According to the World Health Organization, smoking is the leading preventable cause of death in the world. In many counties, packets of cigarettes contain anything from health warnings to graphic images of the harm caused by smoking, and as a result of persistent public health education on the associated dangers, the vast majority of smokers want to quit. Finding out some facts about smoking both paints a picture of the needless harm caused by the combustion of tobacco and goes some way to answering the question of why so many people around the world continue to smoke despite their desire to quit.
The Health Impacts of Smoking
Smoking can have a serious impact on almost every organ in your body. The most widely-known consequence is the increased risk of cancer, but the potential consequences for smokers’ health are in no way limited to cancers.
- Cardiovascular Disease – Smoking has a serious impact on the heart and blood vessels, increasing the risk of developing coronary heart disease and strokes by two to four times. The damage smoking does to blood vessels can lead to increased blood pressure, clots and consequently, heart attacks.
- Respiratory Disease – Smoking has numerous consequences for the lungs, causing chronic obstructive pulmonary disease (COPD). This is when the exchange of gases in the lungs is impaired due to structural damage to the alveoli (“sacks” of air) and bronchioles (airways), and smoking is a common cause of such damage. In emphysema, damage to the alveoli walls ultimately reduces their ability to exchange gas. In bronchitis, the airway lining is irritated, which causes it to thicken and become clogged with mucus.
- Cancers – Smoking can lead to a wide range of cancers, either by weakening the immune system or by causing genetic damage. This can occur in many areas in your body, including the lungs, throat, trachea, stomach, bladder, cervix, esophagus, pancreas and blood. Smokers are around 25 times more likely to develop lung cancer.
- Other health impacts – There are a wide range of other potential consequences of smoking, including reduced fertility, increased diabetes risk, numerous effects in pregnancy such as low birth weight, ectopic pregnancy, stillbirth and sudden infant death syndrome, increased risk for cataracts and negative impacts on dental health.
Deaths Caused by Smoking
- Smoking causes 80 percent of all COPD-related deaths and 90 percent of all lung cancer deaths.
- Smoking is responsible for around one in five deaths in the United States, over 480,000 per year (including those deemed to be related to second-hand smoke).
- Smokers die sooner than non-smokers: around 13.2 years earlier for men and 14.5 years earlier for women.
- Every year, smoking kills more people in the U.S. than HIV, illegal drug use, alcohol, guns and car accidents combined.
- Around 50 percent of smokers will die as a result.
What’s In a Cigarette?
There are over 7,000 chemicals in the smoke from combusted tobacco, many of which result from the burning of tobacco leaves, with some added during the manufacturing process and residue of chemicals used in the growing of the tobacco plant.
- Carcinogens – There are around 70 cancer-causing chemicals in tobacco smoke, including tobacco-specific nitrosamines, formaldehyde, benzene and polonium 210.
- Metals – Toxic metallic components in cigarette smoke include lead, chromium, cadmium and arsenic.
- Gases – Poisonous gases contained within cigarette smoke include hydrogen cyanide, butane, toluene, ammonia and carbon monoxide – which effects the blood cells’ ability to carry oxygen.
Light Cigarettes are Not Safer
“Light” or “low tar” cigarettes are often smoked in the intention of reducing the quantities of harmful chemicals the smoker inhales, but research has shown that there is no significant difference between low tar or light cigarettes and the ordinary variety when it comes to things like carbon monoxide and other toxin exposure. Additionally, these cigarettes don’t reduce the likelihood of developing smoking-related illnesses. Many smokers of low tar or light cigarettes believe that they’re safer because the smoke feels smoother on the throat, but this is effect is accomplished with simple techniques such as:
- Tobacco companies use additives to make the smoke seem smoother. These can include sweeteners such as honey and sugar, or small amounts of other components such as menthol or liquorice flavorings.
- “Filter ventilation” reduces the amount of smoke inhaled per puff. By adding air holes to the filters on some low tar or light cigarettes, the amount of smoke inhaled per puff is reduced. This reduces the concentration of smoke per puff – making the cigarette less irritating to the throat – but smoking a full cigarette still means consuming the same amount of carcinogens and toxins.
Prevalence of Smoking – A Widespread Habit, Regardless
The current numbers of smokers are still disconcertingly high, despite widespread public understanding of the risks associated with the habit.
- 18.1 percent of adults in the US were current smokers in 2012, translating to around 42.1 million Americans aged 18 or over smoke. This encompasses 20.5 percent of men and 15.8 percent of women.
- Smoking is more common in people of lower socioeconomic status, with 27.9 percent of those living below the poverty level smoking in comparison to 17 percent of those who live at or above it.
- According to the Journal of the American Medical Association, people with mental illnesses or substance abuse problems smoke around 44.3 percent of the cigarettes consumed in America. People suffering from a mental illness are twice as likely to smoke.
- In 2012, Kentucky had the highest smoking rate of any state in the U.S., with 28.3 percent of adults smoking. Utah had the lowest rate, at just 10.6 percent. By region, the Midwest has the largest proportion of smokers.
- The overall smoking rate is decreasing, though, going from 20.9 percent in 2005 to 18.1 percent in 2012.
Teen Smoking – When the Habit Takes Root
Teen smoking is illegal, but still continues to be a problem for parents, lawmakers and the teenagers themselves. Although the health effects of smoking will take several years to develop, the addiction to smoking and nicotine often takes root during youth.
- In 2012, estimates based on surveys of middle school and high school students suggest that 14 percent of high school students and 3.5 percent of middle school students are current smokers (defined as smoking on one or more days in the previous month). In both cases, smoking is more common among males.
- Around 88 percent of smokers had started by age 18, and 99 percent had started by age 26.
- It’s estimated that 3,600 youths aged under 18 will smoke their first cigarette every single day, and 900 will become daily smokers.
- Youth tobacco use is associated with having friends who smoke, parents who smoke, beliefs that smoking will lead to positive outcomes such as stress reduction, higher levels of depression and anxiety, low self esteem and low socioeconomic status.
- Current cigarette smoking among middle and high school students declined from 2011 to 2012, with 4.3 percent of middle school and 15.8 percent of high school students fitting the definition in 2011.
The carcinogens and toxins present in cigarette smoke don’t just affect the first-hand smoker. These chemicals are released into the surrounding air, and can be inhaled by – and may potentially cause harm to – non-smokers in the vicinity.
- Second-hand smoke is estimated to cause 46,000 deaths per year in the United States from heart disease in non-smokers.
- It’s estimated that second-hand smoke exposure increases the risk of lung cancer in non-smokers by 20 to 30 percent. However, a recent piece of research which followed over 76,000 women for a decade found no link between second-hand smoke and lung cancer, so this estimate may be called into question.
- For children, second-hand smoke exposure has been associated with more frequent illness, wheezing and coughing, and also may trigger asthma attacks.
What Works for Quitting Smoking?
68.8 percent of smokers report wanting to quit smoking, and over 40 percent of all adult smokers stopped for at least one day in 2010 because they were attempting to stop entirely. So what are the options for quitting smoking, and how successful are they?
- Cold turkey – Quitting smoking “cold turkey” means to stop smoking without any assistance. This is the most popular method of quitting smoking, but also the least successful. After six months to a year, only 3 to 5 percent of those who attempt to quit smoking cold turkey will succeed.
- Nicotine replacement therapy – Nicotine replacement therapy (NRT) includes products like patches and gums that provide the user with a dose of nicotine to reduce the withdrawal symptoms associated with quitting smoking. A systematic review of the evidence available on the use of NRT concluded that it can be expected to add 2 to 3 percent onto cold turkey quitting rates, meaning that 5 to 8 percent of attempts to quit smoking with NRT are successful. Other research shows that NRT is less effective when bought over-the-counter, without behavioral support.
- Medicines – Pharmaceuticals such as bupropion (Zyban) and varenicline (Chantix) are available to assist in attempts to quit smoking. Systematic reviews of the evidence into their effectiveness have shown that bupropion does increase quit rates, and appears to be as effective as NRT, and varenicline is over twice as effective as a placebo (an inactive “fake” medicine). However, both of these are more effective with behavioral support, and research comparing varenicline to patches showed similar success rates.
- E-cigarettes – A new tool often used for quitting smoking is the electronic cigarette. These use a nicotine-containing liquid (often mixed with flavorings), which is vaporized by a heating coil to deliver nicotine in a smoking-like fashion. As a new technology, in-depth systematic reviews aren’t yet available for e-cigarettes, but initial research is promising. A randomized controlled trial comparing e-cigarettes to nicotine patches found them to be at least as effective for quitting, with slightly more of the e-cigarette group remaining abstinent from cigarettes for six months, but not significantly more than in the patch group.
Health Benefits of Quitting Smoking
Smoking may be extremely detrimental to health, but in many cases, the damage caused can be rectified and the increased risks reduced with increasingly long periods of abstinence.
- After eight hours free of smoking, carbon monoxide levels in the blood return to normal levels.
- The risk of a heart attacks decreases after just one day of abstinence from smoking.
- Lung function increases and the circulation improves after anything from two weeks to three months of not smoking.
- After one to two months of abstinence the risk of one type of smoking-related stroke returns to normal levels.
- After between one and nine months the cilia in the lungs are repaired, reducing the risk of infection.
- The risk of heart disease is cut in half after one year of abstinence.
- Stroke risk returns to the level of a non-smoker after five years.
- After ten years, the risk of numerous cancers decreases, and the lung cancer risk shrinks to half of that of a smoker.
- Heart disease risk decreases to the level of a non-smoker after 15 years smoke-free.
- The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General
- Quit.org.au: What’s in Cigarettes?
- CDC: Chemicals in Tobacco Smoke
- Quit.org.au: “Light” or “Low Tar” Cigarettes
- Smokefree NZ: Face the Facts
- American Lung Association: General Smoking Facts
- CDC: Adult Cigarette Smoking in the United States: Current Estimates
- CDC: Tobacco Product Use Among Middle and High School Students — United States, 2011 and 2012
- CDC: Youth and Tobacco Use
- National Alliance on Mental Illness: Smoking and Mental Illness
- CDC: Health Effects of Cigarette Smoking
- CDC: Tobacco-Related Mortality
- CDC: Health Effects of Second Hand Smoke
- CDC: Quitting Smoking
- Shinton, R. and Beevers, G. (1989) Meta-analysis of relation between cigarette smoking and stroke.
- Shah, R. S. and Cole, J. W. (2010) Smoking and stroke: the more you smoke the more you stroke
- Peres, J. (2013) No Clear Link Between Passive Smoking and Lung Cancer
- Wisconsin Tobacco Control Board: How Smokers are Quitting
- Hughes, J.R., Stead, L.F., Hartmann-Boyce, J., Cahill, K. and Lancaster, T. (2014) Do medications used to treat depression help smokers who are trying to quit (Updated)
- Cahill, K., Stead, L.F. and Lancaster, T. (2013) Can nicotine receptor partial agonists, including cytisine, dianicline and varenicline, help people to stop smoking?
- Bullen, C., Howe, C., Laugesen, M., McRobbie, H., Parag, V., Williman, J. and Walker, N. (2013) Electronic cigarettes for smoking cessation: a randomized controlled trial