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Monday, March 27, 2023

Tobacco Harm Reduction in Nigeria: From Awareness to Action

Most countries all over the world have prohibited smoking in public places and the common advice is, “smoking is dangerous to your health… smokers are liable to die young.” However, researches indicate that the majority of deaths due to smoking result from respiratory diseases such as lung cancer, chronic obstructive pulmonary disease, and pneumonia.

Smoking Trends in Nigeria

The trend in current smoking prevalence in the general population in Nigeria is decreasing. In 2000, the overall prevalence was estimated to be around 7.5% and this decreased to 6% by 2015, with a projection to increase to 5% by 2025. Men’s smoking decreased from 13% to 11% between 2000 and 2015 and is projected to decrease further to 10% by 2025 according to WHO trend data.

Women’s Smoking Data

Women’s smoking prevalence during the same period remained low at 2% in 2000 to 1% in 2015 and is projected to reduce further to under 1% by 2025. In Nigeria, most cities including Lagos have outlawed smoking backed with legislation but poor and inadequate enforcement has been the pitfall. People still smoke in open places in all the nook and crannies of the country exposing the non-smokers and tender ones to secondhand smoke, which has also been linked with cancer of the lung and other ill-health effects.

Smoking Death Statistics

According to the World Health Organization (WHO), the tobacco epidemic is one of the biggest public health threats, killing more than seven million people a year. There are at present one billion smokers globally, with nearly 80 percent of them living in low and middle-income countries, where the burden of tobacco-related illness is at its highest; sadly, Nigeria happens to be a major hotspot for this issue. Indeed, several studies have revealed that smoking tobacco is the most harmful way of using nicotine, with the tars and gasses in cigarette smoke being harmful to health, however, many people find it tough to stop smoking because they find it hard to go without nicotine (nicotine addiction).

Tobacco Harm Reduction (THR)

An in-depth study proposes that making lower-risk products available may support people to adjust from smoking, eventually helping them avoid the risk of smoking. This is known as “tobacco harm reduction”. Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and the wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the abuse of other drugs.

Smoking Doesn’t Kill, Tar Does

People smoke for the nicotine but die from the tar. Nicotine can be gotten from a variety of products, which vary in their level of harm and addictiveness, from smoked tobacco (that is cigarettes) at the top end of the harm/addiction spectrum, to medicinal nicotine (that is nicotine replacement therapy products) at the bottom end. A harm reduction approach to tobacco control encourages those smokers that cannot, or not willing to stop smoking, to switch to using nicotine in a less harmful form, and preferably would result in them ultimately quitting nicotine use altogether.

Cancer Substance in Cigarettes

Products that can effectively and acceptably deliver nicotine without smoke have the potential to be less harmful than smoked tobacco. It is quite evident that the ultimate reason why people smoke is because of nicotine but unfortunately, they die from the cancerous substance in the cigarettes, tar.

Quitting is Quite Difficult

The rationale behind Tobacco Harm Reduction is that safer products that do not contain tar should be provided to smokers who cannot quit in order to prevent further unwanted deaths. Tobacco Harm Reduction measures have been focused on reducing or eliminating the use of combustible tobacco by switching to other nicotine products, such as pharmaceutical nicotine replacement therapies or electronic cigarettes, Switching to smokeless tobacco products such as Swedish snus and non-combustible tobacco products. Quitting all tobacco products absolutely reduces the risk the most. However, quitting is quite difficult, and even approved smoking cessation methods have a low success rate.

In addition, some smokers may be incapable or unwilling to achieve abstinence. Harm reduction is likely of substantial benefit to these smokers and public health. Providing reduced-harm alternatives to smokers is likely to result in a lower total population risk than pursuing abstinence-only policies. Irrespective of the perceived increase in the knowledge and awareness of the use of other safer products by smokers, the deaths caused by tobacco-related products still seem to be on the rise and it is increasingly alarming.

Surprisingly, this Tobacco Harm Reduction strategy is controversial: supporters of tobacco harm reduction assert that lessening the health risk for the individual user is worthwhile and manifests over the population in fewer tobacco-related illnesses and deaths whereas opponents have argued that some aspects of harm reduction interfere with cessation and abstinence and might increase initiation.

However, surveys carried from 2013 to 2015 in the UK and France suggest that on the contrary, the availability of safer alternatives to smoking is associated with decreased smoking prevalence and increased smoking cessation.

For instance, while 46 percent of deaths due to smoking result from respiratory diseases such as lung cancer, chronic obstructive pulmonary disease, and pneumonia, there is no evidence that using snus (a smokeless tobacco product) increases the risk of these diseases. Nor does snus appear to increase the risk of other smoking-related diseases including heart disease, stroke and a range of cancers. In addition, the public health benefits of snus versus cigarettes are not only much lower, but the role of snus in both reducing initiation of smoking and increasing cessation of smoking is a key element in defeating the actual cause of tobacco-related ill-health caused by the cigarette.

Smoking has become less acceptable over recent years in a number of countries, and it is about time that Nigeria sees the light and dire importance of Tobacco Harm Reduction.

Regulatory policies based on discouraging people from starting to smoke and encouraging them to quit have been and continue to be effective.  While the proportion of adults who smoke is likely to continue declining, widely accepted estimates suggest that in 10 years’ time, as a result of global population growth, there will still be as many or more tobacco consumers globally as there are today.

In the context of tobacco and health, few governments currently support the development of reduced-risk tobacco products. Most governments simply argue for prevention and cessation.

It is important to work towards producing consumer-acceptable, potentially reduced-risk products because there could be further public health gains if tobacco regulatory policies included harm reduction, for the millions of adults globally who will continue to consume tobacco products.

The concept of harm reduction is increasingly being considered in relation to tobacco use and it is a key determinant of the Nigerian Health System. Tobacco harm reduction is all about finding practical ways to minimize the health impact of an inherently risky activity or behavior associated with tobacco use, without seeking to stop it entirely. It is time we shift our focus from awareness to action in Nigeria because it can and will only get better.

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Melody Okereke
Melody Okereke
Melody Okereke, an Industrial Pharmacist (in view), is a student researcher, drug policy advocate and an artificial intelligence enthusiast. A contributor to The Eastern Herald.

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