Picture source: www.bewell-dowell.org
Do you realise, that all of us are “Smokers”? What should we do?
Do you feel that the number of smokers in the world, in general, and specifically in Malaysia, is shrinking? Are you confident that the world community is becoming more aware of the dangers of smoking? Are you sure the struggle to prevent smoking is effective? Do you feel that staying at home is actually safe? And that you have nothing to worry about?
You cannot be further from the truth!
Statistics show the percentage of hardcore smokers is on the rise despite the increase of non communicable disease such as heart attacks and kidney failures, reaching worrying levels. Globally, the increment of smokers is so widespread, especially in teenagers. This has lead the World Health Organisation (WHO) to take drastic actions in 2013 by suggesting the ban of smoking commercial advertisements in the media and removing all forms of tobacco-related sponsorships. Until 2013, smokers worldwide number around the billions. This is in tandem with the data in Malaysia where smokers increased to nearly 25% of the population and this is record-high since the National Health and Morbidity Survey (NHMS) in 2006.
After the failure of the ‘Tak Nak’ program in 2004, religious edicts and rulings regarding the prohibition of smoking were propagated among the Muslims in Malaysia, but alas, they also fell on deaf ears, despite being issued as early as 1995 by the Jabatan Kemajuan Islam Malaysia (JAKIM). ‘Quit smoking’ clinics have more than doubled by the Ministry of Health in its effort to address this problem but the number of smokers who actually want to quit is tragic, to say the least. Are we still complacent with this situation? This is not our problem, as our family members do not smoke, is it not? Are you sure? But are you sure that you and your family members are not smokers?
Believe it or not, we are all smokers. “Third-hand smokers” at the very least. Hence, please pay attention. “First-hand” smokers are those who are actively smoking and breathe in their own smoke. “Second-hand” smokers or passive smokers are those who breathe in the smoke exhaled by the first-hand smokers. Meanwhile, “third-hand” smokers are those who are exposed to the smoke residues left behind by the first- and second-hand smokers. Whether one is aware or not, nearly everybody on this earth is a third-hand smoker.
This is due to the fact that the smoke particles are very tiny. Finer than a strand of hair and invisible to the naked eye. These particles attach easily to benches, sofas, floor, curtains even carpets, hours after they are produced by the first-hand smoker. For instance, if we pass through an area which had cigarette smoke circulating in it, the residue from the fumes can stick to our body and clothing, rendering us a third-hand smoker. Shaking hands and communicating with first-hand smoker can also transfer the particles to ourselves. Kids happily greeting their fathers returning from work will also be exposed to the particles found on their dads’ shirts despite not being a first-hand smoker. That’s right, all of us are the unlucky third-hand smokers!
Is it dangerous? The smoke residues attached on our skin, limbs and clothes are very difficult to detect. However, the risk is, nonetheless, the same as fated to the passive smokers. Research shows smoke residues contain the same materials as found in the original smoke. Even worse, when they react with air, they can produce compounds, fatal to human health. They can increase the risk of contracting respiratory problems such as asthma, sinusitis and lung cancer, affecting children’s health and retarding the growth of infant brains.
So what can we do as third-hand smokers? Truly, there are no other ways except freeing ourselves from being one. We cannot force others to change, but we can change ourselves and trigger the change around us.
First of all, to hinder the growing numbers of third-hand smokers, we have to avoid being second-hand smokers. Indirectly, we don’t bring home smoke residues and causing our family members being third-hand smokers. Avoid going through areas filled with tobacco smoke. In other words, avoid being in the vicinity of first-hand smokers. Merely covering our face in not enough because, as hard as we try to avoid smoke form directly entering our airways, the smoke can still land on our clothing. For instance, if you are sitting, waiting for the bus, and suddenly a smoker starts to light a cigarette next to you, do move away. The best is we distance ourselves before the cigarette is lit.
Secondly, choose a premise or outlet which practices and declares itself a smoke-free premise. This way, you will be 100% sure that the place you are sitting in is free from smoke residues. Avoid eating in restaurants which permits smoking, even outside the premise. Worse still, buying food or groceries from sellers who smoke. Have you seen greengrocers or poultry sellers smoke while handling their merchandise? Yup, avoid buying from them because, surely, we don’t want substances from their smoke to be brought into our kitchen and food.
The third step includes keeping our hands and body clean. Promote hand washing and cleaning ourselves once we reach home. We are not sure whether we touched or were in areas contaminated with cigarette smoke. So, the best way is to wash our hands and change our clothes when we arrive at home, before coming into contact with the children or doing our house chores. This can minimise the smoke residues we brought home on our bodies and our clothes. Furthermore, we can reduce the exposure to our family members and the number or third-hand smoker once reaching home.
Fourthly, express our rights as a non-smoker clearly. If we are having our meal at a public area, and along comes a person who sits nearby with an intention to smoke, at that instance, do tell the person not to smoke there. State your rights in a nice tone but a strict one as well. I’m confident the smoker will respect your request. What more if you are in a place where smoking is prohibited. Keeping silent implies your consent and permission for that habit to spread. So stand up and speak your rights. Use a rational excuse such as you are trying to enjoy your meal or you have children with you.
Fifth, give the correct advice and continue doing that. Beginning this day, do not only advise the fathers to smoke outside the house. This is wrong and as is you are nullifying the prohibition. But rather, advise them to try to quit smoking altogether. But, as you wait for them to totally quit, fathers must smoke outside. For we all know, smoke residues stick to the fathers’ clothes and will be brought inside and find their way to the children. Residues will contaminate the compound and the children will play there as well. Thus, smoking outside the house is not deterrence but only a temporary step and the real solution is to ultimately quit smoking. By understanding this concept, indirectly the smokers will be compelled to stop smoking. Research show that among the factors encouraging a person to stop smoking is family support. Hence, understanding the ‘third-hand smoker’ concept can inspire parents to stop smoking.
Next, avoid harsh unkind words and negative views towards first hand smokers. Third hand smokers need to give strong support to their smoking family member to stop smoking. Studies show continuous encouragement and support can increase their internal initiative to finally stop smoking. Encourage them to pick a suitable date like the fasting month (Ramadan) or the wedding anniversary as a target for success. Tobacco smoke addiction is a disease that requires proper treatment. Advice can only go so much. Studies show that kind advice along with medication can improve the effectiveness of quitting. Currently, treatment is provided by the ‘quit-smoking’ clinic to help stop smoking and also in respiratory clinics in government hospitals, where hardcore smokers can obtain free treatment. Therefore, smokers can get the medication before the assigned date arrives. Keep complimenting the smokers who successfully reduce the number of cigarette sticks in a day even if it is only by one. Continuous praises can raise the morale and self-confidence to change towards the better. Try to understand that they are in an ongoing process to stop smoking. The third-hand smokers need to know the symptoms that will appear in those who are quitting. The absence of nicotine and their physiological change will lead to short tempers, hot flushes, disturbed sleep or increase in appetite.
Consequently, make smart choices in choosing friends. Not only will we become second-hand/secondary smokers, we could end up being smokers ourselves if we mingle with first hand smokers. If we have close family members who want to quit smoking, tell him/her to state his/her wish to his friends. And if necessary, do move on and find new companies, those who can help in the quitting process and living life free of smoke. Parents need to mind the behaviours of their children and find out what kind of people they hang out with.
To conclude, the struggle of realizing the dream of making a world free from tobacco smoke has to begin from our own self. Despite gathering strength and participation from the general public, it all begins from one single individual’s attitude. Remember to pray to the Almighty and reflect on this every day, and hope that we and our family members are given good health and protected from the dangers of tobacco smoke. Lastly, do not ever try to start smoking!
Written by,
Dr Shaiful Ehsan
Dr Shaiful Ehsan is doing his further studies to become a Family Medicine Specialist and currently a lecturer in International Islamic University of Malaysia. This article was originally written in conjunction with the World Tobacco-Free Day on 31st May 2015 and translated by Azizul Ismie. It is republished in conjunction with Tobacco Free day 2018. https://www.mmgazette.com/kita-semua-adalah-perokok-dr-mohd-shaiful-ehsan/
Reference:
- CDC, C. f. D. C. a. P. (2015). “Smoking and Tobacco Use.” Centers for Disease Control and PreventionRetrieved 15 February, 2015, from cdc.gov/tobacco/.
- NHMS (2011). National Health Morbidity Survey Fact Sheet 2011, Institute of Public Health.
- UpToDate (2015). “UpToDate Control of Secondhand Smoke Exposure” Retrieved fromhttp://www.uptodate.com/contents/control-of-secondhand-smoke-exposure
- University of California (2014). “Third-hand Smoke Just as Deadly as First-hand Smoke, Study Finds.”Science News Retrieved from http://www.sciencedaily.com/
- WHO, W. H. O. “Prevalence of Tobacco Use.” Global Health Observatory Data Retrieved 15 February, 2015, from http://www.who.int/gho/tobacco/use/en/.
- WHO, W. H. O. (2013). “WHO Report on the Global Tobacco Epidemic, 2013 – Enforcing Bans on Tobacco Advertising, Promotion and Sponsorship “.
- WHO, W. H. O. (2014, May 2014). “Tobacco Fact Sheet.” Media Fact Sheets Retrieved 15 February, 2015.
- World Health Organization, W. (2001). “Encouraging People to Stop Smoking.” Behavioural Science Learning Modules.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]