Fifty most often asked questions about tobacco use and health

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1 Fifty most often asked questions about tobacco use and health QuitCore Introduction According to the World Health Organization, tobacco is the single largest preventable cause of cancer in the world today. It is also the leading preventable cause of disease and death in Canada. More than 47,000 Canadians will die prematurely each year because of tobacco use, and almost 1,000 nonsmokers die each year from exposure to second-hand smoke. Close to half of all smokers will die from smoking before they turn 70 years old. Tobacco use usually starts during the teenage years and often becomes a lifelong addiction. Tobacco cessation represents the single most important step that tobacco users can take to enhance the length and quality of their lives. There are many immediate and long-term benefits of being tobacco free. The answers to the following questions about tobacco use and health come from the latest scientific and medical literature and experts. 1. Is there a safe cigarette? No. Cigarettes are the only legal product that, when used as intended, kills approximately 50% of its users. 2. Can you smoke a small number of cigarettes without risk? No. Every cigarette may cause some harm to the body. Light smokers are more likely to die from lung cancer and heart disease than are people who have never smoked. Besides, most smokers seem to find it difficult to smoke only a few cigarettes. 3. How long does it take for a cigarette to harm a smoker? The moment the smoke touches the lips, it begins to attack living tissues and continues to do so wherever it goes: mouth, throat, esophagus, air passages, lungs, and stomach. Its breakdown products eventually reach the bladder, pancreas, and kidneys. 1

2 4. What does nicotine do? The first dose of nicotine, an alkaloid poison found in nature only in tobacco, is a powerful stimulant to the brain and central nervous system; later doses have a depressant effect. Nicotine causes blood pressure to rise and increases the heart rate by as many as 33 beats a minute. The first daily dose of nicotine stimulates the large bowel, while curbing appetite and slowing digestion. It also lowers skin temperature and reduces blood circulation in the legs and arms. In new smokers, nicotine brings on nausea in fact, it is always nauseating to any tobacco user who gets too much of it. Sixty milligrams of nicotine taken at one time will kill the average adult human by paralyzing breathing. It s about as lethal as cyanide. The reason it doesn t kill tobacco users quickly is that they take it in tiny doses, which are quickly metabolized and excreted by the body. 5. What in cigarette smoke causes disease? Cigarette smoke is made up of more than 7,000 chemicals, many of which have been implicated in disease. Among the hazardous chemicals in cigarette smoke are benzene, formaldehyde, hydrogen cyanide, and nitrogen oxide, as well as heavy doses of poisonous carbon monoxide. Heart and circulatory disease, stroke, lung cancer and other cancers, emphysema, and chronic bronchitis have been linked with the chemicals found in cigarettes. All these conditions are disabling and potentially lethal. 6. What is the effect of carbon monoxide in cigarette smoke? When inhaled, carbon monoxide (CO) quickly binds with hemoglobin (Hb) in red blood cells in the lungs, creating COHb. This can affect the amount of hemoglobin available for the transport of oxygen throughout the body, which may in turn lead to symptoms of CO poisoning. While nicotine causes the heart to work harder, COHb deprives it of the extra oxygen this demands. CO also promotes cholesterol deposits in arteries, impairs vision and judgment, and reduces attentiveness to sounds. On average, smokers have many times more COHb in their blood than non-smokers. 7. But aren t the bad effects of inhaling these substances temporary? Most are, but in smokers they are repetitive and cumulative: A pack-a-day smoker inhales smoke about 102,000 times a year. If this continues year after year, the smoker s chances of contracting a serious smoking-related disease are greatly increased. 8. Then is all smoking damage permanent? No, not if the smoker stops soon enough. In smokers who have stopped before the onset of irreversible heart and circulatory disease, the body begins to repair itself. Normally, after a year of not smoking, the risk of a heart attack is halved; after 15 years of not smoking, it s about the same as that of someone who has never smoked. While smoking, the risk of lung cancer continues to rise. However, 10 years after quitting, the lung cancer death rate is about half that of someone who continues to smoke. The cough of chronic bronchitis is reduced when smoking is discontinued, but the progression of emphysema may continue. 9. What about filters? Smokers of filter-tip cigarettes may have a slightly lower risk of lung cancer than those who smoke non-filter cigarettes, but they still have a greatly increased risk of heart attack and emphysema. 2

3 10. What about the low-tar and low-nicotine brands? The low-tar and low-nicotine brands that have taken over a large share of the Canadian cigarette market may theoretically offer a slightly reduced risk of lung cancer for smokers. However, the risk is still there. Although the tobacco used may be somewhat milder in brands advertised as having ultralow tar, any reduction in cigarette potency usually depends on air dilution, which is a controlled leak in the filter. However, many smokers turn low-tar, low-nicotine cigarettes into high-tar, high-nicotine cigarettes by covering the ventilation holes in the paper of the filter, often unconsciously. Regular smokers who switch to low-tar and low-nicotine cigarette often smoke more cigarettes to compensate for the reduced amount of nicotine. Low-tar cigarettes may be more harmful to non-smokers if smokers increase the amount they smoke, in turn creating more second-hand smoke. 11. What about mentholated cigarettes? Menthol cigarette brands have been rising in popularity with adolescents, with high use among younger, newer smokers. The mentholated brands contain enough menthol to produce a cool sensation in the throat when smoke is inhaled, masking the harshness and discomfort of inhaling smoke. Menthol smokers often have a harder time quitting smoking and relapse more often than other smokers. 12. Does cigarette smoking causes cancer? Smoking is estimated to be responsible for 30% of all cancer deaths and specifically related to 85% of lung cancer cases. Lung cancer is the leading cause of cancer death for both men and women in Canada. Smoking is also a contributory factor in the development of cancer of the throat, mouth, bladder, kidney, and pancreas. 13. What in cigarettes causes lung cancer? Sixty-nine carcinogens, which cause or promote cancer, have been found in both first- and second-hand tobacco smoke. Some of these carcinogens are benzene, cadmium, and chromium. 14. What are the chances of being cured of lung cancer? The five-year survival rate is only 18% for women and 13% for men. Most forms of cancer start insidiously and produce no symptoms until the disease is far advanced. Consequently, it is often difficult to detect early enough for a cure. 15. Do cigarettes cause other lung diseases? Chronic obstructive pulmonary disease (COPD) includes two main groups of lung disease: chronic bronchitis and emphysema. Chronic bronchitis is the inflammation (and therefore obstruction) of the bronchial tubes, or bronchi, that bring air into the lungs. Emphysema is a lung disease that reduces the ability of the lungs to expel air. The main cause of COPD is smoking. Quitting smoking does not substantially reverse the harmful effects of tobacco once COPD is established, but it can protect the lungs from further damage. 16. If you smoke cigarettes and don t inhale, is there any danger? Whenever smoke touches living tissues, it does harm. All smokers have an increased risk of lip, mouth, and tongue cancer, no matter what they smoke. And all smokers, even those who don t inhale including pipe and cigar smokers have a greatly increased risk of lung cancer. 3

4 17. Why do smokers have a cigarette cough? The irritants in smoke provoke the protective mechanisms of the air passage and lungs; this causes coughing. The well-known, early morning cough of smokers is a separate phenomenon. Cigarette smoke has an anesthetic effect on cilia, tiny hairlike structures lining the airways that normally beat outwards, forcing foreign matter from the lungs. During the hours of sleep, the cilia recover, and begin working again. Hence, when smokers wake up, they cough because their lungs are attempting to clear the deposits of the previous day s smoking. When cilia are repeatedly exposed to smoke over a long period of time, their action is permanently destroyed. Then smokers lungs are even more exposed to damage than before. 18. Does cigarette smoking affect the heart? Yes, smoking is estimated to be responsible for 15% of deaths due to some form of heart disease and stroke. 19. Is there any smoking risk for pregnant women and their babies? Pregnant women who smoke have a higher rate of spontaneous abortion (miscarriage), stillbirth, premature birth, and babies with below-average birth weight (with consequent risk of disease and death, including sudden infant death syndrome). 20. What about smoking and the pill? Women who use birth control pills and smoke increase their risk of having a stroke or heart problems. The degree of risk differs depending on the levels of hormones in the particular pill used and individual smoking patterns. 21. Are there risks in smoking that you haven t mentioned? According to the U.S. Surgeon General, smoking cigarettes is the primary cause of drug interactions in man. That is, the effects of any medication taken by a patient may be changed or rendered ineffective by smoking. Diagnostic tests may give seriously inaccurate results in smokers. 22. Why don t all cigarette smokers get lung cancer? An estimated 10% to 15% of long-term smokers die of lung cancer. Many more die early of heart attacks. People react differently to all substances for a variety of reasons, including genetic and biological make-up. Since cigarette smoke contains so many thousands of chemicals, it s no wonder that every smoker doesn t contract the same disease. Overall, the fact is inescapable: cigarette smokers die younger than non-smokers. That is why life insurance companies charge different insurance policy premiums based on whether or not a person smokes. According to the World Health Organization, Death rates are uniformly higher among smokers than among nonsmokers in both sexes, whatever the age at death. Among smokers, the death rates from many causes increase with the number of cigarettes smoked per day, the number of years the smoker has smoked, and the earlier the age at which smoking was started. Other variables include depth of smoke inhalation, tar and nicotine levels in smoke inhaled, and the number of puffs per cigarette. 4

5 23. Do non-smokers get lung cancer? Approximately 10% of lung cancers occur in non-smokers. Lung cancer may be due to exposure to certain chemicals at work or to radon gas, asbestos, or second-hand tobacco smoke. Each year, more than 1,000 Canadians die from lung cancer as a result of long-term exposure to the tobacco smoke of other people at home, at work, and in other locations. 24. Does air pollution cause lung cancer? In industrial areas or cities heavily polluted with smog, lung cancer rates are slightly higher than in rural areas, but in both places, the lung cancer rates are always very much higher among smokers than non-smokers. In certain industries where there are high concentrations of radioactive dust or other carcinogens, the lung cancer rate is much greater than it is in the general population. Even among these exposed groups, the lung cancer rate of smokers is more than five times that of a non-smoker in the same occupation indicating a strong multiplying effect between cigarette smoke and occupational exposure. 25. Is it easy to use tobacco for a little while and then quit? It doesn t take very long for a novice tobacco user to defeat the body s natural revulsion for nicotine and become habituated to it. Once this happens, it is extremely difficult to quit. Also, using tobacco becomes a way to deal with stress, a weapon to fight anger and frustration, and a means of enhancing pleasure. And, for many, using tobacco becomes a compulsive response to a very strong addiction to nicotine. 26. Is tobacco use truly addictive? Yes, using tobacco can become an addiction in the same way as the repeated use of alcohol, tranquillizers, and other drugs can often result in an addiction. The essential features of addiction include compulsive use of a substance (i.e., use that is no longer under the voluntary control of the user), tolerance (i.e., a need to increase the dose to achieve the same effect), and often physical dependence, as shown by withdrawal symptoms when use of the substance is stopped. Many tobacco users show all of these features. Biologically speaking, nicotine is addictive because it affects the levels of adrenaline and dopamine in the body. Immediately after a person is exposed to nicotine, he or she feels a kick, in part from the drug s stimulation of the adrenal glands, which leads to a discharge of adrenaline. Nicotine increases dopamine levels in the reward circuits of the brain. Dopamine is a brain chemical that plays a major role in addiction to many kinds of drugs. Cigarette smoking produces a rapid distribution of nicotine to the brain with nicotine levels peaking within 10 seconds of inhalation. The acute effects of nicotine dissipate in a few minutes, as do the associated feelings of reward, causing the smoker to continue dosing to maintain the drug s pleasurable effects and prevent withdrawal. 27. Are there true withdrawal symptoms? Yes. These symptoms include changes in body temperature, heart rate, digestion, muscle tone and appetite. They also include irritability, anxiety, craving for tobacco, sleep disturbances and other more subjective symptoms. They peak after a couple of days and generally diminish in seven days but may not disappear entirely for weeks or months. 5

6 28. Why do people begin to use tobacco? It is generally accepted that peer pressure encourages many young people between the ages of 10 and 18 to begin experimenting with tobacco use. Unfortunately, 5% of youth in Grades 6 to 8 and 36% of youth in Grades 9 to 12 reported having ever tried smoking cigars, cigarillos, or little cigars (flavoured or unflavoured); 14% of youth in Grades 6 to 8 and 44% of youth in Grades 9 to 12 reported having ever tried cigarettes; and 5% of youth who have never tried cigarettes have tried the other tobacco products in Common motives are to appear grown up, to imitate elders (often parents or older brothers or sisters), to rebel against authority or to be the same as others in their peer groups. Tobacco use is often portrayed in the media: by popular stars in movies, for example. Young people may try to emulate their favourite stars. 29. What kinds of people use tobacco? All kinds of people use tobacco! There are certain groups that have higher rates of tobacco use, for example, people who use alcohol or drugs, groups from some ethnic backgrounds and people with lower levels of education or lower incomes. 30. How many people smoke cigarettes in Canada? In 2007, an estimated 5.2 million Canadians, or approximately 19% of the Canadian population, over the age of 15 were cigarette smokers. Alberta s smoking rate was approximately 21%. 31. How much do Canadians smoke? Daily smokers over the age of 15 consumed an average of 15.5 cigarettes per day in 2007, a large drop from two decades ago. In 1985, daily smokers consumed 20.6 cigarettes per day. 32. Is the number of Canadian smokers growing? Statistics from the last three years show that the smoking rate has stabilized at 19% of the Canadian population, after decreasing for a number of years. The Alberta smoking rate has also been stable (21%) over the last three years. 33. Do more men than women use tobacco? In 2007 in Canada, slightly more males (20%) than females (18%) over the age of 15 reported smoking. The difference between the male and female smoking rate has narrowed from 6% in 2005 to only 2% in In Alberta, 22% of males over the age of 15 smoked versus 20% of females. Male Albertans smoked an average of almost 19 cigarettes per day, while women smoked approximately How about young people? In 2007, 15% of Canadians aged 15 to 19 smoked, with no difference between males and females. The smoking rate for young adults, aged 20 to 24 years, was much higher at 25%. Far too many young people start using tobacco, influenced by their family, friends and the media to believe that tobacco use is desirable, adult behaviour. 6

7 35. Why do people continue to use tobacco? Tobacco is the only plant that contains nicotine, a powerful psychoactive drug. While inhaling cigarette smoke, the smoker gets an immediate concentrated dose of nicotine in his or her bloodstream. It hits the brain within 10 seconds, producing temporarily pleasing physical and mood-altering effects. These effects reinforce the continued use of tobacco and nicotine dependence. Nicotine is highly addictive, to a degree similar to or in some respects exceeding addiction to hard drugs such as heroin or cocaine. 36. How does the habit take hold? Although it often makes novice tobacco users ill, nicotine also produces relaxation, stimulation, or other pleasurable or rewarding effects in the user. With repeated use, tobacco users become tolerant to the disagreeable effects and no longer become nauseated or ill when using tobacco. The rewarding effects then become much more significant and can lead to compulsive use. The resulting dependence on nicotine both psychological and physical is responsible for the persistence of the habit even in tobacco users who know that it is harming their health. 37. How many tobacco users try to quit? In 2007, 46.8% of Canadian smokers reported having tried to quit at least once in the previous 12 months. Tobacco users often make multiple attempts to quit before they succeed. 38. Did any succeed? Yes. Every year thousands of Canadians stop using tobacco, many for health reasons. In 2007, there were over 7.5 million former smokers in Canada over the age of 15 years. There are nearly 1 million former smokers in Alberta. 39. How do most people quit using tobacco? Tobacco cessation isn t usually an event it s a process. Tobacco users may try several times (an average of seven to nine attempts) and several methods before they succeed permanently. Examples of methods used to quit using tobacco include attending support groups or counselling, seeking telephone or online counselling, using self-help materials, and taking nicotine replacement therapy or other medications. 40. If I stop using tobacco, will I gain weight? Many tobacco users gain weight when they quit, but it is usually less than 10 pounds. The health problems caused by using tobacco are far greater than any caused by gaining a small amount of weight. Exercise and healthy eating can help to prevent weight gain. 41. Once I stop using tobacco can I have some now and then? When former tobacco users have tobacco, even years after quitting, the nicotine reaction is triggered, and they are quickly hooked again. In the same way that a recovering alcoholic is advised never to drink again, a former tobacco user is also advised not to use tobacco ever again. 7

8 42. If people stopped using tobacco, what would happen to tobacco farmers? During the 1980s, the number of tobacco growers in Canada declined by about 50% and has continued to decline. The government has instituted a transition fund to help growers who would like to exit the industry. Some tobacco farmers have turned to alternative crops (sweet potatoes, peanuts, tomatoes, or specialty crops) and alternative non-farm enterprises. 43. Doesn t tobacco pay a great deal of tax? In 2004, approximately $8.7 billion went to the federal, provincial, and territorial governments in the form of taxes. The tobacco tax revenue for the province of Alberta is expected to be $890 million. There is no denying that these are substantial amounts of money, but they amount to a very small percentage of federal and provincial revenues. 44. How much does tobacco cost our society? In 2002, tobacco use accounted for $17 billion in costs to Canadians. The largest part ($12.5 billion) was in indirect costs for lost productivity due to illness and premature death. The direct costs attributed to tobacco use were estimated to be $4.4 billion. The bulk of this was $2.5 billion for acute care hospitalizations and $1.4 billion for prescription drugs. In 2002, over $470 million was spent in Alberta on caring for people with tobacco-related illnesses. 45. What is second-hand smoke? Second-hand smoke is made up of the smoke produced when a cigarette burns and the smoke that is blown out by a person when they are smoking. It contains over 7,000 chemicals, over 69 of which are known or suspected to be carcinogenic. 46. Is second-hand smoke hazardous? Yes. It increases the risk of heart disease, lung cancer, bronchitis, etc. Never-smoking spouses of smokers have an increased risk of lung cancer of between 20% and 30%. More than 1,000 nonsmokers die each year from exposure to second-hand smoke. 47. Does second-hand smoke affect children? Children who breathe second-hand smoke have increased risks of cardiac disease, asthma, and sudden infant death syndrome (SIDS). In 2007, 7% of Canadian children under the age of 12 (about 290,042 children) were regularly exposed to second-hand smoke at home. Some provinces have banned adults from smoking in cars with children. 48. Is smoking marijuana safer than smoking tobacco? Marijuana cigarettes contain much more tar than tobacco cigarettes. They are also smoked differently: they are inhaled very deeply, the smoke is held for a long time in the lungs, and the cigarettes are smoked to the very end where tar concentrations are highest. Marijuana smoke is more irritating, causing more bronchitis and emphysema. However, no clear link has been established between marijuana and lung and other cancers. 8

9 49. Is chewing tobacco safe? No. Those who chew tobacco have an increased risk of cancer of the oral cavity, as well as leukoplakia, stroke and cardiac disease. Nicotine from this source is absorbed through the mouth s mucous membranes, which can lead to nicotine addiction. It is not a safe substitute for smoking. 50. What about snuff? Snuff is finely ground tobacco in a powder form which may be dry, moist, or in sachets (small teabag-like pouches). Some snuff can be inhaled but it is more common for users to hold it between the cheek and gum. This greatly increases the user s risk of cancers of the oral cavity, pharynx, larynx, and esophagus. Like chewing tobacco, snuff is not a safe substitute for smoking. Sources include Alberta Alcohol and Drug Abuse Commission (2007): Tobacco Basics Handbook; Alberta Government: Finance and Enterprise; Canadian Cancer Society; Canadian Tobacco Use Monitoring Survey 2007; Health Canada; Heart and Stroke Foundation of Canada; Mayo Clinic; Pletcher et al. (2006): Menthol Cigarettes, Smoking Cessation, Atherosclerosis, and Pulmonary Function; Public Health Agency of Canada; Rehm et al. (2002): The Cost of Substance Abuse in Canada 2002; Royal College of Physicians; Youth Smoking Survey 2007 and ; US Surgeon General; World Health Organization. 9

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