EDITORIAL
STOP SMOKING OR PREVENT SMOKING?
It is difficult to eradicate the social custom of smoking. This habit, which was established from times immemorial among the indigenous peoples of America, has religious, magic and curative connotations. It reached Europe in the 16th century. At the beginning of the 16th century, the first response that it received was a sentence, imposed in Spain, on Rodrigo de Jerez, one of the shipmates on Columbus'' first voyage. Rodrigo de Jerez dared to smoke in public and was taken to trial in his village (Ayamonte) for "possession by demons and the emission of hell''s smoke".
However, not much later, the plant was first cultivated in Europe by Francisco Hernández de Boncalo, chamber physician to King Phillip II. He planted it in his birthplace in the Spanish province of Toledo. Tobacco was first introduced was a medicinal product (and was even used as an antiasthmatic) and found acceptance among the upper class, eventually becoming a generalized social habit. This habit was promoted by literary myths (remember Sherlock Holmes'' pipe), cinema (Humphrey Bogart), and politicians (Winston Churchill), and tobacco use reached alarming proportions. The clear interests of the tobacco industry and the no less clear interests of government, which collects tobacco taxes, undoubtedly contributed.
After several centuries in which smoking has been an established social custom, it is very difficult to reduce the number of smokers. However, in recent years people have become alarmed about the pernicious effects of tobacco. It is curious that in Spain the percentage of male smokers in declining (from about 65% of men in 1978 to 40% in 1992), while the number of female smokers has remained stable (20-23%) (1). It is possible that the greater incidence of tobacco-related diseases (cancer, COPD) in men has contributed to this reduction, as well as to the accumulation of the number of former smokers in persons over 45. The incidence of asthma of adult onset also has been related with smoking and has the same predominance in women (2).
Aside from the relationship between smoking and lung cancer, obstructive bronchial disease, suchs as chronic obstructive pulmonary disease (COPD), small airway disease (SAD), chronic bronchitis and asthma, are the most common tobacco-related disorders. The harmful effects of tobacco on the general population and on persons with chronic bronchitis or asthma are evident in passive smokers as well. In a recent study of personnel in several bars in which smoking was prohibited, respiratory symptoms disappeared or improved in 59% of 39 (74% of the total) employees, not all of whom were smokers (3). Similarly, the urine of the children of smokers contains cotinine, the amount of which is related with the number of cigarettes smoked by their parents. The same relation has been observed with increased bronchial reactivity in asthmatic children (4). The influence of maternal smoking on fetal lung development (5) and on the onset of obstructive bronchitis and asthma (6) has been clearly demonstrated.
Tobacco dependence seems to be due to the impregnation of the nucleus ceruleus and the dopaminergic-mesolimbic system with nicotine (1). Dependence has been enhanced (fraudulently in our opinion) by the addition of nicotine to the tobacco, "enough nicotine the keep the smoker hooked", as indicated by an executive of a well-known trademark. Therefore, anti-smoking campaigns, though well-designed (7), face major difficulties because the smoker''s desire to stop smoking is a fundamental premise for achieving this objective.
Dehabituation should begin with health-care professionals, whose example is important. In Spain, the percentage of physicians who smoke has decreased notably, from 49 to 37% between 1985 and 1989. The decline in smoking among respiratory system specialists is even more impressive (47 to 21%) (1) and has probably continued.
Undoubtedly, some of the measures that currently are being taken to reduce smoking are effective, such as establishing non-smoking areas in public places or airline prohibitions of smoking on flights, including intercontinental flights. However, the best preventive measure is to act before the smoking habit is acquired. We know of no studies of the incidence of smoking among primary and secondary school teachers, whose influence on students is fundamental. These professionals should be given more information about the risks of smoking and their influence on students and responsability. The study by M. Barrueco et al published in this issue of Allergologia et Immunopathologia (8) shows that information about the risk of smoking does not reach all students in the Spanish school system and its content is not known. Definitively, in the case of smoking, as for so many other diseases, the popular saying "an ounce of prevention is worth a pound of cure" holds true.
F. Muñoz-López
REFERENCES
1.Jiménez Ruiz JM (edit.). Tabaquismo. Manuales de la Sociedad Española de Neumología y Cirugía Torácica. Madrid; 1995.
2.Toren K, Hermansson BA. Incidence rate of adult-onset asthma in relation to age, sex, atopy and smoking: a Swedish population-based study of 15,813 adults. Int J Tuberc Lung Dis 1999;3:192-7.
3.Eisner MD, Smith AK, Blanc PD. Bartenders'' respiratory health after establishment of smoke-free bars and tavers. JAMA 1998;280:1909-14.
4.Odozze C, Dubus JC, Badier M, Thirion X, Pauli AM, Pastor J, et al. Urinary cotinine and exposure to parental smoking in a population of children with asthma. Clin Chem 1999;45:505-9.
5.Hanrahan JP, Halonen M. Antenatal interventions in childhood asthma. Eur Respir J 1998;27 (Supl): 46S-51S.
6.Stein RT, Holdberg CJ, Sherril D, Wright AL, Taussig L, Martínez FD. Influence of parental smoking on respiratory symptoms during the first decade of life: the Tucson children''s respiratory study. Am J Epidemiol 1999;149:1030-7.
7.Jiménez CA, Cisneros C. Abordaje del tabaquismo en Atención Primaria. El Médico 26 de marzo de 1999. p. 52-65.
8. Barrueco M, Hernández-Mezquita MA, Jiménez CA, Vega MT, Garrido E. Anti-tobacco education in spanish schools. Allergol et Immunopathol 1999;27:189-95.
