World No Tobacco Day: Data Reveals Urgent Need for Tighter Tobacco Control
As we mark World No Tobacco Day 2021, observed each year on May 31, the National Department of Health, the World Health Organisation (WHO), civil society organisations, medical and nursing associations in South Africa have spoken about what should be done to turn the tide on tobacco harm in South Africa.
Deputy Minister of Health, Dr Joe Phaahla, recognised that the debate on tobacco use is gaining momentum and said that the Department of Health is moving on with the legislative process. “The country is currently battling to reduce COVID-19 deaths, and working hard to flatten the curve of the COVID-19 epidemic. The relationship between COVID-19 and smoking cannot be ignored as both affect the lungs.”
Stating that awareness campaigns to highlight the health and other risks associated with tobacco use must be intensified, he said, “Today’s World No Tobacco Day programme marks strong collaboration in the implementation of tobacco control initiatives. As a collective, we care about the health of the South Africans. I am grateful to see growth in the tobacco control partnership and commitment in touching others’ lives. It is through this kind of collaboration between government, private sector and civil society organisations that we can be vocal without fear or favour about the dangers of using tobacco and the business practices of tobacco companies, so that people around the country and globally can claim their right to health and healthy living in order to protect future generations.”
Filling the Data Gap
In answer to the continued need for reliable data specific to South Africa to inform policy, Deputy Minister Phaahla announced the launch of a comprehensive online tobacco control dashboard, the first of its kind in Africa. An initiative of Development Gateway in partnership with the Research Unit on the Economics of Excisable Products (REEP) at the University of Cape Town, the South African Tobacco Control Data Initiative (TCDI) will put access to vital research and information at the fingertips of those who need it.
“The TCDI program aims to understand the data needs and gaps specific to South Africa, identify reliable data, and develop websites that enable policymakers to use essential data more effectively to inform policy in six African countries, including South Africa,” says Megan Little of REEP. “It equips decision-makers with up-to-date evidence to promote tobacco control and public health.”
The TCDI shows that South Africa has a high cigarette prevalence rate at 19% of adults (aged 15 years and older). Smoking prevalence varies by gender in South Africa: 34% of adult men smoke, relative to 7% of women. Tobacco use costs the South African economy R42 billion every year (equating to annual salaries for 215,000 teachers).
When it comes to e-cigarettes, over 1 million South Africans regularly smoked e-cigarettes in 2018. The sale of e-cigarettes has been banned in 41 countries globally, including 4 African countries. Research has shown that South African e-cigarette users are less likely to quit smoking cigarettes in the long-term. This finding directly opposes the tobacco industry claims.
The tobacco industry remains the main cause of the global tobacco epidemic and the main obstacles to greater progress in reducing tobacco use. Strong and persistent government action is needed to protect current and future generations from the devastating consequences of tobacco use.
Dr Phaahla says, “In order to achieve the highest impact, we need to use evidence-based policies. However, designing and implementing these policies requires rich and trustworthy data. We believe that the Tobacco Control Data Initiative website will serve as an important source of reliable information that will aid South Africa’s tobacco control efforts, and it is fitting that we are celebrating its launch on this World No Tobacco Day.”
Creating a Quit-Friendly Environment in SA
Health organisations forming part of the #protectournext partnership, including the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA), the South African Medical Research Council (SAMRC) and the Heart and Stroke Foundation of South Africa (HSFSA), added their support to the global “Commit to Quit” campaign, a year-long campaign with a goal of supporting over 100 million tobacco users trying to quit tobacco use permanently.
“Smoking is the single most preventable cause of death in the world. It has never been more crucial to prevent young people from using any tobacco products, including cigarettes and e-cigarettes, and to motivate smokers to quit. Mounting evidence suggests that tobacco users have a significantly higher chance of developing severe COVID-19 complications compared to non-smokers. The pandemic should serve as a wakeup call to make our lungs healthier now and for the future,” says Dr Sharon Nyatsanza, Project and Communications Manager at the National Council Against Smoking.
“As a partnership of public health organisations, we are steadfast in driving awareness of the dangers of tobacco and united in our support for the new Control of Tobacco and Electronic Delivery Systems Bill to be passed as soon as possible. It’s time for our people and our government to show leadership in implementing global best practice to curb the onslaught of big tobacco, an industry that profits at the expense of addicted smokers, their families, and public health,” Nyatsanza continues.
The amendments in the new bill include regulating electronic cigarettes as tobacco products, 100% smoke free public places; standardised plain cigarette packaging with graphic health warnings; better control of advertising at point of sale, and the removal of cigarettes from vending machines.
Dr Catherine Egbe, Specialist Scientist: Alcohol, Tobacco and Other Drug Research Unit at SAMRC says the Bill will make it easier for South Africans to choose smoke-free lives, regulate e-cigarettes and decrease the impact of second-hand smoke on the majority of the population, who are non-smokers. “We all need to support our right to a smoke free environment and good health, encouraging smokers to quit, regulating e-cigarettes and ensuring our youth are protected from a lifelong addiction to nicotine.”
Dr Angelique Coetzee, Chairperson of the South African Medical Association (SAMA) and Kedibone Mdolo of the Democratic Nursing Association of South Africa (DENOSA), organisations that are members of the South African Tobacco Control Alliance, called for the Control of Tobacco Products and Electronic Delivery Systems Bill to be speedily passed, saying it will reduce tobacco use and exposure to second hand smoke, both of which would greatly reduce the burden of tobacco-related diseases on South Africa’s health system, and its medical professionals.
Help to Quit
Tobacco use is a major risk factor for noncommunicable diseases like cancer, cardiovascular disease, respiratory disease and diabetes. Moreover, people living with these conditions are more vulnerable to severe COVID-19.
The Heart and Stroke Foundation South Africa’s (HSFSA) Health Promotion Manager, Dana Govender, says, “Smoking is the second leading cause of cardiovascular disease and cerebrovascular disease, after high blood pressure. Quitting smoking is one of the best things you can do for your heart and brain health. It’s never too late to quit smoking because quitting almost immediately provides benefits and if you persevere, over time your risk of heart disease and stroke can fall almost identical to that of a non-smoker.”
HSFSA CEO, Professor Pamela Naidoo, adds that it is important to avoid both combustible and non-combustible tobacco products. “Complete tobacco cessation is the only way to eliminate tobacco-related harms. On average, smoking causes smokers to die 13 to 14 years earlier than non-smokers. Quitting tobacco use benefits health at any age. Reaching young smokers with cessation messages and aids has great benefits in terms of years of life saved. At the same time, getting adult smokers to stop helps population health almost immediately.”
Lorraine Govender, National Manager of Health Promotion for CANSA says, “Support to quit is important and the WHO has called on all governments to ensure their citizens have access to advice, toll-free quit lines, mobile and digital quit smoking services, nicotine replacement therapies and tools that are proven to help people quit smoking. CANSA’s eKick Butt programme is an email series to help support people wanting to quit smoking with information. The internet, with its opportunities for communication and sharing information, is an excellent tool for smoking cessation support, especially now with COVID-19 and physical distancing. Online support may be convenient, in that it can be accessed anywhere at any time and offers the option of being anonymous. The journey to new health and unbelievable freedom from addiction can be lot easier with the help of a few online friends.”
Quit Tips from NCAS
The majority of smokers regret ever starting, and most people’s families, partners and friends who are non-smokers would love them to stop, especially in the time of COVID-19. Right now is the time to focus on kicking the habit and an important first step is committing to a quit date.
Nicotine is a highly addictive drug, like cocaine and alcohol, and it is the main reason many smokers keep smoking. Cigarettes, cigars, snuff, hookah pipes and electronic cigarettes are harmful, but because they all contain nicotine, it can be hard to give them up. When you stop smoking you may feel uncomfortable, crave cigarettes and experience nicotine withdrawal. The symptoms of nicotine withdrawal are different from person to person and can include: anxiety, headaches, hunger, fatigue, trouble sleeping and in some cases irritability, cravings, mood changes, restlessness, difficulty concentrating and influenza–like symptoms. The good news is that these symptoms do not last for long!
Nicotine withdrawal symptoms reach their worst in the first 3 days and last for about 14 days. In 3 – 4 weeks you will start to feel better, and you should be more comfortable after two months. “Take it one day a time because it gets better every day. Your body will adjust and learn to live without nicotine.
Commit to your quit date
Choose a quit date and commit, make solid plans on how to deal with cravings. Make it a day that you are not under too much stress, but do not delay it any longer.
Know why you want to quit
Write down a list of the reasons why you want to stop smoking – be it for health, to save money or to protect your loved ones. Put the list on your phone, stick it on your fridge or anywhere you will see it often. This will serve as a reminder and help you resist the urge to smoke and go on for another day.
Identify your smoking patterns
To stay away from smoking, it is also important to know when you smoke, what is also called the smoking pattern. Plan on how to avoid these situations and plan alternatives to smoking, like eating an apple or anything that distracts you.
Have tools to deal with cravings
When the craving hits, delay the urge to light up until the craving goes away. Cravings usually last for about 15 – 20 minutes. Take walks around your home, talk to your supportive family or friends or to ex-smokers. Try carrots and sugar free gums, drink water and keep yourself busy until the cravings go away. Read your quit motivations out loud. The trick is to delay and distract yourself until the craving to smoke passes.
Skip the booze
Avoid smoking triggers. Many associate smoking with alcohol, so if this is you, try and keep to those virgin cocktails.
To keep going also reward yourself – you deserve it. Every single day without a cigarette deserves a reward, and even bigger rewards if you go past the 2-week mark.
Use the best cessation aids
You can also consider using medication to help in stopping smoking. Pharmacists can guide you in choosing which smoking cessation medication to use. The smoking cessation medications which are approved as effective and safe include nicotine replacement therapies such as nicotine gums, patches, sprays and lozenges, which are available over-the-counter at most South African pharmacies. Other prescription drugs like varenicline are also available, all these work by reducing cravings and withdrawal symptoms.
Tobacco Control Data Initiative: https://southafrica.tobaccocontroldata.org/#/en
Webinar “Commit to Quit”: Facebook Live @protectournext – https://fb.watch/5Qx92gR6rV/