Weak enforcement of law exposes minors to tobacco use, risks

Brian Okello, in his late 20s, was in lower primary school when his interest in cigarettes began. His school was separated from the market by a mere barbed wire fence.

During class breaks Okello would sit by the fence and watch young men flock to a nearby shop to buy cigarettes.

“They seemed to be having fun and enjoying themselves as they puffed away and let the smoke out through their mouths and nostrils. So I longed to be as cool as they were,” he said.

The delusion pushed him to begin experimenting with cigarettes in his teens after joining high school.

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“It’s the worst mistake I have ever made in my life,” said Okello who is fighting the addiction to no avail.

“My body is already hooked to nicotin, I can’t function without cigarettes. Whenever I stop smoking I become sick, so I waste my money buying the product just to feel normal.”

Aside from appearing frail and week, Okello’s skin is pale and a bit wrinkled, making him seem much older than he really is. He complains of chest problems and incessant coughs. Doctors say the problems will only go way when he cuts back on cigarettes.

“My life isn’t easy and I wouldn’t wish it on anyone. There’s nothing as bad and scary as being addicted to something that you know is slowly killing you yet you have no power to fight it.”

“If there’s any young person out there thinking of experimenting with cigarettes, please don’t start. I beg you. Don’t repeat the mistake I made,” he pleads. Today, as Kenya marks the World No Tobacco Day, health experts are calling for strict enforcement of tobacco control laws as well as effective programmes that protect the youth against adverse effects of its products.

Tobacco products include cigars, cigarettes, water pipe (such as shisha or hookah) and dissolvable nicotine products as well as smokeless tobacco such as electronic cigarettes (e-cigarettes). People can also consume tobacco by chewing its leaves or sniffing it.

“We need to keep sensitising law enforcers so they can be aware of what is expected of them in tobacco control. Awareness is also important to discourage tobacco use among the youth,” said Gamaliel Omondi, Deputy Director of Public Health at the Ministry of Health (MoH).

Government statistics show that about 10 per cent of Kenyan youth aged between 13 and 15 years use tobacco products. These are innocent children who are mostly experimenting with tobacco products while being oblivious of their catastrophic health impacts as was the case with Okello. Studies show that 90 per cent of adult smokers begin the habit while in their teens or earlier.

Out of this, about two-thirds become daily smokers before they reach the age of 19.

“So, if we’re to prevent deaths from tobacco then the best way is by not starting at all,” said Salim Hassanali, chest and lung specialist at Aga Khan University Hospital (AKUH). Dr Hassanali said that due to peer pressure and out of curiosity, most young people start consuming tobacco products thinking they are harmless only to realise the dangers much later in life when they are already hooked to them.

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According to the World Health Organisation (WHO), the tobacco epidemic is one of the biggest public health threats the world has ever faced.

Tobacco kills up to 50 per cent of its users and is a major risk factor for non-communicable diseases (NCDs) such as cancer, cardiovascular disease, diabetes and chronic respiratory ailments which exert a huge burden on Kenya’s economy.

By 2030, the WHO estimates that tobacco will kill more than eight million people every year, with four out of five deaths occurring in low and middle-income countries like Kenya.

“For every health problem caused by tobacco products the government spends three times more than the revenue it generates from tobacco taxes. So the losses are much more than the gains,” said Dr Omondi.

As per the WHO Framework Convention on Tobacco Control (WHO-FCTC) recommendations, Kenya enacted the Tobacco Control Act in 2007 to combat the epidemic. Among other things, the law prohibits the sale of all tobacco products to minors below the age of 18. Other stipulations of the law such as the ban on the sale of single sticks of cigarettes also protect children from being lured into the tobacco trap. But just as is the case in most countries across sub-Saharan Africa, the implementation of the laws is sub-optimal, hence leaving children vulnerable to the adverse effects of tobacco. A 2018 study by the Africa Tobacco Control Alliance (ATCA) that was conducted in 10 African capital cities, including Nairobi, found that sale of single stick cigarettes was rampant and that they were illegally being sold to school going children.

“Single cigarettes are sold at a price point that allows vulnerable populations, such as the youth, to buy cigarettes without paying the price of a whole pack,” said Bintou Camara, Africa programmes director at the Campaign for Tobacco-Free Kids (CTFK).

She noted that governments should strictly enforce the law in order to protect the most vulnerable categories of their populations, such as children, from the dangers of tobacco consumption and addiction.

According to Ms Camara, tobacco companies also need to be more accountable and put in place compliance mechanisms to ensure that their retailers comply with the law.

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“Some of these retailers lack awareness on the change of laws but others may just be deliberately selling the single sticks so as to boost sales and recruit more customers from a young age,” Joel Gitali, chairperson of the Kenya Tobacco Control Alliance (KETCA) said.

Emma Wanyoyi, CEO of the International Institute for Legislative Affairs noted that selling of single stick cigarettes waters down the effect of high taxes slapped on tobacco products as vulnerable populations like children are still able to access them.

A packet of cigarettes costs between Sh80 to Sh220 while a single stick costs between Sh4 to Sh10.
Following the enactment of the Tobacco Control Act, the government banned all forms of tobacco advertising, promotion and sponsorship.

“However, due to weak law enforcement, advertisement has gone underground and is sometimes done in covert ways,” says Ms Wanyoyi.

For instance, she notes that some unscrupulous retailers reach out to children in shops located next to schools where they inform them of promotional offers like “buy-one-get-one free.”

Smoking is prohibited in Kenyan schools. However, Ms Wanyonyi notes that there is no regulation governing the sale of tobacco in shops near such institutions.

“This is making children vulnerable to tobacco use. The government needs to clearly define the distance such shops should keep from learning institutions. This has happened elsewhere like in Uganda. So we can do it.”

The 2010 Alcoholic Drinks Control Act, for instance, bans alcohol outlets from within a 300-metre radius of learning institutions.

A study last year by the Johns Hopkins Bloomberg School of Public Health in collaboration with the Consumer Information Network (CIN) found that a majority of vendors display cigarettes next to child friendly snacks, sweets and soft drinks.

“This should be stopped as it tempts children and confuses them. They begin associating the goodness of sweets or sodas with cigarettes. So they begin longing for a time when they (come of age and) can also buy cigarettes,” said Mr Gitali.

By nature, Ms Wanyonyi noted that the smell and taste of cigarettes is unpleasant. And that alone may be enough to discourage children keen on experimenting with the product from doing so.

But new products such as shisha and flavoured cigarettes are increasingly becoming attractive among young users. “As a doctor, I have noticed this trend and it’s worrying as these new products are still harmful irrespective of the way they have been packaged. Some are even worse than normal cigarettes,” said Dr Hassanali.

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For instance, statistics from the WHO show that one shisha session is equivalent to smoking about 200 cigarettes.

He said that even e-cigarettes, which are perceived to be less harmful, are still unsafe. “They comprise mainly of nicotine which is highly addictive. Why would you start using something that will eventually end up controlling your life?” Dr Hassanali asked.

A 2017 study published in the “Journal of the American Heart Association” (JAHA) revealed that nicotine in e-cigarettes raises adrenaline hormone levels in the heart, thus making users vulnerable to cardiovascular disease.

As per the recommendation of the law, tobacco companies now put health warning messages and graphic images on cigarette packets. This is aimed at discouraging tobacco use.

“But we need the warnings to be enlarged so that they can be more visible. They should cover 30 per cent of the front section and 50 per cent of the back cover as per the guidelines,” said Ms Wanyonyi.