Africa is expected to double its tobacco consumption in 12 years if current trends continue. The surge in smoking is seen in young people under the age of 20 that constitute the majority of the continents population. In this installment of our series on smoking in Africa, VOA's Henok Fente reports unless governments enact tobacco control laws, Africans who are smoking and those who live with smokers are in great danger.
Homeless street children are selling cigarettes in the streets of the northern Ethiopian town of Mekele. They display cigarette packs on a wooden framed hard paper board and call out the names of local and international cigarette brands.
Here, it may be difficult to find a pack of condoms, but cigarettes are everywhere. From the streets of Mekele, to the city of Abidjan in the West African nation of Cote D'Ivoire; from south to north, throughout the continent of Africa, smoking is on the rise.
For many, smoking starts at a young age. It starts with peer pressure, being exposed to second hand smoking, having parents and best friends who smoke. And for some, just simply to be cool. Dr Adamson Muula is a senior lecturer of public health at the University of Malawi.
"In much of the areas here, it is between 10 percent for low prevalence countries, to 20-25 percent," Dr. Muula says. "Twenty five percent would be rare for our region. Contrast that with Eastern Europe where sometimes 50 percent, 40 percent or even more adults are smoking."
He says in comparison Africa has the lowest rate of smokers, but smoking in general is on the rise on poor continents like Africa, where more than 60 percent of the population is under 18 years of age.
Each year millions of Africans find themselves between a rock and a hard place — between the difficulty of quitting and the suffering that can result from smoking. The World Health Organization estimates tobacco is the second most important risk factor for disease, following malnutrition. According to this report, the number of smoking-attributed deaths worldwide at the turn of the century was more than the number of AIDS-related deaths. Four-point-nine million people died from smoking-related sicknesses. The death rate is even higher in Africa, where treatment options are absent. Despite the figures, Dr. Adamson Muula says, smoking is not a priority in African public health strategies.
"Tobacco is way down in the public health concerns we have," he explains. "There is malaria, malnutrition, HIV-AIDS, and tuberculosis. So, tobacco comes as something we know to be harmful, but we are not ready to handle at this time because of the limited resources that are available."
Very few countries in Africa have tobacco control acts to protect citizens from adverse effects of smoking, second hand smoking and the rate of new addictions. The very few who do, have not built the capacity to enforce the law.
As a result, young people like Kibrom of Mekelle had access to cigarettes in elementary schools. Kibrom says puffing here and there from seventh grade on led him to be a chain smoker before turning 18. "When I drink or eat, I badly need to smoke. Sometimes when I am working, without cigarettes I could not focus on my job," Kibrom explains.
Kibrom has tried to quit several times, but his efforts have been futile. "I hear from doctors that it hurts inside," he says. "But still now, I am not hurt. But economically it really hurts."
Young people who are not economically well off comprise almost half of Africa's smoking population. Unlike in some Western countries, smoke-free public areas are rare. People puff in restaurants, bars, and public transportation, exposing others to secondhand smoking.
According to a 2007 U.S. Centers for Disease Control report, among students 13 to 15 years of age, non-smokers who were exposed to second hand smoking at home or at school were twice as likely to start smoking.
Dr. Adamson Muula of the University of Malawi says in some ways smoking is a taboo in Africa. This leads to young children to hide from immediate family members and society while smoking. At the time young smokers come out of the closet, they are already addicted.
Hakim Tutu lives in Lome, Togo. He says it is difficult to be accepted as a smoker, even as an adult.
"Cigarettes are still taboo," Hakim says. "First of all, my parents don't accept that I smoke, and the same goes for the rest of my family for my brothers and sisters. At work, it is the same thing with my colleagues. Even with friends, people that I see often, when I smell like cigarettes, they pull back from me."
Men constitute of 70-85 percent of African smokers. It is rare to see women smoking in public in Africa. But these days, for young and sophisticated African women, smoking has become a fashion statement. Selam lives in Mekele town in Ethiopia. She smokes when she is chewing Khat and in night clubs.
"I just do it for fun, you know," Selam explains. "When all my friends smoke and when I am with them, I smoke."
Fabric Ebbe, a Togolese anti-smoking activist tells VOA African society should not accept cigarette use, "Overall, we estimate that 31.3 percent of the population are smokers and that 14 percent Togolese youngsters smoke," the activist explains. "We can't say that we smoke a lot, but it is still worrisome. In the minds of young Togolese, smokers are elegant; which is false. It is rather, those who do not smoke who are respected, who are classy. A smoker in Africa is considered a hoodlum, a hooligan. But non-smokers, they are respectable."
Experts say developing nations need a comprehensive approach to curb smoking. In Africa, where the majority of the population is under 20 years old, schools and families can play a significant role in reducing smoking rates. But experts also agree, the political will and legal framework will be needed to minimize smoking among Africans.