Tobacco use is by far the top avoidable cause of disease, disability, and death in the United States, responsible for nearly one in five deaths. Currently about 50 million adults in this country, mostly men, smoke cigarettes. Although smoking is generally declining, the number of adolescents and young adults who are beginning to smoke is on the rise. Cigarette smoke contains more than 4,000 different chemicals; about 200 of them are poisonous, and more than 40 are cancer-causing. Smoking is so dangerous that approximately 400,000 deaths are attributed to smoking-related causes in the United States each year. The health problems caused by smoking are the number one cause of death in men in this country.
If you smoke, you will notice the gradual onset of a host of long-term problems. Your senses of smell and taste will weaken, you will get more frequent colds than before, facial wrinkling will intensify, and you will develop a nagging "smoker's cough," which is actually a symptom of a serious disease called chronic bronchitis (see page 246). You also increase your chances of developing cancers of the lung and other organs, emphysema, high blood pressure, stroke, and heart disease. You also place your family at risk of the same health problems by exposing them to secondhand smoke (see page 31).
Most men first experiment with smoking in adolescence because it makes them feel more adult and rebellious. The earlier someone starts smoking, the less likely he is to quit. Experimentation quickly turns into tolerance of and then addiction to nicotine, the habit-forming drug in tobacco that keeps smokers hooked. Nicotine creates a persistent craving for more tobacco, and the amount and frequency of use usually increases, so that a smoker may feel the need to smoke two packs a day to get the same satisfaction that one daily pack once provided. Not smoking for as few as several hours produces uncomfortable nicotine withdrawal symptoms, including irritability, limited concentration, and intense cravings. These symptoms compel the person to smoke even when he knows the adverse health risks. Many social activities, such as having drinks in a bar with friends, also are conducive to smoking, making it a difficult habit to break.
Tobacco advertising has a major role in encouraging adolescents to take up smoking before they are mature enough to understand the long-term health risks.
28 Young people serve as the largest pool of new customers for the tobacco indus-
The try; they replace adult smokers who have quit or died. Tobacco advertising is no
Healthy longer allowed on television, but the tobacco industry still spends about $5 bil-Man lion each year on advertising in magazines, on billboards, and at music and sporting events to lure new smokers with the promise of sex appeal, glamour, or rugged adventure. The following pages will describe how smoking damages your body, outline the hazardous effects of secondhand smoke, and explain the risks of cigar smoking and smokeless tobacco use.
Smoking's Damaging Effects on Your Body
In addition to the addictive drug nicotine, the other principal harmful substances in cigarettes are tar and carbon monoxide. Tar is a sticky, brown residue that collects in the lungs. Primarily made up of chemicals known as hydrocarbons, tar is a powerful cancer-causing agent that has been linked to the development of lung cancer. Carbon monoxide is a poison that partially replaces the oxygen normally carried throughout the body by red blood cells, robbing the body of sufficient oxygen. Switching to a low-tar cigarette usually does not help because the person usually compensates for the change by inhaling longer or by smoking more cigarettes.
Other toxic chemicals in tobacco smoke include arsenic, formaldehyde, ammonia, lead, benzene, and vinyl chloride. The airways try to fight these poisons by producing excess mucus, which obstructs the airways, producing the telltale smoker's cough that indicates the development of chronic bronchitis.
Tobacco smoke damages not only the cells inside the lungs but also the tiny hairlike projections called cilia that line and protect the airways, hindering the respiratory system's ability to fight infection. Smoke inflames lung tissue, causing the airways to release chemicals that destroy the tiny air sacs in the lungs called alveoli, where oxygen is transferred into the bloodstream. The alveoli merge into fewer but larger air sacs, reducing the surface area in the lungs available for oxygen transfer. Because the level of oxygen in the blood is reduced, the affected person becomes breathless. This process describes the development of the disease known as emphysema (see page 247).
Cigarette smoking causes cancer of the lung, mouth, tongue, throat, pancreas, kidney, and bladder by producing cell changes that cause the cells to reproduce uncontrollably. Smoking is responsible for about 87 percent of all cases of lung cancer in the United States. Most lung cancers begin in a bronchus, one of the two main air passages that enter the lungs.
Smoking also is a major contributor to the development of heart disease (see page 204), by reducing blood levels of high-density lipoprotein (HDL), the "good" cholesterol that protects against heart disease. Additionally, smoking adversely affects the arteries that supply the heart with blood and nutrients. Men who smoke have twice the risk of having a heart attack as do nonsmoking men. Nonsmokers exposed to secondhand smoke also endure an increased risk of heart disease. Up to 30 percent of all deaths from heart disease in the nation can be attributed to cigarette smoking, and the risk increases with the number of cigarettes smoked and the number of years of smoking. Smoking cigarettes also doubles your risk of having a stroke.
In spite of the dire health prospects facing smokers, many of them continue their habit because of nicotine's addictive properties. But if you smoke, effective methods exist to help you quit and avoid starting again.
The most important thing you should know about quitting smoking is that the harmful effects of the habit begin to reverse almost as soon as you stop. Within 20 minutes of your last cigarette, your heart rate and blood pressure drop to normal. After 8 hours of being smoke-free, your blood levels of carbon monoxide and oxygen return to normal. Your risk of having a heart attack decreases after only 24 hours, and in 2 weeks your circulation will improve and your lung function will increase up to 30 percent. These beneficial effects continue until, after 10 years of not smoking, your chances of dying of lung cancer become about the same as for a nonsmoker.
There is no underestimating the difficulty of breaking the smoking habit because of the highly addictive properties of nicotine. You need to build a strong support system within your family and circle of friends and coworkers. You may find that some of the people you know who still smoke may feel uncomfortable or threatened by your efforts to quit. It may be best for you to stay away from them until you feel certain that you can avoid the temptation to smoke. Pick a nonsmoker or another person who is trying to quit as a "buddy" whom you can call when the going gets rough. Meet with your buddy once a week, communicate through e-mail, or talk regularly on the phone. Make a bet with him or her that you can go for 1 month, then 6 months without a cigarette, then celebrate when you have reached your goal.
Experts say that you should prepare yourself to quit in advance of smoking your last cigarette. Identify several strategies, such as relaxation exercises, that can help you cope with your cravings for tobacco. First try to establish one or two other new habits, such as regular exercise, so you will be giving up tobacco in the context of a complete lifestyle change. Exercise is important; it is the highest predictor of success when quitting tobacco use. When you are ready to quit, take the following steps to ensure success:
The Hazards of
Step 1 Take a look at your smoking habits. Make a chart and mark down on it every cigarette you smoke in 24 hours, including the first cigarette you smoke in the morning, the one you automatically light up with a cup of coffee or a drink,
Step 3 Set a date by which you intend to quit smoking. Announce the date to all of the people you know and ask them to help you in your effort so they can support you if you lose your resolve.
Step 4 Ask your doctor about using nicotine gum, a nicotine patch, a prescription nicotine inhaler, or prescription medication (see warning box, page 31) to help you quit smoking. Try sucking on hard candy or chewing gum, munching on raw vegetables, or exercising more. Stay away from places and situations, such as having drinks with friends in a bar, that you associate with smoking. Sit in the nonsmoking section of restaurants. You may want to join a stop-smoking group; ask your doctor to recommend one.
Step 5 When you quit smoking, you probably will feel like eating more often and may gain a few pounds. Don't stop yourself from eating when you feel tense during the first few weeks; it will be hard enough to stay away from cigarettes. Stock up on fresh fruits and vegetables, sugar-free candy and soda, and fat-free pretzels or crackers. Drink plenty of water. Your most intense cravings for nicotine will subside after about 8 weeks, when you can resume your usual eating pattern.
When you quit smoking, you remove an important source of pleasure and a way to reduce stress from your daily routine. You need to replace the nicotine with something else that gives you pleasure and deal with your stress in more positive ways (see page 118). Maintaining your focus on negative reasons for quitting, such as worrying about your health, will not help you succeed. Forget the "no pain, no gain" attitude. Instead, embrace your new, more healthy lifestyle positively, without guilt for your past smoking habit. Praise yourself liberally by telling yourself how much better your life is going to be from now on. And remember the following positive things about quitting each time you feel the urge to take a puff:
• Stopping smoking will free up time that you can now use to exercise, take up a hobby, or spend time with your family.
• You can use the money you used to spend on cigarettes to treat yourself or a loved one to something special.
• Your breath will smell better, your fingers will no longer be yellow, and your clothes and hair will no longer smell like smoke.
• Food will taste better because your sense of smell will improve, and the senses of smell and taste are closely linked.
and the ones you smoke while on break. Keep monitoring your cigarette use for 3 weeks.
Step 2 Write down all of the reasons why you want to stop smoking—for example, to get rid of your smoker's cough and to stop exposing your family to secondhand smoke.
• Your smoker's cough will go away in a few months, a sign that your body is healing itself.
• Being a nonsmoker makes you more attractive.
• You will no longer have to stand awkwardly outside of your workplace in the rain and the cold to smoke on breaks or at lunchtime.
Warning! Potential Health Risks of Misusing Stop-Smoking Aids
Several products containing nicotine are available today to help you stop smoking, including nicotine gum, the nicotine patch, and the nicotine inhaler. Both the patch and the gum are available over-the-counter, while the inhaler requires a doctor's prescription. All three methods put nicotine into your system to help you curb your craving for tobacco and, when used according to directions, can help you kick your nicotine habit. However, if you exceed recommended dosages, continue to smoke while using these methods, or use more than one method at a time, you can overdose on nicotine. Too much nicotine in your bloodstream can overstimulate your heart and pose life-threatening risks to your health—high blood pressure, heart attack, and stroke. If you are considering using a stop-smoking aid that contains nicotine, talk to your doctor so you can learn more about these products and how to properly use them and make an informed decision. If you are already using one of these treatments, carefully follow the directions and note the warnings on the packaging.
Secondhand smoke is the smoke given off by a burning cigarette, cigar, or pipe mixed with the smoke exhaled by the person smoking. This smoke contains the same 200 poisonous and 40 cancer-causing chemicals contained in cigarettes. Because secondhand smoke is distributed throughout the air inhaled by everyone—smokers and nonsmokers alike—present in an enclosed space, exposure to it is called passive or involuntary smoking. The US Environmental Protection Agency (EPA) has classified secondhand smoke as a group A carcinogen (cancer-causing agent) and estimates that it causes 3,000 lung cancer deaths in nonsmokers every year.
Secondhand smoke is an especially dangerous health threat to children. A child's developing lungs are highly susceptible to irritants, producing a cough, wheezing, and excess mucus. Children exposed to secondhand smoke have an increased risk for pneumonia; bronchitis; accumulation of fluid in the ear; and irritation of the eyes, nose, and throat. Children who have asthma (see page 245) and are exposed to secondhand smoke experience more severe symptoms and have asthma attacks more often than those who live in a smoke-free home. Passive smoking is thought to cause the development of asthma in thousands of children each year.
The Hazards of
If you smoke, don't smoke in your home, in your car with the windows closed, or around children. If the weather is too bad to smoke outside, smoke in a room with the windows open enough to provide cross-ventilation. If you are a non-smoker, don't allow anyone to smoke in your house or car, especially around children. Find out about your employer's smoking policy so you can protect yourself from secondhand smoke at work. In a restaurant, ask to sit in the nonsmoking section, as far away from the smoking area as possible. If your community does not have a smoking control ordinance, become active and urge your local government officials to enact one.
Cigars Pose Health Risks, Too
Cigar sales have soared in recent years as cigar smoking has become more socially acceptable. A blitz of cigar advertising in magazines and prominent cigar placement in movies and music videos has made cigar smoking fashionable, even glamorous. Men who smoke cigars may believe that they are less harmful to their health than cigarettes, but this idea is false. Cigar smoking has been linked to the development of cancer of the mouth, larynx (voice box), esophagus (the muscular passage that connects the mouth and the stomach), and lungs. Men who smoke cigars regularly, especially those who smoke several cigars a day, raise their risk of heart disease and lung diseases such as chronic bronchitis (see page 246) and emphysema (see page 247). Drinking three or more alcoholic drinks a day combined with cigar smoking seems to raise the risk of cancers of the mouth, larynx, and throat exponentially. The harmful effects of secondhand smoke (see page 31) from a cigarette also apply to smoke given off by cigars.
While very occasional cigar smoking—for example, one cigar per month— may pose only a minimal health risk, a growing number of men smoke cigars on a far more regular basis, some even daily. Cigars are not an acceptable alternative to cigarettes when it comes to your health or the health of nonsmokers exposed to secondhand smoke from your cigar. It is best for your health to abstain from cigar smoking altogether.
The use of smokeless tobacco, including snuff and chewing tobacco, increases each year, mainly among adolescent boys. Snuff consists of moist, shredded tobacco leaves that come in packages resembling tea bags. The user places the snuff between his lip and gum. Chewing tobacco is made of shredded or compressed tobacco and is placed inside the cheek and chewed. The average quantity of chewing tobacco contains the nicotine found in two cigarettes, but the nicotine in chewing tobacco is more addictive because it is more easily absorbed into the bloodstream.
Although made fashionable by professional baseball players, smokeless tobacco is not a harmless alternative to cigarettes. It wears away tooth enamel, causes the gums to recede and the teeth to loosen, and contributes to tooth decay and discoloration as well as bad breath. Most important, smokeless tobacco use has been linked to development of cancer of the mouth, throat, larynx, and esophagus. When the irritating tobacco is left in contact with the cheeks, gums, or lips for long periods, it produces sores or white patches that do not heal and can eventually become cancerous. Other early signs of oral cancer from smokeless tobacco include a prolonged sore throat and difficulty chewing or swallowing. Cancerous changes can occur after only 4 years of smokeless tobacco use. Disfiguring oral surgery may have to be performed to remove cancerous tissue.
Men who use smokeless tobacco need regular dental cleanings and checkups to look for the early signs of oral cancer, but the best approach is to stop using smokeless tobacco products. Pick a date to quit, cut back on your use before then, and stay tobacco-free for life.
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