Smoking 101 Fact Sheet
May 2007
Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality worldwide. Smoking-related diseases claim an estimated 438,000 American lives each year, including those affected indirectly, such as babies born prematurely due to prenatal maternal smoking and victims of "secondhand" exposure to tobacco's carcinogens. Smoking costs the United States over $167 billion each year in health-care costs including $92 billion in mortality-related productivity loses and $75 billion in direct medical expenditures or an average of $3,702 per adult smoker.1
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Cigarette smoke contains over 4,800 chemicals, 69 of which are known to cause cancer. Smoking is directly responsible for approximately 90 percent of lung cancer deaths and approximately 80-90 percent of COPD (emphysema and chronic bronchitis) deaths.2
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About 8.6 million people in the U.S. have at least one serious illness caused by smoking. That means that for every person who dies of a smoking-related disease, there are 20 more people who suffer from at least one serious illness associated with smoking.3
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Among current smokers, chronic lung disease accounts for 73 percent of smoking-related conditions. Even among smokers who have quit chronic lung disease accounts for 50 percent of smoking-related conditions.4
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Smoking is also a major factor in coronary heart disease and stroke; may be causally related to malignancies in other parts of the body; and has been linked to a variety of other conditions and disorders, including slowed healing of wounds, infertility, and peptic ulcer disease. For the first time, the Surgeon General includes pneumonia in the list of diseases caused by smoking.5
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Smoking in pregnancy accounts for an estimated 20 to 30 percent of low-birth weight babies, up to 14 percent of preterm deliveries, and some 10 percent of all infant deaths. Even apparently healthy, full-term babies of smokers have been found to be born with narrowed airways and curtailed lung function.6
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Only about 30 percent of women who smoke stop smoking when they find out they are pregnant; the proportion of quitters is highest among married women and women with higher levels of education.7 Smoking during pregnancy declined in 2004 to 10.2 percent of women giving birth, down 42 percent from 1990.8
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Neonatal health-care costs attributable to maternal smoking in the U.S. have been estimated at $366 million per year, or $704 per maternal smoker.9
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Smoking by parents is also associated with a wide range of adverse effects in their children, including exacerbation of asthma, increased frequency of colds and ear infections, and sudden infant death syndrome. Secondhand smoke causes an estimated 150,000 to 300,000 cases of lower respiratory tract infections in children less than 18 months of age, resulting in 7,500 to 15,000 annual hospitalizations.10
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In 2005, an estimated 45.1 million, or 21.0 percent of, adults were current smokers. The annual prevalence of smoking has declined 40 percent between 1965 and 1990, but has been unchanged virtually thereafter.11
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Males tend to have significantly higher rates of smoking prevalence than females. In 2005, 23.9 percent of males currently smoked compared to 18.1 percent of females.12
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Prevalence of current smoking in 2005 was highest among Native American Indians/Alaska Natives (32.0%), intermediate among non-Hispanic whites (21.9%), and non-Hispanic blacks (21.5%), and lowest among Hispanics (16.2%) and Asians and Pacific Islanders (13.3%).13
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As smoking declines among the White non-Hispanic population, tobacco companies have targeted both African Americans and Hispanics with intensive merchandising, which includes billboards, advertising in media targeted to those communities, and sponsorship of civic groups and athletic, cultural, and entertainment events. In 2003, total advertising and promotion by the five major tobacco companies was the highest ever reported at $15.15 billion.14
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Tobacco advertising also plays an important role in encouraging young people to begin a lifelong addiction to smoking before they are old enough to fully understand its long-term health risk. Approximately 90 percent of smokers begin smoking before the age of 21.15
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In 2005, 23 percent of high school students were current smokers.16 Over 8 percent of middle school students were current smokers in 2004.17
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Secondhand smoke involuntarily inhaled by nonsmokers from other people's cigarettes is classified by the U.S. Environmental Protection Agency as a known human (Group A) carcinogen, responsible for approximately 3,400 lung cancer deaths and 46,000 (ranging 22,700-69,600) heart disease deaths in adult nonsmokers annually in United States.18
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Workplaces nationwide are going smoke-free to provide clean indoor air and protect employees from the life-threatening effects of secondhand smoke. Nearly 70 percent of the U.S. workforce worked under a smoke free policy in 1999, but the percentage of workers protected varies by state, ranging from a high of 83.9 percent in Utah and 81.2 percent in Maryland to 48.7% in Nevada.19
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Employers have a legal right to restrict smoking in the workplace, or implement a totally smoke-free workplace policy. Exceptions may arise in the case of collective bargaining agreements with unions.
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Nicotine is an addictive drug, which when inhaled in cigarette smoke reaches the brain faster than drugs that enter the body intravenously. Smokers not only become physically addicted to nicotine; they also link smoking with many social activities, making smoking a difficult habit to break.20
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In 2005, an estimated 46.1 million adults were former smokers. Of the current 45.1 million smokers, 42.5 percent of current smokers had stopped smoking at least 1 day in the preceding year because they were trying to quit smoking completely.21
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Nicotine replacement products can help relieve withdrawal symptoms people experience when they quit smoking. Nicotine patches, nicotine gum and nicotine lozenges are available over-the-counter, and a nicotine nasal spray and inhaler are currently available by prescription.22
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In addition, a doctor can prescribe non nicotine pills such as Zyban and Chantix to help smokers quit.
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Nicotine replacement therapies are helpful in quitting when combined with a behavior change program such as the American Lung Association's Freedom From Smoking (FFS), which addresses psychological and behavioral addictions to smoking and strategies for coping with urges to smoke.
For more information on smoking, please review the Tobacco Use Morbidity and Mortality Trend Report in the Data and Statistics section of our website at www.lungusa.org or call the American Lung Association at 1-800-LUNG-USA (1-800-586-4872).
Sources:
1 Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 1997–2001. Morbidity and Mortality Weekly Report
. 2005;54:625-628 . Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a1.htm.
2 Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Tobacco Information and Prevention Source (TIPS). Tobacco Use in the United States. January 27, 2004.
3
Centers for Disease Control and Prevention. Cigarette Smoking Attributable Morbidity – U.S., 2000. Morbidity and Mortality Weekly Report. 2003 Sept; 52(35): 842-844.
4
Ibid.
5
U.S Department of Health and Human Services. Health Consequences of Smoking: A Report of the Surgeon General, 2004.
6 U.S Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General, 2001.
7
Martin J, Hamilton B, Sutton P, Ventura S, Menacker, F. and Munson M. Division of Vital Statistics
Centers for Disease Control and Prevention. National Vital Statistics Reports. Births Final Data for 2003. Vol. 54(2), September 2005. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf. Accessed on 3/15/07.
8
National Vital Statistic Reports. Births: Final Data for 2004. Vol. 55, No. 1, September 2006.
9 Morbidity and Mortality Weekly Report. State Estimates of Neonatal Health-Care Costs Associated with Maternal Smoking – U.S., 1996. Vol. 53, No. 39, October 8, 2004.
10 California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. September 1997.
11 National Health Interview Survey. Vital and Health Statistics: Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2005. Series 10, No. 232, Oct. 4, 2006.
12 Ibid.
13 Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR) Tobacco Use among Adults, Vol. 55 (42); 1145-1148, Oct. 2006. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm. Accessed on 4/19/07.
14 Federal Trade Commission Cigarette Report for 2003. Issued August 2005. Available at: http://www.ftc.gov/reports/cigarette05/050809cigrpt.pdf. Accessed on 4/30/07.
15 U.S. Department of Health and Human Services. Preventing Tobacco Use among Young People: A Report of the Surgeon General, 1994.
16 Morbidity and Mortality Weekly Report. Youth Risk Behavior Surveillance—United States, 2005. Vol. 55(SS05);1-108(pg.14). Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5505al. Accessed on 4/30/07.
17 National Youth Tobacco Survey, 2000-2005 and CDC. Morbidity and Mortality Weekly Report. Tobacco Use, Access and Exposure in Media Among Middle School and High School Students, United States 2004. Vol. 54, No. 12;297-301, April 2005. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5526a2.htm. Accessed on 4/30/07.
18 California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. June 2005. Available at: http://www.epa.gov/smokefree/healtheffects.html. Accessed on 4/30/07.
19
Shopland DR, Gerlach KK, Burns DM, Hartman AM, Gibson JT. State-Specific Trends in Smokefree Workplace Policy Coverage: the Current Population Tobacco Use Supplement, 1993 to 1999. J Occup Environ Med 2001; 43:680-686.
20 National Institute of Drug Abuse. Research Report on Nicotine: Addiction, August 2001.
21 Morbidity and Mortality Weekly Report. Tobacco Use Among Adults—United States, 2005. Vol. 55. No. 42, October 2005. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm. Accessed on 4/19/07.
22 Centers for Disease Control
Secondhand Smoke Fact Sheet
June 2007
Secondhand smoke, also known as environmental tobacco smoke (ETS), is a mixture of the smoke given off by the burning end of a cigarette, pipe or cigar and the smoke exhaled from the lungs of smokers. It is involuntarily inhaled by nonsmokers, lingers in the air hours after cigarettes have been extinguished and can cause or exacerbate a wide range of adverse health effects, including cancer, respiratory infections, and asthma.1
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Secondhand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of cancer in humans (Group A carcinogen).2
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Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke. Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic, including formaldehyde, benzene, vinyl chloride, arsenic ammonia and hydrogen cyanide.3
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Secondhand smoke causes approximately 3,400 lung cancer deaths and 46,000 heart disease deaths in adult nonsmokers in the United States each year.4
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Nonsmokers exposed to secondhand smoke at work are at increased risk for adverse health effects. Levels of ETS in restaurants and bars were found to be 2 to 5 times higher than in residences with smokers and 2 to 6 times higher than in office workplaces.5
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Since 1999, 70 percent of the U.S. workforce worked under a smoke-free policy, ranging from 83.9 percent in Utah to 48.7 percent in Nevada.6 Workplace productivity was increased and absenteeism was decreased among former smokers compared with current smokers.7
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Fifteen states - Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Maine, Massachusetts, New Jersey, New Mexico, New York, Ohio, Rhode Island, Washington and Vermont - as well as the District of Columbia and Puerto Rico prohibit smoking in almost all public places and workplaces, including restaurants and bars. Illinois, Maryland, Minnesota, Montana, New Hampshire, Oregon and Utah have passed legislation prohibiting smoking in almost all public places and workplaces, including restaurants and bars, but the laws have not taken full effect yet.8
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Secondhand smoke is especially harmful to young children. Secondhand smoke is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year, and causes 430 sudden infant death syndrome (SIDS) deaths in the United States annually.9
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Secondhand smoke exposure may cause buildup of fluid in the middle ear, resulting in 790,000 physician office visits per year.10 Secondhand smoke can also aggravate symptoms in 400,000 to 1,000,000 children with asthma.11
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In the United States, 21 million, or 35 percent of, children live in homes where residents or visitors smoke in the home on a regular basis.12 Approximately 50-75 percent of children in the United States have detectable levels of cotinine, the breakdown product of nicotine in the blood.13
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New research indicates that private research conducted by cigarette company Philip Morris in the 1980s showed that secondhand smoke was highly toxic, yet the company suppressed the finding during the next two decades.14
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The current Surgeon General’s Report concluded that scientific evidence indicates that there is no risk-free level of exposure to second hand smoke. Short exposures to second hand smoke can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk of heart attack.15
For more information on secondhand smoke, please review the Tobacco Morbidity and Mortality Trend Report as well as our Lung Disease Data publication in the Data and Statistics section of our website at www.lungusa.org, or call the American Lung Association at 1-800-LUNG-USA (1-800-586-4872).
Sources:
1. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.
2. Ibid.
3. The Health Consequences of Involuntary Exposure to Tobacco Smoke: 6 Major Conclusions of the Surgeon General Report. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet6.html: Accessed on 7/7/06
4. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.
5. U.S. Department of Health and Human Services. Report on Carcinogens, Tenth Edition 2002. National Toxicology Program.
6. Shopland, D. Smoke-Free Workplace Coverage. Journal of Occupational and Environmental Medicine. 2001; 43(8): 680-686.
7. Halpern, M.T.; Shikiar, R.; Rentz, A.M.; Khan, Z.M. Impact of Smoking Status on Workplace Absenteeism and Productivity. Tobacco Control 2001; 10: 233-238.
8. American Lung Association. State Legislated Actions on Tobacco Issues (SLATI). Available at: http://slati.lungusa.org/StateLegislateAction.asp Accessed on 6/18/07.
9. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.
10. Ibid.
11. Ibid.
12. Schuster, MA, Franke T, Pham CB. Smoking Patterns of Household Members and Visitors in Homes with Children in United States. Archives of Pediatric Adolescent Medicine. Vol. 156, 2002: 1094-1100.
13. U.S. Environmental Protection Agency. America’s Children and the Environment: Measures of Contaminants, Body Burdens, and Illnesses. Second Edition. February 2003
14. Diethelm PA, Rielle JC, McKee M. The Whole Truth and Nothing but the Truth? The Research Philip Morris Did Not Want You to See. Lancet. Vol. 364 No. 9446, 2004
15. The Health Consequences of Involuntary Exposure to Tobacco Smoke: 6 Major Conclusions of the Surgeon General Report. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet6.html: Accessed on 7/7/06
All from the American Lung Association www.lungusa.org
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