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WellBeing: March 2016


February 24, 2016
By Elias Markou

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In the past few months I have conducted many firefighter physical exams for a number of fire departments. As I was going through the medical assessments, I observed an interesting trend: a significant number of firefighters still smoke.

A September 2011 article in the American Journal of Industrial Medicine found that 13.6 per cent of career firefighters and 17.4 per cent of volunteer firefighters in the United States smoke. A larger percentage of career and volunteer firefighters used smokeless tobacco – 18.4 per cent and 16.8 per cent respectively. Despite the fire service’s strong position against smoking, and the fact that firefighters need to maintain a high level of health and fitness, there is still a high number of smokers. In the United States, the percentage of firefighters who smoke is equal to that of the public average. But shouldn’t firefighters be more fit and healthy than the average person?

In Canada, tobacco causes about 37,000 deaths each year and is the leading cause of preventable death. A 2008 Health Canada Smoking Report found smoking kills more people in Canada than the combined deaths caused by traffic accidents, suicides, murders and drug abuse. If you weren’t moved by those stats, how about this one: cigarettes contain more than 4,000 harmful chemicals including tar, lead, hydrogen cyanide, acetone and carbon monoxide. At least 70 chemicals found in cigarettes are known to cause, initiate or promote cancer.

Thousands of studies have been conducted worldwide and the results are definitive: smoking tobacco is addictive and a huge risk to a person’s health.

A 2014 report by the United States Department of Health and Human Services found that nearly every organ in the human body is impacted by cigarette smoke exposure, proving that no amount of exposure to tobacco by-products is risk free.

The International Association of Fire Fighters (IAFF) acknowledges the deadly synergy between tobacco use and on-the-job exposures. According to the IAFF website, “This deadly interaction between tobacco use and on-the-job physical stresses and exposures to carcinogens and other toxic agents increases negative effects to even greater levels than the sum of these independent health risks.” The IAFF goes on to say that the expected consequences of smoking are higher rates of heart disease, respiratory disease and cancer.

What is it about cigarettes and tobacco that impacts our health in such a dramatic way? David Abrams from the John Hopkins School of Public Health in the United States found that the greatest risk to smokers is those 4,000 harmful ingredients found in all tobacco products. These chemicals cause irreversible damage to our DNA, so much so that new evidence shows liver and colorectal cancers have strong causal relationships to tobacco.

How can firefighters stop the addictive behaviour of smoking? What help is there available for firefighters to kick this crazy habit?

Acupuncture, acupressure and ear laser therapy are techniques that can assist with smoking cessation. A few acupuncture studies have demonstrated positive associations and abstinence rates in smoking.

There are a number of scientific studies on the effectiveness of using hypnosis to quit smoking. At the end of one study, 61 per cent of patients reported that they had quit smoking. Success rates of smoking cessation after hypnosis seems to fall between 60 to 70 per cent.

Some consider author Allen Carr’s book Easyway to Stop Smoking to be the quit-smoking bible. Carr explains to readers that, yes, nicotine addiction and withdrawal exist, but people need to change the way they think in order to quit. In a 2006 study published in the medical journal Addictive Behaviours, researchers found that after reading the book, 53.3 per cent of all smokers (and 63.6 per cent of pack-a-day or less smokers) were still smoke free after 12 months.

Anti-depressant drugs such as Zyban and Wellbutrin and nicotine-blocker Champix all reduce cravings and help with smoking withdrawal symptoms, but have a number of dangerous side effects on their labels. In one study, Zyban’s six-month quit rate was 18 per cent, and placebo was 11 per cent, while the 12-month quit rate for Champix was 22 per cent under artificial trial conditions.

There are no studies yet available that connect e-cigarettes to smoking cessation. I don’t see how vaping another harmful chemical replaces smoking tobacco.

The fact that research shows smoking causes an increased risk of heart disease, chronic respiratory disease and cancer should be enough to motive firefighters to stop smoking. Quitting smoking is the single most important thing firefighters can do to improve their health.


Elias Markou is in private practice in Mississauga, Ont., and is the chief medical officer for the Halton Hills Fire Department. Contact him at dmarkou@mypurebalance.ca


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