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Health Consequences

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Call To Action

Governments should strive to prevent people from starting tobacco use because it is the best way to avoid the consequences tobacco inflicts on human health.

Tobacco smoke has more than 7000 chemicals, hundreds of which are toxic and negatively affect almost all organ systems. Children born to women who smoke during pregnancy are at higher risk of congenital disorders, cancer, respiratory disease, and sudden death. Smokers and non-smokers who are exposed to secondhand smoke are at higher risk of a long list of serious health conditions, including cancer and pulmonary and cardiovascular diseases. Both active and secondhand smoking increase cardiovascular disease risk by promoting atherosclerosis, blood clot formation, and several other mechanisms. There are at least 69 carcinogens in tobacco smoke, which can cause many types of cancer. Smoking increases risk of death from ischemic heart disease by more than 2.5-fold and death from lung cancer and chronic obstructive pulmonary disease by 20-fold.

Smoking also causes common health problems that may not be associated with immediate serious danger, but that carry substantial costs at the population level. For example, among 18–64-year-olds in the USA in 2008, 16% of current smokers had self-reported poor oral health status, which was 4 times greater than for never-smokers.

Several tobacco products have been introduced that claim to reduce harm, but some of them have already shown harmful effects. The World Health Organization has classified smokeless tobacco as an established cause of cancers of the mouth, esophagus, and pancreas. Smokeless tobacco, water pipes, and low-tar cigarettes expose users to carcinogens that are present in cigarette smoke. Preliminary studies have shown that e-cigarette smokers may be exposed to some harmful compounds or suffer some acute symptoms, but overall, e-cigarettes appear to be less harmful than traditional cigarettes as they do not involve combustion. Nevertheless, their overall impact on public health is unclear (see E-Cigarettes). As there is no safe tobacco product, the best way to prevent tobacco-associated harms is to avoid starting use (or for tobacco users to quit).

Due to limited access to care for early detection and treatment of tobacco-related diseases, individuals with low socioeconomic status or in low- and middle-income countries are likely to suffer more from the harms of tobacco.

Sources

Secretan B, Straif K, Baan R, Grosse Y, El Ghissassi F, Bouvard V, et al. A review of human carcinogens–Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. The lancet oncology. 2009;10(11):1033-4.

Smoking and Health: A Report of the Surgeon General – Appendix: Cigarette Smoking in the United States, 1950-1978. United States. Public Health Service. Office on Smoking and Health, 1979.

Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. Journal of the American College of Cardiology. 2004;43(10):1731-7.

Messner B, Bernhard D. Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arteriosclerosis, thrombosis, and vascular biology. 2014;34(3):509-15.

Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, Lopez AD, et al. 50-year trends in smoking-related mortality in the United States. The New England journal of medicine. 2013;368(4):351-64.

Bloom B, Adams PF, Cohen RA, Simile C. Smoking and oral health in dentate adults aged 18-64. NCHS data brief. 2012(85):1-8.

Hecht SS, Carmella SG, Murphy SE, Riley WT, Le C, Luo X, et al. Similar exposure to a tobacco-specific carcinogen in smokeless tobacco users and cigarette smokers. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2007;16(8):1567-72.

Amato M, Frigerio B, Castelnuovo S, Ravani A, Sansaro D, Tremoli E, et al. Effects of smoking regular or light cigarettes on brachial artery flow-mediated dilation. Atherosclerosis. 2013;228(1):153-60.

Blachman-Braun R, Del Mazo-Rodriguez RL, Lopez-Samano G, Buendia-Roldan I. Hookah, is it really harmless? Respiratory medicine. 2014;108(5):661-7.

Schober W, Szendrei K, Matzen W, Osiander-Fuchs H, Heitmann D, Schettgen T, et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. International journal of hygiene and environmental health. 2014;217(6):628-37.

Chatham-Stephens K, Law R, Taylor E, Melstrom P, Bunnell R, Wang B, et al. Notes from the field: calls to poison centers for exposures to electronic cigarettes–United States, September 2010-February 2014. MMWR Morbidity and mortality weekly report. 2014;63(13):292-3.

Smoking During Pregnancy

Health risks to mothers and children associated with maternal smoking

“Philip Morris USA agrees with the overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers. Smokers are far more likely to develop such serious diseases than non-smokers.” -Philip Morris USA website, 2014

Harm from Tobacco

Tobacco causes disease and disability to almost every organ.

Smoking and the lung

Cleft Palate/Lip

Maternal tobacco use and cleft palate/lip

Maternal smoking increases risk of cleft palate and cleft lip in babies

Risk of cleft lip is approximately 30% higher in children born to women who smoke during pregnancy. Heavy maternal smoking (≥25 cigarettes/day) can increase risk of bilateral cleft palate in newborns four-fold. Due to their limited resources for surgical repairs, children born with cleft palate/lip in low- and middle-income countries can be at higher risk of death or not being adequately treated in a timely manner. Surgeries at older ages can be associated with worse outcomes.

“I felt that I only really had the choice between giving up smoking and giving up breathing.” –Michael Wilken, a COPD patient from Germany, and later the chair of the European Federation of Allergy and Airways Diseases Patients Associations’ COPD Working Group, 2011

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Related

Smoking’s Death Toll

As tobacco use is the most common preventable cause of death, governments must implement effective policies to prevent tobacco use (reducing initiation and promoting cessation) and involuntary exposure to tobacco smoke in order to save lives. Death registries should collect data on tobacco use status to help assess and monitor national tobacco-related death rates.

Smoking Among Women

One of the largest public health opportunities available to governments in the 21st century is to prevent an increase in smoking among women in low- and middle-income countries.

Non-Communicable Diseases

Reducing tobacco use must be a key component of any national or global plan to tackle non-communicable diseases.

Secondhand Smoke

Smoke-free legislation must be enacted to reduce involuntary exposure to tobacco smoke, especially in children. People should be informed about the risks of secondhand smoke and the potential harms of thirdhand smoke.

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