I grew up with the distinct feeling of being a misfit. This social awkwardness which I felt came about for two reasons, both of which were outside my control.
My paternal Aunties always said I had inherited the personality of my father, who was a sensitive and very private man. Simply put he was too shy.
The term they used for it was not complimentary, they called it in Bemba “Ukungutilwa” or more simply translated a dope. My female cousins a rowdy bunch of precocious girls were even blunter and said I was not good looking enough.
They told me that I had a misshaped head, what was called in Bemba “Ulukobo” or a pointed head at the back area or the occiput. So encumbered, was I, with these handicaps, I had to work extra hard to be part of the happening people among my peers. This meant I was always vulnerable to peer pressure. So when a male cousin of mine took me to the back of the family home and offered me a home-made cigarette I was prone to take it. I was just 10 years old at the time.
Fortunately for me, the inhaled smoke felt rather hot in my chest and I started coughing. In University, a few years later when a couple of my friends passed around what was called a “fag”, the in name for a potent home-made cigarette, I had the good sense to decline.
However, in the olden days when cigarettes where advertised on large billboards and John Wayne types cowboys held cigarette butts on one hand, a double barrel shotgun in the other and a beautiful blonde Caucasian women by the side. It was glamorous to smoke cigarettes. There is immense pressure both peer and advertising pressure on young teenagers in Africa to smoke. It is the new tobacco market. The combination of poverty, stress and peer pressure conspire to habituate young people in Zambia very early into smoking. Studies show that most people who start smoking, do it between 17 and 25years. Hardly anyone starts smoking after the age of 25 years if they have never smoked before.
It is well known that cigarettes are harmful to health. So well known is this fact that the cigarette packets declare it as well on their boxes. In discussing the question of smoking and health I want to answer 3 questions.
1.If cigarettes are so obviously harmful to health, why do so many people smoke?
2.How is smoking harmful to health?
3.How can I stop smoking?
In answering the first question, I thought to myself, how did smoking start in the first place. It is not at all entirely clear how smoking started, but it appears to have been started by the South American native tribes.
Sir Walter Raleigh in his exploratory travels imported the practice and the tobacco plant into Europe and it spread from there to the rest of the world. Smoking started as a religious practice intended both to send worship to the Gods and to receive inspiration from them by the priests of the native communities of South America. Most people begin to smoke out of curiosity and peer pressure.
In Zambia, studies done under the Global Youth Tobacco Survey by Siziya showed that eight per cent of school going children smoke. Most students appear to begin smoking in the second year of secondary school in Grade 9. Overall the prevalence of smoking in Zambia is between 15-25 per cent.
It appears to be more common in rural area than urban areas. Cigarette smoke contains more than 4,000 chemicals. The most potent component is chemical called nicotine. This substance has a effect on the nerve transmission. It stimulates the nerves and is responsible for both the pleasurable and addictive effect of smoking.
Special points of interest:
· Passive smoking is as dangerous as active smoking
· Cigarette filters have not reduced the dangers of smoking
· The largest risk population to start smoking is young Africans boys
· Cigarettes smoking kills over 4 million people annually.
· Smoking is the leading cause of Cancer of the Lung.
· Passive smoking is dangerous for children, by smoking you are put your family at risk
· To stop smoking combine personal will power, nicotine replacement therapy and drug medication. This increases your chances of stopping smoking for life.
Smoking stimulates the Brain and the stress response gland the adrenal gland. These organs release the pleasure neurotransmitter dopamine, endorphins and encephalin. These are the pleasure chemicals of the body. These chemicals works on the pleasure centres in the brain. This pleasure creates a vicious nicotine cycle that perpetuates the smoking habit. In short, most people start smoking when they are young due to peer pressure. They find it pleasurable and before too long they become addicted.
How does smoking cause disease?
Perhaps it is necessary to ask the question how big a disease burden is created by Tobacco. Is it something we should be concerned about? The answer has to be a resounding yes. According to the World Health Organisation 4 million deaths annually can be attributed to smoking and 70 per cent occur in developing countries.
There has been a decline in smoking rates in developed countries due to aggressive health campaigns , while in developing countries we have seen a rapid increase in smoking especially among the youth and women. Cigarette smoke contains particulate or solid matter and gaseous material.
The solid component contains chemicals like tar and nicotine. The gas component contains gases like Carbon Monoxide, Sulphur Dioxide and several other gases. These substances damage the lining of blood vessels, the lining of other tubes which contain fine hairs such as the respiratory and reproductive tubes.
They also reduce oxygen available to cells by  increasing other competing gases, damage the structures that carry oxygen, increase fatty molecules that narrow blood vessels and  chemicals called superoxide which injure body cells. These materials damage the chemical DNA which carries the genetic material of cells. This result in a disturbance in the growth of cells leading to cancer. Smoking is associated with 90 per cent of the Cancers of the Lung.It also causes cancers of the blood, the bladder, the neck of the womb (the cervix), the throat and the bowels.
In Zambia smokers are more prone to TB of the lung because their immune systems is lowered. In addition smoking by narrowing blood vessels is associated with strokes (blockage of blood flow to the brain), heart attack (blockage of blood vessels to the heart muscle) and blindness (blockage of the blood vessels to the eye).
It also leads to damage to the reproductive system reducing the ability of both men and women to have children. There has been a progressive decline in fertility in Zambia from about 5 children per women to the current level of 3 children per child bearing woman. This is because it destroys the fine hairs that help in moving the eggs and sperms along the reproductive tubes and promote fertility.
Smoking also causes disease in the lung, it causes Bronchitis, increases Asthmatic attacks (Asthma is a disease in which the tubes of the lung tend to get blocked with mucus, smoking worsens this condition), Chronic Obstructive Air Ways diseases such as Emphysema (This is a disease of the lung sacs or Alveoli, in which the sacs swell like balloons and begin to fail in exchanging gases).
It also increases this risk of occupational lung diseases (Disease of the Lung which are work related such as Silicosis for those working in the mines).
This occurs when smoking reduces the ability of the lung to filter out inhaled impurities. This is because like the reproductive tubes the fine hairs in the Respiratory tube that filter out impurities are damaged by smoking.
Smoking also cause disease of the blood vessel tubes the veins and arteries in the limbs. In particular larger blood vessels, have their walls weakened  by smoking. This lead either to narrowing of blood vessels or excessive widening  of the vessels, what is called aneurysms.
The end result of both is poor blood supply to the exterior such as the feet and legs. People experience this as severe cramps in the calf and feet after walking for short distances, a condition called intermittent claudication. The common experience of smokers is a persistent chronic cough, breathless with minimal exercises and a constant irritability if they have not had a puff. The biggest risk though posed by smoking, is the risk to others.
What is called passive smoking. This risk is sometimes worse than active smoking.
The material the smoker inhales is often passed through a filter to minimises the health damage to the body, the smoke coming off the other side going into the environment is even more toxic. Many countries have legislation banning people from smoking in public places, buildings, building transport areas such as buses, plane, airport, bus stations and so on. However think of the risk posed by a smoker to their family, their children and spouses.
Passive smoke or second hand smoke is tobacco smoke inhaled by non smokers who are in the vicinity of the smoker.
It is quite clear that passive smoke causes similar diseases to active smoking. It also puts children at risk of addiction and becoming smokers themselves in later life. In the USA it has been reported that passive smoking increases the risk of Heart disease and Lung cancer by between 25 to 30 per cent.
Smoking in the home may put your children at risk from respiratory disease, mental illness and cancers. So if you do not care for your own health at least consider the health of your family when you smoke in the house.
How can I stop smoking? Studies show that up to 79 per cent of smokers would like to stop smoking. However the success rates for quitting are fairly low. The number of smokers who successfully quit smoking at their first attempt are only about 5-8 per cent.There are three main methods by which quitting smoking can be attempted. These are grouped as  follows;
1.Behaviour modification methods
2.Nictone Replacement methods
3.Medications
The Behaviour modification methods involve self will and motivation. It is possible to quit smoking if you are highly motivated enough. If you realise for example that your smoking habit is increasing the risk of your child having attacks of Asthma. Many people have difficulty because the nicotine causes a mental addiction that is difficult to overcome by will power alone. Within 72hours of stopping many smokers will have withdrawal symptoms. The brain which has been habituated to the pleasurable dopamines, endorphins and encephalins will demands for these chemicals.
The person may have a headache, tremors, may become restless and even violent. However many people have quit smoking on their will power alone. So it’s worth trying. If you can succeed to stop smoking for 21days you stand a good chance of breaking the habit.
Nicotine replacement is seen as an attractive option by many. This method attempts to replace the nicotine obtained in cigarettes by other sources which contain increasingly lower levels of nicotine. This includes nicotine patches and nicotine gum.
These many not be commonly available in Zambia, but can be ordered through local pharmacies or online. This method is more successful, though a little less “Macho”. It is more gentle on the body and has shown higher success rates.
It allows the body to transition slowly from total lack to partial lack of nicotine. The chance of stopping smoking with some form of nicotine replacement therapy is at 20-25 per cent. It takes about 3 days to get the nicotine levels to fall significantly, and it avoids the severe Nicotine lack associated with the first method.
This condition is called a withdrawal syndrome or “Cold Turkey” , and is common is all addition inducing drugs such as heroin, cocaine and tobacco. E cigarettes are another prop that can be used. It may contain minimal or no nicotine content but helps with the mental addiction of holding the cigarettes.
Some suppliers exist for e cigarettes in Zambia. The World Health Organisation does not currently recommend the use of e cigarettes, because of insufficient evidence of benefit.
Medications. Some medications are recommended particularly in the USA for use, in assisting smokers to quit. The drugs are approved by the Drug regulator in the USA, called the Federal Drug Administration or FDA. Two categories of drugs have often been used, these are;
1.Antidepressants
2.Nictonine antagonists
The antidepressants like Bupropion or Zyban. These drugs are used once daily for a period of at least 12weeks.They increase level of dopamine in the blood and produce a level of well being similar to that produced by cigarette smoking without the side effects.
The Nicotine antagonists like Varenicline or Chantix. This drug blocks the nicotine receptors on which the cigarette chemical acts. This means that when you smoke the nicotine gives you no pleasurable effects. So you find the smoking act no longer pleasurable, so that over time the habit gradually falls off. These drugs are not commonly available in Zambia.
The best approach to stop smoking is a combination of methods including a good support group to help you kick the habit. Remember you cannot succeed to stop smoking on your own.
Conclusion
Smoking is a dangerous and unhealthy habit, not only to the person who smokes, but also to those around them. The people most at risk are the young people of Africa and Zambia. In Zambia in particular the habit starts in Grade 9 in Secondary school or in the first few years of University, College or Work.
The best way to stop smoking is never to start at all.
The period of greatest risk is between the ages of 17 and 25 years. Smoking is one of the leading causes of illness and death in the world in general and Zambia in particular. It is also one of the most common causes of preventable cancers in the world. There has been an increase in Zambia of Heart Disease, High Blood Pressure and Cancers, and one of the major reasons is the increase in the number of people who smoke.
Stopping smoking is difficult but it can be done. It has to begin with  protecting young people from Smoking advertising, stopping smoking in public places and replacing Tobacco growing with more nutritionally useful crops.
As an individual, target a fixed date to stop, have a support group around you, use Nicotine Replacement therapies or drugs if you have too and always get help from your local Doctor or Pharmacist.
Make it a priority to stop smoking today and to stop those around you from smoking. This is one of the best kept little secrets to good health.
Professor Kasonde Bowa, Is Professor of Urology at the Copperbelt University he is also the Dean of the Copperbelt University School of Medicine. kbowa@yahoo.com
He is the Author of the popular motivational book “Making the Cut”