**5. Control of tobacco use through legislation**

The Youths are the most effective groups targeted by public/health policy makers and economists for smoking prevention programmes, since almost all first use of cigarettes occur at this age and the development of addictive habits also begins at this age. Health policy designed to discourage the use of Tobacco products especially in this age group was signed and approved by many countries including Nigeria, under the aegis of the WHO Framework Convention on Tobacco Control (WHO FCTC) of 2005. The WHO Framework Convention on Tobacco Control (FCTC), was adopted by the 56th World Health Assembly on May 21, 2003, and implemented on February 27, 2005. In this treaty, WHO recommends a four-pronged strategy for the control of smoking. The first prong advocates a ban on all forms of advertising and an increase in public health information with special attention to youths. By

**141**

*Smoking and Non-Communicable Diseases in Sub-Saharan Africa: The Nigeria Scenario*

through which the FCTC could be implemented. This acronym stands for (i) Monitor tobacco use and prevention policy, (ii) Protect people from tobacco smoke, (iii) Offer help to quit tobacco use, (iv) Warn people about the dangers of tobacco, (v) Enforce bans on tobacco advertising, promotion and sponsorship, and

2008, WHO revealed a six evidenced-based policy package known as "MPOWER"

The MPOWER also seeks to enhance price and excise tax policy, smoke-free indoor air laws, laws restricting access of minors to tobacco (including retail tobacco licencing), advertising and promotion restrictions on tobacco products, requirements for warning labels on tobacco products, and requirements for product ingredient disclosure [55]. It provides a practical measure for countries wishing to reduce demand for tobacco in line with WHO FCTC [55]. According to the 2013, WHO Report on the Global Tobacco Epidemic, a third of the world's population is covered by at least one measure of the MPOWER at the highest level. Turkey is the only country at present protecting its entire population with all MPOWER mea-

Global Adults Tobacco Survey (GATS) report, a component of the Global Tobacco Surveillance System (GTSS), an initiative of the WHO is used by countries to collect data on adult tobacco use and MPOWER measures [14]. In Nigeria, the 2012 survey report which targeted adults aged 15 and older, showed a generally below average indices to the MPOWER measures [14]. This was compounded by the prolonged delay in signing the tobacco smoking bill into law and currently the

One of the factors that influence consumers in a market economy is price, and the law of demand that defines the typical relationship between price and quantity demanded states that 'consumers will demand more of a particular product at a lower price, and less at a higher price' [37]. This may not entirely apply to cigarette smoking due the associated addiction. The price elasticity of demand measures the responsiveness or sensitivity of the quantity demanded of a particular product to changes in its price [37]. In relation to smoking, there is need to understand how price adjustment will affect the demand for cigarettes. Hence, this will help define the influence of price adjustment as control measure for control of cigarette

With effective control measures in place, the rate of tobacco consumption has been stabilised in developed nations between 1970 and 2000. Unfortunately, there has been tremendous increase in consumption rate in the developing countries. Leder and Esson had projected that within the next 25 years the rate of smoking would have increased by 60% and 100% respectively in countries of Medium and Low level human developments respectively [55]. Fifty percent of the mortality from cigarette smoking was projected to involve the productive age groups (35–69 years) which is a great set back to the socioeconomic development of these countries. Nigeria being a part of the WHO FCTC and in the bid to curb this trend, it is necessary to find out the impact of this anti-smoking policy on smoking

It will be sufficed to say that; passive smoking is also a challenge in Nigeria as overall prevalence in the home was 24.1%, while it stands at 43.0% in non-home areas including public places [57]. The health impact of this is also enormous which include but not limited to lung cancers, stroke, triggering of asthmatic conditions, TB infections and progression to TB diseases, stroke, chronic obstructive pulmonary diseases, cardiovascular diseases [58]. In 2008, Federal Capital Territory (FCT), Abuja passed most comprehensive public ban on smoking, followed by Lagos State [57]. This ban outlawed smoking in all communal areas including restaurants, bars and workplaces. The National Tobacco Act later provide new

procrastination in the operationalization and enforcement of the law.

*DOI: http://dx.doi.org/10.5772/intechopen.96693*

(vi) Raise taxes on tobacco.

sures at the highest level [56].

smoking among the youths.

behaviour of young people.

#### *Smoking and Non-Communicable Diseases in Sub-Saharan Africa: The Nigeria Scenario DOI: http://dx.doi.org/10.5772/intechopen.96693*

2008, WHO revealed a six evidenced-based policy package known as "MPOWER" through which the FCTC could be implemented. This acronym stands for (i) Monitor tobacco use and prevention policy, (ii) Protect people from tobacco smoke, (iii) Offer help to quit tobacco use, (iv) Warn people about the dangers of tobacco, (v) Enforce bans on tobacco advertising, promotion and sponsorship, and (vi) Raise taxes on tobacco.

The MPOWER also seeks to enhance price and excise tax policy, smoke-free indoor air laws, laws restricting access of minors to tobacco (including retail tobacco licencing), advertising and promotion restrictions on tobacco products, requirements for warning labels on tobacco products, and requirements for product ingredient disclosure [55]. It provides a practical measure for countries wishing to reduce demand for tobacco in line with WHO FCTC [55]. According to the 2013, WHO Report on the Global Tobacco Epidemic, a third of the world's population is covered by at least one measure of the MPOWER at the highest level. Turkey is the only country at present protecting its entire population with all MPOWER measures at the highest level [56].

Global Adults Tobacco Survey (GATS) report, a component of the Global Tobacco Surveillance System (GTSS), an initiative of the WHO is used by countries to collect data on adult tobacco use and MPOWER measures [14]. In Nigeria, the 2012 survey report which targeted adults aged 15 and older, showed a generally below average indices to the MPOWER measures [14]. This was compounded by the prolonged delay in signing the tobacco smoking bill into law and currently the procrastination in the operationalization and enforcement of the law.

One of the factors that influence consumers in a market economy is price, and the law of demand that defines the typical relationship between price and quantity demanded states that 'consumers will demand more of a particular product at a lower price, and less at a higher price' [37]. This may not entirely apply to cigarette smoking due the associated addiction. The price elasticity of demand measures the responsiveness or sensitivity of the quantity demanded of a particular product to changes in its price [37]. In relation to smoking, there is need to understand how price adjustment will affect the demand for cigarettes. Hence, this will help define the influence of price adjustment as control measure for control of cigarette smoking among the youths.

With effective control measures in place, the rate of tobacco consumption has been stabilised in developed nations between 1970 and 2000. Unfortunately, there has been tremendous increase in consumption rate in the developing countries. Leder and Esson had projected that within the next 25 years the rate of smoking would have increased by 60% and 100% respectively in countries of Medium and Low level human developments respectively [55]. Fifty percent of the mortality from cigarette smoking was projected to involve the productive age groups (35–69 years) which is a great set back to the socioeconomic development of these countries. Nigeria being a part of the WHO FCTC and in the bid to curb this trend, it is necessary to find out the impact of this anti-smoking policy on smoking behaviour of young people.

It will be sufficed to say that; passive smoking is also a challenge in Nigeria as overall prevalence in the home was 24.1%, while it stands at 43.0% in non-home areas including public places [57]. The health impact of this is also enormous which include but not limited to lung cancers, stroke, triggering of asthmatic conditions, TB infections and progression to TB diseases, stroke, chronic obstructive pulmonary diseases, cardiovascular diseases [58]. In 2008, Federal Capital Territory (FCT), Abuja passed most comprehensive public ban on smoking, followed by Lagos State [57]. This ban outlawed smoking in all communal areas including restaurants, bars and workplaces. The National Tobacco Act later provide new

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

Cigarette smoke is a complex mixture of chemicals. It is believed that the reason

Some smoke components, such as carbon monoxide (CO), hydrogen cyanide (HCN), and nitrogen oxides, are gases. Others, such as formaldehyde, acrolein, benzene, and certain N-nitrosamines, are volatile chemicals contained in the liquidvapour portion of the smoke aerosol. Still others, such as nicotine, phenol, polyaromatic hydrocarbons (PAHs), and certain tobacco-specific nitrosamines (TSNAs) are contained in the submicron-sized solid particles that are suspended in cigarette smoke. In view of this chemical complexity, cigarette smoke has been shown to have multiple and highly diverse effects on human health. These adverse effects have been documented in literature to involve every organ in the human body culminating in various cancers, chronic obstructive pulmonary airway disease to various cardiovascular diseases. It has also been linked with auditory problems [46] while in India and China it has been associated with increased prevalence in pulmonary

The use of tobacco has been reported to be associated with increased chronic lung diseases, asthma, angina depression, arthritis, diabetes, hypertension and cerebrospinal accidents [45–51]. The adverse economic effect of tobacco smoking is huge [5, 52, 53]. In the United States, an estimated \$96 billion per annum were being incurred from tobacco use and related medical expenses due to loss of productivity and over \$2 billion would be saved annually from healthcare insurance if all smok-

The Youths are the most effective groups targeted by public/health policy makers and economists for smoking prevention programmes, since almost all first use of cigarettes occur at this age and the development of addictive habits also begins at this age. Health policy designed to discourage the use of Tobacco products especially in this age group was signed and approved by many countries including Nigeria, under the aegis of the WHO Framework Convention on Tobacco Control (WHO FCTC) of 2005. The WHO Framework Convention on Tobacco Control (FCTC), was adopted by the 56th World Health Assembly on May 21, 2003, and implemented on February 27, 2005. In this treaty, WHO recommends a four-pronged strategy for the control of smoking. The first prong advocates a ban on all forms of advertising and an increase in public health information with special attention to youths. By

why people smoke is due to the active ingredient in the tobacco, nicotine which acts as a stimulant and a relaxant through its effects on the central nervous system, adrenals and the sympathetic nervous system [42, 43]. When a cigarette is smoked, nicotine-rich blood passes from the lungs to the brain within seven seconds and immediately stimulates the release of many chemical messengers including acetylcholine, norepinephrine, epinephrine, vasopressin, arginine, dopamine, autocrine agents, and beta-endorphin [42, 43]. This release of neurotransmitters and hormones is responsible for most of the effects of nicotine. Nicotine appears to enhance concentration and memory due to the increase of acetylcholine. It also appears to enhance alertness due to the increases of acetylcholine and norepinephrine. Arousal is increased by the resultant elevated level of norepinephrine. Pain is reduced by the increases of acetylcholine and beta-endorphin. Anxiety is reduced by the increased beta-endorphin. Nicotine also extends the duration of positive effects of dopamine and increases sensitivity in brain reward systems [44, 45]. This is one of the key

**4. Adverse effects of smoking**

reasons why cigarette is very addictive.

ers in the US were to quit smoking [54].

**5. Control of tobacco use through legislation**

tuberculosis [47].

**140**

opportunities for broad scale reduction in passive smoking exposure in public places at the national level.

In Nigeria, the first law on tobacco regulation was in the Section 6 of the Nigeria (Constitution) Order-in Council of 1954 but it was essentially designed to make provisions for licencing and payment of duties of Tobacco importation. Presently, the only law in-place which also legislates on the consumption and advertisement of tobacco is the "Tobacco Smoking (Control) Decree No. 20 of 1990". It prohibits smoking in public places including schools, public transportation, stadium, theatres, medical establishment etc. It also stipulates restrictions on tobacco advertisements and provides penalties for smokers, sellers and advertisers that do not conform to the provisions [20]. Unfortunately a smoking age limit and the restriction of cigarette sales to or by minor are not provided for in this law. The presence of the so called warnings like: "The Federal Ministry of health warns that Tobacco smoking is dangerous to health" or "Smokers are liable to die young"; appear insufficient since the minors do not understand the implications. The enforcement of the existing law is another questionable issue. The agitations on the existing inefficient anti-smoking laws in Nigeria culminated in the recent commencement of legislative process for the review of the present Tobacco Smoking (Control) Decree No. 20 of 1990. This bill sort for an act to repeal the Tobacco smoking Control Act 1990, CAP. T6 Laws of the Federation and to enact the National Tobacco Control bill 2012 to provide for the regulation and control of production, manufacturing, sale, advertising, promotion and sponsorship of tobacco products in Nigeria and other related matters. The public hearing was held at the National Assembly Complex on 15th October 2014. It was finally passed into law by the legislatures and received the presidential assent on May 27th 2015. The Nigeria National Tobacco Control Act of 2015, was passed to domesticate the WHO FCTC; however, implementation has been poor as most public places are yet to be smoke free, and no funds have been dedicated for tobacco law enforcement. Currently the bureaucratic processes involving the operationalization of the Act is ongoing. The operationalization of this Act needed to be given a deserved attention as report shows half of adolescent smokers become regular smoking adults, and a further half of this population is expected to die of tobacco-associated illnesses, further highlighting the great burden smoking in young poses and the need to end this habit [20]. Hopefully, when the law becomes effectively operationalised and implementation enforced, it will help in reducing the tides of smoking with its attendant health risk.

The health hazards of smoking and the impact on quality of life should be part of focus on tobacco control initiatives for youths. Former smokers should be involved in active antismoking campaigns and the factors that made them quit should be taken into consideration when designing anti-smoking measures.
