TOBACCO SMOKING HABITS ON BOARD MERCHANT SHIPS

Deaths attributable to tobacco smoke represent a very high percentage of the total number of deaths (between 25 and 50%) and it has been estimated that smokers lose an average of about 15 years of life. The total number of deaths attributable to tobacco smoke and those related to the development of various diseases such as ischemic heart disease, cerebrovascular diseases (stroke), chronic obstructive pulmonary disease (COPD) and many other diseases is expected to increase from 5.4 million in 2004 to 8.3 million in 2030, an increase of approximately 10% more deaths worldwide. However, 80% of these deaths will occur in developing countries. Cardiovascular diseases represent the main cause of death, also in the maritime sector. The life on board (work shifts, stress, lack of physical excercise, hyperlipidic diet, low intake of fruit and vegetables, etc) could cause physical and psychological problems that can explain the un-correct lifestyle. In addition, the risk of cardiovascular disease is often linked to long stay on board. Some studies highlighted the increased need to smoke related to stress factors. Therefore, the working environment on board could represent a critical factor for tobacco addiction. Some surveys showed that the prevalence of smokers between seafarers were higher than general population ashore. This study was aimed to acquire information on knowledge and awareness of the problem of tobacco smoking on board ships. MATERIALI E METODI: An anonymous questionnaire was proposed, on a voluntary basis, to seafarers on board ships belonging to three international leaving companies. The questionnaire was divided into: a) demographic data, b) awareness of damages caused by tobacco smoke, c) questions about smoking habits, d) test to evaluate the tobacco dependence. The results were processed in Microsoft Excel 2010. Chi square test was used to examine the relationship between the level of tobacco dependence and nationality, age, and rank of interviewed people. RISULTATI: 1234 people filled in the questionnaire (response rate 98.3%). Over two-thirds of the participants (92.2%) were aware that smoking cigarettes or other tobacco products can seriously damage one’s health, with only 3.6% responding that they were not aware of the damage. However, 4.2% of the participants did not answer the question. Lung and mouth cancer (83.6%), cardiovascular diseases (18.8%) and respiratory diseases (11.1%) were indicated as the main diseases related to tobacco smoking. Questionnaire responses revealed a general awareness of the damage caused by tobacco smoke and the dangerous nature of second-hand smoke (68.6% stated that second-hand smoke is very dangerous). About half of the participants answered to have never smoked, while about the 30% said to smoke and the 15.2% claimed to have stopped smoking. 40.7% of smokers stated that they continued to smoke because it is relaxing, confirming the fact that nicotine is not only addictive but also creates a general state of relaxation throughout the whole body. Heavy smokers (21-30 cigarettes per day) did not seem fully aware that they were smoking too much. Indeed, only 15.2% estimated their smoking as "very much", simply declaring that they smoked enough (33.3%) (Figure 1d). The data from the Fagerström test (an instrument to help determine nicotine dependence) revealed that 55.9% of those who smoke had a mild addiction to cigarette smoking, 25.0% had moderate nicotine dependence, yet another 14.0% had high nicotine dependence and 5.1% had very high nicotine dependence. Although, the majority of respondents were Indians, Italians represented the main smokers. Fagerström Test results showed that the Italians were those with the main percentage of tobacco dependence. Finally, Italians also were those who smoke more cigarettes per day. The sample of interviewed people included smokers of all ages: from less than 20 years to more than 60. Those who were more than 40 smoked the higher number of cigarettes per day (21-30) and failed not to smoke in places where it is forbidden and where there are non-smokers. In addition, the results highlighted differences between ranks. In fact, the higher smokers were the officers, and the dependence was higher in captains (Table 1). CONCLUSIONI: The data obtained from the questionnaire allow to understand that tobacco smoke is also a matter of concern for those who work at sea. Seafarers should be the target of specific educative campaigns about health risks linked with behaviours to minimize the exposure during travel/life at sea. 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