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South African researchers have uncovered shocking details of how smoking kills South Africans as a result of tobacco-related diseases. Using a new research methodology, South Africa has become the first country in the world to gather data, allowing the health impact of smoking within the population, to be monitored. It has made it possible to obtain special insight into smoking effects and the risk individuals have for contracting serious smoking-related diseases, such as tuberculosis, lung cancer, stroke, throat and mouth cancer, as well as various lung and heart diseases.
A new understanding
"The study has led to a new understanding about how smoking affects people dying of serious smoking-related diseases in South Africa and it could do the same elsewhere in the world," says Professor Krisela Steyn, Associate Director of the Chronic Disease Initiative for Africa (CDIA). CDIA is a collaborative research initiative seeking to develop and evaluate models for chronic disease care and the prevention of their risk factors.
Dr Debbie Bradshaw of the Medical Research Council and a member of CDIA, one of the leading participants in this mortality study says, "We have known about the link between smoking and mortality for many decades, but did not know the magnitude of the problem." She explains that, by adding a simple yes/no question regarding smoking history to routine death certification, researchers had gained access to over 480 000 death records between 1999 and 2007, revealing the impact of a lifelong smoking pattern. The study found particularly high tobacco related mortality in the coloured population, for whom smoking causes one in four of all deaths in middle-aged men and one in six of all deaths, in middle-aged women.
A significant drop
According to the latest national statistics in the South African National Health and Nutrition Examination Survey (Sanhanes -1), 16.4% of South Africans were smokers in 2012. This is a significant drop from 32% in 1993, which has been largely attributed to stricter smoking legislation, advertising limitations and steeper tobacco prices. Professor Steyn says that even though smoking has decreased in South Africa, there are still far too many smokers. Smokers also expose family members to second-hand smoke, which also carries a health risk.
Resistance to warnings
Of particular concern is smoking among young people. The Youth Risk Behaviour Survey found that 21% of Grade 8-11 learners smoke, with no change occurring between 2002 and 2008 – showing a resistance to warnings about smoking. "The key message is that we need to apply smoking legislation more strictly than in the past; we need to reach young people to help them understand that although they think they will live forever, they need to know they will die if they keep on smoking," says Professor Steyn. "Young people's idea that they are immune to risk is actually the biggest risk they are exposed to," she says.
Nicotine highly addictive
She quotes research that proves if someone starts smoking in their late teens, their chance of dying of a smoking-related disease by the age of 60 is 50%. "It is imperative to stop young people from taking up smoking as most adult smokers start smoking before 18," she says. Getting people to give up smoking is significantly harder than preventing an individual from smoking in the first place, considering the highly addictive nature of nicotine in tobacco.
In the recent report on the Global Burden of Disease in 2010, smoking is already the second most important risk factor for deaths worldwide, second to only hypertension. Professor Steyn believes the new study will make a valuable contribution to global tobacco research. "The rest of the world can learn from the South African survey and on how to use this important new weapon in the war on smoking-attributed disease."
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