Greeks are among the heaviest smokers in the world, placing the country ahead of other European nations as well as the US, where the incidence of smoking is much lower. The habit currently affects 38 per cent of the population, despite the fact that there has been a substantial reduction in the consumption of conventional cigarettes in the past decade. The government is currently introducing new measures to reduce the incident of smoking in Greece, while doctors are aiming to reduce the frequency and severity of smoking-related disease by improved therapies and diagnosis.

New government measures against smoking

Speaking to journalist Tania Mantouvalou on the radio station Agency 104.9 FM, the head of the National Public Health Organisation (EODY) Christos Hatizichristodoulou, Professor of Health and Epidemiology at the University of Thessaly, has described smoking as one of the most significant threats to the health of the Greek population. The Professor was among six individuals to receive an award from the European Network for Smoking and Tobacco Prevention, at their 9th Conference on Tobacco Control held in Athens from 22nd to 24th October.

The award for Outstanding Contribution to Tobacco Control was in recognition of his efforts over at least a decade, which started long before he became head of the EODY. Asked about the background to the award, Professor Hatzichristodoulou said: “Since 2013 we have been conducting studies about smoking among children as well as adults, and studies about the risk factors associated with the start of smoking, since cutting it out is fine, it’s a control measure, but clearly prevention is better, i.e. people not starting to smoke.”

Four out of 10 Greeks smoke
According to the Professor, a recent study by the EODY on adults found that “38 per cent of Greeks use some form of tobacco product, including conventional tobacco products (mass-produced cigarettes, roll-your-owns, cigars and cigarillos, tobacco pipes, hookahs), heated tobacco products and electronic cigarettes.” The overall figures are as follows:
— 31% of adult Greeks smoke conventional tobacco products;
— 9% of them use heated tobacco products;
— 7% of them use electronic cigarettes.
In terms of exclusive use:
— 24% of adult Greeks use only conventional tobacco products;
— 4% of them use only heated tobacco products;
— 3% of them use only electronic cigarettes.
In terms of multiple use:
— 8% of Greek adults make multiple use of tobacco products, either conventional, heated or electronic products in various combinations, of which the double use of conventional and heated tobacco products accounts for half (4%).

Professor Hatzichristodoulou observed that there has been a significant decline in the use of conventional cigarettes in the past decade, together with an increase in electronic products, especially among the young, “which we need to counter, as we don’t yet know what effects this may have. Theoretically the risk is smaller, but not enough time has elapsed to draw safe conclusions. However there are studies in which there are indications of severe effects and in any case we are expecting even more in the coming years. In addition, the study produced conclusions about passive smoking which we are not happy with.”

Stricter application of the law
Obviously, the prohibition on smoking in closed public spaces needs to be strengthened, the Professor said, given the Greek tendency for the relevant law to be more honoured in the breach than the observance. Thus in the immediate future the health authorities will be giving maximum emphasis to the reduction of smoking in closed public spaces with a view to wiping it out.

At the same time the head of the EODY emphasised that “the total proportion of smokers, at 38 per cent, is especially concerning, because we are among the top countries in the world for smoking, considering that the figure for Europe is 29 per cent and for the US 19.8 per cent. We are aiming to hit 5 per cent in 2040, which is the European as well as the Greek target.” In this context the EODY is planning a series of targeted actions, which the Professor outlined to the Agency FM radio station:

1 “After the studies with adults we are planning to immediately start a study for children, and there we want to concentrate on the risk factors connected with the start [of smoking], so that we can intervene in a targeted manner. For example, we have found that the amount of pocket money received is related to smoking, while smoking at these ages is also related to the availability of single-use electronic cigarettes. Electronic smoking in children is a concerning development, because a significant number of children start with electronic cigarettes, which have their own problems.

2 “We are going to immediately activate a four-digit Help Line, known to the public from the Covid era. The line will provide access to psychologists, who will have one or two sessions with people who want to stop smoking, and subsequently will refer them to Smoking Cessation Clinics.

3 “Smoking Cessation Clinics were started on the initiative of the Hellenic Thoracic Society in 2006 and there are currently 32 throughout the country. We want to strengthen them logistically in collaboration with the Regional Health Authorities, through an ESPA programme. Others will also be created in hospitals, but the Primary Healthcare System will also be reinforced, with a special programme of training for health professionals.
“There will also be targeted information campaigns through the same ESPA programme. For these we will work with doctοrs’ associations and other organisations, as well as opinion makers, which in this case are the doctors, amongst whom we want to increase the cessation of smoking, since they are public examples, as we found in the case of Covid vaccination. Also involved in smoking reduction will be the Mobile Health Units. The EODY’s mobile units, known for Covid testing, are changing their mode of operation and will be providing preventive services to remote areas.

4 “We will be training the specialists in how to convince both children and adults to stop the smoking habit. For example, paediatricians use particular tools to convince children not to start smoking, while cardiologists use other tools to persuade a heart attack victim to give it up.

5 “We have reinstituted a committee of experts, which is already guiding all these activities and is devising a specific strategy which relates to everything we have said today. In Greece we often act on a short-term basis. However, we need to set a long-term strategy and to say that in 5 years we want to reduce the start of smoking among children by 4 per cent and to increase the proportion of the population giving it up by 10 per cent,” Professor Hatzichristodoulou concluded.

Measures aiding the prevention and cure of respiratory diseases

While the government is intensifying efforts to reduce smoking, new therapeutic techniques are assisting in the management of smoking-related and other respiratory diseases. Some of these were discussed at “I Breathe Freely 2024”, an awareness workshop on the respiratory system held at the KAM on Saturday 9th November, which was organised by the Pulmonologists’ Association of the Regional Unit of Chania together with the Municipality of Chania, under the sponsorship of the Hellenic Thoracic Society.

AI an aid to pulmonologists
Applications based on artificial intelligence can provide significant help to pulmonologists as well as in the therapy regimes being followed by patients. At the same time, pulmonologists consider that the public programme of free preventive testing should include pre-symptomatic screening of the chest with low dose CT scans. The State, however, has yet to respond to this requirement, in contrast to what is happening abroad.

Speaking to the media, Chania pulmonologist Miltiades Markatos described the application of AI in the field of pulmonology. “Artificial intelligence is a new field which is already having, and will increasingly have an impact on the management of respiratory diseases as well as on the people who are suffering from them. It seems that the system is increasingly helping both doctor and patient and we believe that it will be of auxiliary help without supplanting the doctor-patient relationship, which must not be broken,” Mr Markatos said.

He explained that more and more new and more powerful applications are appearing: “Applications which help the doctor to better manage diseases but at the same time provide platforms which patients can visit and which enable them to correctly handle the apparatus for administering the drug they are taking and to better understand their illness (e.g. asthma and COPD), but also to receive timely warning of any worsening of their disease and to forestall unpleasant circumstances.”

Preventive testing
On the subject of the prevention of lung cancer, Stelios Vittorakis, private pulmonologist and Head of the Hellenic Thoracic Society’s Primary Health Care Team, told journalists that there are two levels of prevention, the primary and the secondary: “The primary level comprises measures which the State must carry out to prevent the appearance of cancer in its citizens. These include measures to make carcinogenic products less attractive (e.g. by taxation) and the adoption of laws such as the prohibition of smoking in public places.

“The secondary stage of prevention is that which aims at the early diagnosis of cancer, facilitating better treatment of the disease. This is achieved by pre-symptomatic screening with low-dose CT scans. These programmes have been adopted in countries such as the US and UK and it has been found that they increase the timely diagnosis of lung cancer by 24 per cent and reduce deaths from the disease by a similar amount. However, in Greece, although there are screening programmes for breast, colon and prostate cancer, they have not yet been adopted for lung cancer.”

The president of the Pulmonologists’ Association of the Regional Unit of Chania, Athanasios Solakis, said that the aim of the event at the KAM was to raise public awareness on the subject of respiratory health. “Preventive and early diagnosis are cornerstones of primary health care and we want the public to be made aware of how they can forestall any problems of their respiratory system,” he said.
(Haniotika Nea, 16/11/24 (from APE-MPE), 09/11/24)