Cigarette Smoke
Cigarette smoke contains more than 4,000 identified compounds. Many are known irritants and carcinogens. Since the first Surgeon General's Report on smoking and health in 1964, evidence linking the use of tobacco to illness, injury, and death has continued to mount. Many thousands of studies have documented the adverse health consequences of any type of tobacco, including cigarettes, cigars, and smokeless tobacco.
Specific airborne contaminants from cigarette smoke include respirable particles, nicotine, polycyclic aromatic hydrocarbons, arsenic, DDT, formaldehyde, hydrogen cyanide, methane, carbon monoxide, acrolein, and nitrogen dioxide. Each one of these compounds impacts some part of the body. Irritating gases like ammonia, hydrogen sulfide and formaldehyde affect the eyes, nose and throat. Others, like nicotine, impact the central nervous system. Carbon monoxide reduces the oxygen-carrying capacity of the blood, starving the body of energy. Carcinogenic agents come into prolonged contact with vital organs and with the delicate linings of the nose, mouth, throat, lungs and airways.
Cigarette smoke is one of the six major sources of indoor air pollution, along with combustion by-products, microorganisms and allergens, formaldehyde and other organic compounds, asbestos fibers, and radon and its airborne decay products. The carbon monoxide concentration in cigarette smoke is more than 600 times the level considered safe in industrial plants, and a smoker's blood typically has 4 to 15 times more carbon monoxide in it than that of a nonsmoker. Airborne particle concentrations in a home with several heavy smokers can exceed ambient air quality standards.
Sidestream, or second-hand, smoke actually has higher concentrations of some toxins than the mainstream smoke the smoker inhales. Second-hand smoke carries more than 30 known carcinogens. According to a study by the Centers for Disease Control and Prevention (CDC) released in 1996, nearly nine out of 10 nonsmoking Americans are exposed to environmental tobacco smoke as measured by the levels of cotinine in their blood. The presence of cotinine, a chemical the body metabolizes from nicotine, is documentation of exposure to cigarette smoke. On the basis of health hazards of second-hand smoke, the Environmental Protection Agency has classified second-hand smoke as a Group A carcinogen, known to cause cancer in humans.
Cigarettes probably represent the single greatest source of radiation exposure to smokers in the United States today. Two naturally occurring radioactive materials, lead-210 and polonium-210, are present in tobacco. Both of these long-lived decay products of radon are deposited and retained on the large, sticky leaves of tobacco plants. When the tobacco is made into cigarettes and the smoker lights up, the radon decay products are volatilized and enter the lungs. The resulting dose to small segments of the bronchial epithelium of the lungs of about 50 million smokers in the United States is about 160 mSv per year. (One Sv = 100 rem of radiation.) The dose to the whole body is about 13 mSv, more than 10 times the long-term dose rate limit for members of the public.
The U. S. Department of Health and Human Services reported in 1996 that more than 430,000 Americans die each year from smoking. One in every five deaths in the United States is smoking related, the largest preventable cause of illness and premature death in the United States About 10 million people in the United States have died from causes attributed to smoking, including heart disease, emphysema, and other respiratory disease, since the first Surgeon General's report on smoking and health in 1964. Death is caused primarily by heart disease, lung cancer, heart disease, and chronic obstructive lung diseases such as emphysema or chronic bronchitis. In addition, the use of tobacco has been linked to cancers of the larynx, mouth and esophagus, and as a contributory factor in the development of cancers of the bladder, kidney, pancreas, and cervix. Cigarette smoke aggravates asthma, triggers allergies, and causes changes in bodily tissues that can leave smokers and nonsmokers prone to illness, especially heart disease.
About 180,000 Americans will die prematurely of coronary heart disease every year due to smoking. The risk of a stroke or heart attack is greatly increased by nicotine, which impacts the platelets which enable the blood to clot. Nicotine causes the surface of the platelets to become stickier, thereby increasing the platelets' ability to aggregate. Thus, a blood clot or thrombus forms more easily. A thrombus in an artery of the heart results in a heart attack; in an artery of the brain it results in a stroke.
Epidemiological studies reveal a direct correlation between the extent of maternal smoking and various illnesses in children. Also, studies show significantly lower heights and weights in six to 11-year olds whose mothers smoke. A pregnant woman who smokes faces increased risks of miscarriage, premature birth, stillbirth, infants with low birth weight, and infants with physical and mental impairments. Cigarette smoking also impairs fertility in women and men, contributes to earlier menopause, and increases a woman's risk of osteoporosis.
Cigarette smoke contains benzene which, when combined with the radioactive toxins, can cause leukemia. Although smoking does not cause the disease, smoking may boost a person's risk of getting leukemia by 30%.
A long-time smoker increases his risk of lung cancer by 1,000 times. In 1986, according to the CDC, about 117,000 people died of lung cancer directly attributed to cigarette smoke. More than 3,000 people each year develop lung cancer from second-hand smoke. Between 1960 and 1990, deaths from lung cancer among women have increased by more than 400%—exceeding breast cancer deaths.
The addiction to nicotine in cigarette smoke, a chemical and behavioral addiction as powerful as that of heroin, is well documented. The immediate effect of smoking a cigarette can range from tachycardia (an abnormally fast heartbeat) to arrhythmia (an irregular heartbeat). Deep inhalations of smoke lower the pressure in a smoker's chest and pulmonary blood vessels, which increases the amount of blood flow to the heart. This increased blood flow is experienced as a relaxed feeling. Seconds later, nicotine enters the liver and causes that organ to release sugar, which leads to a "sugar high." The pancreas then releases insulin to return the blood sugar level to normal, but it makes the smoker irritable and hungry, stimulating a desire to smoke and recover the relaxed, high feeling.
Nicotine also stimulates the nervous system to release adrenaline, which speeds up the heart and respiratory rates, making the smoker feel more tense. Lighting the next cigarette perpetuates the cycle. The greater the number of behaviors linked to the habit, the stronger the habit is and the more difficult to break. Quitting involves combating the physical need and the psychological need, and complete physical withdrawal can take up to two weeks.
From an economic point of view, the Department of Health and Human Services estimates that smoking costs the United States $50 billion in health expenses. That figure is most likely conservative because the medical costs attributable to burn care from smoking-related fires, perinatal care for low birth weight infants of mothers who smoke, and treatment of disease caused by second-hand smoke were not included in the calculation.
Resources
Books
Haas, F., and S. Haas. The Chronic Bronchitis and Emphysema Handbook. New York: Wiley, 1990.
Moeller, D. W. Environmental Health. Cambridge, MA: Harvard University Press, 1992.
Periodicals
Baker, S., and S. Carl. "Saving Your Lungs and Your Life." Health (June 1991): 64.
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