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Smoke alarm.

Twenty years ago, the U.S. Surgeon General issued a landmark report on the effects of cigarette smoking on human health. The U.S. government had bestowed its authority upon the finding that cigarettes are a major cause of cancer.

Periodically since then the government has updated its findings. With each new report, the connection between smoking and cancer becomes clearer and stronger. Indeed, the more deeply government investigators probe into the effects of smoking, the more convinced they are that cancer is only one of a wide range of problems caused by tobacco. We have learned, for example, that smoking sharply increases the risk of heart attacks. We have learned, too, that women who smoke and also use oral contraceptives are in greater danger of coronary occlusions than those who do not. Physicians have been alerted that their prescriptions may work quite differently for cigarette smokers.

Other recent government reports refer to the adverse effects of smoking on pregnancy; to the body's increased difficulty using food when it must also handle nicotine and smoke in general; and to the health hazards faced by non-smokers when exposed to tobacco smoke from others.

How have the American people responded to the mounting evidence of the serious health hazards of smoking?

The response is mixed. The most encouraging sign is that 30 million Americans have quit smoking and added an average of almost a decade to their life expectancy. On the other hand, this gain is confined to men. More women and more teenagers are smoking than ever before. And the most disturbing fact of all is that 345,000 Americans died last year from smoking-related diseases--a higher death toll than we suffered in either world war.

The greatest paradox is that the government has issued such drastic warnings to the American people about cigarette smoking while supporting the very industry causing the problem in the first place. The taxpayers of the United States gave some $70 million in subsidies last year to tobacco growers for producing a crop that costs the American people billions of dollars in medical bills and lost productivity.

Still another paradox: A study supported by the American Medical Association, with the tobacco industry itself joining in sponsorship, has come up with conclusions confirming the connection between smoking and illness. Yet the tobacco industry has ignored these warnings in its own statements about the effects of smoking. And the tobacco lobby has prevented the government from taking direct action to change or eliminate the poisonous contents of its product. When the Federal Communications Commission required that TV and radio balance cigarette advertising with "opposing viewpoints"--health data about smoking--so many smokers quit that the tobacco producers voluntarily withdrew their ads.

Due largely to public pressure, smoking is legally restricted on buses and airplanes, and 46 states as well as the District of Columbia now have laws to restrain smoking in public places. The government has finally stopped shipping tobacco to the Third World, which in former years received from $17 to $66 million worth of the product under the U.S. Food for Peace program.

Public pressure against smoking is largely the result of the educational campaigns being conducted by the American Cancer Society, the American Lung Association and the American Heart Association. The American Medical Association has thrown its substantial prestige behind the general movement. Citizens organizations such as the Group Against Smoking Pollution (GASP) have campaigned for state and local laws restricting smoking. The Saturday Evening Post has given its Benjamin Franklin Award to John Banzhaf for his work in organizing and running Action on Smoking and Health (ASH), which keeps after government agencies to do their job on matters concerning smoking. Another group, Doctors Ought to Care (DOC), has been founded by Dr. Alan Blum, a family practitioner, for the purpose of educating the public, children especially, about smoking's dangers. Various private corporations have banned cigarette smoking on their premises, and some have even given bonuses to employees who quit smoking or pay for classes to help them kick the habit.

Despite all these efforts, much remains to be done. Even as large numbers of people quit, 54 million Americans continue to smoke; 6 million are children. Worse still, those who continue to smoke are smoking more per capita and raising profits of tobacco companies to an all-time high. The clear conclusion: The campaign against smoking must be intensified, especially among women and children.

Surveys indicate that many people are fearsomely ill-informed about the grave hazards posed by cigarettes. Even the odds of Russian roulette--one in six--are better than those of smoking, where one in three people with a cigarette habit dies of a smoking-related disease. Such facts have led the surgeon general to conclude that cigarette smoking is the single most important environmental factor contributing to premature mortality in the United States. The United Nations World Health Organization, likewise, asserts: "The control of cigarette smoking could do more to improve health and prolong life than any other single action in the whole field of preventive medicine."

Let's translate these facts into things that happen to the individual. What would happen if, say, I lit a cigarette and drew in smoke?

Almost immediately after inhaling, my blood pressure would rise. My heart rate would increase, and my small blood vessels would constrict, lowering my skin temperature and affecting my eyesight. When I exhaled, about 1,200 chemicals--chemicals also contained in chimney smoke and auto exhausts--would remain in my tissues.

If I became a regular smoker, my chances of having a heart attack would rise dramatically. One-third of the deaths from cardiovascular disease, the leading cause of death in this country, are caused by smoking. Researchers have made statistical adjustments for age, sex, race, education level, alcohol use, cholesterol levels, blood pressure and even the celebrated "Type A" personality--and still they conclude that smoking is directly related to 225,000 cardiovascular deaths in this country each year.

As a regular smoker, I would have a dramatically greater chance of contracting lung cancer. Smoking is the No. 1 cause of lung cancer. Of the people who died last year from lung cancer, 80,000 brought about their own disease by smoking.

If I were a cigarette smoker, I would expose myself to other forms of cancer, such as cancer of the mouth, cancer of the larynx or cancer of the bladder.

As indicated earlier, women smokers who use birth-control pills increase their chances of heart attack exponentially. "No less than five independent studies agree on the association," one Food and Drug Administration commissioner told Congress. "I would be astonished if anyone. . .would challenge. . .the lethality of cigarettes in those who use oral contraceptives."

Pregnant smokers substantially increase the chances that they will miscarry, induce fetal birth defects, bear their infants prematurely and have babies of low birth weight. They increase the likelihood their newborns will die in the first month. Medical journals have reported studies showing that cigarette poisons cross the placenta and can later cause cancer in the child and that maternal smoking can cause daughters to suffer early menopause or decreased fertility. Children of women who smoked while pregnant also display retardation in significant numbers until age 11.

Cigarette smoking has a plethora of other effects of particular concern to women. It interferes with nutrition; it causes sleep difficulties; it promotes blood clots. An especially serious effect, mentioned earlier, concerns the combining of cigarettes with prescribed drugs. Some smokers require twice the quantity of certain drugs before they benefit from those drugs. This phenomenon is true of some drugs used to treat serious conditions, such as acute asthma, and other conditions not as dramatic but widespread--those requiring tranquilizers, analgesics and antidepressants.

What about low-tar, low-nicotine cigarettes? How do they affect the total national health picture? Last year these cigarettes totaled half the national sales. A study conducted recently by the American Cancer Society indicated that smokers switching to these brands may have lower death rates and smokers of these brands might find "cold turkey" quitting easier than they would on regular cigarettes. Yet many scientists, along with government officials who have reviewed their work, feel it is a serious mistake to believe that the low-tar, low-nicotine cigarette solves the problem of health risks. Indeed, they feel evidence shows that such a reduction may actually create new dangers. Cigarette smoke contains more than 2,000 chemical compounds; reducing two of them, albeit the most serious ones, does not negate risks from the others. Moreover, additives are being used to enhance flavor in low-tar cigarettes--additives the cigarette companies have not disclosed.

One dangerous compound found in smoke from all cigarettes, whatever the level of tar or nicotine, is carbon monoxide. This gas tends to "bump" oxygen from red blood cells and depletes the body of this vital element. The carbon monoxide produced by a burning cigarette--including a low-tar cigarette--is sufficient to pose serious dangers to people who most need an oxygen reserve--those with heart diseases and pregnant women. Its tendency to lower oxygen levels may be the cause of retardation or even death in the infants of smoking mothers. Even low concentrations of carbon monoxide are dangerous for patients suffering constricted or blocked blood vessels and for people with atherosclerosis. Carbon monoxide also lowers the threshold of angina, the spasmodic, choking pain caused by heart disease. Some studies show that carbon monoxide may not only make heart disease worse; it may cause the problem.

Nicotine has been classified as an addictive or compulsive substance by growing numbers of scientists and institutions, including the National Institute on Drug Abuse. Perhaps for this reason, smokers of low-nicotine cigarettes tend to compensate by inhaling more strongly; smoking more deeply; smoking to a shorter butt length; puffing more frequently; and consuming more cigarettes. Such actions may explain why many people who smoke low-nicotine cigarettes have had as much nicotine (and sometimes more, depending on their addiction) in their bloodstreams as those who smoke regular cigarettes.

The result, of course, is that the low-tar, low-nicotine smokers may end up with equivalent amounts of nicotine and much higher levels of the other dangerous additives. For these reasons, the surgeon general declares: "There is no safe cigarette and no safe level of consumption; the single most effective way to reduce hazards of smoking continues to be that of quitting entirely."
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Copyright 1984 Gale, Cengage Learning. All rights reserved.

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Title Annotation:hazards of cigarette smoking
Author:Cousins, Norman
Publication:Saturday Evening Post
Date:May 1, 1984
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