Is cigarette smoking really a problem?

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If it seems as if many people are still smoking these days, you’re probably right. The Centers for Disease Control and Prevention (CDC) states that, as of 2011, about 21 percent of adults in the U.S. smoke or use tobacco. Karen Hacker, MD, MPH, (the new Allegheny County Health Department director see her introduction below) cites the University of Pittsburgh’s 2009 Allegheny County Health Survey reporting that 24 percent of men and 23 percent of women adults in Allegheny County smoke. The same report reveals large disparities in the rates of smoking in Allegheny County with regard to race, economic status and level of education. In the county, 35 percent of African American adults smoke and 22 percent of Whites smoke. Lower-income populations smoke more than higher-income populations. People with fewer years of education smoke more than people with college degrees.

If people are still smoking, is it really a problem? Public health and health care professionals think so. The CDC reports that:

• Cigarette smoking is second only to obesity as the leading cause of preventable death in the U.S.

• Smoking causes one out of every five deaths in the U.S. each year.

• Smoking causes lung and other cancers, coronary heart disease and other chronic lung diseases.

• More deaths are caused each year by tobacco use than HIV/AIDS, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined.

“Smoking is very dangerous,” says Saul Shiffman, PhD, professor of psychology, of psychiatry, of pharmaceutical sciences and of clinical and translational research at the University of Pittsburgh. “Most people know the health risks of smoking, but they associate it with about the same level of risk as not taking their vitamins. If you take a group of people who smoke and don’t quit, half of them will die because of smoking. It’s a flip of a coin whether it’s going to kill you or not. It’s a huge risk.”

Even nonsmokers are at risk because of secondhand smoke. Secondhand smoke is a mixture of gases and toxins that come from burning tobacco or another person’s exhaled smoke. The U.S. Department of Health and Human Services states that even in nonsmoking adults, secondhand smoke can cause heart disease and/or lung cancer. The department also warns that “there is no risk-free level of contact with secondhand smoke; even brief exposure can be harmful to health.”

Even smoking at a low level will increase people’s chances of having heart disease. Dr. Shiffman says that nondaily smoking is still damaging, even if not as damaging as daily smoking. Through his research, he learned that nondaily smoking is more common in African Americans; however, they show nicotine dependence even at lower rates of smoking.

“We don’t know why nondaily smokers aren’t daily smokers,” says Dr. Shiffman. “It may be for genetic reasons. We know that nondaily smokers aren’t better at self-control. They just seem not need to or want to smoke as much as daily smokers. It’s just as hard for nondaily smokers to quit, though.”

According to the National Institutes of Health, African Americans suffer from the highest rate of lung cancer—more than any other population in the U.S.—even though their overall exposure to cigarette smoke, the primary risk factor for lung cancer, is lower. Dr. Shiffman also cites research showing that African Americans tend to disproportionately smoke menthol cigarettes (it’s a myth that menthol cigarettes are safer than regular cigarettes). Some researchers think that menthol cigarettes encourage deeper inhalation because of the way menthol numbs the airway. Normally, the throat might keep people from inhaling too much smoke. This numbing effect could be the reason African Americans seem to get more nicotine out of each cigarette and become more dependent, even at lower rates of smoke exposure.

With the health risks associated with smoking, it sounds as if kicking the habit would be an obvious decision. It’s not that easy. Nicotine is the drug in tobacco products that causes people’s addiction. The CDC reports that nicotine dependence is the most common form of chemical dependence in the U.S. Research suggests that nicotine may be as addictive as heroin, cocaine or alcohol.

But Dr. Shiffman says that quitting is possible, especially with help. “Quitting is best done using medication and behavioral methods together, even though both work on their own,” he says. “The medication gives people nicotine from a clean source (without the chemicals from cigarettes) and helps them establish nonsmoking behaviors. Behavioral approaches are very practical. They can involve short-term counseling and can be done even over the phone or the Internet.”

Before people can be helped to quit, they need to be encouraged not to start smoking in the first place. Many people start smoking as teenagers because it’s portrayed and seen as cool and rebellious. “The risk of disease or death years later doesn’t mean much to teens,” says Dr. Shiffman. “Many teens say that they’ll quit before they get sick or hooked. Mature smokers say that they wish they had never started and didn’t realize how hard quitting is.

It moves from being something they want to do because it’s cool to something they need to do to function.”

“Smoking is not something to be fooled with,” warns Dr. Shiffman.

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