21.01 Epidemiology of Cigarette Smoking

Cigarette smoking greatly increases the risk of cardiovascular disease. There is an increased risk of heart attacks, strokes, coronary artery disease, peripheral arterial disease, impotence, hypertension, and heart failure. Typically, men who smoke have a 3.5 times and women 4.8 times higher risk than never smokers of having a coronary event. People who smoke cigarettes have a three-fold increase in risk of stroke.

Cigarette smoking greatly increases the risk of cancer. Cancers that cigarette smoking increases the risk include cancer of the lung, mouth, larynx, esophagus, bladder, pancreas, colon and cervix. Lung cancer was almost unknown before the introduction of cigarettes.

In addition to cancer, cigarette smoking causes other respiratory disorders such as COPD (chronic obstructive pulmonary disease), which is a combination of emphysema and bronchitis. Eighty percent of cases of COPD are due to smoking cigarettes. Cigarette smoking is also a cause of end-stage renal failure. Smoking during pregnancy leads to an increased risk of miscarriage, and premature labor, and the infant’s risk of cot death.

One of the reasons that people are encourage to give up, is that some of the effects of cigarette smoking are reversible. Thus, it is never too late to quit, as 4-6 years after quitting, the risk of strokes, heart attacks etc are the same as for non-smokers. Even those smokers who wait until they have a heart attack to quit live longer. However, some effects are not reversible e.g. the lung damage associated with COPD.

Smoking cigarettes is most common cause of preventable death and disease. The World Health Organization estimates that 100 million people will die from tobacco-related diseases over the next 30 years, and this is more than from AIDS, tuberculosis, car accidents, homicide and suicide combined.

In Australia, about half of the Aborigines smoke cigarettes and a third of all Aboriginal deaths are due to smoking related disease. Smoking rates are lower for non-Aborigines in Australia, with about one in five smoking cigarettes. Analysis of who is most likely to smoke has shown it is those with no qualifications, unemployed, or earning less than $30,000/year. Thus, smoking cigarettes is no longer considered glamorous. It is not only the tobacco (nicotine) in cigarettes that is poisonous, as the tar and carbon monoxide produced by burning cigarettes is also toxic. There is some controversy over the fact that sweeteners are added to cigarettes, presumably to make them more palatable, and attract younger people to smoking.