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Cigarette Smoking: Every Exposure is an Unsafe Exposure
By Nancy Kennedy

Throughout this year, The Guide to Good Health will present a series of articles about the adverse health effects of smoking and second hand smoke. In this first part, we examine the way smoking impacts organs beyond the lungs. Future issues will address the impact of smoking on infants, children and teenagers and expert advice about quitting smoking.

Most Americans know that smoking causes lung cancer and respiratory diseases. But they may not know that smoking's adverse health effects go far beyond the lungs, causing damage to nearly every organ in the body. The risk and severity of smoking-related diseases is directly linked to how long one has smoked and how much one smokes. Ultimately, smoking can kill you, but before it does that, it is likely to make you very sick and cause you to suffer, perhaps severely, and possibly for a long time. The diseases that smoking is linked to are not benign conditions – they create symptoms and complications that can be miserable and life-restricting, including pain and breathlessness. They may entail treatments that are difficult to endure.

"Addiction to nicotine means a lifetime of pain and suffering," advises Alexandra Armstrong, MPH, Certified Tobacco Treatment Specialist for Tobacco Free Allegheny. "The health of the smoker and the smoker's family will be adversely affected. But it's important for people to realize that smoking is not only an issue for smokers; it affects everyone. Reducing addiction to nicotine is important to the health and well being of our entire nation." Tobacco Free Allegheny is a community resource that provides smoking cessation, education and prevention services to reduce smoking and the harmful effects of smoking and smoking exposure. It is supported by the Allegheny County Health Department and the PA State Department of Health and collaborates with schools, workplaces and many other organizations throughout the region to prevent people, especially teens, from starting to smoke and to help smokers quit.

According to the CDC, there is no safe level of exposure to tobacco smoke; all exposure is harmful. The adverse health effects fall essentially into three categories: cancer, cardiovascular disease and respiratory disease. But there are other health problems as well. Below are some of the primary health risks associated with smoking.

Smoking Causes Death
Smoking is the number one cause of preventable disease and death. Smoking related illness causes approximately 443,000 deaths or nearly one of every five deaths each year in the U. S. More deaths are caused each year by smoking than by all deaths from HIV/AIDS, illegal drug use, alcohol, motor vehicle injuries, suicides and murders combined. Smoking causes an estimated 90% of all lung cancer deaths in men and 80% of all lung cancer deaths in women.

Smoking Causes Cancers
One third of all cancer deaths are linked to cigarette smoking. Cigarette smoke contains over 4800 chemicals, 69 of which are carcinogens – substances known to cause cancer. Smoking causes these types of cancer: acute myeloid leukemia, cancer of the bladder, cervix, esophagus, kidney, larynx (voice box), lung, oral cavity (mouth), pharynx (throat) stomach and uterus.

Smoking and Your Heart
Smoking is a factor in the development of coronary artery disease, which causes heart attacks. Second hand smoke makes the blood platelets sticky, so that they are more likely to form clots – clots that can block an artery in the heart or the brain. Smoking also narrows the blood vessels and puts smokers at risk of developing peripheral vascular disease (obstruction of the large arteries in the extremities that can cause a range of problems from pain to gangrene). Smoking is associated with abdominal aortic aneurysm, which is a weakening of the main artery of the body and is life threatening, unless detected and treated before rupturing. Dr. Daniel Edmundowicz, Director of Preventive Cardiology at UPMC Heart and Vascular Institute, says, "Certain factors are associated with increased risk for coronary artery disease. Some of these factors can't be changed, such as family history. But others can be changed and smoking is one of them."

Smoking and Breathing
Smoking causes 90% of all lung cancer deaths and 80-90% of deaths from other lung diseases (emphysema, bronchitis, chronic airway obstruction) by damaging the airways and air sacs of the lungs. These diseases are sneaky, insidious ones that present no symptoms until they are well advanced. The chemicals in tobacco smoke inflame the tissues that line the airways, damaging them so that they are unable to do their work of exchanging oxygen and carbon dioxide. Smoking and Diabetes Smoking raises the risk of getting Type II diabetes and worsens the complications of diabetes by interfering with the regulation of blood sugar levels. Diabetic smokers have a higher risk of heart and kidney problems, poor circulation and amputations, nerve damage and eye disease leading to blindness. The link between diabetes and smoking is not well known to the public, says Cindy Thomas, Executive Director of TFA, but her organization is working with diabetes educators to raise public awareness.

Smoking and Pregnancy
Smoking during pregnancy raises the risk of low birth weight, preterm delivery and neonatal death. Nearly a third of low birth weight babies are born to mothers who smoke. These babies are at risk for lifelong neurodevelopmental complications, including visual or hearing impairment, problems with movement and developmental delay. Smoking can damage the DNA in sperm and the reproductive systems of both genders, compromising fertility and possibly harming fetal development. The chemicals in cigarette smoke raise the risk of ectopic pregnancy and miscarriage. Nicotine crosses the placenta and babies can be born addicted to nicotine.

Other Health Problems
The chemicals in cigarette smoke cause inflammation and cell damage, weakening the immune system; this can interfere with the ability to fight off infections. For older people, smoking can be a factor in the development of cataracts. Smoking lowers bone density, which increases the risk of osteoporosis and hip fracture that can lead to life altering disability. Smoking complicates the administration of anesthesia during surgery and delays wound healing due to diminished blood circulation. Smoking can make chemotherapy and other cancer treatment less effective. Smokers and their families are at higher risk of dying in a house fire or suffering burns.

It's Never Too Late to Quit
Quitting gives the body a chance to heal the damage due to smoking. When a smoker quits, the risks of serious illness drop significantly.

Sources: American Cancer Society, American Lung Association, Tobacco Free Allegheny, Centers for Disease Control

You CAN Quit
There are now 50 million people in the United States who have stopped smoking. This means that the number of former smokers now surpasses the number of current smokers, for the first time. Quitting smoking is difficult because nicotine is so highly addictive and often requires repeated attempts. Successful quitters average 6-8 attempts before they finally stop. "It's helpful to keep in mind that withdrawal is not forever," says Alexandra Armstrong. "The best approaches address all three components: physical, emotional and behavioral. A support system is vital, whether it's with a group, an individual or a telephone counselor."

There are many options for those who wish to quit smoking. Experts say that quitting by using medication or counseling improves one's chances of success; using both is more effective. A recent study indicated that those who engage the support of their primary care physicians also improve their chances of success. In Pennsylvania, there is a free "Quitline" telephone program (1-800 – QUIT NOW) available, staffed with highly skilled counselors who offer tools, information and pep talks.

The FDA has approved seven medications to help people stop smoking; these include patches, gum and lozenges, which can be purchased over the counter, and a nicotine nasal spray and inhaler, by prescription. Zyban and Chantix are prescription medications that do not contain nicotine. Armstrong encourages smokers to discuss the use of these products with their pharmacist: "Pharmacists are wonderful counselors, knowledgeable and eager to help." Another resource is your health insurance company; many offer free smoking cessation services as well as supports such as nutrition and stress counseling.

For more information about smoking, second hand smoke and smoking cessation, visit www.tobaccofreeallegheny.org.

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