Smoking and daily routines

Dr Derrick Aarons

Sunday, April 15, 2018

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MOST of us are aware that smoking harms nearly every organ in our bodies, and cigarette smoking causes 87 per cent of the deaths from lung cancers. It also causes other lung disease, other types of cancers, disease of the heart and blood vessels, stroke, and cataracts in the eye.

Yet, there are currently more than one billion smokers worldwide, despite the known risks to their health.

The World Health Organization estimates that 7.2 million people die each year as a direct effect of the negative health consequences of smoking. We therefore need to have a better understanding of why people start smoking, the barriers that exist for them to stop smoking, and how best to motivate them to do so.

Global research suggests that the success rates of quitting smoking could be much higher if smoking cessation programmes focused on the various behavioural, emotional and social factors that are the important drivers for smoking in different cultures.

A 2018 survey has also revealed that smoking behaviour is deeply embedded in the daily rituals and routines that exist for waking, eating, drinking, and socialising. This would explain why simply focusing on the physiological aspects of nicotine craving and addiction has not been successful in bringing an end to smoking.

Smoking cessation programmes

Accordingly, smoking cessation products and programmes need to be customised for different groups in different economic conditions. Smokers around the world are not one homogeneous group of people, and so our approach should embrace a wide range of solutions.

Firstly, the health care system needs to better engage with smokers, and the providers of medical products need to develop more effective tools to help smokers quit. No new drug to help smokers quit has been developed in the past 20 years.

The nicotine that has been deliberately added by the manufacturers to the tobacco in cigarettes remains the fundamental factor in promoting, as well as in sustaining a person's addiction to cigarettes. Therefore, offering guidance and support is still one of the most effective tools that a health care provider can use to help patients quit smoking.

Directly asking them about smoking, repeatedly encouraging them to quit, discussing a range of options available for their support, and following up in assessing their smoking status are some of the effective ways in which help can be provided.


Although not healthy, e-cigarettes are less harmful than combustible cigarettes. They are battery-operated smoking devices that often look like cigarettes but work differently. They are thought to reduce health risks by helping people to stop smoking completely through the replacement of nicotine.

A research survey that interviewed 17,421 current smokers, former smokers, as well as non-smokers in Brazil, France, Greece, India, Israel, Japan, Lebanon, Malawi, New Zealand, Russia, South Africa, the United Kingdom, and the USA showed that 80 per cent of smokers are located in the lower-and middle-income countries, and that many were confused about the relative harms of smoking, what smoking cessation programmes and products work best, and what were the less harmful alternatives to smoking, such as e-cigarettes.

In the research, smokers were more likely to have a partner or spouse who smokes, and to have close friends who smoke. Also, smokers knew the risks to health of smoking and considered themselves less healthy than non-smokers, yet did not visit doctors as often as did non-smokers.

The survey also indicated that smokers do not understand the risks of nicotine.

Although nicotine promotes a person's dependence on cigarettes and drives addiction, most of the cancer-causing effects from smoking come from the actual burning of the tobacco within the cigarettes. Consequently, smokers who sought help to quit smoking often turned to nicotine-replacement therapy and prescription medicine.

Nicotine-replacement therapies such as patches and nicotine gum, however, have low success rates because they do not deliver nicotine in a way that mimics smoking. The e-cigarettes mimic this process far better.

More research needed

A large drop in the use of tobacco (cigarettes) has occurred in Japan over the past 18 months because many smokers there have switched to e-cigarettes. Those smokers wish for a cleaner, fresher smoking experience, and using an e-cigarette allowed them to socialise with friends. Nevertheless, more research is needed to assess whether there is a role for e-cigarettes and vaping devices to help smokers transition from cigarettes to total cessation.

Eighty to 90 per cent of the research on smoking cessation is currently being carried out in the USA and the United Kingdom, but the research also needs to occur in those countries where different solutions are needed.

Hopefully, this new research will jolt many smokers into some action to stop smoking, and spark a meaningful discussion on the deeply complex reasons why so many people continue to smoke despite knowing that smoking causes cancer.

We need to develop more effective communication and interventions to help smokers quit or at least substantially reduce their risks for cancer.

Dr Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in health care, research, and the life sciences, and was the ethicist at the Caribbean Public Health Agency (CARPHA). (The views expressed here are not written on behalf of CARPHA)




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