FATTEH HAMID examines the increasing burden of cigarette abuse in Nigeria and its health implications on smokers
Twenty-five-year-old Janet John, a student of a university in Oyo State started smoking at 15.
Recalling her past, John said she learnt smoking through some of the friends she kept as a teenager.
She said, “When we started, we didn’t start off with the smoking of cigarettes. We started with lightning papers and puffing the smoke, however, when we got to SS2 that was when we first tried smoking cigarettes. It was a big day for us.
“When I got admission to a university, it was a new community and a different environment. I was usually uncomfortable reading together with others because of the urge to smoke. It helps me to read and assimilate. I managed through the first session in a tough way because I have to go out to smoke, so I use the bathroom or toilet, bathe and go out to read.”
Asked how she got addicted to smoking, she stated, “I realised it boosted my memory and made me understand whatever I’m reading faster. That was what made me addicted to smoke.
“When we started a new session, I moved out of one of the halls of residence I stayed in to stay off campus. I did that because I needed a space and to have the opportunity to do my thing without anyone being suspicious or monitoring. I graduated into smoking hemp and other drugs to help me to maintain my educational life. If I don’t get cigarettes, I find solace in drugs to keep my body together.”
Asked if she planned to stop smoking soon, she stated that she couldn’t say because she was still at 300 level and would graduate soon.
John added, “I am currently in 300 level. Maybe when I finish school, I will stop. I think by then, I won’t have a reason that will demand that I smoke all the time like what the situation is now. I can’t really say that not smoking ever led to failing any course.
“I know myself before now so why there is no reason to stop smoking when I know the help it renders.”
In Nigeria, tobaccoatlas.org reported that every year, more than 26,800 die of diseases linked to tobacco. Still, more than 25,000 children (10-14 years old) and 748,8000 adults (15+ years old) continue to use tobacco each day. Complacency amid the tobacco epidemic is believed to fortify the tobacco industry in Nigeria with the death toll from tobacco rising.
For women, though fewer number smoke in Nigeria than on average in low-Human Development Index countries, there are still more than 402,600 women who smoke cigarettes each day. For the girl child, though fewer girls smoke in Nigeria than on average in low-HDI countries, there are still more than 6,100 girls who smoke cigarettes each day while the death record for women generally is 64 weekly.
The combined revenues of the world’s six largest tobacco companies in 2016 was more than $346bn, equal to 87 per cent of the country’s Gross National Income.
Abuja-based Centre for the Study of Economies of Africa and Amaka Chiwuike Uba Foundation, in a report in 2017, said that Nigeria’s health system spent N526.4bn on tobacco-related illnesses annually. It added that tobacco companies contributed less than N100bn to the country’s Gross Deposit Point.
Love for dangerous substance
Cigarette smoking is not limited only to youths. Some elderly people also smoke. But smoking in public has not abated in Nigeria despite laws against such public acts.
But apart from smoking tobacco, some youths including girls also indulge in drug abuse; thereby triggering disturbing figures regarding drug abuse.
The National Drug Law Enforcement Agency in Yobe State noted not long ago that some of the females consume and abuse multiple drugs, especially tramadol, amphetamine, and cannabis.
The Chairman, NDLEA, Brig-Gen Buba Marwa, said that research showed that Nigeria had a drug use prevalence of 14.4 per cent, almost triple the global average of 5.5 per cent.
A businessman, Saliu Abubakar, is a smoker with equal passion for cigarettes like John.
He told Saturday PUNCH that smoking was a normal thing to him because he grew up among brothers, neighbours including his father, whom he described as smokers.
He noted, “I am from the North and eating goro (kolanut) and smoking cigarettes is almost fun to me. My father smokes and as a child then, I used to innocently watch him with other family members. It wasn’t hard for me to copy when I grew up.
“When I came of age, I started smoking too and eating kolanuts. I felt I was then old enough. All the while I started smoking which spanned about a year, neither my father nor any of my brothers knew. Most times, they were not around as they went on business trips.
“One day, I was eating kolanut and my father saw me at the spot where he used to take kolanuts and smoke cigarettes. He was alarmed and I was embarrassed by his outbursts. He called me and explained to me that smoking isn’t good for me and my health. But sadly, I have become a smoker and quitting isn’t what I can guarantee anyone for now.”
A second-hand clothes seller, Celestina Bright, said she started smoking in 2019 when she got depressed. She added that cigarettes steadied her not to commit suicide.
She said, “I was depressed at the time. I had to finish about two bottles of alcohol to get high so I decided to smoke alongside to increase my level of intoxication. I was attached to alcohol so as to not share what I was experiencing with anyone. I decided to bury my pains within myself.
“I was so deep into it that I couldn’t go a day without smoking. I was running away from my suicidal thoughts and pains, so smoking helped me not to concentrate on them. I became addicted to drugs too along the line. It was a crazy moment. I’m however thankful today that I am on the journey of quitting but it hasn’t been easy.”
On when she realised she needed to quit smoking, she noted, “I was getting addicted and I realised smoking wasn’t solving my problems. My sisters met with me and decided that I should see a therapist. I’m on that now and I hope I’ll see the end soon enough.”
For a bricklayer identified as Tayo Adama, took to smoking cigarettes because he believed that it would help him to execute more works on sites.
He said, “I’m a dropout and to survive, I needed to start bricklaying. I found it difficult to carry out more work. I took to smoking cigarettes as I realised it assisted me largely to work more.
“A senior colleague advised me that if I smoke and drink a bit of alcohol, it’ll strengthen me. I tried it once and I discovered that it helped. Most of my colleagues smoke cigarettes and drink alcohol. I decided to engage in it too. That was how I started smoking.”
On whether he was aware that smoking was injurious to his health, he said, “I do not know until a day when my first daughter told me that it is written on the cigarette pack that smokers are liable to die young.”
Another student studying in a university in the South-East identified only as Ibe, told Saturday PUNCH that he started smoking after a breakup.
He told our correspondent that the severity of the emotional pain he suffered led him to smoking.
He said, “I needed to take my mind off the evil things I was thinking about. It was really sad when the incident happened. I thus took to smoking to endure the trauma. Smoking helped me a lot. I could be alone and smoke for long hours, cry and sleep afterwards.
“This went on for about three months and when I got over the heartbreak, it became something I couldn’t do without. It became a part of me. I tried to stop but it has not been easy. Funnily enough, the more I try to quit smoking, the more I find myself returning to it.”
Another smoker who is a businesswoman in Awka, Anambra State, Ogechukwu Paul, told our correspondent that she started smoking after marriage with the belief that it would enhance her sexual pleasure.
She explained, “I was a virgin when I got married and I was always dry when we want to have sex. My partner and I thought it was normal probably because I was new to the experience.
“As time went on, we realised it wasn’t due to my situation as I got tired in minutes and had to seek help. I confided in a friend who advised that I smoke before having sex. I bought cigarettes and smoked them. I noticed that I already had sexual urge. When my husband arrived home that day, it was the first time I enjoyed sex or so it seemed.
“That day was different because I didn’t feel fatigued. When it dawned on me that there could be severe implications for my act in future, I decided to seek medical help.
“The doctor who attended to me told me that my action was driven by psychological effects. He warned that if I didn’t stop, I’ll become an addict which might put my health and that of my baby when I am pregnant at risk. Since then, I started using recommended drugs and some natural herbs.
“The initial sex situation appears to have returned. It’s manageable and I have been using other natural remedies to enhance my sexual urges and hopefully, I will become a normal person in due time.”
Christiana Akpan is another university student. Akpan who attends a university in Ilorin, Kwara State, said she started smoking when she got into the university.
She said, “I was friends with some ladies who partied a lot. I went out with them for some time and before I knew it, I started smoking too at night clubs. I guess it was fun. I am not an addict. I smoke for fun and won’t die if I don’t.”
Talking about the risks associated with smoking, Akpan said that she always used drugs to tackle that.
“That’s why there are detoxifying drugs. They help in cleaning my lungs. I am sure that the drugs work. That’s why there are adverts in newspapers and on radio stations. They are serving their purpose and I am fine with that,” the student stated. Many smokers believe that there are detoxifying agents that help cleanse their lungs damaged by prolonged smoking.
Recently, a Nigerian singer, Oluwatobiloba Daniel, popularly known as Kizz Daniel, noted that he quit smoking, to mark his birthday and for his kid’s sake.
Medical experts’ perspectives on issue
Speaking on the matter, a public health physician and consultant paediatrician, Dr Rotimi Adesanya, noted that health risks which smokers exposed themselves to were severe, adding that it was vital to quickly find a lasting solution to the menace.
He said, “There are existing laws that are against smoking in public and if the law is obeyed, many people will live healthier but the law is hardly obeyed. When smoking happens in public spaces, there are other second-hand smokers. We call them passive smokers. When smokers smoke, they exhale the contents. This is done with force and energy and as such, passive smokers who aren’t aware that there are dangerous particles coming into their system, they don’t take time to use energy and force to exhale too and as a result, the chemical that causes harm.
“Content of cigarettes is so dangerous that they cause different harms to the system such as cancer. There are other health conditions related to smoking such as high blood pressure, stroke, hypertension, respiratory diseases among others. As a result, people that are passive smokers are pretty exposed to many of these diseases which they are unaware of. So, the danger of smoking in the public is much.
“There is also a condition smoking causes to passive smokers where the blood vessels will get thickened as a result of the smoke that is inside the lungs. They bring about carbon monoxide which gets inside the blood vessels. That’s why the government globally has to see an end to this because many people are affected, even pregnant women.’’
The medical practitioner added that pregnant women affected cigarette smoke were likely to have pre-termed babies, miscarriages, intrauterine growth restriction where babies don’t grow.
He noted, “The same way it affects pregnant women who smoke is the way it affects pregnant women who don’t smoke but are passive smokers. The condition is the reason why most pregnant women are advised to be distanced to where smoking is high and for those whose partners smoke, they should not be in the same vicinity when it happens so that what they inhale, it won’t affect the babies.’’
On smoking nursing mothers, Adesanya explained that their babies would be asthmatic and exhibit traits of pneumonia leading to chest infection.
The doctor said, “This is common in infants who are less than one year. Such babies may grow up to have asthma and lung infections. Smoking can be stopped medically. The smoker has to visit the hospital where they have to see family physicians and public health doctors. Psychiatrists and psychologists do see them too because many of the smokers tried to stop but it is hard due to addiction which is beyond them.
“The doctors will then assist the person through what we call psychotherapy, and drugs that doctors offer like some gums to counter the effect of the smoking offered in the hospital. More importantly, they have to go through counselling sessions, which is psychotherapy, and sometimes because of addiction, it may take more time depending on the person in question.’’
On his part, a medical doctor, Dr Muideen Adeyemo, said that there was no medicine that could restore or regenerate a damaged lung.
He noted, “When a human lung is damaged, it cannot be replaced. It is believed that a damaged lung tissue doesn’t regenerate no matter the drugs used or medication the patient is placed on. Most of these smokers don’t understand that if they don’t stop smoking, nothing will change the state of their lungs. The only thing that can happen in that case is a reversal which is only possible when the lung is not completely damaged.’’
Adeyemo said that reversal would only work for tissues that were not completely damaged, noting that the agent causing the injury would have to stop.
The medical doctor stated, “In this case which is smoking, also, this process of reversal takes a good number of years of judicious detoxification, reversal would happen but not to the premorbid state.’’
Troubling statistics on cigarettes
In a report by cancer.ie, cigarette smoking is both toxic and addictive. It stated that a cigarette contains around 7,000 chemicals which are poisonous and over 60 are known to be cancer causing (carcinogenic).
The report added that a typical cigarette contains nicotine, tar, carbon monoxide, arsenic, ammonia, acetone, methylamine, pesticides, polonium -210 and methanol among others. These constituents, it notes, are not only harmful to humans but also extremely dangerous.
Smokers are at risk of cancer, heart diseases, stroke, bronchitis and emphysema, fertility levels and birth problems. Cancer particularly is a prominent disease that affects smokers, ranging from lung, mouth, head and cancer, cancer of the stomach, cancer of the pancreas, cancer of the kidney, cancer of the womb (uterus), cervical cancer, cancer of the bladder, cancer of the colon, and myeloid leukaemia.
In 2021, the Centres for Disease Control and Prevention reported that worldwide, cigarette use causes more than seven million deaths per year. It added that if the pattern of smoking globally doesn’t change, more than eight million people yearly will die from diseases related to tobacco use by 2030.
Also, the World Health Organisation similarly reported in 2015 that tobacco was the only legal drug that kills many of its users when used exactly as intended by manufacturers. WHO estimated that tobacco use (smoking and smokeless) is currently responsible for the death of about six million people across the world each year with many of the deaths occurring prematurely. This total includes about 600,000 people are also estimated to die from the effects of second-hand smoke. Although often associated with ill-health, disability and death from noncommunicable chronic diseases, tobacco smoking is also associated with an increased risk of death from communicable diseases.
Ineffectual law against smoking
Research shows that the National Tobacco Control Bill 2009 prohibits smoking in public. It makes public smoking a crime and punishable under the laws of the country. Those found guilty smoking in public places are punishable by a fine of not less than N200 and not exceeding N1000 or imprisonment to a term of not less than one month and not exceeding two years or to both a fine and imprisonment.
The key highlights of the bill are the prohibition of smoking in public places; including restaurants and bars, public transportation, schools, hospitals etc. A ban on all forms of direct and indirect advertising, prohibition of sales of cigarettes 1000-meter radius of areas designated as non-smoking, mass awareness about the danger of smoking as well as the formation of a committee that will guide the government on the issue of tobacco control in the country. Stakeholders are, however, of the view that the law merely echoes provisions of the 1990 Tobacco Control Act.
Besides, the Lagos State government in 2014 enacted a law to prohibit smoking in designated places in the state. The law recommends a fine of N10, 000 or three months imprisonment, or both for first offenders.
A lawyer, Kingsley Onunwa, who spoke with our correspondent on the issue, noted that Lagos state has a law prohibiting smoking in public places.
He said, “In 2014, the Lagos State House of Assembly enacted a law that prohibits smoking in public places which made it a punishable offence. The law almost is useless as there’s no enforcement of it. People smoke here and there daily and there’s no one to call them to order. Are people even aware of the existence of such laws? Looking at the law, I think the only thing one can be careful about is security operatives not using the law to harass, and abuse well-meaning citizens.
“The government I believe has to be specific by what they mean as a public place. Is it government offices, churches, open ventilated areas, mosques, churches and others? When the government is specific then enforcement can come in.’’
He added that to end the menace, the government must lead and citizens would follow up with actions.
In the same vein, ex-Second Vice-President, Nigerian Bar Association and Chairman, Section on Public Interest and Development Law, Monday Ubani, said that the major issue was inadequate enforcement.
He stated, “The major issue we have here is adequate enforcement. I know there are laws which prohibit indiscriminate smoking in this part of the world. But tell me, is it not security officers and law enforcement agencies that are meant to see that the order is kept? That same officers are those found wanting in this case. You’ll see them smoking indiscriminately under the guise of being able to work.’’
The lawyer added that to tackle the issue the National Assembly needed to enact a workable law to ensure proper enforcement of the existing laws.
Ubani stated, “When this is done, the people will be conscious of their actions going forward. Also, the citizens need to be proactive if we want to see an end to smoking in Nigeria. When someone is seen smoking publicly, they should be reported to appropriate authorities.’’
He submitted that when an example was made of one person, people would be alarmed not to smoke indiscriminately.
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