Smoking
By Emily Korot
Summer Discovery Program: Exploring Careers in Medicine
Instructor: Steve Anisman
Summer, 1998
The mortality and disease statistics related to smoking not only erase all skepticism about the detrimental effects of cigarettes on the smoker, but also provide significant evidence illustrating the need for an end to the severe epidemiological effects of cigarette smoke. Smoking effects entire populations: not only is the health of the smoker impaired, but that of the innocent bystander as well.
Although tobacco use among Americans is currently decreasing, the effects of smoking on long term smokers are only now becoming pronounced, and thus the tobacco related mortality and disease statistics are rising. Although Americans generally do not regard smoking as a significant cause of death, it has claimed the lives of millions of smokers as well as nonsmokers, who are forced to suffer the awful consequences of their neighbor's bad habits. The number of smokers in America is truly a staggering number; according to an in-depth study by the Indiana Prevention Resource Center at Indiana University "approximately 50 million Americans smoke. They consume about 540 billion cigarettes each year, and each year approximately 390,000 people die from smoking- related causes." Cigarettes are referred to as a "gateway drug" because they often form a stepping stone for teenagers to try harder drugs such as cocaine and heroine.
In 1987, a research team at the University of Michigan's Institute for Social Research found that among high-school seniors, daily cigarette smokers were 10 times more likely to use cocaine regularly than were seniors who had never smoked regularly. Students who had never smoked were much less likely to experiment with controlled substances and very unlikely to use them regularly.
The connection between cigarette use and the use of controlled substances is no myth, just as the fact that the average age smokers begin their plight with addiction is well below the legal age is no myth either. "Studies show that the younger a smoker becomes addicted, the tougher it is to quit. According to the American Lung Association, 60 percent of smokers begin by the age of 14, and 90 percent by the age 19, and most of them think they will never get hooked on nicotine." A similar study found virtually equivalent information. In this research, it was found that " approximately three fourths of adult regular smokers tried their first cigarette before the age of 18 years; about half had become regular smokers before their 18th birthday." The fact that more than half of smokers begins before the age of 14, which is well below the minimum legal age of 18 should be alarming enough to both the government and the citizens that something must be done to halt the use of cigarettes among teenagers. In a research done studying the predictors for cigarette use, it was found that "the most important predictors for cigarette use were ethnic group, attitude toward females who smoke, close friends' use of cigarettes, personal use of marijuana,…personal use of alcohol, and school self esteem." In another study conducted with children before the age of adolescence the popularity of candy cigarettes was tested. The experiment found that, young children played with candy cigarettes more than with other candy or snack items and made general references to smoking behaviors. Older children made favorable references to smoking behavior; most knew which stores sold candy cigarettes, and many had chosen to buy and use these items, despite parental disapproval.
This study provides evidence suggesting that children may be taught from a young age to aspire to use tobacco products regardless of parental condemnation. Not only does the legislature have the right granted to them under the constitution to regulate the sale, advertisement, and distribution of tobacco to minors, they also have the obligation to uphold their own laws restricting the illegal use of cigarettes. Even with many of the long term effects of smoking known, "evidence shows that people continue to smoke not because of addiction, but because the rewards are immediate and tangible while the possible negatives consequences are remote and uncertain." In another report comparing the deaths caused by different forms of drug abuse it was found that, "Smoking causes three times the number of deaths as all other forms of drug abuse combined; smoking can be as intractable as other severe dependencies; and smoking is linked to several psychiatric disorders." To realize the immediate need for attention to the subject of smoking, an in depth look must be conducted into the adverse effects and consequences of smoking.
Risks associated with Smoking
Although the deleterious effects of smoking on the smoker have always been present, the severity of these consequences has not been realized until recently. Unfortunately, even with recent discoveries into the destructive nature of smoking, millions upon millions of Americans continue to smoke. Smoking is considered a "preventable cause of death" because rather than cancer or other diseases the smoker can prevent their death by simply not smoking. In an Article entitled "Cigarette Smoking-Related Mortality" researchers found that "Cigarette smoking is the single most preventable cause of premature death in the United States. Each year, more than 400,000 Americans die from cigarette smoking. In fact, one in every five deaths in the United States is smoking related. Each year, smoking kills more than 276,000 men and 142,000 women." In another report it was concluded that "smokers have a 70% greater chance of developing coronary heart disease than do nonsmokers-the risk increasing in direct proportion to the number of cigarettes smoked per day." The number of deaths from tobacco related causes in America may seem staggering-however, they are minute in relation to the global statistics. In an article written by a doctor at the University of Pennsylvania Cancer Center research uncovered that "smoking will kill three million people worldwide per year, or one person every 10 seconds. The number of people dying from smoking is rising, with a prediction that by 2020, 10 million per year will die from smoking."
In another study conducted about the affiliation of smoking with cancer it was found that "Between 1960 and 1990, deaths from lung cancer among women have increased by more than 400%--exceeding breast cancer deaths in the mid-1980s. The American Cancer Society estimated that in 1994, 63,300 women died from lung cancer and 44,300 died from breast cancer." Essentially this article found that smoking related cancer deaths have increased so much that they have surpassed breast cancer as the leading cause of death among women. Although women currently smoke more than men and that statistic is rising, due to past popularity of smoking among men the long term effects if this habit are only now effecting men's' health. Research based on statistical information found that "men who smoke increase their risk of death from lung cancer by more than 22 times and from bronchitis and emphysema by nearly 10 times. Women who smoke increase their risk of dying from lung cancer by nearly 12 times and the risk of dying from bronchitis and emphysema by more than 10 times." Another report found similar data concerning the inconsistencies in the deaths from smoking among men and women. In this report the deaths from smoking related causes were far higher among men than among women. The report determined that "over the 50 years from 1950 to 2000, 60 million people, 50 million men and ten million women, have died or will die from smoking(in developed countries)…About half a billion of the 5.5 billion people currently alive will eventually die by tobacco."
Smoking has become such a prominent cause of death among Americans that it would be neglectful for the federal government not to study its deleterious effects and prevent minors from illegally using it, as well as protect second hand smokers from its life threatening consequences. In a study conducted by the University of Pennsylvania Cancer Center it was found that in any group of 1,000 twenty year old smokers, 6 would die from homicide, 12 from car accidents, 250 in middle age from smoking, and another 250 in old age from smoking. There is obviously an overwhelming majority of deaths directly caused by tobacco and the gravity of smoking's deleterious health effects is brought into light when compared with other causes of death among healthy twenty-year-olds. Not only is smoking related to deaths from cancer and heart disease, but AIDS as well. In a study about HIV infection and smoking behavior, certain research found that "in addition to the immunological effects that could increase risk of infection, smoking also induces endocrinological effects. Such effects include decreases in serum estrogen levels that could contribute to increased risk of acquiring HIV infection by sexual intercourse." To sum up the overall deleterious effects of smoking a report conducted by the office on smoking and health found that "more than one of three smokers dies prematurely of a smoking-related disease." Aside from the most known associations between smoking and disease "clinical experience suggests that the heaviest smokers are found among institutionalized schizophrenics."
Second hand smoke
Perhaps the most persuasive and compelling argument for the governmental regulation of tobacco lies in the health consequences of cigarette smoke on the nonsmoker. Although their are certain freedoms endowed in all citizens of the United States allowing them to do and think what they wish, such as smoke cigarettes, the severely injurious health effects of smoking on the innocent bystander pose a serious argument against the fundamental rights of smokers. Second hand smoke or environmental smoke is often seen as simply a nuisance, and its serious health risks are often forgotten or overlooked. The average cigarette contains more than 4,000 chemicals and 40 carcinogens. In an article published by Americans for Nonsmoker's Rights, the author wrote that, "secondhand smoke is the third leading cause of preventable death in the country, killing 53,000 nonsmokers in the U.S each year." Second hand smoke is not only linked with lung cancer, but heart disease as well. If the prevalence of smoking related diseases among nonsmoking adults is not compelling enough to prove the need for legislation restricting where and under what conditions a smoker should be allowed to smoke, perhaps the health effects of smoking on children would provide enough evidence to convince them. In a study conducted, "one third of all children surveyed were exposed to passive smoke at home and/or at daycare on a daily basis. Over 80% of the asthma and cystic fibrosis respondents reported a change in smoking behavior after the diagnosis of their children's illness." The most intriguing aspect of this survey is not the fact that the parents changed their smoking habits, once informed of their children's illness, but that so many of the parents had to change smoking habits. Aside from increased risks of developing lung cancer, and heart disease in old age, children exposed to passive smoke are more likely to have wheezes, asthma, increased respiratory infection, and increased bronchial hyperactivity according to a study done by the Surgeon General. In an analysis of many studies, the Environmental Protection Agency(EPA) found that every year, between 150,000 and 300,000 children under 1-1/2 years of age get bronchitis or pneumonia from breathing secondhand tobacco smoke, resulting in thousands of hospitalizations. In children under 18 years of age, secondhand smoke exposure also results in more coughing and wheezing, a small but significant decrease in lung function, and an increase in fluid in the middle ear. Children with asthma have more frequent and more severe asthma attacks because of exposure to second hand smoke, which is also a risk factor for the onset of asthma in children who did not previously have symptoms.
Exposure of second hand smoke to children is a serious issue because it is so unjustified and morally wrong. Besides the health effects on children the consequences for adults, to this day are still not completely known, however there is much evidence that second hand smoke causes many more problems than merely an increased risk of developing lung cancer. In a study about the correlation between cigarette smoke and heart disease it was found that "an Individual male never smoker living with a current or former smoker is estimated to have an approximately 9.6% greater chance of dying from ischemic heart disease by the age of 74 years, compared with a 7.4% chance for a male never-smoker living with a nonsmoker. The corresponding lifetime risks for women are 6.1% and 4.9%." These numbers may seem small, but an increased risk of death is not an excusable statistic, regardless of its apparent insignificance.
Thousands of Americans have died from second hand smoke and thousands will continue to die without the ability to defend themselves from this uncontrollable enemy. Cigarette smoke not only deteriorates the health of smokers, but otherwise healthy bystanders as well. Among some of the most seriously effected by this deadly carcinogen are children, and unborn infants. The statistics of current smokers, and mortality rates around the world are convincing enough to show that smoking truly is a global epidemic.