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    The Anti-Smoking Campaign

    Smoking is considered to be the main cause of preventable deaths in Canada. It is estimated that every eleven minutes one Canadian dies from smoking-related complications and that every ten minutes, two teenagers take up smoking. In absolute numbers, the data are impressive. In Quebec only, smoking kills 13 000 people each year, 400 of which because of exposure to second-hand smoke. It’s four times more deaths than murders, alcohol-related deaths, road accidents and suicides combined.
    Smoking is considered to be the main cause of preventable deaths in Canada. It is estimated that every eleven minutes one Canadian dies from smoking-related complications and that every ten minutes, two teenagers take up smoking. In absolute numbers, the data are impressive. In Quebec only, smoking kills 13 000 people each year, 400 of which because of exposure to second-hand smoke. It’s four times more deaths than murders, alcohol-related deaths, road accidents and suicides combined. Smoking causes 33 % of all cancers, and 90 % of all lung cancers.

    Lung cancer causes much damage and has the sad status of most fatal cancer. Cigarette smoking is also associated with a higher risk of cardiovascular disease, respiratory disorders and mental health problems, such as depression and anxiety, all of which contributes to significantly reducing the life expectancy of those who smoke.
    Smoking causes a long list of negative effects. Still, almost a quarter of the population smokes. This proportion reaches 32 % in young adults, aged 20 to 24. Those in this age group will probably be most affected by the new dispositions of the tobacco law that came into effect on May 31, 2006.

    Tobacco law

    The coming into force on May 31, 2006 of the new dispositions of the tobacco law constitutes an important step towards improving our collective health. The changes affect not only tobacco use but also its sale and promotion. The objective of the new dispositions is to reduce the proportion of smokers in Quebec (which is still the highest in Canada), protect the population against the dangers of second-hand smoke and prevent smoking in young people.

    The new tobacco law is made up of several components. To combat second-hand smoke and discourage smoking, it will now be prohibited by law to smoke in bars, restaurants and almost all public areas in Quebec, including bingo halls, taverns and pubs. Smoking areas in restaurants, shopping centers and office buildings will be abolished. Smoking is now prohibited in taxis, on terraces, under tents and big tops located in public areas as well as in common areas of most apartment buildings. Smoking is also prohibited within nine meters of doors leading to a health and social services building, postsecondary institutions, etc.

    In September 2006, smoking will also be prohibited in areas where children go to school, including day-care centres, primary schools and high schools, during periods when children attend school.

    The law also includes new provisions regarding tobacco sale. Penalties related to the sale of tobacco to minors will be more severe and will no longer apply solely to merchants. Within the next year, tobacco sale will be a thing of the past in restaurants, bars, cegeps or any place where sport, artistic or recreational activities are taking place. Within the next two years, measures prohibiting all display of tobacco products will come into force.

    The law includes several new dispositions and only a few are presented in this article. To learn more about the provisions of the new law, read the complete text at:
    http://www.canlii.org/qc/laws/sta/t-0.01/20060412/whole.html
    Of opposition and counter-opposition
    Of course, the new dispositions are not without contest within the population. Smokers are not happy to see their rights restricted in public areas. Facts can be used to answer their dissatisfaction. The smoke from a single cigarette contains over 4000 chemicals, 50 of which being known carcinogens. The harmful effects of these air-borne chemicals affect smokers as well as non-smokers.

    In Quebec, more than 400 people die each year from second-hand smoke related disease, even though they never smoked a single cigarette in their life. For this reason, smokers should think about their family and friends before they light up and avoid « smoking them up »;, especially if they smoke near children, pregnant women and people with heart or respiratory problems. Restricting smoking in public areas is thus a responsible measure that will have major repercussions on the global and collective health of all Québécois.

    Business people are also unhappy with the new dispositions, stating the major economic impact they will have on their revenues if smokers stop patronizing their establishments. Several studies on the subject as well as data from countries and other Canadian provinces that have similar restrictions have shown however that their apprehensions are unfounded. These types of laws apparently have no negative effects on the revenues of restaurant and bars. Smokers will continue going out and non-smokers, who represent 75% of the population, will fully enjoy their outings in public areas.

    Smoking cessation

    We have to remember that the main objective of these new dispositions is to reduce the proportion of smokers among the population. Do you smoke? Do you want to help someone quit? The following information may help you reach a successful outcome.

    Here are a few encouraging facts.

    Quitting smoking will improve your health, regardless of your age when you stop. Studies have shown that many smoking-related adverse effects are reversible over time. For example, one year after quitting, the former smoker’s cardiovascular risk will be cut in half. Ten to fifteen years after quitting, the life expectancy and coronary risk of former smokers will be similar to that of non-smokers.

    Many quitting resources are at the disposal of smokers. Visit the Quebec site www.jarrete.qc.ca (in French) to get answers to your questions and obtain the coordinates of a smoking cessation centre close to home (you can also visit this bilingual Health Canada site: http://www.hc-sc.gc.ca/hl-vs/tobac-tabac/index_e.html). You can also talk to your physician or pharmacist to learn more about drug products to help you quit and general information on quitting.

    Quitting smoking is not easy by any means. Nicotine found in cigarette causes a dependency that is both physical (that the smoker experience as a sensation of well-being) and psychological (when smokers associate smoking with relaxation and stress reduction). The two vicious cycles make it difficult to quit smoking. Eighty percent of smokers experience withdrawal symptoms when they try to quit and this can be a major obstacle.

    As with dependency, withdrawal symptoms can be either physical (dizziness, headaches, increased appetite, sweating, tremors) or psychological (aggressivity, anxiety, confusion, impatience, irritability, agitation, concentration problems). Most physical symptoms reach their peak 48 hours after quitting and usually disappear within two to five weeks. Psychological symptoms however can last longer.

    The level of nicotine dependency can help assess how significant the physical symptoms will be when the person quits. The level of dependency is based on the number of cigarettes smoked each day and the delay between getting up in the morning and the first cigarette. Someone who smokes 20 or more cigarettes each day or lights up a cigarette within 30 minutes of getting up is usually said to be highly nicotine dependant.

    Various quitting strategies

    According to a survey conducted by Health Canada in 2003, nicotine patches is the strategy most relied on when trying to quit (32%), closely followed by trying to gradually reduce the number of cigarettes (29%). Some smokers rely on alternative strategies, such as hypnosis or acupuncture. Smokers who wish to quit should know that several approaches exist. They should choose the one that fits best with their style, or even combine several strategies together.

    Simple lifestyle and environmental changes are among the strategies that do work. People can temporarily change the routine that was associated with smoking or the factors that maintain the habit. For example, smokers can take measures to alleviate the stress and anxiety that may be generated when they quit. Being physically active, doing relaxation exercises, identifying, avoiding and changing the sources of tension in one’s life are other examples.

    People should also avoid places where they used to smoke, tell family and friends they are trying to quit, compensate for the gestural dependency by using a tooth-pick or eating licorice, try to take their mind off cravings by eating a candy or chewing gum. These are several little things that can facilitate this transition.

    If lifestyle changes are not enough or the dependency is too strong, smokers should consult their physician or pharmacist. He can help them choose among the various drugs available to quit smoking. Nicotine replacement therapy is frequently used. The person can gradually reduce his or her intake of nicotine with nicotine patches (Nicoderm®, Nicotrol®, Habitrol®) or gum (Nicorette®, Nicorette® Plus), thus alleviating the unpleasant side effects associated with withdrawal. Nicotine replacement therapy does not expose the person to the toxic substances and carcinogens found in cigarette smoke and help reduce the sensation of pleasure by eliminating the ritual that surrounded smoking.

    The physician may also suggest a drug called Zyban®, to help with quitting. This drug is marketed as tablets to be taken orally. Its exact mechanism of action is not clearly understood, but clinical evidence shows that its efficacy is similar to nicotine patches after a year. When the person fails to quit smoking with nicotine replacement therapy, Zyban is currently the only other option with proven efficacy. In some cases, various drug therapies can be combined.

    People with a strong nicotine dependency who use patches and still experience strong cravings can try to chew nicotine gum. Highly dependant smokers or those who have tried quitting several times without success may try nicotine replacement therapy in combination with Zyban. This combination appears to be more effective than each component used alone, which could maximize the smoker’s chances of success.

    The various strategies available to quit smoking are highly flexible and can be individualized to meet each smoker’s needs. However, smokers need to remember that smoking cessation aids are only part of the solution. Those who really want to quit must be motivated and sure of their decision. After all smokers are the one responsible for the success of this endeavor! The simple fact of talking to a physician or another health professional or joining a support group can help maintain one’s motivation through tough times. Those who really want to quit smoking should use the various resources at their disposal to maximize their chances of success.

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