Dr Ehsan Latif, vice-president for grant management and development at the Foundation for a Smoke-Free World, recently spoke to Asia Times about his work, and excerpts of that interview appear below. Dr Latif has more than 20 years of experience managing the development and implementation of cohesive strategies to achieve public health gains by linking global health priorities to the needs on the ground.

Dr Ehsan Latif.

Previously, Dr Latif served as senior adviser for non-communicable diseases and was director of tobacco control at the International Union Against Tuberculosis and Lung Disease, managing global teams in India, China, Singapore, Mexico, Bangladesh, the Philippines, Vietnam, Pakistan, Brazil and Chad. His work entailed providing leadership for planning, organizing and prioritizing focused interventions for tobacco control to ensure delivery of strategic goals through collaboration.

In his early career, he was responsible for the development of Pakistan’s National Health Policy and served as a main contributor of the debate on non-communicable diseases in the early 2000s. His work has since involved capacity building and provision of grants to governments, civil-society organizations, universities and researchers.

He recently led and managed a US$10 million program to support policy development for tobacco control in low- and middle-income countries faced with the highest burden of diseases caused by tobacco use.

Latif has served on the boards of several public-health entities, including the Framework Convention Alliance, the Non-Communicable Disease Alliance, and the Global Smoke Free Partnership. He is also a member of various international groups working on lung-health and tobacco-control setups under the Framework Convention on Tobacco Control secretariat and the World Health Organization.

Latif holds a doctorate in medicine from Punjab Medical College and a master’s degree in public health from the London School of Hygiene and Tropical Medicine.

Sachi Satapathy: Many of us know about the dangers of smoking, so why do people find it so difficult to stop?

Dr Ehsan Latif: In public health, we have a tendency to treat all smokers alike. Every smoker is an individual with their own needs and preferences. Every smoker that I have come across in both my professional and personal life has tried to quit, but as we all know, it’s not easy.

There are many studies on why some smokers fail to quit the habit while others are successful. In my opinion, we need to remember the basic principle is to combine a variety of approaches tailored to the needs of a smoker who wants to quit. These range from cessation support [and] counseling to offering substitutes for nicotine withdrawal. Some find counseling coupled with nicotine replacement effective and others may need safer nicotine-delivery systems to either gradually wean themselves off combustible cigarettes or continue to use safer nicotine-delivery systems.

SS: What are the benefits of stopping smoking? Do these benefits still apply to people who have been smoking for a long time or already have a lung condition?

EL: The health benefits of quitting are huge. Quitting smoking helps most of the major parts of your body, from the brain to DNA.

Quitting gradually improves your lung function. Unfortunately, scarring of the lungs is not reversible. That is why it is important to quit smoking before you do permanent damage to your lungs.

Within two weeks of quitting, people will notice it’s easier to walk up the stairs, take longer walks and feel fresher. People notice that they cough more than usual when they first quit smoking and take it as negative sign. This is a sign that the cilia, small hairlike projections, are coming back to life, and these cilia are more likely to fight off colds and infections when they become working properly.

Quitting smoking prevents new DNA damage from happening and can even help repair the damage that has already been done. Quitting immediately is the best way to lower your risk of getting cancer.

When you quit smoking, your body will begin to heal from the injuries that smoking caused. Eventually, your white-bloodcell counts will return to normal and your body will no longer be on the defensive.

SS: What predisposes teens to smoke? What interventions work in preventing smoking in pre-adolescents and adolescents?

EL: Teen smoking is mainly driven by social factors combined with the curiosity of teens to explore and rebel. Teens living in a family of smokers, easy accessibility to cigarettes, lack of awareness about the hazards of smoking, and peer pressure all contribute to their predisposition to smoking.

We need to think about ways to engage youth in the work we do and involve them as much as we can. Unfortunately, due to the current approach of shunning smokers or labeling a teenager who smokes as a “bad” person alienates them more, risking isolation. We need to involve them in discussions, engage with them, let them open up on the pressures they are facing, and then address the root causes.

Until we involve them in discussions on what works for them, a top-down approach of interventions designed by public health experts like us will not work and we will see more teens taking up the habit. The message here is to stop stigmatizing the youth who smoke and listen to their needs.

Every country undertakes a Global Youth Tobacco Survey. The question to ask is, how many countries have devised strategies based on the results of these surveys involving youth?

SS: How can organizations like Smoke Free World help to reduce the number of people affected by smoking?

EL: We want to put smokers and their needs at the heart of all debates [on how] to reduce smoking and even end smoking. Unfortunately, smokers have been shunned from these debates, stigmatized over their habit and not involved in policy formulation and implementation.

Tobacco control needs to learn from other public health challenges that met success by involving people who were affected by it. The HIV-AIDS work is one example where involvement and participation of people suffering from the disease helped to address the challenge. If we want to see an end to smoking, smokers need to be the front and center of all discussions to address their needs.

SS: What can governments and decision-makers do to reduce tobacco use in their countries?

EL: They need to ensure full implementation of the Framework Convention for Tobacco Control, put special emphasis and resources into cessation, making it an integral part of their health infrastructures, undertake research on what works for their populations and develop strategies based on the indigenous research results, and lastly consider with an open mind the technological innovations which are now available for smoking cessation.

Governments should study and analyze how Public Health England and other organizations in the UK have adapted these innovations to support their smokers.

SS: Do you have any advice for someone who is finding it difficult to stop smoking?

EL: Seek help, continue to talk about the challenge you are facing, assess what works for you and ask a health-care professional about the options available.

SS: Can you speak a little more about electronic cigarettes? Can you speak specifically about concerns comes up regarding the use of e-cigs by teens and, for that matter, adults? Are there specific plans to address their use? 

EL: Everyone in the public health community agrees that nicotine is addictive, but smokers die from the tar and other combustible products which come out of a cigarette and not nicotine. Electronic cigarettes are safer than cigarettes and can be used to deliver nicotine without the tar and other combustible products and can assist smokers to quit or switch.

The Foundation for a Smoke-Free World agrees with the World Health Organization that youth and teens should not use vaping products. We strongly condemn vaping among youth and teens, just as we condemn smoking among youth and teens. We believe that regulations, public policies, and corporate actions must prevent minors from having access to vape devices, e-cigarettes, or any tobacco-related product.

The role that electronic nicotine-delivery systems like e-cigarettes can have in helping a smoker quit calls for further exploration, but the results to date are promising. For instance, evidence shows e-cigarettes offer potentially significant harm-reduction benefits to smokers in comparison to combustible cigarettes.

The New England Journal of Medicine recently found that e-cigarettes were twice as effective as nicotine-replacement therapies in getting people to quit smoking. These products have been found to be 90% less harmful than combustible cigarettes and are instrumental in substantially cutting smoker health risks.

The Foundation’s mission is to accelerate progress toward ending smoking. Our Health, Science, and Technology agenda explicitly addresses product assessment and development for cessation and harm-reduction innovations. We are agnostic to what product category is used and focus rather on how to ensure that the most effective means of ending smoking is safe and readily available.

We agree that more research is needed across all of the product categories. Therefore, we are funding research projects that will enhance knowledge in this area.

Sachi Satapathy

Sachi Satapathy is an international development practitioner who has worked on large-scale projects. His interests are in public policy, poverty alleviation and public-private partnerships for development in middle-income and developing countries. The author can be reached at sachisatpathy@yahoo.com