Death from smoking remains the single most preventable cause of death in the United States today. A direct relationship exists between nearly all lung cancers and exposure to tobacco smoke, yet in 2005 an estimated 39 million Americans smoked. Smoking is currently responsible for a third of all cancer deaths in many Western countries. Health experts estimate that 1 of every 2 smokers will be killed by tobacco, a total of 3 million people worldwide dying annually of lung cancer. Lung cancer has surpassed breast cancer as the leading cause of death in U.S. women, with more than 160,000 deaths for both sexes reported in 2004. Worldwide, the World Health Organization reports that China has the highest consumption of tobacco-related products and, consequently, the highest number of tobacco-related deaths.
Social epidemiological studies continue to claim that smoking is higher among blacks, blue-collar workers, the less educated, and teens. Although about 43 percent of smokers attempt to quit, the decline is slower for women than men, while it has increased at an alarming rate among teens and in developing countries. By education level, smoking decreases as education rises, and it is certainly higher among the poorest members in society.
In 1964, the U.S. Surgeon General issued the first major U.S. report on smoking and health, concluding that cigarette smoking is a cause of lung cancer in men and a suspected cause in women. Until then, early statements on the dangers of cigarettes and nonsmoking tobacco products were far from definitive, as legislators and public health officials were cautious in their assertions of the scientific proof on the ill effects of smoking. In reality, many legislators were loathe to lose the tobacco manufacturers’ campaign contributions, and those with tobacco growers as a constituency feared the loss of jobs in the tobacco industry. After its report, though, the U.S. Surgeon General’s Office acted diligently to implement public policy and establish statewide education and prevention programs. Continued scientific research further proved the case against smoking, justifying subsequent legislation, as attitudes and cultural norms changed.
Public smoking bans date all the way back to 1590, when Pope Urban VII banned it in all forms (chewing, smoking, or sniffing its powder) on church property, under threat of excommunication. Smoking bans today are public policies, including legal prohibitions and occupational health and safety regulations that restrict smoking in public places. Their aim is to protect workers, citizens, and children from chronic and acute diseases caused by secondhand smoke.
The Public Health Cigarette Smoking Act, passed in 1970, banned radio and television advertising of cigarettes and mandated a stronger health warning on cigarette packages: “Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health.” In 1972, the U.S. Surgeon General warned against secondhand smoke, but smoking bans in federal buildings and on airlines were not enacted until the late 1980s.
The California legislature in 1994 banned smoking in the workplace and then extended this prohibition in 1998 to all facilities, including bars. Soon thereafter, other states or cities—including the nation’s largest city, New York—enacted similar smoking bans. Since then, an increased number of states and countries have been banning smoking in various indoor public sites and workplaces, including bars, restaurants, and social clubs. A total of 35 U.S. states have some form of smoking ban on the books, and the countries of Bhutan, Canada, France, Ireland, Italy, Malta, New Zealand, Norway, Scotland, Sweden, and the United Kingdom are among the countries that have or will have laws enacted and effective by 2008.
Undoubtedly, the laws banning smoking resulted from sustained campaigns by several health and medical organizations. One of these, the Coalition on Smoking or Health, formed in 1982, was a three-way partnership of the American Cancer Society, the American Lung Association, and the American Heart Association to promote national legislation through coordinated lobbying activities on smoking prevention. To focus more sharply on smoking behavior research and interventions, the National Cancer Institute reorganized those efforts by creating its Smoking, Tobacco and Cancer Program. Shortly thereafter, in 1986, the Centers for Disease Control and Prevention (CDC) Report claimed that conclusive evidence existed on the dangers of secondhand smoke, especially on the children of smokers. The public has come to accept the evidence; smokers’ behaviors continue to change as smokers have become increasingly stigmatized when more citizens demand smoke-free environments.
Agencies, both public and private, have funded research with definitive conclusions as to the ill effects of tobacco use, including lung cancer, heart and circulatory disease, infertility, sexual dysfunction in men, pregnancy and newborn complications, respiratory disease, and dental problems. Given this enormous research effort during the past 30 years, few individuals doubt that cigarettes, chewing tobacco, cigars, and pipe tobacco contain harmful chemicals. For example, the Mayo Clinic in 2006 claimed that men who don’t quit smoking lose 13.2 years of life, while smoking women lose even more—an average of 14.5 years.
Recent studies show increases in women smoking in general, although educated women and women over age 65 were more likely to quit. Other studies point to differences among men and women with regard to the motivational behavior patterns associated with smoking. For example, women are more likely to have such smoking styles as deeper breathing, higher amounts of rapid inhalation per cigarette, and the use of cigarettes to reduce boredom, stress, and depression. Both women and younger smokers see smoking as improving their self-images, seeing smoking as “cool” or “chic,” perhaps reflective of advertising portraying the smoker as an attractive image.
By 1995, smoking became known as a “pediatric disease,” given the alarming increase of smoking among high school teenagers and by the growing scientific evidence that children of parents who smoke had higher risks of respiratory and coronary disease, including lung cancer. A CDC report claimed that the earlier young people begin smoking, the more likely they are to continue as adults. Moreover, social scientists had long associated tobacco use with other adolescent problems, such as alcohol and drug abuse. Consequently, federal legislation was enacted in 1997 banning the sales of cigarettes to minors, with severe penalties against abusers.
A Harvard Medical School study of more than 10,000 students enrolled at 119 nationally representative U.S. colleges in 2001 identified 51 percent as “social smokers.” Other studies focusing on age and gender reported that both girls and boys experienced pressure to drink and smoke at a young age. A 2001 National Institutes of Health study among 4,200 middle school teens found that peer pressure, particularly among one’s five closest friends (more so for girls than boys), influenced smoking and drinking patterns. In contrast, parents who were more engaged in their children’s lives—conversing, listening to their problems, attending their after-school events—were more likely to have children who did not drink or smoke.
Sidestream smoke contains more than 4,000 chemicals, including 69 known carcinogens. In 2005, the CDC found that 3,000 people died every year in the United States from lung cancer and another 46,000 from heart disease, all caused by secondhand smoke. Another study concluded that lifelong nonsmokers with partners who smoke in the home have a 20-30 percent greater risk of lung cancer, and those exposed to cigarette smoke in the workplace have an increased risk of 16-19 percent. Involuntary exposure to secondhand smoke remains a serious public health hazard that can be prevented by making homes, workplaces, and public places completely smoke-free.
In spite of the progress made thus far, why do so many adults still smoke? Influencing factors might include the inability of the more seriously nicotine-dependent smokers to quit and also a reduction of federal funding for preventive programs. In contrast, tobacco industry advertising exceeds $15 billion annually. More than 100 million Americans ages 3 or older are exposed to secondhand smoke, and about 20 percent of today’s high school seniors smoke cigarettes regularly.
- Centers for Disease Control and Prevention. (https://www.cdc.gov/tobacco/).
- Mayo Clinic. (http://www.mayoclinic.org/diseases-conditions/nicotine-dependence/home/ovc-20202596).
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