Question of the Week

February 16, 2009


There is a lot of common knowledge floating around about how bad cigarettes are for people's health. That said, there are some things that still cause confusion.

While almost everyone knows that cigarettes cause health problems, not everyone knows how to say, "No," when offered.

"The only thing that really helps a person avoid the problems associated with smoking is staying smoke free. This isn't always easy, especially if everyone around you is smoking and offering you cigarettes. It may help to have your reasons for not smoking ready for times you may feel the pressure, such as 'I just don't like it' or 'I want to stay in shape for soccer' (or football, basketball, or other sport)."

While almost everyone knows that limiting exposure to cigarette smoke also means reducing risks of the health issues associated with cigarette smoke, not everyone understands the risks associated with secondhand smoke.

"Many people think that because they don't smoke, they don't have to worry about cigarettes. The truth is that breathing in secondhand smoke, which is a combination of the smoke coming from the burning end of a cigarette or cigar (sidestream smoke) and the smoke that is exhaled by a smoker (mainstream smoke), is almost as dangerous as smoking. People who smoke don't intend to put others around them in danger, but in essence this is what they are doing. Besides stinking up your clothes and hair, secondhand smoke has more than 4,000 chemical compounds present, many of which increase the risk of cancer and heart disease. Breathing in secondhand smoke can irritate peoples' airways and can even trigger asthma attacks."

While most people have at least heard of secondhand smoke, the term "third-hand smoke" may be unfamiliar terminology.

"Ever take a whiff of a smoker's hair and feel faint from the pungent scent of cigarette smoke? Or perhaps you have stepped into an elevator and wondered why it smells like someone has lit up when there is not a smoker in sight. Welcome to the world of third-hand smoke. 'Third-hand smoke is tobacco smoke contamination that remains after the cigarette has been extinguished,' says Jonathan Winickoff, a pediatrician at the Dana–Farber/Harvard Cancer Center in Boston and author of a study on the new phenomenon published in the journal Pediatrics. According to the study, a large number of people, particularly smokers, have no idea that third-hand smoke--the cocktail of toxins that linger in carpets, sofas, clothes and other materials hours or even days after a cigarette is put out--is a health hazard for infants and children."

Smoking is bad. Second and third-hand smoke are bad. Most people understand these truths at some level, but not everyone understands why.

"Cigarette smoking accounts for about one-third of all cancers, including 90 percent of lung cancer cases. ... On average, adults who smoke die 14 years earlier than nonsmokers. Although nicotine is addictive and can be toxic if ingested in high doses, it does not cause cancer; other chemicals are responsible for most of the severe health consequences of tobacco use. Tobacco smoke is a complex mixture of chemicals such as carbon monoxide, tar, formaldehyde, cyanide, and ammonia—many of which are known carcinogens. Tar exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders. Carbon monoxide increases the chance of cardiovascular diseases. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers."

So, while cigarettes contain a complex mixture of chemicals that increases the risk of cancer, nicotine is not one of these cancer-causing chemicals. Nicotine does, however, negatively affect how the body works.

"Cigarettes and other forms of tobacco, including cigars, pipe tobacco, snuff, and chewing tobacco, contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked. ... Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate. Glucose is released into the blood while nicotine suppresses insulin output from the pancreas, which means that smokers have chronically elevated blood sugar levels. Like cocaine, heroin, and marijuana, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction."

Even those who understand that nicotine is the chemical which is responsible for addiction, not everyone understands that teens are even more likely than adults to get chemically addicted to nicotine.

"Studies suggest that additional compounds in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain. A number of studies indicate that adolescents are especially vulnerable to these effects and may be more likely than adults to develop an addiction to tobacco."

The risk of addiction for adults is high; the risk for teens in general is higher; and then there are teens who have an even higher risk of addiction than most.

"Smokers under age 17 who've inherited common genetic variations may be much more likely to face a lifetime of tobacco addiction. Researchers have found that European-Americans who begin daily smoking at an early age are at greater risk for long-term nicotine addiction if they carry a specific genetic variation within a certain gene cluster. The findings suggest that preventing tobacco use in early adolescence could have a large impact on a person's long-term smoking behavior. According to the American Lung Association, nearly 6,000 children under age 18 start smoking every day. About 4.5 million adolescents in the U.S. are cigarette smokers."

Even those who understand that nicotine is addictive may not understand just how powerful it is.

"Because the smoker inhales only some of the smoke from a cigarette and not all of each puff is absorbed in the lungs, a smoker gets about 1 to 2 milligrams of the drug from each cigarette. A drop of pure nicotine would kill a person--in fact, nicotine can be used as a pesticide on crops."

In fact, while most people have heard of nicotine, most people really don't know much about it.

"Nicotine is both a stimulant and a depressant. That means nicotine increases the heart rate at first and makes people feel more alert (like caffeine, another stimulant). Then it causes depression and fatigue. The depression and fatigue -- and the drug withdrawal from nicotine -- make people crave another cigarette to perk up again. According to many experts, the nicotine in tobacco is as addictive as cocaine or heroin."

So now what? What about the people who (despite all they knew), have managed to get addicted to smoking and now want to quit (or at least know they should)?

"Dangling enough dollars in front of smokers who want to quit helps many more succeed, an experiment with hundreds of General Electric Co. workers indicates. Among those paid up to $750 to quit and stay off cigarettes, 15 percent were still tobacco-free about a year later. That may not sound like much, but it's three times the success rate of a comparison group that got no such bonuses. GE was so impressed it plans to offer an incentive program nationwide next year, aiming to save some of the company's estimated $50 million annually in extra health and other costs for smoking employees. 'This kind of reward system provides them with direct, positive feedback in the present,' not just delayed, intangible health benefits, said Dr. Kevin Volpp, the lead researcher of the study.",w-study-paying-smokers-quit-boosts-success-021209.article

For those who don't have anyone who will pay them to quit, there are other options. For one, they can pay themselves. The $750 over the course of the year that people earned was still less than the average smoker would spend on cigarettes for that same year. For smokers who take all the cigarette money they don't spend (because they are trying to quit) and put it all in one place, they can tangibly track how much extra money they have at the end of a week, month, or year...

Even with the financial and health benefits, it can still be difficult for some people to know where to begin. One place to start is to take a short quiz: "The different categories of questions in the quiz give a great variety of reasons why people with different needs smoke. Nicotine is an extremely powerful drug! It is more addictive than heroin or cocaine. If you read the papers you know cigarette manufacturers manipulate the amount of nicotine in their cigarettes to provide a consistent flavor and also to insure that you get the same dose with each cigarette you light up."

The quiz at the above site is a place to start.
Additionally there are many other sites that offer specific tactics and ideas for those trying to quit. A few websites that the future nonsmoker might find useful include:

Questions of the Week:
What do you and your friends know about: the potential health hazards associated with smoking? the potential health hazards associated with secondhand smoke? and the potential health hazards associated with third-hand smoke? What further information would be useful for you and your friends? What information is important for smokers? What information is important for nonsmokers? For those who want to quit smoking, how do you find the information that will be the most useful for you? For those who don't smoke, but know people who do, what information is useful for you as you help your friends quit and/ or help yourself stay smoke-free?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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