Kenya is making progress in cutting tobacco use, but the going is slow

A smaller proportion of Kenyans are using tobacco products but progress in the past six years has been slow, reveals a Nation Newsplex review of tobacco use data. This is despite the high taxes and laws that ban the sale of loose cigarette sticks and public advertising of the products.

The number of Kenyans aged over 15 who use tobacco products − including manufactured cigarettes and cigars, hand-rolled cigarettes, pipes, shisha, snuff, chewed tobacco and kuber − declined marginally from nine per cent in 2012 to eight per cent in 2017, shows a 2018 National Authority for the Campaign Against Alcohol and Drug Abuse (Nacada) study. This means that about 2.2 million Kenyans use tobacco products, out of which two-thirds smoke cigarettes.

Only seven per cent of smokers who attempt to quit smoking in Kenya succeed.

At the same time, there is a rise in the consumption of cigarettes and cigars. According to the Statistical Abstract 2017, use of cigarettes and cigars jumped by more than two-thirds from 6.7 billion sticks in 2012 to 11.3 billion sticks in 2016.

Cigarette smoking is the number one risk factor for lung cancer. In Kenya, it is linked to more than 70 per cent of lung cancers, according to the National Guidelines for Cancer Management. It also causes cancer in almost all parts of the body and cardiovascular illnesses such as heart disease and strokes.

When age is factored in, one in eight adults aged 36-65 uses tobacco products, a prevalence almost double that of people aged between 15 and 35.

AVERAGE AGE

Progress in kicking the habit is uneven. Tobacco use increased two percentage points among people over 35, from 11 per cent in 2012 to 13 per cent in 2017, according to Nacada. But in a positive development, tobacco use decreased by three percentage points among those aged between 25 and 35, from 10 per cent in 2012 to seven per cent in 2017. A similar decline was experienced among youths aged 15-24. Most smokers start young and struggle to quit. The decline in tobacco use among younger people provides a glimmer of hope that the anti-tobacco campaign can succeed.

Data from a 2015 African Population and Health Research Centre (APHRC) study shows the average age smokers start puffing is 21.

Mr Francis Kioko has been a smoker since he was 15. “We grow tobacco in Kitui County, so my first encounter was rolling the dried leaves on a piece of paper and smoking. On coming to the city, I ‘graduated’ to cigarettes.” He spends Sh32 daily on his favourite cigarette brand, that goes for Sh8 a stick. This translates to Sh960 a month. “I smoke four cigarettes a day. One during lunch-break, and three in the evening when I get home. My family lives in Kitui so they are not exposed to the smoke.”

Like him, a third of daily cigarette smokers consume less than five cigarettes per day while five per cent smoke more than 25 cigarettes daily. The average smoker of manufactured cigarettes smokes seven cigarettes daily while the hand-rolled cigarette smoker lights up twice, indicates the APHRC study.

ATTEMPT TO QUIT

About a third (35 per cent) of smokers have attempted to quit smoking and most failed, illustrating the difficulty faced in breaking the addiction. Mr Kioko is no exception. “Every time I try to quit, I fail. Just the sight of a person smoking, or the smell of burning tobacco is enough to make me buy one. Also, my friends smoke. That’s how we spend our social time,” he says.
Only seven per cent of smokers who attempt to quit smoking in Kenya succeed, with the highest success rate being among those aged between 15 and 24, at 17 per cent, followed by those aged 45-64 (12 per cent) and age 25-44 (three per cent), according to the Global Adult Tobacco Survey 2014.

People who quit smoking have a lower risk of lung cancer than if they had continued to smoke, but their risk is higher than the risk for people who never smoked. Quitting smoking at any age can lower the risk of lung cancer, according to the US Centres for Disease Control and Prevention (CDC).

Aware of the many bad effects of cigarettes, Kioko blames his nagging chest problems on smoking. “Occasionally, I experience chest problems especially if I change the brand I smoke,” he says.

Tobacco use varies widely by region. According to the Nacada survey, Coast and Eastern regions lead with one in nine people aged 15-65 using smoke and smokeless tobacco products, followed by Nairobi with 10 per cent. The prevalence of tobacco use in the three regions is double Nyanza’s five per cent, the lowest. Despite having the second-lowest share of tobacco users, at six per cent, Western experienced the largest increase in prevalence, doubling from three per cent in 2012 to six per cent in 2017.

Western’s prevalence is followed from the rear by Central (seven per cent) Rift Valley (eight per cent) and North Eastern (nine per cent). Other regions that recorded an increase in prevalence are Nyanza (a third), Coast (13 per cent), and Eastern (nine per cent).

North Eastern recorded a 45 per cent fall in the share of people who use tobacco trailed by Nairobi (28 per cent), Central (27 per cent) and Rift Valley (11 per cent).

As expected, the Nacada survey finds that more men than women use tobacco. One in six men uses tobacco, a proportion similar to 2012. In contrast, one per cent of women do the same, a decline by half from two per cent in 2012.
Tobacco use is among the five leading behavioural causes of cancer, and is responsible for about a third of cancer deaths globally, according to WHO.

Data from the Kenya National Bureau of Statistics shows that one in 11 deaths in Kenya was caused by cancer in 2017, making it the third deadliest disease after malaria and pneumonia. The habit is also the second leading cause of cardio-vascular diseases and high blood pressure, according to WHO. The UN agency also reports that tobacco use kills 31,000 people annually in Kenya.

According to the CDC tobacco smoke is a toxic mix of about 7,000 chemicals, of which 70 cause cancer in people and animals.

The CDC reports that cigarette smokers are 15 to 30 times more likely to get lung cancer than those who do not. Even smoking a few cigarettes a day or smoking occasionally increases the risk of lung cancer. Cigarette smoking also causes cancer of the mouth and throat, liver, pancreas, oesophagus, stomach, colon, rectum, voicebox (larynx), trachea, bronchus, urinary bladder, cervix, kidney and renal pelvis, as well as acute myeloid leukaemia.

Secondhand smoke also causes lung cancer in non-smoking adults. The 2015 APHRC study finds that a quarter Kenyans are exposed to secondhand smoke at home.

Smokeless tobacco is not safe either, as it is likely to cause oesophageal and pancreatic cancers. In Kenya, four per cent of tobacco users consume smokeless tobacco (chewing and sniffing).

PASSIVE SMOKERS

Secondhand smoke also causes lung cancer in non-smoking adults. The 2015 APHRC study finds that a quarter Kenyans are exposed to secondhand smoke at home.

WHO estimates that one in seven people killed by tobacco is a passive smoker.

While the Tobacco Control Act bans smoking in public places, a random survey by Newsplex observed several people smoking on the street instead of designated areas.

Despite workplaces being designated as a smoking-free environment, the APHRC Survey, that was done jointly with the Ministry of Health, shows that one in five adults are exposed to secondhand tobacco smoke at their places of work.