By Damilola Babatunde and Marvelene Ekott
According to The Encyclopedia Britannica, “Smoking is the act of inhaling and exhaling the fumes of burning plant material. A variety of plant materials are smoked, including marijuana and hashish, but the act is most commonly associated with tobacco as smoked in a cigarette, cigar, or pipe. Tobacco contains nicotine, an alkaloid that is addictive and can have both stimulating and tranquilizing psychoactive effects”. Smoking of tobacco is one of the most burdensome public health issues the world has ever faced. According to WHO, tobacco ends the life of more than 8 million people a year, more than 87.5% i.e. 7 million of these deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke. About 80% of the 1.1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.
For many decades, it has been a public knowledge that smoking is detrimental to our health. Hazards such as Chronic obstructive pulmonary disease (COPD), heart disease, stroke, asthma, diabetes, and cancers are associated with smoking. The use of tobacco has reached epidemic proportions worldwide, and despite several efforts to change the narrative about smoking, the problem only seems to become worse each year. While smokers are fully aware that cigarettes offer severe harm to their health without any benefit, they will ignore all warnings and advice given to them until something suddenly clicks and tells them that it’s time to stop.
Why is Smoking Difficult to Quit?
The short answer is NICOTINE.
Cigarettes and other forms of tobacco—including pipe tobacco, cigars, snuff, and chewing tobacco—contain this addictive drug. A typical smoker will take 10 or more puffs on a cigarette in about 5 minutes that the cigarette is lit. Therefore, a person who smokes about a pack i.e. 20 cigarettes a day will get at least 200 “hits” of nicotine each day.
Nicotine alters the balance of two important chemicals in the brain known as dopamine and noradrenaline. When nicotine changes the levels of these chemicals, your mood and concentration levels change. Specifically, epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate while the increase in dopamine affects the brain pathway that controls reward and pleasure. Many smokers find this enjoyable.
These changes happens rapidly. When you inhale the nicotine, it immediately rushes to the brain, where it produces feelings of pleasure and reduces stress and anxiety. This is why many smokers enjoy the nicotine rush and become dependent on it. The trick about smoking is that the more you smoke, the more your brain becomes used to the nicotine, this simply means that you will have to smoke more to get the same effect of pleasure. The economic costs of tobacco use are significant and include substantial cost for the treatment of the disease caused by tobacco use and also the lost of human capital that results from tobacco-related morbidity and mortality.
Studies suggests that additional compounds in tobacco smoke, for example acetaldehyde, may potentiate the effect of nicotine on the brain. When an addicted smoker tries to quit, the loss of nicotine changes the levels of dopamine and noradrenaline and he or she experiences withdrawal symptoms such as irritability, depression, attention difficulties, increased appetite, and sleep disturbances. In order to immediately fix these unpleasant feelings, smokers crave nicotine and they continue to smoke in order to avoid these problems.
How can smoking be curbed?
However, all hope is not lost regarding quitting traditional cigarette usage, as there are several tobacco harm reduction strategies that a nicotine user can employ to quit smoking.
In this write-up, our focus is on E-cigarette.
E-cigarette
According to Merriam Webster dictionary, E-cigarette is a battery-operated device that is typically designed to resemble a traditional cigarette and is used to inhale a usually nicotine-containing vapor.
E-cigarettes contain a liquid solution typically consisting of nicotine (you may choose not to add nicotine), propylene glycol or glycerol, and often flavoring. The solution is heated by the battery producing the aerosol or vapor inhaled by the user. Most of them are reusable, having replaceable and refillable cartridges, but some of them are disposable. It should be noted that e-cigarette is also known as electronic cigarette, e-cigs, Electronic Nicotine Delivery Systems – ENDS, vaporizer cigarettes and vape pens. They aim to imitate a similar sensation of inhaling tobacco smoke but without combustion.
People smoke for nicotine, but die from the tar and gasses during combustion – Michael Russell.
The first patent for a “smokeless, non-tobacco cigarette” was requested by a man named Herbert A. Gilbert in 1963. However, the current device wasn’t available until 2003. The e-cigarette as we know it was invented by a Chinese pharmacist named Hon Lik who was working for Golden Dragon Holdings, which is now known as Ruyan. The company began exportation of e-cigarette into major markets in 2005 – 2006. Currently, there are over 460 different brands of e-cigarette on the market.
Components of E-cigarette
Most e-cigarettes consist of four different components, including:
- Cartridge or reservoir: which holds a liquid solution (e-liquid or e-juice) containing varying amounts of nicotine, flavorings, and other chemicals.
- Heating element: atomizer
- Power source: This is usually a battery
- Mouthpiece: This is used to inhale the vapour.
- Electronic circuits
E-cigarette products contains nicotine strengths of between roughly 1 percent and 2.4 percent.
Can E-cigarette Aid Smoking Cessation?
E-cigarette allows the users to get smaller amount of nicotine into their bloodstream to counteract withdrawal symptoms that arises when a person decides to be smoking without exposing him/her to the full-blown health risk of smoking traditional combustible cigarette.
Shu-Hong Zhu, PhD, UC San Diego professor of Family Medicine and Public Health and director of the Center for Research and Intervention in Tobacco Control, and team published their findings in the British Medical Journal on July 26, 2017. In their report they said; “Our analysis of the population survey data indicated that smokers who also used e-cigarettes were more likely to attempt to quit smoking, and more likely to succeed,” “Use of e-cigarettes was associated both with a higher quit rate for individuals as well as at the population level; driving an increase in the overall number of people quitting.”
E-cigarette has the potential to be of great help in assisting smokers to quit smoking and not just by relying on willpower only. A research titled “Strategies to Help a Smoker Who Is Struggling to Quit” which was written by Nancy A. Rigotti, MD identifies that one of the reasons why quit attempts fail is that only one-third of smokers who try to quit use any assistance.
The use of E-cigarette in pregnant women
There is an urgent need to quit smoking during pregnancy because of pregnancy complications and adverse fetal outcomes, such as birth defects, placenta previa, preterm-related deaths, sudden infant deaths, placental abruption, prolonged hemorrhage, miscarriage and stillbirth, ectopic pregnancy and low birth-weights . It is estimated that 8.4–10.2% of pregnant women smoke during their pregnancy in the U.S.
The unfortunate truth is that many pregnant women still smoke despite knowing the risks and havoc it can bring to them and their babies. According to the CDC, 10 % of women report that they smoked during the last three months of pregnancy. The best way to avoid pregnancy complications associated with smoking is to quit. However, this is difficult for many due to addictive effect of nicotine. The potential efficacy of e-cigarettes as a smoking cessation device comes in handy to assist pregnant women to quit or reduce cigarette smoking.
In conclusion, the health risk of e-cigarette is far lower compared to traditional combustible cigarettes, and when used as a cessation aid by smokers, it can be of great benefit in quitting smoking.
However, more research is needed on e-cigarette to bring to light more information and evidences about the benefits and risk associated with the use of e-cigarettes especially in key populations e.g. pregnant women and young people.
Article was written by our Volunteer Ambassadors and edited by Olatunji Uche & Adebisi Yusuff Adebayo, THR Nigeria.
