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Indiana Epidemiology Newsletter
Michael Wade, MPH, MS
Syndromic Surveillance Epidemiologist
Linda Stemnock, BSPH
Adrienne Durham, MPH
Once you make the decision to improve your health, the most important next step is to determine which factors influence your health. The goal is to increase the positive factors and to decrease the negative ones. Smoking tobacco is definitely a major negative factor—or “risk factor”—and is the focus this article. Quitting the smoking habit is a good idea no matter how much you smoke or how long you have been smoking. (1, 2)
Smoking is responsible for 87 percent of lung cancer deaths in the United States. (2, 3) Further, smoking is strongly linked to many other health problems, including lung, oral, throat, laryngeal, and esophageal cancers; chronic lung diseases; and cardiovascular diseases. Recently, the list has expanded to include abdominal aortic aneurysm, acute myeloid leukemia, cataract, cervical cancer, kidney cancer, pancreatic cancer, pneumonia, periodontitis, and stomach cancer. (2) Non-smokers exposed to second-hand smoke also are at significant risk, as they inhale many of the same cancer-causing agents to which active smokers voluntarily expose themselves. According to a recent report by the U.S. Surgeon General, there is no risk-free level of exposure to second-hand smoke, and a smoke-free environment is the only way to eliminate the risk. (4)
It is helpful to gain a basic understanding of how smoking tobacco affects the body, both acutely and chronically. The lungs exchange 8,000-9,000 liters of air each day to meet the body’s metabolic needs. When breathing clean air, the lungs enable oxygen (O2) in the air to bind to circulating red blood cells, so it can travel to and nourish all parts of the body and allow carbon dioxide to exit the body. Introducing tobacco smoke, which contains carbon monoxide, nicotine, and many chemicals, is where the trouble begins.
Carbon monoxide (CO) binds to the hemoglobin in red blood cells much more readily than O2; therefore, when you inhale tobacco smoke, the CO out competes much of the O2 for the passenger seat on the red blood cell. Also, CO binds to hemoglobin in such a way that O2 has a more difficult time unloading once it reaches its destination. These events significantly reduce the amount of life-giving O2 available to the tissues that need it. (5)
Also, through the tobacco smoke, nicotine enters the bloodstream through the lungs and very quickly causes an increase in heart rate and blood pressure and constricts the blood vessels. These effects, coupled with the negative influence of CO, make the heart work harder to deliver enough blood to the body and, hence, place many individuals at an increased risk for myocardial infarction and other cardiovascular problems. Nicotine also is highly addictive and is largely responsible for the difficulty smokers have in kicking the smoking habit. (6)
Adding further insult, 69 cancer-causing agents have been identified in tobacco smoke, 7 of which are likely to cause cancer in humans. (2) Chronic exposure to these known carcinogens dramatically increases the probability of the smoker developing cancer. In addition to nicotine, toxic substances such as arsenic, lead, and tar also are present in tobacco smoke. (7) As stated previously, health risks from these exposures to tobacco smoke are present for the active smoker, as well as for non-smokers breathing second-hand smoke.
So, the take-home message broadens a bit: Eliminate tobacco smoke from your environment, improve your health.
As mentioned in previous issues of the Indiana Epidemiology Newsletter, there is no reporting requirement for health behaviors such as smoking; hence, these data must be obtained from another source. That source, the Behavioral Risk Factor Surveillance System (BRFSS) survey, is an annual, random-digit dial telephone survey of adults aged 18 years and older. The survey is conducted through a cooperative agreement with the Centers for Disease Control and Prevention, and all 50 states and the District of Columbia participate.
So how does Indiana measure up to the rest of the United States with regard to the smoking habit? According to 2005 BRFSS data, the Hoosier state has the second highest percentage (27.3%) of current adult smokers (second only to Kentucky). (8) In 2004, 24.8 percent of adults reported smoking, which was a significant decrease compared to 2002 (27.7%) and 1996 (28.6%). (9) The national median for smoking prevalence has decreased since 2002 (see Figure 1).
In 2005, males in Indiana were statistically more likely to be current smokers than females (29.7% vs. 25.0%, respectively). African-American respondents were statistically more likely to report current smoking than Caucasian respondents (36.8% vs. 26.1%, respectively), while Hispanic (can be of any race) respondents (33.3%) were not statistically different from Caucasian or African-American respondents. (9)
Smoking prevalence is related to income and education. Adults with household incomes of $50,000 or more were statistically less likely to smoke than those with household incomes of less than $50,000. Smoking prevalence decreased as education increased (see Figure 2).
Respondents who had received medical care in the past 12 months were asked how many times a doctor or health provider had advised them to quit smoking. Of those respondents, 61.5 percent reported getting advice to quit smoking by a doctor or other health provider. Additionally, 32.4 percent of those respondents reported that their doctor discussed medication to assist with quitting smoking, and 23.6 percent reported that their doctor or health provider recommended or discussed methods and strategies other than medication to assist them with quitting smoking. There was no significant difference between Caucasian and African-American respondents for being advised to quit smoking three, four, and five or more times. This information was not available for Hispanic respondents. Caucasian respondents were more likely than African-American respondents to report having quit smoking (23.6% vs. 14.2%, respectively). (9)
As mentioned previously, kicking the smoking habit will improve your health, but what is the best way to quit? Although there may not be one best method to quit, according to the American Cancer Society, there are four critical factors for quitting:
Becoming well acquainted with these factors will dramatically improve your ability to successfully quit the tobacco habit. (10, 11)
Further, there are many organizations and resources available to provide help. An excellent place to find the help you need is on the INShape Indiana Web site, where an entire section is devoted to supporting your goal to quit the tobacco habit (https://secure.in.gov/inshape/2381.htm ).
Making the decision to quit smoking—and acting on it—will be one of the most important actions you take in your life. Do it!