In 2015 while in high school, Christian Abayisenga started hanging out with friends whom he later found out were smokers — something they’d do after school. It wasn’t long before he too picked up the habit.

"Smoking started as a way of bonding with friends, also, it made me feel cool,” he says.

The now 28-year-old says he is ‘hooked’ to cigarettes, a habit he regrets as it has also affected his family.

Abayisenga is just one of the many youths who started smoking due to peer pressure, and now find it hard to quit.

‘World No Tobacco Day’ is observed around the world every year on 31 May with focus on young people as they are the biggest burden. This yearly event informs the public on the dangers of using tobacco, the business practices of tobacco companies, what the World Health Organization (WHO) is doing to fight against the use of tobacco, and what people around the world can do to claim their right to health and healthy living and to protect future generations.

The day was celebrated under the theme ‘Protecting youth from industry manipulation and preventing them from tobacco and nicotine use’.

In Rwanda, the day was marked by increasing awareness using different media platforms.

Today, around 1.3 billion of the world’s population uses tobacco. Of these, over 80 per cent live in low- and middle-income countries.

There is an estimated $1.4 trillion of the global economic burden each year lost in health-care costs, lost productivity, fire damage, and environmental harm from cigarette litter and destructive farming practices, according to the World Health Organization.

Dr Christophe W Ngendahayo, a global NCDs and climate change expert, says its commemoration keeps us awake and reflects on our responsibility to tackle this threat.

A closer look at the situation

Tobacco is so deadly that it kills more than 8 million people each year, globally, of which more than 7 million are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.

According to a study conducted in 2016, Sub-Saharan Africa was shown to have a lower tobacco-related death burden which probably reflected in its historical lower smoking prevalence.

However, Ngendahayo says with an increase in affordability of tobacco products and the tobacco industry’s aggressive marketing in Africa, smoking prevalence has already started to rise, or is likely to substantially increase in the future.

Meanwhile, locally, the 2015 research carried out by the Ministry of Youth and University of Rwanda showed that 4.7 of youth aged 14 to 15 are dependent on nicotine.

Rwanda has been ranked 173 in the world’s countries smoking rates with an estimatde death of 2,100 people in 2016.

Youngsters hit hard

Evariste Ntaganda, the cardiovascular diseases officer at Rwanda Biomedical Center (RBC), says the more one is exposed to smoking at an early age, the more diverse health effects they are likely to experience.

He says tobacco exposure affects humankind regardless of the age.

"Children and youth who are exposed to second hand tobacco smoke breathe the same dangerous chemicals that smokers inhale, they’re at higher risk of getting respiratory diseases and other conditions,” he says.

Globally, around half of the children regularly breathe air polluted by tobacco smoke in public places, mainly in their homes and 65,000 die each year from illnesses attributed to second-hand smoke.

Ntaganda goes on to add that second hand smoke causes numerous health problems in infants and children.

These, he says, include more frequent and severe asthma attacks, respiratory infections like pneumonia or bronchiolitis, ear infections, and sudden infant death syndrome (SIDS), among others.

Smoking during pregnancy results in more than 1,000 infant deaths annually, he says.

Ngendahayo says teens and youth use tobacco due to several factors including peer influence, as it gives them a sense of belonging, or a way to cope with stress.

"The consequences in youth are the same as in adults, with special addiction and destroyed futures due to poor education in schools,” he says.

"Because of nicotine in cigarettes, it’s addictive and harmful for youth brain development,” Ngendahayo adds.

Tobacco and NCDs

Ngendahayo says tobacco is a very potent risk factor for cardiovascular diseases, cancer, lung diseases and diabetes.

With each inhalation, he explains, smoke brings more than 7,000 chemical substances, including tar and carbon-monoxide into contact with the body’s tissues.

Of the thousands, he says, hundreds are toxic and 70 cause cancers.

Over time, he says, smoke also damages nerve-endings in the nose, causing loss of smell.

"Inside the airways and lungs, smoke increases the likelihood of infections, as well as chronic diseases like bronchitis and emphysema,” he adds.

According to Ntaganda, many of the chemicals inside cigarettes can trigger dangerous mutations in the body’s DNA that make cancers form.

Additionally, he says, smoking can cause cancer in multiple tissues and organs, as well as damaged eyesight and weakened bones.

For women, the medic says, it makes it harder for them to get pregnant and in men, it can cause erectile dysfunction.

Nevertheless, Dr Dynamo Ndacyayisenga, the in-charge of management of alcohol and drug use disorders at RBC, says for those who quit smoking, there’s a huge positive upside with almost immediate and long-lasting physical benefits.

By the one-year anniversary of quitting, he says heart diseases risk plummets to half as blood vessel function improves.

However, he notes that quitting smoking is not easy as some of the side effects may include anxiety and depression, resulting from nicotine withdrawal.

Fortunately, such effects are usually temporary.

Meanwhile, Ndacyayisenga says, nicotine replacement therapy through gum, skin patches, lozenges, and sprays may help wean smokers off cigarettes.

"They work by stimulating nicotine receptors in the brain, thus preventing withdrawal symptoms without the addiction of other harmful chemicals,” he says.

Ndacyayisenga says counselling and support groups, cognitive behavioural therapy, and moderate-intensity exercise also help smokers stay cigarette-free.

Tobacco and Covid-19

According to experts, tobacco use has increased for some youth during this Covid-19 period.

Ngendahayo explains that if smoking is common within a household, the social isolation will likely increase the use both actively and passively.

"Some see the use of tobacco as a coping mechanism for the anxiety currently being experienced,” he notes.

Measures in place

Dr Edison Rwagasore, the Field Epidemiology and Laboratory Program coordinator at RBC, says while creating awareness, the Ministry of Health doesn’t separate tobacco from other drugs, rather, tobacco is seen as an illicit drug and always classified among other harmful drugs.

Most of the measures in place, he says, focus on prevention of tobacco use at an early age, to let them know the negative effects that come with smoking.

This, he says, is done by creating an awareness campaign through different channels, where information is provided regarding how to avoid smoking.

The ministry is also working with the Private Sector Federation (PSF) to not advertise tobacco, instead, indicate on every cigarette packet the harmful effects.

Rwagasore says respiratory infectious diseases are always linked to the use of tobacco, for this reason, there is what is called ‘community education’; which is an outreach programme targeting groups of the population to avoid tobacco use.

He explains that here, the ministry also focuses on the second hand consumers (passive smokers).

Ndacyayisenga, says people exposed to harmful use of tobacco in health facilities are being treated.

He says this is done by treating tobacco-related diseases, specifically addiction to tobacco and other areas affected by respiratory infections.

At the level of tobacco addiction, he says patients get different techniques and medications to help the problem.

He adds that they provide a nicotine patch and chewing gum, to help fight the withdrawal symptoms.

These, however, Ndacyayisenga says, are accompanied by psychological support to work on behavioural change in general.