20 established causes of deaths caused by cigarettes:
(Surgeon General Report 2014)
11 cancers – Lip and oral, esophageal, stomach, colorectal, liver, pancreatic, laryngeal, lung, urinary bladder, kidney, and
acute myeloid leukemia
6 vascular – ischemic heart disease, other heart disease, stroke, atherosclerosis, aortic aneurysm, other arterial diseases
2 pulmonary – Pneumonia and influenza, COPD
These diseases account for about 83% of the total excess mortality (higher mortality rates than non-smokers) observed among current smokers.
Several causes of death newly associated with cigarette smoking have recently been added as a result of a study of 1 million men and women over a 10 year period. (NEJM 372;7, Feb 12, 2015)
About 9% of both men and women were current smokers.
42% (women) and 58% (men) were former smokers. (56-70% quit over 20 years ago)
49% (women) and 32% (men) never smoked.
Causes of deaths newly associated with smoking (with relative risk compared to non-smokers)
(1.0 is the mortality risk of a non-smoker)
ischemic disorder of intestines – 5.6 (nearly 6 times that of a nonsmoker)
liver cirrhosis – 3.6
cancers of unknown sites – 3.2 ( 2-6% of all cancers)
hypertensive heart disease – 2.9
all other digestive disorders – 2.6
renal failure – 2.1
all infections – 2.2
prostate cancer – 1.2
Most of the remaining 15-17% of excess mortality of smokers over nonsmokers is accounted for by these newly designated diseases.
The relative risks of death for smokers went up as the number of daily cigarettes smoked went up.
The relative risks went down among former smokers as the number of years since quitting went up.
How do people stop smoking?
Conscious decision “cold turkey” (after being scared to death by statistics like this) – 4-7% success rate
nicotine replacement therapy (NRT) – gum,patch, aerosol, lozenges
prescription medication – Wellbutrin, Chantix (always needs to be combined with support or cognitive therapy – even just telephone
counseling) 25% success rate at 6 months
support groups – NA, quitnet.com, Great American Smokeout
hypnosis, acupuncture, mind-body practices, herbals
E-cigarettes – the jury is still out; no consistency of ingredients among brands is one problem in evaluating health risks.
filter cigarettes – do not reduce nicotine inhaling; actually can increase craving
magnet therapy – “a small magnet on each ear”
chewing or other oral tobacco
The addiction to nicotine and to marijuana can be mapped using functional MRIs to the same part of the brain – the part of the brain that “lights up” with cocaine ingestion. Some treatment programs and several research projects are honing in on this “dual addiction” of cigarettes and joints.
Interestingly, ingestion of the most common food “addictions”, ice cream, pizza and french fries, also maps to this same part of the brain. Maybe as we get fatter and happier as a nation by using these substances other than tobacco, we will smoke less cigarettes, and live longer!