Last partial update: July 2017 - Please read disclaimer before proceeding.
Incidence of smoking / facts about smoking
Smoking is responsible for 20 per cent of all deaths and 30 per cent of all cancer deaths. Fifty per cent of regular smokers die of smoking-related causes with tobacco causing more mortality and illness than any other drug. Approximately 80 per cent of all drug related deaths are due to smoking. Unfortunately, the effect of smoking on mortality is even greater in younger age groups.
The good news is, most of this mortality can be prevented if smoking is given up early. Stopping smoking before middle age (say 45 years) reduces disease due to smoking by 90 per cent.
Source: Australian Institute of Health and Welfare
In 2013 in Australia approximately 13% of Australians over the age of 13 years were daily smokers. (About 25% were ex-smokers and 60% had never smoked.) This is half the 1991 incidence. A wonderful achievement. For males, the highest incidence of daily smoking in 2013 (18%) was in the 40 49 year age group while in females it was in the 25 to 29 year age group (15%).
Smoking is more common in Indigenous Australians (the rate is about 50% for men and women), people of Arabic decent and in those with mental illnesses (32%). It is a problem that starts in adolescence with 16% of 14 to 19 year olds smoking, the majority of whom are girls. Eighty per cent of smokers have started by the age of 18 years. Many girls start up because they think it keeps their weight down. However, while it does cause minor weight loss due to increasing the body's metabolic rate, it also inhibits fat burning and this promotes ‘flabby tummies’; not something many teenage girls aspire to. The earlier a person starts smoking the more likely they are to continue.
The implementation of anti-smoking campaigns has meant that the incidence of smoking is slowly decreasing in the adult population in Australia. Importantly, more recent research is indicating that teenage smoking is also deceasing and that teenagers who do try smoking are doing it at an older age. (Results from the latest Australian School Students Alcohol and Drug Survey, released in 2015, shows that only 5 per cent of 12 to 17-year olds were smokers in 2014 (3.4% smoked daily), down from 7 per cent in 2011 and 2008.)
Cigarette smoke contains over 400 pharmacologically active chemicals that are harmful. They can be carcinogenic (cause cancer), irritant (harm living cells), cytotoxic (kill living cells), antigenic (cause allergic reactions) or mutagenic (cause changes to cell genes).
Cancer and other diseases caused by smoking
Smoking is the leading cause of cancer deaths in both men & women in Australia, causing 30 per cent of all cancer deaths.
Smoking causes 85 per cent of lung cancers with cancer incidence being related to the duration and intensity of smoking. In males, lung cancer is the most common cause of cancer and causes the most deaths from caner. In women, it is the fourth most common cancer but the most common cause of cancer deaths. While the average age of lung cancer diagnosis in men is 72 and in women is 71, many of these cancers and deaths unfortunately do occur in relatively young people. Just one pack of cigarettes per day increases lung cancer risk by 10 times and two packs per day increase it by 25 times. Living in the same house as a smoker (i.e. passive smoking) increases the lung cancer risk to 1.25 to 1.5 times that of the normal population.
While at present lung cancer is significantly more common in males, this reflects past smoking habits. The increase in female smokers and reduction in male smokers over the past 25 years has caused the lung cancer rate between 1990 and 2000 to decrease by 1.4 per cent per year in males and increase by 0.7 per cent per year in females. This trend is continuing.
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Other cancers caused by smoking are shown in the table above.
Diseases other than cancer associated with smoking. A long list!
- Respiratory diseases, including:
- Chronic obstructive lung disease (chronic bronchitis and emphysaema). Chronic obstructive lung disease, better known as chronic bronchitis and emphysema, are responsible a huge amount (about 3.7 per cent) of the total burden of disease in Australia. Unfortunately, many people with milder disease remain undiagnosed as they accept their symptoms of cough and milder shortness of breath as a normal part of ageing. Screening smokers at an early age (say 35) using tests that assess their lung function could help identify this condition early on and alert affected people to their urgent need to quit smoking. (The reason the need is urgent is that symptoms progressively worsen with continued smoking and are unfortunately fairly permanent. Quitting early (preferably before 40) is by far the best treatment available.) People who smoke and are 35 or over should ask to have their lung function checked by their GP.
- Exacerbations of asthma
- Increased incidence of pneumonia and other respiratory tract infections.
- Vascular disease, including coronary artery disease (heart attacks), strokes, peripheral vascular disease and impotence in men. (Vascular disease due to smoking is a greater robem in women.) The causes of this increase in vascular disease include:
- Toxic injury to cells lining the blood vessels
- An increase in the tendency of blood to clot
- Oxidation of blood lipids (fats), especially LDL (bad) cholesterol.
- Reduction in blood HDL (good) cholesterol level
- Hypertension (high blood pressure)
- Loss of vision due to vessel disease in the retina (The retina is the tissue at the back of the eye that absorbs light entering the eye.)
- Rheumatoid arthritis
- Osteoporosis. Smoking increases the likelihood of sustaining vertebral fractures by 13 per cent and hip fractures by 31 per cent.
- An increased risk of developing diabetes
- Premature ageing (wrinkling) of the skin, especially the face. The skin also becomes drier and has a grey appearance. It is very easy to recognise a longstanding smoker and it is not a good look!
- Reduced male fertility, due to reduced sperm quality and quantity.
- Complications associated with taking oestrogen-containing oral contraceptive pils ('The Pill'). Women who smoke and are taking an oestrogen-containing oral contraceptive pill are at a greater risk of stroke and heart attack. Smokers over the age of 35 years should not take oestrogen-containing oral contraceptive pills. (Most contraceptive pills do contain oestrogen.)
- Wound infections after surgery
- Problems that affect young smokers: Problems that adolescents need to consider include stained teeth, bad breath, stained skin (hands), a gradual greying and wrinkling of the skin, reduced ability to exercise, impaired sense of smell, the precipitation of asthma in those with the condition and, as mentioned above, 'flabby tummies' due to an inhibition of 'abdominal fat burning'.
- Depression: There is a strong association between smoking and depression, with the incidence of smoking being double the incidence in the general population. Depression also makes quitting more difficult and relapses of depression commonly occur after quitting.
The contributions that these diseases make to the burden of disease caused by tobacco is shown in the figure below.
Source: Adapted from Australian Institute of Health and Welfare: Begg, S. 2007. |
Passive smoking
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Maternal smokingSmoking during pregnancy is associated with several serious health outcomes including an increase in the incidence of the following.
Up to 14% of non-indigenous Australian women smoke during their pregancy, with rate in indigenous women being about 52%. Many women quit during their pregnancy ut unfortunately up to 80% relapse within a year of the birth of their child. |
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Types of smoking products and disease
Light ‘low-tar’ cigarettes
The smoking of light (low tar / low nicotine) cigarettes does not reduce the incidence of smoking related disease. The reason for this is that, to compensate for getting less nicotine per cigarette, smokers actually inhale deeper, which increases the amount of particulate matter inhaled into the lungs. Another problem with this type of cigarette is that people just smoke more of them to maintain their usual nicotine levels.
Pipes and cigars
Pipe and cigar smokers inhale less and therefore have a slightly lesser mortality from smoking cigarettes (except with respect to upper airway cancers). However, they do get high levels of nicotine and are likely to be very nicotine dependant, making quitting more difficult.
Illegal tobacco products
With the increasing cost of cigarettes, some people are starting to smoke cheaper illegal tobacco products. (Often referred to as 'chop chop' tobacco.) These products have several health problems in addition to those normally associated with tobacco use as follows.
- Fungal growths in the lungs which can cause serious illness, such as aspergillosis and asthma exacerbations. (Heat treatment of the tobacco does not reduce the risk of fungal infection.)
- Contamination by harmful chemicals such as pesticides and 'fillers' such as grass clippings.
These products are definitely not a natural, healthier alternative as is sometimes thought / promoted.
Nicotine
What is nicotine?
Nicotine is the addictive chemical in tobacco and it is just as addictive as narcotic drugs such as heroine. As well as being addictive, nicotine is a brain stimulant that causes:
- a feeling of pleasure
- reduced anxiety
- improved concentration and memory
- appetite suppression.
Nicotine also causes blood pressure to rise, decreases muscle tone and increases basal metabolic rate. (This means smokers burn up more energy and may lose weight as a result of their habit.) The withdrawal that temporarily accompanies quitting has the reverse effects while the brain adjusts to non-smoking.
Nicotine is rapidly absorbed, reaching the brain within 20 seconds of inhaling, and is rapidly broken down. This means smokers have multiple nicotine ‘pleasurable peaks’ during the day, which helps promote addiction.
Genetic predisposition to nicotine addiction
There is good evidence to support a genetic cause for nicotine dependence, which may be a significant factor in the failure of long-term users to quit. About a third of people who start smoking become very addicted and have great difficulty in quitting. (Tobacco companies know this.) This genetic predisposition is due to several factors.
- An enzyme that breaks down nicotine, called cytochrome P450 2A6, has three different forms and possessing the form that breaks down nicotine more quickly leads to increased risk of addiction.
- Smoking has an antidepressant effect on the brain. This is caused by the lowering of a brain enzyme called monoamine oxidase and means that depressed people feel better when smoking and are more likely to become addicted. Many cases of depression are inherited.
- There are inherited differences in the way nicotine acts on the nervous system.
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Smoking Prevention
Smoking is an issue that concerns everyone, smoker or non-smoker. The people that have been affected, are affected or will be affected may well be children, parents, or other loved ones.
Smoking is an addictive habit that is usually commenced in adolescence, with 80 per cent of smokers having started by the age of 18 years. (Fourteen years of age is when most children who experiment with cigarettes switch to becoming established smokers and about 43,000 teenagers are making this move each year!!! )
The addiction process starts from the first puff and thus the traditionally held belief that experimentation with smoking is harmless is incorrect. Most adolescents who start occasional smoking show signs of addiction after about two to three months and by 12 months withdrawal symptoms are present.
In Australia, about 9 per cent of adolescents aged 14 to 19 smoke occasionally and 16 per cent smoke regularly; over 200,000 school students. Half of the young people who continue to smoke will die from this habit.
Smoking in adolescence is encouraged by company marketing that directly targets these vulnerable young people. They do this because they know the following.
- Teenagers' brains are not yet fully developed and a defining characteristic of their underdeveloped brain is risk taking. Thus, teenagers are more likely than older people to take risks with their health.
- About 33 per cent who take up smoking will have great difficulty stopping due a genetic predisposition to become addicted to nicotine.
It takes as little as smoking two cigarettes a week for addiction to start developing. (Most people who do become addicted have done so by the time they are 18 years of age.) Techniques that are being or have been used by cigarette companies to induce smoking in adolescents include the following.
- Generous payments to actors and film companies to increase the use of cigarettes by actors in movies.
- Making cigarettes ‘tasty’ by including additives such as honey, chocolate, maple syrup, vanilla and fruit extracts.
- The disruption of youth smoking prevention programs and the creation of ‘scampaigns’ that appear to discourage youth smoking but are in fact designed to increase use by associating cigarette use with an adult world.
- Placing cigarettes in positions in stores that are easily accessible to young people. Placement in stores amongst everyday household foods, such as bread and confectionery, helps to make cigarettes appear a ‘normal’ product.
- The promotion of fashion parades and dance parties (through the internet) where cigarette smoking was promoted and encouraged.
- Actively lobbying politicians and political parties, including making financial contributions to political parties..
This targeted marketing is allowed to persist because the general population does not care enough about its youth. There can be no better evidence for this than the fact that some political parties in this country feel (or have felt) that they can accept financial assistance from tobacco companies without electoral harm. Please remember that politicians are elected by us.
What can be done to help reduce smoking in the community?
As an individual, there are several ways of helping reduce the promotion of smoking in the community.
- Not supporting any organisation that helps promote smoking byits acceptance of tobacco sponsorship and exerting pressure on organisations to do the same.
- Not purchasing any products made by tobacco companies. Some of tobacco companies have diversified away from just producing cigarettes.
- Writing to your local government member regarding tobacco marketing. Laws can be changed. If you feel strongly about this issue, become involved in the anti-smoking lobby. A good start would be to ring ASH Australia. Here are some suggestions for some changes that would make a difference.
- Remove cigarettes from display in shops and have them sold under the counter
- Ensure that all events attended by underage people are smoke-free.
- License tobacco retailers (as alcohol retailers are).
- Increase quit campaign adverting aimed at young people
- Enforce the use of plain, unattractive packaging for cigarettes. The only information would be the name and health warnings / information.
- Rate movies as MA or R if they promote smoking in a positive manner; that is, make it appear appealing or fashionable.
- Ban funding for political parties by companies that profit from the tobacco industry
Adolescent smoking prevention
As previously stated, most people start smoking while they are adolescents and one of a parent’s most important prevention tasks is to do everything possible to stop their teenage children experimenting with smoking. Children should receive adequate education regarding the risks of smoking and an appreciation of the way that they are being manipulated and intentionally harmed. Part of this education program should include making the home a smoke free zone as this significantly reduces the likelihood that adolescents will take up smoking. Having parents that do not smoke, not surprisingly, has a similar effect.
Smoking prevention is particulary important in women as they have greater difficulty in quitting. (A contributing factor in some women is that nicotine replacement therapy is less effective in women.)
Adverse effects of smoking on teenagers / young people
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Adolescent smoking risk factors
There are numerous factors that increase the likelihood a teenager will experiment with smoking, many of which parents can influence.
- Parental smoking: Any smoking in the home increases the risk of a child starting to smoke, with the risk being three times as great if both parents / guardians smoke. It has been shown that parents who stop smoking before their children start significantly reduce the risk of their children becoming smokers.
- Marital conflict
- Maternal depression
- Peer group smoking: If several peer group members smoke, the risk of smoking increases by eight times. If most of the peer group smoke, the likelihood increases by 36 times!!! The likelihood of successfully stopping smoking (and successfully stopping risky alcohol use if it is an issue) is closely associated with being in or changing to a peer group that does not use these substances.
- Weight loss: Weight loss and fear of weight gain are reasons often cited for young females to commence and to refrain from ceasing smoking. Instruction about healthy approaches to weight management are important for all teenagers, especially girls.
- Teenage depression / anxiety. This is often associated with cigarette smoking and other substance abuse.
In young people, smoking unfortunately can occur in conjunction with other problem behaviours such as harmful alcohol use, delinquency, truancy, risk-taking behaviour and aggressive behaviour. Many factors such as genetic predisposition and personality type are hard to alter. However, addressing the risk factors mentioned above may be helpful. Also, applying and improving the general parenting skills will be of benefit.
Talking to a GP about such problems is often a great place for parents to air their problems and determine a plan of action to help their children. While a few adolescents develop long-standing addictive and anti-social behavioural problems similar to those mentioned above, most do not.
For these young people, the aim is minimize the risks they are exposed to while they get through the difficult 'anti-parent' years (roughly 13 to 17 year olds for girls and a few of years older for boys) with a minimum risk of harm. This will mean setting limits (and thus being unpopular), being observant (even nosey), anticipating problems, and being around when there is a chance of things going wrong. And still being a loving parent even though little is offered in return (in the short term). It is probably the hardest task adults will face but also the most important; and one that it is very important never to give up on. Things will get difficult at times, so don’t be afraid to seek some help from your GP, friends or relatives. (Parents can also be a support for other parents!!)
Recognising possible lung caner symptoms
Lung cancer is the smoking-related disease that causes the most illness. Reporting symptoms that may possibly indicate the presence of a lung cancer as soon as they appear may help detect early cancers and allow the disease to be cured in some cases. Any of the following symptoms can be an indication that lung cancer is present. (It needs to be emphasised that they also occur in many other diseases and people with these symptoms will probably not be shown to have cancer. However, this cannot be assumed and symptoms need to be investigated!)
- Coughing up blood stained sputum
- A respiratory infection that doesn’t settle in the usual length of time
- A cough that persists
- A change in a smoker’s ‘usual cough’
- Shortness of breath or an increase in a smoker’s' usual' shortness of breath
- Persistent heezing
- Chest pain
- General symptoms such as tiredness / lethargy, weight loss
Smokers past and present need to be especially observant as most lung cancer cases occur in present (and past) smokers. Most smokers will have a chronic cough and perhaps chronic wheezing / shortness of breath. A change in this normal pattern of cough / wheeze / shortness of breath may also indicate lung cancer.
Other influences on lung cancer incidence |
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Occupational health risk factors Asbestos Silica (mining industry) Radon |
All increase the risk of developing lung cancer |
Diet rich in fruit (and vegetables) |
Helps protect against lung cancer |
The future - Screening for lung cancer
Most patients with lung cancer die from the disease because they are diagnosed too late for treatment to achieve a cure. However, if lung cancers can be caught early enough, cures can be achieved. (Stage 1 lung cancers have a cure rate of 70 per cent.)
At present there is no evidence that screening for lung cancers using chest X-rays increases life expectancy.
Research is presently being done on the use of low-dose helical CT scans for this purpose but it is too early to say whether it is likely to provide any benefit for past or present smokers.
Further information
Infact (a good worldwide site regarding all issues about smoking)
www.infact.org
Quitline’
A Government sponsored service to information and help for people considering quitting smoking.
Phone number: 131 848 (at any time, 24 hours a day).
http://www.quitnow.gov.au or https://www.icanquit.com.au