The lethal dangers of passive smoking

By Amina Shadab:

Passive smoking is commonly understood as inhaling second hand smoke (SHS) from an active smoker. However, there is another type of passive smoking, through the environment, called environmental tobacco smoke (ETS). The focus of this article is on the implications of passive smoking for pregnant women and their babies in Kurdistan.

Since 1988 the threat of passive smoking has risen, especially amongst new-born babies. The following factors make smoking so dangerous: cigarette smoke consists 5% of carbon monoxide which, when inhaled, readily diffuses across the walls of the alveoli and into the red blood cells which then is combined with a heam group forming carboxyhaemoglobin. ‘Heamoglobin combines with carbon monoxide two hundred and fifty times more readily than it does with oxygen’. If wholesome cigarette smoke is inhaled for a prolonged time, an individual can die from asphyxiation because it dramatically reduces the oxygen-carrying capacity.

Passive smoking has a huge impact on the respiratory system in which the organs involved are the nose, mouth, epiglottis, throat, trachea, bronchi, lungs, alveoli, diaphragm and the cardiovascular system. This has led to a dramatic rise in lung cancer. It is tar which builds up after prolonged smoking or exposure to smoke which forms deposits in the lungs – usually these do not remain in the lungs but continuous smoking causes a build-up of tar. Tar and soot particles from the cigarette form deposits in the pulmonary tissue.

Thick dust cloud in Iraq

The dispersal of smoke can potentially cause a non-smoker great physical harm such as lung cancer. The health system within Southern Kurdistan does not measure this effect which is causing pregnant women and young children great distress. Thousand of non-smokers die every year. (Although this is not entirely the fault of second hand smoke: environmental smoke also derives from car engines, open fires, oil sanctuaries and pollutants put into the atmosphere. Another factor is the dust storms which happen now and then and which the health care system should thoroughly prepare for).

A cigarette contains 4,000 chemicals. The health system must put in place campaigns to help smokers quit. However, research has repeatedly shown that there is a huge relapse rate due to the addictive qualities of nicotine. Nicotine can also be found in some agricultural insecticides. Nicotine raises the levels of a neurotransmitter called dopamine which is associated with rewards and pleasure. The effects of nicotine may indicate why smokers find it so difficult to completely give up.

There are two types of smoke in a cigarette: one, known as mainstream, which comes from the core of the cigarette (from the filter or mouth tip) and the other, side stream smoke, which comes from the burning tip of the cigarette. Side stream smoke is where 75% of the second hand smoke comes from.

It is strongly advisable that, once pregnant, a woman should stop smoking as this is beneficial to her health and her unborn child’s. For the mother it can decrease the chances of getting early heart disease. ‘Almost two-thirds of women cut down or stop smoking during pregnancy, however only a quarter actually stop’. The prevalence of smoking in pregnancy is much higher in those women who are single/young/unemployed and in low social-economic groups (Yes, there are single mothers and a considerable number of women who smoke in Kurdistan). The tendency to smoke is even greater if a partner is an active smoker.

Smoking during pregnancy affects the foetal growth, as cigarette smoke restricts the unborn baby from getting an essential value of oxygen, the carbon monoxide displaces oxygen from haemoglobin and the nicotine causes vaso-constriction. Therefore, if a pregnant woman stops smoking, the levels of carbon monoxide in the body will decrease and allow the oxygen levels to go back to normal. Stopping smoking can also reduce the risks of stillbirths occurring. There is considerable evidence that many babies’ low birth weights are due to smoking/second hand smoke.

Cot death, also known as sudden infant death, is one of the potential threats to the foetus caused by passive smoking. It is said that babies that have parents who smoke have a higher tendency to be admitted to hospital for pneumonia and bronchitis in their first year of life. ‘17,000 children under the age of five years old are admitted into hospital every year’ due to the effects of passive smoking. It has been stressed that smoking around a baby increases the likelihood if it suffering from cot death.

Unfortunately, cot death can happen in any family. The risks are greater in the first six months of the baby’s life and soon after reaching the age of one, the number of cot deaths declines. The reasons for cot deaths are not fully known although it has been suggested that it can be inherited, such as the baby having a metabolic defect. There needs to be programmes put into the health system across the provinces of Southern Kurdistan to raise awareness of avoiding cot deaths happening repeatedly. More babies die of cot death every year than from leukaemia, road accidents and meningitis put together.

Ways to avoid cot death include:

Stopping smoking by mothers and fathers and by family and friend visitors.
Not having the baby sleep in the same place as the mother/carer, such as bed or arm chair, as there is a possibility of rolling over and suffocating the baby.
Making sure that the baby is positioned to sleep on their back, rather than their front or side, and with their feet touching the bottom of the platform of sleep.

A stillbirth is a term used for when the baby dies before being born or after the 24^th week of pregnancy. The reasons for this traumatic occurrence are unknown. However, it has been said that smoking/second hand smoke could be a high risk factor. Stillbirths happen in Kurdistan mainly when the child reaches the full nine months. Attention must be given to the mother’s after care and to the psychological effect the birth might have had on the mother. Unfortunately the world of psychology is largely ignored within the healthcare profession and this is the most prominent area that needs to be developed, for it to become available to the people of Kurdistan, especially because of the horrible experiences of individuals in the past.

Due to the biological complications that second hand smoke causes there are grounds for smoke-free laws prohibiting smoking in public areas and indoor work places. Behind most local shops in the localities shishas are smoked; and evidently often in front of pregnant women, new born babies and young children.

There are a lot of gaps in the health care system currently and action is needed to fill them; after all the system is there to look after the population. What is stopping the health system from meeting the demands of the people? Healthcare must pay great attention to the little things and not try to ‘quick fix’ everything.

There is considerable evidence that passive smoking has a huge impact not just on babies’ health but that they are the most susceptible to the damages it can cause. The easiest way to find out is just to listen with a stethoscope to the ‘Weezzy’ sounds of the lungs: solid evidence even if there is no other data.

Most of the Kurdistan public are not aware of the dangers that come with second hand smoke and they should take moral responsibility to stop smoking rather than expect the change to come from the health system. However, the healthcare system needs to provide people with options and encouragement. It won’t be enough just to rely on religion to teach these smokers to stop. As for parents, in particular, it is in their family’s best interests to enforce a smoke-free zone around the house.

Amina Shadab is originally from Shno, Eastern Kurdistan. She is a university student pursuing a medical career and founder of the WHAM project