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Smoking as a Public Health Issue
By Sam MacArthur

Smoking as a public health issue finds its roots nearly a century ago. It was in the 1930s when health care practitioners began to grasp the dangers caused by the use of tobacco fully. About fifteen years later, the American Cancer Society began to proactively warn smokers about the health hazards caused by smoking. It was around this time that serious amounts of researchers began to study the effects of smoking and public health.

By the early 1950s, the widely-popular Reader’s Digest published what was to become a landmark article  – Cancer by the Carton – an overwhelmingly convincing narrative about the smoking dangers that would ultimately impact the tobacco industry’s free reign of questionable, at best, advertising. Fans of the TV show Mad Men – a show that focused on advertising executives in that era – know all too well how the tobacco industry put forth tremendous efforts to obscure the negative scientific evidence about the harmful effects of smoking from public view.

What Makes Smoking a Public Health Issue? 

Smoking, only a half-century ago, was prescribed by doctors as a weight-loss or relaxation regimen, which in retrospect, seems to rise to a level that nears malpractice.

Fortunately, the health risks uncovered by the decades of research eventually forced the US Surgeon General to release scathing findings of the dangers of smoking from the first study funded by the federal government. Without question, the US surgeon general’s report in 1964 directly linked public health and smoking to specific cancers, and other health conditions. This study is recognized as the most effective declaration of the harmful effects of smoking – it changed the perception of tobacco use and sales worldwide. The findings included –

  • A smoker had an age-revised mortality rate that increased by 70%.
  • Smoking was a primary contributor to chronic bronchitis.
  • There was a causal link between heart disease/emphysema and smoking.
  • Pregnant women who smoked were more likely to have underweight newborns.
  • Smoking was linked to a ten-fold to twenty-fold increase in the chances of lung cancer.

At this time, smoking was still viewed as a habit, a habit in which someone could break with a concerted effort. By the beginning of the 1970s, the United States Congress enacted a law that banned all advertising of cigarettes on either radio or TV – another visible step towards the government’s admission that smoking presented a public health risk. In 1989, Dr. C Everett Koop, the acting US Surgeon general, officially redefined cigarette smoking as an addiction. What was once termed a habit had now officially become a disease/disorder.

Statistics about Smoking

The statistics regarding public health and smoking are quite remarkable when one considers how many smokers are in America. The statistics about tobacco use and smoker demographics are managed at the national level by the Centers for Disease Control & Prevention (CDC).

To learn about statistics on smoking in the US, the CDC delineates statistics about smoking in a number of fundamental categories like –

  • The Percent of Smokers by State by age.
  • How many smokers are in America that quit each year?
  • E-vaping vs. smoking percentage by state.
  • Changes to statistics of smoking in the US, year over year.

According to the CDC, it is estimated that about 18% of American adults are recognized as chronic and consistent smokers. This translates to significant smoker demographics that equal more than 42 million individuals lighting up on a consistent basis.

Additional smoking demographics and statistics of smoking in the US help answer the question – How many smokers are in America –

  • Are underage and begin smoking each day? Answer – more than 3,100.
  • That begin as casual, underage smokers become daily smokers – each day? Answer – About 300.

Statistics about Smoking

The facts and statistics about tobacco use and statistics on smoking in the US are quite eye-opening.  Fortunately, efforts to educate the public have effectively reached millions and millions of people and have convinced them to finally quit smoking, or maybe to never start smoking. 

But for those individuals who continue to smoke and assume the risks of inhaling the deadly chemicals, it is important to recognize what percent of smokers by state and country become ill each year and the smoking percentage by state of those who succumb to their smoking-related illness or disease.

Fact – Tobacco use & smoking is considered the leading cause of those deaths deemed preventable.

The adverse effects on one’s health from using tobacco have been studied extensively and documented across decades of research. Consider some of the other negative health impacts from smoking –

  • Smoking is the cause of death for nearly ½ million Americans each year, of which about 10% of the deaths are attributed to secondhand smoke. This translates to about 1,200 deaths each day.
  • It is estimated that, on average, individuals who smoke die ten years earlier than their non-smoking counterparts.
  • Approximately 90% of lung cancer deaths have a direct connection to smoking or tobacco use.
  • Each year, more women die from lung cancer than from breast cancer.

It has been shown through scientific research that smoking is among the primary cause of the following disorders –

  • Heart Disease – estimates reveal that the chance for coronary disease increases 2 to 4 times when smoking.
  • Diabetes – smoking increases an individual’s chances (by 30-40%) of developing diabetes and also makes it more difficult to control Type 2 diabetes.
  • Stroke – estimates note that the chance for a stroke increases 2 to 4 times for those who smoke.
  • COPD – smokers are about 12 times more likely to die from COPD disease than their nonsmoker counterparts.
  • Cancer – estimates reveal that the chance for lung cancer in men increases 25 times for smokers.
  • Cancer – estimates reveal that the chance for lung cancer in women increases 25.7 times for smokers.
  • Cancer – smoking can cause cancer in most areas of the body. This includes the mouth, the larynx,  the tongue, the liver, the bladder, the colon, the kidney, the pancreas, the blood, and the stomach, among others.
  • Decrease in fertility – smoking contributes to a newborn’s low birth weight, pre-term delivery issues, ectopic pregnancies, and even SIDS – Sudden Infant Death Syndrome.
  • Smoking cause and exasperates autoimmune diseases, like lupus, hypothyroidism or diabetes.

Smoking and Quitting

It has been shown through ample research that quitting smoking – in only a matter of minutes – decreases an individual’s risk for heart disease or heart attack. Over time, the benefits of quitting smoking offer the following cumulative benefits –

  • At about one year, cardiovascular risks drop significantly, and the risk for heart attack drops.
  • Between year two through five after quitting smoking, an individual who has quit smoking has reduced their risk of a stroke to a level that nears that of a nonsmoker.
  • Five years after quitting smoking, the risk for oral/bladder cancers is cut by 50%. Oral cancers include cancer of the throat, the mouth, the tongue, and the esophagus, etc.
  • Ten years after quitting smoking, the risk of dying from lung cancer for anyone who has quit smoking is cut by one-half.

Ways to Help Smokers Quit

Years ago, the only way to quit smoking was to tough it out – cold turkey. And while many people were successful, many found they packed on the pounds (which comes with its own health woes) when they finally were able to give up cigarette smoking.

These days, there are several options to help smokers quit a smoking habit and hopefully avoid gaining any weight. Many people report that they are only successful in quitting smoking after they have started and failed several times. But, in the end, they finally beat the smoking addiction – an addiction that could likely lead to health problems and perhaps, an early death. Helpful smoking cessation products include –

  • Prescription medication.
  • Nicotine patches, lozenges or gum.
  • Counseling or hypnosis.
  • Support groups.
  • Lots of hugs.

Those who are serious about quitting smoking must recognize that it takes a serious commitment to quit. Consider this helpful advice from the CDC –

  • Set a date to quit.
  • Remove all smoking products from the car, house, office, and anywhere else!
  • Make a personal commitment – to yourself – not to smoke.
  • Avoid alcohol while quitting because alcohol lowers one’s self-discipline and is unhealthy and helps you gain weight.
  • Remember why you are choosing to quit when the going gets tough.
  • Expect some tough times, and be prepared to overcome them.
  • Try to stay away from smokers – at least in the beginning.

The Freedom From Smoking® initiative developed by the American Lung Association (ALA) was designed for adults who need help to quit smoking. Take advantage of the insight and techniques provided at no cost through the American Lung Association’s advocacy efforts for –

  • Reducing or quitting tobacco use.
  • Reducing the exposure of secondhand smoke to others.

It is emphasized that most smokers find they need more than one attempt to successfully quit smoking and that they are most successful when using a combination of resources that works for them.

Ironically, vaping – which was invented as a means to help smoker quit – has become a public health concern on its own.

The Impact of Smoking on the Healthcare System 

Like most health care issues, analyzing the costs of smoking to society was, and is, complicated.

The economic impact of smoking has been a hotly debated medical issue for decades. The debate does not focus on whether or not smoking is harmful – the dangers of tobacco are already known. These debates are financially-based and borne from the results found in professional studies specifically designed to reveal how much do smokers cost society or the health care system in general.

Health Care Costs for Smokers vs. Nonsmokers

Ultimately, from a public health perspective, public officials are tasked with the responsibility of reducing the number of tobacco users, at least in its jurisdiction because,  – it is just good public health policy.

But how much do smokers cost the healthcare system and society?

While it is a fact that smokers tend to have more diseases and health issues than nonsmokers, it is also true that nonsmokers live longer than smokers. So, the answer to the health care cost of smoking must consider both of these facts.

In the early 1990s, the US Surgeon General issued a report –

Medical experts continue to deliberate the issue. One side suggests that while smokers incurred larger medical expenses (while they were alive), these expenses were partially offset by taxes generated by the sale of tobacco, and the fact the smokers would likely die sooner, which would effectively eliminate the costs in pension payouts or nursing homes.

In other words, those who support this position assert that because nonsmokers live longer, the cost of their medical support (over their longer lives) equates to the cost of medical support for smokers who live shorter, more expensive lives.

How would these factors impact of smoking on health care costs change?

Studies abound that suggest that medical expenses for smokers who quit would ultimately be lowered, at first, but eventually, as ex-smokers regained their health and began to live longer, the cost of medical support would likely begin to increase.

The Effects of Smoking on Health

The effects of smoking on health places the cigarette habit/addiction as the number one cause of preventable diseases and death in the country. Cigarette smoking effects on health in the population are overwhelming, with more than 40 million American adults smoking cigarettes, despite the many and varied warnings about how smoking kills- despite mandated health warnings stamped on every box and carton of cigarettes sold in the US.

More than 15 million Americans live with a smoking-related disease/disorder chronically.

The impacts of smoking on health do not just affect the smoker because there are also dangerous health effects of secondhand smoke on children.

Unfortunately, many children begin smoking, so the health impacts of smoking may also include their friends and siblings – additional effects of secondhand smoke on children’s health. More than 4.5 million middle/high-school students use tobacco, which is why school curriculums must include classes that teach the following –

  • How does smoking affect your health?
  • What are the second-hand smoke health effects?
  • How the impact of smoking affects individuals and families?
  • How to help manage the health effects of cigarette smoking for friends and family members?
  • How to manage the impact of smoking when facing peer pressure?

How does smoking affect your health?

  • Smoking damages most parts of the body and is the number one cause of preventable death.
  • The medical cost attributable to smoking costs billions of dollars each year. This only compares with the billions spent by tobacco companies on their marketing initiatives.
  • Smoking generates damaging health effects of secondhand smoke on children and nonsmoking family members.

Health Effects of Secondhand Smoke

Smoking not only has damaging health effects of cigarette smoking on the smoker, but combustible tobacco products also give off damaging effects of secondhand smoke on children’s health. These include cigars and smokeless tobacco. Combustible tobacco products also generate smoke that impacts those standing by the smoker and ultimately exposes them to dangerous and toxic secondhand smoke.

Secondhand smoke is created when tobacco is burned or ignited electronically. Secondhand smoke also includes the smoke that has been exhaled by a smoker.

The smoke of burning tobacco has more than 7,000 chemicals with 70 known cancer-causing toxic chemicals. Most secondhand smoke exposure happens in either the home or workplace. Although anyone can be exposed to secondhand smoke in casinos or bars, for instance, however, it is becoming increasingly difficult to find an inside environment that permits smoking at all.

The exposure to second hand smoke has, fortunately, decreased over the years. This marked decrease is likely due to the efforts of –

  • The increasing number of states, cities, and communities enacting legislation that prohibits smoking in any indoor area deemed public – like bars, casinos, restaurants, offices.  
  • The increasing number of homes that have smoke-free homes.  
  • A decline in the use of cigarettes.
  • A change in a societal value that now considers smoking socially unacceptable.

The CDC notes that nearly 90% of Americans around 1990 had levels of measurable cotinine. Cotinine is the chemical created when nicotine is broken down by the body.

About eighteen years later, only 40% – less than half – of Americans had levels of measurable nicotine. In 2012, only 25% of Americans had levels of measurable Cotinine.

Smoking Products & Terms

  • E-cigarettes offer a combustible electronic version of a cigarette and have potential health consequences.
  • Smokeless tobacco has been shown to cause cancer and is addictive.
  • The smoke from a Hookah has the same toxic chemicals found in cigarettes.
  • The addictive drug in tobacco and all tobacco products (think cigars, cigarettes, e-cigarettes, etc.) is nicotine.

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