40 percent of smokers begin between the ages of 15-19. According to researchers, the intensity of spiritual-psychological and social problems between the ages of 13 and 19 puts youths under a higher risk of starting smoking. Smoking as an adolescent can be related to low self-esteem and academic problems. It is an established fact that teenage smoking is the most influential risk factor for adult smoking. A young person looking for a role model can be influenced by one’s parents, teachers, and friends. Family structure and social environments are influential regarding smoking and other addictive behaviors. Keeping away from smokers reduces the likelihood of smoking.

It is reported that light depression increases smoking, and that regular smokers’ have higher incidences of depression and suicide when compared to non-smokers. Smoking rates are higher with those who do manual labor, who have smokers among family members or close friends, who live in urban centers, who have a high income, who work under difficult conditions, who have a history of social problems, and who are male. It is also reported that 94% of people who smoke more than three cigarettes a day at the beginning become addicted in the long run.

Why do people insist on continuing a behavior they know to be harmful or that they cannot give up easily even if they wish to? There are various reasons for this. First of all, human beings do not only make decisions and act within the control of reason, logic, willpower, and conscience. Cigarettes contain addictive chemicals that stimulate the brain’s pleasure center. Developing an addiction weakens willpower. When individuals realize how dangerous this addiction is, it is mostly too late to give up, since it takes significant willpower. We act not only based on logical information, but on intense feelings, too. Thus, a person continues to smoke in spite of knowing the dangers. A person’s degree of psychological and spiritual “hunger,” the strength of their feelings, and a failure to meet other healthy goals can be contributing factors to an addiction.

The World Health Organization defines dependence syndrome as “a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value.” Considering cigarette dependence, the person may find it really hard to break free from a vicious cycle beginning with thought, gaining velocity with feelings, and ending with the execution of a certain act.

In terms of the human brain and neurotransmitters, smoking causes nicotine to react with nicotine receptors. As a result of long-term nicotine intake, a neuro-adaptation increases the number of nicotine receptors in the brain. The brain develops tolerance to certain effects of nicotine. After a person has become neuro-physiological dependent, they begin to crave nicotine.

The effects of nicotine on the human body depend on the dose and have two aspects. The reduction of nicotine in blood causes symptoms of depravation, and its increase causes symptoms of poisoning. If a person smokes more cigarettes, and has free access to them, the amount required to achieve stimulation grows; their tolerance gets higher. Because nicotine is a psychological and spiritual stimulant, it often gives a feeling of temporary relief, which helps the smoker to forget their problems. This causes the smoker to draw a connection between smoking and a lack of worries, thus further affecting their reasoning and will power. Researches have shown that as the daily number of cigarettes increases, the habit shifts from the critical phase to the supercritical, and that psychological dependence turns into neuro-psychological dependence. 75-80 percent of smokers wish to give up smoking, and one third of dependent smokers attempted to give up smoking at least three times.

Phases of treatment

The purpose in treatment is making the smoker give up the habit in the long run. The first goal is to get the behavior under control by reducing the amount of cigarettes, and then, finally, cutting them out completely. A set of psychological thresholds smokers need to overcome are defined. Each of them is passed by overcoming different psychological and social obstacles.

1. Not being aware of the damage and not taking any steps for change: At this phase, the smoker does not calculate the possible harm of smoking and thus does not wish to give it up. When the subject is mentioned, it is dismissed by means of certain defense mechanisms. Those who wish to help the smoker must know this situation, and they should never engage in a dispute about smoking; by using soft spoken words, they should patiently try to make that person feel the grim realities of smoking.

2. Beginning to think about giving up smoking: At this phase, the person states that he or she will give up smoking whenever the subject is mentioned. The person also expresses being aware of the dangers and being in need of help to give up. However, taking action can sometimes take months, or even years. At this phase, the person should make a self-evaluation for the sake of putting one’s knowledge to real life practice, and to help them face their conscience. Those who wish to give up smoking had better prepare a list of the advantages to not smoking. Sincerity and empathy shown by the person to help the smoker are the most influential help; a single look or word might have an adverse effect and cause a relapse.

3. The preparation: The person is ready to give up smoking. At this phase, it will be useful to prepare a practical plan by benefiting from the tips of those who gave up smoking successfully. The date to give up should be set, preferably a meaningful day for the person, such as a birthday or anniversary. For spiritual support, it can be useful to previously announce the day to give up smoking to the person’s friends and family.

4. Action: The person has quit smoking. Having a small ceremony can be beneficial, as it creates a sense of psychological and social obligation; in the interest of these obligations, it’s important the person receive social support throughout the process. The person should keep away from people and places that make them feel like smoking. Exercise is a good way to combat any urges. When the person feels an urge to smoke, one must take a deep breath, and then release it slowly after holding it for some time. They should know that an intense urge to smoke only lasts for two or three minutes and soon subsides.

5. Continuing the newly acquired good behavior: At this phase, the person must be resolved not to relapse. At this point, the issue depends on the person’s freewill. It will be useful to reward ones’ self for not having started again. One of the most important components of treatment is helping the smoker develop proper interests and hobbies so that they are not tempted to start smoking again. Others around the person can provide positive psychological support. It is narrated that one drunken man came to visit Rumi, but his disciples tried to get rid of him with harsh treatment. On seeing this, Rumi remarked: “He drank the toxicant, but you have become intoxicated.” In the same way, we must also act with magnanimity, tolerance, and a feeling of responsibility to save our friends from such a dangerous habit.

Smoking is a habit that can be given up and treated

Is it a wise strategy to give up smoking all of a sudden? Is it possible? Is it advised to give it up gradually? Answers to these questions differ from patient to patient. First and foremost, giving up smoking depends on the person’s own wish, resolution, and willpower. It is possible to give up this habit. According to the WHO, treating smokers are among a doctor’s duties. It is known that as a consequence of anti-smoking campaigns and activities, millions of people gave up smoking. As the average rate of success remains under 10% for those who receive no help, we need to provide as much support as possible and encourage people to be healthy.

None of the methods for giving up smoking are 100% successful on their own. The best results are obtained when medical treatment supports the psychological, mental, and spiritual processes. Medical treatment include symptomatic treatments that target the feeling of deprivation that arise after giving up smoking and using other drugs to lessen the wish to smoke.

References

• Heatherton, Todd F. et al. 1991. “The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire.” British Journal of Addiction 86:1119-1127.
• JC Norcross, Krebs PM, Proschaska JO. 2011. “Stages of Change.” J. Clin. Psychol. Feb. 67 (2):143-54.
• World Health Organization http://www.who.int/mediacentre/factsheets/fs310/en/index.html. Accessed March 9, 2013.

Harming our bodies or health is a betrayal against this incredible gift. One of the major ways people harm the body is through smoking cigarettes.

Smoking harms human health in countless ways. It is one of the main causes of many diseases, such as lung and throat cancer, along with cardiovascular and respiratory track diseases, such as chronic bronchitis. According to the latest report from the World Health Organization, smoking remains the fourth of the top ten risks that threaten human health. Approximately 20-30% of adult fatalities are caused by ailments contributed to by smoking. Recent studies have shown the negative effects smoking has on human reproductive functions.

Effects on fallopian tubes

Smoking has a negative impact on female reproductive organs; this impact is determined by how long, and how much, a woman smokes. It may cause infertility by damaging the fallopian tubes that serve as a ground for the egg to be fertilized by sperm. In many studies, the risk of damage to the fallopian tubes was very high – this danger increases if a woman starts smoking a pack a day before the age of 18.

Effects on female hormones

Many toxic substances in cigarette smoke, including nicotine, directly inhibits the activity of the enzyme called aromatase, which plays a major role in the synthesis of the female hormone (estrogen) in the ovaries. Depending on the biological function, estrogen can be found in three different forms: as estrone, estriol and estradiol. Polyaromatic hydrocarbons found in cigarette smoke stimulate the microsomal cytochrome P-450 enzyme system that degrades hormones in the liver and, consequentially, increases conversion of estradiol with high biologic activity into estriol with the lowest activity. Alkaloids, one of the harmful substances found in cigarette smoke, were discovered to prevent production of progesterone in the ovaries. This plays a role in preparing the womb and in continuation of the pregnancy during the first three months. Therefore, smoking leads to progesterone deficiency during the early stages of pregnancy, causing miscarriages.

Effects on the maturation of the egg

The concentrations of the FSH hormone that is involved in the maturation of reproductive cells in the ovaries are especially high in young female smokers. In other words, a resistance develops against the FSH hormone in the ovaries and higher FSH hormone levels are required for the maturation of the egg. Thus, fertilization problems and missed periods can occur because of an absent reproductive cell. During the treatment of such patients with insufficient egg cell maturation, there is a 50% decrease in the success of the implantation (placement of the fertilized egg into the womb) and the continuation of the pregnancy in smokers when compared to nonsmokers. This means smoking significantly reduces ovarian functions, and ovarian stimulation becomes inadequate at earlier ages in women.

The negative effects of smoking on the reproductive system are also observed during the implementation of reproduction methods such as in vitro fertilization and assisted fertility technologies. The presence of high androgenic hormone levels (pre-metabolites of gender related hormones: androstenedione, DHEAS and testosterone/SHBG) in female smokers has been found to decrease the possibility of pregnancy during in vitro fertilization efforts.

Effects during pregnancy

There are many harmful consequences of smoking during pregnancy, especially for older women who are pregnant. Some of these consequences are premature birth, miscarriage, retardation of development, inadequate baby weight, perinatal mortality, ectopic pregnancy, placental praevia, and placental abruption. Placental praevia is the abnormal placement of placenta in the womb. In this case, depending on the excessive bleeding that occurs after the eighth month of gestation, the lives of the mother and fetus become imperiled, and fetal development is hindered. Placental abruption occurs depending on the premature separation of placenta from the womb, causing excessive bleeding that can also endanger the lives of the mother and baby.

In pregnant smokers, the postnatal ratio of infant mortality and disability increases as a consequence of deficiencies involving lung function and nerve development. These effects are directly proportional to how much a woman smokes. There are also negative impacts when a pregnant woman is exposed to second hand smoke by a spouse or close friend. Harmful metabolites of nicotine reach the baby via the placenta. Furthermore, nicotine is degraded slowly in the liver of a pregnant woman. Inadequate baby weight is related to smoking dosage and time.

Due to smoking in the early stages of pregnancy, the hormone levels of estriol, estradiol, progesterone and hCG, hPL which is secreted from the placenta, have been found to decrease. This reduction, which is observed in parallel with the amount of smoking, can result in miscarriages.

Toxic polyaromatic hydrocarbons have been found to accumulate at elevated ratios in the wombs of women who were exposed to cigarette smoke for a long time. During pregnancy, this situation leads to the deterioration of sertoli cells located in the reproductive glands of male fetuses. These glands assist in sperm production during adulthood, and damage to them can therefore cause a reduction in sperm generation.

An insufficient placental development occurs because of the negative effects of nicotine, cadmiums, and polyaromatic hydrocarbons damage the reproduction of trophoblast cells that make up the placenta. This situation explains the increasing miscarriage ratios among female smokers.

The free T4/TSH ratio in the serum of the umbilical cord, which connects the fetus to the placenta, increases in the babies of smokers compared to those of nonsmokers. This means that in babies of smokers, the thyroid glands may become overactive during birth. Depending on a mother’s smoking habits, this hyperactivity of the fetal thyroid increases the metabolic speed and the amount of consumed oxygen in the body, thus leading to the inadequate development of fetus.

Menopause occurs two-to-four years earlier due in women who smoke, as compared to non-smokers. This is due to the aging of the eggs. The risk of entering menopause before the age of 45 in women who quit smoking at least ten years prior is 87% less than smokers who don’t quit. Therefore, the earlier a woman stops smoking, the lower the risk of early menopause.

Effects of smoking on men

In research studies, it has been discovered that smoking has many harmful effects on testicular development and functions. These effects can be summarized as follows:

• Reduction of semen volume and quality, increase in its adhesiveness, delay in its becoming liquid, and resulting deformation of the sperm.

• Reduction in the number and mobility of sperm cells.

• Delayed sperm nucleus maturation, deteriorated DNA integrity.

• Decrease in the production of testosterone from Leyding cells.

• Decrease in the egg fertilization capacity of the sperm.

As a consequence of these negative effects, male infertility can occur. As the amount of daily cigarette consumption increases, the number, strength, and types of anomalies also increase. In a study conducted in 2010, smoking has been showed to decrease zinc levels in the seminal plasma. As a result of this decrease, oxidative agents populate and DNA breaks take place, thus causing a disruption of sperm functions and infertility. Zinc deficiency at the same time leads to the destruction of seminiferous tubule cells where sperm cells are produced. Paternal smoking generates negative results during the application of assisted fertility methods (such as in vitro fertilization). The damage in the sperm DNA of the father can disrupt the embryo development. The risk of anomalies, cancer, and genetic diseases increases for the fetus.

Cigarette smoking clearly occupies a position as one of the worst enemies of mankind because of its destructive effects on the body. In this case, it does not make any sense to try finding excuses for smoking, for it is harmful to the body that has been loaned to us as a gift and a temporary property.

Cihanoglu is a professor of medicine in KATU, Trabzon, Turkey.

It is estimated that 80 to 90 percent of all cancer cases are related to environmental and lifestyle influences (1). Many cancer research centers estimate that 80 to 90 percent of human cancers are preventable. Beside chemicals and infections (viral and parasitic), extrinsic factors include diet among a variety of other factors wholly or partly determined by personal behaviour. Though genetic factors and age affect cancer onset rates, the conclusion holds that many human cancers are avoidable (2). A great number of these are related to tobacco smoking and chewing, alcohol consumption, homosexuality, promiscuity and excessive exposure to solar radiation as in sunbathing, all practices disapproved in traditionally religious societies.

Dr John Hill, a London physician, reported an increase of lip cancer in pipe smokers as long ago as 1761. Sir Percival Pott reported cancer of the scrotum in chimney sweeps in 1777, which he attributed correctly to lodgement of soot in the rugose scrotal skin. This type of cancer was virtually eliminated by simple personal hygiene (3). Later, many chemicals were proved to be carcinogenic and hence many cancers became avoidable by taking more care when dealing with them. Ionizing radiation is still an important hazard, preventable by taking better care.

Tobacco and Cancers

In many countries cancer is the second most important cause of death. In the USA and many developed countries, it accounts for 20 percent of all deaths (1,2). An estimated 6 million new cases of cancer occur annually worldwide, of which about a million are caused by tobacco smoking and chewing (4). The death toll due to malignant disease in the USA amounts to 400-450,000 annually of which 100,000 are due to lung cancer, 85 to 90 percent of those due to cigarette smoking (1,2). Indeed, tobacco (smoked, chewed or sniffed) is the most important single factor in cancer causation generally, responsible for 30- 40 percent of all cancers (5). No other single agent has been examined in more detail, nor more firmly established as a causal agent, than cigarette smoking (6). Let us look at some of the facts.

The risk of cigarette smokers developing lung cancer increases with the number of cigarettes smoked the duration of smoking, the time of onset and the type of smoking. Approximately one-sixth of those who smoke two packs of cigarettes per day will eventually develop lung cancer. The risk to hose who smoke 40 cigarettes per day are 25 times more that to non-smokers (6-8). Cigarette smoking causes all ol the major types of lung cancer including squamous cell carcinoma, adeno carcinoma, oat cell and large cell carcinoma (6). Cancer of the lung was a rare form of cancer at the beginning of this century, even in developed countries. As smoking increased dramatically after World War I among men, and among women after World War II, the incidence of cancer of the lung showed incessant increase until the seventies, after which it began to decline among men and a decade later among women. Nevertheless, cancer of the lung is still the first killing cancer among men and women in many developed and developing countries (7,9,13). In Hong Kong, the rates for women are now the highest in the world (13). Lung cancer rates in Chinese men (e.g. 50.2 per 100.000 in Shanghai) are higher than in many North American and European populations (13). It is the leading cause of cancer mortality among males in Bulgaria. Cuba, Czechoslovakia, Egypt, Greece, Hong Kong. Hungary, Israel, the Philippines, Poland, Romania, Singapore, Thailand, Uruguay and Zimbabwe. The risk is particularly high among cigarette smokers, and a clear cut dose-response relationship has been confirmed. The risk is greater among those who started smoking at a young age and those who smoke high tar cigarettes (2,14-16).

Laryngeal cancer is the second cancer caused by cigarette smoking, but the total number of cases is smaller than lung cancer and the survival is much better (6). Cigarette smokers are five times more likely to develop cancer of the oral cavity and the oesophagus than non-smokers (&-8). There is synergism between alcohol and cigarette smoking in causing cancer of the larynx oesophagus and oral cavity(6-8.14-16,22).

Cigarette smoking is also an important contributing factor in cancers of the bladder, kidney and pancreas. Association between gastric cancer and smoking has also been noted (23-26). Cigarette smoking has even been implicated in cancers affecting the breasts, kidneys, liver, cervix, uteri and many other organs (27-29). It has also been implicated in childhood cancer as a result of prenatal exposure to parental smoking (30). Passive smoking was implicated in causing many cases of cancer (31-33).

Non-smoked Tobacco

Long term use of chewing tobacco or snuff has been linked to cancer of the oral cavity, cheek, gums and oropharynx (6). Oral cancer is one of the ten most common cancers in the world. In Bangladesh, India, Pakistan and Sri Lanka, it is the most common malignant disease and accounts for a third of all cancers. More than 100,000 new cases occur annually in South and South East Asia (13). The commonest cause for oral cancer is tobacco chewing, usually in the form of betel quid which consists of betel vine leaf (piper betel), areca nut, lime and tobacco (13,34). Tobacco chewing is also widespread in parts of Yemen, Sudan and Southern Province of Saudi Arabia: the so called ‘shamma’ is a tobacco plus lime and ash mix, implicated in many cases of oral cancer in these areas (35,36).

Tobacco was propagated in developed countries by tobacco companies after the decline of cigarette smoking there. The 39th World Health Assembly in 1986 adopted Resolution WHA39 which declared that ‘the use of tobacco in all its forms is incompatible with the attainment of health for alt by the year 2000’ (37). The study group concluded that the use of smokeless tobacco caused cancers in humans, the evidence of causality being strongest for cancers of the oral cavity. It also increased the risk of cancers of the nasal cavity, pharynx, larynx, oesophagus, pancreas and urinary tract. Laboratory studies clearly supported the observations that smokeless tobacco caused a number of precancerous oral lesions (37).

Carcinogens in Tobacco Smoke

Tobacco smoke is an aerosol consisting of about 2000 different substances, 50 of which are already proven to be human carcinogens e.g. Benza pyrines, Benza anthracene, Benzo floaranthene, Benzene and other Benzyl derivatives, cadmium, chrysene, methylchryscne, methyl fiouranthene and nitroso compounds (38,39).

Cigarette smoke also contains significant amounts of radioactive substances e.g. thorium Th228, polonium-210 and radium-Rd226. These compounds lodge in the lungs where they constantly irradiate the nearby cells and hence facilitate malignant change (38). Even the urine of cigarette smokers contains mutagenic substances for bacteria, and substances that cause changes in the chromosomes of human cells in tissue culture.

Sidestream smoke which is inhaled by non-smokers contains fifty fold greater concentration of nitrosamines than mainstream smoke. In one hour of breathing in a smoke filled room, a non-smoker may inhale an amount of nitrosamines equivalent to the amount inhaled after having smoked 15 filter cigarettes (38).

Cessation of Smoking

The risk after cessation of smoking decreases dramatically. Light smokers approximate the risk of nonsmokers after 10 to 15 years of cessation of smoking, while heavy smokers have a residual two to three fold increase after cessation (2,6). The mechanism of lung carcinogenesis and smoking cessation has been extensively studied (40).

Women and Smoking

As women started smoking long after men, there is a time lag in the incidence of lung cancer. The incidence of lung cancer has already fallen for men in most developed countries while it was still increasing for women early in the eighties. In 1984, 32 percent of the women smoked in Britain compared with 36 percent of men. In 1961, the figures had been 60 percent of men, and 40 percent of women. Whereas in 1950 the average woman smoker smoked half as many cigarettes as the average male smoker, in the eighties the corresponding figures were 14 and 16 cigarettes (41).

During the second decade of the anti-smoking campaign in Britain, smoking started to fall among women too, slowly at first, but with accelerating momentum (42). Similar trends are found in all developed countries, In some countries e.g. Australia, smoking among young and middle aged women was rising in the early eighties (5,43A4). The proportion of male smokers was falling in 19 out of 22 developed countries, and for women rising or stable in II countries (42-44). In Austria, Germany, Italy, Japan, U.S.S.R., smoking among women was still rising in the early eighties(42).

We may note that lung cancer has already surpassed breast cancer in the number of fatalities it causes. Non-smoking wives of smoking husbands (passive smokers) and non-smoking women working in smoking environments are also afflicted with lung cancer(6,31-33.37).

Trends in Developed and Developing Countries

Anti-smoking campaigns have been launched in the developed countries in the last three decades with tremendous achievements. In Britain, 60 percent of men were smokers in 1961 (the year before the first report of the Royal College of Physicians about smoking was published). By 1971 this figure had dropped to 47 percent, by 1984 to 36 percent, and by 1992 less than 25 percent of the adult males are smoking. As already noted, a similar trend among women smokers was apparent with a ten-year lag (42-45). The decline in cigarette consumption in other European countries and the USA has been comparable. By the mid-eighties sales had plummeted by an impressive 2$ percent with a 5-10 percent annual decline (42-44).

How have the tobacco companies been selling the 10 billion cigarettes they produce daily? By promoting sales in the poor Third World, already suffering from serious health hazards. Consumption of tobacco in Third World has seen a horrendous increase. The World Health Organization (WHO) has reported that tobacco related diseases are on the rise in developing countries.

During the last three decades: in Senegal the percentage of men who smoke in urban areas has reached an unprecedented 80 percent in Bangladesh 70 percent; in Lagos 72 percent of the Faculty of Medicine male students were smoking (46). Statistics from the Chamber of Commerce of Saudi Arabia show an unbelievable increase in tobacco imports: over 4,5 million kgs in 1972: over 27 million kgs in 1977; nearly 36 million kgs in 1981; 42 million kgs in 1984 – an increase of 900 percent (47-48). It is no surprise to find that lung cancer in Saudi Arabia has increased dramatically – from the twelfth most common cancer in a 1950-61 study (49) to the third most common cancer in a 1979-84 study (50). It is expected to be the leading cancer in the nineties us the effects of smoking are unfolding.

The tobacco companies’ methods are unscrupulous as well as aggressive, with bribery of government officials to permit promotion not unusual. In 1982, the head of the Malaysian parliament retired and went to work as a chairman of Rothman’s, Malaysia’s largest cigarette manufacturer (48-51). Ethiopia imported 200 million expensive British cigarettes in 1984 when a large portion of its population were starving to death (52). In Bangladesh, smoking of five cigarettes daily robs the family of a quarter of its food supply, which results in an estimated 18.000 deaths among children annually (53). Unfortunately, the World Bank and Western Governments are co-operating with the seven giant tobacco companies (three American, three British and one French). The World Bank has given Pakistan 60 million dollars in loans to raise tobacco and the US Food for Peace Programs have spent 2 billion dollars in loans to developing countries for the purchase of U.S. tobacco and to establish joint-venture tobacco projects and factories (48-51). Tobacco needs to be cured with heat, obtained by burning wood. This results in deforesting 7 million acres annually with the obvious detrimental impacts on the local ecology, Heavy use (without protective measures) of carcinogenic pesticides on tobacco plantations has also resulted in many fatalities.

Neither tobacco promotion nor high tar content are restricted in many third world countries. Cigarettes smoked in China. India. Pakistan. Sri Lanka the Philippines etc. contain 21-33mg tar and 2-3mg nicotine: while in tile developed countries of U.S.A., Canada, Western Europe, the maximum legally permitted levels are 15 mg tar and 1 mg nicotine (13,46,48).

China consumes one third of the world’s production of cigarettes, while the other developing countries consume another third (48,54). The Eastern and Western block combined consume the remaining third.

The WHO emphasizes the need for a ban on tobacco promotion which should be comprehensive, fully implemented, well publicized, given major priority by governments and health authorities, and sustained on a long term basis (13).

Islamic Law and Tobacco

Muslim muftis and grand ‘ulama’ proscribed smoking tobacco soon after it was introduced to Turkey around 1000H (1573). Sultan Murad of the Ottoman Caliphate made it a capital offence in 1663. The former Grand Mufti of Saudi Arabia, Sheikh Mohammed bin Ibrahim (55) included in his fatwa the names (If many grand ‘ulama’ and muftis who had proscribed tobacco use since its first appearance in Turkey, Morocco, Egypt, Syria, and Yemen (56). All the religious authorities in Saudi Arabia, including of course the present Grand Mufti, Sheikh Abdul Aziz bin Baz, prohibited tobacco use, its promotion, sale, cultivation or dealing with it in any way other than destroying it.

Recently the 1st International Islamic Conference of ulama’ (On Drugs, Narcotics and Liquors held in Madina, March 22-25, 1982, under the auspices of Crown Prince Abdullah bin Abdul Aziz passed a resolution prohibiting the use of tobacco in any of its forms, its cultivation, manufacture, trading in. selling or promoting it in any way (57). The WHO Eastern Mediterranean office published a book in 1988 under the title Al-Hukm al-Shar’i fi at-Tadkhin (Islamic legal ruling on smoking) which involved the decision of the ten leading ‘ulama’ of Egypt, including Sheikh Al-Azhar, who explicitly considered tobacco use as haram (58).

The grounds for these judgments were:

1. Smoking is detrimental to health. The Qur’an states clearly Don’t kill yourselves (4.29) and Make not your own hands contribute to your destruction (2.195). Islamic teachings generally, as well as hundreds of sayings of the Prophet, upon him be peace, encourage Muslims to preserve good health and abstain from things injurious to health.
2. Tobacco use wastes huge sums of money. Saudi Arabia spends annually more than one billion riyals on tobacco imports (59). Some poor Muslim countries spend more money on smoking and other tobacco use than on health promotion or education. The Qur’an deplores such waste: Squander not your wealth senselessly. Squanderers are indeed the like of Satans (17.26, 27).
3. Smoking is had and impure, khabath. The Qur’an declares that the Prophet, upon him be peace, forbids all that is bad and impure and allows all that is good and clean (7.157). Smoking is bad and impure, as it Causes environmental pollution and is unpleasant, even seriously harmful, to those who do not smoke, injuring others is completely prohibited in Islam and considered one of the worst sins a believer can commit.

There is a great need to inform Muslim communities about the legal opinions on tobacco use and the rationale for them. The Muslim governments should stand firmly against the pressures exerted upon them by the tobacco companies and their powerful Western backers. If Muslim countries and peoples adhere to the traditional religious lifestyles. They will succeed in avoiding the perils and tragic losses of life and wealth caused by tobacco consumption.