The 1982 Surgeon General's Report stated that "Cigarette smoking is the major single cause of cancer mortality in the United States." This statement is as true today as it was in 1982. Because cigarette smoking and tobacco use is an acquired behavior, one that the individual chooses to do, smoking is the most preventable cause of premature death in our society.

Who Smokes?

According to the Centers for Disease Control and Prevention (CDC), 46.2 million US adults were current smokers in 2001 (the most recent year for which numbers are available). This is 22.8% of all adults (25.2% of men, 20.7% of women) - nearly 1 in every 4 people.

When broken down by race/ethnicity, the numbers were as follows:

Whites African Americans Hispanics American Indians/Alaska Natives Asian Americans

24.0% 22.3% 16.7% 32.7% 12.4%

Alarmingly, the numbers were higher in younger age groups. Almost 27% of those 18 to 24 years old were current smokers.

Nationwide, 22.9% of high school students were current smokers in 2002. White and Hispanic students were among the highest in terms of cigarette use. (For more information, see the American Cancer Society document, "Child and Teen Tobacco Use.")

Health Effects of Smoking

Each year, a staggering 440,000 people die in the US from tobacco use. Nearly 1 of every 5 deaths is related to smoking. Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.

Cigarette smoking accounts for at least 30% of all cancer deaths. It is a major cause of cancers of the lung, larynx (voice box), oral cavity, pharynx (throat), and esophagus, and is a contributing cause in the development of cancers of the bladder, pancreas, liver, uterine cervix, kidney, stomach, colon and rectum, and some leukemias.

About 87% of lung cancer deaths are caused by smoking. Lung cancer is the leading cause of cancer death among both men and women, and is one of the most difficult cancers to treat. It is very hard to detect when it is in the earliest, most treatable stage. Fortunately, lung cancer is largely a preventable disease. Groups that promote nonsmoking as part of their religion, such as Mormons and Seventh-day Adventists, have much lower rates of lung cancer and other smoking-related cancers.

But cancers account for only about half of the deaths related to smoking. Smoking is also a major cause of heart disease, bronchitis, emphysema, and stroke, and contributes to the severity of pneumonia. Tobacco has a damaging affect on women's reproductive health and is associated with increased risk of miscarriage, early delivery (prematurity), stillbirth, infant death, and is a cause of low birth weight in infants. Furthermore, the smoke from cigarettes has a harmful health effect on those around the smoke. (Refer to the American Cancer Society documents "Secondhand Smoke" and "Women and Smoking.")

Based on data collected from 1995 to 1999, the CDC estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.

But not all of the health problems related to smoking result in deaths. In the year 2000, about 8.6 million people were suffering from at least one chronic disease due to current or former smoking, according to the CDC. Many of these people were suffering from more than one smoking-related condition. The diseases occurring most often were chronic bronchitis, emphysema, heart attacks, strokes, and cancer.

Ingredients in tobacco: Cigarettes, cigars, and smokeless and pipe tobacco consist of dried tobacco leaves, as well as ingredients added for flavor and other properties. More than 4,000 individual compounds have been identified in tobacco and tobacco smoke. Among these are about 43 compounds that are carcinogens.

Cigarettes, cigars, and smokeless and pipe tobacco consist of dried tobacco leaves, as well as ingredients added for flavor and other properties. More than 4,000 individual compounds have been identified in tobacco and tobacco smoke. Among these are more than 60 compounds that are known carcinogens (cancer-causing agents).

There are hundreds of substances added by manufacturers to cigarettes to enhance the flavor or to make the smoking experience more pleasant. Some of the compounds found in tobacco smoke include ammonia, tar, and carbon monoxide. Exactly what effect these substances have on the cigarette consumer’s health is unknown, but there is no evidence that lowering the tar content of a cigarette improves the health risk. Manufacturers do not provide the public information about the precise amount of additives used in cigarettes, so it is difficult to accurately gauge that public health risk.

Nicotine addiction:

Addiction is characterized by the repeated, compulsive seeking or use of a substance despite harmful consequences. Addiction is often accompanied by adverse physical and psychological dependence on the substance. Nicotine is the addictive drug in tobacco. Regular use of tobacco products leads to addiction in a high proportion of users.

In 1988, the US Surgeon General concluded the following:

• 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 all forms of tobacco. It is absorbed readily from tobacco smoke in the lungs and from smokeless tobacco in the mouth or nose and rapidly spreads throughout the body.

Tobacco companies are required by law to report nicotine levels in cigarettes to the Federal Trade Commission (FTC) but are not required to show the amount of nicotine on the cigarette brand labeling. The actual amount of nicotine available to the smoker in a given brand of cigarettes may be different from the level reported to the FTC.

Although 70% of smokers want to quit and 35% attempt to quit each year, less than 5% succeed. The low rate of successful quitting and the high rate of relapse are related to the effect of nicotine addiction.

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

• Smoking cessation has major and immediate health benefits for men and women of all ages. Benefits apply to persons with and without smoking-related disease.
• Former smokers live longer than continuing smokers. For example, persons who quit smoking before age 50 have one-half the risk of dying in the next 15 years compared with continuing smokers.
• Smoking cessation decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease.
• Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth weight baby to that of women who never smoked.
• The health benefits of smoking cessation far exceed any risks from the average 5-pound (2.3-kg) weight gain or any adverse psychological effects that may follow quitting.

The risk of having lung cancer and other smoking-related cancers is related to total lifetime exposure to cigarette smoke, as measured by the number of cigarettes smoked each day, the age at which smoking began, and the number of years a person has smoked.

The risk of having lung cancer and other cancers can be reduced by quitting. The risk of lung cancer is less in people who quit smoking than in people who continue to smoke the same number of cigarettes per day, and the risk decreases as the number of years since quitting increases.

People who stop smoking at younger ages experience the greatest health benefits from quitting. Those who quit by age 35 avoid 90% of the risk due to tobacco use. However, even smokers who quit after age 50 substantially reduce their risk of dying early. The argument that it is too late to quit smoking because the damage is already done is not true.

For more information, see the American Cancer Society document, "Guide to Quitting Smoking."

US Surgeon Generals Report. Reducing tobacco use: A Report of the Surgeon General

Smoking and Cancer Mortality Table

National Report on Human Exposure to Environmental Chemicals

References

American Cancer Society. Cancer Facts and Figures 2003. Atlanta, Ga: American Cancer Society; 2003.

Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, years of potential life lost, and economic costs - United States, 1995-1999. MMWR Morb Mort Wkly Rep. 2002;51 300-303. Available online at www.cdc.gov/mmwr//preview/mmwrhtml/mm5114a2.htm. Accessed October 2003.

Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults - United States, 2001. MMWR Morb Mort Wkly Rep. 2003;52(40) 953-956. Available online at www.cdc.gov/mmwr//preview/mmwrhtml/mm5240a1.htm. Accessed October 2003.

Centers for Disease Control and Prevention (CDC). Cigarette smoking-attributable morbidity - United States, 2000. MMWR Morb Mort Wkly Rep. 2003;52(35) 842-844. Available online at www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a4.htm. Accessed November 2003.

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion. Toxic chemicals in tobacco products. Available online at: www.cdc.gov/tobacco/research_data/product/objective21-20.htm. Accessed October 2003.

Centers for Disease Control and Prevention (CDC), Tobacco use among middle and high school students - United States, 2002. MMWR Morb Mort Wkly Rep. 2003; 52(45); 1096-1098. Available online at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5245a2.htm. Accessed November 2003.

Office of the US Surgeon General. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1990. Available online at http://profiles.nlm.nih.gov/NN/B/B/C/T/. Accessed October 2003.

Office of the US Surgeon General. The Health Consequences of Smoking: Cancer: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1982. Available online at http://profiles.nlm.nih.gov/NN/B/C/D/W/. Accessed October 2003.

Office of the US Surgeon General. The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1988. Available online at www.cdc.gov/tobacco/sgr/sgr_1988/index.htm. Accessed October 2003.

Office of the US Surgeon General. Reducing Tobacco Use: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 2000. Available online at www.cdc.gov/tobacco/sgr/sgr_2000/index.htm. Accessed October 2003.

Peto R, Darby S, Deo H, Silcocoks P, Whitlety E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ. 2000; 321: 323-329.

Peto R, Lopez AD, Boreham J, Thun M, Heath C, Jr. Mortality from Smoking in Developed Countries 1950-2000. New York: Oxford University Press, 1994.

Thun MJ, Day-Lally CA, Calle EE, Flanders WD, Heath CW. Excess mortality among cigarette smokers: changes in a 20-year interval. AJPH. 1995; 85:1223-1230.

Revised 11-14-03