This paper analyzes the relationship between smoking and increased disease risk, focusing on cardiovascular disease and cancer. It establishes current smoking prevalence among U.S. adolescents and adults, explores the biochemical mechanisms linking smoking to CVD (including oxidative stress and inflammation), and reviews cancer risks from tobacco's 69 carcinogens. The paper then compares smoking rates and disease mortality across three major U.S. metropolitan areas—Massachusetts, New York City, and Los Angeles—to assess geographic variation. While smoking rates have declined, the paper concludes that 30–60 million Americans face substantially elevated CVD and cancer risk, justifying continued public health investment in smoking cessation programs.
In 2015, the U.S. Census Bureau (2014) projected that 17 million adolescents between the ages of 14 and 17 would be residing in the United States, compared to 250 million adults aged 18 and over. The rate of tobacco use among high school students in the U.S. is estimated at 6 percent based on data from the U.S. Centers for Disease Control and Prevention (CDC, 2014). This rate reflects students who smoked cigarettes at least 20 days out of the last 30 days; therefore, approximately one million high school students are frequent tobacco users. The percentage increases substantially when less frequent use is considered, including cigars and smokeless tobacco.
By comparison, nearly 19 percent of all adults aged 18 and over were current smokers in 2010, with slightly higher concentrations of smokers in the Midwest and South (CDC, 2013). This translates into almost 50 million smokers in the U.S. today. Tobacco use is a significant public health concern because researchers have demonstrated that tobacco users face increased risk of cardiovascular disease, cancer, lung disease, and reproductive problems (CDC, 2013). The direct medical costs attributed to smoking total $96 billion, with an additional $97 billion in lost productivity. This essay examines the prevalence of smoking among youth and adults, in addition to the smoking-related causes of heart disease and cancer.
Worldwide, cardiovascular disease (CVD) accounts for 30 to 40 percent of all deaths, of which 10 percent has been attributed to tobacco use (Kim, Han, & Lee, 2014). Among smokers, 31 percent of all smoking-related deaths are caused by CVD. The threat of stroke and coronary heart disease increases by 2- to 4-fold in smokers, demonstrating a close, strong relationship between smoking and CVD prevalence.
The etiology of CVD risk from smoking is complex and involves multiple mechanisms, including endothelial dysfunction, induction of a prothrombic state, chronic inflammation, changes in lipid metabolism, and hypoxia (Kim, Han, & Lee, 2014). Among the most well-studied causes is the induction of reactive oxygen species (ROS), which leads to oxidative stress, reduced nitric oxide bioavailability, induced prothrombic state, inflammation, and lipoprotein oxidation. Although cigarette smoke contains ROS species, these tend to be short-lived; their overall impact is minor by comparison to the ROS induced within the body.
Smoking in childhood and adolescence increases lifelong smoking risk, largely due to development of physical dependence on nicotine (Dratva et al., 2013). While most research on smoking-related disease risk has focused on adult populations, a recent study examined predictors of CVD risk in children, adolescents, and young adults between the ages of 8 and 20. An early indicator of atherosclerosis—the thickness of the carotid artery intima media—was found to be significantly increased in smokers compared to non-smokers within this age group (Dratva et al., 2013). This finding is important because CVD risk begins in childhood, partly due to arterial changes that occur early in life. Based on these findings, youth who begin smoking substantially increase their risk of CVD development later in life.
Lung cancer was linked to smoking more than 50 years ago (Caffrey, 2014). Since then, numerous other cancers have been linked to smoking, including colorectal and breast cancer. Recent evidence supports smoking cessation as at least as effective as the best chemotherapy drugs in bringing about cancer remission. Given that chemotherapy treatment can cost in excess of $100,000 per patient, smoking cessation represents a significant economic advantage.
"Rates in Massachusetts, NYC, and Los Angeles"
"Policy priorities and remaining disease burden"
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