Are smokers a dying breed?

The anti-smoking campaigner Dr Saul Shiffman brings his expertise to the Middle East, and says things are changing the same as they have elsewhere in the world where smoking is declining.

Dr Saul Shiffman.
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Cheap tobacco and an often flagrant disregard for clean air policies mean it's fair to say the UAE is something of a smoker's paradise. Such is the prevalence of smoking - whether it be cigars, cigarettes, shisha or, as preferred by some, midwakh pipes - many argue that it is a key constituent of this region's culture, with the direct consequence that for those who make it their resolution to quit, the odds are stacked against them being able to beat their addiction.

It's much easier for would-be quitters elsewhere. In the West, those who persist in puffing away are no longer tolerated as accepted annoyances, but are now largely persona non grata to the rest of society. Stringently observed and enforced legislation has banished smokers from most public spaces, forcing them to huddle together, exposed to the elements, outside bars, restaurants and offices.

As a result, more are stubbing out their habits for good. For example, in the UK, the percentage of adults who smoked tobacco has fallen from around 55 per cent in 1970, to around 21 per cent in 2011. Whereas, in the US, within the same time period it has decreased from 44 per cent in 1970, to around 22 per cent. Although exact figures don't exist for the UAE, health professionals estimate that currently between 30 and 35 per cent of adults regularly smoke.

One man who's determined to make his mark on this high figure is Dr Saul Shiffman, a professor at the University of Pittsburgh, who has clocked up more than three decades of clinical research on the subject of addiction.

Shiffman is a regular visitor to the Emirates, and has just completed another lecture tour of the region with pharmaceutical giants GlaxoSmithKline, where he advised physicians about the methods they could use to help smokers quit.

Unsurprisingly, considering the sponsor of his tour, he firmly endorses the use of nicotine replacement products. Yet there are other, and less expensive, weapons in a doctor's armoury, he says, and none are more effective than impressing on a patient the likelihood of them contracting a fatal illness.

Shiffman explains: "If you smoke, there's a 50 per cent chance you'll die from a related disease. Even so, research has proven that although smokers are fully aware of the hazards of their habit they tend to believe that they're somehow immune to these illnesses.

"Smokers either stop thinking about [the risks], because it's too uncomfortable, or they start developing self-exempting beliefs. People have this image that they can smoke up until the age of 70, then they're going to just die peacefully in their sleep. I wish it was like this, but the reality is if they continue smoking, they're going to have a painful death.

"For example, chronic pulmonary disease is the most horrible death you can imagine. It's a progressive 10-to 12-year death, where you can't breathe, you can hardly walk more than a few steps and you're basically drowning in your own lungs.

"So it's not a matter of, I'll enjoy myself now and give up just before I die. If a physician sits down with a patient and chats to them one-on-one for just three minutes, explaining all this, it increases the chances of that person quitting by 30 per cent."

Nevertheless, physicians in this country face a number of impediments in this line of argument.

Firstly, there is the low cost of cigarettes in the UAE, which average Dh7 a packet. This compares to the US, where a pack of 20 is priced between $5 [Dh18] and $10 [Dh36], depending on each individual state's tax, or the UK, where paying up to £7 [Dh42] is not uncommon.

An analogy can be drawn here between tobacco and fuel prices. In the West, just as excessive taxes on fuel are forcing many to curtail their travel habits or buy more fuel-efficient cars, the spiralling cost of cigarettes is impelling many to quit, or at least reduce their intake.

Contrast this reality with the UAE, where even those on a moderate income can afford powerful, gas-guzzling cars and a prolific smoking habit.

Shiffman believes that although a hefty tax on tobacco could discourage smokers, other actions are also necessary. These include placing stark warnings on packets and banning words such as "light" or "mild", which give a false impression that these products are somehow less harmful than others.

Shiffman says: "Putting prices up would definitely have some effect in combating smokers. Indeed, all these kind of policies can motivate people to quit. It's sort of like driving them into a wall and then not providing exits from this."

But if smoking is considered an accepted part of the prevailing culture here, would all this legislation prove fruitless?

Shiffman contends that this idea that smoking is an integral facet of Middle Eastern life is a myth and, just as its prevalence has declined in the West, the region will soon follow suit.

"Compared to the US, yes it's obvious that smoking is a lot more accepted in the Gulf," he observed. "What you see here in the Emirates is how it was not so long ago in the US and in Europe. Up until a few years ago [in the West] people smoked freely in bars, clubs, restaurants, at work and on public transport.

"Things are starting to change. For example, I know a number of malls in Dubai are totally smoke-free. So it's happening.

"I would argue that it's not a fixed aspect of culture, rather that the governments and cultures all around the world are now mobilising against tobacco. So I see it not a fixed difference, but as a developmental trajectory."

As attitudes change, he argues, non-smokers will feel more empowered in asking others to stub it out.

"I know that the UAE government has passed laws to restrict smoking in public places, so it's serious about it, but, as yet, they [have not been] consistently obeyed or enforced. Personally, I think this is just a transitional phase and the fact that most people don't take them seriously leads smokers to think they can get away with it," he states.

"Many years back, this was happening in the USA, too. But then over time it began to change. It wasn't that the police spent a lot of time fining people, but the fact that there was a law, it gradually allowed non-smokers who were bothered to be able to say 'excuse me, this is a place where you're not supposed to smoke'. Now the laws have become very much obeyed, without the need for formal enforcement."

So, with the government, physicians and even average onlookers edging tobacco users to the margins of society, the smoker's utopia that is the UAE could, at least according to Shiffman's predictions, be nearing its end.