Because of the way newspapers, radio, and TV deal with risk, it’s difficult for us to understand the relative importance of the various risks in our lives. We read newspaper headlines about products that have been taken off the market because consuming them might lead to a one-in-a-million chance of getting cancer. Many smokers quite understandably feel that if cigarettes really posed a substantial health risk, they would hear more about it than they presently do. Unfortunately, this is not the case.
1,475 Deaths Per Day
If three commercial 747 jumbo jets were to crash every day for an entire year, it would certainly make front-page news. And deservedly so, for this would add up to about 540,000 deaths per year. But according to one current estimate, the number of premature deaths caused or accelerated by cigarette smoking works out to the same number. This adds up to 1,475 deaths per day. Other experts have estimated the number of excess deaths at 350,000 per year, “merely” 1,000 excess deaths per day.
If you knew that three jumbo jets would go down in flames today, you would probably be extremely wary about boarding a commercial airliner. Yet 54 million smokers light up every day, most of them without a second thought.
What makes a ”Tragedy”?
The risk of dying in a plane crash and the risk of smoking related disease are treated quite differently for a number of reasons:
Unexpected, surprising news triggers terror and fear, while the “same old story” has lost its news value and is easily ignored. Furthermore, when misfortune befalls a large group of people together, it is perceived as much more “tragic” than if the same number of individuals were to suffer a similar fate individually. Thus, if a bus containing sixty people is involved in a traffic accident and all occupants are killed, this is considered a much more important “tragedy” than if sixty motorists were to die in sixty separate accidents.
Voluntary vs. Involuntary Risks
In addition to the factors above, people will accept risks that are substantially higher—as much as 100 times higher—if they are able to choose such activities freely. People don’t like to be forced to accept risks—even though they might choose to take similar or greater risks in other matters. This helps explain the unwillingness of nonsmokers to accept even the relatively small risks of “passive” smoking—because they are forced to breathe tobacco smoke against their will.
Some smokers console themselves that although smoking may indeed be dangerous, they could just as easily be murdered on the street or die in an auto accident. But a review of the facts makes it clear that this is little more than a convenient self-deception. Of every 1,000 young male smokers, one will be murdered, six will die on the roads, and 250 will be killed by tobacco related diseases.
Average Risks vs. Actual Risks
The smoking-related risks of heart disease, cancer, and other diseases are already discussed in the previous chapter. But these are all average risks. Some smokers are at even higher risk of being injured or killed by smoking. You may be at increased risk if:
• You have a medical condition that is make worse by smoking;
• You have an inherited susceptibility to a smoking related disease;
• You are exposed to environmental or occupational toxins;
• You are an especially heavy smoker;
• Psychological or social factors might make it especially difficult for you to quit, even if you should decide to do so.
Risk is Proportional to Total Lifetime Dose
When a physician or other health professional takes a complete medical history, one item that is always included, for smokers, is the Total Lifetime Dose (TLD) of tobacco smoke. The TLD, usually expressed in pack-years, is a rough approximation of the number of cigarettes you have consumed over your lifetime. One pack-year equals 365 packs or 7,300 cigarettes. Since patterns of inhalation vary widely from smoker to smoker, a pack–year is a relatively rough measure.
Two smokers’ actual effective dose of tar, carbon monoxide, and nicotine may vary considerably, even though they may have smoked the same number of cigarettes over their lifetime:
• Those who smoke low-tar brands may be exposed to less tar (though not necessarily less carbon monoxide) than those who smoke unfiltered, high-tar brands.
• Those who take more puffs per cigarette are at greater risk than those who take fewer puffs.
• Those who smoke their cigarette farther down, leaving shorter butts, are at greater risk than those who extinguish their cigarette earlier.
• Those who inhale deeply are at greater risk than those who inhale little or no smoke.
With these qualifications, the factor that seems to be proportional to risk is your total lifetime dose (TLD)--the total number of cigarettes you have smoked since your very first cigarette.
Calculating Your Lifetime Dose
Your total lifetime dose is proportional to the average number of cigarettes smoked per day times the number of years you have smoked. This number is relatively easy to calculate:
1. Determine the number of years you have smoked.
2. Determine the approximate number of packs you smoked per day for each year
3. Add up the pack-year figures to get your lifetime smoking dose.
Your health risk is roughly proportional to your total lifetime dose. The greater your lifetime dose, the greater your risk of coming down with a smoking-related disease. Thus, if you have smoked three packs a day for fifty years, you would have a TLD of 150. If you have smoked ten cigarettes per day for four years, you would have a TLD of 2.
Ten Types of High-Risk Smokers
The sections that follow outline ten risk factors than can make some individuals more vulnerable to smoking-related injury or disease. These high-risk categories are as follows:
1. Pregnant women.
2. Women over thirty who take birth control pills.
3. Members of families at high risk for heart disease.
4. Smokers who already have smoking-related diseases.
5. Smokers exposed to toxic agents in the workplace
6. Smokers with high-risk lifestyles.
7. Smokers with high-risk personalities.
8. Smokers about to undergo surgery.
9. Smokers with abnormal lab tests or family histories.
10. Smokers who are heavily addicted to nicotine.
1. Pregnant Women
The babies of women who smoke suffer from a variety of negative consequences, including lower birth weight, shorter stature, smaller head and arm circumferences, higher risk of prematurity, higher risk of spontaneous abortion, decreased fetal movements, increased risk of early rupture of fetal membranes, and higher risk of neurological impairment when compared to the babies of nonsmokers. The decrease in birth weight is greatest if the mother is a heavy smoker. Maternal smoking has negative effects on the baby’s breathing; moreover, the baby’s heart rate increases as soon as its mother lights up a cigarette. Overall, the risk of death during or before birth is 27 percent higher for the babies of smoking mothers.
Smoking slows the baby’s growth through two independent pathways:
• Carbon monoxide poisoning—Carbon monoxide passes freely from the mother’s circulatory system into the baby’s bloodstream and tissues, decreasing the baby’s available oxygen levels.
• Increased catecholamine levels—Nicotine increases the release of catecholamines, hormones that narrow the baby’s arteries and limit blood flow.
Most researchers would now agree that prospective mothers who smoke during pregnancy may well be committing inadvertent child abuse. If there is one group of smokers who should most definitely quit smoking – it is pregnant women.
If all efforts fail at quitting, pregnant women should at the very least:
1) Reduce their smoking to five or less low-tar cigarettes per day
2) Supplement their diet with extra portions of milk, eggs, and cheese during their pregnancy.
It is now a well-established fact that reduction of smoking during pregnancy improves the birth weight of the infant. Quitting smoking altogether during pregnancy provides optimal conditions for fetal growth.
2. Women Over Thirty Who Take Birth Control Pills
Mixing cigarettes and birth control can lead to heart attack and stroke. Risks are particularly high for smokers over 40. The risks are higher for women who smoke more than 25 cigarettes per day. Women under 35 can take the Pill without increasing their risk to dangerous levels – provided they do not smoke. Women over 40 who do not smoke should take the Pill only in extreme situations. Smokers over 30 who are on the Pill and are unable to quit should switch to another form of birth control.
3. Members of Families At High Risk for Heart Disease
Have any of your close relatives died of heart disease before age 45? If they have, and you smoke, you have three times the normal risk of developing smoking-related heart disease.
4. Smokers Who Already Have Smoking-Related Diseases
Such diseases include heart disease, lung cancer, emphysema, chronic bronchitis, ulcers, high blood pressure, diabetes, osteoporosis, blood clots in the legs, and glaucoma.
5. Smokers Exposed to Toxic Agents in the Workplace
No chemical or industrial by-product comes close to equaling tobacco smoke as a health hazard. Researchers estimate that smoking 1.4 cigarettes produces a risk of loss of life comparable to consuming 100 charcoal-broiled steaks or living near to a polyvinyl-chloride (PVC) plant for 20 years. The categories of workers listed below may be exposed to toxic substances that combine with tobacco smoke to put smokers at a significantly greater risk than nonsmokers exposed to these same substances:
• Workers exposed to carbon monoxide (firefighters, traffic control officers, traffic police, bus drivers, tunnel workers, turnpike workers).
• Workers exposed to asbestos. Asbestos workers who smoke may be at 50 times risk of lung disease compared to nonsmokers not exposed to asbestos.
• Workers exposed to sulfur dioxide, uranium, coal and coal dust, cotton dust, mineral dusts, and other particulate matter (silica, mica, iron oxide, aluminum oxide) show small airway damage similar to that suffered by asbestos workers. They may be at similar risk for lung disease.
• Quarry workers, mine workers, grain workers, forestry workers, woodworkers, construction workers, iron and steel foundry workers, aluminum workers, shipyard workers, car industry workers, rubber workers, hospital workers exposed to high levels of ethylene oxide (a chemical used to sterilize surgical instruments).
• Workers exposed to arsenic, beryllium, chloromethyl ethers, chromium, radiation, mustard gas, or nickel, and those who worked in factories manufacturing polyvinylchloride before 1975.
6. Smokers With High-Risk Lifestyles
Current research suggests that the following groups of smokers are at increased risk from smoking and/or are much more likely to smoke:
• People who are overweight, especially those with substantial fat deposits in their abdomens, in other words a big gut. Here’s the easiest way to find out whether you are at risk for both heart attack and stroke: Take your waist and hip measurements, and then divide your waist measurement by your hip measurement. A ratio of more than 1.0 in men or 0.8 in women suggests that you may be at increased risk.
• People who are extremely thin.
• Heavy drinkers.
• People who are unmarried, divorced, or separated.
• Lack of exercise.
7. Smokers With High-Risk Personalities
Research has shown that smokers have different personalities than nonsmokers. Smokers tend to be more extroverted, defiant, and impulsive. They are more likely to take risks and more likely to be divorced or separated. They consume more alcohol, coffee, psychoactive drugs, and aspirin than nonsmokers.
8. Smokers About to Undergo Surgery
Studies show that complications during surgery are as much as 2.4 times higher in smokers. This effect can be considerably reversed by a mere 12 hours without cigarettes. The principal culprit is carbon monoxide. Smoking reduces the oxygen-carrying capacity of your blood. This is especially dangerous during anesthesia.
9. Smokers With Abnormal Lab Tests or Family Histories
The following risk factors may significantly increase your smoking risks:
• A family history of high blood pressure.
• High serum cholesterol.
• Emphysema.
• High heart rate.
• Abnormal EKG (also called ECG: electrocardiograph).
• High hematocrit. The hematocrit measures the percentage of blood volume that is made up of red blood cells.
10. Smokers Who Are Heavily Addicted to Nicotine
Persons who are strongly addicted to nicotine are usually heavier smokers and tend to have a more difficult time cutting down or quitting because of their extreme degree of nicotine dependence. One key sign of being heavily addicted is needing a cigarette immediately after waking up. The number of minutes between waking up and lighting the first cigarette of the day appears to be a useful index of addiction. Other signs of intense addiction are:
• Experiencing the first cigarette of the day as the most satisfying.
• Smoking heavily first thing in the morning.
• Having difficulty refraining from smoking in no-smoking areas.
• Smoking more than 25 cigarettes per day.
• Being unable to cut down or quit when you are ill.
• Smoking high-nicotine or unfiltered cigarettes.
• Inhaling deeply on every puff.
• Smoking each cigarette down to a short butt.
• Lighting a new cigarette right after finishing the last one.
• Experiencing severe anxiety about running out of cigarettes.
