The right to choose

Deborah Chen,  guest columnist

The issue of choice has been raised in discussion in relation to tobacco smoking. I would like to raise a few points for consideration regarding this issue. Data from the Jamaica Health and Lifestyle Survey 2008 show that 40 per cent of smokers initiate the habit by age 16. The National Council on Drug Abuse Global Youth Tobacco Survey 2010 shows that 17.8 per cent of young persons 13-15 years old are current users of cigarettes (an increase from 15.4 per cent in 2006). Additionally, 25.3 per cent of those who ever smoked first smoked cigarettes before the age 10.

We must then realise that it is highly unlikely that the long-term effects of this habit had been thought through at the outset by this young, impressionable cohort. There are valid reasons why young people in this age group are not allowed to hold a driver's licence or to vote. There are similar reasons why they would not have thought through the health consequences of smoking and why, in fact, it is illegal for cigarettes to be sold to them.

The tobacco company states that it does not sell cigarettes to minors. Based on the data, however, we can see that minors can very easily access cigarettes. These young people then become addicted, most of them for life. Is this really an informed choice for the 40 per cent of persons in Jamaica who start to smoke under the age of 16 years? Data in the USA show that 80 per cent of all adult smokers first become regular smokers before age 18, and more than 90 per cent do so as teenagers.

Addiction symptoms

"Many teenagers and younger children inaccurately believe that experimenting with smoking, or even casual use, will not lead to any serious dependency. In fact, the latest research shows that serious symptoms of addiction - such as having strong urges to smoke, feeling anxious or irritable, or having unsuccessfully tried to not smoke - can appear among youths within weeks or only days after smoking first begins" (http://www.tobaccofreekids.org/research/factsheets/pdf/0264.pdf).

Tobacco smoking is an addiction for young and older persons alike and needs to be recognised as such. What may have started as a social habit soon turns into an addiction. When a habit becomes an addiction, choice is usually not an option.

Another issue to be considered when discussing the right to choose is the well-documented evidence of the health effects of second-hand smoke. In addition to the effects on family members who are exposed to tobacco smoke in the home, consideration also needs to be given to the workers who are subjected to an unhealthy working environment, particularly in some nightclubs and hotels in Jamaica. Is it fair that in an effort to provide for themselves and their families, their health has to suffer? The legislation to ban smoking in public places would address this issue somewhat. Some smokers, however, do show consideration for non-smokers in choosing where to smoke.

Premature death

Another consideration is that smoking not only causes premature death, it also causes disability linked to various health problems such as lung and heart disease. This renders the smoker unable to care for his/her family, usually in the prime of their life. Is this a choice most smokers would consciously make were it not for the fact that they were addicted?

Yes, we all make many choices in life, but choices are best made in an environment where due consideration is given to the effect of our choice, directly and indirectly, on those around us. Choice comes with responsibility. The Government should choose policies that create an environment that facilitates healthy lifestyles, such as smoke-free environments that would discourage smoking. For those who wish to stop smoking, The Heart Foundation of Jamaica, the other member organisations of the Jamaica Coalition for Tobacco Control, and the National Council on Drug Abuse stand ready to assist.

We welcome the announcement by the minister of health on June 6 that the long-awaited tobacco-control legislation, which includes the banning of smoking in public places, will be tabled in Parliament within three weeks. We look forward to continued policy choices that promote healthy lifestyles.

Deborah Chen is executive director, the Heart Foundation of Jamaica; vice-president-elect of the World Heart Federation; and president-elect of the Inter American Heart Foundation. Email feedback to columns@gleanerjm.com.