Fifty most often asked questions

Fifty most often asked questions about smoking and health.

(Information supplied by: Canadian Cancer Society)

1. Is there a safe cigarette?
No. Cigarettes are perhaps the only legal product whose advertised and intended use -- that is, smoking them -- has a great capacity to cause bodily harm.

2. Can one smoke a small number of cigarettes without risk?
No. Since every cigarette may cause some harm to the body, even relatively light smokers may show lung damage on autopsy. Besides, in practice, most smokers seem to find it difficult to smoke only a few cigarettes. However, the more cigarettes smoked, over time, the higher the risk of smoking-related disease.

3. How long does it take for a cigarette to harm a smoker?
The moment the smoke touches the lips, it begins to attack living tissues and continues to do so wherever it goes; mouth, tongue, esophagus, air passages, lungs, stomach, and its breakdown products eventually reach the bladder, pancreas, and kidneys.

4. What does nicotine do?
Nicotine, an alkaloid poison found in nature only in tobacco, is a powerful stimulant to the brain and central nervous system. However, it can also have a depressant effect. Nicotine causes blood pressure to rise and increase heart rate by as many as 33 beats a minute. The first daily dose of nicotine stimulates the large bowel, while curbing appetite and slowing digestion. It also lowers skin temperature and reduces blood circulation in the legs and arms. Nicotine, in new smokers, brings on nausea. In fact, it is always nauseating to any smoker who gets too much of it -- sixty milligrams of nicotine -- by paralyzing breathing. It's about as lethal as cyanide. The reason it doesn't kill smokers quickly is that they take tiny doses, which are quickly metabolized and excreted by the body.

5. What in cigarette smoke causes disease?
Cigarette smoke "tar" is made of several thousand solid chemicals, many of which have been implicated in disease. Among the chemicals in cigarette smoke are acids, glycerol, glycol, alcohols, aldehydes, ketones, aliphatic and aromatic hydrocarbons, phenols, and such corrosive gases as hydrogen cyanide and carbon monoxide. Heart and circulatory disease, lung and other cancers, emphysemas and chronic bronchitis have been experimentally linked with certain of these substances. All these conditions are disabling and potentially lethal.

6. What is the effect of carbon monoxide (CO) in cigarette smoke?
Carbon monoxide (CO), which makes up about 4% of the smoke of the average cigarette, has a stronger affinity for red blood cells than does oxygen-which red blood cells are meant to distribute to the body's tissues. Thus, CO in smoke will replace the oxygen in red cells, forming carboxyhemoglobin (Cohb). On average, smokers have from 2.5% to 13.5% more Cohb in their blood than non-smokers. While nicotine causes the heart to work harder, Cohb deprives it of the extra oxygen this demands. CO also promotes cholesterol deposits in arteries. It impairs vision and judgment, and reduces attentiveness to sounds. Thus, CO is dangerous to drivers, reduces athletic performance, and poses particular hazards to flight crews.

7. But aren't bad effects of inhaling these substances temporary?
Most are, but in smokers they are repetitive and cumulative -- a pack a day smoker inhales smoke about 102,000 times a year. If this continues year after year, the smoker's chance for contracting a serious smoking related disease is seriously increased.

8. Then is all smoking damage permanent?
No, not if the smoker stops soon enough. In smokers who have stopped before the onset of irreversible heart and circulatory disease, the body begins to repair itself. Normally, after a year of non-smoking, the risk of a heart attack is halved; after ten to fifteen years of non-smoking, it's about the same as that of someone who has never smoked. While smoking, the risk for lung cancer continues to rise. However, once a person stops smoking, the risk for lung cancer levels off and may even decrease. The cough of chronic bronchitis usually disappears when smoking is dropped but the progression of emphysema may continue.

9. What about filters?
Smokers of filter-tip cigarettes may have a slightly lower risk of lung cancer than those who smoke non-filter cigarettes; but they still have greatly increased risks of heart attack and emphysema.

10. What about the low tar/nicotine brands?
Theoretically, the low tar and nicotine brands that have taken over a large share of the Canadian cigarette market in the past few years may offer a slightly reduced risk of lung cancer. But only theoretically. Several facts not widely known are: 1. The "light" effect is generally achieved through air dilution using ventilation holes near the filter. 2. Regular smokers who switch to those low tar and nicotine cigarettes tend to compensate by smoking more cigarettes, or by inhaling more deeply and longer, or by covering up the ventilation holes. Thus they do not really reduce the amount of tar and nicotine they inhale. 3. Smokers of these cigarettes have a greatly increased risk of heart attack because they get more carbon monoxide by inhaling more deeply and longer.

11. Are mentholated cigarettes more or less harmful?
About 4% of all Canadian cigarettes sold contain some menthol. The mentholated brands contain enough to produce a cool sensation in the throat when smoke is inhaled. Menthol does not add or detract from the harm caused by cigarettes, so far as tests show.

12. Has it been scientifically proven that cigarette smoking causes cancer?
Smoking is estimated to be responsible for 30% of all cancer deaths and specifically related to about 87% of lung cancer cases. It is also a contributory factor for the development of cancer of the throat, mouth, bladder, kidney and pancreas.

13. What in cigarettes causes lung cancer?
According to the 1989 Surgeon General's report, 43 human and/or animal carcinogens have been found in tobacco smoke. A number of others are co carcinogens -- that is, they produce cancer when combined with other chemicals present in smoke. Some are tumor promoters; once a cancer starts, they cause it to grow faster. These effects have been identified in the standard "bioassays" used by the government and by the cigarette industry -- painting tar on the shaved backs of mice, or exposing animals to smoke gases. Anything that causes skin tumors -- even non cancerous tumors -- on mice is assumed to be hazardous for smokers; the inside of the lungs is made up of tissues very much like those of skin. And mouse skin is similar to human skin.

14. What are the chances of being cured of lung cancer?
Very low; the five-year survival rate is less than 15%. Most forms of the disease start insidiously and produce no symptoms until far advanced; consequently, it is often difficult to detect early enough for a cure. Fortunately, lung cancer is largely a preventable disease. That is, by not smoking.

15. Do cigarettes cause other lung diseases?
Cigarette smoking is recognized as being the major cause of emphysema - a chronic obstructive lung disease that gradually destroys breathing capacity. All adults start with about 85 square metres of interior lung surface. This large surface is created by the lungs' thousands of tiny air sacs. In emphysema, the walls between the sacs break down, creating larger and fewer sacs -- thus gradually diminishing interior lung surface. The process appears to proceed with continued cigarette smoking. Eventually, lung surface, through which vital oxygen is taken from air into the blood, is so small that patients spend most of their energy in trying to breathe. Emphysema cripples its victims and kills over 1,100 Canadians each year.

16. If you smoke cigarettes and don't inhale, is there any danger?
Whenever smoke touches living tissue, it apparently does harm. All smokers have an increased risk of lip, mouth and tongue cancer -- no matter what they smoke. And all smokers have a greatly increased risk of lung cancer. However, in order to derive nicotine from the kind of tobacco typically used in cigarettes, cigarette smokers must inhale the smoke. Cigarette smoke is slightly acid and its nicotine doesn't penetrate mouth tissues. But pipe and cigar smoke, which is alkaline, permits nicotine to enter the bloodstream via the mucous tissues of the mouth.

17. Why do smokers have a "cigarette cough?"
The irritants in smoke provoke the protective mechanisms of the air passages and lungs; this causes coughing. The well-known early morning cough of smokers is a separate phenomenon. Cigarette smoke has as anesthetic effect of cilia, tiny hair like structures lining the airways that normally beat outwards, forcing foreign matter from the lungs. When they stop, some of the poisons in the smoke remain in the lungs. During the hours of sleep, the cilia recover and begin working again. Hence, when smokers arise, they cough because their lungs are attempting to clear the deposits of the previous day's smoking. When cilia are repeatedly exposed to smoke over a long period of time, however, their action is permanently destroyed. Then smokers' lungs are even more exposed to damage than before.

18. Does cigarette smoking affect the heart?
Yes, based on Health Canada figures, the Heart and Stroke Foundation of Canada estimates that smoking plays a role in 30% of deaths due to some form of heart disease and stroke -- that is about 16,000 deaths per year in this country.

19. Is there any smoking risk for pregnant women and their babies?
Pregnant women who smoke have a higher rate of spontaneous abortion (miscarriage), still birth, premature birth, and babies who weigh below average at birth (with consequent risk of disease and/or death). More of their babies die soon after birth than those of non-smoking mothers.

20. What about smoking and "the pill"?
Women who use birth control pills have twice the risk of having a heart attack as non pill users, but women who use the pill and smoke have ten times the risk of heart attack.

21. Are there risks on smoking you haven't mentioned?
According to the U.S. Surgeon General, smoking cigarettes is "the primary cause of drug interactions in man." That is, the effects of any medication taken by a patient may be changed or rendered ineffective by smoking. Diagnostic tests may give seriously inaccurate results in smokers.

22. How can cigarette smoke have such a wide variety of health effects?
It can because cigarette smoke is composed of a large number of different substances that affect many parts of the body. Cigarette "tar" -- a short name for the condensed solid particles in smoke -- contains about 4,000 known chemicals, including poisons and cancer-causing substances.

23. Why don't all cigarette smokers get lung cancer?
An estimated 10% to 15% of long-term smokers do die of lung cancer. Many more die early due to heart attacks. People react differently to all substances for a variety of reasons, including genetic and biological make-up. Since cigarette smoke contains so many thousands of chemicals, it's no wonder that every smoker doesn't contract the same disease. But overall the fact is inescapable: cigarette smokers die younger than non-smokers. That is why many life insurance companies are now reducing life insurance policy premiums for non-smokers. According to the World Health Organization, "Death rates are uniformly higher among smokers that among non-smokers in both sexes...whatever the age at death." Among smokers, the death rates from many causes increase with the number of cigarettes smoked per day, the number of years the smokers has smoked, and the earlier the age at which smoking was started. Other variables include depth of smoke inhalation, tar/nicotine levels in smoke inhaled, and the number of puffs per cigarette.

24. Do non-smokers get lung cancer?
Lung cancer is extremely rare in non-smokers. A small number of lung cancers may be due to exposure to certain chemicals at work, exposure to radon gas and exposure to second-hand tobacco smoke. It was estimated in 1985 that about 330 Canadians die from lung cancer as a result of long-term exposure to the tobacco smoke of other people at home, at work and in other locations.

25. Does air pollution cause lung cancer?
Perhaps, to a small degree. In industrial areas or cities heavily polluted with smog, lung cancer rates are slightly higher than in rural areas. But in both places, the lung cancer rates are always very much higher among smokers than non-smokers because pollutants in the air are more diluted than those in cigarette smoke. In certain industries where there are high concentrations of radio-active dust or other carcinogens, the lung cancer rate is much greater than in the general population. But even among these exposed groups, the lung cancer rate of smokers in the same occupation -- indicating a strong multiplying effect between cigarette smoke and occupational exposure.

26. Supposing I smoke for a while and then quit?
This answer has two parts: 1. Most smokers, even teenagers, show evidence of early airway and lung disease -- chronic bronchitis (characterized by excess mucous, hacking coughing, spitting) and emphysema. This deterioration of the lungs is why smokers get out of breath more quickly than non-smokers. And this condition becomes progressively worse as long as smoking continues. 2. It doesn't take very long for a novice smoker to defeat the body's natural repulsion to nicotine and become habituated to it. Once this happens, it is extremely difficult to stop smoking. Also, cigarettes become a crutch to support stress, a weapon to fight anger and frustration, and a means of enhancing pleasure. And for many, smoking becomes not merely a habit, but a very strong addiction to nicotine. In one study, opiate addicts reported that they could more easily do without these drugs than cigarettes.

27. Is cigarette smoking truly addictive?
Yes, cigarette smoking can become an addiction in the same way as the use of alcohol, tranquilizers, and other drugs. The essential features of addition include: compulsive use of a substance (i.e.., use that is no longer under the voluntary control of the user), tolerance (a need to increase the dose to achieve the same effect), and often physical dependence, as shown by withdrawal symptoms when use of the substance is stopped. Many cigarette smokers show all of these features.

28. Are there true withdrawal symptoms?
Yes, these symptoms include changes in temperature, heart rate, digestion, muscle tone, and appetite. They also include irritability, anxiety, craving for tobacco, sleep disturbances, and other more 'subjective' symptoms. They generally diminish in seven days, but may not disappear entirely for weeks or months.

29. Why do people begin to smoke?
It's generally accepted that it's "peer pressure" that encourages many young people between the ages of 10 and 18 to begin experimenting with smoking. The most common motives are to appear grown up, to imitate elders, often parents or older brothers or sisters, to rebel against authority or to be the same as others in their peer group. These motives are often contradictory, but smoking is not essentially a rational decision. Unfortunately, the average starting age for smoking has continued to drop. Among children ages 3-7, 25% have tried smoking and of those, 80% say they would like to smoke in the future.

30. What kind of people smoke?
Consistently, studies show that smoking cigarettes varies in inverse ratio to education and income. That is, the best educated highest income groups in the population contain the least number of smokers. Some groups have particularly high smoking rates i.e..: young people who are school dropouts, native Canadians, Francophones in Quebec and Ontario, those who use alcohol or other drugs.

31. How many people smoke cigarettes in Canada?
In 1994/95, an estimated 6.9 million Canadians over the age of 15 were cigarette smokers.

32. How much do they smoke?
Canadian consumption of cigarettes and fine-cut tobacco (roll your owns) in 1996 totaled 50 billion units; this amounts to about one pack per day per smoker. 33. Is the number of Canadian smokers growing? The decline in the prevalence of smoking has stopped. Statistics show that the overall prevalence of smoking remains stable. However, prevalence of smoking among 15-19 year olds increased 12% in 1990 to 29% in 1994-95, which is a serious step backward to the 1985 rate.

34. Do more men than women smoke?
According to a survey conducted in 1994-1995, overall, men were more likely than women to be smokers: 33% versus 29%. Among people aged 15 to 19, this trend is reversed; smoking was higher among young women than young men (30% compared to 28%).

35. How about young people?
According to a 1994-95 national population health survey, about 29% of Canadians aged 15-19 smoked. Far too many people started smoking, influenced by family, friends and tobacco marketing to believe that smoking is a desirable, adult behaviour. Surveys also show that smoking uptake is increasing among young people, particularly among young women.

36. Why do people continue to smoke?
When large numbers of people smoke a vegetable or plant derivative -- marijuana, hashish, and opium are example -- it's always to get a kick of a "psychoactive" drug, a drug that affects their mood. Tobacco is the only plant that contains nicotine, a powerful psychoactive drug. Inhaling cigarette smoke, the smoker gets an immediate concentrated dose of nicotine in his blood stream. It hits his brain within six seconds -- twice as fast as mainlining heroin.

37. How does the habit take hold?
It is now generally recognized by experts in this field that nicotine is capable of producing dependence. Though it often makes novice smokers ill, it also produces relaxing, stimulating, or other pleasurable or rewarding effects in the user. With repeated use, smokers become tolerant to the disagreeable effects and no longer become nauseated or ill when they smoke. Therefore, the rewarding effects become much more significant and can lead to compulsive use. The resulting dependence on nicotine -- both psychological and physical -- is responsible for the persistence of the cigarette habit even in smokers who know that it may be (or is) harming their health.

38. How many smokers would like to quit?
CCS surveys show that over 85% of cigarette smokers would like to stop. In 1994, almost 75% of Canadian smokers reported having tried to quit at least once.

39. Do any succeed?
Yes, every year thousands of Canadians stop smoking, many because of health reasons. For those people it's a question of motivation. As with any addictive drug, giving it up is always possible if the motive is strong enough.

40. How do most people quit smoking?
Quitting smoking isn't usually an event -- it's a process. About 95% of smokers who quit do so on their own, "cold turkey". They may try several times before they succeed permanently. Almost anything may help individuals give up or stay off cigarettes -- it depends on their motives for smoking, and how addicted they are. The Canadian Cancer Society offers self-help materials which have aided many smokers in stopping smoking. Others may need the support of quit -- smoking groups or nicotine replacement therapy. There is no one right way to quit -- since smoking is done for a variety of personal reasons; stopping smoking, too, will be accomplished differently by different smokers. Anything that's legal, ethical, moral and effective is worth trying -- this could include gum chewing, carrot sticks, hiding ashtrays, taking long walks, spending time in a library or any place that doesn't permit smoking.

41. Once I stop smoking can I take a cigarette now and then?
No, nicotine seems to create permanent tolerance in the body. When ex-smokers take a cigarette, even years after quitting, the nicotine reaction is triggered and they are quickly hooked again. In the same way that a recovering alcoholic can never drink again, an ex-smoker should never smoke again.

42. If people stopped smoking, what would happen to tobacco farmers?
During the 1980's, the number of tobacco growers in Canada declined by about 50%. In 1986, the government instituted the Tobacco Diversification program (TDP) which offers assistance for farmers wishing to diversify out of tobacco growing and supports the development of alternative crops and markets for tobacco growers. Since the TDP was introduced, an estimated 44% of flue-cured producers have taken advantage of this program.

43. Doesn't tobacco pay a great deal of tax?
In 1991, consumers spent over $10.1 billion on tobacco products. Of this about $6.6 billion went to the federal, provincial and territorial governments in the form of taxes. There is no denying that this is a substantial amount of money but it amounts to less than 2% of federal and provincial revenues.

44. If the entire country stopped smoking would it cause an economic hardship?
Considering that the number of people who smoke should gradually decrease, any economic effects would be slowly absorbed. When people stop smoking completely, the country will save money. In 1993, the societal costs attributable to smoking were estimated to be $11 billion, which is far higher than the income from tobacco. These costs of tobacco use include foregone income due to early death, disability, hospital costs, physician costs, fire damage and so forth. However, the very real costs of the premature loss of a loved one, or the pain of illness, cannot be measured in dollars.

45. What is second-hand smoke?
Second-hand smoke, or passive smoking, is the inhaling of smoke in smoke-filled atmospheres by people who don't smoke. They inhale a good deal of side stream smoke, that is, smoke that is not drawn through the cigarette. Smoke exhaled by smokers is filtered by their lungs; undiluted side stream smoke contains much higher percentages of tar, nicotine, and noxious gases than inhaled smoke.

46. Is second-hand smoke hazardous?
Tobacco smoke, a major indoor pollutant, is dangerous to people with certain kinds of heart disease. It causes breathing difficulties in some and sets off allergic reactions in others. By 1989, some twenty scientific studies had shown an increased risk of lung cancer among the non-smoking wives of cigarette smokers. This leads to strong concern for the health of non-smokers who are frequently exposed to second hand smoke at home or in the workplace.

47. Does second-hand smoke affect children?
Children in households where one or both parents smoke have double the amount of bronchitis or pneumonia during the first year of life as children in non-smoking households. They also have more adenoid and tonsil operations than the children of non-smokers.

48. Is smoking marijuana safer than smoking tobacco?
Marijuana cigarettes contain much more "tar" than tobacco cigarettes. They are also smoked differently -- inhaled very deeply, the smoke held for a long time in the lungs, and smoked to the very end where tar concentrations are highest. All these suggest that smoking marijuana -- even though most marijuana smokers use fewer cigarettes than do tobacco smokers -- may be even more likely to cause cancer than tobacco. It is also more irritating, causing more bronchitis.

49. Is chewing tobacco safe?
No, several studies and significant medical experience show that those who chew tobacco have an increased risk of cancer of the oral cavity. In India, where the habit is widespread, this has been well documented. People who chew tobacco become as addicted to nicotine as smokers. Nicotine from this source, unlike cigarettes, is absorbed through the mouth's mucous membranes. Tobacco chewers may be tempted to switch from smokeless tobacco to smoking cigarettes because nicotine is even more quickly available to the body when inhaled in cigarette smoke.

50. What about snuff?
Dipping snuff isn't either. Habitually rolled in a pellet and placed between the gum and the cheek, snuff increases risk of cancer of the oral cavity and larynx. Like tobacco chewers, snuff users become habituated to nicotine and may be tempted to switch to cigarettes to get larger and quicker dose of that drug.

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