VietNamNet Bridge – Holding a burning cigarette in his stained lips, Nguyen Minh Khang, (not his real name) breathes in deeply. Taking the cigarette out, he rounds his lips to shape smoke into rings running to each other. He closes his eyes and enjoys the moment. His ghostly pale face looks relaxed.

A man smokes a cigarette with a warning that "Smoking may cause lung cancer" on its box. According to the Ministry of Health, over 60 per cent of Vietnamese people are passive smokers.

Khang, 43, who annually burns up VND10 million (US$476) in cigarettes, has smoked for 26 years.

"I started smoking when I was 17 years old. I used to buy tobacco threads to make cigarette sticks to save money."

He laughed about his old days, showing all his yellow teeth. He is one of 15.3 million Vietnamese who are addicted to smoking.

The latest statistics of the Ministry of Health show nearly 50 per cent of Vietnamese males and two per cent of females smoke cigarettes.

And more than that, over 50 million Vietnamese are passive smokers at the workplace and at home, accounting for more than 60 per cent of the country's population.

In 2011, Vietnamese people spent over VND22.04 trillion (more than $1 billion) on tobacco products.

Khang says cigarettes were his source of inspiration and strength for a long time.

"I considered them as a magical vitamin for me. I felt sad, I smoked. I felt happy, I smoked. I was tired, I smoked."

"There was not any second when I wondered whether it would harm me. I was proud of myself as a cigarette smoker, with the belief that cigarettes turned me into an attractive man.

"My parents said nothing about it. No one complained. I smoked whenever and wherever I wanted."

At one point, Khang smoked one and a-half packets of cigarettes a day.

Le Viet Hoa, a project manager of Health Bridge, an international organisation working for public health. says cigarette addicts will smoke anywhere and everywhere, even in hospitals.

And non-smokers unconditionally accept the situation, although they have to suffer a space filled with cigarette smoke.

Some of them (passive smokers) cough from inhaling too much smoke. But they never complain.

Hoa says part of the problem is that cigarettes at VND10,000 a packet are too cheap in Viet Nam. Even students can afford them. Those who don't have much money can buy individual cigarettes, she says.

So, the smoking habit has become popularised within the society.

World Health Organisation Representative in Viet Nam Dr Takeshi Kasai says tobacco packets are well-designed and eye-catching so young people are interested and wish to try them, he says.

So, they start their smoking habit without any concern. Which is sad, because for many years after they quit smoking there will be negative impacts on their health, he says.

In fact, though Khang says the number of cigarettes he smoked a day increased over the years, there were no discernible affects to his health in the early days.

But it was his daughter who became the victim. She developed a cough and at three years old was diagnosed with asthma.

"My wife and I were shocked. And worse, the doctor said our daughter's disease may have resulted from my smoking."

This incident was a catalyst to difficulties in Khang's relationship with his wife.

"Hundreds of times she complained about the house being filled with my cigarette smoke. I didn't consider it as serious and suggested she clean the house as much as possible.

"We argued but I always won on the grounds that I needed cigarettes for working and relaxing."

But when Khang was deemed responsible for his daughter's asthma, he could not forgive himself, he says.

Also, at around that time, in 2009 (after 22 years as a smoker), Khang became weak and felt tired all the time. His weight fell to 52kg and he developed stomach problems.

"It seems all of my strength was sucked up."

He was informed his heart was not well.

Dr Kasai says tobacco smoke contains more than 7,000 chemicals, of which 250 are toxic substances and 69 are carcinogens.

Tobacco causes more than 25 diseases which can be classified into five main groups: cancers, respiratory diseases, heart diseases, reproductive health disorders and premature ageing, he says.

Smoking is responsible for up to 90 per cent of lung cancers and 75 per cent cases of chronic respiratory diseases (COPD). And it also raises the risks of asthma and respiratory infections.

About 25 per cent of cases of ischemic heart diseases are caused by smoking, he says. (Ischemia is a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism, to keep tissue alive.)

Khang's heart problems resulted from the fact that smoking damages the inner membrane of the blood vessel. This leads to arteriosclerosis and blocking of blood vessels causing ischemic heart diseases and other ailments, Dr Kasai says.

This is just one of three main ways smoking harms people's health, he says. Children who inhale cigarette smoke are at high risk of getting asthma.

Worse, when being in the same space, the volume of toxic substances which secondhand smokers directly inhale is much higher than smokers who just breathe these in via the filter end of cigarettes, he says.

Health Ministry statistics show tobacco use is responsible for 40,000 deaths each year in Viet Nam. If there are no preventive measures, this number will rise to 70,000 cases per year by 2030.

Khang and his daughter have spent weeks getting treatment in hospitals. "Dozens of millions of dong have been spent on treatment of my heart disease and stomach complaint, coupled with my daughter's asthma."

Khang says money is now a worry for the family because he had been unable to work while in hospital and his wife had to temporarily stay at home to take care of their daughter.

As a public officer, it is not easy to pay all the costs so all their savings have been used up.

The Viet Nam Steering Committee on Smoking and Health (Vinacosh) says the average costs for each episode of hospitalisation due to COPD, cancer or heart disease were VND4.3 million (US$204), VND14.4 million ($685) and VND36.6 million ($1,472) respectively, in 2007.

Dr Kasai says these are for only three diseases. Added to that, a patient's life span could be reduced by more than 10 years.

Says Khang: "There was no reason to stay addicted to smoking. I decided I must give up before it is too late."

He started reducing the number of cigarettes he smoked day by day.

"It was like a torture. I felt stressful. Something seemed to be gnawing and groaning inside me."

At times, Khang tried working more and taking up tennis and running to help take his mind off the addiction. It took him three years to cut back to three cigarettes a day.

"Anytime I desire to smoke more than three, I think about my poor situation and diseases."

Dr Nguyen Van Tien, deputy head of the National Assembly's Committee of Social Affairs, says leaders of agencies should take legal responsibility for implementing the Tobacco Control Law.

Hoa from Health Bridge says key deterrent points of the law include pictorial health warnings, a ban on advertising tobacco products, a ban on smoking indoors at work and public places and and the establishment of the Tobacco Control Fund.

For example, images of stained teeth or patients with lung cancer making up 50 per cent of the tobacco packet cover are meant to deter smokers. Or the ban on smoking indoors in public places is an inconvenience for smokers, she says.

Experts also suggest that it is necessary to raise the tax of each cigarette packet to more than 70 per cent of the retail price, instead of 45 per cent currently.

They also said heavier fines are needed to prevent violations of the bans.

Dr Kasai says high sanctions in Singapore and Hong Kong are an effective deterrent.

Khang says advice had not encourage him to give up his smoking habit but strict fines and other deterrence measures might have. He is now on a diet for his stomach and keeps trying to give up smoking completely.

A newly planted garden on the terrace of his house is now a smoking place when he is in dire need for a cigarette.

"No smell and no harm for my family.

"I am trying to make my life totally independent from cigarettes because I have no second chance."

Source: VNS