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Smoking: The Leading
Preventable Cause of Death in the United States
Prior to
the late 1800’s, tobacco use in the United States was
limited to cigar and pipe smokers. A new method to cure
tobacco made cigarettes possible, and with the advent of the
technology of mass production, the use of cigarettes began
to increase. By the early 1900’s, the per capita consumption
of cigarettes had begun to skyrocket, but it was not until
20 to 30 years later that the profound health effects became
evident. The first reports of a serious increase in
illnesses related to cigarette smoking began to appear in
the medical literature in the 1940’s and 50’s. The first
Surgeon General’s report on the adverse consequences of
smoking was published in 1964 and has been followed by more
than 20 subsequent reports describing the serious health
care problems related to smoking.
Every day,
new headlines proclaim the dangers of cigarette smoking, new
regulations or changes taking place in the industry. We hear
on a daily basis the reasons why we should stop smoking or
stop surrounding ourselves with people who smoke.
Tobacco-related illnesses are overwhelming our
population. These illnesses include heart disease, stroke,
other vascular diseases, a variety of cancers, and chronic
obstructive pulmonary disease. In the United States, nearly
half a million people die annually from the direct or
indirect effects of smoking. Smoking is the most important
preventable cause of death. Tobacco alone causes more deaths
than alcohol, cocaine, heroine, murder, car accidents and
AIDS combined.
Smoking
was once considered merely an unhealthy habit that was
largely a matter of personal choice, it is now widely
recognized by the American Psychiatric Association and fits
their criteria for substance use disorder. The latest
reseach in the biology of nicotine addiction suggests that
the drug-addicted brain is qualitatively different from the
nonaddicted brain.
Nicotine
is considered the chief addictive component of tobacco. Like
other addictive drugs, nicotine is thought to affect the
reward and withdrawal pathways of the brain. The addictive
properties of nicotine are similar to other drugs that are
known to be addictive, including heroin and
cocaine. However, nicotine addiction has several unique
features. It can be a particularly reinforcing drug because
of the rapid effect it produces when it is inhaled.
Approximately 90% of the nicotine absorbed in the lung
reaches the brain within 10 seconds after inhaling.
Until
recently, all of the aids to help smokers quit provided some
other form of nicotine delivery system (patch, gum, or nasal
spray) to replace the nicotine otherwise obtained from
tobacco products. The Food and Drug Administration (FDA)
recently approved a non-nicotine aid to smoking cessation in
the form of a pill. Zyban (bupropion HCl) is an
antidepressant which affects both the reward and withdrawal
pathways in the brain.
When a
smoker quits, certain levels of neurotransmitters in these
two areas of the brain decline, helping to produce
withdrawal symptoms. Zyban diminishes some of these
symptoms. This new therapy remains one of many tactics
smokers can use to help them “kick the habit.”
Smokers
who quit improve their health status and can have a profound
impact on specific diseases, including a variety of cancers,
premature coronary heart disease, and other vascular
disorders. For example, in former smokers who have not
smoked for 10 years, the risk of lung cancer is about 30% to
50% of the risk for those who continue to smoke.
The risk
of cancers of the oral cavity and esophagus is halved after
5 or more years of not smoking. The risk of bladder cancer
is reduced by half after only a few years. Quitting can also
results in substantial reductions in the risk of stroke, as
well as in the risk of developing peripheral artery disease.
While
treating smokers today remains the primary focus for
physician, prevention is still the key. Smoking is on the
rise among youngsters under 18, according to the American
Cancer Society, increasing 30% in the last six years. The
global tobacco settlement (recently defeated in congress)
would have partially address these issues - by eliminating
cartoon characters that appeal to the young, such as Joe
Camel - but more must be done.
Physicians
are in a unique position to help smokers quit. Smokers
represent over 25% to patients coming in for office visits
and more than 70% of smokers see a physician each
year. Physicians must help their patients deal with the
addictive nature of tobacco.
Smoking
imposes an enormous cost, in terms of health, as well as
economic factors. Both preventive measures and treatment
methods are essential to minimize the degree of
suffering and the
economic burden on society.
Content
of articles can only be used with writer attribution to Dr.
Kevin Weiland.
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