Rajiv Parakh, chairman, department of peripheral vascular and endovascular surgery at New Delhi’s Sir Ganga Ram Hospital, is worried. “Over the last decade, there has been an increase in the number of women taking to smoking. Look around in cafes, hotel lobbies, offices, bars and restaurants, and what you see speaks louder than available statistics.” Loud enough, he says, to merit more than ordinary concern.
According to a World Health Organization study, First Report on Global Tobacco Use, released earlier this year, one in every 10 women in India smokes or chews tobacco.
In a nationally representative study of smoking in India, conducted by the New England Journal of Medicine in February, more than 62% of women smokers in India will die in their productive years, compared with 38% of non-smokers.
More than 20% of these are at risk of contracting respiratory diseases, 12% are vulnerable to heart attacks, and 9% to tuberculosis, the study states.
Other Survey also suggest that since the 1990s, more women than men started smoking in the crucial adolescent years. A study done by the All India Institute of Medical Sciences (AIIMS) in 2006, on 6,000 students across 32 schools in Delhi and Chennai, showed that 20% of the girls in class VI are lighting up.
A new generation
The big cities, say medical professionals, are the biggest offenders. In Delhi, for instance, class XI girls whose mothers have not smoked a single cigarette can expertly blow smoke rings. Urvashi, 17, started smoking after class X Board exams to be a “trailblazer”.
Komal, 19, says she started smoking because she wanted to beat the boys at their game. Manya, 19, who began working after school and took up a correspondence course, smokes because she can “afford” it and because it “looks smart”. Samita, studying to be a chartered accountant, picked up the habit just after school to “beat stress”.
But, are these youngsters aware of the effects of smoking? “Of course,” says Paramita, a third-year college student in Delhi. She says: “I know it causes cancer. But only if you smoke till you are old. It’s safe if I stop by 50.”
She’s 19, and has been smoking for two years. Paramita knows that smoking can affect her lungs. She’s heard of lung cancer. But, peripheral artery disease? “What’s that?” she laughs.
Tobacco smoke contains at least 1,400 chemicals. Besides the poisonous carbon monoxide, the nicotine in tobacco makes it addictive because it increases the level of feel-good dopamine.
Some cigarettes also include ammonia to increase nicotine absorption. That, say experts, is what narrows and, ultimately, hardens arteries, and plays havoc with heart rate and blood pressure.
Action on Smoking and Health, a registered public charity in the UK, quotes a BBC report that warns the chemicals that smokers inhale. These include cyanide, benzene, formaldehyde, methanol (wood alcohol) and acetylene.
Smoke contains harmful gases such as nitrogen oxide and carbon monoxide. According to the study by the New England Journal of Medicine, an estimated 20% of all male deaths, and one in 20 of all female deaths between 30 and 69 years, will be caused by smoking by 2010.
That’s more than any other cause of death.
Quit to win
The earlier you start smoking, the more the number of years that you smoke, and the number of cigarettes you smoke each day—all these add to the risk of health problems.
One World Bank study warns that most new smokers “underestimate the risk of becoming addicted to nicotine.” If they can’t quit, “half of the long-term smokers will eventually be killed by tobacco, and half of these will die in middle age”.
Dr (Col) R. Ranga Rao, senior consultant, medical oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, says that it’s a time bomb we’re puffing on. “It’s never too late to quit. You’ll start feeling better within 24 hours.
“Two days after you quit, your risk of a heart attack will start decreasing. And that’s just the beginning,” he adds.
WOMEN SMOKERS, WATCH OUT
Women are as susceptible as men to all smoking-related diseases; here’s a list of what they need to be additionally careful about
Dr Rao says, “Smoking causes more breathing difficulties in women than in men.” It is not asthma alone; women smokers are also susceptible to chronic obstructive pulmonary disease (COPD), believed, until recently, to be more likely to strike men. COPD shows up in symptoms such as frequent colds, a stubborn cough, phlegm, shortness of breath and breathing problems. According to a study by Norway’s National Institute of Public Health, the amount of chemicals a woman smoker draws in is the same as men do. However, as most women are smaller built than men, their breathing systems take in a higher concentration of the poisons.
Research suggests that the risk of cardiovascular disease, including heart attacks and strokes, increases at least fourfold for women smokers above the age of 35 compared with non-smoking women in the same age group, among those who use oral contraceptives. Medical experts in the US recommend that no oral contraceptives should be prescribed to women above 35 who smoke 15 or more cigarettes a day.
A number of studies suggest that women who smoke have lower fertility. Women smokers who have stopped taking contraceptives show a reduced rate of fertility as compared to non-smokers who have. According to one study conducted in Queensland, smokers who enrolled for IVF-ET (in vitro fertilization and embryo transfer) have a poorer outcome than those who don’t smoke. Smoking women produce fewer oocytes (immature eggs), have a pregnancy rate less than half that of non-smokers, and have more chances of miscarriages, the same study adds.
MENSTRUATION AND MENOPAUSE
Women who smoke are more prone to secondary amenorrhoea (absence of menstruation) and irregular periods, according to a report by the US department of health and human services. Such women are also more likely to experience unusual vaginal discharge or bleeding, and reach natural menopause one to two years earlier than non-smokers or ex-smokers, it adds. This is due to a toxic effect on the ovaries caused by smoke exposure, or the significantly lower levels of oestrogen in smokers.
As with men, cigarette smoking contributes to osteoporosis, an increase in bone fragility that accompanies ageing, in women too. Because of its effects on oestrogen, smoking reduces bone density: A study suggests that women who smoke up to 20 cigarettes in a day through adulthood will have reduced their bone density by around 5-10% by the time they reach menopause, compared to non-smokers. This deficit in bone density is enough to increase the risk of fractures.
Women smokers are more susceptible to cancers of the cervix and vulva. Evidence also suggests that passive exposure to smoking is a risk factor for cancer of the cervix. A 1991 study published in ‘American Journal of Public Health’ suggests that even low exposure to environmental tobacco smoke has systemic effects.
Nicotine, carbon monoxide and other toxic constituents of tobacco smoke cross the placenta readily, directly impacting the oxygen supply to the foetus, and the structure and function of the umbilical cord and placenta. A number of tobacco smoke constituents that cross the placenta are known carcinogens. Nicotine also has a direct effect on foetal heart rate and breathing movements. It is also found in the breast milk of women who smoke. Maternal smoking also predisposes the child to respiratory illnesses, and parental smoking has been linked with decreased pulmonary function and asthma in children.
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