Of the 45 million Americans who smoke tobacco each year, approximately 1.35 million will quit successfully and about 435,000 will die from smoking-related diseases (1). Unfortunately, the number of new smokers each year nearly matches the attrition rate, so the year-to-year decline in smoking rates has been slight. In stark contrast, nearly 30 million smokers attempt to quit each year and fail, which emphasizes just how addictive tobacco is. These unfortunate people, if they are lifelong smokers, will face a 50% chance of developing a fatal smoking-related disease and dying prematurely. Tobacco use is responsible for a full 20% of all deaths each year, all of them preventable.
Of the 435,000 people who die each year from smoking-related diseases, about 30% will die from lung cancer (2). Lung cancer is almost always fatal by the time it is detected. Chronic Obstructive Pulmonary Disease (COPD), a severe and irreversible form of lung disease, affected 12.1 million Americans in 2002 (3). Current estimates suggest close to 90% of COPD cases worldwide can be attributed to a history of smoking tobacco (4). Tobacco use also increases the risk of developing hypertension, cardiovascular disease, stroke, and other forms of cancer besides lung (3), and smokers often suffer from more than one disease at a time.
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Not only do smokers have an increased risk of developing serious, mostly fatal diseases, but their nonsmoking friends and family members do as well. Nonsmokers exposed to secondhand cigarette smoke at work suffer a 20 to 30% increased risk of developing cardiovascular disease and lung cancer (5). Pregnant women who smoke also put their infant at risk for a 40% reduction in newborn lung function and developing childhood asthma and COPD later in life (6). The numbers of potentially affected newborns is quite large, over 400,000 per year in the United States alone.
Nicotine, the main addictive component of cigarette smoke, acts on brain neurotransmitters to enhance mood, cognitive acuity, and physical energy (1). Nicotine is rapidly absorbed into the blood and finds its way to the nervous system within seconds after inhaling, where it binds to cells and triggers the release of a number of neurotransmitters including GABA, glutamate, and dopamine. Dopamine is part of the pleasure seeking circuitry in the brain and nicotine produces a sense of well-being (1). Unfortunately, nicotine results in habituation of neurotransmitter circuits, which leads to increased tobacco use in an attempt to feel good again and avoid symptoms of withdrawal. Smokers going through withdrawal experience irritability, craving, restlessness, anxiety, and despondency.
The dangers of tobacco use are quite clear from recent research studies and the societal cost is immense; approximately 7.5 trillion dollars during the lifetime of all smokers in the United States combined (7, 8). On an individual basis, the lifetime cost is approximately 106,000 and 220,000 dollars per female and male smoker, respectively (7).
1. N Engl J Med (2010), 362(24):2295-2303
2. Oncogene (2002), 21:7326-7340
3. Intl J COPD (2009), 4:351-363
4. J Physiology Pharma (2008), 59(Suppl 6):19-34
5. Am J Pub Health (2007), 97(8):1376-1382
6. Lung (2009), 187(5):281-289
7. “The Price of Smoking” (2004), MIT Press
8. Jane Russell’s Health Facts (2010), http://www.jrussellshealth.org/smokwomen.html
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