7.4: Tobacco Use

“More doctors smoke Camels than any other cigarette.”

“Reach for a Lucky instead of a sweet.”

“Lucky Strike Cigarettes . . . are less irritating to sensitive and tender throats than other cigarettes.”

“Lucky Strike- To keep a slender figure no one can deny”

“Viceroys filter the smoke! As your dentist, I recommend Viceroys.”

With doctors, dentists, and researchers proclaiming the healthful effects of smoking, smoking rates increased throughout the first half of the 20th century until 1964. In 1964 the U.S. Public Health Service released the first publication linking cigarette smoking to lung cancer, laryngeal cancer, and chronic bronchitis, it was known as the Surgeon Generals Report on Smoking and Health. The report ranked as among the top news stories of 1964. A year later the Federal Cigarette Labeling and Advertising Act of 1965 was passed requiring cigarette packages to include a health warning this was followed by the Public Health Cigarette Smoking Act of 1969 which regulated the advertising of tobacco products banning cigarette advertising in the broadcast media. With this report and the two Acts, cigarette smoking began to decline^[2].

It is now well known, documented, and accepted that all forms of tobacco are harmful, and there is no safe level of exposure to tobacco. Tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarette smoking results in more than 480,000 premature deaths in the United States each year, about 1 in every 5 U.S. deaths. In 2020, 12.5% (nearly 13 of every 100) U.S. adults aged 18 years or older ) currently smoked cigarettes. This means an estimated 30.8 million adults in the United States currently smoke cigarettes. Over 16 million people live with at least one disease caused by smoking, and 58 million nonsmoking Americans are exposed to secondhand smoke. Some good news is that smoking has declined from 20.9% (nearly 21 of every 100 adults) in 2005 to 12.5% (nearly 13 of every 100 adults) in 2020.

Tobacco smoke contains more than 7,000 chemical components, and at least 250 of these chemicals are harmful to human health. Some of the chemicals, and where they are commonly found besides in cigarettes, include:

• Carbon monoxide is emitted from vehicle exhaust
• Nicotine is found in pesticide
• Arsenic and DDT are used in insect poison
• Hydrogen cyanide was used in the gas chambers in World War II and is currently used in rat poison
• Acetone is paint stripper and is a component of nail polish remover
• Ammonia is used in household cleaning products
• Butane and methanol are found in fuel
• Cadmium is in car batteries
• Formaldehyde is used as a tissue and specimen preservative commonly found in science labs.

Secondhand Smoke

The harmful effects of smoking extend far beyond the smoker. Exposure to secondhand smoke can cause serious diseases and death. Since the 1964 Surgeon General’s Report, 2.5 million adults who were nonsmokers died because they breathed secondhand smoke^[3]. Exposure to secondhand smoke causes an estimated 41,000 deaths each year among adults in the United States, causing 7,333 annual deaths from lung cancer and 33,951 annual deaths from heart disease.

Electronic Cigarettes

What are they?

E-cigarettes are battery-operated devices that typically produce a flavored nicotine vapor that looks like tobacco smoke. E-cigarettes are sometimes called “e-cigs,” “vapes,” “e-hookahs,” “vape pens,” and “electronic nicotine delivery systems (ENDS).” Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items.

Are e-cigarettes less harmful than regular cigarettes?

Although e-cigarette vapor does not contain the tar currently responsible for most lung cancer and other lung diseases, that doesn’t mean e-cigarettes are safe. Many studies suggest e-cigarettes and noncombustible tobacco products may be less harmful than combustible cigarettes. However, there is not yet enough evidence to support claims that e-cigarettes and other ENDS are effective tools for quitting smoking.

E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. However, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents. It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine

The U.S. Food and Drug Administration (FDA) has established rules for e-cigarettes and their liquid solutions in an effort to help protect the public from the dangers of tobacco use. Because e-cigarettes contain nicotine derived from tobacco, they are now subject to government regulation as tobacco products, including the requirement that both in-store and online purchasers be at least 18 years of age.

Can e-cigarettes help people quit smoking traditional cigarettes?

Because they deliver nicotine without burning tobacco, e-cigarettes are thought by many to be a safer alternative to conventional cigarettes, and some people even think they may help smokers lower nicotine cravings while they are trying to quit smoking. However, e-cigarettes are not currently approved by the FDA as a quit smoking aid. The U.S. Preventive Services Task Force, a group of health experts that makes recommendations about preventive health care, has concluded that evidence is insufficient to recommend e-cigarettes for smoking cessation in adults.

In a 2021 review of 61 studies focused on the use of e-cigarettes as a tool for quitting^[4], the researchers were moderately confident that nicotine e-cigarettes help more people to stop smoking than nicotine replacement therapy or nicotine-free e-cigarettes, however more research is needed.

Smokeless Tobacco (Chewing Tobacco)

Smokeless tobacco is associated with many health problems. Smokeless tobacco contains cancer-causing agents and nicotine, which is highly addictive. Because young people who use smokeless tobacco can become addicted to nicotine, they may be more likely to also become cigarette smokers later.

Smokeless tobacco comes in three types: Chewing tobacco (loose leaf, plug, or twist and may come in flavors), Snuff (moist, dry, or in packets [U.S. snus]), and Dissolvables (lozenges, sticks, strips, orbs).

Using smokeless tobacco:

• Can lead to nicotine addiction
• Causes cancer of the mouth, esophagus (the passage that connects the throat to the stomach), and pancreas
• Is associated with diseases of the mouth
• Can increase risks for early delivery and stillbirth when used during pregnancy
• Can cause nicotine poisoning in children
• May increase the risk for death from heart disease and stroke

Health Effects of Tobacco Use

Smoking leads to disease and disability and harms nearly every organ of the body.

Although nicotine is addictive and can be toxic if ingested in high doses, it does not cause cancer—other chemicals are responsible for most of the severe health consequences of tobacco use. Tobacco smoke is a complex mixture of chemicals such as carbon monoxide, tar, formaldehyde, cyanide, and ammonia—many of which are known carcinogens. Carbon monoxide increases the chance of cardiovascular diseases. Tar exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders. Smoking has also been linked to leukemia, cataracts, and pneumonia. On average, adults who smoke die 10 years earlier than nonsmokers.

Smoking and Cancer

Cigarette smoking accounts for about one-third of all cancers, including cancers of the blood (acute myeloid leukemia), bladder, cervix, colon, rectum, esophagus, kidney, renal pelvis, larynx, liver, mouth, throat, pancreas, stomach, trachea, lungs, and bronchi. If nobody smoked, one of every three cancer deaths in the United States would not happen.

Although smoking increases your risk of almost all cancers, it directly accounts for about 85-90 percent of lung cancer cases, or nearly 9 out of 10 lung cancers are caused by smoking cigarettes. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers. More people in the United States, both men and women, die from lung cancer than any other type of cancer. Although the risks of smoking are more clear today than in 1964, smokers have a greater risk for lung cancer today than they did in 1964, even though they smoke fewer cigarettes.

Quitting smoking lowers the risks for cancers of the lung, mouth, throat, esophagus, and larynx.

• Within 5 years of quitting, your chance of getting cancer of the mouth, throat, esophagus, and bladder is cut in half.
• Ten years after you quit smoking, your risk of dying from lung cancer drops by half.

Smoking and Cardiovascular Disease

In addition to cancer, smoking causes lung diseases such as chronic bronchitis and emphysema, and increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm. One out of every four deaths from Cardiovascular Disease is caused by a person choosing to smoke.

Smoking can:

• Raise triglycerides (a type of fat in your blood)
• Lower “good” cholesterol (HDL)
• Make blood sticky and more likely to clot, which can block blood flow to the heart and brainDamage cells that line the blood vessels
• Increase the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels
• Cause thickening and narrowing of blood vessels

Secondhand Smoke and CVD

Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25-30 percent and lung cancer by 20-30 percent. Non-smokers exposed to secondhand smoke may experience coughing, overproduction of phlegm, reduced lung function and respiratory infections, including pneumonia and bronchitis. Breathing secondhand smoke can interfere with the normal functioning of the heart, blood, and vascular systems in ways that increase your risk of having a heart attack. Even briefly breathing secondhand smoke can damage the lining of blood vessels and cause your blood to become stickier. These changes can cause a deadly heart attack.

Each year about 150,000 – 300,000 children younger than 18 months old experience respiratory tract infections caused by secondhand smoke. Children exposed to secondhand smoke are at an increased risk of ear infections, severe asthma, respiratory infections and death. In fact, more than 100,000 babies have died in the past 50 years from sudden infant death syndrome (SIDS), and other health complications as a result of parental smoking. Children who grow up with parents who smoke are more likely to become smokers, thus placing themselves (and their future families) at risk for the same health problems as their parents when they become adults.

There is no safe level of exposure to tobacco smoke.

Smoking and Your Brain

Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked. A typical smoker will take 10 puffs on a cigarette over the period of about 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 pack (25 cigarettes) daily gets 250 “hits” of nicotine each day.

Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate.

Similar to other addictive drugs like cocaine and heroin, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of negative consequences. Studies suggest that additional compounds in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain.

When an addicted user tries to quit, he or she experiences withdrawal symptoms including irritability, attention difficulties, sleep disturbances, increased appetite, and powerful cravings for tobacco. Treatments can help smokers manage these symptoms and improve the likelihood of successfully quitting.