World No Tobacco Day or not, anti-smoking campaigns have been initiated and carried out here, there and everywhere. But in reality, an abundance of activities is one thing. Effectiveness is another.
"It really is an uphill task to raise awareness regarding the danger of tobacco smoking," said pulmonologist Dr Wudthichai Suttithawil from his decades of experiences attending patients who smoke. "Unlike HIV where the health impact can be seen immediately after infection, consequences of smoking take time to be detected. You smoke now and it doesn't mean you will get sick now."
Even though statistics in Thailand reveal a slight drop in the number of Thai smokers, Dr Wudthichai said it is in fact hard to pinpoint if it is actually on the rise as such numbers depend largely on where and how data is collected, meaning studies from different sources might say different things.
But based on the 2014 report by the National Statistical Office in collaboration with Mahidol University, the Thai Health Promotion Foundation and the Action on Smoking and Health Foundation, Thailand saw a decrease in the number of smokers from 21.4% of the country's population in 2011 to 20.7% in 2014. Males smoke far more than females do. The average age of first-time smokers also dropped from 16.8 years old in 2007 to 15.6 in 2014.
What's alarming, according to the report, is that children as young as six were found in 2014 to start smoking.
Dr Wudthichai added that there are more than 4,000 chemicals in cigarettes. Smoking can cause not just cancer of the lungs but also of 13 other organs, according to Cancer Research UK, including the liver, stomach, kidneys, bowel, ovaries, mouth and upper throat, to name only a few. The World Health Organization (WHO) also last year revealed that tobacco kills up to half of its users or around 8 million people worldwide each year.
But sadly, the WHO also stated that studies show few people understand the specific health risks of tobacco use.
"For example, a 2009 survey in China revealed that only 38% of smokers knew that smoking causes coronary heart disease and only 27% knew that it causes stroke," reads a statement from the WHO's website.
Smoking cessation is the only intervention with the likelihood of reducing tobacco-related sickness and deaths both in the short- and long-term. And several smoking cessation techniques have been around for decades, though some of them are easier said than done.
Besides conventional methods like nicotine patches, gum, lozenges and inhalers, according to Dr Wudthichai, electronic cigarettes -- or e-cigarettes -- have also come in as the newest approach to quit smoking, although they have received mixed reactions from medical practitioners across the globe.
"E-cigarettes first started to be widespread in China in around 2004 before they made their way to the United States in 2005-2006," explained the lung specialist. "Studies have since been conducted on possible health impacts of the devices but in the past there was little scientific evidence to back up their efficacy as a smoking cessation technique. E-cigarettes were therefore not recommended in the United States."
It wasn't until August last year that Public Health England (PHE), an executive agency of the Department of Health in the United Kingdom, announced that e-cigarettes were 95% less harmful than conventional cigarettes and suggested the electronic devices could one day be offered alongside nicotine patches as a smoking cessation aid. PHE then came under fire, of course.
And just last month, Britain's Royal College of Physicians came out in support of e-cigarettes, saying they should be widely promoted among smokers to help them quit tobacco. According to the study, based on the growing body of scientific research on e-cigarettes, their benefits far outweigh the potential harm. It concludes that the devices are helping people more than harming them given they release nicotine without the harmful tar and cancer-causing chemicals.
"The British doctors said it [e-cigarette smoking] is cleaner. It doesn't release 4,000 chemical substances like tobacco does. And consequently the devices are recommended among those who fail to use conventional smoking cessation techniques," explained Dr Wudthichai.
E-cigarettes as a tool to quit smoking are still new, so much so that they are and will still be subject to criticism. But putting aside these devices, Dr Wudthichai said there are still certain medications that are effective and are used among medical practitioners around the world.
According to the pulmonologist, Varenicline (Champix) renders the most successful smoking cessation result, with around 24-28% of smokers being able to quit. The second most successful smoking cessation aid is multiple nicotine replacement therapy, the combination of nicotine replacement therapeutic methods, with 8% effectiveness. Behavioural therapy for smoking cessation is in third place with only a 4% quit rate, but it is the approach most doctors start with.
"We usually begin with methods that involve no medication," he explained. "Behavioural therapy is that we find out first what leads to people smoking such as stress and we fix that. If this fails, then we might opt for medications. But medical data states that [smoking cessation] drugs can only be used with patients for a maximum of six months.
"And because even the best smoking cessation medication gives less than 30% effectiveness plus side effects, it means a large proportion of smokers still do not benefit from the drug. This is where some doctors do believe that e-cigarettes are likely to be safer than letting them continue smoking tobacco."
For World No Tobacco Day this year, the WHO's framework has been set around plain cigarette packaging, calling on all countries to get ready for plain packages of tobacco products. This, according to the lung specialist, is a good initiative but it might not be as effective as it should be.
"A lot of smokers understand that cigarette smoking is a health hazard but they want to take the risk. It is said people who smoke a 20 pack-year [20 pack-year means a person smoking one pack of cigarettes a day for 20 years] puts themselves at risk of suffering pulmonary emphysema [abnormal enlargement of the airspaces]. But that only happens to 15% of smokers, which means 85% of them walk free. They feel good when they smoke. And health impacts are not near. So I believe the idea of using plain packaging might work but not as much as we expect."
Dr Wudthichai added that even if today all smokers quit, everyone on this planet will still have to pay the price in the next 10 to 20 years with tobacco-related cancers as well as other health issues. So the only one thing he can advise is for smokers to stop smoking right now.
"Cigarette smoking does not just affect smokers themselves," he said. "It also affects their family members and other people in society too. Today we doctors help people quit smoking. But it is equally important to prevent people from starting smoking too."
