In October 2021, a seminar titled “Reducing Cigarette Addiction and Cancer Prevention in the Czech and European Context” took place. The panel discussion was organized by the Harm Reduction Academy. The discussion was prompted by concerns over the high rates of smoking in the Czech Republic, where approximately 1.4 million people smoke daily.
The panel discussion focused on evaluating the impact of smoking on public health in the Czech Republic and existing solutions to reduce cigarette addiction. Special attention was given to implementing the European Cancer Plan, which includes measures to reduce the number of smokers and prevent oncological diseases. Statistics show that in 2020, 23% of adults in the Czech Republic smoked, although the number of cigarettes smoked per person increased. Ladislav Csémy warned that current measures are not effective enough in controlling tobacco use, as confirmed by data on mortality and smoking prevalence. However, a positive trend is the decline in adolescent smoking since 2010.
Impact of Smoking on Public Health
There are approximately 1.4 million daily smokers in the Czech Republic, representing a significant portion of the population. According to the State Health Institute’s 2020 statistics, 23% of adults smoked, which is 1.8% less than in 2019, yet the number of cigarettes smoked per day increased from 11.3 to 12.7.
Ladislav Csémy noted that current tobacco control measures are not sufficiently effective, as evidenced by mortality and smoking prevalence data. Nevertheless, it is encouraging that the number of adolescent smokers has been declining since 2010.
In Europe, smoking contributes to approximately 16% of annual mortality. The Czech Republic is among the countries where smoking-related deaths are between 16,000 and 18,000 per year. Out of this number, around 6,000 deaths are due to malignant diseases, most commonly lung cancer, accounting for nearly 5,000 deaths. Although smoking is the cause of about a quarter of all oncological diseases, most smokers die from heart attacks and strokes, followed by respiratory diseases and others.
Tobacco Smoke as the Main Problem
The main risks for smokers are posed by tobacco smoke, which contains about a hundred carcinogens, of which 60 are proven to contribute to the development of oncological diseases. Prof. Eva Králíková stated that quitting smoking is always beneficial, even after an oncological diagnosis, as smoking affects a wide range of medications—for example, the effectiveness of chemotherapeutics is reduced by up to 40% due to smoking.
The presenters also focused on the alkaloid nicotine. “The longer I deal with this issue, the more understanding I have for smokers. Many people are unable to quit smoking due to nicotine addiction. These people would prefer not to smoke if they could,” said Prof. Králíková, who further emphasized that nicotine is not among the carcinogens but is responsible for tobacco addiction.
Csémy described the effects of nicotine on the stimulation of nicotine receptors in the central nervous system (influencing tension, anxiety, reducing feelings of hunger, etc.) and the development of addiction. He mentioned that among all commonly used addictive substances, nicotine ranks first in terms of addiction strength but last in terms of intoxication severity.
Electronic Cigarettes Present Lower Risks
How can we prevent the health impacts caused by cigarette smoking? The presenters agreed that the least risky approach is through alternative methods of nicotine consumption, such as snus (chewing tobacco), nicotine pouches, or electronic cigarettes. Compared to smoking tobacco, these modifications are less harmful to health.
Significant attention was given to electronic cigarettes. According to the presenters, they offer health and economic benefits, such as reducing the health risks of cigarette smoking by up to 90%. When used for smoking cessation, they are more effective than traditional nicotine replacement therapy products (nicotine patches, gum, or sprays). The presenters also mentioned the situation with smoking in the Nordic countries. Ernest Groman, from the Medical University of Vienna, highlighted the differences in smoking rates between Sweden and Austria, noting that the situation in the Nordic country is much more favourable. According to Groman, the possible reason lies in the alternative nicotine use methods that have been widespread in Sweden for several decades.
Educate, Don’t Penalize
How can we motivate smokers to switch to less harmful forms of cigarette consumption? Traditional methods based on price increases, taxation, bans, and penalising cigarette consumers have diminishing returns and smokers are becoming immune to them. According to Karl Erik Lund from the Norwegian Institute of Public Health, this only leads to the stigmatization of smokers. He also pointed out that the image of the typical smoker has changed, but preventive program strategies remain the same.
“While smoking used to be associated with higher social status, nowadays more smokers are from lower-income groups, and current measures (e.g., increasing cigarette prices) only worsen their life situation. They should be informed about the existing ‘healthier’ alternatives that can compete with cigarettes. The net benefit to public health will thus be positive,” concluded Lund.