World No Tobacco Day, 31 May 2013

Smoking: A serious disease

Tobacco consumption is one of the most serious public health problems in modern society. According to the World Health Organization (WHO) and many scientific/medical associations, smoking is a serious chronic disease and the smoker should be considered as a patient who needs frequent medical attention and care. Despite the fact that tobacco smoke contains a variety of particularly harmful chemical substances, as continually reported by the International Agency for Research on Cancer (IARC) (among others), tobacco products are still on sale as legitimate goods. This is remarkable given the fact that no other such harmful product, causing so much lethal damage to people’s health, is manufactured and sold legally around the world.

Tobacco consumption is associated with many diseases and disabilities, and is therefore leading to degradation of the quality of life and increases in social health cost, including the high subsequent cost for medical care and reduction in economic productivity. Smoking is not only harmful for the smokers themselves but is a significant risk factor for passive smokers, as shown epidemiologically by Professor Trichopoulos as long ago as 1981.

The harmful habit of smoking reached the dimensions of a global pandemic during the 20th century. Approximately 1.2 billion people are smoking globally and 220 million are smoking in Europe (data for 2009).

Addictive smoking is the primary cause of deterrent mortality in the developed world. Smoking is increasing the incidence of serious diseases and moreover increases the mortality rate of those diseases. The most important and frequent of these are:

  •  coronary heart disease (myocardial infarction)
  •  cancer (lung, larynx, bladder cancer, etc.)
  •  chronic obstructive pulmonary disease
  •  brain vascular disease (stroke).


Smoking is also increasing infant mortality and causes fetal complications during pregnancy.

At this point, we could mention some ‘useful’ examples of the documented harmful effect of smoking on mortality. A 25-year-old man who smokes one packet of cigarettes per day will live 4.6 years less than expected. If he smokes two packets per day will live 8.3 years less! Starting smoking at the age of 15 reduces the life expectancy by 8 years! Starting at 25 reduces the life expectancy by 4 years (US DHHS 1989).

It is evident that the risks arising from smoking increase the:

  • younger the age of smoking starts
  • longer the total period of smoking
  • greater the number of cigarettes smoked.


For all the above reasons, WHO concluded a Treaty for Tobacco Control with 192 countries in 2003 (Greece is among these countries). This treaty is seen as a catalyst for taking measures and initiatives in order for the countries that have signed it to break free from the scourge of smoking.

It should be clear to both the health professionals and the public that confronting smoking is a complicated issue. Smoking, apart from the damage that it causes to many systems of the human body, is a very difficult habit to quit and successfully rehabilitate from. There is therefore the need to develop strategies with international co-operation to:

‘Cure’ the people who already smoke and discourage as many as possible from starting smoking.


Tobacco consumption in Greece 

Greece has one of the highest percentages of per capita tobacco product consumption among the European Union (EU) member states (Figure 1).

More specifically, in 2000 in Greece, smokers comprised:

  •  37.6% of the adult population
  •  46.8% of men
  •  29% of women

(Source: WHO. The European Tobacco Control Report 2007. Copenhagen: WHO, 2007)

According to WHO, the smoking population in Greece increased during the period 2000-2009, as opposed to the downward trend in many other European countries.

According to Euromonitor International, the annual average per capita consumption of cigarettes was 3.055 in 2008 and 2.942 in 2009, figures that rank the Greeks as the greatest fans of smoking in Europe.


Figure 1: Percentage (%) of smokers by age group and gender, Greece, 2000


Source: Eurostat, 2007

Approximately one-third of students (32%) at Greek schools have said that they have tried to smoke (at least once in the past), while 16.2% (17.1% of boys and 14.4% of girls) have reported that they often smoke tobacco products. Moreover, 25% of student smokers stated that they started smoking before the age of 10. Boys seem to be more likely to start smoking. In conclusion, although a low rate of childhood and adolescence smoking has been reported in Greece, the smoking rate among adults is disappointingly high. At the same time, the smoking rate in the 17-18 age group is one of the highest in Europe (Figure 2).


Figure 2: Percentage of pupils/students 17-18 years of age who smoke more than 11 cigarettes per day during the last 30 days (ESPAD Project), in Greece


Source: Andersson et al., 2007


Consequently, it is vital to emphasize the importance of health education and the need for a targeted public health policy towards the prevention of tobacco use, particularly to adolescents. In Greece, young adults between the ages of 18 and 22 tend to use tobacco products daily, thus they should be discouraged from starting smoking.


Smoking cessation

The benefits of stopping smoking are scientifically proven. Much of the damage to the body is restored and the disease evolution caused by smoking is suspended. Specifically:

  • 3-9 months after quitting, dyspnea and other respiratory problems improve
  • 3-9 months after quitting, lung function is improved by 10%
  • 5 years after quitting, heart attack risk is reduced by 50%
  • 15-20 years after quitting, equilibration of lung cancer risk is observed between ex-smokers and non-smokers (US DHHS 1989, IARC 2002).

When a smoker quits smoking early (especially under the age of 35), the risk of developing disease reverts to the levels of non-smokers (Wilson et al. 2000).

According to the latest data available for the last 5 years, surveys conducted by the Ministry of Health and the Hellenic Center for Disease Control and Prevention (HCDCP/KEELPNO), regarding individuals attempting to quit smoking, based on a 2011 study, 57% said the effort was unsuccessful, which means that we must strengthen services to create a social and scientific environment that promotes the ban of smoking in public areas. It is surprising that women smokers seem to be more ‘passionate’ about the bad habit of smoking. Both men and women smokers should have a complete picture of the health risks of this harmful habit, while the structures that can support them to quit smoking should be strengthened.


Research basis for the ‘hotline for smoking’

The findings of the 2011 research are very interesting, produced by multistage sampling, using a quota related to the population’s geographical distribution, sex and age. The number of study subjects was 2,061 (men and women) aged over 18 years.

The population’s systematic and occasional smokers showed that the majority (66%) made no attempt to break free of the habit, while 15.3% resorted to using a pharmaceutical formulation of nicotine replacement. Some visited a website in order to receive information and guidance, while others followed an alternative method for stopping smoking (e.g. acupuncture). Most of them (68.4%) said that the best motivation for stopping smoking was concerns about their personal health, while 36.6% declared the cost of cigarettes to be reason to stop smoking. It is striking that 73.6% reported that the economic crisis had led to a reduction in smoking habits.

Regarding former smokers, 77.3% reported that they managed to stop smoking without any help, and that the main reason for quitting were concerns about personal health. Finally, all of the respondents (smokers and non-smokers) complied with law enforcement regarding a total ban on smoking in public areas in the summer of 2010. 


Aim of the hotline for smoking (1142)

The hotline for smoking, 1142, was launched officially on 1 September 2010. It is a hotline for information and support for quitting smoking. Its aim is primarily to inform citizens and professionals on the current anti-smoking law, and to support and provide useful information for those who want to quit smoking. The line was greeted with an audience from the first day of its operation. It continues to record problems with implementation of the law (3868/2010-Chapter G) and complaints about breaches in sanitary sites, health stores and workplaces in both public and private sectors. All complaints are forwarded to the relevant departments, which will perform audits.
The line also provides advisory information on stopping smoking and detailed information on public and private ‘Cessation Centers’ throughout the Greek territory.

As of 31 March 2013, the line has received 61,533 calls since the beginning of its operation (1 September 2010). From the line reports, Figure 3 shows the audits that have been carried out in various sanitary areas.

Figure 3: Audits for smoking throughout Greece, 2010-2013

Complaints to the line from 1 September 2010 until 31 March 2013 are depicted by region in Figure 4.

Figure 4: Complaints under the Act on Smoking in Greece, 2010-2013


Smoking cessation outpatient clinics

Smoking cessation clinics operate throughout Greece under the auspices of private and public hospitals, staffed by qualified medical personnel. The purpose of their function is to aid smokers in their attempt to quit smoking.

The first clinic, organized a decade ago, is the Special Clinic for Smoking Cessation-Unit for Pulmonary Diseases, of the University of Athens. It is considered to be the clinic with the greatest experience, because it has dealt with and monitored therapeutic interventions for more than 5,000 smokers, and has the highest success rate, of more than 60% of participants, and in some cases up to 80–90%. This rate of success exceeds the percentages at similar centers abroad. Those who are interested in quitting smoking can find the contact details of all the clinics on the internet. The determination, effort and help from the experts can act as a catalyst in achieving the desired result:

Stop Smoking!

Moreover, continuous informative programs and interventions by health education campaigns and training in high schools and universities are informing young people about the risks and are discouraging them from taking up smoking.

Philip Koukouritakis, e-health Information Office, HCDCP
Garyfallia Antoniou, Dimitris Iliopoulos, Operation Center, HCDCP