This anti-smoking photo (Figure 13.6.1) clearly makes the point that smoking causes death. The image is not using hyperbole, because smoking actually is deadly. It causes about 7 million deaths each year, and is the single greatest cause of preventable death worldwide. As many as half of all people who smoke tobacco die from it. As a result of smoking’s deadly effects, the life expectancy of long-term smokers is significantly less than that of non-smokers. In fact, long-term smokers can expect their lifespan to be reduced by as much as 18 years, and they are three times more likely than non-smokers to die before the age of 70.

As shown in Figure 13.6.2, tobacco smoking has adverse effects on just about every bodily system and organ. The detrimental health effects of smoking depend on the number of years that a person smokes and how much the person smokes. Contrary to popular belief, all forms of tobacco smoke — including smoke from cigars and tobacco pipes — have similar health risks as those of cigarette smoke. Smokeless tobacco may be less of a danger to the lungs and heart, but it, too, has serious health effects. It significantly increases the risk of cancers of the mouth and throat, among other health problems.

Even non-smokers may not be spared the deadly risks of tobacco smoke. If you spend time around smokers either at home or on the job, then you are at risk of the dangers of secondhand smoke. Secondhand smoke enters the air directly from burning cigarettes (and cigars and pipes), and indirectly from smokers’ lungs. This smoke may linger in indoor air for hours, and it increases the risk of a wide range of adverse health effects. According to Health Canada, second-hand smoke causes 800 deaths from lung cancer and heart disease in non-smokers every year. The 2014 U.S. Surgeon General’s Report concluded that there is no established risk-free level of exposure to secondhand smoke. Non-smokers who are exposed to secondhand smoke may have as much as a 30 per cent increase in their risk of lung cancer and heart disease. 

Tobacco contains nicotine, which is a psychoactive drug. Although nicotine in tobacco smoke does not directly cause cancer or most of the other health risks of smoking, it is a highly addictive drug. Nicotine is actually even more addictive than cocaine or heroin. The addictive nature of nicotine explains why it is so difficult for smokers to quit the habit, even when they know the health risks and really want to stop smoking. The good news is that if someone does stop smoking, his or her risks of smoking-related diseases and death soon start to fall. By one year after quitting, the risk of heart disease drops to only half of that of a continuing smoker.

One of the main health risks of smoking is cancer, particular cancer of the lung. Because of the increased risk of lung cancer with smoking, the risk of dying from lung cancer before age 85 is more than 20 times higher for a male smoker than for a male non-smoker. As the rate of smoking increases, so does the rate of lung cancer deaths, although the effects of smoking on lung cancer deaths can take up to 20 years to manifest themselves, as shown in Figure 13.6.3. Besides lung cancer, several other forms of cancer are also significantly more likely in smokers than non-smokers, including cancers of the kidney, larynx, mouth, lip, tongue, throat, bladder, esophagus, pancreas, and stomach. Unfortunately, many of these cancers have extremely low cure rates.

When you consider the composition of tobacco smoke, it’s not surprising that it increases the risk of cancer. Tobacco smoke contains dozens of chemicals proven to be carcinogens, or causes of cancer. Many of these chemicals bind to DNA in a smoker’s cells, and may either kill the cells or cause mutations. If the mutations inhibit programmed cell death, the cells can survive to become cancer cells. Some of the most potent carcinogens in tobacco smoke include benzopyrene, acrolein, and nitrosamines. Other carcinogens in tobacco smoke are radioactive isotopes, including lead-210 and polonium-210.

Long-term exposure to the compounds found in cigarette smoke — such as carbon monoxide and cyanide — are thought to be responsible for much of the lung damage caused by smoking. These chemicals reduce the elasticity of alveoli, leading to chronic obstructive pulmonary disease (COPD). COPD is a permanent, incurable, and often fatal reduction in the capacity of the lungs, reducing the lungs’ ability to fully exhale air. The chronic inflammation that is also present in COPD is exacerbated by the tobacco smoke carcinogen acrolein and its derivatives. COPD is almost completely preventable simply by not smoking and by also avoiding secondhand smoke.

Inhalation of tobacco smoke causes several immediate responses in the heart and blood vessels. Within one minute of inhalation of smoke, the heart rate begins to rise, increasing by as much as 30 per cent during the first ten minutes of smoking. Carbon monoxide in tobacco smoke binds with hemoglobin in red blood cells, thereby reducing the blood’s ability to carry oxygen. Hemoglobin bound to carbon monoxide forms such a stable complex that it may result in a permanent loss of red blood cell function. Several other chemicals in tobacco smoke lead to narrowing and weakening of blood vessels, as well as an increase in substances that contribute to blood clotting. These changes increase blood pressure and the chances of a blood clot forming and blocking a vessel, thereby elevating the risk of heart attack and stroke. A recent study found that smokers are five times more likely than non-smokers to have a heart attack before the age of 40.

Smoking has also been shown to have a negative impact on levels of blood lipids. Total cholesterol levels tend to be higher in smokers than non-smokers. Ratios of “good” cholesterol to “bad” cholesterol tend to be lower in smokers than non-smokers.

A wide diversity of additional adverse health effects are attributable to smoking. Here are just a few of them:

• Smokers are at significantly increased risk of developing chronic kidney disease (in addition to kidney cancer). For example, smoking hastens the progression of kidney damage in people with diabetes.
• People who smoke — especially the elderly — have a greater risk of influenza and other infectious diseases than non-smokers. Smoking more than 20 cigarettes a day has been found to increase the risk of infectious diseases by as much as four times the risk in non-smokers. These effects occur because of damage to both the respiratory system and the immune system.
• In addition to oral cancer, smoking causes other oral problems, including periodontitis (gum disease). Roughly half of the cases of gum inflammation are attributable to current or former smoking. This inflammation increases the risk of tooth loss, which is also higher in smokers than non-smokers. In addition, smoking stains the teeth and causes halitosis (bad breath).
• Smoking is a key cause of erectile dysfunction (ED), probably because it leads to narrowing of arteries in the penis, as it does elsewhere in the body. The incidence of ED is about 85 per cent higher in males who smoke than it is in non-smokers.
• Smoking also has adverse effects on the female reproductive system, potentially causing infertility, in part because it interferes with the body’s ability to produce estrogen. Female smokers are about 60 per cent more likely to be infertile than non-smokers. Pregnant women who smoke or are exposed to secondhand smoke have a higher risk of miscarriages and low-birth-weight infants.
• Certain therapeutic drugs, including some antidepressants and anticonvulsants, are less effective in smokers than in non-smokers. This occurs because smoking increases levels of liver enzymes that break down the drugs.
• Smoking causes an estimated ten per cent of all fire-related deaths worldwide. Smokers are also at a greater risk of dying in motor vehicle crashes and other accidents.
• Smoking leads to an increased risk of bone fractures, especially of the hip. It also leads to slower wound healing after surgery, and an increased rate of postoperative complications.

The item in Figure 13.6.4 looks like a regular cigarette, but it’s actually an electronic cigarette, or e-cigarette. E-cigarettes are battery-powered devices that change flavored liquids and nicotine into vapor that the user inhales. E-cigarettes are often promoted as being safer than traditional tobacco products, and their use is touted as a good way to quit smoking. They are often not banned in smoke-free areas, where it is illegal to smoke tobacco cigarettes.

A study completed in 2015 by researchers at the Harvard School of Public Health and widely reported in the mass media found that e-cigarettes may, in fact, be very harmful to the user’s health. E-cigarettes contain nicotine and cancer-causing chemicals, such as formaldehyde. According to the study, about three-quarters of flavored e-cigarettes also contain a chemical called diacetyl that causes an incurable and potentially fatal disorder of the lungs, commonly called “popcorn lung” (bronchiolitis obliterans). In this disorder, the bronchioles compress and narrow due to the formation of scar tissue, greatly diminishing the breathing capacity of people with the disorder. Popcorn lung gained its common name in 2004, when it was diagnosed in workers at popcorn factories. The buttery flavoring used in the factories contained diacetyl.

Some manufacturers of e-cigarettes and flavorings advertise that their products are now free of diacetyl. However, because e-cigarettes are not currently regulated by the FDA, there is no way of knowing for sure whether the products are actually safe. Equally disturbing is the appeal of flavored e-cigarettes to teens and producers’ attempts to specifically market their products to this age group. Flavors such as “cotton candy,” “Katy Perry’s cherry,” and “alien blood” are obviously marketed to youth. Not surprisingly, the use of e-cigarettes is on the rise in middle and high school students, who are more likely to use them than regular cigarettes. Public health officials fear that e-cigarettes will be a gateway for teens to move on to smoking tobacco cigarettes. Some U.S. states have recently passed laws prohibiting minors from buying e-cigarettes, and Brazil, Singapore, Uruguay, and India have banned e-cigarettes. E-cigarettes were not initially regulated by Health Canada because they don’t contain nicotine, which made them illegal to sell, but this was not widely enforced. However, Canada enacted the Tobacco and Vaping Products Act (TVPA) on May 23, 2018. As more questions are raised about their potential negative health effects, it is likely that more laws will be passed to regulate e-cigarettes. Watch the news for updates on this issue.

Attributions

Figure 13.6.1

References

Allen, J. G., Flanigan, S. S., LeBlanc, M., Vallarino, J., MacNaughton, P., Stewart, J. H., Christiani, D.C. (2016, June 1). Flavoring chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored E-cigarettes [online article]. Environmental Health Perspectives, 124:733–739. https://doi.org/10.1289/ehp.1510185

Health Canada. (2015). Dangers of second-hand smoke [online article]. Government of Canada. https://www.canada.ca/en/health-canada/services/smoking-tobacco/avoid-second-hand-smoke/second-hand-smoke/dangers-second-hand-smoke.html

RWJ Barnabas Health. (2019, September 25). The dangers of vaping. YouTube. https://www.youtube.com/watch?v=QL2-EsjfiAU&feature=youtu.be

TEDx Talks. (2015, August 7). Blowing smoke: The lost legacy of the surgeon general’s report | Alan Blum | TEDxTuscaloosa. https://www.youtube.com/watch?v=lgVvnnnawvw&feature=youtu.be

Tobacco and Vaping Products Act. (2016, June 26). Government of Canada. https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/legislation/federal-laws/tobacco-act.html

Vaping, E-cigarettes to be regulated by Health Canada. (2016, November 22). CBC/Radio-Canada. HTTP://www.cbc.ca/news/health/vaping-health-canada-legislation-1.3862589

Wikipedia contributors. (2020, August 9). Regulation of electronic cigarettes. In Wikipedia.  https://en.wikipedia.org/w/index.php?title=Regulation_of_electronic_cigarettes&oldid=972059825