ASH Ireland

Dr Patrick Doorley, Chairperson ASH Ireland has been elected to the Board of the European Network for Smoking and Tobacco Prevention (ENSP). Dr Doorley is a specialist in Public Health Medicine and a fellow of the Faculty of Public Health Medicine of Ireland.

ENSP is an international non-profit organisation whose mission is to develop a strategy for co-ordinated action among organisations active in tobacco control in Europe by sharing information and experience and through co-ordinated activities and joint projects. ENSP aims to create greater coherence among smoking prevention activities and to promote comprehensive tobacco control policies at both national and European levels.

ENSP’s top priority objectives are:

·      to implement the Framework Convention on Tobacco Control (FCTC) in Europe by 2020, and

·      to reduce the prevalence of tobacco use in Europe to less than 5% by 2040.

ENSP’s vision for the future is to eliminate health inequalities among European citizens and suffering caused by ill health and early death due to tobacco-related diseases.

To attain its purpose, ENSP undertakes to conduct the following activities;

·      to focus in priority on co-ordination and consensus-building, education, prevention and cessation;

·      to facilitate the creation and development of national and international alliances for smoking prevention and tobacco control in Europe, as well as support for their actions;

·      to promote collaboration amongst member organisations and support their actions;

·      to stimulate and participate in joint projects at national and international levels;

·      to undertake the collection, distribution and exchange of information relevant for tobacco control to the members of the network, non-governmental organisations, intergovernmental organisations, national governments all over Europe and the institutions of the European Union;

·      to sponsor, promote and organise education and training seminars, conferences, missions and exhibitions on matters relevant to smoking and tobacco prevention and cessation.

Ms Norma Cronin Board Member, ASH Ireland was previously a member of the Board of ENSP.

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Dr Patrick Doorley, Chairperson of ASH Ireland spoke recently about the importance of the ban on smoking in cars with children and said:

ASH Ireland first proposed a ban in smoking in cars in 2008 and we are very pleased that it is in place. We believe that this important piece of legislation is helping to ensure that our children are protected from the harmful effects of passive (environmental) tobacco smoke.

Prior to the ban, one in seven Irish children was being exposed to tobacco smoke in cars, which was totally unacceptable. There is definitive evidence to show that non-smokers travelling in a car while another person is smoking will be harmed by the toxic chemicals which are released in such a restricted environment. Researchers have found that secondhand smoke in cars poses a major health risk and the toxins found are thought to be the most important among the thousands in tobacco smoke that cause smoking-related disease.

Children’s lungs are particularly sensitive and it is well established that children are very vulnerable to such toxins in cars. Adults who suffer from asthma and other respiratory conditions are also affected of course.  We believe that the introduction of the law has heightened awareness about the harm caused by smoking in cars, especially to children. Like the ban on smoking in the workplace, it was not envisaged that this initiative would have to be driven by fear of prosecution. It is the law and we believe that the vast majority of smokers, and particularly parents, are responsible and comply with legislation. We would hope therefore that significantly fewer children are being exposed to tobacco smoke in motor vehicles since the ban was introduced.

Dr Patrick Doorley, Chairman of ASH Ireland has responded to a new study about e-cigarettes and urged people to start vaping only as a last resort when trying to quit smoking.

 

The study, just published in the peer-reviewed journal Thorax (British Medical Journal Group), has shown that e-cigarette vapour destroys protective cells that keep the lungs clear of harmful particles. It showed that the vapour impairs the activity of cells known as macrophages, which help remove dust, bacteria and allergens. Some of the damage highlighted by the study is similar to the effects of tobacco and chronic lung disease.

 

Dr Doorley said that the report adds to reservations about the safety of e-cigarettes. Speaking to the Irish Independent, he said,

“We certainly shouldn’t dismiss this study. We have known for quite some time about the concerns of vaping. Our health regulator HIQA conducted a major study in recent years which acknowledged that, while e-cigarettes could help people quit smoking, there were still many reservations. The single biggest concern we have at the moment is their long-term safety.”

 

Dr Doorley told the Irish Independent that e-cigarettes should not be the go-to solution when giving up smoking. “There are options that are safer and have a good long-term track record, like the drug Varenicline, along with nicotine replacement therapy.”

 

For help quitting, please contact the National Quitline at http://www.quit.ie or call 1800 201203.

 

The article just published about the study on e-cigarettes is available in full here.

The Irish Independent article is available here.

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What are cigars and how do they differ from cigarettes?

A cigar is defined as a tube-shaped tobacco product that is made of tightly rolled, cured tobacco leaves in a tobacco leaf wrapper or a wrapper that contains tobacco.[1] Cigars differ in design from cigarettes, typically being composed entirely of whole-leaf tobacco, wrapped in leaf tobacco rather than paper and typically smoked without a filter.[2] According to the World Health Organisation, cigars generally contain several times as much tobacco as cigarettes, but their size is much more variable, ranging from the size of a cigarette to products that are several times the diameter and containing as much tobacco as a package of 20 cigarettes or more.[3]

Does cigar smoking cause health harm?

Yes. Cigar smoking causes cancer and other diseases.[4]

What cancers does cigar smoking cause?

According to the U.S. National Cancer Institute[5], cigar smoking causes cancer of the oral cavity, larynx, oesophagus, and lung. It may also cause cancer of the pancreas. Regular cigar smokers and cigarette smokers have similar levels of risk for oral cavity and oesophageal cancers. The more you smoke, the greater the risk of disease.

What other diseases does cigar smoking cause?

Daily cigar smokers, particularly those who inhale, are at increased risk for developing heart disease and other types of lung disease [6] as well as other diseases and disability referenced below.

What if I don’t inhale the cigar smoke?

Many cigar smokers believe that they are at no risk or less risk of health harm because they do not inhale cigar smoke. The National Cancer Institute addresses the question about inhaling cigar smoke as follows[7]:

“Unlike nearly all cigarette smokers, most cigar smokers do not inhale. Although cigar smokers have lower rates of lung cancer, coronary heart disease, and lung disease than cigarette smokers, they have higher rates of these diseases than those who do not smoke cigars.

All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to smoke and its toxic and cancer-causing chemicals. In addition, when saliva containing the chemicals in tobacco smoke is swallowed, the oesophagus is exposed to carcinogens. These exposures probably account for the similar oral and oesophageal cancer risks seen among cigar smokers and cigarette smokers.”

More information about cancer, cigars and cigar smoking researched and written by the U.S. National Cancer Institute may be found here: https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cigars-fact-sheet

What about cigar smoking compared with cigarette smoking?

As noted, there are differences in health harms from cigar and cigarette smoking. However, a scientific study published in 2015 which was a systematic review of 22 studies of the health effects of cigar smoking found that cigar smoking carries many of the same health risks as cigarette smoking.[8] Mortality risks from cigar smoking vary by level of exposure as measured by cigars per day and inhalation level and can be as high as or exceed those of cigarette smoking.

Some key points from this systematic review are to be found at the link below from the online men’s health resource (www.menshealth.com) which says that “lighting up a Cuban could be more lethal than you think: Cigar smokers are at risk of dying from many of the same diseases that affect people who puff on cigarettes”.[9] https://www.menshealth.com/health/a19544365/dangers-of-cigars/

The scientific study was published in 2015 in the peer -reviewed journal BMC Public Health and is available in full at this link:

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1617-5

An overview of scientific studies of cigars and cigar usage

Here are sixteen points from Viegas’s overview of scientific studies of cigars and cigar usage [10]:

1.     Cigar smoking results in a considerable risk of developing smoking-related diseases.

2.     In comparison with individuals who never smoked, cigar smokers have a greater risk of coronary disease and cerebrovascular accident, as well as a higher overall rate of mortality due to other diseases.

3.     The great majority of cigars have more nicotine than the sum of many cigarettes (1-2 mg of nicotine in a cigarette and 100-400 mg of nicotine in a cigar, which contains up to 17 g of tobacco).

4.     Cigar smoke is more alkaline than is that of cigarettes, thereby facilitating its dissolution and absorption by the oral mucosa. This makes it possible to achieve the desired dose of nicotine without the need to inhale the smoke into the lungs. Despite the fact that many cigar smokers do not inhale, cigars can cause nicotine dependence, because they make high levels of nicotine available so rapidly.

5.     Cigar smoke contains a class of highly carcinogenic compounds (nitrosamines, hydrocarbons and aromatic amines) at levels significantly higher than those found in cigarette smoke.

6.     Biochemical analysis has shown that, for an equal number of grams of tobacco smoked, tar, carbon monoxide and ammonia are produced in larger quantities through the burning of cigars than through the burning of cigarettes. In addition, the tar derived from cigars has high concentrations of carcinogenic agents such as polycyclic aromatic hydrocarbons. Viegas explains that this could be the reason that the risk of presenting with lung cancer is up to nine times greater for cigar smokers than for nonsmokers.

7.     The rates of lung cancer among cigar smokers are related to the number of cigars smoked per day and to the degree of inhalation of the smoke.

8.     Cigar smokers who inhale no smoke expose the oral cavity and the tongue to large quantities of smoke, thereby increasing the risk of oral cancer. The constituents of tobacco dissolved in the saliva are also swallowed, increasing the incidence of oesophageal cancer in this group.

9.     Tobacco and alcohol act synergistically to increase the development of oral and pharyngeal cancer.

10.  The risk of developing cancer in the oral cavity (lips, tongue, mouth and throat), larynx or oesophagus is twice as high for cigar smokers as it is for nonsmokers.

11.  Cigar smokers also present an increased risk of developing COPD and coronary disease.

12.  The risk of dying from cancer of the pancreas or bladder has been shown to be two and three times higher, respectively, for cigar smokers who inhale the smoke than for nonsmokers.

13.  Compared with cigarette smokers, cigar smokers also present an increased risk of respiratory and heart diseases, as well as cancer of the oral cavity, throat and oesophagus.

14.  Cigar smoking has been related to the onset of erectile dysfunction in men.

15.  Secondary smoke from cigars contributes more to environmental pollution than does cigarette smoke.

16.  Since cigar smoke contains higher concentrations of toxins and cancerous substances than does cigarette smoke, it also contributes to increasing the risk of lung cancer and other smoking-related diseases in nonsmokers (passive smokers).

All quotes above from Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073. The full article is available at this link: https://pdfs.semanticscholar.org/5074/4f764adcd62b86756555b75addf579e23848.pdf

Other useful links about cigars and cigar smoking [11] [12] [13] [14]

You will find more specific information about cigar smoking at these useful links, including about the rise in flavoured cigars aimed at the children’s market:

https://www.cancer.ie/cancer-information/oesophagus-cancer/causes-prevention#sthash.VMuyQpJQ.dpbs

http://cancerpreventionresearch.aacrjournals.org/content/early/2017/11/05/1940-6207.CAPR-17-0084

https://www.verywellmind.com/facts-about-cigar-smoking-2824739

https://www.tobaccofreekids.org/what-we-do/industry-watch/cigar-report

Quitting cigar smoking

You will find information on smoking cessation on the ASH Ireland website here: https://www.ash.ie/quitting-smoking/ including links to the HSE quit.ie resource.

Summary

In short, cigar smoking harms health. Cigar smoking causes cancer, heart disease, chronic obstructive pulmonary disease (COPD), and other diseases. Cigar smoke contains the same toxins as cigarette smoke. Secondhand smoke from cigars harms people around cigar smokers, who are passive smokers. Quitting smoking will improve your health and the health of those around you. Help is available from your GP and from www.quit.ie

 

Joan Hanafin, July 2018

References

[1] National Cancer Institute (NCI) 2018. https://www.cancer.gov/ Accessed 12 July 2018.
[2] Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073.
[3] http://www.who.int/tobacco/communications/events/wntd/2006/Report_v8_4May06.pdf Accessed 12 July 2018.
[4] Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073.
[5] National Cancer Institute (NCI) 2018. https://www.cancer.gov/ 12 July 2018.
[6] Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073.
[7] National Cancer Institute (NCI) 2018. https://www.cancer.gov/ Accessed 12 July 2018.
[8] Chang CM, Corey CG, Rostron BL, Apelberg BJ. Systematic review of cigar smoking and all cause and smoking related mortality. BMC Public Health 2015 15:390 https://doi.org/10.1186/s12889-015-1617-5
[9]  https://www.menshealth.com/health/a19544365/dangers-of-cigars/ Accessed 12 July 2018.
[10] Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073.
[11] https://www.cancer.ie/cancer-information/oesophagus-cancer/causes-prevention#sthash.VMuyQpJQ.dpbs Accessed 12 July 2018.
[12] http://cancerpreventionresearch.aacrjournals.org/content/early/2017/11/05/1940-6207.CAPR-17-0084 Accessed 12 July 2018.
[13] https://www.verywellmind.com/facts-about-cigar-smoking-2824739 Accessed 12 July 2018.
[14] https://www.tobaccofreekids.org/what-we-do/industry-watch/cigar-report Accessed 12 July 2018.

 

Staff and Students of North Dakota State University with Dr Patrick Doorley at the Workshop on Public Health Policy, Dublin, 25th May 2018

Dr Patrick Doorley, Chairperson ASH Ireland facilitated an afternoon workshop in Dublin on 25th May 2018. The workshop for medical students and staff from North Dakota State University consisted of a presentation by Dr Doorley on the work of ASH Ireland, tobacco control, and public health policy in Ireland followed by an interactive question and answer session. Mark Mulally, Learn International, who organised the event thanked Dr Doorley for his time and expertise and said, “It was a hugely informative, interactive and entertaining workshop which the students really enjoyed”.

 

CALL FOR ADDITIONAL SMOKEFREE OUTDOOR SPACES BY ASH IRELAND

While recognising that Ireland has made good progress over the last decade
in decreasing smoking prevalence among adults and children*, the current
rate of progress is not adequate to achieve the adult prevalence target
of 5% by 2025; as set out by a previous Government.

Dr Patrick Doorley, Chairman of ASH Ireland said today, “We are now
urging the Government to introduce more intensive measures to ensure that the 5%
target is met seven years from now. The good news is that smoking
prevalence among children is at an all-time low and it appears therefore
that we are on track to achieve the target of 5% for children. The
reduction of smoking among young people is bad news for the tobacco
industry as new recruits are required to replace those 6,000 of our
citizens who die from tobacco related disease annually.”

The sad and tragic reality of tobacco addiction is disease, disability
and death. Given that 6,000 people die each year from tobacco-related
diseases,we cannot afford to become complacent about the issue of tobacco
addiction.

Dr Doorley continued, “In recent years ASH Ireland has driven the
development of smokefree outdoor spaces – in children’s playgrounds, parks, sports
stadia, and higher education institutions. In 2013, the government committed to a
number of measures in its strategy TFI (Tobacco Free Ireland), including
the possibility of banning smoking in some outdoor spaces. We now call on
the Government to implement new anti-smoking measures, particularly in
outdoor spaces that are frequented by children. We hold the view, based on
past experience, that such measures will have the support of the Irish
people”

Additional protective measures against the harmful effects of
environmental tobacco smoke may well be opposed by vested interests.  The
tobacco industry and its allies will strongly oppose these measures in
order to protect its profits, so their position on such health matters
should be entirely ignored.”

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For contact: E  info@ash.ie  or  T 0818 305055

Secondhand smoke (SHS), also called environmental tobacco smoke (ETS), is a mixture of two forms of smoke that come from burning tobacco: mainstream smoke (the smoke exhaled by a smoker) and sidestream smoke (the smoke from the lighted end of a cigarette, pipe, or cigar, or tobacco burning in a hookah.

Prohibiting tobacco use in outdoor areas such as parks, playgrounds, beaches, access areas, outdoor restaurants and football stadia provides several benefits. As there is no safe level of exposure to secondhand smoke, and exposure to secondhand smoke can occur in outdoor areas, bans in areas where people congregate can be justified on health grounds, particularly for those at increased risk of respiratory problems e.g., asthmatics.

Cigarette butts and other tobacco product wastes are the most common items picked up in urban and beach cleanups worldwide. Prohibiting smoking in these areas will greatly reduce cigarette butt litter, thereby enhancing the locations both visually and environmentally, and reducing fire risk.

Only 18 per cent of our population are now daily smokers. The experience in other countries like Canada and the UK is that smoke free outdoor spaces contribute to the normalisation of tobacco free lifestyles, making the healthy choice the easy choice.

“Denormalisation” strategies aim to make smoking-related behaviours less visible. Prohibiting tobacco use in outdoor areas reduces visibility and will also contribute therefore to the reduction of the social acceptability of smoking. Denormalisation of smoking assists young people in making healthy choices around experimenting with tobacco, assists current smokers in considering the decision to quit and facilitates continued abstinence in ex-smokers.

ASH Ireland initiated the ‘outdoor smokefree’ project in Ireland and has been pivotal in its success. Over the past eight years, ASH Ireland has advanced the ‘outdoor smokefree’ project in Ireland through engagement with county councils, national sports bodies, the Office of Public Works, Iarnród Éireann, and the third-level education sector. In line with Irish society becoming better informed on the health risks, there is a general momentum towards ‘outdoor smokefree’; the denormalisation of smoking is widely accepted and the industry has lost its clout with the decision-makers and society.

In Dublin, the Aviva stadium is entirely smokefree and Croke Park is partially so. The Gaelic Athletic Association (GAA) is currently working on a smokfree trial project with a number of its clubs. Over 80% of our public playgrounds are smokefree, as are two third-level education institutions, with others deeply engaged in the ‘going smokefree’ process. Many of our hospitals are now smokefree, an initiative being driven by the Health Service Executive.

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