Smoking, inhalation and exhalation
of the fumes of burning tobacco. Leaves of the tobacco plant are smoked in
various ways. After a drying and curing process, they may be rolled into cigars
or shredded for insertion into smoking pipes. Cigarettes, the most popular
method of smoking, consist of finely shredded tobacco rolled in lightweight
paper. About 46 million people in the United States smoke an estimated 420
billion cigarettes each year.
Until the 1940s smoking
was considered harmless, but laboratory and clinical research has since
confirmed that tobacco smoke presents a hazard to health. Smoke from the
average cigarette contains around 4,000 chemicals, some of which are highly
toxic and at least 43 of which cause cancer. Nicotine, a major constituent of
tobacco smoke, is both poisonous and highly addictive. According to the
American Cancer Society, smoking is the most preventable cause of death in
America today.
HISTORY OF SMOKING
|
European explorers who
arrived in the Western Hemisphere in the 1500s observed Native Americans
smoking tobacco plant leaves in pipes. The colonists who followed them grew
tobacco plants as a cash crop for export, and smoking became part of European
culture by the 1600s. Most tobacco was consumed in pipes and cigars or as snuff
(finely pulverized tobacco inhaled into the nostrils). This pattern changed by
the early 20th century, by which time smokers consumed more than 1,000
cigarettes per capita each year in the United States and some European
countries. The general attitude of society was that smoking relieved tension
and produced no ill effects. During World War II (1939-1945) American
physicians endorsed sending soldiers tobacco, and cigarettes were included in the
field ration kits of U.S. armed forces personnel until 1975.
Some scientists noticed,
however, that lung cancer, which was rare before the 20th century, had
increased dramatically since about 1930. The American Cancer Society and other
organizations initiated studies comparing deaths among smokers and nonsmokers
over a period of several years. All such studies found increased mortality
among smokers, both from cancer and other causes. In addition, experimental
studies in animals showed that many of the chemicals contained in cigarette
smoke are carcinogenic.
In 1962 the U.S. government
appointed a panel of ten scientists to study the available evidence concerning
the health effects of smoking. Their conclusions were included in the 1964
surgeon general’s report, which stated that “cigarette smoking is a health
hazard of sufficient importance in the United States to warrant appropriate
remedial action.” Smoking in adults, measured as an average number of
cigarettes smoked per year, began to decline steadily after the 1964 report and
has fallen more than 40 percent since 1965.
HEALTH
EFFECTS OF SMOKING
|
About 442,000 people in
the United States die each year from illnesses caused by cigarette smoking.
Smoking accounts for nearly 90 percent of lung cancer deaths. Additionally,
smokers are at increased risk for cancer of the larynx, oral cavity, esophagus,
bladder, kidney, and pancreas. While some negative health effects of smoking
manifest slowly over time, others can be measured almost immediately. Sticky
brown tar leaves yellow stains on fingers and teeth. Some of the inhaled tar is
absorbed by lung cells, causing them to die. Tar also damages the cilia in the
upper airways that protect against infection. Nicotine causes arteries to
constrict, lowering skin temperature and reducing blood flow to the hands and
feet. Carbon monoxide deprives the body of oxygen, binding to red blood cells
in place of the oxygen molecule and forcing the heart to pump more blood
through the body.
One-third of smoking-related
deaths are caused by coronary heart disease or chronic airway obstruction. For
example, the nicotine in tobacco combines with carbon monoxide in tobacco smoke
to damage the lining of blood vessels and make blood platelets stickier.
Platelets form part of the damaging plaque buildup in artery walls (see Arteriosclerosis).
These effects in combination contribute to the development of heart disease. Smoking
also increases the risk of stroke by 50 percent—40 percent among men and 60
percent among women. Other research has shown that mothers who smoke give birth
more frequently to premature or underweight babies, probably because of a
decrease in blood flow to the placenta. Babies born to mothers who smoke during
pregnancy are also at increased risk for sudden infant death syndrome.
Cigar and pipe smoke contains
the same toxic and carcinogenic compounds found in cigarette smoke. A report by
the National Cancer Institute concluded that the mortality rates from cancer of
the mouth, throat, larynx, pharynx, and esophagus are approximately equal in
users of cigarettes, cigars, and pipes. Rates of coronary heart disease, lung
cancer, emphysema, and chronic bronchitis are elevated for cigar and pipe
smokers and are correlated to the amount of smoking and the degree of
inhalation.
Studies have found that
cigarettes are addictive because an unknown component of tobacco smoke appears
to destroy an important brain enzyme known as monoamine oxidase B (MAO B). The
enzyme is vital for breaking down excess amounts of dopamine, a
neurotransmitter that triggers pleasure-seeking behavior. Smokers have
decreased levels of MAO B and abnormally high levels of dopamine, which may
encourage the smoker to seek the pleasure of more tobacco smoke.
Even nonsmokers are at
risk from smoking. Recent research has focused on the effects of environmental
tobacco smoke (ETS)—that is, the effect of tobacco smoke on nonsmokers who must
share the same environment with a smoker. The United States Environmental
Protection Agency (EPA) estimates that exposure to ETS, which contains all the
toxic agents inhaled by a smoker, causes 3,000 lung cancer deaths and an
estimated 35,000 deaths from heart disease per year among nonsmokers.
Secondhand smoke can aggravate asthma, pneumonia, and bronchitis, and impair
blood circulation.
The smoking habit and
addiction to nicotine usually begin at an early age. In the United States, more
than 90 percent of adults who smoke started by age 21, and nearly half of them
were regular smokers by the age of 18. Despite increasing warnings about the
health hazards of smoking and widespread bans on smoking in public places,
smoking remains common among teenagers and young adults. In 2001 surveys of
students in grades 9 through 12 found that more than 38 percent of male
students and nearly 30 percent of female students smoke. Although black
teenagers have the lowest smoking rates of any racial group, cigarette smoking
among black teens increased 80 percent in the late 1990s. Advertisements aimed
at a young audience are largely blamed for this new generation of smokers.
QUITTING
SMOKING
 |
Nicotine Patch
A nicotine patch, a type of transdermal patch,
is applied to the upper arm. The patch will continually release a small amount
of nicotine into the body through the bloodstream. This will reduce the
patient’s craving to smoke cigarettes.
Studies of former smokers
show that their risk of dying from smoking-related disease decreases with each
year of abstinence. According to the World Health Organization (WHO), smokers
who quit smoking before the age of 50 reduce their risk of life-threatening
disease by half after just one year, compared with those who continue smoking.
Other benefits of quitting
smoking include more disposable income, admission to social activities and
institutions that ban smoking, and often, lower health insurance premiums.
Nonetheless, to quit smoking is difficult, most likely because smokers crave
the effect of the nicotine in the smoke. The U.S. surgeon general declared
nicotine an addictive drug comparable to other addictive substances, including
cocaine, heroin, and alcohol, in its ability to induce dependence. Overall,
tobacco smoking causes about 20 times the number of deaths in the United States
than all other addictive drugs combined.
Smoking cessation methods
are plentiful, and many books and products are available to help an individual
stop smoking. Many smokers turn to group help because of the support and
understanding provided by other former smokers or people trying to quit. Most
successful group-help techniques involve a challenge and reward system that
also bolsters the self-discipline of the former smoker.
A number of nicotine replacement
products are available to help a person quit smoking. Nicotine patches are
small, nicotine-containing adhesive disks that must be applied to the skin. The
nicotine is slowly absorbed through the skin and enters the bloodstream. Over
time, a smoker uses nicotine patches containing smaller and smaller doses of
nicotine until eventually the craving for nicotine ends. Nicotine gum works in
a similar manner, providing small doses of nicotine when chewed. A nicotine
nasal spray is a physician-prescribed spray that relieves cravings for a
cigarette by delivering nicotine to the nasal membranes. Also available by
prescription, the nicotine inhaler looks like a cigarette; when puffed, the
inhaler releases nicotine into the mouth.
An approach combining
three different smoking cessation therapies has found remarkable success. This
approach combines an antidepressant drug called bupropin, marketed under the
brand name Zyban, with a nicotine replacement product and counseling. While
less than 25 percent of smokers who use nicotine replacement products alone
remain smoke-free for more than a year, 40 to 60 percent of smokers using this
combination approach achieved this milestone.
ANTISMOKING ACTION IN SOCIETY
|
In the United States,
the first direct action to curb smoking after the U.S. surgeon general’s 1964
report on smoking was the mandate of a warning on cigarette packages by the
Federal Trade Commission. This warning took effect in 1964 and was strengthened
in 1969 to read: “Warning: The Surgeon General Has Determined That Cigarette
Smoking Is Dangerous to Your Health.” A stronger sequence of four alternative
warnings was developed in 1984. In 1971 all cigarette advertising was banned
from radio and television, and cities and states passed laws requiring
nonsmoking sections in public places and workplaces.
This trend has continued
and smoking is now banned at the federal and state levels in most government
buildings and in many private businesses. As of February 1990 federal law
banned smoking on all domestic United States airline flights under six hours in
duration. By 1998 more than 90 percent of nonstop flights between the United
States and all foreign countries were also smoke free.
In 2002 President George
W. Bush signed into law the Safe and Drug-Free Schools and Communities Act. The
law bans smoking within any indoor facility used for childhood education. By
2003 a number of states (including New York, Connecticut, Maine, and
California) and cities (including Boston, Massachusetts and Austin, Texas)
passed laws banning smoking in all bars, restaurants, and clubs. Several
European countries also began to ban smoking in public places—especially in
restaurants, bars, and cafes. They include Ireland, Italy, Netherlands, and
Norway. A ban in the United Kingdom is scheduled to take effect in 2007; a ban
in France, in 2008.
The tobacco industry has
been increasingly criticized for its role in encouraging smoking, particularly
in young people. Various lawsuits have been brought against tobacco companies
to reclaim damages due to disease or death associated with smoking. The first
major successful suit occurred in March 1996 when the Liggett Group, a
consortium of companies, agreed to pay damages to five states. An onslaught of
litigation against the tobacco industry followed. In part to avoid potentially
ruinous lawsuits filed by states, in 1998 the tobacco industry and attorneys
general from 46 U.S. states agreed to a $206-billion settlement. The settlement,
to be paid over 25 years, will be used to compensate states for the costs of
treating smoking-related illness, to finance nationwide antismoking programs,
and to underwrite health care for uninsured children.
The tobacco industry must
also contend with a barrage of lawsuits filed by individual smokers and their
families seeking damages for smoking-related health problems and deaths. Across
the United States, such lawsuits have had mixed results. In several cases,
juries have cleared the tobacco companies of all responsibility. While several
other cases have resulted in large awards for the plaintiffs, few hold up under
the appeals process.
Tobacco industry representatives
long denied that nicotine is addictive and that there is a link between smoking
and poor health. In recent years, however, cigarette makers have faced
increased pressure from smoking-related lawsuits and federal regulators to
accept prevailing scientific opinions about the health risks of smoking. In
late 1999 Philip Morris, now known as Altria, the nation’s largest cigarette
maker, publicly acknowledged that smoking is addictive and causes serious
health problems. This latest admission was considered a way to make it more
difficult for those who have recently started smoking to claim they were
unaware of the dangers if they choose to sue cigarette companies. In 2003 an
Illinois judge ordered Philip Morris to pay $10.1 billion in damages for using
misleading advertising campaigns suggesting that cigarette brands marketed as
“low tar” or “light” are safer than regular brands. Numerous scientific studies
prove that the use of low-tar cigarettes does not reduce the risk of developing
smoking-related disease, and the judge found that Philip Morris intentionally
disregarded consumer rights by spreading disinformation.
