Lives are lost to smoking every day. Yet, the tobacco epidemic rarely earns widespread attention—particularly amidst more acute crises like COVID-19. On World No Tobacco Day (WNTD) we strive to reinvigorate the fight against smoking, and to stress the uniquely devastating effects of tobacco on global health.
Launched in 1988 under the auspices of the World Health Organization (WHO), WNTD aims to achieve two goals: support smokers in their efforts to quit and prevent youth from picking up the habit. Over the years, there have been various initiatives toward these ends. Schools ran poster competitions; cities and NGOs organized marches in favor of smoke-free laws; and universities hosted seminars to accelerate implementation of effective policies. Many of these initiatives yielded laudable change. Yet, somewhere along the way, anti-smoking efforts lost sight of a key constituency they purport to help: smokers.
During the first WNTD, I contributed to a special edition of the South African Medical Journal devoted exclusively to smoking—its human impact, the need for effective laws, and the value of quitting. In time, that work led to increased taxes and tougher legislation that has saved countless lives. Yet, in recent years, I have observed an increased focus on policy issues, rather than the needs of smokers. This shift is evident in the theme of this year’s WNTD, “protecting youth from industry manipulation and preventing them from tobacco and nicotine use.” This goal is vital and must be addressed. Reducing tobacco uptake among youth will yield tremendous public health gains for future generations. Yet, in our attempt to minimize the smokers of tomorrow we cannot overlook the smokers of today.
There are currently 1.3 billion tobacco users in the world. WNTD represents an opportunity to provide this community with the information and motivation they need to start to their journey toward a healthier, smoke-free future. Empathetic engagement with adult smokers does not contradict the critical effort to discourage smoking among youth; rather, it complements this effort to create a more encompassing and effective approach to tobacco control.
Similarly, the understandable attention to current pandemic should not overshadow the world’s ongoing fight against smoking and related diseases. In fact, we must attend to the points at which these deadly crises intersect. Surveys of individuals under various conditions of lock-down show that smokers are experiencing high levels of stress, and that tobacco is often their primary coping mechanism for managing this stress. While many of those surveyed reported that they would like to quit, they often lacked access to the information, support, and nicotine alternatives that might enable this transition.
Quitting is never easy; and many of the approaches tried will fail. Yet, if we work with smokers to find solutions that fit their needs, it is possible to dramatically reduce cigarette consumption across the world. Strategies least likely to fail involve the use of nicotine alternatives (from the patch, gum, and snus, to e-cigarettes and heated tobacco products), combined with sound behavioral support from health professionals or through digital platforms. This is the time to reach out to current smokers with empathy—and to assure them that cessation is achievable and valuable at any age.
On the eve of WNTD, leading tobacco researchers published a large study with two powerful messages: (1) smokers who started their habit before 15 years of age were at substantially greater risk of premature death than both nonsmokers and those who started later in life; and (2) smokers who quit by age 40 “avoided almost all the excess mortality due to smoking.” The study, which followed 120,000 Cubans for almost 20 years, conveys the importance of both preventing youth uptake and encouraging adult cessation.
As the world grapples with a new and terrifying virus, WNTD reminds us that smoking, too, is a pandemic. Relief from its devastation will come not from a vaccine, but from innovative solutions that consider the needs of smokers themselves.