Tobaccoism
Smoking to death
Barely a third of Cubans are active smokers, but many who are not are also in close contact with smoke, even in crowded buses and maternity hospitals sometimes. Much as they want to, most nicotine addicts seem unable to find their way into one of the (still insufficient) doctor’s offices and get help to kick the habit, so they end up instead joining the ranks of the more than a billion people worldwide who kowtow to this harmful vice.
By Gilda Fariñas y Tania Chappi
A CubaNews translation. Edited by Walter Lippmann. (Editing incomplete.)
Virtually all Cubans know that tobacco and health get on badly, yet too many of us keep smoking, cradled in the arms of age-old traditions and poor preventive strategies.
As a chain-smoker, Carlos José Villamil is a well-known man, not because many people like him, but rather because they find it hard to forget his image, always enveloped in “angelic” cigarette smoke.
Had he survived such a strong addition when medical science was still in its infancy 500 years ago, he surely would have suffered the same fate as Rodrigo de Jerez, one of Columbus’s crew members, who upon his return to Spain was accused of being possessed by evil spirits and thrown into jail by the Inquisition, only for the exotic habit of blowing smoke out of his mouth.
Those who remained on the island kept smoking, first small jerrybuilt cigars, then regular ones and finally the cigarettes commonly made around the second half of the 19th century in many factories in some cases staffed, among others, by soldiers and convicts.
The pitcher goes so often to the well...
Yes, but this one didn’t come home broken until around 1970. Although pro-smoking ads had been eliminated a decade before, over 60% of the Cubans had an addiction to tobacco and were totally unconcerned about the fact that the assertion of British sciences that there was a tobacco-cancer link were already a certainty.
A sign saying Cigarette Smoking May Be Hazardous to Your Health was printed on every pack of cigarettes and doctors started to warn of the negative effects of smoking, but it was not until later that decade that the number of addicts and overall consumption began to fall, thanks to anti-smoking campaigns launched by the National Smoking Prevention and Control Program established by the Cuban Domestic Demand Institute and then redesigned by the Ministry of Public Health.
Cuban natives used tobacco for medical and magical-religious purposes.
The findings of the II National Survey of Risk Factors and Prevention of Uncontagious Chronic Diseases conducted by the Hygiene and Epidemiology Institute in 2000 and 2001 dispelled any doubts: the number of smokers had dropped from 36.8% to 31.9% compared to 1995 figures. Nevertheless, Cuba still ranked among the world’s top heavy smoking countries, and on top of that the number of teenagers who smoked had increased.
In parallel with this study, a worldwide survey on tobaccoism in young people –which Cuba did in Havana high schools– aroused concerns over teenage smoking, as almost one third of the students admitted to having smoked at least once in their life and many who never had said they would if a cigarette fell into their hands.
Bottomless pockets
Consumption rates went up again in 2002: people smoked 8.4% more cigarettes and 5.9% more cigars than in the previous year. Sociologists blame it on the atmosphere of international tension and the danger of war, but other people put it down to stress, and still others held that some social groups had more purchasing power now...
What’s certain is that 46.5% of the 232 individuals polled by Bohemia throughout Cuba are smokers.
Every single day, a stand across the street from Parque de la Libertad in the city of Matanzas sells more than a thousand pesos in cigarettes, which also account for over 15% of what the coffee shop Palmares has to offer just a few blocks away: cigarettes at a price ranging from 50 cents to a full CUC.
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Photo: YAMIL LAGE |
The smoke produced by
the last portion of a cigar has a higher concentration of carcinogens
than the smoke inhaled by the smoker.
Our interviewees complain almost as one of smoking’s impact on both
their health and their pockets, but they keep exposing themselves to
what James I of England wrote circa 1603: "Surely smoke becomes a
kitchen (…) in the inward parts of men fouling and infecting them with
an unctuous and oily kind of soot as hath been found in some great
tobacco-takers that after their death were opened. [It’s] a custom (…)
harmful to the brain, dangerous to the lungs…”
On the fence
Cuba has the paradox of one of the world’s first tobacco-producing
countries being interested in preserving the health of its people. After
twenty years devoted to designing prevention strategies to this end,
researcher and professor Nery Suárez Lugo’s answer to the question of
whether Cuban society is ready to tackle tobaccoism is not quite.
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Photo: RAÚL CASTILLO |
Cuba has one of the
highest rates of cigarette consumption in Latin America and Caribbean
region, on a par with Argentina, Brazil and Chile
"This habit is deeply entrenched in the Cuban population. Tobacco is
closely linked to our national traditions,” she says.
"Advertising returned in 1996 with a vengeance,” Dr. Nery adds, “with
increasingly aggressive and sugarcoated marketing strategies that
included the distribution of free samples, sponsorship of conferences,
etc., with a strong impact especially on young people."
In recent years we’ve seen packs showing eye-catching youth-oriented
images and heavenly natural environments, a blatant contradiction of
what Cuba advocates about tobaccoism.
Retail sales also fuel consumption, as does the selling of cigarettes at
a lower price to workers in social organizations and institutions, to
say nothing of television, no doubt a character-molding medium that
bombards us all with conflicting messages: no sooner have we seen an ad
urging people to quit smoking than there comes a soap opera or a show
where heroes and heroines alike have a cigarette dangling from their
lips at all times.
Experts believe the levels of nicotine and other substances found in
Cuban cigars cause more dependence. As a rule, a nicotine addict has no
idea what kind of tobacco they’re smoking, let alone its ingredients, as
this information is seldom printed on the pack. And this goes as well
for imported brands, which show it in another language, if at all.
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Photo: LUIS TOCA |
As part of the
National Program for Cancer Education, preventive anti-smoking messages
are disseminated during the Terry Fox Marathon of Hope
Much as the Ministry of Public Health’s National Center for Health
Promotion and Education makes a real effort to raise awareness of the
need to both set limits to a cigarette’s nicotine, tar and carbon
monoxide content and revise the current –and mostly unheeded– health
warning posted on the pack, it will be long before this wish comes true.
In the year 2000, the Executive Committee of the Council of Ministers
signed Agreement No. 3790, a number of measures to discourage tobacco
use in order to improve the Cuban people’s health and quality of life.
Still, anti-smoking resolutions passed by the Ministries of Public
Health, Education and Domestic Trade go largely ignored, including bans
on selling to underage customers and smoking in enclosed public places,
food production and service facilities, hospitals, schools and public
buses. Likewise, smoking areas are seldom specified when applicable.
Do as I say, not as I do
There’s no shortage of preventive actions. From daycare centers to
universities, students learn about the adverse effects of smoking, but
sending the message is hardly enough. The Ministry of Education itself
has acknowledged that despite concerted efforts to curb consumption
little has been achieved to get principals, teachers and workers at all
levels of the system involved in the struggle to eliminate such a toxic
addiction.
Nor have the countless measures taken by the National Program for Cancer
Education had the desired effect, including training courses on smoking
prevention for methodologists and other staff from the Ministry of
Education.
According to Dr. Nery Suárez, these preventive actions have been
unsuccessful because they become just an educational tool rather than a
coherent, well-thought-out program held in place by a proper and
effective advertising campaign. Less marketing and more barriers will
surely do the trick, not the old do-as-I-say-not-as-I-do approach.
Another Achilles’ heel of the National Smoking Prevention and Control
Program is precisely what should be its No. 1 strength: the human
factor.
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Will the child imitate
these adults in the future?
As if they were in the courts of seventeen century-Europe, certain
doctors actually encourage consumption, not by ascribing tobacco any
healing powers –in the style of Mr. Osorio, the fictional character who
tried to deal with a cholera epidemic in Havana through the most bizarre
ways– but by smoking quite openly anywhere regardless of Resolution
130/2002 of the Ministry of Public Health, which bans smoking in all
facilities and their immediate vicinity, ranging from hospitals to
pharmacies and office buildings and is binding on all health care
employees without exception.
But this situation is not the only reason for concern. “In our surveys
we have asked doctors and nurses whether tobacco is a drug and whether
nicotine is addictive, and they have replied NO on both accounts,” says
Dr. Patricia Varona, from the Hygiene and Epidemiology Institute. “If
they don’t even know that at primary level, no message they pass on will
ever be fruitful.”
The scent of tobacco… and something else
It’s 2:00 p.m. at the Provincial Hospital of Pinar del Río. Patients and
visitors are smoking right under the impassive guards’ nose.
Dr. Dania Véliz, head of the Uncontagious Chronic Disease Program in
this provinces, points out that smoking in health care facilities is not
as commonplace as it used to be, but “we have a very difficult job here,
as tobacco is very much part of our life since the day we’re born. Pinar
del Río has the highest rate of consumption in Cuba, but not the highest
number of smokers. However, those who smoke here do it more often than
their fellow countrymen in the rest of the country”. Respiratory
diseases are more frequent and one of the ten leading causes of death in
this province.
Many smokers wish
to quit but don’t know where to go for help or what treatment they need.
That the staff involved in prevention goes to great lengths to change
these facts is beyond doubt. Suffice it to say that in 2000 this
province took first place in the WHO-sponsored international contest
Quit smoking and win by talking more than 2% of its smokers out of
consuming tobacco for a whole month.
Long-term suicide
His name was not recorded in the survey, but his statement was: “I’m a
medical student who lives in the province of La Habana and works in
Salvador Allende Hospital (formerly Covadonga) here in the capital city.
I quit smoking when I realized the number of people who die for that
reason.”
Figures alerting to tobacco’s silent and lethal legacy are not
restricted to Cuba’s westernmost province. Cardiovascular disease,
malignant tumors –especially lung cancer– and cerebrovascular disorders
are a common smoking-related risk factor and the leading causes of death
in Cuba.
Of the 77,000 deaths we have in Cuba every year, 17% -over 13,000 of
them– are attributable to tobaccoism and therefore easily avoidable.
Epidemiologist Teresa Romero Pérez, who presides over the Technical
Committee of the National Program for Cancer Education, describes the
traditional method of prevention (issuing damage reports) as quite
ineffective and calls for other ways to encourage people to view things
differently and gradually change their behavior.
And this is a deeply rooted behavior at that. For centuries, everyone in
Cuba from John Q. Public up to painters, musicians, writers and poets
have sung the praises of tobacco, never mind that so many of them have
paid with their lives their worship of such a scourge.
Journalist
Guillermo Cabrera, director of the José Martí International Institute of
Journalism
It was a comrade in arms who gave him the first taste of nicotine back
in the days of the Bay of Pigs invasion. Thirty-nine years later and out
of respect for many friends who stood by him in another fight for his
life, he dealt a deathblow to the foremost foe of his personal health.
It was July 25, 2000, the day before he was scheduled to undergo
open-heart surgery.
“I quit for them, although I still feel the urge. I used the same method
day in, day out, saying to myself: ‘I will spend the next 24 hours
without smoking’, and I haven’t even tried a cigarette since. My
struggle is not against the whole pack, but only a cigarette: the first
one. Bottom line, I can walk up any stairs up to the top floor without
losing my breath, and last year in Bolivia I even managed to climb the
Chacaltaya, a peak 5,320 meters above sea level.”
Luis Valerio
Acosta, a tobacco harvester in the province of Pinar del Río
He’s 55 now, and a smoker since he was 18, because –he says– his body’s
always crying out for it. Since he was born in the town of Piloto he has
lived his life among tobacco leaves, surrounded by their smoke.
“I’m a farmer who works the land very hard,” he remarks, relishing the
stub of his cigar. I like to smoke, and I don’t know if it’s just for
pleasure or out of necessity. I limit myself to two or three cigars a
day after my meals, because when I’m working it’s impossible, I have no
time for that. Besides, smoking seems to agree with me; all I’ve got is
an ulcer.”
Jesús Nogueiras
Santiago, Gran Maestro de Ajedrez
We meet in his house in Santa Clara city. He told us he smoked now and
then as a teenager just to do what others did. The fact that no one at
home ever smoked plus one or two duly noted words of advice helped him
checkmate the destructive enemy.
“You can’t smoke in the room where you’re playing chess. As far as I
know, none of the great young players I know is a smoker. Energy and
concentration are essential in this game, and you get that from nature,
not smoking. When I’m in competition I try other things. Once in a Chess
Grand Prix while I was playing against [Russian grandmaster Garry]
Kasparov I would stand up now and then and walk around a little...”
At the end of a rehearsal with his new band Izquierdo Reservado,
director and lead singer Alexis says he dislikes tobacco smoking, albeit
not without admitting to a few tries in his teenage years. “Back then I
used to think it made me look very manly and cool, but as soon as I
started to sing in earnest I quit, because my vocal chords would get
really sore. Fortunately, none of the seven member of my new band likes
to smoke”.
The popular singer stays away from night clubs. “There’s always smoke
all around you, to the point that your clothes smell of nicotine when
you come out. They’re ‘special’ places for passive smokers. I’ve
performed in a few of them, and it’s very annoying because you can
hardly sing”.
Henry Núñez Méndez
won the 2002 national contest
Quit Smoking and Win
sponsored by the World Health Organization.
Henry holds a Physical Culture degree. He was a pitcher with Villa Clara
province’s baseball team for several seasons before he became a
self-defense instructor for a security agency. At the age of 15 he
burned his first Popular.
Only during his hard training sessions would Henry do without a
cigarette. “My wife Mariana is a nurse, and she was always busting my
chops to quit the habit. When we heard of the contest, she put in a lot
of effort to make me understand that I had to grab at the chance and
stop smoking for good.”
He was 27 when he decided to take up the challenge and give up his daily
pack. In the end he won more than just a prize. “My lungs got well again
and my health improved as a result, something I check regularly
following every strenuous session with my trainees. Oh, and now my
family can make ends meet so much easier!”
Dr. Teresa Romero
Pérez is an expert epidemiologist who heads the Technical Commission of
the National Program on Cancer Education.
"Quitting at once or little by little? That’s up to every smoker. What
matters is that you find your own personal ‘trigger’ to do it and have
psychological help and full support of your family,” Dr. Romero
underscores. She warns to the wrong views held by some people that an
edict banning smoking is the key to eliminate the habit. “There can’t be
only coercive measures; our goal is not to make people neurotic through
sheer repression, but to preserve their health. We must be educational
in order that they can take part in their own process of change.
“When you quit you start to recover your capacities, even if sometimes
it looks as if you’re getting worse because you start to expectorate,
but that’s just what happens as the layer covering a smoker’s
respiratory system begins to come off and then out of your body. It’s an
ordinary stage in your detox process that might take months till it’s
over.”
Neither active nor passive
There are almost 1,250 million smokers in the world whose habit has
fallout on other hundreds of millions.
History is likely to have no record of the first human being who came up
with the idea of choosing tar to make them company, but whoever that was
turn those around them into the first passive smokers. They are part of
tobacco’s history too, even if the notion was coined by Japan
researchers only a few decades ago.
If you love him,
why do you put his life in such a high danger?
This person doesn’t smoke but is in the immediate vicinity of a smoker
on a regular basis. “Only 15% of the harmful substances found in the
smoke that comes out of the smoker’s mouth reach nonsmokers. The
remaining 85% comes from the cigarette or the cigar burning down slowly
on an ashtray or in the smoker’s hand. That’s the most harmful smoke,
because it never goes through the biological filter of the smoker’s
lungs,” explains Dr. Alfredo Aldama Figueroa, a researcher at Cuba’s
Angiology Institute, who has studied for ten years the effects of
tobaccoism on children. His conclusions can’t be more impressive: he
found as much thiocyanate –a substance inhaled together with the smoke–
in the bloodstream of the most exposed minors as in that of heavy
smoking adults. He also found in a high number of affected children
incipient vascular lesions bound to get worse if they remain exposed to
this toxin.
Children, pregnant women and the female population in general are the
hardest hit by passive smoking.
There’s ironclad evidence that passive smoking increases the risk of
lung cancer by 24% among those who live with smokers. Exposure in the
workplace makes this risk grow an additional 17%. The danger that lies
ahead of them is the occurrence of heart conditions and sudden infant
death syndrome, not to mention that children of smoking parents are
likely to suffer from breathing problems and acute and chronic
inflammation of the ear.
Hence the need to restrict those who can’t or won’t stop filling their
lungs with smoke to the so-called smoking sections established by law
but seldom regarded.
“Our campaigns must make a clear distinction between the rights of each
of these two groups,” says Dr. Patricia Varona. “Without making addicts
feel cornered or witch-hunted, we must demand respect for non-smokers
even if they not always claim such right.”
As long as the institutions in charge of fighting this pandemic settle
for educating the active smokers, very little progress will be made. The
adverse effects of exposure to tobacco smoke are barely disseminated
nowadays. A smoker’s right ends when a non-smoker’s is violated.
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Province |
Telephone number |
Province |
Telephone number |
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P. del Río |
75 42 96 |
Camagüey |
29 65 45 |
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C. Habana |
260 97 70 |
La Tunas |
4 47 73 |
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La Habana |
20 04 77 |
Holguín |
42 22
29 |
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Matanzas |
24 45
91 |
Granma |
42 63 70 |
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Cienfuegos |
51 61 80 |
S. de Cuba |
62 31 10 |
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Villa Clara |
20 28 26 |
Guantánamo |
32 74 67 |
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S. Spíritus |
2 35 20 |
I. Juventud |
32 23 84 |
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C. de Ávila |
2 22 12 |
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An X-ray of the Cuban smoker
According to the abovementioned II National Survey conducted by the
Hygiene and Epidemiology Institute and Bohemia magazine’s recent
poll:
There are more male than female smokers, but their numbers tend to level
off. As an average, the former smoke 14.3 cigarettes per day and the
latter around 12.
The number of smokers increases with age up to the 49 mark, but starts
to drop from the age of 50.
The lower the level of education, the higher the number of smokers.
Divorced individuals smoke more than the married ones, and these in turn
smoke more than those who are single and widowed.
A full 70% starts smoking at the age of 20, mainly out of curiosity,
peer pressure and imitation of smoking relatives.
Most smokers have no idea, or refuse to admit, that they have become
dependent on nicotine.
Over 64% of those polled wish to quit.
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Economía |
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Carlos
José
Villamil es
un hombre
popular y no
por agradar
a mucha
gente, más
bien porque
resulta
imposible
olvidar su
imagen
siempre
envuelta en
ese humillo
"angelical"
del cigarro.
Muchos
aseguran
haberle
visto
encender uno
tras otro
durante una
noche.
Los
indígenas
cubanos
usaban el
tabaco con
fines
medicinales
y vinculado
a las
ceremonias
mágico-religiosas
Buen
número de
fumadores
desea dejar
de hacerlo,
pero
desconoce a
dónde
dirigirse o
qué terapia
seguir
Guillermo
Cabrera,
periodista y
director del
Instituto
Internacional
de
Periodismo
José Martí
Luis
Valerio
Acosta,
cosechero de
tabaco,
Pinar del
Río
Jesús
Nogueiras
Santiago,
Gran Maestro
de Ajedrez
Henry
Núñez
Méndez,
ganador
nacional en
2002 del
concurso
Deja de
fumar y Gana,
que
patrocina la
Organización
Mundial de
la Salud
Doctora
Teresa
Romero
Pérez,
especialista
en
Epidemiología
y presidenta
de la
Comisión
Técnica del
Programa
Nacional de
Educación en
Cáncer
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Nacionales |
Internacionales |
Cultura |
Deportes |
Economía |
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