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By Emma Ross, June 18, 2002
Tobacco smoke is even more cancerous than previously thought, for both smokers and nonsmokers who breathe in the fumes, causing cancer in many more parts of the body than previously believed, a panel of experts has concluded. Smoking is blamed for one third of all cancer deaths in the United States, and 85 percent of the lung-cancer deaths.
Although smoking has been established as a leading cause of cancer, scientists have only now been able to track more than one generation of smokers to develop a clear picture of the dangers of tobacco.
The
scientists, convened by the International
Agency for Research on Cancer, a branch of the World Health
Organization (WHO), said Wednesday that for types of cancer already
known to be caused by smoking, the risk of tumors is even higher than
previously noted. The research also definitively proves that secondhand
smoke causes cancer.
The analysis is the first major examination of the accumulated research on tobacco smoke and cancer since 1986. A full report of the findings will be published later this year.
The scientists combined the results of more than 3,000 studies involving millions of people, which allowed them to draw conclusions not possible in smaller studies.
``We are still learning about just how damaging cigarette smoking is,'' said the panel's chairman, Dr. Jonathan Samet, head of epidemiology at the Johns Hopkins School of Public Health. ``Only now are we beginning to see the full picture of what happens when a generation begins to smoke at an early age, as youth do, and then smoke across their whole lifetime. Before, we only had snapshots.''
``The
full picture is more disturbing than what we saw when we only had the
smaller pieces,'' he said.
There are about 1.2 billion smokers worldwide, half of whom will die prematurely from cancer, heart disease, emphysema or other smoking-related diseases, research has shown.
The best way to prevent those deaths is to get smokers to quit, the scientists said.
``Our group concluded that any possible public health gains from changes in cigarette characteristics or composition would be minimal by comparison. Changes in cigarettes are not the way to prevent cancer,'' Samet said.
The 29
experts from 12 countries found that in types of cancer already linked
to smoking, the risk is even higher than previously believed.
``For example, for tumors of the bladder and the renal pelvis, previously we thought the elevated risk was maybe three to four times that of a nonsmoker. Today, it looks like the risk is elevated five to six times,'' said Dr. Paul Kleihues, director of the U.N. cancer research agency.
Two cancer types under suspicion were cleared — those of the breast and endometrium, or lining of the womb. Prostate cancer has been less studied, but the group did not believe it is caused by smoking.
Types of cancer newly declared to be caused by smoking were cancers of the stomach, liver, cervix, uterus, kidney, nasal sinus and myeloid leukemia.
``It
does look as if it's the cancers that are principally caused by hormones
that are not affected by smoking. Most of the other cancers throughout
the body are induced by exposure to chemicals, often environmental
ones,'' said Sir Richard Doll, an Oxford University professor who was on
the panel.
``Practically all the cancers of tissues that are exposed to the environment in one way or another are affected by the chemicals distributed throughout the body when you inhale tobacco smoke,'' Doll said.
Cancers already identified as being caused by smoking include lung, oral cavity, gullet, larynx, pharynx, pancreas and bladder.
The panel also analyzed 20 or 30 years of research on cancer and secondhand smoke, and concluded secondhand tobacco smoke increases the risk of lung cancer by 20 percent.
While
some national governments have concluded secondhand smoke causes cancer,
this is the first time the U.N. cancer agency — which has strict
criteria for evaluating evidence — or any organization with a global
sweep has reached this conclusion.
The group found no clear evidence that children exposed to their parent's tobacco smoke in the womb or after birth have an elevated risk of developing childhood cancers. Whether they face an increased risk of lung or other cancer in adulthood remains unclear, the panel said.
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NOTE: Wasn't it bad enough that tobacco can interfere with your sex life or even kill you?
08/12/2007
Scotland's leading ophthalmologist, Sir Stewart Duke-Elder, wrote a classic manual for eye surgeons, entitled "Textbook of Ophthalmology". Duke-Elder, who was born on this date in 1898, was one of the first doctors to link tobacco to a visual defect.
The condition, known as "tobacco amblyopia", impairs the eye's ability to see green and red. "The patient, usually a man of a little over 50, complains for some weeks his sight has gradually and without apparent reason failed, so that now he finds difficulty in reading or doing fine work; he sees a mist before his eyes hanging in front of everything he looks at", he wrote.
However, once the patient quit smoking, the condition could be easily treated with vitamin B-12 and brewer's yeast.
The Associated Press
November 25, 2004
DURHAM, N.C. - Cigarettes may cost smokers more then they believe. A study by a team of health economists finds the combined price paid by their families and society is about $40 per pack of cigarettes.
The figure is based on lifetime costs for a 24-year-old smoker over 60 years for cigarettes, taxes, life and property insurance, medical care and lost earnings because of smoking-related disabilities, researchers said.
"It will be necessary for persons aged 24 and younger to face the fact that the decision to smoke is a very costly one - one of the most costly decisions they make," the study's authors concluded.
Smokers pay about $33 of the cost, their families absorb $5.44 and others pay $1.44, according to health economists from Duke University and a professor from the University of South Florida. The study drew on data including Social Security earnings histories dating to 1951.
Incidental costs such as higher cleaning bills and lower resale values for smokers' cars were not included.
Most smoking studies rely on a snapshot of annual costs, said co-author Frank Sloan, an economics professor and the director of the Center for Health, Policy, Law and Management at Duke's Terry Sanford Institute of Public Policy.
Despite the finding that smoking is a costly habit for individuals, society carries less of a burden than generally believed, the study's authors determined.
"The reason the number is low is that for private pensions, Social Security, and Medicare - the biggest factors in calculating costs to society - smoking actually saves money," Sloan said. "Smokers die at a younger age and don't draw on the funds they've paid into those systems."
Given the high costs, it is "remarkable," the authors conclude, that money from the 1998 settlement involving 46 state attorneys general and major tobacco manufacturers largely are not being spent on smoking-cessation or related programs.
But even after taking into account the cost savings from early deaths, smoking still costs society $2.20 a pack for such things as sick leave, life insurance outlays and medical care not paid by smokers. The researchers concluded that after subtracting the 76 cents a pack smokers pay in state and federal taxes, society's net cost is $1.44 a pack.
Many states use the money to cover budget deficits or, as in North Carolina, on economic development in tobacco communities.
The study's other co-authors are Jan Ostermann, Christopher Conover and Donald H. Taylor Jr. of Duke, along with Gabriel Picone of the University of South Florida. Their research was supported in part by a grant from the National Institute on Aging.
May 22, 2003
New study findings show that fourth-graders who live with at least one smoker are more likely than those who don't to miss school because of a respiratory illness.
Living with more than one smoker further increased the likelihood that kids would call in sick, especially if the child had asthma, according to the report.
These findings indicate that even kids who are old enough to attend school full-time, and therefore spend every weekday away from home, still feel the effects of secondhand smoke, write Dr. Frank Gilliland and colleagues at the University of Southern California in Los Angeles.
"Thus, although (secondhand smoke) exposure among school-aged children is likely to be substantially lower than that among preschool children, the adverse effects appear to be substantial," they write in the May 15th issue of the American Journal of Epidemiology.
While missing a day of school here and there may appear somewhat harmless, absences can be markers of much larger problems, according to editorialists led by Dr. Anthony J. Alberg of the Johns Hopkins Bloomberg School of Public Health in Baltimore.
"Lurking behind a school absence may lie sleepless nights, physician visits, emergency department visits, hypersomnolence (excessive sleepiness), poor concentration, parents missing work, and poor asthma-specific quality of life," Alberg and his colleagues write.
The current study "adds to the importance of promoting smoking cessation among parents who smoke cigarettes," they add.
Gilliland and his team obtained their findings from information about illness-related absences among 1,932 California fourth-graders during 1996.
Parents or guardians reported whether a doctor had ever diagnosed their children with asthma, and how many smokers lived in their households.
Children who lived with at least one smoker were 27 percent more likely to have been absent from school due to respiratory illness than children whose homes were smoke-free.
And the more smokers in the house, the worse off children were, the authors note. Children who lived with at least two smokers were 75 percent more likely than those from non-smoking homes to miss school due to respiratory illness.
Having asthma also made the situation worse, Gilliland and his team write. Children with asthma who lived with smokers were more than twice as likely to stay home because of respiratory illness than non-asthmatic kids from smoke-free households.
In asthmatic kids who lived with at least two smokers, the risk of such absences shot up by more than four-fold.
Gilliland and his colleagues point out that secondhand smoke may help cause or aggravate respiratory infections, or worsen pre-existing asthma.
In the editorial, Alberg and his colleagues suggest that school officials could interpret repeated absences as a sign that a child has undiagnosed asthma, or, if already diagnosed, needs better treatment.
Does Cigarette Smoking Cause Stress?
Andy C. Parrott
University of East London
|
Abstract Correspondence may be addressed to Andy C. Parrott, Department of Psychology, University of East London, London, Great Britain, E15 4LZ. Electronic mail may be sent to andy2@uel.ac.uk |
Smoking and Stress in Adult Regular Smokers
The majority of smokers report feeling more relaxed when they smoke a cigarette and state that mood control is an important reason for smoking cigarettes. Ikard, Green, and Horn (1969) found that 80% of smokers agreed with statements indicating that cigarette smoking was "relaxing" or "pleasurable". In questionnaire surveys, most smokers respond positively to statements such as "Smoking relaxes me when I am upset or nervous", "Smoking calms me down", and "I am not contented for long unless I am smoking a cigarette" (Ikard et al., 1969; Russell, Peto, & Pavel, 1974; Speilberger, 1986; Tomkins, 1968 ). These findings suggest that smoking aids mood control: "Cigarette smoking is a mood modifier for smokers, calming and reducing the smokers' feelings of anxiety and anger" (Warburton, 1992, p. 57). However, regular smokers also report adverse moods when they have not smoked recently, with feelings of stress and irritability building up during periods of nicotine abstinence (Hughes, Higgins, & Hatsukami, 1990 ; Parrott, Garnham, Wesnes, & Pincock, 1996 ; Office of the U.S. Surgeon General, 1988 ). The positive mood changes experienced during smoking may therefore reflect instead the simple reversal of these unpleasant abstinence effects: "Smoking doesn't make the smoker less irritable or vulnerable to annoyance, not smoking or insufficient nicotine makes him more vulnerable" (Schachter, 1978 , p. 210).
When smokers are asked about their moods over the day, they typically report a pattern of repetitive mood fluctuations, with normal moods during smoke inhalation followed by periods of increasing stress between cigarettes (O'Neill & Parrott, 1992 ; Parrott, 1994a , 1994b ). These mood fluctuations also tend to be strongest in the most dependent smokers, who also report mood control is a core reason for their smoking (Parrott, 1994b ). However, smokers' stress levels tend to be similar to nonsmokers' only when they have just smoked and become worse during periods of nicotine abstinence (Parrott & Garnham, 1998 ). Moreover, when nicotine-deprived and nondeprived smokers were allowed to smoke a single cigarette, mood improvements occurred only in the deprived smokers, who were already suffering from poor moods. When nondeprived smokers had a cigarette, their self-rated stress levels were hardly affected by smoking; rather, they remained at normal or average levels very similar to those of nonsmokers (Parrott & Garnham, 1998 ). This shows that the apparent mood benefits of smoking only reflect a process of mood normalization: the simple reversal of the tension and irritability that build up during nicotine abstinence (Schachter, 1978 ).
Regular smokers, therefore, experience periods of heightened stress between cigarettes, and smoking briefly restores their stress levels to normal. However, soon they need another cigarette to forestall abstinence symptoms from developing again. The repeated occurrence of negative moods between cigarettes means that smokers tend to experience slightly above-average levels of daily stress. Thus, nicotine dependency seems to be a direct cause of stress. Various surveys have shown that smokers report slightly higher levels of daily stress than do nonsmokers. In the U.K. Health and Lifestyle Survey of 9,003 participants, significantly more smokers than nonsmokers reported feeling constantly under stress and strain (Warburton, Revell, & Thompson, 1991 ). In a survey of male shift workers, the cigarette smokers reported significantly higher levels of self-rated stress than did the nonsmokers during both day and night shifts (Jones & Parrott, 1997 ). West (1992 , p. 166) has similarly noted, "Against the anxiety reduction theory, is the finding that smokers do not present as less anxious than non-smokers. Indeed, in surveys they emerge as significantly more anxious overall".
Smoking Initiation and Stress During Adolescence
If nicotine dependency leads to heightened stress, then novice smokers should report increasing stress as they develop regular patterns of smoking. The empirical evidence is consistent with this model. In a cross-sectional survey of 1,684 Canadian schoolchildren, the regular and heavy smokers reported significantly higher stress (nervousness, anxiety, worry) than did similarly aged nonsmokers (Mitic, McGuire, & Neumann, 1985 ). When adolescents in British schools were surveyed, the lowest levels of self-rated stress were found with the nonsmokers, comparatively greater stress was noted by occasional smokers, and the highest levels of self-rated stress emerged from the regular smokers (Lloyd & Lucas, 1997 ). When American adolescents were asked to retrospectively describe their changes in smoking behavior and feeling states over the previous two years, an increase in affective distress accompanied the move from experimental to more regular smoking (Hirschman, Leventhal, & Glynn, 1984 ). In a two-year prospective study, stress levels increased in schoolchildren who became more frequent smokers (Wills, 1986 ). When female schoolchildren were asked about their moods during smoking, the regular smokers reported that they felt calmer when actually smoking but suffered abstinence symptoms without their cigarettes. The authors concluded that the apparent mood benefits of smoking only reflected the relief of withdrawal symptoms. Moreover, nicotine dependency was evident even among the youngest smokers: "The relationship between feeling calmer when smoking and reports of aversive symptoms when attempting to give up was evident even among those in their first year of smoking" (McNeill, 1991 , p. 591).
If smoking does lead to increased stress, then quitting should reduce stress. Again, this has been empirically confirmed in a number of studies. In a review of cross-sectional studies in this area, the U.S. Surgeon General concluded that former smokers were found to be less stressed than current smokers in some studies, whereas in other studies the two groups did not differ significantly; however, not a single study found former smokers to be more stressed than continuing smokers (Davis, 1990 , pp. 533—541). Longitudinal or prospective research designs are more powerful than cross-sectional studies; they generally demonstrate a pattern of poor moods for the first few weeks after cessation, followed by mood improvements in the longer term. Hughes (1992) found increased anger, anxiety, and restlessness in the first few days after quitting. By the 14-day session, the group average mood scores had returned to baseline; at subsequent sessions, these moods gradually improved over those found at baseline. Cohen and Lichtenstein (1990) monitored smokers who were attempting to quit unaided. Over the six-month period, each volunteer regularly completed the Perceived Stress Scale, at which time their current smoking status was also noted. Those smokers who failed to quit reported unchanging levels of high stress at every session. In contrast, those former smokers who completely abstained for the six-month period reported a steady decrease in stress over time. Crucially, the successful and unsuccessful quitters reported similar stress levels at baseline; thus, it was not just the less stressed smokers who managed to quit. Other longitudinal studies have confirmed that quitting leads to a significant reduction in self-reported stress. Parrott (1995) found a slight reduction in stress levels three months postcessation, followed by a further lowering of stress six months after quitting. Carey, Kalra, Carey, Halperin, and Richards (1993) noted a significant reduction in self-rated stress in Australians who successfully quit smoking. West and Hajek (1997 , p. 1589) similarly found that quitting resulted in significantly lower state anxiety scores: "Giving up smoking is quite rapidly followed by a reduction in anxiety that may reflect removal of an anxiolytic agent, nicotine". However, one prospective study (Gilbert et al., 1998 ) failed to find mood improvements after quitting; instead, their "former" smokers reported mood decrements during the month after quitting. However, abstinence was not biochemically confirmed, and their volunteers were allowed to smoke a few cigarettes and still be counted as quitters. Overall, therefore, Gilbert et al. (1998) cannot be seen as a true cessation study. It is crucial that abstinence is total,because any smoking relapse will probably reestablish nicotine dependency as a problem (Parrott, 1995 ; West & Hajek, 1997 ); merely cutting down will probably lead to increased stress.
Traditional Explanations for the Smoking—Stress Relationship
The traditional explanation for the smoking—stress relationship is that smoking relieves stress. The smoker feels relaxed when smoking and tense without nicotine; thus, their tobacco and cigarettes are seen as helping them cope with the stresses and strains of everyday life (Warburton, 1992 ). Certainly the positive association between smoke inhalation and stress relief is so strong that few smokers question it. Schoolchildren in the mid-1990s gave stress control as a reason for smoking (Lloyd & Lucas, 1997 ), just as their parents did in earlier surveys (Ikard et al., 1969 ). However, this raises the crucial question: Why does the smoker feel stressed without nicotine? There seem to be two possible answers to this. Smokers may be constitutionally neurotic. Alternatively, their stress may be caused by nicotine dependency.
In support of the first explanation, in a number of studies researchers have found above-average neuroticism scores in adult smokers compared with nonsmokers, although some studies have failed to confirm this (see Gilbert, 1995 , p. 152). Thus, it may be suggested that nicotine helps constitutionally anxious (i.e., neurotic) individuals cope with stress. However, there are several problems with this notion. Most importantly, there is no empirical evidence to support it. When tobacco-naive adults are first administered nicotine, they report feelings of anxiety and tension rather than relaxation (Newhouse et al., 1990 ). Similarly, when adolescents take up occasional smoking, they become more rather than less stressed, and their stress levels increase as they become regular smokers (see the Smoking Initiation and Stress During Adolescence section). Thus, there is no empirical evidence that nicotine does alleviate stress. Furthermore, when adults quit smoking, they become less stressed rather than more stressed (see the Smoking Cessation and Stress section). Thus, there is no evidence that smokers suffer without tobacco or nicotine (other than during the initial brief period after quitting; Hughes, 1992 ; Parrott, 1998 ). There is also no neurochemical rationale for predicting that nicotine should alleviate stress, because it is a cholinergic agonist with sympathomimetic rather than sedative properties (Davis, 1990 ; Office of the U.S. Surgeon General, 1988 ; Parrott, 1998 ). Given that nicotine does not alleviate stress, explanations for the (slight) positive association between neuroticism and smoking need to be sought. One possible explanation is that neurotic individuals develop nicotine dependency more readily. Another is that if nicotine dependency causes stress, then some smokers may become slightly more neurotic as they develop regular patterns of smoking (note that these explanations are not alternatives and may be linked).
Nicotine Dependency: A Cause of Stress?
The model proposed here is that nicotine dependency can cause stress. The regular smoker needs nicotine to maintain normal moods and suffers from unpleasant feelings of irritability and tension between cigarettes, when his or her plasma nicotine levels are falling. Abstinence symptoms are therefore central to any understanding of nicotine dependency, just as they are with many other addictive drugs (e.g., heroin, cocaine). The main difference between nicotine and these other drugs is that nicotine users feel normal on the drug. Thus, there are few differences between smokers replete with nicotine and nonsmokers. This means that regular smokers need to maintain their nicotine intake in every type of situation: at work, rest, and play. This model also explains why smoking is most pleasurable after an extended period of abstinence (e.g., the first cigarette of the day). Indeed, the degree of satisfaction provided by a cigarette has been shown to be a direct monotonic function of the duration of prior abstinence (Fant, Schuh, & Stizer, 1995 ).
Smokers also learn that regular smoking prevents abstinence symptoms from developing. Thus, the link between regular smoke intake and keeping moods within normal bounds becomes strongly conditioned over time. With around 60,000 inhalations each year, a regular smoker soon finds smoking is a highly over-learned behavior, which is why quitting can be so difficult. Many smokers also use cigarettes to cope with adverse moods in stressful situations (Office of the U.S. Surgeon General, 1988 ; Schachter, 1978 ). The indirect coping strategy of "lighting up" under stress is reported by both adult and adolescent smokers (Lloyd & Lucas, 1997 ; Office of the U.S. Surgeon General, 1988 ). However, this drug-based strategy may be counterproductive, because although the smoker may feel somewhat relieved, it can leave the real problem unresolved (Lloyd & Lucas, 1997 ). The frequent failure of smokers to tackle problems directly may provide a further reason why they suffer from more stress than do nonsmokers.
This model raises a number of practical and theoretical issues, which need to be empirically investigated. If stress levels are increased by smoking, what exactly is the nature of this link–is it direct and causal or more subtle and indirect? What neurochemical changes occur in the novice child smoker, which lead the child to feel irritable when without nicotine? How crucial are the ineffectual coping strategies cigarette use provides (e.g., lighting up instead of tackling the problem); do they make the smoker less effective at handling negative life events? Are there individual differences (e.g., in neuroticism) that influence the development of adverse moods during abstinence, and how crucial are these withdrawal symptoms for explaining nicotine dependency? Shiffman (1989 , p. 545) noted, "While dependent smokers showed signs of acute withdrawal that were relieved by smoking, chippers (light occasional smokers) showed no signs of withdrawal prior to smoking, and little subjective reaction to smoking". Does the absence of withdrawal symptoms in light or occasional smokers explain how they manage to avoid becoming nicotine dependent? Patterns of cigarette uptake also differ across socioeconomic group, race, gender, and psychiatric status; is there a common factor of susceptibility to stress in at-risk groups? Finally, what are the effects of no-smoking policies? They may exacerbate stress in highly dependent smokers. However, because drug use, craving, and expectancy are strongly context dependent, the widespread adoption of no-smoking policies could help prevent some occasional smokers from becoming more habitual smokers.
Implications for Health Education
The message that smoking can increase stress needs to be more widely known. The majority of smokers recognize that smoking is physically unhealthy but mistakenly believe it has positive psychological functions. In particular, most smokers state that cigarettes help relieve the feelings of stress that they seem to experience so frequently (Lloyd & Lucas, 1997 ; Office of the U.S. Surgeon General, 1988 ). Smokers need to become aware of why these beliefs are incorrect. Health education packages should contain information on how smoking can exacerbate stress, and how quitting can lead to reduced stress. This may help many adults to stop smoking. Former smokers who have recently quit are also in danger of relapse (Davis, 1990 ); one way to help maintain abstinence would be to inform them that their stress levels will probably increase again if they do relapse (Cohen & Lichtenstein, 1990 ). Preteenage and adolescent schoolchildren also need to be taught that not only is nicotine highly addictive but it can also increase stress. Hopefully, this might help more youngsters withstand the social pressures to initially try cigarettes.
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April 11, 2002
Each pack of cigarettes sold in the United States costs the nation $7 in medical care and lost productivity, the government said today.
The study by the Centers for Disease Control and Prevention put the nation's total cost of smoking at $3,391 a year for every smoker, or $157.7 billion. Health experts had previously estimated $96 billion.
Americans buy about 22 billion packs of cigarettes annually. The CDC study is the first to establish a per-pack cost to the nation.
The agency estimated the nation's smoking-related medical costs at $3.45 a pack. It said job productivity lost because of premature death from smoking amounted to $3.73 a pack, for a total of $7.18.
The average cost of a pack of cigarettes in 1999 was $2.92.
"There's a big difference in the cost to society and what society is getting back in tax", said the CDC's Terry Pechacek. "We believe society is bearing a burden for the individual behavioral choices of the smokers".
The CDC said it analyzed expenses, both personal and for the health care industry, and used national medical surveys to calculate the costs to the nation.
The agency also reported that smoking results in about 440,000 deaths a year in the United States, up from the government's previous figure of 430,000, established in the early 1990s. The new study was conducted from 1995 to 1999.
"The fact that nearly half a million Americans lose their lives each year because of smoking-related illnesses is a significant public health tragedy", said David Fleming, the CDC's acting director.
A spokesman for tobacco giant Brown & Williamson objected that the study presents the figures in a vacuum, without comparing smoking to the financial burdens other people — nonsmokers with diabetes, for example — place on society.
"What does that number mean?" spokesman Mark Smith said. "It doesn't mean anything. It's bordering on meaningless".
Representatives from the nation's two other leading tobacco companies — Philip Morris and R.J. Reynolds — did not immediately return calls for comment.
Among other findings:
Smoking causes an average man to lose more than 13 years of life, and an average woman to lose 14.5 years.
Smoking during pregnancy causes about 1,000 infant deaths each year.
Lung cancer causes the most deaths among smokers, following by heart disease and lung disease.
Men account for about 60% of smoking deaths — 264,000 a year, compared with 178,000 deaths among women.