March 2, 2006

According to one survey, 40 per cent of Pakistani males and eight per cent of Pakistani females smoke on a regular basis. Judging by the many different surveys conducted over the years, and the views of a large number of people spoken to, it seems that most smokers start young, when health is the last issue on their minds. Surveys reveal that 85 per cent of smokers in Pakistan begin smoking between 14 and 17, observes Shanaz Ramzi

In North America, smoking has come to be regarded as an undesirable social activity, so much so that it is discouraged with a vengeance. Most public places have been converted into no smoking areas, and for the benefit of the few who find it difficult to survive without a puff, smoking areas are generally ear-marked in public buildings, where the smoke raised is probably enough to kill a passer-by from passive smoking.

Some buildings don’t even have that facility, with the result that no matter how freezing the temperatures, smokers have to brave the bitter cold or hot weather and step out of their premises to give in to their urges. What’s more, most homes do not allow smoking, so much so that there are no ashtrays available, and even guests are categorically asked to step outdoors if they wish to light up.

Pakistanis, on the other hand, quick to emulate the West have not yet become health-conscious enough to blacklist smoking. Admittedly, there are public spaces like airports and hospitals where smoking is prohibited, but, by and large, smokers are not actively discouraged. It is traditionally regarded as being disrespectful to smoke in front of one’s elders, so children, regardless of their age, generally abstain from smoking in the presence of their parents or family elders.

However, that is not to say that the parents are not aware that their children smoke, or that they have made a conscious effort to discourage the habit in their young ones. More often than not, at least one of the parents is a smoker too, thereby endorsing, that it is an acceptable activity to be indulging in and definitely not a prohibitive act.

So, why is it that so many people in Pakistan smoke? According to one survey conducted a couple of years ago, 40 per cent of Pakistani males and eight per cent of Pakistani females smoke on a regular basis, which is quite a formidable number. And why are they not making a conscious effort to discourage smoking, given the increased awareness of the health hazards involved?

Judging by the many different surveys conducted over the years, and the views of the large number of people spoken to for the purpose of this article, it seems that most smokers start young, when health is the last issue on their minds. Surveys reveal that 85 per cent of smokers in Pakistan start in their teens, between the ages of 14 and 17.

Most boys and men this writer spoke to admitted that they started smoking because it was and still is regarded the ‘in’ thing to do at a young age. In fact, among the many reasons proffered for picking up the addiction the most commonly cited ones were ‘peer pressure’, ‘it was fashionable’, ‘our elders did it’, ‘it was the manly thing to do’, and ‘the advertisements made it seem exciting’.

Interestingly, some boys confessed that their chauffeurs were responsible for getting them hooked on to cigarettes. Apparently, each time they would go for a spin together, their drivers would buy cigarettes for both of them, and once the children were addicted, would depend on them for their regular supply.

While there is no doubt that more males are into smoking than females, it is by no means indicative of the fact that women are not heavy smokers. Every generation has had its share of women who’ve shown an inclination for tobacco, but it seems that those who have taken to smoking have generally done so at a later age than the boys. Another interesting point to note is that women smokers are generally frowned upon, although our society seems to have no problems with males who smoke like chimneys.

It seems that while women have pretty much the same reasons for smoking as men, it is more a class issue in their case. Male smokers exist in every social stratum, but female smokers –– particularly of cigarettes, as opposed to hookah or beeri — tend to hail more from the upper classes.

Interestingly, some of the women interviewed, other than mentioning that they initially took it up because it gave them the aura of being very fashionable and bold, claimed that they did it for a sense of excitement, and in defiance. Those who had lived in hostels, in particular, admitted that they took up smoking because it carried the risk of expulsion if caught, which gave them a thrill.

One gentleman, who wishes to remain anonymous, had very interesting comments to make about his foray into the world of cigarettes and subsequent battle with it. Says he, “Smoking signifies the right of passage in many social classes. I started smoking when I was 14, an age when you believe you aren’t a man till you’ve lit up, so I did it to appear ‘cool’.” He says he started with a couple of cigarettes a day, which he would smoke with his friends after school hours. Now, he smokes eight to ten cigarettes a day.

That is not to say that he does not realize he is putting his life at risk. “I have been trying to kick off the habit and know at the back of my mind that what I am doing is harmful to me. But, it is easier said than done. When I was in Canada, there were cigarettes available with different levels of nicotine, so I worked my way to the lightest level, and had I stayed back, might have quit smoking altogether, as a gradual weaning off tends to have more permanent results. As it was, I came back and went cold turkey, giving up smoking entirely for eight months, but then succumbed to the temptation, once again. However, I am trying my best to shake off my addiction even now and every time I have an urge, I drink water instead,” he stated.

According to him, as indeed according to a number of people who have lived in the West for a while, it is a lot easier to kick off the addiction in countries which actively discourage the practice than in our country where it is ‘one of the easiest things to get into’.

While countries like Canada and the US levy heavy fines on people caught smoking in public areas, here one is surrounded by smokers, whether in pubic transport, offices, restaurants etc. In fact, ours is such a free country that people don’t even refrain from smoking in air-conditioned rooms and cars!

So anti-smoking is North America that cigarette advertisements are strictly banned. What’s more, a warning about cigarettes being injurious to health accompanied by graphic pictures occupies more than 30 per cent of all cigarette box faces, so as to discourage smokers. And, it is illegal to sell cigarettes to anyone below 21 years of age, so that it is not uncommon for a shopkeeper to ask for identification if they are suspicious of a purchaser’s age.

In Pakistan, on the other hand, tobacco in all its various forms is readily available, and if a person cannot afford to purchase an entire pack, the ubiquitous ‘paan walas’ are more than willing to sell just one or two cigarettes to buyers, regardless of their age.

Yasmeen, a heavy smoker in her forties, says she started when she was 17. She has an interesting smoking history — she used to light cigarettes for her grandmother who was a smoker, and would occasionally ask her for a last puff just for kicks. The occasional puff or two gradually converted into three or four cigarettes a day until she got married to a non-smoker.

She thought that would end her habit, until she found that her mother-in-law, also a smoker, was supportive of her. Before she knew it, her ‘habit’ grew into an addiction, and she began to go through a pack a day. Says she “The only time I quit smoking was during my two pregnancies. At that time, I just didn’t feel the urge, but as soon as I had delivered, I would be back to normal. I know it is not good for my health, but I don’t have the will power to give it up.”

Considering that the overall environment is not exactly unfavourable for those contemplating smoking, it is not surprising that children start at an early age, and once addicted find it impossible to let go. According to different reports, around 1,200 to 1,500 schoolchildren between the ages of six and 16 years take up smoking every day in Pakistan. But, not all smokers start off in their childhood. There are a number of instances of both men and women who have taken up smoking after entering ‘adulthood’. Their reasons are different, in that most claim that they did it to relieve stress.

Interestingly enough though, according to a research it is a misconception that smoking helps relieve tension. In fact, research indicates that tobacco use actually increases the level of stress and anxiety, which in turn demands more and more nicotine.

Yet another reason cited by smokers, both men and women, who got addicted after they attained maturity was ‘to lose weight’. Since smoking kills the appetite, they felt it would be an ideal way to shed off pounds without having to physically exert themselves. The fact that along with the weight loss they were succeeding in damaging their health did not bother them as they felt it was too remote a reality for them to worry about.

From the attitude of most of the smokers spoken to, in fact, one gets the feeling that though they are by and large aware of the fact that smoking is detrimental to health, they are not overly pushed about it and do not set too much store by it, either. One feels that the main reason for this is the lack of governmental support to drive home the gravity of the problem.

As earlier pointed out, tobacco in all its forms — gutka, hookah, sheesha, pan masala, niswar, beeri, chilum — is easily and cheaply available; there are relatively few places where smoking is prohibited and no attempt is made to ban advertisements promoting the use of cigarettes.

According to Dr Suleman Haque, a pulmonologist, lung cancer is the number one cause of cancer deaths among Pakistani males and over 90 per cent of such cases can be prevented simply by avoiding tobacco. He regrets that the tobacco companies in the country have been given a free hand to promote an addictive substance.

As if that is not frightening enough, the WHO estimates that by 2020-2030 tobacco will be responsible for 10 million deaths per year, with 70 per cent of them occurring in developing countries, which has become the prime target market for international brands.

Hence, it is obvious that by just holding awareness programmes it is not going to be enough to discourage people from smoking. To be really effective, campaigns must be supplemented with action on the part of the government, such as price and non-price control measures including a ban on all types of direct and indirect advertising and the promotion of tobacco products. There is a need to implement anti-smoking legislation.

One must remember that prevention is better than cure. If effective measures are taken to prevent people from falling into the trap of smoking, the exercise will bear far more fruit than attempting to get hooked smokers off their addiction. It is never easy to break off a bad habit, and more so if the will is not there. Having said that, it is never too late to try, either. Undoub tedly, it is an uphill task coping with withdrawal symptoms, but at the risk of sounding clichéd, where there is a will, there surely is a way.
 

Questions answers

Questions put to counsellors by smokers to shake off their addiction: What are the most effective ways to quit smoking? There is a strong dose-response relationship between the amount of psychological treatment and rate of success in quitting. The best possible outcome requires both medication —— nicotine patches, Zyban and so forth ——- as well as psychosocial intervention. Each doubles a person’s chance of quitting successfully. Do smokers need therapy? Yes. About 70 per cent of smokers want to quit, but smokers also have a much higher rate of depression and anxiety than those who don’t smoke. There is also growing evidence that the longer you smoke, the more likely you are to develop some of these negative emotional states. What makes a person quit, then start again? The most characteristic way people relapse is that they encounter an upsetting stressor — an argument, anger or anxiety. Negative mood inflates the incentive value of drug use; expectations that smoking will soothe that negative mood, hence, increase. Smokers are in withdrawal virtually all the time. As soon as the body’s nicotine level starts to drop, they start to go through withdrawal. So, smokers are always getting some ‘reward’ from smoking. Addiction, one knows, is a vicious cycle. The best predictor of success is how much negative mood a person experiences in the first few days of quitting. Another interesting part of this equation is that many smokers don’t experience a decline in withdrawal symptoms after they quit, but rather, their withdrawal symptoms can be higher one or two months later. With the help of psychotherapy and medication you can perhaps get through it? On your own, the success rate is around five per cent. But with intensive treatment, it can be five times higher. When you quit smoking, in some sense it’s like mourning. Nicotine stimulates some of the same brain regions stimulated by interaction with a loved one. So when smokers say, “I feel like I lost my best friend,” neurologically, they have. What advice would you offer? Don’t be too optimistic about what quitting is going to be like; that will make you better prepared. As opposed to mourning a loved one who is gone forever, here the loved one is available at the nearest panwalla. Once a person has a single puff, the odds are 80 to 85 per cent they will go back to full-time smoking. So should they keep trying? Smokers are most likely to quit in their third, fourth or fifth attempt. It is difficult to predict success like failure. –– S.R.

 

Types of smoking

Smoking can be counted as one of the oldest indulgences. Be it in the form of regular cigarettes, aristocratic cigars, classy smoking pipes, traditional hookah or simple and cheap beeri, people all over the globe seem to enjoy the pleasures of the fleeting smoke rings. Cigarette The most common mode of smoking is cigarette smoking. A cigarette is a tobacco product containing that finely chopped tobacco leaves, rolled into a paper-wrapped cylinder. Men-women, rich-poor, old-young, find this slim cylindrical bundle of tobacco comfortably accessible. A wide price range also makes cigarette an attractive option compared to its rather elite counterparts i.e. pipes and cigars. Pipe In old Hollywood movies the look of the hero was never complete without a hat and a smoking pipe. These days pipes are only sported by a few, for smokers prefer easily available alternatives such as cigarettes. A pipe consists of a small bowl-like chamber that holds the substance to be smoked and a thin stem that ends in a mouthpiece. The design and structure of pipe have improved throughout the ages. These days, pipes range from the simple machine-made briar pipe to highly-prized handmade ones, which also serve as expensive collector's items. Cigar The aristocratic counterpart of cigarette, cigar is associated with the smoker's social standing. Cigars are presented as a rich man's accessory. In some cultures, cigars are often smoked to mark a joyous occasion such as the birth of a child. Some consider it a good luck charm and keep a cigar 'for luck' when placing a bet. The business of manufacturing handmade cigars was an important vocation, employing many people before mechanized manufacturing of cigars was introduced. Despite the modern technology, all cigars of high quality are still rolled by hand; some boxes bear the phrase Hecho a Mano, "made by hand", as proof of the cigar’s high quality. Hookah There are two types of hookah commonly known here, one that is smoked in villages and has Asian origins, another is sheesha, the trendier version of the traditional hookah, hailing from the Middle East. Sheehsa is a water pipe that cools the smoke by filtering it through a vase of water. The tobacco is mixed with a sweetener, such as honey and fruit flavoured tobaccos have also become popular. The pleasant smoke produced by sheesha has led many to believe that smoking it is less detrimental to health than cigarette smoking. However, research has shown that the concentration of cancer-causing and addictive substances in water pipes may be equal to those found in cigarettes, with the heat involved being sufficient to generate carcinogenic substances and the charcoal adding some carcinogenic hydrocarbons as well as heavy metals to the smoke. –– A.K.

 

A mother’s account

The slightly discernible whiff of smoke in the air and the startled look on the face of my boldest son, tells me that he has done it again. It also took him quite a while to open the door, when I knocked. All windows and the door leading to the balcony, I can see, are wide open and I also notice the towel on the bed which was the instrument used in the desperate attempt to dispel the tobacco smoke out of the room. “What’s the matter, are you okay?”, I pretend not noticing it. “Yes, Mama, just a little sleepy,” says he. “There is some sort of strange odour here, don’t you think?” I ask, thoroughly enjoying his discomfiture. “Ah, no, no, is there?” he fumbles for an answer between ‘yes’ and ‘no’. He is 17, almost an adult, but still a child. Once in a while, he abandons caution to treat himself to a puff of smoke. There are many things that give me a clue to his clandestine smoking. Every morning, it is me, who has to clean up the mess he makes in his room and put things in order. Like most adolescents, he is convinced cleaning is a mom’s job. The first time I found a cigarette butt in a corner of his room — which I suppose he forgot to throw out — I was horrified. I picked up what remained of the cigarette carefully, read its half burnt label and put it in a jar. I discussed the ‘grave’ matter with my husband in the evening, who thoroughly enjoyed the situation. He also confessed that he had taken the first puff at the age 17. But as days went by I realised that there was absolutely no question of it becoming an addiction for him. My husband probably discussed the subject with him and an understanding was reached between the two ‘men’. I still have to clean up the mess made by him every morning. At times I pretend to smell some ‘strange odour’, when there is none. We have never mentioned the word smoking, but he knows that I know and I know he knows I know.  — Moniza Inam

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