DIZZY and nauseous. This was how Raymart Domingo Abaño described his first taste of cigarette.
“Nahilo ako sa umpisa nang subukan ko manigarilyo [I began to feel dizzy when I first started to smoke],” Abaño recalled. It was days before his 16th birthday.
Now 20, Abaño puffs his way through five sticks of cigarettes every day.
He said it was his first cousin who influenced him to smoke when he was still a third-year student at Santo Domingo National High School in Calauag, Quezon province.
“Sinubukan ko lang manigarilyo kasi na-curious lang ako [I tried smoking out of curiosity],” Abaño said.
Inside their house, smoking is never an issue for his father, also a smoker. But he said that when he has a family of his own, he will not let any of his children smoke.
Abaño has stopped going to school, and is currently a maintenance worker for an apartment in Quezon City that is owned by his relative.
Had he had Concepcion Apolinar as mother, things could have been different.
Apolinar, 59, mother of four, is adamant against smoking.
Mother’s woe
APOLINAR, a dressmaker, has continuously complained his son has been addicted to smoking for three years now.
“Hindi ko talaga alam na naninigarilyo siya. Nahuli na lang ng mga kapatid niya, kaya umamin siya [I didn’t know he acquired the habit, until his siblings caught him smoking],” Apolinar said of son Mario, 18 years old and a student of Sauyo National High School.
Apolinar said that since his husband died four years ago, she focused too much on earning for her family.
“Minsan nahuhuli ko pa nga siya na nangungupit para lang makabili ng sigarilyo. Hindi bumababa sa anim isang araw ang binibili niya [I caught him stealing money to buy cigarettes. He consumes at least six sticks a day],” she said.
Apolinar said it’s her deepest desire that his son quit smoking.
“Ayoko siya magkasakit…magastos [I don’t want him to get sick, because it’s very expensive],” she lamented.
Doctor’s advice
ENCARNITA Blanco-Limpin, Framework Convention on Tobacco Control (FCTC) executive director, said it would really be better if young people will not start smoking.
“If parents are smoking, then don’t show your children,” said Limpin, who is also a physician. “You are teaching them a bad habit.”
According to the doctor, she had a patient who died at the age of 35 because of lung cancer.
“He started smoking at the age of 11. Imagine that? A waste of money, a waste of life,” she said. “Life is beautiful. Why don’t we just enjoy it by living healthy?”
The Department of Health (DOH) has repeatedly pointed to studies that have shown that most young people who smoke regularly continue to smoke throughout adulthood and fall prey to being replacement smokers of tobacco industry.
Hence, the DOH called on students, as well as the rest of the young population, to never start smoking.
Teenage smokers
THE 2015 Global Youth Tobacco Survey (GYTS) data released on May 5 by the DOH-Epidemiology Bureau showed there has been an increase in the number of teen smokers—between the ages of 13 and 15—in the past four years. The GYTS data also recorded a decline in the number of Filipino adult smokers.
The GYTS also noted an increase in tobacco-use prevalence from 13.7 percent in 2011 to 16 percent in 2015. That survey involved 8,789 respondents, of which 48.1 percent, or 4,227, were boys, while 51.9 percent, or 4,561, were girls.
The study showed that 12 percent of those surveyed admitted they were smoking cigarettes. This was 3 percent higher compared to the 2011 GYTS that revealed only 8.9 percent said they were smokers.
Male teen smokers also increased from 12.9 percent in 2011 to 17.6 percent in 2015. The number of female teen smokers also was higher at 7 percent in 2015, compared to the 2011 study, in which only 5.3 percent of female respondents said they were smokers.
The study, however, noted that the 2015 figures were still lower compared to the 2007 GYTS, in which 17.5 percent of participants admitted to being smokers.
The GYTS is a nationally representative school-based survey of students in grade school and between 13 and 15 years of age. The GYTS is designed to produce cross-sectional estimates for each country. It assists countries in fulfilling their obligations under the World Health Organization-Framework Convention on Tobacco Control (WHO-FCTC) to generate comparable date within and across countries.
Reductions
MEANWHILE, the Global Adult Tobacco Survey (GATS) 2015 noted that the prevalence of cigarette smoking among Filipino adults has dropped significantly from 29.7 percent in 2009 to 23.8 percent in 2015.
The GATS is a nationally representative household survey among adults 15 years and older. The Philippines agreed to conduct the study first in 2009, followed by another round in 2015, as provided for under the WHO-FCTC.
The survey further bared that exposure to secondhand smoke has decreased, as well: from 25.5 percent in 2009 to 13.6 percent in 2015. It noted that the smoke-free policies initiated by various government agencies and local government units (LGUs) have contributed substantially to the reduction.
The overall reduction in exposure to secondhand smoke does not, however, “disconnect” the findings that a significant number were still exposed in public places. The exposure comes from bars and nightclubs (86.3 percent), public transport (37.6 percent) and restaurants (33.6 percent).
The same study emphasized there is no safe level for secondhand smoke and, therefore, urged that all Filipinos must be protected against exposure to cigarette fumes.
Scare tactics
RAISING the horror associated with cigarette smoking seems to have worked well among Filipinos, the GATS said.
Warning labels and graphic health information have influenced many of them to quit smoking, from 37.4 percent in 2009 to 44.6 percent in 2015, the study said.
Similarly, the percentage of adults who noticed anticigarette-smoking information at any given location has increased from 80.1 percent in 2009 to 83.2 percent in 2015.
Graphic health information through DOH policy issuances (DOH AO 2010-0013) greatly contributed to the progress as evidenced by the significant reduction recorded in smoking data.
The concluding analysis stated that “despite these gains, however, the government must institute further actions to sustain the gains and overturn the tobacco epidemic.”
Raising taxes
HEALTH Secretary Paulyn Jean Rosell-Ubial said that drastically raising the tobacco excise taxes, which forced the steady increase on cigarette prices from 2013 through 2017, proved to be the single most effective way of reducing tobacco use among smokers in the Philippines.
The tobacco-taxation measures enacted since 2012 were among the crucial catalysts that led to a significant decrease in tobacco use and notable drop in secondhand-smoke exposure among Filipinos from 29.75 percent in 2009 to 23.8 percent in 2015.
Ubial said the reduction in tobacco use among adult Filipinos is strongly expected to result in a marked reduction in tobacco-related noncommunicable diseases, such as cardiovascular diseases, chronic obstructive pulmonary disease, diabetes and cancers.
The 2015 GATS also reported that close to 16 million Filipino adults have smoked tobacco products: 40 percent are men and 5 percent are women.
Tobacco exposure has been linked to 87,000 annual deaths among Filipinos, which are more than the number of deaths due to HIV/AIDS, tuberculosis and malaria combined. The GATS has noted the Philippine economy loses approximately P188 billion every year from tobacco-related hospitalization and productivity loss.
Cause, effect
THE GATS Philippines 2015 data has shown that the reduction in the purchase and use of tobacco products coincided with the increase in the prices.
The data also indicated that the proportion of Filipino smokers with intent to quit has increased.
Limpin describes high taxes on tobacco products as a “game changer”. The price of tobacco now gives the poor a different perspective.
“If they [poor] don’t have enough money to spend, then they would rather spend it to the more important needs of the family: food, education, children, clothing, instead of buying cigarettes,” she explained.
However, Ubial said there’s still more to be done, as nearly one in every four Filipino adults continues to use tobacco products. She said there is still a high degree of exposure to secondhand smoke for nonsmoking Filipinos in public places and even in their own homes.
“We are grateful for government initiative to impose a smoking ban in public places, where nonsmokers become unwillingly exposed to second-hand smoke,” Ubial said. “It is incumbent on both the national and local governments to protect the health of all Filipinos who choose not to endanger themselves with these substances, and are inadvertently exposed to them due to the actions or indifference of many other Filipinos.”
WHO support
WORLD Health Organization (WHO) Representative to the Philippines Gundo Weiler credits the partnership between government and non-governmental groups to have reduced the negative impact of tobacco on Filipinos’ health.
According to Weiler, “The outstanding results of GATS constitute evidence that determination, leadership and strong advocacy truly work.”
The WHO representative said the Philippines has achieved one of the most pronounced decreases in prevalence of tobacco use among countries in Asia over the last several years.
“While this is truly a great achievement, we need to redouble our efforts and intensify the interventions that have been proven to be effective,” Weiler said in a news briefing on March 20.
He reiterated the need to impose smoking ban in public places nationwide and the full implementation of the FCTC, including the tobacco-taxation law.
Weiler said the WHO will continue to support the efforts by the Philippine government to reduce the morbidity and mortality among Filipinos linked to tobacco use.
Wait, watch
THE Department of Finance (DOF) has signaled the agency has been closely monitoring the implementation of the restructured taxation schedule for tobacco products.
Finance Assistant Secretary Ma. Teresa Habitan said this particular legislative measure was the first instance in which a flat tax rate was imposed on cigarette products.
Habitan said the law should first be allowed to be fully implemented in order to determine whether it fulfills its objectives to significantly curb smoking prevalence among Filipinos, while generating appropriate revenue for the government at the same time.
“Let us first see how well Republic Act 10351 works in the long run,” she said.
Ubial said the progress and achievements of the tobacco-control policies and advocacies should be maximized and pushed further by maintaining the unitary excise-tax structure for tobacco products.
She said all local government units must strongly enforce all necessary legal restrictions on tobacco use in public places, while recognizing the contributions of all the DOH partners and organizations in government, international community and civil society despite various obstacles and difficulties.
Smoke-free schools
EDUCATION Secretary Leonor Magtolis-Briones reiterated that schools all over the country should be strictly 100-percent smoke-free.
Briones said that even before she assumed the post, tobacco-control policy is already strictly implemented.
“We are also implementing the Graphic Health Warnings [GHW] template,” she said.
The GHW law requires all tobacco products manufactured and for sale in the Philippines to carry GHWs. Department of Education (DepEd) Department Order (DO) 98 issued last year mandates the use of GHW template to educate kids on the dangers of smoking.
“They are also included in relevant subjects under the K-to-12 curriculum to educate the students on the ill effects of tobacco use,” said Briones, former National Treasurer.
The DepEd is also emphasizing the need of prevention, she added.
That is why the department integrates antismoking and other risky behaviors in the curriculum for them not to catch the bad habit, according to Briones.
She also noted they will soon conduct trainings on comprehensive tobacco control for school principals and other members of the schools’ Child Protection Committees (CPC).
Established in every school nationwide since 2012, the CPC is tasked to ensure the effective implementation of the DepEd’s DO 48. The order, also called “Policy and Guidelines on Comprehensive Tobacco Control”, was issued last year.
According to the DepEd, the content of the training manual on the effective implementation of the DO 48 was drafted in March.
The DO 48 aims to facilitate the enforcement of tobacco-control policies in schools and offices, with emphasis on the protection against tobacco-industry interference in the DepEd. The DO defines tobacco-industry interference as “the broad array of tactics and strategies utilized by the tobacco industry to influence or interfere with the setting and implementation of tobacco-control policies.”
Kicking the habit
THE DOH urged those who have started smoking to quit immediately and seek professional help.
Ubial has said that not smoking or quitting smoking greatly reduces our risk for disease and early death.
The DOH assured government interventions for smoking are in place to extend help to those who need it.
In Metro Manila, the government’s smoking cessation centers are located in several hospitals and clinics. These centers are:
- Dr. Jose Rodriguez Memorial Hospital in Caloocan City
- Amang Rodriguez Memorial Hospital in Marikina
- Rizal Medical Center in Pasig City
- San Lorenzo Ruiz Women’s Hospital in Malabon City
- Philippine General Hospital in Manila
- Lung Center of the Philippines
- Philippine Heart Center
- National Children’s Hospital
- Saint Luke’s Medical Center
- Quirino Memorial Medical Center
“The success of these efforts is living proof that health for all can truly be achieved when all partners work toward the same goal,” Ubial said. “There is still much to be done in our country’s efforts to limit and curtail tobacco use, especially for our economically disadvantaged countrymen who are the most affected with diseases linked to long use and exposure to tobacco products.”
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