Title: The Negative Health Impacts of Smoking Cigarettes
Introduction
Smoking cigarettes is a major public health issue that impacts millions of people worldwide. While the long term health effects of smoking are well known, it remains a prevalent addictive behavior, especially among young adults. This paper examines research on the negative health consequences of smoking cigarettes with a focus on cancer, cardiovascular and lung disease. It also explores factors that perpetuate smoking behavior and recommendations to curb its public health toll.
Cancer Risk
There is overwhelming scientific evidence that smoking cigarettes greatly increases the risk of developing several types of cancer. Cigarette smoke contains over 7,000 chemicals, many of which are known carcinogens (cancer-causing substances). The two primary carcinogens in cigarette smoke that have been extensively studied are benzene and radioactive polonium-210 (Siemiatycki et al., 2004). These toxic compounds damage cells in the body and can cause permanent genetic mutations that initiate cancer.
Lung cancer is by far the most directly linked cancer to smoking. Research shows that cigarette smoking is the primary risk factor for lung cancer, causing about 90% of lung cancer deaths (CDC, 2020). The more cigarettes smoked per day and the longer duration of smoking increases lung cancer risk in a dose-dependent manner. Compared to never smokers, the risk of lung cancer is at least 20 times higher for heavy long-term smokers and four times higher for light smokers (Thun et al., 2013). Beyond lung cancer, smoking is a causative agent in several other types of cancer including cancers of the mouth, throat, esophagus, pancreas, bladder, kidney and cervix (Siemiatycki et al., 2004). Current estimates attribute 30% of all cancer deaths to smoking (Raupach et al., 2014).
Cardiovascular Disease Risk
In addition to cancer, cigarette smoking substantially raises the risks of cardiovascular diseases, which collectively represent the largest cause of preventable death globally. Active smoking nearly doubles the risk of dying from heart disease compared to never smokers and doubles the risk of having a sudden cardiac death (Ambrose & Barua, 2004). For perspective, smoking is a more important risk factor for heart disease than high blood pressure or high cholesterol.
The biological mechanisms by which smoking promotes cardiovascular disease are complex but involve both direct damage from chemicals in smoke as well as indirect effects on other disease risk factors. For instance, cigarette smoke increases inflammation, reduces HDL (good) cholesterol levels and triggers vasoconstriction – narrowing of blood vessels. Over time, these effects promote plaque buildup in arteries, increase the likelihood of blood clots, and raise blood pressure (Ambrose & Barua, 2004).
Studies find smokers have a 2 to 4 times higher risk of stroke compared to non-smokers (Carandang et al., 2006). Risk increases with the number of cigarettes smoked and declines after quitting. Smoking triples the risk of peripheral vascular disease which reduces blood flow in legs and can lead to amputation (USDHHS, 2014). Young smokers under age 40 already have risks for coronary artery disease comparable to lifetime nonsmoking men in their mid-60s (USDHHS, 2014). Overall, at least 1 in every 5 premature deaths from cardiovascular disease can be attributed to smoking (Raupach et al., 2014).
Lung Disease Risk
Unsurprisingly, smoking is the number one risk factor for chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis and causes inflammation and damage to lung tissue over time (Eisner et al., 2010). As many as 80-90% of COPD cases are directly linked to smoking or secondhand smoke exposure. Compared to never smokers, regular smokers have a 10-20 fold higher risk of developing COPD (USDHHS, 2014). Importantly, even after quitting smoking, COPD risks remain elevated the longer a person smoked.
Pneumonia is another leading cause of smoking related lung disease. Smokers are 6 times more likely to contract pneumonia than nonsmokers and have worse pneumonia outcomes with higher mortality risk (Schenkein et al., 2006). Secondhand smoke further raises risks of lower respiratory illnesses in children and of COPD and lung cancer in nonsmoking adults exposed at home or work.
Reproductive Health Risks
Smoking is also a reproductive health hazard. In women, cigarette smoking before and during pregnancy can cause ectopic pregnancy, placental problems and preterm birth. Children of smoking mothers face increased risks of being born premature and at low birth weight which raises infant mortality (USDHHS, 2014). Males smokers may have lower sperm counts and semen quality impairing fertility (Vine, 1996). Both male and female partners who smoke double their risk of experiencing infertility (Jensen et al., 1998).
Smoking cessation is shown to mitigate long term risks. Quitting before age 30 avoids over 90% of smoking-attributable mortality, allowing near normal lifespans. But risks remain elevated for several illness even with later cessation though risks steadily decline over time after quitting (Doll et al., 2004). This highlights smoking’s widespread detrimental impacts and shows lifetime benefits of avoiding tobacco use.
Factors Influencing Smoking Behavior
Understanding determinants of smoking perpetuation can inform prevention. While nicotine dependence drives sustained use, psychosocial influences are implicated in initial uptake, especially among youth. Peer smoking is a strong predictor of youth smoking and susceptibility to initiate (Kobus, 2003). Tobacco marketing heavily promotes images equating smoking with manhood, rebelliousness and weight control, particularly attracting female teens/young adults (Pierce et al., 1991).
Cigarette affordability and availability sustain addiction. Government support for tobacco farming and lack of taxation kept cigarettes historically affordable. Tax increases since 2009 have boosted prices yet cigarettes remain inexpensive relative to their health damage costs. Availability through sales to minors also promotes youth initiation with over 90% of regular smokers having their first cigarette by age 18 (USDHHS, 2012). Schools with tobacco control programs experience less student smoking progression underscoring environmental antismoking influences.
Genetics are estimated to contribute 60-70% to nicotine dependence risk (Kendler et al., 2007). Children with a smoking parent are twice as likely to smoke themselves compared to peers without parents. Co-occuring conditions like depression or antisocial behaviors enable smoking as a self-medication intensifying addiction vulnerability (Epler et al., 2009). Personality traits like risk-taking also interact with socioenvironmental cues to predict smoking (Terracciano & Costa, 2004).
Recommendations to Reduce Smoking’s Toll
Given smoking’s massive individual health and societal economic costs, comprehensive tobacco control remains a urgent public health priority. Recommendations with research support include:
Higher tobacco product taxes – Tax increases reduce smoking rates, especially among youth and pregnant women, disproportionately deterring new versus committed smokers. Additional tax dollars aid cessation programs.
Smoke-free laws – Banning smoking in public spaces, worksites and restaurants protects nonsmokers from toxic secondhand smoke without harming smokers. These policies de-normalize smoking and encourage quit attempts.
Youth access restrictions – Raising legal minimum tobacco purchase age to 21 closes the window of transitioning from experimental to regular use during late adolescence – a high risk period. Enforcing bans on youth product access also helps.
Cessation support – Insurance coverage incentivizes evidence-based cessation treatments including nicotine replacement therapy, bupropion, varenicline and behavioral counseling assistance shown to double quit rates. Curbing smoking saves money sooner from avoided medical costs.
Anti-tobacco advertising – Public education campaigns highlight tobacco-related disease. They help change social norms by countering pro-smoking messages, especially important as marketing remains widespread globally.
School-based programs – Teaching kids about tobacco’s harms integrated into standard curriculums protects them from exploitation by tobacco companies constantly seeking new customers. Multi-component anti-smoking lessons impact social influences facilitating initiation.
Tobacco industry regulation – Restricting flavored products appealing to youth and requiring graphic health warnings on cigarette packs can reduce uptake and addiction potential. Banning misleading terms like “light” cigarettes is also warranted. Monitoring industry activities that undermine tobacco control supports population-level prevention measures.
Concluding Remarks
Extensive research irrefutably links smoking to heightened risks of mortality and myriad deadly illnesses. While challenging to quit due to nicotine’s addictiveness, cessation options exist to support quit attempts. Comprehensive multi-pronged tobacco control combining individual, social and policy-level strategies represent the most promising solution to curb smoking’s devastating toll. Severely limiting tobacco industry influence on policymaking is likewise imperative for public health’s long term success in remedying this preventable epidemic.
Andrew Stroud