SMOKERS’ CHESTNUTS
"Loathsome to the eye, hateful to the nose, harmful to the braine, dangerous to the lungs, and in the black stinking fume thereof nearest resembling the horrible Stigian smoke of the pit that is bottomlesse"- King James I.
Cigarette smoking was almost unknown before the 1890s. Hopefully it will soon largely disappear in the western world. There may well remain a battle to remove a new scourge from the third world.
In pubs, in the corridors of power, and in doctors' consulting rooms the smoking debate goes on. A few who wish to stop smoking, but cannot summon up the motivation, are prepared to say rather weakly that they lack the "will power". Many, however, in order to rationalise their smoking, put forward various arguments in defence of the habit. Similar arguments are also paraded by the tobacco industry and their associates.
In this document many of the arguments are raised. Most of these will be familiar to those who have taken an interest in the subject and have participated in discussions, in "phone-ins”, newspapers, seminars and in the course of “putting the world to rights”. The responses to these arguments are intended as specimen rather than model answers. They are intended to stimulate debate and hopefully to lead to a reappraisal of established attitudes.
"My uncle smoked 20 cigarettes a day and lived to be 80."
Everyone is able to recall a friend or relative in this category. However, smokers who produce these examples do not dwell on the numerous smokers they knew who died well before this age.
For men who are heavy smokers many are dead before the age of 70 years. Of those who are still alive many are disabled by bronchitis, angina, heart failure or have had legs amputated. That leaves perhaps 10% to 15% who are apparently in reasonable health and survive to the age of 80 or more. Unfortunately we have no way of predicting who will be relatively undamaged by smoking - the odds are unfavourable and the only safe course is not to smoke.
"My aunt died of cancer yet she never smoked in her life."
Most cancers are not caused by smoking. There are many different types of cancer - as many and varied as weeds in the garden. We do not know the cause of many types of cancer. However, the part played by smoking in causing lung cancer is powerful and chilling - as anyone who has to deal with this common disease will testify.
Lung cancer is the most common cancer in men and accounts for nearly one in four of all male cancer deaths. It is very uncommon in non-smokers (out of 441 British male doctors who died of lung cancer only 7 had never smoked). It is less common in women but it has increased in past decades as smoking in women peaked in the 1960’s at 45 per cent; hopefully this increase in cancers has now levelled off as smoking rates in women are now decreasing each year and have fallen to 20 per cent. Other cancers which are more common in smokers include those affecting the tongue, larynx, pancreas, bladder, cervix and colon. It is estimated that about 20 per cent of all cancers are due to smoking; that is 60,000 cases each year.
Breast cancer, the commonest cancer in women, has nothing to do with smoking. We know some of the causes of breast cancer including obesity and alcohol misuse; there are campaigns for measures to reduce the risks. Doctors campaign just as vigorously as they do over the lung cancer and smoking issue.
"People who don't smoke also suffer from heart attacks."
There is not one cause of "heart attacks” (medically called coronary thrombosis or myocardial infarct). Several "risk factors" are recognised. The narrowing and blockage of the coronary arteries, which is the cause of angina and heart attacks, is due to a "furring" up process in which the "fur" is deposits of fat. This "furring" up occurs in all of us as we get older, but it happens more rapidly in people with high blood pressure, diabetes, high blood fat levels - and smokers.
One rarely sees heart attacks in younger patients unless they are smokers or they are considerably overweight, have high blood fats, high blood pressure or diabetes.
Since the ban on smoking in public places was introduced there has been a 2.4 per cent reduction in admissions for heart attacks in England – that amounts to 1200 cases.
For smokers who have survived a heart attack and then stop smoking - the risk of a further heart attack is halved compared with those who continue to smoke.
"If someone dies of lung cancer you can't prove that it is because they smoked."
The association of lung cancer with smoking is based on statistical studies - and statistics do not provide proof concerning any individual case.
With physical or chemical injury in low dosage, the onset of illness is usually delayed and may not occur at all. Nevertheless the public has had no difficulty in accepting, on statistical grounds, that asbestos may cause mesothelioma; radiation may cause leukaemia and other cancers; and certain drugs, but not all drugs, may cause foetal abnormalities if given in pregnancy. These disasters affect the minority and the majority remain unaffected. The disorders do occur in others without any known abnormal exposure. The harmful effects of the agents may or may not be reproducible in animals.
The statistics relating to lung cancer indicate that it is very uncommon in life-long non-smokers. Cancer becomes increasingly more common with increasing levels of smoking. The risk of developing cancer reduces year by year after stopping smoking. Experimentally, tar from tobacco will induce cancer when painted on the skins of mice, so there is no doubt about its cancer producing potential. It is therefore reasonable to conclude that exposing human lungs and other tissues to tar over a long period may lead to cancer. Individual susceptibility will vary.
The association of smoking with coronary heart disease is also statistical. Again, the more cigarettes smoked per day the more the hazard. The hazard reduces when smoking is abandoned.
The association of coronary disease with other risk factors such as obesity, lack of exercise, high blood fats and diabetes is also statistical. The association has a logical basis because of the known mechanisms of arterial narrowing or "hardening."
Statistics do not prove that a particular individual had a heart attack because - he smoked - or was overweight - or had diabetes - or high blood fats - or a combination of these factors. But they still provide a logical basis on which to offer advice on prevention - and statistically the advice works.
"I believe that moderation in anything doesn't cause any harm”.
At first sight a disarmingly simple statement which doesn't stand up too well to close examination. There is nothing to commend moderation in lead poisoning, dangerous driving, exposure to asbestos or radiation. Similarly cigarette smoking poses a health hazard even in small doses and the hazard increases steadily with the number of cigarettes smoked. Younger men who are only light smokers show a considerable risk of sudden death from heart attacks when compared with non-smokers. There is no safe level of cigarette smoking.
"You are just as likely to be run over crossing the road."
In the UK there were 1901 deaths on the roads in 2011 compared with 100,000 deaths due to smoking. On average, 5-6 people die on the roads every day from all traffic accidents; this compares with 100 people dying every day from lung cancer and at least as many from chronic bronchitis and from coronary artery disease.
"Other things besides smoking are bad for you - why don't we have Government health warnings on bottles of beer and spirits - or even on food."
Alcohol, food, motor cars and sex may be dangerous if abused. Cigarettes are dangerous even when used according to the manufacturers' recommendations.
"You have got to die of something."
Agreed. This comment is usually made as an act of bravado by someone who feels in good health. It is amazing how the bravado disappears when the person has developed chest pain or coughed up blood – he or she then desperately, and understandably, wishes to be told that there is nothing seriously wrong with them.
"I don't know that I want to live to be old."
Most people would like to live a long time, probably at least for their three score years and ten - though no-one wants to get old! The idea of departing this world with a "clean" death at some desirable age is attractive to some. It must be a matter of individual taste as to what age is considered desirable – maybe aged 75 or 80 - or later? Unfortunately there is no guarantee that a smoking related death will be "clean" or to schedule. It might be sudden from a heart attack at the age of 50 years, with no distress to the victim, but leaving a distraught family and a widow (or widower) facing 20-40 years of loneliness. Alternatively death may only come after 5-10 years of progressive disability from angina or chronic bronchitis - too troubled by pain or breathlessness to be able to work or to enjoy everyday pleasures.
"Not tonight, I've got a heartache!"
"If we stop people smoking we will have many more old people to look after."
It is possible to speculate in this callous way about "other people" but few people find it possible to apply this philosophy to their own nearest and dearest. It is always a sad event when a member of a family dies - even though that person has reached or surpassed their three score years and ten. It is not morally justifiable to defend smoking as an acceptable form of population control; respect for human life demands that we should strive to avoid factors which cause premature death - whether these factors are cigarette smoking, malnutrition, substance abuse, or treatable disease. We do not seek to cull our fellow humans - either by neglect or indifference. Smoking does, of course, not merely cause death from disease in older age groups - it causes deaths from the late 20's onwards - in an unpredictable and tragic manner. It is not even a cull: more an indiscriminate holocaust.
"I work in a lot of dust and fumes - I think that's what causes my bronchitis, not my smoking."
No-one would pretend that working in dust and fumes is good for the lungs. But most people working in this type of environment do not develop bronchitis unless they also smoke.
If a smoker has a job of this type then his lungs are under continuous assault at work or at rest - he is likely to smoke on his way to work, at his morning break, lunch break, and tea break, and again on the way home. In the evening at home or outside the pub the assault continues - only when he is asleep does he breathe non-smoky air. Even holidays and weekends bring no respite for he may well smoke more than when he is at work. There is a special need for people in jobs with dust and fumes not to add insult to injury.
"What about the fumes from motor cars and industry? They probably cause a lot of lung cancer."
There is no real evidence that this is so. Lung cancer is more common in industrial towns than in rural areas - but "blue collar" workers are more likely to be smokers and most "blue collar" workers live in towns.
Lung cancer is more common in men than women though most breathe the same air. If air pollution was important the lung cancer rates should be much the same in both sexes.
In recent decades the lung cancer rate in women has steadily risen though atmospheric pollution has got less - this seems to reflect the fact that smoking was very rare in women before the 1940s and it usually takes several decades to develop lung cancer. Now that women are reducing their level of smoking, the lung cancer rate is leveling off. Men have given up smoking at a much greater rate than women, and lung cancer in men is falling faster.
Jersey which has few fumes and lots of fresh air, once had the highest rate of lung cancer in the world. Cigarettes there were very cheap.
"I think stress is the main cause of heart attacks."
Stress is difficult to measure. Is it more stressful to be a high powered executive with hectic schedules and responsibilities for maintaining the competitiveness of a large company; or alternatively to be a parent with low income, too many children, poor housing and difficult neighbours? Prime ministers might be thought to live under stress but in this country most have lived to a ripe old age and only one has died under the age of 70 in the past 160 years ( Robert Peel aged 62 after a fall from his horse.) On the whole there is not too much evidence that stress is an important factor in heart disease.
"It is not burning the candle at both ends that causes harm, rather it is burning the cigarette at one end."
"If I developed a serious illness such as heart disease then I would give up."
Unfortunately the first sign of heart trouble for many people is a heart attack (a "coronary thrombosis" or "myocardial infarct"), some do not survive their first attack so that only the "lucky" ones are around to change their ways.
Lung cancer, once it has developed, has an even more serious outlook - 93% of people are dead within five years.
"If I give up smoking I will put on weight."
This does happen quite often in people who give up smoking. In some it is simply that food tastes and smells better and so eating becomes more enjoyable. In others cigarettes have constituted a form of oral gratification and food is a substitute. Weight gain is usually temporary. The health hazards of modest weight gain are less than those of continuing smoking.
"If smoking is so bad for you, why do doctors smoke?"
Smoking is now very uncommon amongst doctors - less than 1 in 10 now smoke. In the 1950s doctors used to smoke as much as the rest of the population. As the hazards of smoking were recognised, the rate of smoking amongst doctors dropped markedly - much more rapidly than in other occupations. In consequence doctors have shown a significant drop in the death rate from diseases that are caused by smoking - especially heart disease, bronchitis and lung cancer.
Doctors are aware of their responsibility to set a good example by not smoking and so come under considerable social pressure. "Being a smoking doctor is uncomfortable these days for your colleagues either pity you or despise you" - Rose 1981.
"Adults should be left to make up their own minds about smoking.”
In the adult population roughly one in five people smoke (20% of males and females). Most people who fall victims to the habit have become so in their early teens or earlier. The law prohibiting sales of tobacco to children under the age of eighteen has not been rigidly enforced.
Very few people take up smoking for the first time after the age of 18. Thus the choice whether or not to smoke is rarely the "free" choice of an adult - they have been induced to start smoking as a child and are firmly addicted. Many desperately wish to give up - but can't - or at least feel that they can't.
"Why don't non-smokers just leave smokers alone?"
Around two-thirds of smokers would like to give up, either for reasons of health, finance, example to others, or self-esteem. Many of these seek help, and generally most of the help that is available comes from non-smokers rather than smokers. The minority who say they do not wish to give up, includes a percentage who have not fully understood the evidence linking smoking with disease.
"I enjoy smoking. I don't want to give up."
There is also a percentage who would in fact like to stop smoking but have failed in their efforts to stop. To admit that they are unable to stop is not an image that they would wish to project, so they inform the world that they positively do not wish to stop, and their self-esteem is preserved.
"Tobacco is a legal product. In a free country a company has the right to sell its products."
The legal right to sell tobacco to over 18s is unquestioned. What is questionable is the morality. Would any socially responsible person promote a dangerous product on which its victims become "hooked"? Knowing, moreover, that most are "hooked" when they are young and impressionable and have not reached the legal purchasing age.
Smoking is pushed by those whose main motive is profit. There is a basic disregard for other people's welfare. Surely this all adds up to the unacceptable face of exploitation.
The tobacco industry provides support for organizations who play down the evidence for the risks and undesirability of smoking. The organizations usually employ non-smokers who are able to precede any propaganda with a statement as an apparent neutral “I have never smoked but …......”
"If everyone stopped smoking, a lot of people would be out of jobs."
There are fewer than 6,000 people employed solely in cigarette manufacture and distribution in the UK. Thousands more are partially involved in tobacco sales (e.g. Newsagents and Tobacconists). If everyone stopped smoking then there would be job losses in the tobacco industry. However, this is not the end of the story. Currently about £16 billion (£16,000,000,000) is spent on cigarettes (legal and illegal sales combined) – plus around £25 per person annually on lighters or matches. If people stopped smoking they would usually not "save" the money - they would spend the money on alternative goods and services - so creating jobs in other industries.
In a household where both partners smoke the average of around 14 cigarettes a day there would be over £3000 each year to spend on clothes. carpets, TVs, washing machines; or holidays, a safer car, or better food. Other members of the family would benefit from these; rather than having merely to endure inhaling the smoke.
Abolition of smoking would certainly have an effect on the jobs available for nurses, doctors, undertakers, florists and firemen.
It cannot be a source of satisfaction to the tobacco workers that the price of each job is the death of 15 UK citizens each year -- plus many others overseas.
"Many developing countries depend on tobacco crops to buy food and other goods."
Many developing countries are major tobacco growers - they produce half of world tobacco. It seems lamentable that when so many poorer countries have food shortages and starvation, fertile land which could be used for growing food is used for an uneatable product. In feeding poor people in poor countries there is no substitute for self-sufficiency in food.
Cigarette smoking in developing countries is being vigorously promoted by international tobacco companies - using advertising techniques that would be unacceptable in the developed countries where the companies are based.
Smoking related diseases are now being added to the burdens of malnutrition and diseases due to poor water supplies and sanitation already existing in poorer countries. The tobacco industry is the worst type of parasite encountered by developing countries.
"The tax from cigarettes more than pays for the additional illness that smokers get."
The revenue from tobacco tax is some £10 billion (£10,000,000,000) a year. The cost to the NHS of treating smoking related diseases is difficult to evaluate though it has been estimated to be approximately £2.7 billion a year. The cost includes the hospital treatment of lung cancer, coronary artery disease and bronchitis and also includes many cases of disorders such as strokes, arterial disease of the legs, peptic ulcer, hernias, cancer of the bladder, cervix and colon.
It is also necessary to take into account delayed recovery from any surgery in smokers because of chest complications of anaesthetics and impaired wound healing.
Small babies are more common in women who smoke in pregnancy; the children of smoking parents are more likely to require hospital treatment for chest and ear ("glue-ear") problems and the increased occurrence of meningococcal meningitis and acute leukaemia.
Smokers are much more likely to require treatment from their G.Ps. for heart, lung and other problems; thus there is considerable expenditure on cough medicine, antibiotics and drugs for angina and heart failure.
There is also major expenditure on sickness benefits for the increased absences from work of smokers. Later there follows permanent disability benefits and widows pensions.
Smoking is a major cause of fires in homes, factories and countryside causing extensive damage.
Much of the cleaning costs outside public buildings and in the streets in general is the result of discarded cigarette ends, packets and wrappings.
Smokers are more likely to be involved in car accidents; probably mostly because of the distraction from the process of lighting and manipulating a cigarette; though habitual risk taking may be a factor.
The British Medical Association in evidence to a Royal Commission on the Health Service stated that the total cost of smoking exceeds the income from tobacco tax. A proper Government evaluation is overdue. The total cost to society may be £14 billion.
Even if there were, in fact, an excess of income from tobacco tax over the total cost of caring for ill health and other problems due to tobacco, it would not justify smoking as a means of providing general taxation revenue. Smokers are a disadvantaged minority; they are recruited predominantly from low income sections of society; they deserve to be helped, and not to be exploited by vested interests or by government on behalf of other sections of society.
"Smoking doesn't cause any real harm to other people."
For most non-smokers the main problem is annoyance rather than harm. Other people's smoke causes irritation to the nose and eyes and a lingering smell in the clothes. Increasingly, non-smoking households object to visitors smoking and leaving a smell which lingers for days. When smokers become ex-smokers they are commonly amazed to find how offensive tobacco smoke is to the non-smoker.
People with asthma or angina may find that their condition is made worse by other peoples’. smoke.
The children of parents who smoke are affected in two main ways (l) Heavy smoking in pregnancy doubles the likelihood of the baby dying before or after birth. The baby is lighter on average and more come into the premature baby category with a decreased chance of survival. (2) There is a greater likelihood, particularly if the mother smokes, that the growing child will suffer from chest infections and hearing problems (glue ear); sudden infant death syndrome is more common in smoking households. Meningitis and leukaemia are more common in the children of smokers.
Domestic fires with loss of life are very frequently due to cigarette ends being dropped on bedding or furniture - the smoker is often not the only victim. Young children playing with matches etc. also cause tragic fires and in many cases the availability of matches, stems from parental smoking.
Seat belt legislation has led to a fall in admissions for car occupant injuries. Similarly, since thousands of beds are occupied by victims of smoking related diseases - the avoidance of these unnecessary illnesses would enable more resources to be devoted to the care of diseases that are not avoidable.
"What about low tar cigarettes?"
Smokers of low tar cigarettes are less liable to develop lung cancer compared with smokers of high tar or non-tipped. There is no significant difference in the liability to coronary heart disease.
The addictive substances in cigarettes are nicotine and tar; nicotine produces the stimulant effect and tar supplies the taste. Cigarette smoke contains three constituents which are thought to be the main harmful substances: (l) TAR which is responsible for bronchitis and lung cancer. (2) CARBON MONOXIDE (the gas that kills in old fashioned coal gas and car exhaust fumes). This is believed to cause problems by damaging the lining of the arteries supplying the heart, legs and brain leading to hardening of these arteries. It also reduces the oxygen carrying ability of the blood by combining with haemoglobin. (3) Finally NICOTINE which is the least harmful of the three substances. Some of its effects may be harmful since it does raise the pulse rate and blood pressure; it also constricts arteries everywhere but particularly the coronary arteries supplying the heart. It raises the blood sugar and blood fats and makes the blood stickier - factors which are related to hardening of arteries.
Smokers of stronger cigarettes become used to taking in certain levels of nicotine and tar. Consequently if they switch to cigarettes with a lower nicotine and tar content they tend to take longer and more frequent puffs in order to secure the accustomed "dose". Thus, the cigarettes are weaker - but the "dose" of harmful substances is the same.
"I've cut down from 20 a day to 10 a day."
Reducing the intake by this sort of amount doesn't usually make a big difference to the daily "dose" of tar, carbon-monoxide and nicotine. To the heavier smoker who cuts down, each cigarette becomes more precious - he is reluctant to leave cigarettes burning in the ashtray - he smokes each cigarette more intensely and to a shorter stub. Thus he ensures his "dose" of the addictive nicotine and tar, the health risk is little altered.
A reduction as a step towards stopping altogether is justifiable but as a long term change of habit it is not very useful health-wise.
"Are pipes or cigars safer?"
Life long smokers of pipes or cigars have only a slightly increased risk of death from heart disease but a considerably increased risk of death from lung cancer and chronic bronchitis. Cigarette smokers who switch to pipes or cigars continue with a substantial risk of lung cancer and bronchitis - probably because many continue to inhale the smoke.
"I've been smoking cigarettes now for 30 years - it's too late to give up."
The risk of a fatal heart attack in someone with no history of heart disease drops quite quickly with giving up smoking and within a few years the risks are not much greater than for a life-long non-smoker. So even if you feel healthy the sooner you stop smoking the better. For the patients who survive their first heart attack the outlook is considerably improved if they never smoke again. The outlook for a smoker who has survived a heart attack and continues to smoke is bleak.
The risk of developing lung cancer takes much longer to reduce but 15 years after stopping the risk is reduced by 80%.
"I can't really afford to smoke."
For most people they imply that they cannot afford to smoke for financial reasons - in reality they cannot afford to smoke for the sake of their health.
We would like to think that the intelligent British public are persuaded by the health arguments but, perhaps we should not be too disappointed by this response. For example, we know that many women who are trying to lose weight are doing so for the sake of their appearance - whereas medically the important issue is the ill health associated with being overweight. Being realistic if, in fact, people give up smoking for financial reasons - then so be it - we should be pleased.
Smoking in different social groups varies, the average is 20 per cent in men and women. In professional groups the rate is low; in unskilled workers the rate is higher. Thus the people in the lowest paid groups spend most on cigarettes - and suffer the highest rate of ill health. In low income families where both partners each smoke the average of around 14 cigarettes daily, the expenditure of around £50-70 per week on smoking will make serious inroads into disposable income after payment for rent, council tax, heating, lighting, transport, food and clothes. Because of the addictive nature of cigarette smoking it may take precedence over spending on food.
Truly no-one can afford to smoke – financially, or from a health point of view. Least of all those who are already disadvantaged.
"Cigarettes are one of the working man's pleasures."
It is to be hoped that Trades Unions and poverty action groups will become increasingly concerned about the effects of the smoking habit on lower income groups. Tobacco tax is high; lower income groups as the principle consumers of tobacco pay the bulk of this tax. The burden is even greater when considered as a percentage of their disposable income.
Clearly reducing tobacco tax is not the answer- this step would increase health problems - in all age groups. It is a sad irony that the high price is for many the biggest disincentive to smoking. For example, seemingly paradoxically a lowered income on retirement often acts as an incentive to give up smoking - and so a longer and healthier retirement ensues.
The way ahead would seem to lie in applying pressure for further Government restrictions on tobacco advertising and promotion. Education of "working people" on the dangers of smoking is of great importance. There is a need to try and change the traditional view that "they" ("those in charge") are trying to deprive "us" ("the working people") of "one of our pleasures". That "pleasure" has to be seen as the source of a host of problems and human misery.
Abandonment of smoking and a switch of expenditure to consumer goods will have the most impact on the standard of living and the health and vitality of the lowest income groups. That should interest politicians, trades-unions and any who care.
We should beware of persuasive individuals who are not directly involved with the welfare of working people, who preach the doctrine of "freedom" to make yourself ill by smoking if it is your choice. That "freedom" is most widely exercised by the least well educated, least health conscious sections of society.
"A cigarette settles my nerves. It's either cigarettes or valium."
To be permanently relaxed and "laid back" is perhaps everyone's dream. Some give the impression that nothing disturbs their equanimity - while others, usually with no greater share of problems, nevertheless live their lives feeling that their days are filled with doubts, fears and set-backs - they suffer permanently from "nerves". Most of us are somewhere between the two extremes.
In a search for freedom from tension, people may adopt various measures. Some take tranquillisers of the Valium type - they may be helpful in tiding people over acute emotional crises - but if used for long standing problems, the effect wears off in a few weeks and the anxiety returns; then the patient is likely to be just as anxious, but is now hooked on tranquillisers. Alcohol has been in use since Biblical times and there is no evidence that its use in moderation at appropriate times causes harm; it is, however, unsuitable for day time use for anyone required to make reasoned judgments. With more than modest amounts, physical, social and mental problems arise.
Smoking has a symptom relieving effect for two main reasons. Firstly, for the habituated, nicotine has the ability to tranquillise when anxious and to stimulate when fatigued. Secondly, the act of taking out or offering a cigarette, lighting it, and manipulating it when smoking, provides tension relieving activity - akin to manipulating worry beads, ring twirling, scratching, picking, finger nail chewing or other even less socially acceptable activities. Smoking can serve as an all too readily available prop, so that almost any mildly stressful event is preceded or punctuated by an intake of nicotine or a smoking related activity. The stressful event may be making a telephone call, entering a room containing other people, an awkward pause in conversation. Boredom, rumination, watching competitive events, frustration, loneliness or unwelcome weariness are also stressful.
Smoking has to be seen as another snare and delusion. It is not appropriate as a means of tackling the minor recurring stresses occurring each day in life. It is inappropriate primarily because of the adverse effect on health produced by the various constituents of tobacco smoke. The impact is mainly on the smoker but there is a significant and occasionally major effect on other people. In the longer term the health of many smokers deteriorates, this affects vitality and enjoyment of other pleasures and pastimes. Anxiety about deteriorating health ensues. There is also anxiety and guilt about indulgence in the smoking habit in relation to self-esteem, example to others and effect on others.
Smokers need to be directed towards less damaging ways of relieving their tension, social unease or boredom. The alternative activities may include physical activity, chewing non-fattening food stuffs, chewing gum, "dummies" and yoga - there are many others. With improved health, vitality, finance and self-esteem the daily burden of anxiety is less. Paradoxically, the anxiety prone individual who is anxious about his or her smoking has a good chance of surprising even himself or herself by giving up smoking.
"I wish I could stop - I've tried acupuncture, hypnosis, patches and chewing gum but nothing has worked."
No-one pretends that giving up smoking is easy. Like all worthwhile achievements in life it requires effort. The main requirement is motivation - you have got to want (effort) to give up, rather than wishing (magic wand approach) to give up.
Many of the people who have "tried everything" are looking to give up by the magic wand approach rather than being truly committed to stopping by their own efforts. Giving up is painful - but has to be seen as worthwhile. The necessary motivation will differ with each individual and it is a matter of finding one that works. There are various areas to contemplate and they include health, finance and self-esteem.
1. Young people are not much impressed by the health risks - to apparently flirt with death may even seem attractive - sickness and death in middle age seems very remote. The one stigma they cannot escape is the unpleasant smell on their clothes and breath. Identification with non-smoking pop or sports idols may help.
2. Adult women may be motivated by the realisation of the effects of smoking on their appearance - and they can witness it in their friends who smoke. Smoking has an ageing effect - the most tangible evidence is that women smokers tend to have an earlier menopause – their ovaries have aged prematurely. The face shows the more obvious visible features; smoking constricts the blood vessels in the skin so that the face becomes uniformly white or grey and the pink complexion fades. Deprived of blood supply the facial skin deteriorates and becomes wrinkled prematurely. Many women spend money on expensive facial creams and beauty treatment - without realising that smoking may be a major cause of their problem.
3. For adult men the main consideration must be health. Far too many do not live to retirement age having paid all their lives into some sort of retirement fund. Couples plan for their retirement but the hopes are not fulfilled. Few widows are "merry".
Good health is to a degree a lottery but only a fool leaves everything to destiny. Even a carefully maintained and sensibly driven car may break down -- but it does not weaken the case for common-sense.
4. People who are in positions of authority or influence have an exemplar role. Thus school teachers, politicians, youth workers and health workers have special responsibilities to discharge. Since most (80 per cent) adults do not smoke and two-thirds (67 per cent) of smokers would like to stop, it seems that smoking is viewed by most people as undesirable. It follows that most of those who continue to smoke are presumed to do so because they are unable to stop. If the people in positions of influence who would wish to be regarded as possessing special knowledge, determination and discrimination seem not to be able to stop --- what is lacking in their make-up? ---- and what chance is there for the lesser mortals who they aspire to influence and impress?
Many people make several attempts at stopping smoking before they finally succeed. Each effort is probably easier because they know what symptoms to expect and can prepare to counteract them. The symptoms of nicotine withdrawal vary from individual to individual - sometimes they border on the "cold turkey" of the victims of heroin addiction. The symptoms subside after a few weeks or months leading to improved well-being and self-esteem. In patients who have to give up smoking for serious medical reasons, e.g. admission to a coronary care unit, there are rarely troublesome symptoms. This suggests that much of the "addiction" is in fact psychological dependence.
The number of smokers drops each year. In the U.K. there are now some 10 million smokers - and over 55 million non-smokers.
IT’S THE CIGARETTE THAT SMOKES --- DON’T BE THE SUCKER ON THE OTHER END
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