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Tobacco Use

Smoking is the most preventable cause of death in our society. Tobacco use is responsible for nearly one in five deaths in the United States. Based upon data from the American Cancer Society's Cancer Prevention Study II, it is estimated that smoking is related to about 419,000 US deaths each year. Although the number of cardiovascular deaths is declining, smoking-related cancer deaths continue to rise. According to the World Health Organization approximately 3 million people die worldwide each year as a result of smoking. Smokers lose an average of 15 years of life.

The risks of dying of lung cancer are 22 times higher for male smokers and 12 times higher for female smokers than for people who have never smoked. In addition to being responsible for 87% of lung cancers, smoking is also associated with cancers of the mouth, pharynx, larynx, esophagus, pancreas, uterine cervix, kidney, and bladder. Smoking accounts for 30% of all cancer deaths, is a major cause of heart disease, and is associated with conditions ranging from colds and gastric ulcers to chronic bronchitis, emphysema, and cerebrovascular disease.

Questions About Smoking, Tobacco, and Health...and the Answers

Trends in Smoking

The National Health Interview Survey (NHIS) data show that cigarette smoking among adults aged 18 and over declined 40% between 1965 and 1990 - from 42% to 25%. However, between 1990 and 1993, overall smoking prevalence was virtually unchanged. Between 1983 and 1993:

Smoking prevalence among men declined from 34% to 27% for white men, from 41% to 32% for black men..

Smoking prevalence for women declined from 30% to 23%.

Prevalence among college graduates declined by 34% from 21% to 14%, among adults without a high school education from 41% to 36%.

Data from the NHIS show that between 1992 and 1993 there was a significant decline in the prevalence of daily smoking - from 22% to 20%. This phenomenon might be attributed to the widespread adoption of worksite smoking restrictions and other public smoking prohibitions.

Per capita consumption of cigarettes continues to decline. After peaking at 4,345 in 1963, consumption has fallen 41% since then to 2,576 in 1993.

Profiles of Smokers

In 1993, there were an estimated 46 million adult current smokers in the US: 20% of adults smoke every day and 5% smoke on some days.

Smoking prevalence is higher for men (28%) than for women (23%), and highest among American Indians/Alaskan Natives (39%) compared with other race/ethnic groups. Smoking prevalence is highest among men who have dropped out of high school (42%).

Over 70% of adults who have smoked started smoking daily by age 18. The 1993 Youth Risk Behavior Survey data show that:

Nationwide, 70% of high school students have tried cigarette smoking.
14% of high school students are frequent smokers, and white students are more likely than black or Hispanic students to smoke frequently.

Cost of Tobacco

The 1992 Surgeon General's Report estimates that the total lifetime excess medical care costs for smokers exceed those for nonsmokers by $501 billion.

The US Congress Office of Technology Assessment estimates that cigarettes cost Americans $68 billion annually in tobacco-related health care costs and lost productivity. The cost of treating smoking-related diseases and lost productivity amounts to $2.59 for each pack of cigarettes sold in the US. For every 10% increase in the price of tobacco products, it is estimated that tobacco consumption would decline 4%.

Cigarette Exports

US cigarette exports have increased due to aggressive marketing by tobacco companies and expanding foreign markets. A September 1993 tobacco report of the US Department of Agriculture estimates:

US cigarette exports have increased about 275% since 1985.
US cigarette exports to Japan have increased almost 800%, from 6.5 billion in 1985 to 56 billion in 1993.
Exports to South Korea have grown from 1.3 billion in 1987 to 4 billion in 1993.
Exports to the countries that formerly comprised the Soviet Union have increased from 4.6 billion in 1991 to 13.6 billion in 1993.
US cigarette output from July 1992 to June 1993 was 702 billion. Even though domestic consumption has dropped, this recent increase is the result of foreign demand of US tobacco leaf and US manufacturers offering discounted cigarettes and lower prices on premium brands.

Nicotine Addiction

Tobacco smoke contains over 4,000 chemical compounds including at least 43 different carcinogenic substances.

The 1988 Surgeon General's Report on Nicotine Addiction concluded:

Cigarettes and other forms of tobacco are addicting.
Nicotine is the drug in tobacco that causes addiction.
The pharmacologic and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine.

Nicotine is found in substantial amounts in tobacco. It is absorbed readily from tobacco smoke in the lungs and from smokeless tobacco in the mouth or nose and is rapidly distributed throughout the body.

Smoking Cessation

In 1993, about 46 million adults were former cigarette smokers - about 50% of adults who had ever smoked had quit. Among adults who had ever smoked:

52% of men and 47% of women had quit.
52% of whites, 38% of blacks, and 44% of Hispanics had quit.
Almost two-thirds of adults with a college education or more had quit.

In September 1990, the Surgeon General outlined the benefits of smoking cessation:

People who quit smoking, regardless of age, live longer than people who continue to smoke.
Smokers who quit before age 50 have half the risk of dying in the next 15 years compared with those who continue to smoke.
Quitting smoking substantially decreases the risk of lung, laryngeal, esophageal, oral, pancreatic, bladder, and cervical cancers.
Benefits of cessation include risk reduction for other major diseases including coronary heart disease and cardiovascular disease.

Almost 70% of current smokers reported interest in quitting smoking according to the 1993 NHIS. A Gallup poll conducted that year found that among smokers:

65% believe their health has already been affected.
78% believe that serious health problems are likely if they continue smoking.
81% would not start smoking again if they had to do it over.
75% say they are addicted to cigarettes.

Environmental Tobacco Smoke

In December 1992, the Environmental Protection Agency concluded that widespread exposure to environmental tobacco smoke (ETS) presents "a serious and substantial" public health problem in the United States. Each year about 3,000 nonsmoking adults die of lung cancer as a result of breathing the smoke of other's cigarettes.

The risk of dying of lung cancer is 30% higher for a nonsmoker living with a smoker compared with a nonsmoker living with a nonsmoker.
It is estimated that ETS causes 35,000 to 40,000 excess heart disease deaths among people who are not current smokers.
ETS contains essentially all of the same carcinogens and toxic agents that are inhaled by the smoker.
ETS can result in aggravated asthmatic conditions, impaired blood circulation, bronchitis, and pneumonia.
ETS poses additional health hazards for unborn and young children. According to the 1988 NHIS, about 10 million children under the age of six are exposed to ETS by a household member.
Children exposed to secondhand smoke have increased risks of respiratory illnesses and infections, impaired development of lung function, and middle ear infections. Infants born to women who smoked during pregnancy are more likely to die of Sudden Infant Death syndrome.

Smokeless Tobacco

There has been a resurgence in the use of all forms of smokeless tobacco, plug, leaf, and snuff, but the greatest cause for concern centers on the increased use of "dipping snuff." In this practice, tobacco that has been processed into a coarse, moist powder is placed between the cheek and gum, and nicotine, along with a number of carcinogens, is absorbed through the oral tissue. Dipping snuff is highly addictive, and exposes the body to levels of nicotine equal to those of cigarettes.

In 1986, the US Surgeon General concluded that the use of smokeless tobacco "is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous oral conditions and can lead to nicotine addiction and dependence."
Oral cancer occurs several times more frequently among snuff dippers compared with non-tobacco users.
The excess risk of cancer of the cheek and gum may reach nearly fiftyfold among long-term snuff users.
The use of smokeless tobacco is increasing among male adolescents and young male adults.
According to the US Department of Agriculture, US output of moist snuff has risen 83%, from about 30 million pounds in 1981 to an estimated 55 million pounds in 1993.
About 5 million US adults use smokeless tobacco.
The Centers for Disease Control and Prevention's 1993 Youth Risk Behavior Survey reported that 20% of male high-school students used smokeless tobacco.

Industrial Hazards

Industrial workers are especially susceptible to lung diseases due to the combined effects of cigarette smoke and exposure to certain toxic industrial substances, such as fumes from rubber and chlorine, and dust from cotton and coal. Exposure to asbestos in combination with cigarette smoking increases an individual's lung cancer risk nearly 60 times. Smoking also enhances lung cancer risk in underground miners exposed to radon.

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