The Multinational Monitor

July/August 1987 - VOLUME 8 - NUMBERS 7 & 8

T H E   T O B A C C O   T R A P

Smoke Damage

The Health Effects of Tobacco

by Marc Manley

Each year tobacco kills over 350,000 people in the United States - nearly 1,000 deaths per day. It is far and away the country's largest preventable cause of death and disease. Cigarettes kill more people in this country than heroin, cocaine, all other illicit drugs, automobile crashes, homicides and suicides combined. At least one of every six deaths in the United States is caused by tobacco, according to U.S. Department of Commerce estimates.

The scientific evidence documenting the hazards of tobacco use is probably more extensive than for any other substance. Over 50,000 studies of the health effects of tobacco, performed in dozens of countries, have detailed the dangers. In 1986 alone, nearly 2000 studies of tobacco were published. Most of the major health effects of tobacco use are well established; the questions that remain concern the less common diseases. Perhaps the most notorious and the most studied of the diseases caused by smoking is lung cancer, the most fatal malignancy in the world. Over 80 percent of people who develop lung cancer are smokers, and a significant number of the other 15-20 percent are "passive smokers."

The number of deaths due to lung cancer, 131,000 in 1984, increases each year. Among women, the increase is particularly rapid. Lung cancer has now replaced breast cancer as the leading cause of cancer deaths among women.

But lung cancer is not the worst of the diseases caused by smoking. More people die of heart disease caused by smoking than of lung cancer. Smoking is one of the major risk factors for heart disease, and is thought to be responsible for one-third of all heart disease and heart disease-related deaths - about 180,000 deaths each year.

People who smoke are nearly twice as likely to have a heart attack as non-smokers. For middle-aged men the risk is almost three times as great. Women who smoke while taking birth control pills are ten times more likely to die from heart disease than women who neither smoke nor use birth control pills. Because heart disease is the leading cause of death in the United States, the increased risk caused by smoking translates into thousands of preventable deaths each year. Aside from heart disease, smokers also face increased risk of stroke.

Another well-known, often fatal disease caused by smoking is chronic obstructive lung disease, one form of which is emphysema. As with lung cancer, almost all people who die from this disease are smokers. In addition to the 50,000 people who die from chronic obstructive lung disease each year, emphysema disables 2 million people annually, making it one of the chief causes of chronic disability in the United States.

The list of diseases caused by tobacco goes on: cancer of the larynx, oral cancer (most often found in smokeless tobacco users), esophageal cancer, bladder cancer, and cancer of the pancrPas. Smoking contributes to peptic ulcer disease, and may cause cancer of the cervix and kidney. Babies born to mothers who smoke are more likely to be premature or small at birth. Both of these effects increase the risk of death for these babies.

Involuntary exposure to tobacco smoke is not limited to unborn children. Millionsof nonsmokers inhale enough cigarette smoke to increase their risk of disease and death. For most nonsmokers, the largest exposure to tobacco smoke occurs at work, but non smoking wives of smokers have been found to have a higher risk of disease.

Both the U.S. Surgeon General and the National Academy of Sciences have recently reviewed the now extensive evidence about passive smoking, and both reached the same conclusion: involuntary smoking causes disease, including lung cancer, in healthy non-smokers. Five thousand non-smokers die of lung cancer every year because of the tobacco smoke in the air.

Passive smokers may also have an increased risk of heart disease. Children of smoking parents have more respiratory ill nesses and decreased lung functions. And pregnant women who don't smoke but are exposed to smoke in the air are more likely to have a baby with low birth weight.

Finally, smoking is the leading cause of fires in homes, killing 1,500 and injuring 4,000 people every year. Death rates from house fires are highest for young children and the elderly. In spite of the tobacco industry's attempts to cloud these issues, the facts remain. Four people are killed by tobacco every minute of every day. That is the equivalent of two jumbo-jet crashes a day, 365 days a year. There is no longer any doubt about the lethal nature of tobacco.

Marc Manley is a physician trained in preventive medicine and former researcher at Public Citizen's Health Research Group

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