Introduction

Overview
Cigarette smoking is the leading contributor to preventable deaths in the United States. It is estimated that in the U.S., 25.9 million men (23.9 percent) and 20.7 million women (18.1 percent) are smokers. Quitting smoking is one of the best things people can do for their heart and overall health.

According to the Surgeon General, smoking contributes to or causes over 25 specific diseases. In 2007, tobacco use was blamed for more than 437,000 deaths in the United States. Researchers estimate that smoking cuts an average of 10 years off a person's life expectancy. These "lost" years, however, can be regained. Recent studies show that a smoker who quits by age 35 can live as long as non-smokers.

Who is Affected
In addition to affecting the smoker, cigarette use also affects all individuals who are exposed to secondhand smoke. Also called "involuntary smoking," secondhand smoke is responsible for about 3,000 lung cancer deaths among non-smokers each year. Additionally, 300,000 children are affected by respiratory tract infections annually due to exposure to secondhand smoke. It is estimated that over 250 infants die each year of SIDS (Sudden Infant Death Syndrome) from inhaling secondhand smoke.

Physical Symptoms of Smoking
There is hardly an area of the body that is not affected by cigarette smoking. Here is a list of just a few of the many symptoms most smokers can expect to see in their shortened lifetime:

• Headaches
• Tooth decay, gum disease and bad breath
• Yellow teeth
• Bronchial infections
• Coughing and wheezing
• Depressed immune system
  
• Heartburn and ulcers
• High blood pressure
• Cancer of the lungs, mouth, throat, esophagus, bladder, and pancreas
  

The good news is that the sooner you quit smoking, the sooner your body will start to repair itself. Many of the damaging symptoms of smoking are reversible, and life can return to its health and normal state.

Treatment
There are many methods used for smoking cessation. Many people choose to receive professional help from their doctor, nurse, or a trained counselor. Others choose nicotine replacement therapies, such as nicotine patches, gum, lozenges, and nasal spray. Ongoing medical research has aided in the development of new prescription drugs which assist in kicking the habit. There are also alternate forms of treatment, such as psychosocial behavior therapy.

Frequently Asked Questions

Q. How many people smoke?
A. Recent estimates show that approximately 46.6 million people in the United States are smokers. Over half of these (56%) are male.

Q. What chemicals are in cigarettes?
A. Cigarette smoke contains about 4000 chemicals. 43 of these are carcinogenic, meaning they are known to cause cancer. Among these harmful chemicals are nicotine, ammonia, lead, formaldehyde, and mercury.

Q. Who is most likely to become addicted?
A. Nicotine is highly addictive, and anyone who starts smoking is at risk for becoming addicted. The younger a person is when they begin to smoke, the more likely they are to become addicted; in fact, 90% of adult smokers began smoking when they were under 19 years of age.

Q. Are mild or "light" cigarettes less harmful than regular strength cigarettes?
A. No, they pose the exact same health risks. Smokers who switch to a "light" cigarette usually compensate by inhaling more deeply and more frequently in order to get the same nicotine hit.

Q. Will I gain weight if I quit smoking?
A. You don' t have to. Quitting smoking in itself doesn't cause weight gain; replacing cigarettes with snacks can cause weight gain. If you keep your food intake the same when you quit smoking, your weight will remain steady. When cigarettes are replaced with snacks, you should choose healthy foods like fruits and vegetables instead of a sweet snack.

Q. How does smoking affect pregnant women and their babies?
A. Any smoking during pregnancy places the health and the life of the unborn baby in jeopardy. Pregnant women who smoke are smoking for two--the nicotine, carbon monoxide, and all the other harmful chemicals pass through her bloodstream and enter the baby's body. This places babies born to women who smoke at a greater risk for the following difficulties: miscarriage, premature delivery, stillbirth, infant death, low birth-weight, and SIDS. It has also been suggested by some research that children of women who smoked during pregnancy or who are exposed to secondhand smoke may be slower learners in school, be shorter and smaller than other children, and are more likely to smoke as an adult.

Q. What are the dangers of secondhand smoke?
A. Secondhand smoke is also called Environmental Tobacco Smoke (ETS), and occurs when non-smokers breathe in other people's cigarette smoke. This includes smoke that is inhaled and then exhaled into the air by smokers, and also smoke from the burning cigarette. ETS contains the exact same harmful ingredients that smokers inhale. Surprisingly, because it is formed at a lower temperature, ETS contains even higher proportions of some cancer-causing toxins than does mainstream smoke. ETS causes approximately 3,000 lung cancer deaths each year and about 35,000 deaths from heart disease in healthy non-smokers who live with smokers.

Q. Is smokeless tobacco harmful?
A. Smokeless forms of tobacco, such as snuff and chewing tobacco, are just as dangerous as smoking cigarettes. Because nicotine is still found in these drugs, users will become just as chemically dependent on them as a smoker is on their cigarette. Snuff and chewing tobacco also cause a higher blood nicotine level which is maintained for a longer period of time, since the product tends to be chewed over a period of hours.

Q. I've tried to quit before and it didn't work. What can I do?
A. Try again! Remember that most people have to try to quit two or three times before they are successful. Keep trying new strategies and implementing strategies that have worked in the past. Eventually, you will find the right combination that will work for you.

Questions and Answers adapted from The American Cancer Society and The Smoking Cessation Organization.

Smoking and Pregnancy

Mothers who smoke put their unborn children at risk for many negative consequences. In fact, smoking can affect a couple's ability to even get pregnant in the first place, regardless of which partner smokes. According to Dr. Philip Owen, nicotine reduces a woman's fertility by affecting the production of hormones that are necessary for pregnancy. Smoking also hinders the transportation of the egg through the Fallopian tubes to the womb. Men who smoke have a 15% lower sperm count on average.

According to the Discovery Pregnancy Center, 13% of pregnant women in the United States smoke during their pregnancy. While a baby is in the womb, it is completely dependent on the mother for everything. Substances including food and oxygen come to the baby through the placenta and the umbilical cord. When a pregnant woman smokes, her unborn child is exposed to all of the harmful chemicals found in cigarette smoke. Because smoking a cigarette decreases the amount of oxygen in someone's blood, it follows that a mother who smokes will decrease the amount of oxygen available to her baby. Fetal heart rate increases as the unborn child struggles to get enough oxygen.

Women who smoke are more likely to miscarry their baby or have a stillbirth pregnancy. However, mothers who smoke during pregnancy and have a live birth have babies who:

• are born prematurely
• have a low birth weight that is on average 7 ounces less than babies born to mothers who didn't smoke during pregnancy.
• have smaller-than-average organs
• have poorer lung function
• are more likely to die from sudden infant death syndrome
• are ill more frequently
• are more likely to become smokers themselves

If you are currently smoking during pregnancy, it isn't too late to stop. Every cigarette you decide to not smoke will improve your baby's health. Make the decision to stop today.

Why Does Anybody Smoke?

With all of the well-established dangers and unpleasant side effects of smoking, some people may find it shocking that anybody starts or keeps smoking. Ernest Dichter from The Psychology of Everyday Living interviewed several hundred people and asked them why they liked to smoke cigarettes. Many people responded that smoking is simply fun; that it provides a good break during their day, a time to relax and get refreshed. Hundreds of people said that smoking is a reward system for them. Each time they accomplish something they tell themselves they deserve a cigarette as a reward. Soon this system of rewards becomes a conditioned response. One of the most significant reasons people smoke is that it provides oral pleasure. There is a powerful erotic sensitivity of the mouth region, and sucking on cigarettes stimulates this pleasure.

The online reference site Wise Geek provides more information on why people continue to smoke. Tobacco advertising can have a big effect on people's decision to smoke. For years, the industry has focused on making smoking glamorous through advertising in movies, television, and billboards. Now tobacco advertising is controlled by laws, but its effects can still be felt through free samples, coupons, and other media mechanisms. Another factor in continuing smoking is the social factor involved. Many people have friends and associates who smoke, so it is the natural thing for them to do as well.

People who smoke have many reasons for doing so, even though they are well-aware of the dangers they are exposing themselves to. The truth is that most people who smoke continue to do so because they simply can't quit. Smokers get a rush after a cigarette, and quitting smoking produces unpleasant side effects like withdrawal symptoms and trouble sleeping. About 70% of people who quit smoking will pick up the habit again. Smokers must be educated and offered effective treatment programs in order to effectively quit smoking.

The Chemicals in Cigarettes

Cigarette smoke contains about 4,000 different chemicals according to the Quit Smoking Campaign. 43 of these are carcinogens meaning they are known to cause cancer in humans. A decision to smoke is a decision to put yourself at incredibly increased risk for cancer. Here is just a small list of some of the chemicals you can find in cigarette smoke (and keep in mind that these same chemicals are found in secondhand smoke):

1. Formaldehyde: a clear, highly poisonous liquid that is used to preserve dead bodies. Formaldehyde is associated with cancer; respiratory, skin, and gastrointestinal problems.
2. Ammonia: commonly used as a household cleaner.
3. Acetone: an efficient solvent that is used in nail polish remover.
4. Carbon Monoxide: the deadly poison that is exuded by car exhaust pipes.
5. Benzene: a solvent that is obtained from coal and petroleum. Benzene has been extensively linked to leukemia.
6. Tar: the material used to make roads. About 70% of the tar found in cigarette smoke is directly deposited into the smoker's lungs.
7. Butane: A chemical found in cigarette lighter fluid.

It's plain to see that nobody would want these chemicals in their body in any amount. Yet, according to the American Cancer Society, almost 50 million people in the United States still smoke.

The Nicotine Patch

For many people, the nicotine patch is the first thing that comes to mind when it comes to quitting smoking. But how do these patches work, and are they effective? Nicotine patches have been available over-the-counter since 1996, and deliver nicotine, the addictive substance in cigarettes, through the skin and into the bloodstream. The nicotine is released at a steady, controlled rate, thereby reducing the effects of nicotine withdrawal. The patches are available in different doses, which are prescribed depending on how many cigarettes the smoker used every day. A regular cigarette delivers about 1 mg of nicotine, so the patches regularly come in 21, 14, and 7 mg doses. The goal is to slowly decrease dosage over a period of weeks. According to MedLine Plus, the nicotine patch is applied directly to the skin on a clean, hairless area like the upper chest, upper arm, or hip. The same patch is worn for 16-24 hours, depending on the brand and dosage.

A study by Hays, et. al followed a group of 958 people smokers. Half of the participants received the nicotine patch treatment, while the other half received a placebo patch. After 24 weeks, the authors of the study concluded that the nicotine patch is an effective and safe treatment for smoking cessation. However, research does show that successful quitting smoking is most likely to occur with the combination of the patch and another stop smoking program. The New York Times reported that individuals who use the nicotine patch are more than twice as likely to quit smoking for at least six months than those who don't use a patch. Luckily, this treatment is also affordable; on average it costs a user $20-$30 per week, a figure equal to or less than the money spent on cigarettes each week.

Secondhand Smoke

Secondhand smoke, also called passive or environmental tobacco smoke, consists of two categories:
1. Mainstream smoke: the smoke exhaled by a smoker.
2. Sidestream smoke: the smoke coming directly off the burning cigarette.
The Environmental Protection Agency has classified secondhand smoke as a Class A carcinogen, meaning it is a substance known to cause cancer in humans. It contains twice as much nicotine and tar as the smoke directly inhaled by smokers, and five times the amount of carbon monoxide.

According to the University of Minnesota's Division of Periodontology, between 70 and 90% of Americans, including children and adults, are regularly exposed to secondhand smoke. Only about 15% of the smoke generated by a cigarette is inhaled by the smoker. The other 85% of this smoke containing 40 carcinogens lingers in the air for everyone else to breathe. For every eight smokers who die from smoking, one innocent non-smoker also dies. Shockingly enough, if a person sits in the same room with someone smoking for about two hours, they will have inhaled the equivalent of four cigarettes.

These statistics are scary because nobody can avoid secondhand smoke altogether. Each time we walk by someone smoking or sit in the same room as them, we are inhaling cancer-causing chemicals. This should be yet another motivation for active smokers to quit: smoking is definitely not an individual decision. Your decision to smoke negatively affects everyone around you. As non-smokers, there are some things we can do to avoid the harmful effects of secondhand smoke:

• Don't allow anyone to smoke inside your house. If they have to smoke, ask them to do it outside.
• Avoid restaurants and other public places where people are allowed to smoke. Go to smoke-free places only.
• If someone is smoking on the street, walk quickly past and don't linger near them.
• In situations where sitting by a smoker is unavoidable, simply ask them politely to put out their cigarette or smoke elsewhere.