory Data-2016, the average life expectancy at birth of the global population is 72 years and 62.5 for Uganda. There is a high prevalence of tobacco use in Uganda, studies show that 1 in 10 adults use tobacco products daily.

There has been a notable global shift in causes of morbidity and mortality from infectious diseases (such as malaria, pneumonia and HIV) to Non Communicable Diseases(NCDs) such as Cancer, Diabetes and Hypertension. In 2018 when WHO commemorated World No Tobacco Day, The Minister of State for Health in charge of Primary Health Care, Dr. Joyce Kaducu Moriku did mention that tobacco affects the heart gravely, with 12 percent of all heart-related deaths related to passive smoking. She emphasized the need to stop tobacco consumption. 

WHO’s Global Status report on Non Communicable Diseases (NCDs) indicated that tobacco use has been the main risk factor for NCDs which we now know account for 25% of all the deaths in the country. Research conducted at Uganda Cancer Institute also showed that 25% of patients who suffered from lung cancer were tobacco users, 16% oral cancer, 13.7% stomach cancer and 12.6% throat cancer, all these patients were tobacco users.

On average, the life expectancy of a smoker is 10 years less than a nonsmoker. It has been established that cigarette smoke contains more than 7,000 chemicals, 70 of which are known to cause cancer of the head, neck, throat, oesophagus and oral cavity (mouth, tongue, lip and gums) as well as various dental diseases and more recently recognized by chest physicians to significantly contribute to risk of infection and severity of COVID 19.

Tobacco is a household name for a number of plants in the Nicotiana genus and the Solanaceae family. It is a potentially addictive substance, and a gateway for most people that become addicts in later life, despite the negative consequences in the long term. Conversely, compared to other substance of abuse, legally acceptable substances such as tobacco and alcohol are medically far more harmful if used in non-over-dose amounts compared to illegal drugs such as marijuana. And again this is no justification for illicit drug use if we must take up a well thought drug prevention strategy.

Data from the WHO suggests that tobacco use contributes to poverty through diversion of household income from basic needs such as food, shelter to tobacco.To add insult to injury, there is significant impact of tobacco use on the economy. The health care costs for treating the complications of diseases that result from its chronic use such as cancer, straining already struggling health systems, the lost human capital resulting from tobacco-related deaths notwithstanding.

According WHO all forms of tobacco are harmful and there is no caveat for a safe level of exposure to tobacco. So far, cigarette smoking is the common form worldwide. Other tobacco products include cigars, cigarillo, roll-your-own tobacco, pipe tobacco.

Lately, there is a growing fancy trend of emerging Heated Tobacco Products (HTPs), the devices heat the tobacco within a very specific temperature range, the electronic heat-control system prevents it from burning, by contract, e-cigarettes (aka Electronic Nicotine Delivery Systems-ENDS and Non Nicotine Delivery Systems) vaporize a liquid containing flavorings and sometimes nicotine, depending on the type. ENDS contains varying amounts of nicotine and harmful chemicals which are not safe especially for children and young adults whose brains continue to develop up to about 25 years age as well as damaging the growing baby if used by a pregnant woman. They have been promoted as an alternative to conventional smoking and having reduced harm. However, these equally contain toxic chemicals that cause cancer and there is no sufficient evidence to suggest they are less harmful than conventional cigarettes.

Different forms of tobacco

  1. Waterpipe tobacco - In Uganda, it is also known as Shisha/hookah.

It is an ancient practice that started in India. It involves passing tobacco smoke through water prior to inhalation by the individual consuming it. The danger lies on misconceptions, a deeply held belief that it is free from health hazards. Contrary to popular belief, it is associated with adverse health outcomes on both short and long-term basis. The smoke that emerges out contains toxicants known to cause lung cancer, heart disease and other diseases. A good number of pubs in Kampala sell Shisha.

Waterpipe sessions may expose you to more smoke over longer period of time, than when smoking a cigarette. According to CDC, cigarette smokers take about 8 to 12, 40 to 75 ml puffs in over 6 minutes, therefore inhaling approximately 0.5 to 0.6 litres of smoke. Interestingly, Shisha sessions for example last 20 to 80 minutes, during this time, a smoker may take 50 to 200 puffs, which range from 0.15 to 1 litre each. Therefore, a Shisha smoker will inhale as much smoke during one session as a cigarette smoker would inhale, consuming 100 or more cigarettes. The dangers of waterpipes are not well understood by users.

Summary of key facts.

  • 1-hour long Shisha smoking session for example is equivalent to inhaling a volume of 100 – 200 times the volume of smoke inhaled with one cigarette or in simple terms this means that, it is equivalent to smoking about 100 to 200 cigarettes.

  • The charcoal used to generate heat produces its own intoxicants such as carbon monoxide, cancer-causing chemicals and metals.

  • There is no proof that the accessories used make this practice less harmful. Do not be deceived by individuals advertising these waterpipes.

  • Sharing a waterpipe mouthpiece increases the risk of transmission of diseases as such Covid-19, tuberculosis and hepatitis.

Second-hand smoke from these pipes is a mixture of tobacco smoke, and the smoke from charcoal used as a source of fuel. A combination of this will pose a serious risk to the non-smokers.

      2. Smokeless tobacco products

These are tobacco products that do not need to be burnt; they can be chewed, snuffed, sucked, spat or swallowed depending on how it is made. Some companies are making flavored forms that maybe appeal to young people.

Other tobacco products that are not combustible include those that are finely ground and pressed to form tablets, sticks, or even strips. Some companies make them look attractive; like candy bars or small mints and can be confused for ordinary chewing gum.

  1. Cigars

It is worth noting that cigars are not a safe alternative to cigarettes. You will still be at risk of getting mouth, throat and lung cancer not forgetting heart disease. They contain the same addictive, toxic and cancer-causing chemicals found in cigarettes. These smokers are 4 times more likely to suffer and die from cancer. A cigarette contains approximately 1 to 2 milligrams of nicotine, while a cigar contains 100 to 200 milligrams, some cigars have 400 milligrams of nicotine. Cigar smoke is more concentrated.

  1. Cigarillos

 These are the ones that are wrapped in tobacco leaves or a brown tobacco-based paper, and are relatively smaller than the cigars