Chapter 10

Health effects of tobacco use, alcohol
consumption, and drug abuse
Learning objectives
You will be able to gain proper understanding and explain:- The health effects of tobacco use.
- The health effects of alcohol consumption.

smoking, and therefore, breastfeeding is recommended.
In young people, there are health risks, including the effects on physical activities and sports,
contracting respiratory disease, progression to nicotine dependence, an increased risk for using alcoholand drugs such as cannabis and cocaine, and the fact that the younger they start tobacco use, the higher
the risk for developing lung cancer becomes.3
Nasal cavity/ Sinus cancer
Oral/ pharyngeal cancer

StrokeLaryngeal cancer

Periodontal disease
Ischemic heart disease

Esophageal cancer- The health effects of drug abuse.
- Why some people begin tobacco use and alcohol consumption while knowing that they are harmful
to their health.
- Why it is difficult for people to stop tobacco use, alcohol consumption, and drug abuse.

Nicotine dependence

Lung cancer

Peripheral arteriosclerosis

Liver cancer

Development ofType 2 diabetes

Gastric cancer

In this chapter, you will learn the health effects of tobacco use, alcohol consumption, and drug abuse,and the factors underlying them. Specifically, you will learn about the spread of tobacco use, alcohol
consumption, and drugs in Cambodia as well as what you can do to protect the health of young people

Figure 10.1 Health effects of tobacco use

from tobacco use, alcohol consumption, and drug abuse by understanding drug dependence, relationships
between tobacco use and health, and relationships between alcohol consumption and health.

1. Tobacco use and health
1) Health effects of tobacco use

12) Harmful chemicals contained in tobacco
Tobacco smoke contains approximately 5300 types of chemicals, of which approximately 50 to 70 types
are shown to be carcinogenic. Among its gas components, carbon monoxide competes with oxygen tobind to hemoglobin in erythrocytes, decreasing the amount of oxygen carried by erythrocytes. If thestate of oxygen deficiency chronically persists, red blood cell count may increase to maintain the delivery

When lit by flame, tobacco generates various components (i.e., gas and particulate components). If theseof oxygen, which increases blood viscosity and raises blood pressure. Tar, a particulate component, is acomponents are inhaled, they circulate around the body through the blood and do harm to many organs

complex mixture that contains chemicals having carcinogenic effects, meaning they turn healthy cellsof the human body (Figure 10.1). The smoke inhaled by a smoker is called the mainstream smoke, andinto cancer cells, as well as cancer-promoting actions, which grow cancer cells. Nicotine, a type ofthe smoke coming from the end of the tobacco is known as the sidestream smoke. The sidestream

alkaloid (a substance that neutralizes acid to form salt), is a deadly poison with strong neurotoxicity.

smoke contains more harmful chemicals than the mainstream smoke that is inhaled through a filter. This

After being taken into the body through tobacco smoke, nicotine rapidly spreads throughout the body.

is why tobacco use has serious health effects not only on smokers but also on their children and partners

Because of the dependency on nicotine, it becomes difficult to give up the habit of smoking. In addition,

who live with the smokers and are subject to passive smoking.

it has a strong vasoconstrictor effect, which constricts capillaries and increases blood pressure. Although2

In pregnant women, smoking and passive smoking can increase the possibilities of miscarriage andpremature delivery. The chemicals of tobacco inhaled by a pregnant woman affect her fetus through the

nicotine itself is not shown to be carcinogenic, nitrosoamines, which are produced when nicotine isbroken down / metabolized in the body, are known to be carcinogenic.

blood, increasing the risk of her delivering a low-birth-weight baby (with a birth weight of less than2500 g) or delaying the development of the fetus. Attention should also be paid to smoking and passive
smoking by breastfeeding women. The mother’s milk, which contains harmful substances in two to

4

Column: Emergence of heated tobacco products, a new type of tobacco

three times higher concentrations than the mother’s blood, can do harm to the infant (the lung and theHeated tobacco products (HTPs) are tobacco products that produce aerosols containing nicotine

brain in particular). Furthermore, smoking has been shown to decrease the amount of mother’s milk

and other chemicals, and inhaled by users through the mouth. They contain the highly addictive

secretion. Note that the benefits of breast-feeding are considered to outweigh the risks of mother’schemical nicotine. They also contain additives and are often flavored. They also make people mimic

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Chapter 10

Health effects of tobacco use, alcohol consumption, and drug abuse

173the behavior of smoking a conventional cigarette. The products include iQOS from Philip Morris

such as vomiting, a depressed level of consciousness, and worsening of respiratory status. In the long

International, PloomTECH from Japan Tobacco International, Glo from British American Tobacco,term, meanwhile, it has effects on the liver, which bears the burden in breaking down alcohol, and on theand PAX from PAXLabs. These products use a battery-powered heating system to heat tobacco up

whole body (Figure 10.2). Examples of the long-term effects include increased susceptibility to alcoholic

to 350°C in order to generate vapors containing nicotine.

hepatitis, cirrhosis, hypertension, cancer, diabetes, and cerebral atrophy.

Currently, there is no evidence to show that HTPs are less harmful than conventional tobacco
products. However, some studies sponsored by the tobacco industry have claimed that theysignificantly reduce the formation of and exposure to harmful and potentially harmful components

Alcohol dependence

relative to standard cigarettes. Presently, there is no evidence suggesting that reduced exposure to

Cerebral atrophythese chemicals leads to reduced risk in humans. Therefore, in order to verify the claims of reduction

Cardiomyophathyof risks and harm, additional studies without conflicts of interest are needed. In addition, there isHypertension

insufficient evidence regarding the effects of passive smoking caused by HTPs. Further studies areneeded to assess the risk of being exposed to emissions released from HTPs.

Fatty liver

All forms of tobacco use are harmful, including HTPs. Tobacco is inherently toxic and contains
carcinogens even in its natural form. Therefore, HTPs should be subject to policy and regulatory
measures applicable to all other tobacco products in line with the WHO Framework Convention on

Pharyngeal cancer
Laryngeal cancer
Esophageal cancer
Gastric ulcer

Alcoholic hepatitis

Gastric cancer

Cirrhosis

Development ofType 2 Diabetes

Liver cancer

Tobacco Control (FCTC).5

Oral cancer

The Phnom Penh Post reported in March 2021 that the National Authority for Combating Drugs
Figure 10.2 Effects of alcohol consumption on the body

(NACD) of Cambodia has directed all relevant ministries and agencies as well as organizations to
6take action to immediately stop the commercialization and use of HTPs.
Column: What is a conflict of interest (COI)?

2) Alcohol dependence8

Take a study sponsored by the tobacco industry as an example. If a relationship based on interest is

Chronic consumption of large amounts of alcohol will develop dependence on alcohol, resulting in asuspected between the company and a researcher who conducts the sponsored study, it will leadpersistent or chronic disorder of mental/physical function. Symptoms of dependence consist of psychic

to a situation in which third parties may have doubts about the neutrality, objectivity, and scientificallydependence and physical dependence. In psychic dependence, symptoms that may appear include arigorous procedures that are required in the study of HTPs and health effects. That is, they may raisestrong desire to consume alcohol, inability to control drinking behavior through one’s own will (e.g.,questions about the possibilities of data being falsified or fabricated to deliberately produce study

time and quantities), and a tendency to consume alcohol to cope with feelings of frustration, tension, andresults that support the interest of the tobacco industry. This situation is called a conflict of interest,

depression from daily stress. If psychic dependence progresses further, it leads to harmful behaviors,

and researchers are required to disclose relationships based on interest to ensure that public trust inincluding spending most of a day consuming alcohol and sobering up by disregarding pleasures otherthe study will not be lost.

than alcohol consumption, and not abstaining alcohol even though mental/physical problems haveworsened. Thus, psychic dependence is a condition in which the habitude has changed in such a way that

2. Alcohol consumption and health
1) Health effects of alcohol7

the person is driven by a strong desire to re-experience a pleasant sensation that can be obtained whenalcohol activates the reward system of the central nerve, and this condition is the nature of dependence.
In physical dependence, withdrawal symptoms appear, including trembling hands and fingers andsweating, when alcohol is cleared from the body. These symptoms can lead to alcohol consumption at
the workplace, a decline in work performance and absence from work, and human-relation problems at

Alcohol is a central nervous depressant and has a relaxing effect if consumed in small amounts. However,

the workplace, causing difficulties in work. In addition, people who consume alcohol in the daytime canbefore consuming alcohol, we need to understand that it has short- and long-term health effects. In thedestroy their family lives for reasons including being unable to engage in housework or childcare, using

short term, it suppresses the brain function and has psychological effects, such as impaired judgment,

violence toward family members, and borrowing money for alcohol consumption. In the case of students,

and physical effects, including slower body movement. Moreover, consuming a large amount of alcohol

they will not be able to continue their studies for reasons such as absence, poor academic performance,

in a short period of time can cause acute alcohol intoxication, resulting in life-threatening conditions,and dropping out.

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Chapter 10

Health effects of tobacco use, alcohol consumption, and drug abuse

175

Table 10.1 Types of drugs and examples of symptoms

In this way, if psychic and physical dependence are developed, social lives in one’s workplace,family, school, and community can be destroyed.

Type

Symptom

Stimulant (central nervous
excitation)

Exhibits a neuroexcitatory action for several hours. Then, severe weakness,fatigue, and malaise occur. Hallucinations and delusions appear. Results indeath if consumed in large amounts. Likely to develop toxic psychosis. May
cause flashbacks even after stopping use.

Cocaine (central nervous
excitation)

Alkaloid contained in coca. Gives the experience of extreme euphoria and afeeling of being full of energy. Hallucinations and delusions appear. A large
amount of consumption causes generalized seizure and difficulty ofbreathing, resulting in death.

MDMA (Ecstasy) (central
nervous excitation)

A type of synthetic narcotic. Changes perception. Increases a feeling of wellbeing and a sense of closeness to others. On the other hand, increases
sleeplessness and uneasiness. Gives a strong psychic dependence. A large
amount of consumption results in hyperthermia and death.

Heroin (central nervous
depression)

A drug made from poppy. Causes severe withdrawal symptoms, including
severe pain, chill, vomiting, and fainting. A large amount of consumption
results in difficulty of breathing, and coma followed by death.

3) Social impacts caused by alcohol9
A drunken condition (drunkenness) is a condition in which emotional control and judgment are impaired.
It can cause social issues and problems such as traffic accidents resulting from drunk driving, accidents
including falls, and high-risk behaviors such as unprotected sexual behavior and self-injurious behavior,as well as violent incidents, domestic violence/abuse, and involvement in crimes.

3. Harm of tobacco use and alcohol consumption byminorsTobacco use and alcohol consumption by minors are said to cause greater health damage and are more
likely to cause dependence. This is because the organs of the growing body are undergoing maturation,
thus making them more susceptible to harmful chemicals and alcohol. Particularly, the period between
10 and 24 years of age, defined by the World Health Organization (WHO) as young people, correspondsin the reward system circuit, and produce pleasure. Both of them affect the brain and may result into puberty/adolescence, which is not merely a period for becoming sexually mature and physicallydeath if consumed in large amounts at one time.

developing into an adult, but is also a transitional period toward psychosocially developing into an adult

Note that besides tobacco, alcohol, and the drugs listed in Table 10.1, there are other drugs andby achieving the developmental tasks of the relevant age group through brain development andchemicals that may be abused, such as volatile organic solvents (e.g., lacquer thinners and toluene for10

maturation.

Although the accomplishment of physical, cognitive, and psychosocial developmental

tasks are affected by other factors mentioned in Chapters 3 and 11, alcohol has influences on thepainting, and adhesive bond) and pharmaceuticals (e.g., analgesics, purgatives, antitussives, sleeping
pills/antianxiety drugs, and cold medicine), which are easily available and thus require attention.

development of the brain of young people and is considered to have impacts on the accomplishment ofdevelopmental tasks as well.
This is why many countries define the minimum ages for tobacco use and alcohol consumption. In

Column: Is cannabis legal or illegal?

Japan, the legal minimum age is 20 years old for both. In Cambodia, the minimum age for tobacco use

The possession and use of cannabis have been illegal for many years. It is also true, however, that itis 18 years old. Although the minimum age for alcohol consumption is not established as of 2020, there

has historically/traditionally been used as medicine and food materials.

is a movement to it at 21 years old.

In recent years, there have been growing movements to legalize cannabis in some countries andregions. Cannabis is used for recreational, medical, and industrial purposes. It is used for personal,

4. Drug abuse and health
1) What is drug abuse?

recreational enjoyment, to provide analgesia/sedation as a medicine, and to process clothes,cosmetics, and foods in industry. Cannabis for industrial use does not have euphoric effects and issaid to pose little risk of being abused as a drug.
Currently, cannabis for recreational use is legalized nationwide in Uruguay, Canada, and Mexico.
In the United States of America, it is prohibited by the federal government but legalized by some

Drug abuse refers to the use of illicit drugs and the use of pharmaceuticals for purposes other than theirstate governments. The aims of legalization are to conduct proper management by setting the legal

intended use. Drugs that may be abused include stimulants, cocaine, the synthetic narcotic MDMAage for cannabis use and the maximum amount that can be possessed, and to cut off funding(methylenedioxy-methylamphetamine, known as Ecstasy), and heroin (Table 10.1). Among drugs, there

sources for criminal organizations by restricting the cannabis trade on the black market.

are central nervous system stimulants (uppers) and central nervous system depressants (downers).

There are arguments for and against the legalization of cannabis, and it has been discussed at

Despite their different actions, they eventually increase dopamine activity in the brain, excite nerve cells

the WHO and the United Nations as well. Cannabis is said to be a gateway drug (drugs that serve

176

Chapter 10

Health effects of tobacco use, alcohol consumption, and drug abuse177as a gateway to the use of other substances with stronger dependence and adverse reactions, suchas stimulants, heroin, and cocaine). This is because those who become unsatisfied with cannabis

Repeated abuse and tolerance

will begin to use other drugs for a stronger stimulus. The legalization of cannabis use may promote
the abuse of other drugs.
It has been pointed out that cannabis use would affect the health of young people, including

Drug effect wears off

cognitive distortion, impairment of concentration, mental disease, excessive vomiting, anddependence. In puberty and adolescence in particular, it may affect the development of prefrontal
cortices as well as the neural circuit and neural structure of the hippocampus, having negative
effects on brain functions to control attentiveness, thinking, and behavior as well as on memory; it isconsidered that the earlier they begin to use cannabis, the greater the effect becomes. Therefore,

Drug seeking behavior

regardless of whether it is legal or illegal, cannabis should not be used during the ages in which the11brain develops, as in the case of alcohol consumption and tobacco use.

For adults, in whom the period of brain maturation has finished, societies will consider how theyshould deal with cannabis use from various perspectives, including risks, traditional / medical values,

Mental/physical pain

and impacts of legalization on communities.

Figure 10.3 Cycle of drug dependence

2) What is drug dependence?
has since spread to more than 130 countries around the world, proposes The Twelve Steps as a guide to
Drug dependence refers to a condition in which people cannot give up using a drug on their own as arecovering from alcohol dependence. The first step is a “powerless declaration” saying: We have admitted

result of the continued use of the drug since stopping makes them feel unpleasant (Figure 10.3). Because

we are powerless over alcohol—that our lives have become unmanageable. Al-Anon has a base in

obtaining the drug becomes the highest priority in their daily life, they may have difficulty leading a

Phnom Penh, while Alcoholics Anonymous (AA), a likeminded mutual self-help group, holds meetingsnormal life, or may try to obtain the drug without a thought for how they look. Using a drug as a one-in Phnom Penh, Siem Reap, and Battambang. Mutual self-help groups aiming for recovery from drug

time experiment may result in drug dependence, or some cue may prompt a person who stopped the use

dependence are also expected to play an active role in Cambodia.

of a drug to begin it again.
Drug addicts have a strong desire to use a drug when its effect wears off. As a result, money to buy
the drug becomes necessary, and they even commit crimes, such as shoplifting, robbery, and prostitution,

Column: What is drug tolerance?

to obtain the drug. They cannot control their desire by themselves even if they think that they do not

Tolerance to a drug develops when the body gets used to the drug by taking it repeatedly, and thus

want to use the drug or they want to give it up after using a certain amount. Stopping drug use may leadthe amount of the drug necessary to get the same effect increases. One of the physiologicalto sleeplessness/hypersomnia, depression, anxiety, fretfulness, hallucination/delusion, muscle/joint

mechanisms that develops tolerance is a faster excretion of the drug from the body, as a result of

pain, convulsive seizure, hyperphagia, weakness, vomiting, diarrhea, abnormal sweating, and withdrawal

increased metabolic efficiency of the drug or the creation of a new metabolic pathway (metabolism

symptoms. The habitual use of a drug builds up tolerance to the drug, increasing the amount necessarylevel). In addition, decreased sensitivity to the drug in the bodily tissues can also be raised (bodily

to gain pleasure.

tissue level).

No specific medicine or therapeutic method is available for curing drug dependence. The only
possible way is to continue to live without using a drug. Receiving appropriate advice from experts andcontinuing to live without using drugs will make it possible to return to social life. This is called recovery.

3) Spread of drugs in the Western Pacific region12

In order to effectively achieve this recovery, people suffering from dependence on alcohol or illicit
drugs, such as stimulants, should accept that they cannot voluntarily control their behavior and try to

The Golden Triangle, an area covering Myanmar, Thailand, and Laos, is known as a production/

keep themselves away from drugs through ties with people who have also suffered from drug abuse by

distribution area for opium (Figure 10.4). Myanmar in particular has become famous for its abundantjoining a mutual self-help group.

poppy fields. In recent years, the types of narcotic drugs produced in this Golden Triangle have changed

In this connection, Al-Anon, a mutual self-help group that started in the United States in 1951 and178

from opium and heroin, which are made from poppy, to stimulants (synthetic narcotics). Stimulants are
Chapter 10

Health effects of tobacco use, alcohol consumption, and drug abuse179

prevalence of smoked tobacco standing at 16.6% for the entire group, 32.9% for men, and 2.4% for

China

women. Meanwhile, the use rate of smokeless tobacco (chewing tobacco) among people aged 15 years

Golden Triangle

and older is 0.8% for men and as high as 8.6% for women.15 The material that is mainly used as smokelessVietnam

Myanmartobacco is betel quid, which generally refers to a mixture of betel nut / Areca catechu and slaked limeLaoswrapped in a betel leaf (Figure 10.5). It has been shown that one out of ten rural women uses this typeof smokeless tobacco, with the use rate increasing with age.15 Although smokeless tobacco has beenThaiculturally/traditionally regarded as medicinal in some cases, it is considered to have an adverse effectCambodia

Malaysia(the risk of oral cancer) on the human body, like smoking.

Distribution
channelFigure 10.4 Golden Triangle

not only consumed in Myanmar, Thailand, and Laos, but also smuggled into the surrounding countries:
Cambodia, Vietnam, Bangladesh, India, and China. Moreover, they spread to the entire Asia-Pacificregion, including Japan, Korea, Taiwan, Indonesia, Malaysia, Singapore, the Philippines, Australia, and
New Zealand. Besides the Golden Triangle, there are many areas where narcotic drugs are produced

Figure 10.5 Betel quidaround the world. Drugs including narcotics, which are smuggled across borders, are threatening thehealth of people around the world.

Concerning the use of tobacco products by the younger age group, 6.4% of children aged 13 to 15
years old have used tobacco products (smoked and/or smokeless), with 2.4% presently using tobacco
products.16 There are many advertisements in urban districts that encourage people to smoke, and theColumn: What are narcotic drugs?

media report scenes in which tobacco is used. In addition, cheap tobacco prices may be another reason

Narcotic drugs originally referred to various substances that numb sensation to reduce pain. Today,that the younger age group can easily begin using tobacco.

opium, opium derivatives, and opioid medications synthesized from opium extracts are called

On the other hand, there are many adults who think tobacco use can cause heart disease and lungnarcotic drugs. However, because narcotic drugs can refer to other drugs, they are collectively

cancer, and support restricting tobacco use in public places and increasing the tobacco tax.15 Like adults,

called opioids for clarification. Opioids are a class of drugs that include heroin, morphine, andchildren also understand the impacts of tobacco on their health and the importance of restricting tobacco

codeine13

use in public places (Table 10.2).16
Table 10.2 Students’ knowledge and attitudes toward smoking

5. Spread of tobacco use, alcohol consumption, anddrugs in Cambodia

Knowledge and Attitudes

1) Tobacco use in Cambodia
The WHO’s Report on the global tobacco epidemic 2019-Cambodia Country Report-14 states that thelatest surveys of tobacco use in Cambodia are the National Adult Tobacco Survey of Cambodia (2014)15

and the Global Youth Tobacco Survey (2016).16 Described below is the present situation of tobacco use%

Students who definitely thought other people’s tobaccosmoking is harmful to them

78.50%

Students who favored prohibiting smoking inside enclosed
public places60.70%

Students who favored prohibiting smoking at outdoor public
places60.80%
16

Source: WHO. Global Youth Tobacco Survey Cambodia 2016

in Cambodia based on these reports.
According to the National Adult Tobacco Survey of Cambodia (2014), as of 2014, 22% (approx.
1.68 million) of Cambodian people aged 15 years and older use some form of tobacco product, with the180

Chapter 10

Health effects of tobacco use, alcohol consumption, and drug abuse

1812) Alcohol consumption in Cambodia

20

Column: Most At Risk Young People (MARYP) Survey at Hot Spots

As for Cambodian peoples’ alcohol consumption, the annual per capita consumption of alcohol among
17

A survey of socially vulnerable young people aged 10 to 24 years who engage in high-risk behavior

drinkers aged 15 years and older is 21.7 liters (Table 10.3). This represents the consumption converted

was conducted in 2010. The aim of the survey was not to understand the situation of general young

to pure alcohol; the annual consumption is equivalent to 434 liters in the case of beer with an alcohol

people but to identify the behavior and consciousness of MARYP, who manifest high risk behavior

content of 5%.

related to alcohol, drugs, and sex and flock to “hot spots” (e.g., bars, karaoke places, massage
salons, and game centers), in eight states where high-risk behaviors for HIV infection have spread.

Table 10.3 Total alcohol per capita consumption, drinkers only (in liters of pure alcohol)

Among those aged 10 to 19 years who were surveyed, 81.4% of men and 57.6% of women

CambodiaJapan

ThailandMyanmarVietnamLao PDR

responded that they have experienced alcohol consumption. Of these people, 2.3% of men (1.9%

21.7

14.1

20.3

17.6

22.8

25.9

The awareness of high alcohol consumption differs between the sexes, and the difference is evenof the total) and 18% of women (10.4% of the total) are aware that their alcohol consumption is high.

17

Source: WHO. Global Status Report on Alcohol and Health 2018

greater in the age group of 20 to 24 years old. This is probably because young women who work at
karaoke bars and night clubs have many opportunities to consume alcohol with their customers.
The survey shows that reasons for alcohol consumption by MARYP include curiosity to experience

According to the results of the 2013 Global School-based Student Health Survey (GSHS),18 among

something new; coping with stress and depression; coping with events that occurred at school (i.e.,boys and girls aged 13 to 17 years old, the percentage of those who consumed at least one drink offailure in the exam, pressure of deadlines, altercations with friends, and love relationships); alcohol

alcohol in the last 30 days was 12.5% (N=1250) for boys and 4.4% (N=1526) for girls. The percentage

consumption by family members; frequent encounters with alcohol consumption/drug use/tobaccoof those who have ever consumed alcohol was 28.7% for boys and 12.7% for girls. The percentage ofuse in the neighborhood or community; avoiding ostracism from friends; and psychosocial reasons

those who have had problems resulting from alcohol consumption, including problems with familysuch as peer pressure. It also indicates that they think, from their point of view, that education does

members or friends, absence from school, and brawls, was 2.6% for boys and 1.6% for girls.

not guarantee success in life, and stylish appearance is very important, with alcohol consumption

Currently, Cambodia has a minimum level of legal restrictions on alcohol without the establishedseen as a stylish behavior.

minimum age for alcohol consumption or restrictions on advertisements for alcohol. Although there areblood alcohol concentration limits for driving, it is unclear whether a crackdown on drunk driving isproperly carried out on the basis of the limits. There are also cases in which unofficial manufacturers’3) Drug abuse in Cambodia

19

tax payment is evaded because of lax restrictions (Table 10.4). To solve these challenges, there is amovement to revise the law. Restricting accessibility to alcohol leads to not only the prevention of healthAs described in “Spread of drugs in the Western Pacific region” in this Chapter, Cambodia is not included

damage and dependence but also the prevention of incidents and accidents, including drunk driving,in the Golden Triangle, but drugs come into the country for trafficking from neighboring Thailand, Laos,

brawls, domestic violence, and sexual deviancy.

and Vietnam. In Cambodia, stimulants (methamphetamine tablets and crystalline methamphetamine),
Ecstasy, heroin, and ketamine are abused. Since 2017, because of the launch of the anti-drugs campaign
by the government, a crackdown on drugs has been intensified and the amount seized has increased year

Table 10.4 Issues in legal restrictions on alcoholby year (Table 10.5).21 However, drug dependence remains a challenge, and it is said that more than

1. Inadequate age restrictions

20,000 people are in rehabilitation facilities under the control of the Ministry of Health. Drug abuse isspreading particularly among young people, and 49% of the people admitted to drug treatment centers

2. Inadequate restrictions on the hours for sales of alcohols

are reported to be young people aged 18 to 25 years old (Figure 10.6).21,22

3. Emasculated blood alcohol concentration limits for driving

Drugs pose a threat to children as well. A survey of children between 13 and 18 years of age23 has
shown that 15.9% of the children have seen the trading of drugs in the area where they live. The

4. Inadequate restrictions on advertisements

percentage of children who have seen someone abusing a drug was 18.9%, of which 70.2% said theysaw it in the area where they live. The percentage of children who have been offered drugs by a friend

5. Lack of laws regulating sponsors and sales promotion

or a neighbor was 4.9%. It has been reported that children who have seen the trading of drugs in the area

6. Non-mandatory inclusion of warning messages in packages and advertisements

where they live and those who have been offered drugs by their friends or neighbors tend to feel anxious
19

Source: The Asia Foundation (2016)

182

when staying at home alone or dislike going to school or public places. For healthy growth andChapter 10

Health effects of tobacco use, alcohol consumption, and drug abuse

183

Table 10.5 Seizures of selected drugs in Cambodia 2014-2019 -UNODC 2020

Many young people were worried that they might be excluded from a group if they refused such offers,

Unit

2014

2015

2016

2017

2018

2019

and accepted the offers to maintain friendships. In all of these cases, they intended to try just once but

tablets

87,000265,760

490,689

371,556

77,000483,402

came to use habitually.20,24

kg

29

72.9

66.3

80.1

306.6

384.9

It is thought that there is a relationship between alcohol consumption and tobacco use: men who

tablets

10,53370

5,509

83,533599,200

382,728

smoke are more likely to consume alcohol than men who do not smoke. Although the relationship is not

Cannabis herb

kg

19.9

1,511.5

37

116.3

74.0

102.8

as clear as in men, women who use smokeless tobacco are said to be more likely to consume alcohol.25

Cocaine

kg

7.9

5.3

14

12.8

5.4

61.1

In order to change interrelated risk behaviors, that is, alcohol consumption, tobacco use, drug abuse,

Heroin

kg

1.8

2.5

6.2

22.5

1.3

47.9

and unprotected sexual acts, it is necessary to reduce social stress as well as steadily carry out health

Ketamine

kg

0.0

0.1

1.1

6.3

36.3

33.1

education and social policy to change values.

Drug type

Methamphetamine tablets
Crtstalline methamphetamine
Ecstasy

Source: United Nations Office on Drugs and Crime (UNODC) : Synthetic Drugs in East and South-East Asia: Latest developments andchallenges. 2020

>46 years 1%
36-45 years

7%

10-17 years

8%

Column: Global strategies regarding tobacco and alcohol (Figure 10.7)

As a global tobacco strategy, the Framework Convention on Tobacco Control 5 was adopted at
the 56th World Health Assembly in 2003 and entered into force on February 27, 2005. The objectiveof the Convention is to protect present and future generations from the harmful health effects of
tobacco use, etc. To achieve this objective, the Convention includes “Protection from exposure to26-35 years

35%

tobacco smoke,” “Ensuring that tobacco product packaging and labelling do not promote tobacco
18-25 years

49%

products by any means that are false, misleading, deceptive or likely to create an erroneous
impression, and health warnings shall be no less than 30% of the principal display areas,” “A
comprehensive ban or restrictions on all tobacco advertising, promotion and sponsorship,” “Taking
measures to eliminate illicit trade in tobacco products, including requiring unit packets and packages

Source: UNODC: Synthetic Drugs in East and South-East Asia: Latest developments and challenges. 2020

Figure 10.6 Drug treatment center admission in Cambodia by age group -UNODC 2020of tobacco products to carry effective marking indicating the final destination,” “Implementing
effective measures to prohibit the sales of tobacco products to minors,” “Establishing the Conferenceof the Parties that keeps under regular review the implementation of the Convention and takes
decisions necessary to promote its effective implementation,” and “Each Party shall submit to thedevelopment of children, it is important to have a drug abuse prevention program aimed at creating a

Conference of the Parties periodic reports on its implementation of this Convention.”5

safe community, in which social norms are developed to enhance a sense of unity in the community andto refuse drug use. To achieve this, it is necessary to improve the community’s socioeconomic andcultural environments, such as addressing the community’s poverty, unemployment or lack of
employment, social unrest, and high density of shops that sell alcohol and tobacco.

4)	Psychological/social factors related to tobacco use, alcohol consumption,and drug abuse
Column: As touched on in the section on the Most At Risk Young People (MARYP) Survey at Hot Spots,
triggers for high-risk young people to begin tobacco use, alcohol consumption, and drug abuse arecasual curiosity such as “I just wanted to try something new,” or “I just gave it a try,” or the influenceof family members/friends or advertisements such as “they looked cool,” “they looked tasty,” and “I saw
advertisements.” Some young people began when they become depressed because of a problem with afriend, lover, or family member. In addition to these, offers or pressure from friends is another factor.
184

Figure 10.7 Social measures (warning messages on tobacco packages)

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Health effects of tobacco use, alcohol consumption, and drug abuse

185

Meanwhile, “the global strategy to reduce the harmful use of alcohol”26 was unanimously adopted

High

and mortality related to alcohol as well as the resulting social impacts, and to improve the health ofindividuals, families, and society, in order to significantly curb the use of alcohol, which is the thirdlargest factor adversely affecting health and societies in the world. To achieve this objective, thestrategy calls for a broad range of measures, including restrictions on advertisements, bans or
restrictions on bargains and all-you-can-drink offers, and alcohol price increases through taxationand minimum price systems.26

Dangerous
range

Drug level in the bloodat the 63rd WHO general assembly in 2010. The objective of this global strategy is to reduce morbidity

Effective
range
Ineffective
range

Column: How to use pharmaceuticals

Although pharmaceuticals are originally designed to alleviate or cure human diseases and disorders,

Source: Risk/Benefit Assessment of Drugs - Analysis and Response. Kusuri Guidebook.
Copyright ©RAD-AR Council, Japan. All rights Reserved. Translated with permission.

they need to be properly used because even beneficial pharmaceuticals can have adverse effects
on health if used in the wrong way. Pharmaceuticals have, by nature, “main effects,” which are to

Figure 10.8 Drug levels in the blood and drug efficacy 27

achieve the intended purposes of easing and curing the symptoms of disease, and “side effects,”
which are adverse influences on the body resulting from the use of the pharmaceutical. Side effects
can occur with any pharmaceutical as well as in people with certain predispositions or conditions.

Exercises for further thought and research

Pharmaceuticals are drugs designed to be used for the diagnosis, treatment, or prevention ofhuman and animal diseases. They have the components and forms (e.g., liquid, semisolid, and solid)[10-1] As restrictions on advertisements for alcohol consumption, there are “bans on advertisingthat are suited for the effect and efficacy (e.g., easing pain). In addition, usage (dosage andappealing to minors” in Canada, and “bans on advertising on television and movies” in France.

administration, and timing) is established so that pharmaceuticals can properly exhibit effect andConsider what kind of social measures can be taken in Cambodia to create an environment for

efficacy.27 However, even pharmaceuticals can cause side effects if used in the wrong way. For

preventing tobacco use and alcohol consumption among children.

example, if you miss a dose of a drug that needs to be taken three times a day and take a double[10-2] Smokers say that they feel refreshed after smoking tobacco and that they cannot help smoking

dose of the drug at one time, drug levels in the blood can rise to a dangerous degree, possibly

tobacco when they feel stressed. Present your counterarguments against these opinions.

causing anaphylactic shock. Or, if you adjust the dose of a drug and take a subtherapeutic dose,[10-3] Consider what you need to create a society in which drugs have no place.

drug levels in the blood will be too low to be efficacious (Figure 10.8). Therefore, in using drugs, it is[10-4] Understand the relationships between risk behaviors related to tobacco, alcohol, and sex, andconsider why young people display those behaviors.

important to carefully consult a physician, pharmacist, or pharmacy personnel about the usage of27

the drug, and to follow the dosage and administration stated on the package.

Low-quality pharmaceuticals and counterfeit medicines, which include those with false[10-5] Consider what should be done to encourage children to refuse drug offers.
[10-6] Consider how a teacher should act if a child reports that he/she witnessed a person abusing
alcohol or a drug, or trading drugs in the area where he/she lives.

labeling of contents and ingredients, those not meeting quality standards or specifications, andthose that have not been assessed or approved by regulatory authorities, are rapidly increasing
28

mainly in Asia, South America, and Europe. The WHO’s survey[10-7] Research cannabis restrictions in Cambodia. Study how cannabis has been historically andculturally used in Cambodia.

reports that low-quality

pharmaceuticals and counterfeit medicines account for approximately 10.5% of available
phamaceuticals in low- and middle-income countries. It also reports that these pharmaceuticals
particularly affect pneumonia and malaria in children. There is a concern that the spread of theinternet may increase the online sales of low-quality pharmaceuticals and counterfeit medicines.
In Cambodia, the estimated percentage of these pharmaceuticals widely varies from 4% to90%. Particular attention should be paid to drugs that community stores sell in loose form as they
contain many low-quality pharmaceuticals, counterfeit medicines, or unapproved drugs.29
Pharmaceuticals should be obtained at reliable places, such as hospitals and pharmacies.

References
1
2

186

Ministry of Health, Labour and Welfare: e-healthnet “Health effects of tobacco use.” https://www.e-healthnet.mhlw.go.jp/
information/tobacco-summaries/t-02
CDC. Smoking, Pregnancy, and Babies. https://www.cdc.gov/tobacco/campaign/tips/diseases/pregnancy.html
Chapter 10

Health effects of tobacco use, alcohol consumption, and drug abuse

187

Chapter 113

WHO: Health effects of smoking among young people. https://apps.who.int/tobacco/control/populations/youth_health_effects/en/
index.html

4

WHO: Heat-Not-Burn tobacco products information sheet. https://apps.who.int/tobacco/publications/prod_regulation/heat-not-burnproducts-information-sheet/en/index.html

56

WHO: WHO Framework Convention on Tobacco Control. 2003. https://www.who.int/fctc/text_download/en/
Chheng N. New tobacco device banned. The Phnom Penh Post. March 21, 2021. https://www.phnompenhpost.com/national/new-

Mental and physical changes duringadolescence

tobacco-device-banned
7

Ministry of Health, Labour and Welfare: e-healthnet “Health effects of alcohol.” https://www.e-healthnet.mhlw.go.jp/information/
alcohol-summaries/a-01

8

Ministry of Health, Labour and Welfare: e-healthnet “Alcohol and dependence.” https://www.e-healthnet.mhlw.go.jp/information/
alcohol-summaries/a-05

9

Ministry of Health, Labour and Welfare: e-healthnet “Alcohol and social issues.” https://www.e-healthnet.mhlw.go.jp/information/
alcohol-summaries/a-06

10 WHO Western Pacific Region Office. Young People and Alcohol: A Resource Book. 2015. https://apps.who.int/iris/bitstream/
handle/10665/208202/9789290616849_eng.pdf?sequence=1&isAllowed=y
11 Dharmapuri S, Miller K, Klein JD. Marijuana and the Pediatric Population. Pediatrics. 146 (2) e20192629. 2020. https://pediatrics.
aappublications.org/content/146/2/e20192629
12 Global News View: “The Golden Triangle—Rapidly increasing stimulants.” https://globalnewsview.org/archives/9905
13 United States Drug Enforcement Administration. Drug Fact Sheet: Narcotics. https://www.dea.gov/sites/default/files/2020-06/
Narcotics-2020.pdf
14 WHO: Report on the global tobacco epidemic 2019 -Country report Cambodia-. https://www.who.int/tobacco/surveillance/policy/

Learning objectives
You will be able to gain proper understanding and explain:- The mental and physical changes and the issues associated with growth and development duringadolescence and how to handle them.
- Pregnancy and childbearing and sexually transmitted infections in youth.
- The social challenges regarding sexual health in Cambodia and discuss their solutions.
In this chapter, you will learn about the following three topics: characteristics of mental and physicalgrowth and development in adolescence in the context of sexual health; basic information about
pregnancy/childbearing and sexually transmitted infections, and the current landscape and challenges in
Cambodia concerning these issues; and the current state of sexual health and its handling in Cambodia.

country_profile/khm.pdf
15 National Institute of Statistics, Ministry of Planning, Cambodia: National Adult Tobacco survey of Cambodia, 2014. https://
untobaccocontrol.org/impldb/wp-content/uploads/cambodia_2018_annex-1_national_adult_tobacco_survey_report_2014.pdf
16 WHO: Global Youth Tobacco Survey 2016 -Country Report Cambodia-. https://extranet.who.int/ncdsmicrodata/index.php/
catalog/690/related_materials
17 WHO: Global Status Report on Alcohol and Health. 2018. https://www.who.int/substance_abuse/publications/global_alcohol_report/
gsr_2018/en/
18 WHO Cambodia - Global School-Based Student Health Survey 2013. https://extranet.who.int/ncdsmicrodata/index.php/catalog/220/
data_dictionary
19 The Asia Foundation. The Alcohol Industry in Cambodia -A Study of Taxation, Regulation, Distribution, and Consumption of
Alcohol-. 2016. https://think-asia.org/bitstream/handle/11540/7313/The-Alcohol-Industry-in-Cambodia_report.pdf?sequence=1
20 Ministry of Education, Youth and Sports, Cambodia: Most at Risk Young People Survey Cambodia. 2010. https://
healtheducationresources.unesco.org/library/documents/most-risk-young-people-survey-cambodia-2010
21 UNODC: Synthetic Drugs in East and South-East Asia: Latest developments and challenges. 2020. https://www.unodc.org/
documents/scientific/ATS/2020_ESEA_Regonal_Synthetic_Drug_Report_web.pdf
22 AIPA Council on Dangerous Drugs: Country Report of Cambodia-. 2019. https://www.parliament.go.th/ewtadmin/ewt/aipa2019/
download/article/AIPACODD/Annex%20J%20-%20Country%20Report%20of%20Cambodia.pdf
23 Good Neighbors Cambodia: Survey Report -The Child’s Reporting on The Situation of Drug Use in Community-. 2019. http://www.
gncambodia.org/wp-content/uploads/2019/11/GNC_Drug-Survey-Reported-by-Voluntary-Grassroots-Youth-EN.pdf
24 Peltzer K, Pengpid S, Tepirou C. Associations of alcohol use with mental health and alcohol exposure among school-going students
in Cambodia, Nagoya Journal of Medical Science. 78(4): 415–422.2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159467/
25 Banta JE, Addison A, Job JS, Yel D, Kheam T, et.al. Patterns of Alcohol and Tobacco Use in Cambodia. Asia Pac J Public Health.
25(5 Suppl): 33S–44S. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5043075/
26 WHO: Global strategy to reduce the harmful use of alcohol. 2010. https://www.who.int/substance_abuse/alcstratenglishfinal.pdf
27 RAD-AR Council, Japan. KUSURI GUIDEBOOK. https://www.rad-are.com/downloads/kusurigb-pdf02.pdf
28 WHO: WHO Global surveillance and monitoring system for substandard and falsified medical products. 2017. https://www.who.int/
medicines/regulation/ssffc/publications/GSMS_Report.pdf
29 Khan MH, Okumura J, Sovannarith T, Nivanna N, Nagai H, et al. Counterfeit Medicines in Cambodia—Possible Causes.
Pharmaceutical Research 28:484-489. 2010. https://www.researchgate.net/publication/47157896_Counterfeit_Medicines_in_
Cambodia-Possible_Causes

188

1. Characteristics of mental and physical growth anddevelopment in adolescence (Table 11.1)
1) Physical changes(1) Signiﬁcance of adolescence as a period of transition from childhood to adulthood

1

Adolescence is a period when a child undergoes dramatic changes biologically, physically, and socially.
During this period, one experiences the appearance of secondary sexual characteristics due tohormonal changes in the body, while mentally, one goes through rapid cognitive and emotional
development. The human brain continues to develop until around the age of 25; during adolescence, one
becomes able to control their impulses and make more rational judgments as they grow older.
The ﬁrst half of adolescence is a period during which, as one grows, one becomes increasingly more
susceptible to the inﬂuence of people of the same age group, while becoming less dependent on theirparents. What you should keep in mind when addressing adolescence is the fact that the duration ofadolescence is growing “longer.” Speciﬁcally, most men and women today are experiencing theappearance of secondary sexual characteristics earlier in life, while entering into a period in life when
they assume social roles expected of adults, such as those connected to marriage, later, compared to what
they used to assume.
2(2) Secondary sexual characteristics

During the second half of adolescence (ages 15–19), one experiences sexual development andmaturation following the growth spurts in the ﬁrst half of adolescence. Physical growth and sexual
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Mental and physical changes during adolescence

189