Tobacco smoking is the practice of burning tobacco and ingesting the smoke that is produced.
The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is
generally done with pipes and cigars [5]. They can also be consumed as snuff, chewing tobacco,
dipping tobacco and snus.
Use of Tobacco Worldwide:
Between 1970 and 1995, per-capita tobacco consumption in poorer developing countries
increased by 67 percent, while it dropped by 10 percent in the richer and developed world [5].
Over 80% of the world's 1.3 billion tobacco users live in low and middle income countries.
Tobacco Consumption Rate in Bangladesh:
The two major tobacco companies in Bangladesh include British American Tobacco, which
holds 66.6% of the cigarette market by volume, and Dhaka Tobacco Industries (under Akij
Group), with 20.5% of the cigarette market [16]. Smaller domestic companies include Abul Khair
Leaf Tobacco, Alpha Tobacco Company, Nasir Gold Tobacco Company, and Sonali Tobacco. In
2018, 91.6 billion cigarettes were sold in Bangladesh. Bangladesh is one of the largest tobacco
consuming countries in the world. The tobacco consumption rate is given below:
35.3% of all adults (age 15+) use any tobacco products (men 46.0%; women 25.2%).
18.0% smoke tobacco (men 36.2%; women 0.8%).
20.6% of adults use smokeless tobacco (men 16.2%; women 24.8%).
Among youth (ages 13–15), 6.9% use tobacco in any form (boys 9.2%; girls 2.8%).
2.9% currently smoke tobacco (boys 4.0%; girls 1.1%).
4.5% use smokeless tobacco products (boys 5.9%; girls 2.0%) [16].
Secondhand Smoke Exposure in Bangladesh:
42.7% of adults who work indoors are exposed to secondhand smoke in the workplace,
49.7% of those who visit restaurants are exposed there, and 44.0% of adults who use
public transport are exposed while on it.
59.0% of youth (ages 13–15) are exposed to secondhand smoke in public places and
31.1% of youth are exposed to secondhand smoke at home. [16]
The current tobacco tax structure in Bangladesh is complex. A VAT of 15% on all tobacco
products is applied to all tobacco products [14]. The National Assembly of Bangladesh passed the
Tobacco Control Law Amendment Bill on 29th April, 2013 [3]. Some of the most important
measure in the amendment are as follows:
1. Advertisements at points of sale are now banned.
2. Sales of tobacco to and by minors have been banned.
3. Graphic health warnings are to be printed on tobacco packs.
4. Smokeless tobacco has been brought under the definition of “Tobacco”.
5. Restaurants and indoor workplaces have now been included among the public places that
are to be completely smoke-free.
6. The Ministry of Health is now mandated by law to establish and operate the “National
Tobacco Control Cell” (until now, the Cell has functioned under an administrative order)
and so on [3].
Problems Related to Tobacco Usage:
Few of the reasons of banning Tobacco is given below:
Health Issues:
German scientists identified a link between smoking and lung cancer in the late 1920s, leading to
the first anti-smoking campaign in modern history. In 1950, British researchers demonstrated a
clear relationship between smoking and cancer. Many substances in it trigger chemical reactions
in nerve endings, which heighten heart rate, alertness and reaction time [5]. According to the
Imperial College London, "Nicotine seems to provide both a stimulant and a depressant effect,
and it is likely that the effect it has at any time is determined by the mood of the user, the
environment and the circumstances of use. Studies have suggested that low doses have a
depressant effect, while higher doses have stimulant effect."[7] The World Health Organization
estimates that tobacco caused 5.4 million deaths in 2004 and 100 million deaths over the course
of the 20th century [5]. By 2030, the World Health Organization (WHO) forecasts that 10 million
people a year will die of smoking-related illness, making it the single biggest cause of death
worldwide, with the largest increase to be among women [5]. Tobacco smoking is the leading
cause of preventable death and a major public health concern [8]. One person dies every six
seconds from a tobacco related disease [9]. The tobacco is one of the deadliest object in the
history of human civilization. It kills about 6 million people every year. It kills half its long-term
users [1]. Tobacco use leads most commonly to diseases such as:
1. Cancer:
The primary risks of tobacco usage include many forms of cancer, particularly lung
cancer, kidney cancer, cancer of the larynx and head and neck, bladder cancer, cancer of
the esophagus, cancer of the pancreas and stomach cancer. Studies have established a
relationship between tobacco smoke, including secondhand smoke, and cervical cancer in
women. There is some evidence suggesting a small increased risk of myeloid leukemia,
squamous cell Sino nasal cancer, liver cancer, colorectal cancer, cancers of the
gallbladder, the adrenal gland, the small intestine, and various childhood cancers. The
possible connection between breast cancer and tobacco is still uncertain [20].
2. Pulmonary:
In tobacco smoking, long term exposure to compounds found in the smoke (e.g., carbon
monoxide and cyanide) are believed to be responsible for pulmonary damage and for loss
of elasticity in the alveoli, leading to emphysema and chronic obstructive pulmonary
disease (COPD). COPD caused by smoking is a permanent, incurable (often terminal)
reduction of pulmonary capacity characterized by shortness of breath, wheezing,
persistent cough with sputum, and damage to the lungs, including emphysema and
chronic bronchitis. The carcinogen acrolein and its derivatives also contribute to the
chronic inflammation present in COPD [20].
3. Cardiovascular disease:
Inhalation of tobacco smoke causes several immediate responses within the heart and
blood vessels. Within one minute the heart rate begins to rise, increasing by as much as
30 percent during the first 10 minutes of smoking. Carbon monoxide in tobacco smoke
exerts negative effects by reducing the blood's ability to carry oxygen. Smoking also
increases the chance of heart disease, stroke, atherosclerosis, and peripheral vascular
disease. Several ingredients of tobacco lead to the narrowing of blood vessels, increasing
the likelihood of a blockage, and thus a heart attack or stroke. According to a study by an
international team of researchers, people under 40 are five times more likely to have a
heart attack if they smoke. Exposure to tobacco smoke is known to increase oxidative
stress in the body by various mechanisms, including depletion of plasma antioxidants
such as vitamin C [20]. Tobacco smoke is a complex mixture of over 7,000 toxic
chemicals, several of which 98 are associated with an increased risk of cardiovascular
disease and 69 of which are known to be carcinogenic [8].
4. Renal:
In addition to increasing the risk of kidney cancer, tobacco smoking can also contribute
to additional renal damage. Smokers are at a significantly increased risk for chronic
kidney disease than non-smokers. A history of smoking encourages the progression of
diabetic nephropathy [20].
5. Influenza:
A study of an outbreak of an (H1N1) influenza in an Israeli military unit of 336 healthy
young men to determine the relation of tobacco smoking to the incidence of clinically
apparent influenza, revealed that, of 168 smokers, 68.5 percent had influenza, as
compared with 47.2 percent of nonsmokers. Influenza was also more severe in the
smokers; 50.6 percent of them lost work days or required bed rest, or both, as compared
with 30.1 percent of the nonsmokers. Smoking tobacco seems to cause a higher relative
influenza-risk in older populations than in younger populations. In a prospective study of
community-dwelling people 60–90 years of age, during 1993, of unimmunized people
23% of smokers had clinical influenza as compared with 6% of non-smokers [20].
6. Mouth:
Perhaps the most serious oral condition that can arise is that of oral cancer. However,
smoking also increases the risk for various other oral diseases, some almost completely
exclusive to tobacco users. The National Institutes of Health, through the National Cancer
Institute, determined in 1998 that "It causes a variety of cancers including cancers of the
oral cavity (lip, tongue, mouth, throat), esophagus, larynx, and lung." Smokeless tobacco
causes gingival recession and white mucosal lesions. Tobacco smokers have significantly
greater loss of bone height than nonsmokers. It has been proven to be an important factor
in the staining of teeth. Halitosis or bad breath is common among tobacco smokers [20].
7. Psychological:
American Psychologist stated, "Tobacco smokers often report that cigarettes help relieve
feelings of stress. However, the stress levels of adult smokers are slightly higher than
those of nonsmokers, adolescent smokers report increasing levels of stress as they
develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far
from acting as an aid for mood control, nicotine dependency seems to exacerbate stress.
This is confirmed in the daily mood patterns described by smokers, with normal moods
during smoking and worsening moods between cigarettes. Thus, the apparent relaxant
effect of smoking only reflects the reversal of the tension and irritability that develop
during nicotine depletion. Dependent smokers need nicotine to remain feeling normal."
[20]
The reasons given by some smokers for this activity have been categorized as
addictive smoking, pleasure from smoking, tension reduction/relaxation, social smoking,
stimulation, habit/automatism [6]. Some smokers argue that the depressant effect of
smoking allows them to calm their nerves, often allowing for increased concentration [6].
8. Cognitive function:
The usage of tobacco can also create cognitive dysfunction. There seems to be an
increased risk of Alzheimer's disease (AD) [19]. It has been found to contribute to
dementia and cognitive decline, reduced memory and cognitive abilities in adolescents,
and brain shrinkage (cerebral atrophy). Most smokers, when denied access to nicotine,
exhibit withdrawal symptoms such as irritability, jitteriness, dry mouth, and rapid
heartbeat. The onset of these symptoms is very fast, nicotine's half-life being only two
hours. A very large percentage of schizophrenics smoke tobacco as a form of self-
medication. The high rate of tobacco uses by the mentally ill is a major factor in their
decreased life expectancy, which is about 25 years shorter than the general population [20].
Passive Smoking and Second Hand Smoke:
Passive smoking is the inhalation of tobacco smoke by individuals who are not actively smoking.
Second-hand smoke (SHS) is the collection of chemicals released when the burning end is
present, and environmental tobacco smoke (ETS) or third-hand smoke is the smoke that remains
after the burning end has been extinguished. Because of its negative implications, exposure to
SHS has played a central role in the regulation of tobacco products. Six hundred thousand deaths
were attributed to SHS in 2004 [13]. Non-smokers who are exposed to second-hand smoke at
home or work are thought, due to a wide variety of statistical studies, to increase their heart
disease risk by 25–30% and their lung cancer risk by 20–30%. Second-hand smoke has been
estimated to cause 38,000 deaths per year, of which 3,400 are deaths from lung cancer in non-
smokers. The current US Surgeon General's Report concludes that there is no established risk-
free level of exposure to second-hand smoke. Short exposures to second-hand smoke are
believed to cause blood platelets to become stickier, damage the lining of blood vessels, decrease
coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk
of heart attack.
Environmental Issues:
The impact that tobacco has on the environment is less well recognized [17]. The environmental
lifecycle of tobacco can be roughly divided into four stages: (i) tobacco growing and curing; (ii)
product manufacturing and distribution; (iii) product consumption; and (iv) post-consumption
waste. Here, we describe the environmental concerns at each of these stages.
1. Tobacco growing and curing:
Tobacco growing usually involves substantial use of chemicals – including pesticides,
fertilizers and growth regulators. These chemicals may affect drinking water sources
as a result of run-off from tobacco growing areas. Research has also shown that
tobacco crops deplete soil nutrients by taking up more nitrogen, phosphorus and
potassium than other major crops. This depletion is compounded by topping and de-
suckering plants, which increase the nicotine content and leaf yields of tobacco plants
[17]
.
2. Product manufacturing and distribution:
In 1995, it was estimated that global tobacco manufacturing produced over 2000000
tonnes of solid waste, 300000 tonnes of non-recyclable nicotine-containing waste and
200000 tonnes of chemical waste. If annual cigarette production had remained
constant for the past 20 years (output has actually increased from 5 to 6.3 trillion
cigarettes annually), tobacco factories would have deposited a total of 45000000
tonnes of solid wastes, 6000000 tonnes of nicotine waste and almost 4000000 tonnes
of chemical wastes during this time. Other toxic by-products of tobacco
manufacturing or chemicals used in manufacturing include ammonia, hydrochloric
acid, toluene and methyl ethyl ketone [17].
3. Product consumption:
Most cigarettes are lit using matches or gas-filled lighters. If, for example, one
wooden match is used to light two cigarettes, the six trillion cigarettes smoked
globally each year would require the destruction of about nine million trees to
produce three trillion matches.10 There are also environmental impacts of
manufacturing and disposing of the plastic, metal and butane used in making cigarette
lighters [17].
4. Post-consumption waste:
With 6 trillion cigarettes manufactured annually, about 300 billion packages
(assuming 20 cigarettes per pack) are made for tobacco products. Assuming each
empty pack weighs about six grams, this amounts to about 1800000 tonnes of
packaging waste, composed of paper, ink, cellophane, foil and glue. The waste from
cartons and boxes used for distribution and packing brings the total annual solid post-
consumption waste to at least 2000000 tonnes. This compares with an estimated
1830000 tonnes annually of plastic waste from mineral water bottles. Electronic
cigarettes may contain batteries that require special disposal as well as chemicals,
packaging and other non-biodegradable materials. Cigarette butts are the most
commonly discarded piece of waste globally and are the most frequent item of litter
picked up on beaches and water edges worldwide. Hazardous substances have been
identified in cigarette butts – including arsenic, lead, nicotine and ethyl phenol. These
substances are leached from discarded butts into aquatic environments and soil.
Although the environmental impact of this waste has not yet been quantified, the
large quantity of discarded butts may allow leachates to affect the quality of drinking
water [17].
Tobacco causes harms from massive pesticide use and deforestation. It is not sustainable in a
world of global warming [1]. Deforestation for tobacco growing has many serious environmental
consequences – including loss of biodiversity, soil erosion and degradation, water pollution and
increases in atmospheric carbon dioxide.
Carbon dioxide emissions:
Tobacco smoking leads directly to the emission of 2600000 tonnes of carbon dioxide and about
5200000 tonnes of methane. Data from 66 low- and middle-income countries showed that
tobacco growing and curing caused significant deforestation between 1990 and 1995, amounting
to approximately 2000 hectares – on average, 5% of each country’s estimated deforestation
during that five-year period. Worldwide, approximately 13000000 hectares of forest are lost due
to agriculture or natural causes each year and of this, at least 200000 hectares are for tobacco
agriculture and curing. One estimate of the impact of deforestation in tobacco agriculture and
curing is that it causes almost 5% of global greenhouse gas production. British American
Tobacco estimated in 2006 that production of one million cigarettes produces 0.79 tonnes of
carbon dioxide. According to this estimate, 4740000 tonnes of carbon dioxide would be emitted
annually by global cigarette manufacturing. Other analyses assert that this is a gross
underestimate of the greenhouse gas burden due to tobacco growing, manufacturing and
transport [17].
Highly Addictive:
The nicotine in tobacco makes it highly addictive. This means that once you start, it is extremely
difficult to stop. The stress of health problems or the stress of discontinuing can really make
tobacco a problem that puts a lot of strain on mind and body [2]. Consuming nicotine—through
regular cigarettes or vaping—leads to the release of the chemical dopamine in the human brain.
As with many drugs, dopamine prompts or “teaches” the brain to repeat the same behavior (such
as using tobacco) over and over. This is also known as reinforcement. A typical smoker takes 10
or more puffs on each cigarette, so a person who smokes about one pack (25 cigarettes) daily
gets at least 250 "hits" every day. That’s a lot of “teaching” the brain to keep using nicotine. And
repeated use increases the risk of addiction. Whether a person consumes nicotine through
tobacco or vaping, its reinforcing effects might be much more harmful than the user imagines.
This might also be why teens who try vaping often switch to regular cigarettes—to get more and
more of the nicotine that the brain now craves [18]. Nicotine also temporarily boosts aspects of
cognition, such as the ability to sustain attention and hold information in memory [19].
Economic Loss:
The total economic contribution of the tobacco sector (in terms of household final consumption
expenditure, private and public domestic investment and net export) to the GDP in Bangladesh
was estimated at BDT 229.1 in 2016-17 fiscal year in 2018 prices. This is BDT 76.5 billion short
of the estimated total cost of tobacco, BDT 305.6 billion. Tobacco thus appears to be causing
significant net economic loss to Bangladesh [23]. The annual estimate of total economic cost of
tobacco in Bangladesh more than doubled since 2004 (the last time such an analysis was
undertaken). Productivity loss accounted for 83% of the increase in tobacco-attributable costs,
and increased health care expenditures explain the rest. For a rapidly growing economy such as
Bangladesh’s, this cost is expected to get larger over time and undermine the growth potential of
households who fall prey to the tobacco epidemic. It is urgent that the government act on curbing
the tobacco epidemic for sustaining the momentum of rapid economic growth with equity [23].
Most of the richer countries of the globe, however, are making progress in reducing both
smoking rates and overall consumption [1]. Apart from reducing human suffering, abolishing the
sale of tobacco would result in savings in the realm of healthcare costs, increased labor
productivity, lessened harms from fires, reduced consumption of scarce physical resources, and a
smaller global carbon footprint [1]. The primary reason for elimination of tobacco, is that smokers
themselves dislike the fact they smoke [1].
Why Tobacco Ban is Effective:
Banning tobacco tends to lessen air pollution in all cities where banning policies are
being implemented. According to the supporters of tobacco bans, all the cities and states
that prohibited smoking in all restaurants, cafes, and public indoor places can boast of a
better quality of indoor air. In contrast, the places where public smoking is still allowed
tend to have poor air quality [21].
One of the facts that prove the effectiveness of tobacco bans is the one related to a
significant risk reduction of catastrophic fires. The point is that smoking can potentially
increase the risks of fire in the areas with the materials that are highly flammable. There
are dozens of examples of fires that started in a flash from a small cigarette. What is
more, there have been instances of explosions at workplaces that also started from lit
cigarettes. In other words, smoking bans can not only reduce air pollution but literally
save people’s lives [21].
Tobacco ban can contribute to lower personal expenses and consumption of energy. If
smoking is not allowed in public areas like cafés, restaurants, and shopping malls, there
will be no need to provide ventilation. This, in turn, leads to lesser consumption of energy
and, as a result, lesser costs. When it comes to smokers, many experts admit that a person
who has this bad habit and smokes one pack a day tends to spend nearly $20 every day
and almost $720 every twelve months. With strict tobacco prohibition, it can easily cut in
half the expense for cigarette purchases of an individual [21].
Implementing tobacco bans across the globe boosts office productivity. A lot of
proponents admit that not every person in the work environment smokes. In case smoking
is allowed at the office, non-smokers tend to inhale harmful smoke. As a result, the
process can be inconvenient for them to smell the smoke. At the same time, if office
smoking is banned, employees tend to have better productivity [21].
The risk of lung cancer reduces almost from the first day someone quits smoking.
Healthy cells that have escaped mutations grow and replace the damaged ones in the
lungs. In the research dated December 2019, 40% of cells in former smokers looked like
those of people who had never smoked [12].
Tobacco control:
In 2007, WHO introduced a practical, cost-effective way to scale up implementation of the main
demand reduction provisions of the WHO FCTC on the ground: MPOWER. Each MPOWER
measure corresponds to at least 1 provision of the WHO Framework Convention on Tobacco
Control.
The 6 MPOWER measures are:
Monitor tobacco use and prevention policies
Protect people from tobacco use
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco.
WHO has been monitoring MPOWER policies since 2007 [22].
Although it has been noted that many people depend on tobacco industries for exports and
employment opportunities to earn then a living while governments use taxes levied on it for
infrastructural development. Using Tobacco can lead to major health issues. The direct and
indirect cost of lung cancer, asthma and chronic obstructive pulmonary disease of which
smoking is considered to be the number one cause. That’s not a good trade-off, even if we only
consider it economically [4]. The risks that arise from tobacco smoking outweighs the advantages
[24]
. Tobacco smoking has no health benefits. Yet tobacco is legally sold in every country in the
world even after understanding its harm. It remains not only legal but highly accessible and
profitable. So taking all the harmful sides in consideration, all sorts of tobacco products should
be banned according to me. It is not in principle difficult to end the sale of cigarettes; most
communities–even small towns–could do this virtually overnight [1]. Even though I mentioned
that banning tobacco may not help us to wake up in a world where smokers no longer exist.
Whether we like it or not, we cannot make everyone give up tobacco smoking. In conclusion,
banning tobacco is the right step to take to not only make our environment a better place to live
but to also save people’s lives all over the world and that is most definitely a positive
development.
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