Effects of smoking on health and disease risk

Physiological and Societal Effects of Smoking

Smoking cigarettes is the single most dangerous habit that one can adopt from the perspective of human health and longevity. However, smoking is much more than just a problem affecting the personal health of the individual; it is the source of numerous health problems in non-smokers exposed to second-hand and third-hand smoke and it is the source of a tremendous amount of public funds and other healthcare resources that must be devoted to treating disease and illnesses that are easily preventable. Of course, as the single greatest cause of preventable premature human mortality, smoking is also the cause of incalculable human emotional suffering and trauma suffered by the families and loved ones of smokers who die prematurely because of their smoking habit. While outright prohibition of tobacco smoking is likely highly impractical, there are other legislative mechanisms that the government could impose that could help solve this societal and human health problem.

Nature and Scope of the Problem

Smoking is damaging to almost every organ and physiological system in the human body (CDC, 2011). In the United States alone, smoking is directly responsible for 443,000 deaths every year, which is more than all of the human deaths caused by HIV / AIDS, illicit drug use, alcohol, motor vehicle accidents, suicide, and violent crime, combined. Smoking is directly responsible for approximately 85% of all deaths from lung cancer and approximately 90% of deaths from chronic obstructive lung disease (COPD) in the American population. Furthermore, in terms of other specific medical ailments directly attributable to smoking, the list includes doubling to quadrupling the risks of coronary heart disease (the leading cause of death in the U.S.), and stroke; increasing the risk of lung cancer 23 fold in men and 13 fold in women; and death from COPD 12 to 13 times (CDC, 2011).

Smoking also destroys the circulatory system by narrowing the arteries and the capillaries that supply blood to all organs and limbs, often resulting in the development of peripheral vascular disease typically associated with pain, tissue loss, and the need to amputate limbs because of gangrene (CDC, 2011). It causes chronic respiratory diseases such as emphysema and bronchitis (apart from COPD), by destroying the alveoli that are essential for respiration and blood oxygenation (Taylor, Lillis, & LeMone, 2008). According to the U.S. Centers for Disease Control and Prevention (CDC, 2011), cigarette smoking is also a known cause of these other forms of cancers: acute myeloid leukemia, bladder cancer, cancer of the cervix, cancer of the esophagus, kidney cancer, cancer of the larynx, cancer of the oral cavity, cancer of the pharynx, stomach cancer, and cancer of the uterus.

However, cancers are hardly the only medical problems caused by smoking. The CDC (2011) also lists the following common health consequences of cigarette smoking (by mothers): infertility, preterm delivery, stillbirth, low birth weight in infants, and sudden infant death syndrome (CDC, 2011; O'Keefe & Pollay, 1996). It causes low bone density in postmenopausal women and, therefore, is indirectly implicated in death among elderly women by virtue of the known connection between bone density, hip fractures, and mortality following hip fractures in the elderly from the related consequences of hip fractures (CDC, 2011).

In total, cigarette smoking is the cause of a virtually incalculable amount of human disease and reduction in the length and quality of life, in addition to the waste of billions of precious dollars within a national healthcare system that is already desperately incapable of meeting the needs of the population because of the ever-increasing costs of healthcare services. In principle, there is no other single change in human behavior that could benefit the health of individuals, of the national healthcare system, and the nation than simply eliminating cigarette smoking and all of its attendant risks and consequences.

Historical Origin and Cause of the Problem

Nicotine is a mild stimulant that has been used in various forms for many thousands of years by indigenous peoples of regions where tobacco grows, so much so that tobacco was routinely harvested as a tradable commodity throughout the world. In fact, tobacco was the second most important crop (second only to cotton) whose cultivation on farms fueled the demand for African slaves in the American southern states that eventually precipitated the American Civil War in the middle of the 19th century.

Smoking tobacco is highly addictive, primarily because of the nicotine content of tobacco (Taylor, Lillis, & LeMone, 2008). Typically, the individual tries smoking for the first time as a teenager and in social circumstances where peer-pressure is a very significant factor. Many lifelong smokers report that they never intended to become regular smokers and that they tried to quit numerous times throughout their lives without long-term success. That is because nicotine withdrawal produces extremely strong cravings in its addicts and uncomfortable symptoms such as headaches, irritability, inability to concentrate, and insomnia, in addition to increasing caloric intake, frequently resulting in unwanted weight gain among nicotine-addicted individuals who try to quit (Taylor, Lillis, & LeMone, 2008).

Until the second half of the 20th century, the medical community was largely unaware of the health consequences of smoking (Pollay, 2007). At that time, many physicians smoked (even in their offices), and cigarette advertisements frequently featured physicians and other symbols of health and vitality that the tobacco companies used to promote the use of their products (Pollay, 2007). Gradually, the medical community became aware of the connection between smoking and human disease but the tobacco companies expressly denied any such connection through scientific-sounding "research groups" that were nothing more than fronts for the deliberate obfuscation of the truth of the extent of the dangers to human health posed by regularly inhaling concentrated cigarette smoke (Cummings & Pollay, 2002).

For decades, the major tobacco companies spent billions of dollars suppressing the truth from the American public in disinformation campaigns (Cummings & Pollay, 2002) They did so through aggressively lobbying legislators and political representatives and by corrupting physicians who were willing to testify falsely, even directly to the U.S. Congress, such as in the infamous hearings of the 1980s and 1990s in which physician after physician on the payrolls of the tobacco companies perjured themselves by announcing that they were "unaware of any scientific evidence" that nicotine is addictive or linking cigarette smoking to human disease, and to cancer, in particular (Cummings & Pollay, 2002).

Meanwhile, the tobacco companies new without a doubt that smoking causes cancer (Cummings & Pollay, 2002). When the U.S. government began publicizing the evidence linking smoking to cancer (and other human diseases) and requiring that tobacco companies provide information on packages of so-called "light" or "low-tar" cigarettes, the tobacco companies invested millions of dollars developing ways of circumventing those requirements, the most famous of which had to do with the placement or aeration holes in supposedly "low-yield" cigarettes (Anderson, Ling, & Pollay, 2006). Specifically, as part of their research and development program, the major R.J. Reynolds (and other companies) obtained some of the same equipment that the government used to test cigarettes for the purpose of measuring compliance with labeling requirements and for testing the accuracy of the reported information about the concentration of toxins in cigarette smoke.

That research led very quickly to the discovery that the smoking machines held cigarettes very differently from human smokers. By placing small aeration holes in the filters of cigarettes manufacturers managed to reduce their measurable toxic yield substantially (when "smoked" by testing machines) and enough for them to be marketed as "low-yield" or "low-tar" cigarettes. However, the placement of those aeration holes was specifically and deliberately intended to correspond precisely to the places on the filters where smokers typically held their cigarettes, thereby entirely blocking the aeration holes and, in effect, turning cigarettes that were legally marketed as a "safer alternative" back into ordinary cigarettes that delivered the full-yield "satisfaction" and dangers of ordinary cigarettes (Anderson, Ling, & Pollay, 2006).

Similarly, while the tobacco companies were busily assuring the public that their products were safe, they were also deliberately devising chemical processes designed to increase the addictive quality of nicotine even beyond its naturally addictive properties (Cummings & Pollay, 2002). Specifically, ammonia was added to cigarette tobacco as means of intensifying the nicotine rush and its addictive properties through the process of freeing the molecular base of the nicotine molecule. If that sounds familiar, that is because it is precisely the same chemical process used by crack dealers to transform powdered cocaine (which, much like nicotine, is already highly addictive in its natural consumable state) into a free-base vapor that intensifies the experience and addictive nature of cocaine (Cummings & Pollay, 2002).

Furthermore, the patents associated with these chemical processes were deliberately filed in South American countries to limit public knowledge about them through the routine disclosures of U.S. patents published annually by the U.S. Patent and Trademark Office in the U.S. (Cummings & Pollay, 2002). Not until the 1990s did anybody associated with this disinformation campaign come forward, after which the public finally became privy to internal research results, notes, and corporate communication documents within the tobacco companies detailing their unequivocal knowledge of the direct link between smoking and human cancer and of their deliberate manipulation of nicotine content to promote addiction to their products (Cummings & Pollay, 2002).

Toward an Effective Solution

In principle, the most effective solution to the tremendous problem of cigarette smoking in the U.S. would simply be to impose legislation banning the manufacture, sale, or consumption of cigarettes altogether. In fact, it is impossible to justify any logical distinction between the current illegal status of marijuana (at the federal level and in almost all of the individual states) and the fact that a slightly different cultivated vegetation that is empirically linked to almost half a million preventable premature deaths annually is still perfectly legal to market at great financial profits. However, from a practical perspective, the U.S. already had experience during the Prohibition era of the 1920s with the difficulties of trying to ban alcohol. In addition to widespread violation by otherwise law-abiding citizens, that ban created such a tremendous opportunity for profit associated with the black market production and distribution of alcohol that the organized criminal gangs that emerged from that era still operate today in the form of the most notorious modern organized crime syndicates. Moreover, thousands died or were blinded from unregulated alcohol production at that time (Goldfield, Abbot, Argersinger, et al., 2005). Unfortunately, simply criminalizing tobacco products would likely only create a lucrative black market in the same fashion.

On the other hand, it might be possible to create different types of legislation that could, over time and several generations, effectively reduce cigarette smoking substantially among the American population. In fact, one of the most insidious aspects of cigarette marketing could provide the means for such a mechanism. Specifically, one of the most damaging pieces of information to be disclosed in the 1990s by the revelations about the truth behind tobacco company marketing communications is the degree to which tobacco companies deliberately focus their efforts on new smokers (Cummings & Pollay, 2002).

By definition, "new smokers" means young, first-time smokers, for several reasons." First, all of the cigarette brands advertised in the U.S. are owned by only a very small number of tobacco companies. Therefore, there is little revenue to be gained by convincing smokers to switch brands in the first place, in addition to which, smokers are notoriously loyal to their chosen brands (Mintz & Torry, 1998). That means the majority of the revenue available to cigarette manufacturers must come from new smokers. Second, the tobacco companies are well aware (as their internal communications proved) that the vast majority of smokers begin smoking as teenagers and that so few individuals begin smoking for the first time as adults that the industry would be unsustainable without the continual cultivation of new (i.e. teenage) smokers (Mintz & Torry, 1998).

Unfortunately, state legislation requiring proof of age (most commonly at 18) has obviously not been very effective at reducing smoking among teenagers. Across the international community, efforts to reduce smoking have been similar to those currently relied upon in the U.S.: namely, criminalizing the sale of tobacco products to minors, prohibiting the display of tobacco products in certain kinds of advertising media or in entertainment media in connection with young-appearing performers, and by imposing high sales taxes as an economic disincentive to purchasing cigarettes. Unfortunately, none of those measures has proven particularly successful because large percentages of young people continue to begin smoking and to become adult smokers.

The best approach to reduce the harms caused by smoking in the U.S. would include the following measures: (1) Raise the legal age to purchase tobacco products to 21 through the same federal funding incentives that already promote the minimum age of 18 in state law; (2) Increase the severity of penalties for providing cigarettes to underage smokers; (3) Increasing the severity of criminal penalties against underage smokers; (4) Require mandatory reporting of underage smoking by parents under penalty of law; (5) Increasing the taxes on cigarettes in general; (6) Imposing the costs of enforcement on the cigarette companies whose products are identified in the possession of underage smokers.