Smoking is a childhood problem

       World Health Organization (W.H.O.) celebrates 31^st May every year as "No Tobacco Day". This year the theme is "Second-hand smoke kills. Let's clear the air".  The problem of smoking and diseases and disorders due to it are on the increase. W.H.O. Director General Gro Brundtland has pointed out to the magnitude of the problem. According to the figures available, 500 million people alive today will eventually be killed by tobacco. Worldwide the death rates from tobacco is likely to rise from about 4 million deaths a year in 1998 to about 10 million a year in 2030. This figure is more than the total deaths from malaria, maternal and major childhood conditions and tuberculosis combined. Over 70% of these deaths will be in the developing world. It clearly shows that smoking is not the problem of developed and affluent countries. It simply means the current death rate of 1 person every 8 seconds now will rise to 1 per 3 seconds in 2030. By 2020, smoking will cause about 1 in 3 of all adult deaths, up from 1 in 6 adult deaths in 1990. Unfortunately, this tobacco epidemic is man-made. Still all tobacco related deaths and diseases are PREVENTABLE.

         Smoking is now considered as a childhood problem. Child learns most of the habits in his initial years. Various studies carried out clearly show that majority of smokers (about 80%) start smoking before the age of 18 years. Also the earlier the age of initiation of smoking, the more difficult it is to leave smoking due to tobacco's powerful addictive properties. It means if the child is protected from this devastating habit till this age, there is least risk of his being a smoker. The tobacco industry too knows it well and acts accordingly. Hence, fellow young are the special targets of tobacco advertisements. Some of the cigarettes companies offer free cigarettes to the young at disco clubs. Tobacco companies definition of "young adults" is as low as children 14 years old.  The tobacco epidemic is a communicated disease. It spreads through advertisements, through the examples of smokers and through the smoke to which non-smokers; especially children are exposed. Our job is to educate the people about it i.e. to "immunize" them.   Smoking is now considered as a childhood problem as the child suffers from it even before he's born. If the pregnant mother is a smoker:- there are high chances of spontaneous abortions, ectopic pregnancy, stillbirths, intrauterine growth retardation, preterm baby, low birth weight baby, delayed cry after birth with attendant consequences and high incidence of "sudden infant death syndrome", oral clefting etc. These babies are more cranky and irritable. They are more likely to refuse feedings and spit up; are more likely to have sore eyes, noses and throats. These babies suffer from lower respiratory tract infections during first 5 years of their life. These babies have an increased risk of developing cancer during both childhood and adulthood.   An important fact is that children of non-smokers are less likely to become smokers themselves.

       Also, children exposed to Environmental tobacco smoke (ETS) have a higher incidence of ear diseases in the form of otitis media, the increased need for operations for it i.e. tympanostomy tubes, higher rates of asthma and other respiratory illnesses and increased incidence of hospitalization and deaths due to them. When translated to actual figures, it amounts to more than 2 million cases of ear problems with over 1 lac operations for removal of tonsils. ETS is associated with more than 5 lac asthma cases among children less than 15 years of age. Being exposed to second hand smoke all the day is the same as smoking 2-3 cigarettes per day. Apart from health problems, ETS is associated with serious economic consequences. The cost of treating afflictions related to children's exposure to tobacco runs at around $1 billion each year in United States alone.

  Various reasons put forth for the young to start smoking are as follows:

I>             PHARMACOLOGICAL dependence: as stated earlier, because of the strong addictive properties of nicotine and other chemicals in smoking, the smoker finds it hard to leave the habit.

 II> PSYCHOLOGICAL:

1.    as a sign of maturity.

2.    to ease of "tension"

3.    Peer group pressure: to get accepted in the group.

4.    as a sign of rebellion: against the traditions of family/ community

5.    mimicking "heroes and sportsstars"

6.    as a solution of failures and frustrations

7.    to impress upon others esp. girl/ boy friends.

8.    sign of independence

9.    for seeking fun and pleasure

10.to satisfy curiosity. 

        Even experimentation of smoking is equally harmful, as there are 50% chances of a child of becoming smoker in future even if he/she's tested a single cigarette. Most of these children have no access to the knowledge of the adverse effects of smoking. According to a study, 2/3 of the smokers mistakenly believe that smoking does little or no harm. Just to illustrate the impact of advertisement on the children, Dr. Sharad Vaidya from Goa carried out a study on school children after the Will World Cup Cricket in 1996. The report is published in Journal of the Indian Medical Association. The series was broadcast live to a 2-billion viewers worldwide. The sponsoring company Wills was extensively advertised. Players and managers wore the company logo. Wills logo was displayed about 158 times during the day. Almost 10% of previous non-smokers were initiated into the smoking habit after the series. The conclusion is quite clear that the sponsorship promoted not just the advertised brand but also smoking in general. Hence, the need of the dissemination of the knowledge and information regarding adverse effects of smoking esp. to the young population.

 Most of these reasons are misbiliefs and don't have any scientific

basis. Also the researchers inform that children are likely to start smoking if they grow up in an environment where tobacco advertising is prolific, where smoking rates are high among adults (including those who serve as role model for young people), where tobacco products are cheap and easily accessible, and where smoking is unrestricted in public places. Educational programmes and health promotion campaigns are more useful at places where harms of tobacco are not widely known. However, to be more successful these programmes should be strongly backed by strong public policies and government commitment.

         Please take into cognizance that tobacco is a silent killer and it's everybody's problem. Hence, let's all commit to get smokers to quit and non-smokers not to pick up the addictive habit and make this day a great success.

 Dr. Satish V. Agrawal, M.D., D.C.H., D.N.B.(Paediatrics)

drsva99@vsnl.com

Dr. Sau.Jyoti S. Agrawal, M.B.B.S., M.D. (Paediatrics)

jyoneon@hotmail.com

Agrawal Children Hospital & Intensive Care Unit, AMRAVATI.

 Ph. Nos. 577228/ 679988

[Dr. Satish V. Agrawal has held the post of Secretary of I.A.P. (Indian Academy of Paediatrics), Amravati branch for 2 successive years.]