What Nicotine Does to the Body
Cigarette smoke contains almost four thousand different chemical compounds, many of which are toxic, mutagenic (capable of increasing the frequency of mutation), and carcinogenic (cancer-causing). At least forty-three carcinogens have been identified in tobacco smoke. In addition to nicotine, the most damaging substances are tar and carbon monoxide. Smoke also contains hydrogen cyanide and other chemicals that can damage the respiratory system. These substances and nicotine are absorbed into the body through the linings of the mouth, nose, throat, and lungs. About ten seconds later, they are delivered by the bloodstream to the brain.
Tar, which adds to the flavor of cigarettes, is released by the burning of tobacco. As it is inhaled, it enters the alveoli (air cells) of the lungs. There, the tar hampers the action of cilia—small, hairlike forms that clean foreign substances from the lungs—allowing the substances in cigarette smoke to accumulate.
Carbon monoxide (CO) affects the blood's ability to distribute oxygen throughout the body. CO is chemically
FIGURE 5.8
Consumption of large cigars, 1984-2002
Smokeless tobacco, which includes chewing tobacco and snuff, also creates health hazards for its users. In 1979 the annual Report of the Surgeon General noted that smokeless tobacco was associated with oral cancers; in the 1986 Report, the Surgeon General concluded that it was a cause of these diseases. The nicotine in smokeless tobacco is absorbed into the bloodstream through the lining of the mouth and has been linked to periodontal (gum) disease, as well as cancers of the lip, gum, and mouth.
Diseases and Conditions Linked to Tobacco Use
Results of medical research show an association between smoking and cancer, heart and circulatory disease, fetal growth retardation, and low-birthweight babies. The 1983 Report of the Surgeon General linked cigarette smoking to cerebrovascular disease (stroke) and associated it with cancer of the uterine cervix. Two 1992 studies showed that people who smoke double their risk of forming cataracts, the leading cause of blindness. Recent research links smoking to unsuccessful pregnancies, increased infant mortality, and peptic ulcer disease. In 2004 U.S. Surgeon General Richard H. Carmona released a comprehensive report on smoking and health, The Health Consequences of Smoking: A Report of the Surgeon General, revealing for the first time that cigarette smoking causes diseases in nearly every organ of the body. Table 5.3 lists diseases and other adverse health effects for which cigarette smoking is identified as a cause.
TABLE 5.2
Percentage of high school students who used smokeless tobacco, smoked cigars, and used any tobacco product, by sex, race/ethnicity,
and grade, 2003
| Current smokeless tobacco usea | Current cigar useb | Current tobacco usec | ||||||||
| Female | Male | Total | Female | Male | Total | Female | Male | Total | ||
| Category | % | % | % | % | % | % | % | % | % | |
| Race/ethnicity | ||||||||||
| Whited | 1.6 | 13.2 | 7.6 | 8.6 | 21.3 | 15.1 | 28.9 | 33.2 | 31.1 | 2.6 |
| Blackd | 2.0 | 4.1 | 3.0 | 10.3 | 19.5 | 15.0 | 14.9 | 23.7 | 19.3 | 2.8 |
| Hispanic | 3.3 | 6.1 | 4.7 | 12.2 | 14.9 | 13.7 | 19.8 | 24.9 | 22.4 | 3.3 |
| Grade | ||||||||||
| 9 | 3.8 | 9.1 | 6.6 | 10.0 | 13.6 | 11.9 | 22.4 | 21.5 | 22.0 | 3.0 |
| 10 | 1.0 | 9.6 | 5.4 | 9.3 | 17.0 | 13.2 | 23.6 | 29.2 | 26.4 | 3.2 |
| 11 | 2.0 | 13.3 | 7.8 | 10.0 | 22.2 | 16.3 | 27.0 | 33.7 | 30.4 | 3.4 |
| 12 | 1.3 | 12.7 | 7.1 | 7.8 | 29.8 | 19.1 | 25.7 | 40.3 | 33.0 | 3.1 |
| Total | 2.2 | 11.0 | 6.7 | 9.4 | 19.9 | 14.8 | 24.6 | 30.3 | 27.5 | 2.4 |
| aUsed chewing tobacco, snuff, or dip on ≥1 of the 30 days preceding the survey. | ||||||||||
| bSmoked cigars, cigarillos, or little cigars on ≥1 of the 30 days preceding the survey. | ||||||||||
| cSmoked cigarettes or cigars or used chewing tobacco, snuff, or dip on ≥1 of the 30 days preceding the survey. | ||||||||||
| dNon-Hispanic. | ||||||||||
In 1998 the National Cancer Institute noted the following about cigar smoking: (1) Cigars contain most of the same cancer-causing chemicals found in cigarettes; (2) regular cigar smoking causes cancer of the lungs, mouth, larynx (voice box), esophagus (food tube), and probably cancer of the pancreas; (3) cigar smokers have four to ten times the risk of dying of cancers of the larynx, mouth, or esophagus than nonsmokers.
Reporting on a study funded by the National Cancer Institute, lead author Carlos Iribarren reported in "Effect of Cigar Smoking on the Risk of Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, and Cancer in Men" (New England Journal of Medicine, June 1999) that cigar smokers are twice as likely as nonsmokers to develop cancer of the mouth, throat, and lungs. Cigar smokers are also more likely to develop heart disease or chronic pulmonary disease. Iribarren observed, "Many people still believe it is safe to smoke cigars. Our research shows that there are serious health consequences for cigar smokers."
In an editorial accompanying the aforementioned article, then-Surgeon General Dr. David Satcher said, "Restrictions on the sale of cigars (through the setting of excise rates, for example) ought to be at least as stringent as those currently applied to other tobacco products." Dr. Satcher has urged the Federal Trade Commission to require warning labels on cigars, like those on cigarettes.
Analyzing the health problems of smokers, the Public Health Service estimated that smokers annually miss eighty-one million days of work and spend 145 million days sick in bed. Compared with nonsmokers, smokers had, per year:
- eleven million more cases of chronic illnesses
- 280,000 additional cases of heart disease
- one million more cases each of chronic bronchitis, emphysema, and peptic ulcer
- 1.8 million more cases of sinus problems
The National Institute on Drug Abuse, in Nicotine Addiction (Washington, DC: U.S. Department of Health and Human Services, August 2001), found that smoking accounted for about $80 billion each year in health care costs. However, this amount is only about half the total cost of smoking to society, because it does not include perinatal care for low-birth-weight infants of mothers who smoke; medical care costs associated with diseases caused by secondhand smoke; and burn care from smoking-related fires. Including these costs, the total financial burden of smoking is estimated at more than $100 billion a year.
Premature Aging
Smoking cigarettes contributes to premature aging in a variety of ways. Results of research over two decades show that smoking enhances facial aging and skin wrinkling (M. Placzek et al., "Tobacco Smoke Is Phototoxic," British Journal of Dermatology, vol. 150, 2004). Additionally, smoking has been associated with a decline in overall fitness in women.
TABLE 5.3
Diseases and other adverse health effects for which smoking is identified as a cause in the 2004 Surgeon General's report
| Disease | Highest level conclusion from previous Surgeon General's reports (year) | Conclusion from the 2004 Surgeon General's report |
| Cancer | ||
| Bladder cancer | "Smoking is a cause of bladder cancer; cessation reduces risk by about 50 percent after only a few years, in comparison with continued smoking." (1990) | "The evidence is sufficient to infer a causal relationship between smoking and… bladder cancer." |
| Cervical cancer | "Smoking has been consistently associated with an increased risk for cervical cancer." (2001) | "The evidence is sufficient to infer a causal relationship between smoking and cervical cancer." |
| Esophageal cancer | "Cigarette smoking is a major cause of esophageal cancer in the United States." (1982) | "The evidence is sufficient to infer a causal relationship between smoking and cancers of the esophagus." |
| Kidney cancer | "Cigarette smoking is a contributory factor in the development of kidney cancer in the United States. The term 'contributory factor' by no means excludes the possibility of a causal role for smoking in cancers of this site." (1982) | "The evidence is sufficient to infer a causal relationship between smoking and renal cell, [and] renal pelvis … cancers." |
| Laryngeal cancer | "Cigarette smoking is causally associated with cancer of the lung, larynx, oral cavity, and esophagus in women as well as in men.…" (1980) | "The evidence is sufficient to infer a causal relationship between smoking and cancer of the larynx." |
| Leukemia | "Leukemia has recently been implicated as a smoking-related disease…but this observation has not been consistent." (1990) | "The evidence is sufficient to infer a causal relationship between smoking and acute myeloid leukemia." |
| Lung cancer | "Additional epidemiological, pathological, and experimental data not only confirm the conclusion of the Surgeon General's 1964 report regarding lung cancer in men but strengthen the causal relationship of smoking to lung cancer in women." (1967) | "The evidence is sufficient to infer a causal relationship between smoking and lung cancer." |
| Oral cancer | "Cigarette smoking is a major cause of cancers of the oral cavity in the United States." (1982) | "The evidence is sufficient to infer a causal relationship between smoking and cancers of the oral cavity and pharynx." |
| Pancreatic cancer | "Smoking cessation reduces the risk of pancreatic cancer, compared with continued smoking, although this reduction in risk may only be measurable after 10 years of abstinence." (1990) | "The evidence is sufficient to infer a causal relationship between smoking and pancreatic cancer." |
| Stomach cancer | "Data on smoking and cancer of the stomach … are unclear." (2001) | "The evidence is sufficient to infer a causal relationship between smoking and gastric cancers." |
| Cardiovascular diseases | ||
| Abdominal aortic aneurysm | "Death from rupture of an atherosclerotic abdominal aneurysm is more common in cigarette smokers than in nonsmokers." (1983) | "The evidence is sufficient to infer a causal relationship between smoking and abdominal aortic aneurysm." |
| Atherosclerosis | "Cigarette smoking is the most powerful risk factor predisposing to atherosclerotic peripheral vascular disease." (1983) | "The evidence is sufficient to infer a causal relationship between smoking and subclinical atherosclerosis." |
| Cerebrovascular disease | "Cigarette smoking is a major cause of cerebrovascular disease (stroke), the third leading cause of death in the United States." (1989) | "The evidence is sufficient to infer a causal relationship between smoking and stroke." |
| Coronary heart disease | "In summary, for the purposes of preventive medicine, it can be concluded that smoking is causally related to coronary heart disease for both men and women in the United States." (1979) | "The evidence is sufficient to infer a causal relationship between smoking and coronary heart disease." |
| Respiratory diseases | ||
| Chronic obstructive pulmonary disease | "Cigarette smoking is the most important of the causes of chronic bronchitis in the United states, and increases the risk of dying from chronic bronchitis." (1964) | "The evidence is sufficient to infer a causal relationship between active smoking and chronic obstructive pulmonary disease morbidity and mortality." |
| Pneumonia | "Smoking cessation reduces rates of respiratory symptoms such as cough, sputum production, and wheezing, and respiratory infections such as bronchitis and pneumonia, compared with continued smoking." (1990) | "The evidence is sufficient to infer a causal relationship between smoking and acute respiratory illnesses, including pneumonia, in persons without underlying smoking-related chronic obstructive lung disease." |
| Respiratory effects in utero | "In utero exposure to maternal smoking is associated with reduced lung function among infants.…" (2001) | "The evidence is sufficient to infer a causal relationship between maternal smoking during pregnancy and a reduction of lung function in infants." |
| Respiratory effects in childhood and adolescence | "Cigarette smoking during childhood and adolescence produces significant health problems among young people, including cough and phlegm production, an increased number and severity of respiratory illnesses, decreased physical fitness, an unfavorable lipid profile, and potential retardation in the rate of lung growth and the level of maximum lung function." (1994) | "The evidence is sufficient to infer a causal relationship between active smoking and impaired lung growth during childhood and adolescence." "The evidence is sufficient to infer a causal relationship between active smoking and the early onset of lung function decline during late adolescence and early adulthood." "The evidence is sufficient to infer a causal relationship between active smoking and respiratory symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea." "The evidence is sufficient to infer a causal relationship between active smoking and asthma-related symptoms (i.e., wheezing) in childhood and adolescence." |
| Respiratory effects in adulthood | "Cigarette smoking accelerates the age-related decline in lung function that occurs among never smokers. With sustained abstinence from smoking, the rate of decline in pulmonary function among former smokers returns to that of never smokers." (1990) | "The evidence is sufficient to infer a causal relationship between active smoking in adulthood and a premature onset of and an accelerated age-related decline in lung function." "The evidence is sufficient to infer a causal relationship between sustained cessation from smoking and a return of the rate of decline in pulmonary function to that of persons who had never smoked." |
| Other respiratory effects | "Smoking cessation reduces rates of respiratory symptoms such as cough, sputum production, and wheezing, and respiratory infections such as bronchitis and pneumonia, compared with continued smoking." (1990) | "The evidence is sufficient to infer a causal relationship between active smoking and all major respiratory symptoms among adults, including coughing, phlegm, wheezing, and dyspnea." "The evidence is sufficient to infer a causal relationship between active smoking and poor asthma control." |
TABLE 5.3
Diseases and other adverse health effects for which smoking is identified as a cause in the 2004 Surgeon General's report [CONTINUED]
| Disease | Highest level conclusion from previous Surgeon General's reports (year) | Conclusion from the 2004 Surgeon General's report |
| Reproductive effects | ||
| Fetal death and stillbirths | "The risk for perinatal mortality—both stillbirth and neonatal deaths—and the risk for sudden infant death syndrome (SIDS) are increased among the offspring of women who smoke during pregnancy." (2001) | "The evidence is sufficient to infer a causal relationship between sudden infant death syndrome and maternal smoking during and after pregnancy." |
| Fertility | "Women who smoke have increased risks for conception delay and for both primary and secondary infertility." (2001) | "The evidence is sufficient to infer a causal relationship between smoking and reduced fertility in women." |
| Low birth weight | "Infants born to women who smoke during pregnancy have a lower average birth weight …than…infants born to women who do not smoke." (2001) | "The evidence is sufficient to infer a causal relationship between maternal active smoking and fetal growth restriction and low birth weight." |
| Pregnancy complications | "Smoking during pregnancy is associated with increased risks for preterm premature rupture of membranes, abruptio placentae, and placenta previa, and with a modest increase in risk for preterm delivery." (2001) | "The evidence is sufficient to infer a casual relationship between maternal active smoking and premature rupture of the membranes, placenta previa, and placental abruption." "The evidence is sufficient to infer a causal relationship between maternal active smoking and preterm delivery and shortened gestation." |
| Other effects | ||
| Cataract | "Women who smoke have an increased risk for cataract." (2001) | "The evidence is sufficient to infer a causal relationship between smoking and nuclear cataract." |
| Diminished health status/morbidity | "Relationships between smoking and cough or phlegm are strong and consistent; they have been amply documented and are judged to be causal.…" (1984) "Consideration of evidence from many different studies has led to the conclusion that cigarette smoking is the overwhelmingly most important cause of cough, sputum, chronic bronchitis, and mucus hypersecretion." (1984) |
"The evidence is sufficient to infer a causal relationship between smoking and diminished health status that may be manifest as increased absenteeism from work and increased use of medical care services." "The evidence is sufficient to infer a causal relationship between smoking and increased risks for adverse surgical outcomes related to wound healing and respiratory complications." |
| Hip fractures | "Women who currently smoke have an increased risk for hip fracture compared with women who do not smoke." (2001) | "The evidence is sufficient to infer a causal relationship between smoking and hip fractures." |
| Low bone density | "Postmenopausal women who currently smoke have lower bone density than do women who do not smoke." (2001) | "In postmenopausal women, the evidence is sufficient to infer a causal relationship between smoking and low bone density." |
| Peptic ulcer disease | "The relationship between cigarette smoking and death rates from peptic ulcer, especially gastric ulcer, is confirmed. In addition, morbidity data suggest a similar relationship exists with the prevalence of reported disease from this cause." (1967) | "The evidence is sufficient to infer a causal relationship between smoking and peptic ulcer disease in persons who are helicobacter pylori positive." |
Interactions with Other Drugs
Smoking can have adverse effects when combined with over-the-counter (OTC) and prescription medications that a smoker may be taking. In many cases tobacco smoking reduces the effectiveness of medications, such as pain relievers (acetaminophen), antidepressants, tranquilizers, sedatives, ulcer medications, and insulin. With estrogen and oral contraceptives, tobacco smoking may increase the risk of heart and blood vessel disease and can cause strokes and blood clots.
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