The national focus on the opioid crisis unfortunately obscures the fact that the use of cigarettes is the leading preventable cause of mortality, accounting for about 480,000 deaths annually, and about 30 percent of all cancer deaths. Despite an over-50-year-long government campaign against cigarettes, smoking continues to hold many people in its addictive grip as well as draw new victims. Indeed, It is particularly worrisome to watch adolescents smoke either traditional (combustible) cigarettes or JUULs, knowing that smoking early in life is not only a strong predictor of smoking as an adult, but also greatly increases the likelihood of using other drugs. Adults who continue to smoke cigarettes will likely face a host of medical complications and increase the risk of transmitting the smoking habit to their children.
A Brief History of Cigarettes
Americans have always embraced tobacco, ever since the first European settlers were introduced to it by the Indians they encountered in the New World. Tobacco was a major driver of the national economy during the colonial period, though it was more likely to be chewed than smoked. It was not until the late 1800s that cigarette-rolling machines were created, greatly expanding the cigarette market. Around the middle part of the 20th century, it must have seemed like everyone was smoking cigarettes. You could turn on the television and watch Lucille Ball, John Wayne, and even Fred Flintstone extolling the virtues of cigarettes. At peak rates of consumption, over 40 percent of Americans smoked cigarettes. Neither medical professionals nor the public were fully aware of the link between cigarette smoking and major health concerns.
By the early 1950s, medical journals began to publish data showing that smoking was associated with lung cancer. While cigarette smoking briefly declined, the cigarette industry responded by hiring public relations firms to calm the public, and even introduced “filtered” cigarettes, which sounded healthier but did not really filter anything of significance.
The evidence linking smoking and cancer continued to mount. The tipping point in public attitudes toward smoking is thought to have been the 1964 Surgeon General’s Advisory Committee Report detailing the multiple harms of cigarette smoking, although it stopped short of considering it an addiction. One year later, warning labels were placed on cigarette packs, and in 1971, commercials advertising cigarettes were banned. Increased education on the harms of smoking and further public policy changes limiting where cigarettes can be smoked have led to a sharp decline in national rates of smoking. Yet, today, about 16 percent of adults and 10 percent of twelfth-grade students still smoke cigarettes.
Effects of Cigarette Smoking
The tobacco contained in cigarettes is usually smoked, though chewing tobacco remains popular in the South and in select states across the country. The active ingredient in tobacco is nicotine, which is a central nervous system stimulant that reaches the brain in seconds and increases breathing rate, heart rate, and blood pressure. Much like caffeine, another stimulant drug, nicotine induces a sense of relaxation and well-being. It also sharpens the mind, improving short-term cognitive functioning, attention, and memory.
The two primary health concerns with smoking cigarettes are well known. The first is that it is highly addictive and often leads to regular use. It can cause physical dependence, characterized by troublesome withdrawal symptoms when trying to stop (irritability, anxiety, cravings, inattention, sleep problems). In fact, while many smokers try to quit, only about six percent each year succeed. Significantly, it turns out that it is no easier to quit smoking a few cigarettes per day than two packs a day. Teenagers who vape report similar withdrawal symptoms, which is why they should be offered treatment to help them manage the cravings and withdrawal associated with smoking cessation.
The second problem with traditional cigarettes is that the nicotine is mixed with other compounds to enhance its flavor and increase absorption. These compounds are linked to numerous serious medical conditions: lung cancer (80 percent of lung cancer deaths are due to nicotine), bronchitis, emphysema, COPD, increased risk of heart disease, diabetes, RA, inflammation, reduced immune function, cataracts, and cognitive decline. Smokeless tobacco is associated with higher rates of oral cancers, mouth lesions, heart disease, and dental problems. Smoking while pregnant increase the risk of miscarriage, premature delivery, and the development of learning and behavior problems in children. We also know now that secondhand smoke can lead to health problems, and that children regularly exposed to cigarette smoke are at higher risk for ear infections, asthma, and lung infections.
Treatment Options
The most important requirement to stop smoking is a strong desire to quit. In fact, most people quit “cold turkey” without a specific plan or pharmaceutical support. Nevertheless, there are now a number of FDA-approved, evidence-based treatment options for those who have trouble stopping on their own. These include nicotine replacement therapies (gums, patches, lozenges, sprays, inhalers), and medications that can reduce cravings and minimize withdrawal symptoms (Zyban, Chantex). Behavioral therapies can help people make lifestyle changes that promote healthier behaviors. These are all matters to be discussed with your primary care doctor or with a representative on the 1-800-QUIT-NOW line, a service that sets smokers up with a live (or online) coach to initiate and sustain abstinence.
Dr. Kidorf is Associate Director of Addiction Treatment Services and Associate Professor, Psychiatry and Behavioral Sciences, at Johns Hopkins University School of Medicine. This article is part of the series presented by Chayeinu, a new organization dedicated to providing education and guidance to our community regarding substance use disorder.
