Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=230904
Story Retrieval Date: 4/17/2015 11:14:46 AM CST
Smoking remains the single largest cause of preventable death in the U.S., according to the Centers for Disease Control and Prevention.
The U.S. has cut the number of smokers in half in its fight to reduce tobacco use in the past 50 years, but a recent report from the Surgeon General shows that the battle isn’t over yet.
Ventilated filters, chemical additives, and clearer links to other illnesses make smoking riskier than ever. For women, the risks of lung cancer skyrocketed 100 percent over that 50 years.
“The implications are huge – more people die from tobacco related disease than from alcohol, drugs, HIV, and suicide combined,” said Andrea King, director of the Clinical Addictions Research Laboratory at the University of Chicago. Cigarette smoking and secondhand smoke exposure is responsible for 1,300 deaths every day, according to the CDC.
“Prevention programs do work, but are often not continued because of cutbacks, and the funding and profits of the tobacco company are enormous. It is like a David and Goliath-type situation and that has not changed,” King said.
In the 32nd tobacco-related report since 1964, the Surgeon General stressed illnesses linked to smoking and the dangers of secondhand smoke, particularly among women.
“While most people think of smoking and links to lung cancer, there are a whole host of other diseases and health problems shown to also be associated with smoking,” King said.
The Surgeon General introduced new diseases linked to smoking in The Health Consequences of Smoking – 50 Years of Progress, released earlier this year.
Lung cancer risks for smokers rose dramatically in the past 50 years, according to the report. Nonsmokers are at risk for lung cancer as well: Exposure to secondhand smoke causes approximately 7,330 lung cancer deaths among nonsmokers every year, according to the American Lung Association.
But evidence suggests smoking is now also linked to liver cancer, colorectal cancer, stroke, macular degeneration, tuberculosis, diabetes, erectile dysfunction, rheumatoid arthritis, impaired immune function, ectopic pregnancy and orofacial clefts in newborns, according to the Surgeon General’s report.
“This report solidifies a half-century of progress in uncovering those diseases and reducing smoking prevalence since the peaks in the 1960s, but we still have a very long way to go,” King said.
A representative from R.J. Reynolds Tobacco Company said it does not comment to university publications or wire services, but referred to its website which links to the 2014 Surgeon General Report.
Evidence shows a definitive gender disparity in the risk of lung cancer, according to the Surgeon General’s report. Among female smokers, risk of lung cancer increased 10-fold in the past 50 years. Among male smokers, risk doubled, the report said. Lung size and occupation may be related to the gender disparity of lung cancer risk, experts say.
The Surgeon General report also included another gender disparity with women and Chronic Obstructive Pulmonary Disease, a disease linked closely with smoking. The number of women dying from COPD now exceeds the number of men, and evidence suggests that women are more susceptible to develop severe COPD at younger ages.
“There’s this attitude because the prevalence has gone down that we solved the problem, but we haven’t. One in five people in this country still smokes,” said Carol Southard, a nurse and tobacco treatment specialist at Northwestern Memorial Physicians Group.
Smoking rates among adults and teens are less than half of what they were in 1964. Yet that means 42 million adults and 3 million middle and high school students continue to smoke. If current rates continue, 5.6 million Americans under 18 who are alive today are projected to die prematurely from smoking-related diseases, according to the report.
The rate of new lung cancer cases among nonsmokers and smokers combined has increased in women by 100 percent over the past 36 years, while the rate for men has dropped 24 percent, according to the American Lung Association. It isn’t clear why the incidence of lung cancer in women has risen more than men, but there are several theories, according Dr. Kyle Hogarth, an expert in pulmonary disease.
“Given that the average woman is smaller than the average man, it could be just pure and simple that there’s less lung there to begin with,” said Hogarth, Medical Director of the Pulmonary Rehabilitation Program at the University of Chicago. “The effect of cigarette smoking on women is more pronounced.”
Secondhand smoke and the tendency of some women to use smoking as a way to stay slim may also contribute to women’s vulnerability to the effects of smoking, according to Hogarth.
The first proof of secondhand smoke came from flight attendants back when smoking was permitted on planes, Hogarth said. “You had a group of people who worked in an environment of recycled air who were nonsmokers, and they had a much higher rate of lung cancer and COPD than you would expect in the general population. And what was their only risk factor? Secondhand smoke,” Hogarth said.
Smokers today have a greater risk of developing lung cancer than ever before due to changes in design and composition of cigarettes, according to the Surgeon General. Ventilated filters enable smokers to inhale more vigorously, drawing carcinogens contained in cigarettes smoke deeper into lung tissue. In addition, at least 70 of the chemicals in cigarette smoke are known carcinogens. Levels of some of these carcinogenic chemicals have increased as manufacturing processes have changed.
Many tobacco companies enhance the taste of cigarettes with fruity flavors to appeal to teenagers, according to Hogarth. “It is without a doubt geared towards children,” he said.
“The whole purpose of the tobacco industry is to grow new customers,” Hogarth said. “They have a set amount (of customers) that clearly don’t live to old age, and they also have a set amount that quit. Tobacco companies lose customers, so they need to keep growing them.”
Tobacco companies also put chemicals such as arsenic, ammonia and formaldehyde in cigarettes that cause them to burn slower and distribute the effect nicotine more evenly, according to Hogarth.
“If I’m making a product that I want you to enjoy and get addicted to, the last thing I want you to do is have a negative experience,” Hogarth said. “It’s very effective, obviously.”
The new Surgeon General report calls upon lawmakers and health care providers to act now to “help achieve a society free of tobacco-related death and disease” by using proven tobacco control strategies such as higher taxes on tobacco, smoke-free policies and easy-access cessation treatments.
However, tobacco treatment specialists say that more government funding is needed to make an impact. In recent years, funding for smoking cessation counseling and medication has been reduced nationwide.
“For the past three to five years, I’ve seen funding specifically for cessation dwindle and now it’s non-existent. It’s horrible,” Southard said.
From 2008 to 2014, 33 states added treatments to Medicaid coverage of smoking cessation treatments while 21 states removed treatments from coverage, according to the Centers for Disease Control and Prevention. During this same period, eight states removed treatments for coverage without adding any treatments for coverage, the CDC said.
“Medicaid in Illinois is the most drastic in terms of its limited resources,” said Ethan Israelsohn, a clinical social worker who conducts a tobacco cessation program at the University of Chicago Medicine. “Illinois Medicaid has gone to the point where they’re funding between one and three months worth of tobacco cessation medication, and these are critically important products for helping people quit.”
“Smokers are being judged and not treated. They’re being pushed aside,” Southard said. “Even though we know how to help smokers quit more than ever, smokers are getting less treatment than ever because it is treated as a moral issue instead of a medical issue, and health care is a profit-driven industry,” Southard said.
“Thirty percent of hospital admissions wouldn’t happen if we really focused on helping people quit. There’s no other rational explanation why this product is still legal and why people are still smoking,” Southard said.
The most successful method of smoking cessation is a combination of three things, beginning with truly wanting to quit, Hogarth said.
“For the people who want to quit and are motivated to quit, the things that work best are a combination of counseling and medication,” Hogarth said. “Either way, what is probably the most important thing, and unfortunately what most patients forget, is that your physician can help you.”
“No matter how long you’ve been smoking, if you can quit now or soon, your health is likely to be better off no matter how long you’ve been smoking,” Israelsohn said.