Let us not forget the mental anguish of those suffering from residential second-hand smoke

October 10 is World Mental Health Day.  Instead of discussing mental health in abstraction, I would like to highlight the mental health anguish of non-smokers held captive by residential second-hand smoke, especially during this pandemic, where working from home and home-based learning are almost a default.

Studies have documented the mental health toll exacted on adults, adolescents and children by second-hand smoke. 

In a large study of adults in China, while the background prevalence of mental distress is 25 per cent among non-smokers, 65 per cent of the mentally distressed non-smokers reported exposure to passive smoking, also known as second-hand smoke (1).  The researchers concluded that passive smoking is an important risk factor for non-smokers’ mental distress. (1) 

In another study in the US among children and adolescents, major depressive disorder, generalised anxiety disorder, attention-deficit/hyperactivity disorder and conduct disorder were found to be positively associated with serum cotinine level - a metabolite of nicotine in the blood indicative of second-hand smoke exposure. (2). 

These findings are hardly surprising.  The harm of cigarette smoke by now is common knowledge. 

Here in Singapore, second-hand smoke no doubt exacerbates the intense stress which our young are already experiencing from our high-pressure education system.

For someone who is trapped in his or her own home with neighbours’ second-hand smoke, the thought of the cigarette smoke slowing killing them over time, in addition to the physical effects like respiratory symptoms and asthma attacks, which they might have already experienced, is distressing enough.

While we urge all to pay attention to one another’s mental health on World Mental Health Day, I appeal to the government to take decisive and meaningful action to protect long suffering non-smokers from the scourge of residential second-hand smoke on this high-density living island.

References:

1.    (1)Association between passive smoking and mental distress in adult never-smokers: a cross-sectional study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985981/)

“The estimated prevalence of mental distress among never-smokers in Jilin province is 24.5%, and the estimated prevalence of passive smoking among the mental distressing group is 65.0%.”

“Passive smoking is an important risk factor for mental distress in never-smokers of Jilin province, which reminds Chinese government of increasing the awareness of public health and take measure to prevent SHS, especially with regard to SHS exposure at home and workplace.”

(2)Secondhand Smoke Exposure and Mental Health Among Children and Adolescents (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075798/)    

“Among nonsmokers, serum cotinine level was positively associated with symptoms of DSM-IV major depressive disorder, generalized anxiety disorder, attention-deficit/hyperactivity disorder, and conduct disorder after adjusting for survey design, age, sex, race/ethnicity, poverty, migraine, asthma, hay fever, maternal smoking during pregnancy, and allostatic load. Associations with serum cotinine level were more apparent for boys and for participants of non-Hispanic white race/ethnicity.”

The Chinese language tragedy in a Caifan musical comedy

The recent viral “Caifan” song and music video in the form of a parody of Chinese language-handicapped Singaporeans reduced to saying “this and that” when ordering at economy rice stalls struck a chord in many.

The song is creative, comedic, entertaining and ironically uses copious amount of the Chinese language to tell the story.

My sincere wish is that after the highs and having a good laugh at ourselves, may the song evoke reflections on how and why ethnic Chinese in Singapore have become incapacitated in simple Chinese language contexts, such as ordering Chinese dishes, as depicted in the song.   

My observations are that, for example, our Malay friends, do not have to resort to “this and that” when they are at the Nasi Pandang stall.

It will be even more unimaginable to see a French Canadian pointing and saying “this and that” rather than saying croissant and baguette at the local bakery.

However, we do commonly see the Chinese Singaporean heavily relying on sign language and summoning his moribund Chinese effortfully to order at the Caifan stall.

Beyond the comedy and music, I also see the tragedy of a parody so closely mimicking reality. 

Ours is a Singaporean Chinese identity where the command of the Chinese language is non-essential. 

A Chinese identity that is divorced from the Chinese language, one that is ancient, beautiful and embodies the semantics of being Chinese, ultimately loses richness and subtleties.

My wish is that the song can also stimulate the desire and effort in some people to at least master some rudimentary functional Chinese or re-discover the little that was retained from many years of going through the motion learning the mother tongue.

Perhaps it is too late to make the call now, as Chinese is already discarded like pre-loved shoes, to paraphrase a Chinese saying, “弃之如敝履” qì zhī rú bì lǚ. 

But I remain hopeful. Afterall, what is left after the Pandora box was opened is, hope. 

Secondhand and thirdhand cigarette smoke - part of the price to pay for using public transport

My wife and I could afford a car but we choose to take public transport to be environmentally friendly, to keep physically active and also not add to further road congestion.

Our resolve to take public transport is constantly challenged by secondhand cigarette smoke from smokers taking smoking breaks at/around bus stops, at/within the perimeter of non-smoking zones at MRT entrances and exits and along walkways accessing bus stops and MRT stations. There is no escape because these are common access points to the public transport system.

Furthermore, as much as you try to avoid them, smokers walk into you all the time.  When one eventually gets on a bus or train, one has to suffer, often enough, thirdhand smoke from the breath and garments of chain smokers.  It is also very common and distressing to be stuck in a taxi, with a driver emitting dense thirdhand smoke.  Lest you think we are fussy, you are welcome to check out the ill effects of thirdhand smoke by searching for the term on the internet or go to the HPB website.

For the vast majority of non-smokers, numbering 86% of the population, taking public transport is not a choice and they should not be penalised further by breathing in secondhand cigarette smoke which kills 600,000 people worldwide (figures from the World Health Organisation).

On behalf of all non-smoking public transport users, our plea is that tougher non-smoking laws be in place around public transport access points. The current no smoking within 5 metres of entrance/exit rule is only marginally useful as smokers gather at dustbins just outside the 5-metre zone to smoke (some dustbuns are placed within the 5-metre zone). For bus stops, the 5-metre rule does not even apply and you can find smokers smoking around the perimeter of the bus stops all the time.

Singapore public sector is known for great integrated coordination. I earnestly hope that the transport ministry could do more to protect non-smokers in the context of public transport by working with the health and environmental agencies.  The aim of encouraging more Singaporeans not to own cars and rely on public transport will be well served by reducing commuters' exposure to secondhand and thirdhand smoke. 

Smoke-free HDB blocks

Haze pollution is in the news again, and rightly so, due to the health hazards it poses. If we are concerned about seasonal haze pollution, all the more we need to be worrying about the highly toxic Environmental Tobacco Smoke (ETS) which we are exposed to daily. 

According to the Health Promotion Board, ETS causes twice as many deaths as all other types of air pollution combined. Few know that cigarette smoke contains 4,000 toxic compounds which include hydrogen cyanide, used in chemical weapons; butane, which is used in lighter fluid; toluene, found in paint thinners; arsenic; lead; carbon monoxide; and even polonium-210, the highly radioactive carcinogen that was used to murder former Russian spy Alexander V. Litvinenko in 2006. Many of the compounds can cause cancer (source: The New York Times).

Last year, during the parliamentary debate on the amendment to a smoking bill, a Sembawang GRC Member of Parliament, Ms. Ellen Lee, mentioned an unfortunate case of a pregnant woman who lived next door to a family of smokers in a HDB block. The smokers smoke at the corridor because they have a child inside their flat. The trouble is that the second hand smoke assaults the pregnant woman next door. We do not know if the cigarette smoke, distress and depression caused by the inconsiderate smoking neighbours have anything to do with it, but the woman tragically had a miscarriage. The couple wrote to the MP to tell their sad story.

86% of Singaporeans do not smoke and the torment of this unfortunate woman is by no means unique in all the HDB flats when we give ears to people in the heartlands on this issue. Will the HDB consider legislating new rules such that for 86% of new flats, only non-smokers are eligible to apply? For the remaining 14%, both smokers and some brave non-smokers are welcomed to apply.

I could almost hear the litany of reasons from the authorities on why we cannot do this. The hard facts are that seven Singaporeans die prematurely from smoking-related diseases each day and that the social cost of smoking ranged from S$673 to S$839 million, based on 1997 estimates (source: Health Promotion Board).

As it is now, we have a racial quota for HDB flats. So there is already precedence on housing policy in support of social policy. Perhaps we can be innovative in welding housing policy and health policy together in this regard.

Two bits' worth

Just started to experiment with blogging.  It is late, but better than never.