18 May


Tobacco use is by far the top avoidable cause of disease, disability, and death in the United States, responsible for nearly one in five deaths. Currently about 50 million adults in this country, mostly men, smoke cigarettes. Although smoking is generally declining, the number of adolescents and young adults who are beginning to smoke is on the rise. Cigarette smoke contains more than 4,000 dif- ferent chemicals; about 200 of them are poisonous, and more than 40 are cancer- causing. Smoking is so dangerous that approximately 400,000 deaths are attributed to smoking-related causes in the United States each year. The health problems caused by smoking are the number one cause of death in men in this country.

If you smoke, you will notice the gradual onset of a host of long-term prob- lems. Your senses of smell and taste will weaken, you will get more frequent colds than before, facial wrinkling will intensify, and you will develop a nag- ging “smoker’s cough,” which is actually a symptom of a serious disease called chronic bronchitis (see page 246). You also increase your chances of developing cancers of the lung and other organs, emphysema, high blood pressure, stroke, and heart disease. You also place your family at risk of the same health problems by exposing them to secondhand smoke (see page 31).

Most men first experiment with smoking in adolescence because it makes them feel more adult and rebellious. The earlier someone starts smoking, the less likely he is to quit. Experimentation quickly turns into tolerance of and then addiction to nicotine, the habit-forming drug in tobacco that keeps smokers hooked. Nicotine creates a persistent craving for more tobacco, and the amount and frequency of use usually increases, so that a smoker may feel the need to smoke two packs a day to get the same satisfaction that one daily pack once pro- vided. Not smoking for as few as several hours produces uncomfortable nicotine withdrawal symptoms, including irritability, limited concentration, and intense cravings. These symptoms compel the person to smoke even when he knows the adverse health risks. Many social activities, such as having drinks in a bar with friends, also are conducive to smoking, making it a difficult habit to break.

Tobacco advertising has a major role in encouraging adolescents to take up smoking before they are mature enough to understand the long-term health risks.

Young people serve as the largest pool of new customers for the tobacco indus- try; they replace adult smokers who have quit or died. Tobacco advertising is no longer allowed on television, but the tobacco industry still spends about $5 bil- lion each year on advertising in magazines, on billboards, and at music and sporting events to lure new smokers with the promise of sex appeal, glamour, or rugged adventure. The following pages will describe how smoking damages your body, outline the hazardous effects of secondhand smoke, and explain the risks of cigar smoking and smokeless tobacco use.

Smoking’s Damaging Effects on Your Body

In addition to the addictive drug nicotine, the other principal harmful substances in cigarettes are tar and carbon monoxide. Tar is a sticky, brown residue that col- lects in the lungs. Primarily made up of chemicals known as hydrocarbons, tar is a powerful cancer-causing agent that has been linked to the development of lung cancer. Carbon monoxide is a poison that partially replaces the oxygen normally carried throughout the body by red blood cells, robbing the body of sufficient oxygen. Switching to a low-tar cigarette usually does not help because the per- son usually compensates for the change by inhaling longer or by smoking more cigarettes.

Other toxic chemicals in tobacco smoke include arsenic, formaldehyde, ammonia, lead, benzene, and vinyl chloride. The airways try to f ight these poisons by producing excess mucus, which obstructs the airways, producing the telltale smoker’s cough that indicates the development of chronic bron- chitis.

Tobacco smoke damages not only the cells inside the lungs but also the tiny hairlike projections called cilia that line and protect the airways, hindering the respiratory system’s ability to fight infection. Smoke inflames lung tissue, caus- ing the airways to release chemicals that destroy the tiny air sacs in the lungs called alveoli, where oxygen is transferred into the bloodstream. The alveoli merge into fewer but larger air sacs, reducing the surface area in the lungs avail- able for oxygen transfer. Because the level of oxygen in the blood is reduced, the affected person becomes breathless. This process describes the development of the disease known as emphysema (see page 247).

Cigarette smoking causes cancer of the lung, mouth, tongue, throat, pancreas, kidney, and bladder by producing cell changes that cause the cells to reproduce uncontrollably. Smoking is responsible for about 87 percent of all cases of lung cancer in the United States. Most lung cancers begin in a bronchus, one of the two main air passages that enter the lungs.

Smoking also is a major contributor to the development of heart disease (see page 204), by reducing blood levels of high-density lipoprotein (HDL), the “good” cholesterol that protects against heart disease. Additionally, smoking adversely affects the arteries that supply the heart with blood and nutrients. Men

who smoke have twice the risk of having a heart attack as do nonsmoking men. Nonsmokers exposed to secondhand smoke also endure an increased risk of heart disease. Up to 30 percent of all deaths from heart disease in the nation can be attributed to cigarette smoking, and the risk increases with the number of cigarettes smoked and the number of years of smoking. Smoking cigarettes also doubles your risk of having a stroke.

In spite of the dire health prospects facing smokers, many of them continue their habit because of nicotine’s addictive properties. But if you smoke, effec- tive methods exist to help you quit and avoid starting again.

How to Quit Smoking

The most important thing you should know about quitting smoking is that the harmful effects of the habit begin to reverse almost as soon as you stop. Within

20 minutes of your last cigarette, your heart rate and blood pressure drop to nor- mal. After 8 hours of being smoke-free, your blood levels of carbon monoxide and oxygen return to normal. Your risk of having a heart attack decreases after only 24 hours, and in 2 weeks your circulation will improve and your lung func- tion will increase up to 30 percent. These beneficial effects continue until, after

10 years of not smoking, your chances of dying of lung cancer become about the same as for a nonsmoker.

There is no underestimating the difficulty of breaking the smoking habit because of the highly addictive properties of nicotine. You need to build a strong support system within your family and circle of friends and coworkers. You may find that some of the people you know who still smoke may feel uncomfortable or threatened by your efforts to quit. It may be best for you to stay away from them until you feel certain that you can avoid the temptation to smoke. Pick a nonsmoker or another person who is trying to quit as a “buddy” whom you can call when the going gets rough. Meet with your buddy once a week, communi- cate through e-mail, or talk regularly on the phone. Make a bet with him or her that you can go for 1 month, then 6 months without a cigarette, then celebrate when you have reached your goal.

Experts say that you should prepare yourself to quit in advance of smoking your last cigarette. Identify several strategies, such as relaxation exercises, that can help you cope with your cravings for tobacco. First try to establish one or two other new habits, such as regular exercise, so you will be giving up tobacco in the context of a complete lifestyle change. Exercise is important; it is the high- est predictor of success when quitting tobacco use. When you are ready to quit, take the following steps to ensure success:

Step 1 Take a look at your smoking habits. Make a chart and mark down on it every cigarette you smoke in 24 hours, including the first cigarette you smoke in the morning, the one you automatically light up with a cup of coffee or a drink, and the ones you smoke while on break. Keep monitoring your cigarette use for 3 weeks.

Step 2 Write down all of the reasons why you want to stop smoking—for example, to get rid of your smoker’s cough and to stop exposing your family to secondhand smoke.

Step 3 Set a date by which you intend to quit smoking. Announce the date to all of the people you know and ask them to help you in your effort so they can support you if you lose your resolve.

Step 4 Ask your doctor about using nicotine gum, a nicotine patch, a prescrip- tion nicotine inhaler, or prescription medication (see warning box, page 31) to help you quit smoking. Try sucking on hard candy or chewing gum, munching on raw vegetables, or exercising more. Stay away from places and situations, such as having drinks with friends in a bar, that you associate with smoking. Sit in the nonsmoking section of restaurants. You may want to join a stop-smoking group; ask your doctor to recommend one.

Step 5 When you quit smoking, you probably will feel like eating more often and may gain a few pounds. Don’t stop yourself from eating when you feel tense during the first few weeks; it will be hard enough to stay away from cigarettes. Stock up on fresh fruits and vegetables, sugar-free candy and soda, and fat-free pretzels or crackers. Drink plenty of water. Your most intense cravings for nico- tine will subside after about 8 weeks, when you can resume your usual eating pattern.

When you quit smoking, you remove an important source of pleasure and a way to reduce stress from your daily routine. You need to replace the nicotine with something else that gives you pleasure and deal with your stress in more positive ways (see page 118). Maintaining your focus on negative reasons for quitting, such as worrying about your health, will not help you succeed. Forget the “no pain, no gain” attitude. Instead, embrace your new, more healthy lifestyle positively, without guilt for your past smoking habit. Praise yourself liberally by telling yourself how much better your life is going to be from now on. And remember the following positive things about quitting each time you feel the urge to take a puff:

•  Stopping smoking will free up time that you can now use to exercise, take up a hobby, or spend time with your family.

•  You can use the money you used to spend on cigarettes to treat yourself or a loved one to something special.

•  Your breath will smell better, your fingers will no longer be yellow, and your clothes and hair will no longer smell like smoke.

•  Food will taste better because your sense of smell will improve, and the senses of smell and taste are closely linked.

•  Your smoker’s cough will go away in a few months, a sign that your body is healing itself.

•  Being a nonsmoker makes you more attractive.

•  You will no longer have to stand awkwardly outside of your workplace in the rain and the cold to smoke on breaks or at lunchtime.

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