In this interview by SADE OGUNTOLA, Professor Olufemi Adewole, a consultant physician and pulmonologist at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Osun State, says that the cost of smoke, be it from cigarette or marijuana, to individual?s health and the health system is heavy and is better avoided.

What is the implication of parents smoking for the health of their children? Reports suggest that more women in Nigeria now use tobacco in its various forms. A video in circulation links smoking by parents to increasing cancer cases in children.

That is true when you have a parent who smokes and smokes habitually and in the presence of the children. There are risks other than cancer for these children. One thing to understand again is that even though smoking is directly injurious to the person smoking, it is also harmful to people around the individual. The cigarette has a filter. So, when smoking, this filter reduces the amount of pollutants and particulate matter the individual inhales. As such, the so-called passive smoker is exposed to inhaling these pollutants and particulate matter that the smoker himself is somehow a little protected from. Even in certain instances, a passive smoker would be at the worst receiving end of these injurious effects, compared to an active smoker, even though we tend to focus more on the active smoker.

So, if you have a parent that smokes habitually and the children are there, definitely they are inhaling all sorts of pollutants, particulate matter, and volatile organic compounds like paraldehyde which could cause respiratory diseases, respiratory inflammation and, of course, over some time, it could lead to cancer formation. Parental smoking has also been associated with stunting and malnutrition-related illnesses

We know that cancer formation is multifactorial, but smoking is one of the factors that tend to initiate some steps for cancer formation, both in smokers and in children who are exposed to cigarette smoke. It is a factor to be considered, with the rise in the rate of cancers globally. Of course, the individual may not necessarily have lung cancer, even though lung cancer seems to be the most common form of cancer linked with active or passive smoking. It causes at least 16 different types of cancer, including throat and bowel cancers.

In developed countries, people are advised not to smoke indoors, particularly where they have children because of the health risks to them and because it is more or less also initiating them into the smoking culture, which needs to be discouraged, to a large extent. Most people, if they want to do that, they probably go outside of the home environment to smoke, because of the potential danger.

What is the danger it poses to children, maybe because their mom sells alcohol, or they live in an area where a lot of smokers reside?

If the exposure is profound and habitual, then the risk is very strong. If it?s just an occasional thing, like passing through a place where people are smoking, the risk may not be substantial. However, the individual may end up with some airway inflammation, allergy, or rhinitis that probably will clear up after a few days.

It is the same thing in pregnancy. Whether a pregnant woman smokes or lives in an environment where they smoke, it is dangerous for the woman and her unborn baby. Smoke directly gets into the bloodstream, increasing its carbon monoxide level. This tends to reduce its oxygen-carrying capacity, and so affecting the circulation and amount of the blood?s oxygen concentration, available to the unborn baby over a long period. When this happens, then there is the tendency for growth retardation and even placenta abruption. Placenta abruption is a gynaecological emergency: the placenta is not properly attached to where it is supposed to be attached, and this predisposes the mother to bleeding. So, it is bad. Sometimes the baby could die, if it?s not well managed. So, the whole issue goes beyond just cancer, it goes beyond the spectrum of problems that the individuals may have, including malnutrition and growth retardation.

Is it only cancers those passive smokers are liable to develop? This seems to address smoking generally and not specifically passive smokers.

Not really. But of course, cancer is the most feared of them, because we know the problems and challenges of managing cancers anywhere in the body. But, there may be other problems with memory, blood flow around the body, connective tissue disease and so on. Asthma, for example, is a big issue for those with allergic tendencies. And of course, it could have some sort of stimulant effect or euphoria. Over a prolonged time, it can become a form of addiction. When it gets to that point they may want something that will make them feel higher, and so graduate to other forms of drugs. And so, it?s a wide spectrum, even malnutrition-related illnesses are included because smoking can affect from head to toe of an individual.

How about smoke from hemp or marijuana, is its effect similar to cigarette smoke?

We tend to talk more about smoke from tobacco because the studies that show the relationship between tobacco smoking and a whole wide range of health issues are fairly well established over a long period. It?s the same thing with marijuana. However, marijuana has more neurologic involvement over and above that of cigarette smoke. According to research, exposure to smoke from marijuana also predisposes to respiratory issues, weak immunity, mood changes and poor quality of life.

The ingredients in marijuana that are cancerous are not as profound as you have in cigarette smoke. It has more of those ingredients that stimulate the central nervous system and the risk of cancer may not be as high as smoking. However, people also chew tobacco and this has health implications over a long time, including dental problems and cancers of the lips, mouth, face and the back of the throat and nose.

What?s the implication of getting exposed to smoke from marijuana?

Even if you don?t smoke it, it also tends to stimulate your central nervous system in one way or the other. It could get you excited, and then increase your stress level. And depending on what people are smoking sometimes people would have added to the marijuana. People are doing a whole lot of mixtures now. And so, if what is mixed with marijuana is highly volatile, when it vapourises, it will also affect the individual?s respiratory system. There could be some breathing problems. So, for an individual who is just exposed to smoking marijuana, it has a transient effect, in terms of CNS stimulation. And that could cause some irritation in the individual, actually, after that.

Are there things that individuals can do to protect themselves from being passive smokers of cigarettes or marijuana?

The most important thing an individual can do is to avoid such places where they are smoking and individuals who smoke. For people who are trying to quit smoking, we also encourage them not to walk with smokers. By associating with smokers, you are not likely going to be successful in your quit attempts because anytime you perceive an aroma like this, you want to have your cigarette stick again and go on with it.

There is a framework convention on tobacco control that prohibits smoking in public places amongst many of its action plan. That should be enforced. You know, it is very difficult, if for example, to just demand anyone smoking at the bus stop to stop smoking except the framework convention that prohibits smoking in public places is implemented. Again, smoking areas can be created for those who want to smoke. But of course, that has its own legal and moral issues. That is important, that people will want to consider it.

Then the government could go a step further by ensuring that we have a smoking cessation practice and clinic. Smoking is an addiction and sometimes it is very difficult to break it. We can have smoking cessation clinics, where people can come in for treatment and be encouraged to quit. These will ensure that individuals are not exposed to passive smoking, and it will reduce the smoking rate in the country generally.

There are a lot of economic and political power tussles involved, which probably will make it a little bit more difficult, but if we follow the framework convention, and we look at it and look at the health impact of smoking, and the cost of it on our health system, it?s probably not out of place to discourage it. Smoking costs more than $1 trillion annually in healthcare costs and lost productivity. I know people are talking about e-cigarettes these days, which, is probably similar to smoking. It may not be as addictive as cigarette smoking. Secondly, probably, the danger involved in it is not so widespread to the public, compared to cigarette smoking.

The danger for the individual, who is also smoking e-cigarettes, is also there. However, new evidence is showing that, compared to tobacco smoking, e-cigarettes can cause sudden death, within a short time, called vaping-induced sudden cardiac arrest. E-cigarettes are fairly expensive; it does not completely solve the problem associated with smoking tobacco, and in actual fact have more severe health effects than smoking.

How about the lung detox products, including tea for smokers that were suggested to help reduce the risk of cancer because it makes smoking healthy?

They seem to be gaining popularity. In the real sense, there is no scientific data to support the claims. Your lungs are self-clearing organs and have mechanisms in place to protect it from damage. However, there are natural ways to help your lung like regular exercise, avoiding toxins and proper diet.

Okay. Because there?s a product that NAFDAC was also reacting to, the producer was saying, yes, if you are a smoker, you can take this, it will cleanse your mouth, it will do this, it will do that, and NAFDAC is saying it?s not approved in Nigeria, and it cannot work, based on all that they said. Essentially what I think it does for smokers is to reduce smoking odour. It is just like somebody smoking and then going on to take toffee or mint-containing sweets because they don?t want its odour coming from your mouth. It does not stop the individual from smoking; it?s just a cover-up. It certainly does not protect from the cancers, and other health problems associated with tobacco use because they have already inhaled the pollutants, particulate matter, and volatile organic compounds in the smoke. So, by washing your mouth, it does not protect against these problems. From a basic pharmacology and physiology point of view, even if it?s going to work, the only thing it might do is just to make sure that the individual?s mouth does not smell tobacco smoke. It certainly wouldn?t prevent any major health problems. (Saturday Tribune)

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