Smoking 'heavily ingrained' in Malta

Cigarette smoking is currently the single most preventable cause of disease and death the world over and there is still much to be done in the field of health education with regard to smoking and its effects among the Maltese, a medical paper says.

The paper, published in this month's edition of the Malta Medical Journal, says smoking is still "quite heavily ingrained" in Maltese society at all ages.

"We must also try harder to teach these smokers that there is much one can do to stop smoking and that this can be done utilising modern means to make cessation easier and more successful," it says.

However, until now, "we seem to have failed in both these areas," authors Charlotte Sant Portanier, Marianne Sant Fournier and Stephen Montefort say.

Entitled Cigarette Smoking Across Three Maltese Generations, the paper investigates the smoking habits of 16 to 21-year-olds, 40 to 45-year-olds and 60 to 65-year olds.

Conducted among about 400 people from a randomly chosen sample, the survey found that the Maltese are quite heavy smokers, across all ages and gender, and most are not seeking medical help to try and quit. In fact, only 5.3 per cent of the smokers, who constituted 27.7 per cent of the population studied, said they were seeking medical help to try and stop smoking.

"It is disappointing to see that a very small minority seek medical advice to stop smoking, utilising pharmaceutical means or psychological support," the authors say, adding that smoking cessation clinics are available locally but the national health scheme does not sponsor nicotine replacement therapy or bupropion. This could contribute to most smokers trying to stop on their own - with little success.

The study found that 35 per cent of men and 21 per cent of women were regular smokers. While there was a higher percentage of male smokers in the younger and elder age groups, more women than men smoked in the 40 - 45 age group.

With regard to geographical distribution, the authors say the highest rates of smoking is to be found among the Gozitans and the lowest in the central southern region of Malta. However, the variability does not reach statistical significance.

Meanwhile, smoking was found to be significantly higher among the unemployed, 69 per cent of whom smoke. Partly skilled workers come next on the graph, followed by unskilled workers.

The study found that although none of the professional class interviewed smoked, 40 per cent of them were former smokers.

Questioned about why they started smoking, a majority of smokers from the three groups said it was mainly due to peer pressure. Fourteen per cent of the younger age group and seven per cent of the older age group said they started smoking "to impart a cool image". None of the participants said they felt cigarette advertising persuaded them to start smoking.

The study found that smokers are more likely to have a morning cough, produce sputum, have experienced wheezing in the past year and experience shortness of breath on moderate exertion.

It takes quite a long history of smoking for significant decreases in pulmonary function to take place and these respiration symptoms do not seem to deter smokers who suffer from other medical conditions. A total of 19 per cent of smokers across the three age groups said they suffered from asthma, 29 per cent suffered from ischaemic heart disease and 16 per cent of smokers were diabetics.

The report is particularly timely in view of new legislation that will curtail smoking in public places.

Currently, smoking is specifically mentioned in the Workplace (Minimum Health And Safety Requirements) Regulations (legal notice 44 of 2002), which was issued under the Occupational Health and Safety Authority Act, published in the government Gazette in 2002.

The regulation states that the employer shall identify those areas in which smoking could cause a risk of fire or explosion and ensure that smoking is not allowed in such areas. It also states that the employer shall identify separate areas where smoking is allowed, to protect non-smokers against the discomfort of tobacco smoke.

Special mention is made of rest rooms and the regulations bind the employer to ensure that these "include suitable arrangements for the protection of non-smokers against discomfort caused by tobacco smoke".

Moreover, part of the regulations stipulate that employers must ensure that no person is allowed to smoke, or eat and drink, at any workplace where any harmful agent is stored, handled or used.

The employee has the right to ask for the required protective and preventive measures to be in place. The Occupational Health and Safety Authority says this could best be achieved by ensuring consultation and participation of workers in all decisions affecting their occupational health and safety.

The OHSA pointed out that comments by authority chairman Joanna Drake reported on yesterday's paper referred to the above regulation and not to the smoking ban that is expected to come into force in a few weeks' time in public places.