stop smoking essay introduction

Persuasive Essay Guide

Persuasive Essay About Smoking

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.

It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.

A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:

Simple persuasive essay about smoking

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Persuasive Essay Examples About Smoking

Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.

A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.

Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

Check out some more persuasive essay examples on various other topics.

Argumentative Essay About Smoking Examples

An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.

If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

Check out the video below to find useful arguments against smoking:

Tips for Writing a Persuasive Essay About Smoking

You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.

Choose a Specific Angle

Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.

Think about how you want to approach the topic. For instance, you could write about why smoking should be banned.

Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!

Research the Facts

Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.

You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies.

For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.

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Make an Outline

The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.

Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.

Use Persuasive Language

When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.

Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.

Introduce Opposing Arguments

Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.

By doing this, your essay will come off as more balanced and objective, making it more convincing.

Finish Strong

Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.

A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.

To conclude,

By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.

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How To Write A Smoking Essay That Will Blow Your Classmates out of the Water

Writing a Smoking Essay. Complete Actionable Guide

A smoking essay might not be your first choice, but it is a common enough topic, whether it is assigned by a professor or left to your choice. Today we’ll take you through the paces of creating a compelling piece, share fresh ideas for writing teen smoking essays, and tackle the specifics of the essential parts of any paper, including an introduction and a conclusion.

Why Choose a Smoking Essay?

If you are free to select any topic, why would you open this can of worms? There are several compelling arguments in favor, such as:

A smoking essay can fit any type of writing assignment. You can craft an argumentative essay about smoking, a persuasive piece, or even a narration about someone’s struggle with quitting. It’s a rare case of a one-size-fits-all topic.
There is an endless number of environmental essay topics ideas . From the reasons and history of smoking to health and economic impact, as well as psychological and physiological factors that make quitting so challenging.
A staggering number of reliable sources are available online. You won’t have to dig deep to find medical or economic research, there are thousands of papers published in peer-reviewed journals, ready and waiting for you to use them.

Essential Considerations for Your Essay on Smoking

Whether you are writing a teenage smoking essay or a study of health-related issues, you need to stay objective and avoid including any judgment into your assignment. Even if you are firmly against smoking, do not let emotions direct your writing. You should also keep your language tolerant and free of offensive remarks or generalizations.

The rule of thumb is to keep your piece academic. It is an essay about smoking cigarettes you have to submit to your professor, not a blog post to share with friends.

How to Generate Endless Smoking Essay Topic Ideas

At first, it might seem that every theme has been covered by countless generations of your predecessors. However, there are ways to add a new spin to the dullest of topics. We’ll share a unique approach to generating new ideas and take the teenage smoking essay as an example. To make it fresh and exciting, you can:

Add a historic twist to your topic. For instance, research the teenage smoking statistics through the years and theorize the factors that influence the numbers.
Compare the data across the globe. You can select the best scale for your paper, comparing smoking rates in the neighboring cities, states, or countries.
Look at the question from an unexpected perspective. For instance, research how the adoption of social media influenced smoking or whether music preferences can be related to this habit.

The latter approach on our list will generate endless ideas for writing teen smoking essays. Select the one that fits your interests or is the easiest to research, depending on the time and effort you are willing to put into essay writing .

How To Write An Essay About Smoking Cigarettes

A smoking essay follows the same rules as an academic paper on any other topic. You start with an introduction, fill the body paragraphs with individual points, and wrap up using a conclusion. The filling of your “essay sandwich” will depend on the topic, but we can tell for sure what your opening and closing paragraphs should be like.

Smoking Essay Introduction

Whether you are working on an argumentative essay about smoking or a persuasive paper, your introduction is nothing but a vessel for a thesis statement. It is the core of your essay, and its absence is the first strike against you. Properly constructed thesis sums up your point of view on the economic research topics and lists the critical points you are about to highlight. If you allude to the opposing views in your thesis statement, the professor is sure to add extra points to your grade.

The first sentence is crucial for your essay, as it sets the tone and makes the first impression. Make it surprising, exciting, powerful with facts, statistics, or vivid images, and it will become a hook to lure the reader in deeper.

Round up the introduction with a transition to your first body passage and the point it will make. Otherwise, your essay might seem disjointed and patchy. Alternatively, you can use the first couple of sentences of the body paragraph as a transition.

Smoking Essay Conclusion

Any argumentative and persuasive essay on smoking must include a short conclusion. In the final passage, return to your thesis statement and repeat it in other words, highlighting the points you have made throughout the body paragraphs. You can also add final thoughts or even a personal opinion at the end to round up your assignment.

Think of the conclusion as a mirror reflection of your introduction. Start with a transition from the last body paragraph, follow it with a retelling of your thesis statement, and complete the passage with a powerful parting thought that will stay with the reader. After all, everyone remembers the first and last points most vividly, and your opening and closing sentences are likely to have a significant influence on the final grade.

Bonus Tips on How to Write a Persuasive Essay About Smoking

With the most challenging parts of the smoking essay out of the way, here are a couple of parting tips to ensure your paper gets the highest grade possible:

Do not rely on samples you find online to guide your writing. You can never tell what grade a random essay about smoking cigarettes received. Unless you use winning submissions from essay competitions, you might copy faulty techniques and data into your paper and get a reduced grade.
Do not forget to include references after the conclusion and cite the sources throughout the paper. Otherwise, you might get accused of academic dishonesty and ruin your academic record. Ask your professor about the appropriate citation style if you are not sure whether you should use APA, MLA, or Chicago.
Do not submit your smoking essay without editing and proofreading first. The best thing you can do is leave the piece alone for a day or two and come back to it with fresh eyes and mind to check for redundancies, illogical argumentation, and irrelevant examples. Professional editing software, such as Grammarly, will help with most typos and glaring errors. Still, it is up to you to go through the paper a couple of times before submission to ensure it is as close to perfection as it can get.
Do not be shy about getting help with writing smoking essays if you are out of time. Professional writers can take over any step of the writing process, from generating ideas to the final round of proofreading. Contact our agents or skip straight to the order form if you need our help to complete this assignment.

We hope our advice and ideas for writing teen smoking essays help you get out of the slump and produce a flawless piece of writing worthy of an A. For extra assistance with choosing the topic, outlining, writing, and editing, reach out to our support managers .

Home — Essay Samples — Nursing & Health — Addictions — Smoking

Essays About Smoking

Smoking essay, types of essay about smoking.

Cause and Effect Essay: This type of essay focuses on the causes and effects of smoking. It discusses why people start smoking and the consequences of smoking on both the smoker and those around them.
Argumentative Essay: This essay type aims to persuade the reader about the negative effects of smoking. It presents an argument and provides supporting evidence to convince the reader that smoking is harmful and should be avoided.
Persuasive Essay: Similar to an argumentative essay, this type of essay aims to persuade the reader to quit smoking. It presents facts, statistics, and other relevant information to convince the reader to stop smoking.

Smoking Essay Example: Cause and Effect

Identify the causes of smoking: Start by examining why people start smoking in the first place. Is it peer pressure, addiction, stress, or curiosity? Understanding the reasons why people smoke is crucial in creating an effective cause and effect essay.
Discuss the effects of smoking: Highlight the impact smoking has on an individual's health and the environment. Discuss the risks associated with smoking, such as lung cancer, heart disease, and respiratory problems, and explain how smoking affects non-smokers through secondhand smoke.
Use reliable sources: To make your essay more convincing, ensure that you use credible sources to back up your claims. Use scientific studies, government reports, and medical journals to support your arguments.
Provide statistical evidence: Incorporate statistical data to make your essay more impactful. Use figures to show the number of people who smoke, the effects of smoking on the environment, and the costs associated with smoking.
Offer solutions: Conclude your essay by suggesting solutions to the problem of smoking. Encourage smokers to quit by outlining the benefits of quitting smoking and offering resources for those who want to quit.

Smoking: Argumentative Essay

Choose a clear position: The writer should choose a side on the issue of smoking, either for or against it, and be clear in presenting their stance.
Gather evidence: Research and collect facts and statistics to support the writer's argument. They can find data from reliable sources like scientific journals, government reports, and reputable news organizations.
Address counterarguments: A good argumentative essay will acknowledge opposing viewpoints and then provide a counterargument to refute them.
Use persuasive language: The writer should use persuasive language to convince the reader of their position. This includes using rhetorical devices, such as ethos, pathos, and logos, to appeal to the reader's emotions and logic.
Provide a clear conclusion: The writer should summarize the key points of their argument and reiterate their stance in the conclusion.

Persuasive Essay on Smoking

Identify your audience and their beliefs about smoking.
Present compelling evidence to support your argument, such as statistics, research studies, and personal anecdotes.
Use emotional appeals, such as stories or images that show the negative impact of smoking.
Address potential counterarguments and refute them effectively.
Use strong and clear language to persuade the reader to take action.
When choosing a topic for a smoking persuasive essay, consider a specific aspect of smoking that you would like to persuade the audience to act upon.

Hook Examples for Smoking Essays

Anecdotal hook.

Imagine a teenager taking their first puff of a cigarette, unaware of the lifelong addiction they're about to face. This scenario illustrates the pervasive issue of smoking among young people.

Question Hook

Is the pleasure derived from smoking worth the serious health risks it poses? Dive into the contentious debate over tobacco use and its consequences.

Quotation Hook

"Smoking is a habit that drains your money and kills you slowly, one puff after another." — Unknown. Explore the financial and health impacts of smoking in today's society.

Statistical or Factual Hook

Did you know that smoking is responsible for nearly 8 million deaths worldwide each year? Examine the alarming statistics and data associated with tobacco-related illnesses.

Definition Hook

What exactly is smoking, and what are the various forms it takes? Delve into the definitions of smoking, including cigarettes, cigars, pipes, and emerging alternatives like e-cigarettes.

Rhetorical Question Hook

Can we truly call ourselves a smoke-free generation when new nicotine delivery devices are enticing young people? Investigate the impact of vaping and e-cigarettes on the youth.

Historical Hook

Trace the history of smoking, from its ancient roots to its prevalence in different cultures and societies. Explore how perceptions of smoking have evolved over time.

Contrast Hook

Contrast the images of the suave, cigarette-smoking characters from classic films with the grim reality of tobacco-related diseases and addiction in the modern world.

Narrative Hook

Walk in the shoes of a lifelong smoker as they recount their journey from that first cigarette to a battle with addiction and the quest to quit. Their story reflects the struggles of many.

Shocking Statement Hook

Prepare to uncover the disturbing truth about smoking—how it not only harms the smoker but also affects non-smokers through secondhand smoke exposure. It's an issue that goes beyond personal choice.

The Harmful Effects of Smoking: Physical, Social, and Economic Consequences

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Can Smoking Be Prevented by Making Tobacco Illegal

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The History of Tobacco Use and Its Dangers

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How to Write the Essay on “Ways to Quit Smoking”?

In the process of your research on essay or persuasive speech on smoking , you will most likely find out that there is a certain study, which says this way works better than the other. Then you just turn the next page and see that there is another way to quit smoking and it’s better than all what you knew before. As you see, it’s a never-ending story. As an alternative, you may dedicate your paper to putting together a special quit smoking program, which can be applied by the others.

“Ways to Quit Smoking” Essay: Write a Hooking Introduction!

There are more than 4000 (!) health-damaging elements in tobacco. The element that makes a human being addicted to smoking is nicotine. Just a drop of information for you to include into the assignment! The thing is that the first two or three lines are the most crucial for they will either attract your readers or make them put the project aside for good. Make sure to start your paper with a hooking open theme to make sure your audience will be longing for more once they’re done with the intro.

Writing an Essay or a Speech About Smoking: Successful Quit-Smoking Plan

Once you decide to work out a booming quit smoking program, make sure to include the following elements in your essay:

Pharmacological products appropriate use . Those, who are severely addicted to the cigarettes, could consider using nicotine-replacement elements so that the body could gradually get rid of nicotine-addiction. Make sure to recommend your audience to consult their doctors before using the drugs.
One-to-one counseling. It is highly important to point out that qualified support helps smokers to identify their aims. Moreover, in the moments of weakness, a professional counselor will help to prevent relapse. Consider telephone counseling, one-to-one counseling, group support, internet programs for smokers, etc.
Measure & Record. Suggest your readers an idea to take a black-and-white look at how much they actually smoke, how much $ they pay each months (day, week, etc.) for their addiction and how much money they could actually save.
Improve Your Knowledge. Tell your readers to read the science, converse with the experienced experts in order to make 100% sure how smoking ruins their health and the health of the people around. Being aware of how the others have tackled life-saving challenge will give courage to those, who are still fighting the addiction!

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Office on Smoking and Health (US). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2006.

Cover of The Health Consequences of Involuntary Exposure to Tobacco Smoke

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.

1 introduction, summary, and conclusions.

Introduction

The topic of passive or involuntary smoking was first addressed in the 1972 U.S. Surgeon General’s report ( The Health Consequences of Smoking , U.S. Department of Health, Education, and Welfare [USDHEW] 1972 ), only eight years after the first Surgeon General’s report on the health consequences of active smoking ( USDHEW 1964 ). Surgeon General Dr. Jesse Steinfeld had raised concerns about this topic, leading to its inclusion in that report. According to the 1972 report, nonsmokers inhale the mixture of sidestream smoke given off by a smoldering cigarette and mainstream smoke exhaled by a smoker, a mixture now referred to as “secondhand smoke” or “environmental tobacco smoke.” Cited experimental studies showed that smoking in enclosed spaces could lead to high levels of cigarette smoke components in the air. For carbon monoxide ( CO ) specifically, levels in enclosed spaces could exceed levels then permitted in outdoor air. The studies supported a conclusion that “an atmosphere contaminated with tobacco smoke can contribute to the discomfort of many individuals” ( USDHEW 1972 , p. 7). The possibility that CO emitted from cigarettes could harm persons with chronic heart or lung disease was also mentioned.

Secondhand tobacco smoke was then addressed in greater depth in Chapter 4 (Involuntary Smoking) of the 1975 Surgeon General’s report, The Health Consequences of Smoking ( USDHEW 1975 ). The chapter noted that involuntary smoking takes place when nonsmokers inhale both sidestream and exhaled mainstream smoke and that this “smoking” is “involuntary” when “the exposure occurs as an unavoidable consequence of breathing in a smoke-filled environment” (p. 87). The report covered exposures and potential health consequences of involuntary smoking, and the researchers concluded that smoking on buses and airplanes was annoying to nonsmokers and that involuntary smoking had potentially adverse consequences for persons with heart and lung diseases. Two studies on nicotine concentrations in nonsmokers raised concerns about nicotine as a contributing factor to atherosclerotic cardiovascular disease in nonsmokers.

The 1979 Surgeon General’s report, Smoking and Health: A Report of the Surgeon General ( USDHEW 1979 ), also contained a chapter entitled “Involuntary Smoking.” The chapter stressed that “attention to involuntary smoking is of recent vintage, and only limited information regarding the health effects of such exposure upon the nonsmoker is available” (p. 11–35). The chapter concluded with recommendations for research including epidemiologic and clinical studies. The 1982 Surgeon General’s report specifically addressed smoking and cancer ( U.S. Department of Health and Human Services [USDHHS] 1982 ). By 1982, there were three published epidemiologic studies on involuntary smoking and lung cancer, and the 1982 Surgeon General’s report included a brief chapter on this topic. That chapter commented on the methodologic difficulties inherent in such studies, including exposure assessment, the lengthy interval during which exposures are likely to be relevant, and accounting for exposures to other carcinogens. Nonetheless, the report concluded that “Although the currently available evidence is not sufficient to conclude that passive or involuntary smoking causes lung cancer in nonsmokers, the evidence does raise concern about a possible serious public health problem” (p. 251).

Involuntary smoking was also reviewed in the 1984 report, which focused on chronic obstructive pulmonary disease and smoking ( USDHHS 1984 ). Chapter 7 (Passive Smoking) of that report included a comprehensive review of the mounting information on smoking by parents and the effects on respiratory health of their children, data on irritation of the eye, and the more limited evidence on pulmonary effects of involuntary smoking on adults. The chapter began with a compilation of measurements of tobacco smoke components in various indoor environments. The extent of the data had increased substantially since 1972. By 1984, the data included measurements of more specific indicators such as acrolein and nicotine, and less specific indicators such as particulate matter ( PM ), nitrogen oxides, and CO . The report reviewed new evidence on exposures of nonsmokers using bio-markers, with substantial information on levels of cotinine, a major nicotine metabolite. The report anticipated future conclusions with regard to respiratory effects of parental smoking on child respiratory health ( Table 1.1 ).

Conclusions from previous Surgeon General’s reports on the health effects of secondhand smoke exposure

Involuntary smoking was the topic for the entire 1986 Surgeon General’s report, The Health Consequences of Involuntary Smoking ( USDHHS 1986 ). In its 359 pages, the report covered the full breadth of the topic, addressing toxicology and dosimetry of tobacco smoke; the relevant evidence on active smoking; patterns of exposure of nonsmokers to tobacco smoke; the epidemiologic evidence on involuntary smoking and disease risks for infants, children, and adults; and policies to control involuntary exposure to tobacco smoke. That report concluded that involuntary smoking caused lung cancer in lifetime nonsmoking adults and was associated with adverse effects on respiratory health in children. The report also stated that simply separating smokers and nonsmokers within the same airspace reduced but did not eliminate exposure to secondhand smoke. All of these findings are relevant to public health and public policy ( Table 1.1 ). The lung cancer conclusion was based on extensive information already available on the carcinogenicity of active smoking, the qualitative similarities between secondhand and mainstream smoke, the uptake of tobacco smoke components by nonsmokers, and the epidemiologic data on involuntary smoking. The three major conclusions of the report ( Table 1.2 ), led Dr. C. Everett Koop, Surgeon General at the time, to comment in his preface that “the right of smokers to smoke ends where their behavior affects the health and well-being of others; furthermore, it is the smokers’ responsibility to ensure that they do not expose nonsmokers to the potential [ sic ] harmful effects of tobacco smoke” ( USDHHS 1986 , p. xii).

Major conclusions of the 1986 Surgeon General’s report, The Health Consequences of Involuntary Smoking

Two other reports published in 1986 also reached the conclusion that involuntary smoking increased the risk for lung cancer. The International Agency for Research on Cancer ( IARC ) of the World Health Organization concluded that “passive smoking gives rise to some risk of cancer” ( IARC 1986 , p. 314). In its monograph on tobacco smoking, the agency supported this conclusion on the basis of the characteristics of sidestream and mainstream smoke, the absorption of tobacco smoke materials during an involuntary exposure, and the nature of dose-response relationships for carcinogenesis. In the same year, the National Research Council ( NRC ) also concluded that involuntary smoking increases the incidence of lung cancer in nonsmokers ( NRC 1986 ). In reaching this conclusion, the NRC report cited the biologic plausibility of the association between exposure to secondhand smoke and lung cancer and the supporting epidemiologic evidence. On the basis of a pooled analysis of the epidemiologic data adjusted for bias, the report concluded that the best estimate for the excess risk of lung cancer in nonsmokers married to smokers was 25 percent, compared with nonsmokers married to nonsmokers. With regard to the effects of involuntary smoking on children, the NRC report commented on the literature linking secondhand smoke exposures from parental smoking to increased risks for respiratory symptoms and infections and to a slightly diminished rate of lung growth.

Since 1986, the conclusions with regard to both the carcinogenicity of secondhand smoke and the adverse effects of parental smoking on the health of children have been echoed and expanded ( Table 1.3 ). In 1992, the U.S. Environmental Protection Agency ( EPA ) published its risk assessment of secondhand smoke as a carcinogen ( USEPA 1992 ). The agency’s evaluation drew on toxicologic information on secondhand smoke and the extensive literature on active smoking. A comprehensive meta-analysis of the 31 epidemiologic studies of secondhand smoke and lung cancer published up to that time was central to the decision to classify secondhand smoke as a group A carcinogen—namely, a known human carcinogen. Estimates of approximately 3,000 U.S. lung cancer deaths per year in non-smokers were attributed to secondhand smoke. The report also covered other respiratory health effects in children and adults and concluded that involuntary smoking is causally associated with several adverse respiratory effects in children. There was also a quantitative risk assessment for the impact of involuntary smoking on childhood asthma and lower respiratory tract infections in young children.

Table 1.3. Selected major reports, other than those of the U.

Selected major reports, other than those of the U.S. Surgeon General, addressing adverse effects from exposure to tobacco smoke

In the decade since the 1992 EPA report, scientific panels continued to evaluate the mounting evidence linking involuntary smoking to adverse health effects ( Table 1.3 ). The most recent was the 2005 report of the California EPA ( Cal/EPA 2005 ). Over time, research has repeatedly affirmed the conclusions of the 1986 Surgeon General’s reports and studies have further identified causal associations of involuntary smoking with diseases and other health disorders. The epidemiologic evidence on involuntary smoking has markedly expanded since 1986, as have the data on exposure to tobacco smoke in the many environments where people spend time. An understanding of the mechanisms by which involuntary smoking causes disease has also deepened.

As part of the environmental health hazard assessment, Cal/EPA identified specific health effects causally associated with exposure to secondhand smoke. The agency estimated the annual excess deaths in the United States that are attributable to secondhand smoke exposure for specific disorders: sudden infant death syndrome ( SIDS ), cardiac-related illnesses (ischemic heart disease), and lung cancer ( Cal/EPA 2005 ). For the excess incidence of other health outcomes, either new estimates were provided or estimates from the 1997 health hazard assessment were used without any revisions ( Cal/EPA 1997 ). Overall, Cal/EPA estimated that about 50,000 excess deaths result annually from exposure to secondhand smoke ( Cal/EPA 2005 ). Estimated annual excess deaths for the total U.S. population are about 3,400 (a range of 3,423 to 8,866) from lung cancer, 46,000 (a range of 22,700 to 69,600) from cardiac-related illnesses, and 430 from SIDS. The agency also estimated that between 24,300 and 71,900 low birth weight or pre-term deliveries, about 202,300 episodes of childhood asthma (new cases and exacerbations), between 150,000 and 300,000 cases of lower respiratory illness in children, and about 789,700 cases of middle ear infections in children occur each year in the United States as a result of exposure to secondhand smoke.

This new 2006 Surgeon General’s report returns to the topic of involuntary smoking. The health effects of involuntary smoking have not received comprehensive coverage in this series of reports since 1986. Reports since then have touched on selected aspects of the topic: the 1994 report on tobacco use among young people ( USDHHS 1994 ), the 1998 report on tobacco use among U.S. racial and ethnic minorities ( USDHHS 1998 ), and the 2001 report on women and smoking ( USDHHS 2001 ). As involuntary smoking remains widespread in the United States and elsewhere, the preparation of this report was motivated by the persistence of involuntary smoking as a public health problem and the need to evaluate the substantial new evidence reported since 1986. This report substantially expands the list of topics that were included in the 1986 report. Additional topics include SIDS , developmental effects, and other reproductive effects; heart disease in adults; and cancer sites beyond the lung. For some associations of involuntary smoking with adverse health effects, only a few studies were reviewed in 1986 (e. g ., ear disease in children); now, the relevant literature is substantial. Consequently, this report uses meta-analysis to quantitatively summarize evidence as appropriate. Following the approach used in the 2004 report ( The Health Consequences of Smoking , USDHHS 2004 ), this 2006 report also systematically evaluates the evidence for causality, judging the extent of the evidence available and then making an inference as to the nature of the association.

Organization of the Report

This twenty-ninth report of the Surgeon General examines the topics of toxicology of secondhand smoke, assessment and prevalence of exposure to secondhand smoke, reproductive and developmental health effects, respiratory effects of exposure to secondhand smoke in children and adults, cancer among adults, cardiovascular diseases, and the control of secondhand smoke exposure.

This introductory chapter (Chapter 1) includes a discussion of the concept of causation and introduces concepts of causality that are used throughout this report; this chapter also summarizes the major conclusions of the report. Chapter 2 (Toxicology of Secondhand Smoke) sets out a foundation for interpreting the observational evidence that is the focus of most of the following chapters. The discussion details the mechanisms that enable tobacco smoke components to injure the respiratory tract and cause nonmalignant and malignant diseases and other adverse effects. Chapter 3 (Assessment of Exposure to Secondhand Smoke) provides a perspective on key factors that determine exposures of people to secondhand smoke in indoor environments, including building designs and operations, atmospheric markers of secondhand smoke, exposure models, and biomarkers of exposure to secondhand smoke. Chapter 4 (Prevalence of Exposure to Secondhand Smoke) summarizes findings that focus on nicotine measurements in the air and cotinine measurements in biologic materials. The chapter includes exposures in the home, workplace, public places, and special populations. Chapter 5 (Reproductive and Developmental Effects from Exposure to Secondhand Smoke) reviews the health effects on reproduction, on infants, and on child development. Chapter 6 (Respiratory Effects in Children from Exposure to Secondhand Smoke) examines the effects of parental smoking on the respiratory health of children. Chapter 7 (Cancer Among Adults from Exposure to Secondhand Smoke) summarizes the evidence on cancer of the lung, breast, nasal sinuses, and the cervix. Chapter 8 (Cardiovascular Diseases from Exposure to Secondhand Smoke) discusses coronary heart disease ( CHD ), stroke, and subclinical vascular disease. Chapter 9 (Respiratory Effects in Adults from Exposure to Secondhand Smoke) examines odor and irritation, respiratory symptoms, lung function, and respiratory diseases such as asthma and chronic obstructive pulmonary disease. Chapter 10 (Control of Secondhand Smoke Exposure) considers measures used to control exposure to secondhand smoke in public places, including legislation, education, and approaches based on building designs and operations. The report concludes with “A Vision for the Future.” Major conclusions of the report were distilled from the chapter conclusions and appear later in this chapter.

Preparation of the Report

This report of the Surgeon General was prepared by the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention ( CDC ), and U.S. DHHS. Initial chapters were written by 22 experts who were selected because of their knowledge of a particular topic. The contributions of the initial experts were consolidated into 10 major chapters that were then reviewed by more than 40 peer reviewers. The entire manuscript was then sent to more than 30 scientists and experts who reviewed it for its scientific integrity. After each review cycle, the drafts were revised by the scientific editors on the basis of the experts’ comments. Subsequently, the report was reviewed by various institutes and agencies within U.S. DHHS. Publication lags, even short ones, prevent an up-to-the-minute inclusion of all recently published articles and data. Therefore, by the time the public reads this report, there may be additional published studies or data. To provide published information as current as possible, this report includes an Appendix of more recent studies that represent major additions to the literature.

This report is also accompanied by a companion database of key evidence that is accessible through the Internet ( http://www.cdc.gov/tobacco ). The database includes a uniform description of the studies and results on the health effects of exposure to secondhand smoke that were presented in a format compatible with abstraction into standardized tables. Readers of the report may access these data for additional analyses, tables, or figures.

Definitions and Terminology

The inhalation of tobacco smoke by nonsmokers has been variably referred to as “passive smoking” or “involuntary smoking.” Smokers, of course, also inhale secondhand smoke. Cigarette smoke contains both particles and gases generated by the combustion at high temperatures of tobacco, paper, and additives. The smoke inhaled by nonsmokers that contaminates indoor spaces and outdoor environments has often been referred to as “secondhand smoke” or “environmental tobacco smoke.” This inhaled smoke is the mixture of sidestream smoke released by the smoldering cigarette and the mainstream smoke that is exhaled by a smoker. Sidestream smoke, generated at lower temperatures and under somewhat different combustion conditions than mainstream smoke, tends to have higher concentrations of many of the toxins found in cigarette smoke ( USDHHS 1986 ). However, it is rapidly diluted as it travels away from the burning cigarette.

Secondhand smoke is an inherently dynamic mixture that changes in characteristics and concentration with the time since it was formed and the distance it has traveled. The smoke particles change in size and composition as gaseous components are volatilized and moisture content changes; gaseous elements of secondhand smoke may be adsorbed onto materials, and particle concentrations drop with both dilution in the air or environment and impaction on surfaces, including the lungs or on the body. Because of its dynamic nature, a specific quantitative definition of secondhand smoke cannot be offered.

This report uses the term secondhand smoke in preference to environmental tobacco smoke, even though the latter may have been used more frequently in previous reports. The descriptor “secondhand” captures the involuntary nature of the exposure, while “environmental” does not. This report also refers to the inhalation of secondhand smoke as involuntary smoking, acknowledging that most nonsmokers do not want to inhale tobacco smoke. The exposure of the fetus to tobacco smoke, whether from active smoking by the mother or from her exposure to secondhand smoke, also constitutes involuntary smoking.

Evidence Evaluation

Following the model of the 1964 report, the Surgeon General’s reports on smoking have included comprehensive compilations of the evidence on the health effects of smoking. The evidence is analyzed to identify causal associations between smoking and disease according to enunciated principles, sometimes referred to as the “Surgeon General’s criteria” or the “Hill” criteria (after Sir Austin Bradford Hill) for causality ( USDHEW 1964 ; USDHHS 2004 ). Application of these criteria involves covering all relevant observational and experimental evidence. The criteria, offered in a brief chapter of the 1964 report entitled “Criteria for Judgment,” included (1) the consistency of the association, (2) the strength of the association, (3) the specificity of the association, (4) the temporal relationship of the association, and (5) the coherence of the association. Although these criteria have been criticized (e. g ., Rothman and Greenland 1998 ), they have proved useful as a framework for interpreting evidence on smoking and other postulated causes of disease, and for judging whether causality can be inferred.

In the 2004 report of the Surgeon General, The Health Consequences of Smoking , the framework for interpreting evidence on smoking and health was revisited in depth for the first time since the 1964 report ( USDHHS 2004 ). The 2004 report provided a four-level hierarchy for interpreting evidence ( Table 1.4 ). The categories acknowledge that evidence can be “suggestive” but not adequate to infer a causal relationship, and also allows for evidence that is “suggestive of no causal relationship.” Since the 2004 report, the individual chapter conclusions have consistently used this four-level hierarchy ( Table 1.4 ), but evidence syntheses and other summary statements may use either the term “increased risk” or “cause” to describe instances in which there is sufficient evidence to conclude that active or involuntary smoking causes a disease or condition. This four-level framework also sharply and completely separates conclusions regarding causality from the implications of such conclusions.

Four-level hierarchy for classifying the strength of causal inferences based on available evidence

That same framework was used in this report on involuntary smoking and health. The criteria dating back to the 1964 Surgeon General’s report remain useful as guidelines for evaluating evidence ( USDHEW 1964 ), but they were not intended to be applied strictly or as a “checklist” that needed to be met before the designation of “causal” could be applied to an association. In fact, for involuntary smoking and health, several of the criteria will not be met for some associations. Specificity, referring to a unique exposure-disease relationship (e. g ., the association between thalidomide use during pregnancy and unusual birth defects), can be set aside as not relevant, as all of the health effects considered in this report have causes other than involuntary smoking. Associations are considered more likely to be causal as the strength of an association increases because competing explanations become less plausible alternatives. However, based on knowledge of dosimetry and mechanisms of injury and disease causation, the risk is anticipated to be only slightly or modestly increased for some associations of involuntary smoking with disease, such as lung cancer, particularly when the very strong relative risks found for active smokers are compared with those for lifetime nonsmokers. The finding of only a small elevation in risk, as in the example of spousal smoking and lung cancer risk in lifetime nonsmokers, does not weigh against a causal association; however, alternative explanations for a risk of a small magnitude need full exploration and cannot be so easily set aside as alternative explanations for a stronger association. Consistency, coherence, and the temporal relationship of involuntary smoking with disease are central to the interpretations in this report. To address coherence, the report draws not only on the evidence for involuntary smoking, but on the even more extensive literature on active smoking and disease.

Although the evidence reviewed in this report comes largely from investigations of secondhand smoke specifically, the larger body of evidence on active smoking is also relevant to many of the associations that were evaluated. The 1986 report found secondhand smoke to be qualitatively similar to mainstream smoke inhaled by the smoker and concluded that secondhand smoke would be expected to have “a toxic and carcinogenic potential that would not be expected to be qualitatively different from that of MS [mainstream smoke]” ( USDHHS 1986 , p. 23). The 2004 report of the Surgeon General revisited the health consequences of active smoking ( USDHHS 2004 ), and the conclusions substantially expanded the list of diseases and conditions caused by smoking. Chapters in the present report consider the evidence on active smoking that is relevant to biologic plausibility for causal associations between involuntary smoking and disease. The reviews included in this report cover evidence identified through search strategies set out in each chapter. Of necessity, the evidence on mechanisms was selectively reviewed. However, an attempt was made to cover all health studies through specified target dates. Because of the substantial amount of time involved in preparing this report, lists of new key references published after these cut-off dates are included in an Appendix . Literature reviews were extended when new evidence was sufficient to possibly change the level of a causal conclusion.

Major Conclusions

This report returns to involuntary smoking, the topic of the 1986 Surgeon General’s report. Since then, there have been many advances in the research on secondhand smoke, and substantial evidence has been reported over the ensuing 20 years. This report uses the revised language for causal conclusions that was implemented in the 2004 Surgeon General’s report ( USDHHS 2004 ). Each chapter provides a comprehensive review of the evidence, a quantitative synthesis of the evidence if appropriate, and a rigorous assessment of sources of bias that may affect interpretations of the findings. The reviews in this report reaffirm and strengthen the findings of the 1986 report. With regard to the involuntary exposure of nonsmokers to tobacco smoke, the scientific evidence now supports the following major conclusions:

Secondhand smoke causes premature death and disease in children and in adults who do not smoke.
Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome ( SIDS ), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.
Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.
Chapter Conclusions

Chapter 2 Toxicology of Secondhand Smoke

Evidence of carcinogenic effects from secondhand smoke exposure.

1. More than 50 carcinogens have been identified in sidestream and secondhand smoke.
2. The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and its condensates and tumors in laboratory animals.
3. The evidence is sufficient to infer that exposure of nonsmokers to secondhand smoke causes a significant increase in urinary levels of metabolites of the tobacco-specific lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone ( NNK ). The presence of these metabolites links exposure to secondhand smoke with an increased risk for lung cancer.
4. The mechanisms by which secondhand smoke causes lung cancer are probably similar to those observed in smokers. The overall risk of secondhand smoke exposure, compared with active smoking, is diminished by a substantially lower carcinogenic dose.

Mechanisms of Respiratory Tract Injury and Disease Caused by Secondhand Smoke Exposure

5. The evidence indicates multiple mechanisms by which secondhand smoke exposure causes injury to the respiratory tract.
6. The evidence indicates mechanisms by which secondhand smoke exposure could increase the risk for sudden infant death syndrome.

Mechanisms of Secondhand Smoke Exposure and Heart Disease

7. The evidence is sufficient to infer that exposure to secondhand smoke has a prothrombotic effect.
8. The evidence is sufficient to infer that exposure to secondhand smoke causes endothelial cell dysfunctions.
9. The evidence is sufficient to infer that exposure to secondhand smoke causes atherosclerosis in animal models.

Chapter 3. Assessment of Exposure to Secondhand Smoke

Building designs and operations.

1. Current heating, ventilating, and air conditioning systems alone cannot control exposure to secondhand smoke.
2. The operation of a heating, ventilating, and air conditioning system can distribute secondhand smoke throughout a building.

Exposure Models

3. Atmospheric concentration of nicotine is a sensitive and specific indicator for secondhand smoke.
4. Smoking increases indoor particle concentrations.
5. Models can be used to estimate concentrations of secondhand smoke.

Biomarkers of Exposure to Secondhand Smoke

6. Biomarkers suitable for assessing recent exposures to secondhand smoke are available.
7. At this time, cotinine, the primary proximate metabolite of nicotine, remains the biomarker of choice for assessing secondhand smoke exposure.
8. Individual biomarkers of exposure to secondhand smoke represent only one component of a complex mixture, and measurements of one marker may not wholly reflect an exposure to other components of concern as a result of involuntary smoking.

Chapter 4. Prevalence of Exposure to Secondhand Smoke

The evidence is sufficient to infer that large numbers of nonsmokers are still exposed to secondhand smoke.
Exposure of nonsmokers to secondhand smoke has declined in the United States since the 1986 Surgeon General’s report, The Health Consequences of Involuntary Smoking .
The evidence indicates that the extent of secondhand smoke exposure varies across the country.
Homes and workplaces are the predominant locations for exposure to secondhand smoke.
Exposure to secondhand smoke tends to be greater for persons with lower incomes.
Exposure to secondhand smoke continues in restaurants, bars, casinos, gaming halls, and vehicles.

Chapter 5. Reproductive and Developmental Effects from Exposure to Secondhand Smoke

1. The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke and female fertility or fecundability. No data were found on paternal exposure to secondhand smoke and male fertility or fecundability.

Pregnancy (Spontaneous Abortion and Perinatal Death)

2. The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke during pregnancy and spontaneous abortion.

Infant Deaths

3. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and neonatal mortality.

Sudden Infant Death Syndrome

4. The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and sudden infant death syndrome.

Preterm Delivery

5. The evidence is suggestive but not sufficient to infer a causal relationship between maternal exposure to secondhand smoke during pregnancy and preterm delivery.

Low Birth Weight

6. The evidence is sufficient to infer a causal relationship between maternal exposure to secondhand smoke during pregnancy and a small reduction in birth weight.

Congenital Malformations

7. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and congenital malformations.

Cognitive Development

8. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and cognitive functioning among children.

Behavioral Development

9. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and behavioral problems among children.

Height/Growth

10. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and children’s height/growth.

Childhood Cancer

11. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood cancer.
12. The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke during pregnancy and childhood cancer.
13. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke during infancy and childhood cancer.
14. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood leukemias.
15. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood lymphomas.
16. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood brain tumors.
17. The evidence is inadequate to infer the presence or absence of a causal relationship between prenatal and postnatal exposure to secondhand smoke and other childhood cancer types.

Chapter 6. Respiratory Effects in Children from Exposure to Secondhand Smoke

Lower respiratory illnesses in infancy and early childhood.

1. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and lower respiratory illnesses in infants and children.
2. The increased risk for lower respiratory illnesses is greatest from smoking by the mother.

Middle Ear Disease and Adenotonsillectomy

3. The evidence is sufficient to infer a causal relationship between parental smoking and middle ear disease in children, including acute and recurrent otitis media and chronic middle ear effusion.
4. The evidence is suggestive but not sufficient to infer a causal relationship between parental smoking and the natural history of middle ear effusion.
5. The evidence is inadequate to infer the presence or absence of a causal relationship between parental smoking and an increase in the risk of adenoidectomy or tonsillectomy among children.

Respiratory Symptoms and Prevalent Asthma in School-Age Children

6. The evidence is sufficient to infer a causal relationship between parental smoking and cough, phlegm, wheeze, and breathlessness among children of school age.
7. The evidence is sufficient to infer a causal relationship between parental smoking and ever having asthma among children of school age.

Childhood Asthma Onset

8. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and the onset of wheeze illnesses in early childhood.
9. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and the onset of childhood asthma.
10. The evidence is inadequate to infer the presence or absence of a causal relationship between parental smoking and the risk of immunoglobulin E-mediated allergy in their children.

Lung Growth and Pulmonary Function

11. The evidence is sufficient to infer a causal relationship between maternal smoking during pregnancy and persistent adverse effects on lung function across childhood.
12. The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke after birth and a lower level of lung function during childhood.

Chapter 7. Cancer Among Adults from Exposure to Secondhand Smoke

Lung cancer.

1. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure and lung cancer among lifetime nonsmokers. This conclusion extends to all secondhand smoke exposure, regardless of location.
2. The pooled evidence indicates a 20 to 30 percent increase in the risk of lung cancer from secondhand smoke exposure associated with living with a smoker.

Breast Cancer

3. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke and breast cancer.

Nasal Sinus Cavity and Nasopharyngeal Carcinoma

4. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and a risk of nasal sinus cancer among nonsmokers.
5. The evidence is inadequate to infer the presence or absence of a causal relationship between secondhand smoke exposure and a risk of nasopharyngeal carcinoma among nonsmokers.

Cervical Cancer

6. The evidence is inadequate to infer the presence or absence of a causal relationship between secondhand smoke exposure and the risk of cervical cancer among lifetime nonsmokers.

Chapter 8. Cardiovascular Diseases from Exposure to Secondhand Smoke

The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and increased risks of coronary heart disease morbidity and mortality among both men and women.
Pooled relative risks from meta-analyses indicate a 25 to 30 percent increase in the risk of coronary heart disease from exposure to secondhand smoke.
The evidence is suggestive but not sufficient to infer a causal relationship between exposure to secondhand smoke and an increased risk of stroke.
Studies of secondhand smoke and subclinical vascular disease, particularly carotid arterial wall thickening, are suggestive but not sufficient to infer a causal relationship between exposure to secondhand smoke and atherosclerosis.

Chapter 9. Respiratory Effects in Adults from Exposure to Secondhand Smoke

Odor and irritation.

1. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure and odor annoyance.
2. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure and nasal irritation.
3. The evidence is suggestive but not sufficient to conclude that persons with nasal allergies or a history of respiratory illnesses are more susceptible to developing nasal irritation from secondhand smoke exposure.

Respiratory Symptoms

4. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms including cough, wheeze, chest tightness, and difficulty breathing among persons with asthma.
5. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms including cough, wheeze, chest tightness, and difficulty breathing among healthy persons.
6. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and chronic respiratory symptoms.

Lung Function

7. The evidence is suggestive but not sufficient to infer a causal relationship between short-term secondhand smoke exposure and an acute decline in lung function in persons with asthma.
8. The evidence is inadequate to infer the presence or absence of a causal relationship between short-term secondhand smoke exposure and an acute decline in lung function in healthy persons.
9. The evidence is suggestive but not sufficient to infer a causal relationship between chronic secondhand smoke exposure and a small decrement in lung function in the general population.
10. The evidence is inadequate to infer the presence or absence of a causal relationship between chronic secondhand smoke exposure and an accelerated decline in lung function.
11. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and adult-onset asthma.
12. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and a worsening of asthma control.

Chronic Obstructive Pulmonary Disease

13. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and risk for chronic obstructive pulmonary disease.
14. The evidence is inadequate to infer the presence or absence of a causal relationship between secondhand smoke exposure and morbidity in persons with chronic obstructive pulmonary disease.

Chapter 10. Control of Secondhand Smoke Exposure

Workplace smoking restrictions are effective in reducing secondhand smoke exposure.
Workplace smoking restrictions lead to less smoking among covered workers.
Establishing smoke-free workplaces is the only effective way to ensure that secondhand smoke exposure does not occur in the workplace.
The majority of workers in the United States are now covered by smoke-free policies.
The extent to which workplaces are covered by smoke-free policies varies among worker groups, across states, and by sociodemographic factors. Workplaces related to the entertainment and hospitality industries have notably high potential for secondhand smoke exposure.
Evidence from peer-reviewed studies shows that smoke-free policies and regulations do not have an adverse economic impact on the hospitality industry.
Evidence suggests that exposure to secondhand smoke varies by ethnicity and gender.
In the United States, the home is now becoming the predominant location for exposure of children and adults to secondhand smoke.
Total bans on indoor smoking in hospitals, restaurants, bars, and offices substantially reduce secondhand smoke exposure, up to several orders of magnitude with incomplete compliance, and with full compliance, exposures are eliminated.
Exposures of nonsmokers to secondhand smoke cannot be controlled by air cleaning or mechanical air exchange.
Methodologic Issues

Much of the evidence on the health effects of involuntary smoking comes from observational epidemiologic studies that were carried out to test hypotheses related to secondhand smoke and risk for diseases and other adverse health effects. The challenges faced in carrying out these studies reflect those of observational research generally: assessment of the relevant exposures and outcomes with sufficient validity and precision, selection of an appropriate study design, identification of an appropriate and sufficiently large study population, and collection of information on other relevant factors that may confound or modify the association being studied. The challenge of accurately classifying secondhand smoke exposures confronts all studies of such exposures, and consequently the literature on approaches to and limitations of exposure classification is substantial. Sources of bias that can affect the findings of epidemiologic studies have been widely discussed ( Rothman and Greenland 1998 ), both in general and in relation to studies of involuntary smoking. Concerns about bias apply to any study of an environmental agent and disease risk: misclassification of exposures or outcomes, confounding effect modification, and proper selection of study participants. In addition, the generalizability of findings from one population to another (external validity) further determines the value of evidence from a study. Another methodologic concern affecting secondhand smoke literature comes from the use of meta-analysis to combine the findings of epidemiologic studies; general concerns related to the use of meta-analysis for observational data and more specific concerns related to involuntary smoking have also been raised. This chapter considers these methodologic issues in anticipation of more specific treatment in the following chapters.

Classification of Secondhand Smoke Exposure

For secondhand smoke, as for any environmental factor that may be a cause of disease, the exposure assessment might encompass the time and place of the exposure, cumulative exposures, exposure during a particular time, or a recent exposure ( Jaakkola and Jaakkola 1997 ; Jaakkola and Samet 1999 ). For example, exposures to secondhand smoke across the full life span may be of interest for lung cancer, while only more recent exposures may be relevant to the exacerbation of asthma. For CHD , both temporally remote and current exposures may affect risk. Assessments of exposures are further complicated by the multiplicity of environments where exposures take place and the difficulty of characterizing the exposure in some locations, such as public places or workplaces. Additionally, exposures probably vary qualitatively and quantitatively over time and across locations because of temporal changes and geographic differences in smoking patterns.

Nonetheless, researchers have used a variety of approaches for exposure assessments in epidemiologic studies of adverse health effects from involuntary smoking. Several core concepts that are fundamental to these approaches are illustrated in Figure 1.1 ( Samet and Jaakkola 1999 ). Cigarette smoking is, of course, the source of most secondhand smoke in the United States, followed by pipes, cigars, and other products. Epidemiologic studies generally focus on assessing the exposure, which is the contact with secondhand smoke. The concentrations of secondhand smoke components in a space depend on the number of smokers and the rate at which they are smoking, the volume into which the smoke is distributed, the rate at which the air in the space exchanges with uncontaminated air, and the rate at which the secondhand smoke is removed from the air. Concentration, exposure, and dose differ in their definitions, although the terms are sometimes used without sharp distinctions. However, surrogate indicators that generally describe a source of exposure may also be used to assess the exposure, such as marriage to a smoker or the number of cigarettes smoked in the home. Biomarkers can provide an indication of an exposure or possibly the dose, but for secondhand smoke they are used for recent exposure only.

The determinants of exposure, dose, and biologically effective dose that underlie the development of health effects from smoking. Source: Samet and Jaakkola (more...)

People are exposed to secondhand smoke in a number of different places, often referred to as “microenvironments” ( NRC 1991 ). A microenvironment is a definable location that has a constant concentration of the contaminant of interest, such as secondhand smoke, during the time that a person is there. Some key microenvironments for secondhand smoke include the home, the workplace, public places, and transportation environments ( Klepeis 1999 ). Based on the microenvironmental model, total exposure can be estimated as the weighted average of the concentrations of secondhand smoke or indicator compounds, such as nicotine, in the microenvironments where time is spent; the weights are the time spent in each microenvironment. Klepeis (1999) illustrates the application of the microenvironmental model with national data from the National Human Activity Pattern Survey conducted by the EPA . His calculations yield an overall estimate of exposure to airborne particles from smoking and of the contributions to this exposure from various microenvironments.

Much of the epidemiologic evidence addresses the consequences of an exposure in a particular microenvironment, such as the home (spousal smoking and lung cancer risk or maternal smoking and risk for asthma exacerbation), or the workplace (exacerbation of asthma by the presence of smokers). Some studies have attempted to cover multiple microenvironments and to characterize exposures over time. For example, in the multicenter study of secondhand smoke exposure and lung cancer carried out in the United States, Fontham and colleagues (1994) assessed exposures during childhood, in workplaces, and at home during adulthood. Questionnaires that assess exposures have been the primary tool used in epidemiologic studies of secondhand smoke and disease. Measurement of biomarkers has been added in some studies, either as an additional and complementary exposure assessment approach or for validating questionnaire responses. Some studies have also measured components of secondhand smoke in the air.

Questionnaires generally address sources of exposure in microenvironments and can be tailored to address the time period of interest. Questionnaires represent the only approach that can be used to assess exposures retrospectively over a life span, because available biomarkers only reflect exposures over recent days or, at most, weeks. Questionnaires on secondhand smoke exposure have been assessed for their reliability and validity, generally based on comparisons with either biomarker or air monitoring data as the “gold” standard ( Jaakkola and Jaakkola 1997 ). Two studies evaluated the reliability of questionnaires on lifetime exposures ( Pron et al. 1988 ; Coultas et al. 1989 ). Both showed a high degree of repeatability for questions concerning whether a spouse had smoked, but a lower reliability for responses concerning the quantitative aspects of an exposure. Emerson and colleagues (1995) evaluated the repeatability of information from parents of children with asthma. They found a high reliability for parent-reported tobacco use and for the number of cigarettes to which the child was exposed in the home during the past week.

To assess validity, questionnaire reports of current or recent exposures have been compared with levels of cotinine and other biomarkers. These studies tend to show a moderate correlation between levels of cotinine and questionnaire indicators of exposures ( Kawachi and Colditz 1996 ; Cal/EPA 1997 ; Jaakkola and Jaakkola 1997 ). However, cotinine levels reflect not only exposure but metabolism and excretion ( Benowitz 1999 ). Consequently, exposure is only one determinant of variation in cotinine levels among persons; there also are individual variations in metabolism and excretion rates. In spite of these sources of variability, mean levels of cotinine vary as anticipated across categories of self-reported exposures ( Cal/EPA 1997 ; Jaakkola and Jaakkola 1997 ), and self-reported exposures are moderately associated with measured levels of markers ( Cal/EPA 1997 ; Jaakkola and Jaakkola 1997 ).

Biomarkers are also used for assessing exposures to secondhand smoke. A number of biomarkers are available, but they vary in their specificity and in the dynamics of the temporal relationship between the exposure and the marker level ( Cal/EPA 1997 ; Benowitz 1999 ). These markers include specific tobacco smoke components (nicotine) or metabolites (cotinine and tobacco-specific nitrosamines), nonspecific biomarkers (thiocyanate and CO ), adducts with tobacco smoke components or metabolites (4-amino-biphenyl hemoglobin adducts, benzo[ a ]pyrene DNA adducts, and polycyclic aromatic hydrocarbon albumin adducts), and nonspecific assays (urinary mutagenicity). Cotinine has been the most widely used biomarker, primarily because of its specificity, half-life, and ease of measurement in body fluids (e. g ., urine, blood, and saliva). Biomarkers are discussed in detail in Chapter 3 (Assessment of Exposure to Secondhand Smoke).

Some epidemiologic studies have also incorporated air monitoring, either direct personal sampling or the indirect approach based on the microenvironmental model. Nicotine, present in the gas phase of secondhand smoke, can be monitored passively with a special filter or actively using a pump and a sorbent. Hammond and Leaderer (1987) first described a diffusion monitor for the passive sampling of nicotine in 1987; this device has now been widely used to assess concentrations in different environments and to study health effects. Airborne particles have also been measured using active monitoring devices.

Each of these approaches for assessing exposures has strengths and limitations, and preference for one over another will depend on the research question and its context ( Jaakkola and Jaakkola 1997 ; Jaakkola and Samet 1999 ). Questionnaires can be used to characterize sources of exposures, such as smoking by parents. With air concentrations of markers and time-activity information, estimates of secondhand smoke exposures can be made with the microenvironmental model. Biomarkers provide exposure measures that reflect the patterns of exposure and the kinetics of the marker; the cotinine level in body fluids, for example, reflects an exposure during several days. Air monitoring may be useful for validating measurements of exposure. Exposure assessment strategies are matched to the research question and often employ a mixture of approaches determined by feasibility and cost constraints.

Misclassification of Secondhand Smoke Exposure

Misclassification may occur when classifying exposures, outcomes, confounding factors, or modifying factors. Misclassification may be differential on either exposure or outcome, or it may be random ( Armstrong et al. 1992 ). Differential or nonrandom misclassification may either increase or decrease estimates of effect, while random misclassification tends to reduce the apparent effect and weaken the relationship of exposure with disease risk. In studies of secondhand smoke and disease risk, exposure misclassification has been a major consideration in the interpretation of the evidence, although misclassification of health outcome measures has not been a substantial issue in this research. The consequences for epidemiologic studies of misclassification in general are well established ( Rothman and Greenland 1998 ).

An extensive body of literature on the classification of exposures to secondhand smoke is reviewed in this and other chapters, as well as in some publications on the consequences of misclassification ( Wu 1999 ). Two general patterns of exposure misclassification are of concern to secondhand smoke: (1) random misclassification that is not differential by the presence or absence of the health outcome and (2) systematic misclassification that is differential by the health outcome. In studying the health effects of secondhand smoke in adults, there is a further concern as to the classification of the active smoking status (never, current, or former smoking); in studies of children, the accuracy of secondhand smoke exposure classification is the primary methodologic issue around exposure assessment, but unreported active smoking by adolescents is also a concern.

With regard to random misclassification of secondhand smoke exposures, there is an inherent degree of unavoidable measurement error in the exposure measures used in epidemiologic studies. Questionnaires generally assess contact with sources of an exposure (e. g ., smoking in the home or work-place) and cannot capture all exposures nor the intensity of exposures; biomarkers provide an exposure index for a particular time window and have intrinsic variability. Some building-related factors that determine an exposure cannot be assessed accurately by a questionnaire, such as the rate of air exchange and the size of the microenvironment where time is spent, nor can concentrations be assessed accurately by subjective reports of the perceived level of tobacco smoke. In general, random misclassification of exposures tends to reduce the likelihood that studies of secondhand smoke exposure will find an effect. This type of misclassification lessens the contrast between exposure groups, because some truly exposed persons are placed in the unexposed group and some truly unexposed persons are placed in the exposed group. Differential misclassification, also a concern, may increase or decrease associations, depending on the pattern of misreporting.

One particular form of misclassification has been raised with regard to secondhand smoke exposure and lung cancer: the classification of some current or former smokers as lifetime nonsmokers ( USEPA 1992 ; Lee and Forey 1995 ; Hackshaw et al. 1997 ; Wu 1999 ). The resulting bias would tend to increase the apparent association of secondhand smoke with lung cancer, if the misclassified active smokers are also more likely to be classified as involuntary smokers. Most studies of lung cancer and secondhand smoke have used spousal smoking as a main exposure variable. As smoking tends to aggregate between spouses (smokers are more likely to marry smokers), misclassification of active smoking would tend to be differential on the basis of spousal smoking (the exposure under investigation). Because active smoking is strongly associated with increased disease risk, greater misclassification of an actively smoking spouse as a non-smoker among spouses of smokers compared with spouses of nonsmokers would lead to risk estimates for spousal smoking that are biased upward by the effect of active smoking. This type of misclassification is also relevant to studies of spousal exposure and CHD risk or other diseases also caused by active smoking, although the potential for bias is less because the association of active smoking with CHD is not as strong as with lung cancer.

There have been a number of publications on this form of misclassification. Wu (1999) provides a review, and Lee and colleagues (2001) offer an assessment of potential consequences. A number of models have been developed to assess the extent of bias resulting from the misclassification of active smokers as lifetime nonsmokers ( USEPA 1992 ; Hackshaw et al. 1997 ). These models incorporate estimates of the rate of misclassification, the degree of aggregation of smokers by marriage, the prevalence of smoking in the population, and the risk of lung cancer in misclassified smokers ( Wu 1999 ). Although debate about this issue continues, analyses show that estimates of upward bias from misclassifying active smokers as lifetime nonsmokers cannot fully explain the observed increase in risk for lung cancer among lifetime non-smokers married to smokers ( Hackshaw et al. 1997 ; Wu 1999 ).

There is one additional issue related to exposure misclassification. During the time the epidemiologic studies of secondhand smoke have been carried out, exposure has been widespread and almost unavoidable. Therefore, the risk estimates may be biased downward because there are no truly unexposed persons. The 1986 Surgeon General’s report recognized this methodologic issue and noted the need for further data on population exposures to secondhand smoke ( USDHHS 1986 ). This bias was also recognized in the 1986 report of the NRC , and an adjustment for this misclassification was made to the lung cancer estimate ( NRC 1986 ). Similarly, the 1992 report of the EPA commented on background exposure and made an adjustment ( USEPA 1992 ). Some later studies have attempted to address this issue; for example, in a case-control study of active and involuntary smoking and breast cancer in Switzerland, Morabia and colleagues (2000) used a questionnaire to assess exposure and identified a small group of lifetime nonsmokers who also reported no exposure to secondhand smoke. With this subgroup of controls as the reference population, the risks of secondhand smoke exposure were substantially greater for active smoking than when the full control population was used.

This Surgeon General’s report further addresses specific issues of exposure misclassification when they are relevant to the health outcome under consideration.

Use of Meta-Analysis

Meta-analysis refers to the process of evaluating and combining a body of research literature that addresses a common question. Meta-analysis is composed of qualitative and quantitative components. The qualitative component involves the systematic identification of all relevant investigations, a systematic assessment of their characteristics and quality, and the decision to include or exclude studies based on predetermined criteria. Consideration can be directed toward sources of bias that might affect the findings. The quantitative component involves the calculation and display of study results on common scales and, if appropriate, the statistical combination of these results across studies and an exploration of the reasons for any heterogeneity of findings. Viewing the findings of all studies as a single plot provides insights into the consistency of results and the precision of the studies considered. Most meta-analyses are based on published summary results, although they are most powerful when applied to data at the level of individual participants. Meta-analysis is most widely used to synthesize evidence from randomized clinical trials, sometimes yielding findings that were not evident from the results of individual studies. Meta-analysis also has been used extensively to examine bodies of observational evidence.

Beginning with the 1986 NRC report, meta-analysis has been used to summarize the evidence on involuntary smoking and health. Meta-analysis was central to the 1992 EPA risk assessment of secondhand smoke, and a series of meta-analyses supported the conclusions of the 1998 report of the Scientific Committee on Tobacco and Health in the United Kingdom. The central role of meta-analysis in interpreting and applying the evidence related to involuntary smoking and disease has led to focused criticisms of the use of meta-analysis in this context. Several papers that acknowledged support from the tobacco industry have addressed the epidemiologic findings for lung cancer, including the selection and quality of the studies, the methods for meta-analysis, and dose-response associations ( Fleiss and Gross 1991 ; Tweedie and Mengersen 1995 ; Lee 1998 , 1999 ). In a lawsuit brought by the tobacco industry against the EPA, the 1998 decision handed down by Judge William L . Osteen, Sr., in the North Carolina Federal District Court criticized the approach EPA had used to select studies for its meta-analysis and criticized the use of 90 percent rather than 95 percent confidence intervals for the summary estimates ( Flue-Cured Tobacco Cooperative Stabilization Corp. v. United States Environmental Protection Agency , 857 F. Supp. 1137 [M.D.N.C. 1993]). In December 2002, the 4th U.S. Circuit Court of Appeals threw out the lawsuit on the basis that tobacco companies cannot sue the EPA over its secondhand smoke report because the report was not a final agency action and therefore not subject to court review ( Flue-Cured Tobacco Cooperative Stabilization Corp. v. The United States Environmental Protection Agency , No. 98–2407 [4th Cir., December 11, 2002], cited in 17.7 TPLR 2.472 [2003]).

Recognizing that there is still an active discussion around the use of meta-analysis to pool data from observational studies (versus clinical trials), the authors of this Surgeon General’s report used this methodology to summarize the available data when deemed appropriate and useful, even while recognizing that the uncertainty around the meta-analytic estimates may exceed the uncertainty indicated by conventional statistical indices, because of biases either within the observational studies or produced by the manner of their selection. However, a decision to not combine estimates might have produced conclusions that are far more uncertain than the data warrant because the review would have focused on individual study results without considering their overall pattern, and without allowing for a full accounting of different sample sizes and effect estimates.

The possibility of publication bias has been raised as a potential limitation to the interpretation of evidence on involuntary smoking and disease in general, and on lung cancer and secondhand smoke exposure specifically. A 1988 paper by Vandenbroucke used a descriptive approach, called a “funnel plot,” to assess the possibility that publication bias affected the 13 studies considered in a review by Wald and colleagues (1986) . This type of plot characterizes the relationship between the magnitude of estimates and their precision. Vandenbroucke suggested the possibility of publication bias only in reference to the studies of men. Bero and colleagues (1994) concluded that there had not been a publication bias against studies with statistically significant findings, nor against the publication of studies with nonsignificant or mixed findings in the research literature. The researchers were able to identify only five unpublished “negative” studies, of which two were dissertations that tend to be delayed in publication. A subsequent study by Misakian and Bero (1998) did find a delay in the publication of studies with nonsignificant results in comparison with studies having significant results; whether this pattern has varied over the several decades of research on secondhand smoke was not addressed. More recently, Copas and Shi (2000) assessed the 37 studies considered in the meta-analysis by Hackshaw and colleagues (1997) for publication bias. Copas and Shi (2000) found a significant correlation between the estimated risk of exposure and sample size, such that smaller studies tended to have higher values. This pattern suggests the possibility of publication bias. However, using a funnel plot of the same studies, Lubin (1999) found little evidence for publication bias.

On this issue of publication bias, it is critical to distinguish between indirect statistical arguments and arguments based on actual identification of previously unidentified research. The strongest case against substantive publication bias has been made by researchers who mounted intensive efforts to find the possibly missing studies; these efforts have yielded little nothing that would alter published conclusions ( Bero et al. 1994 ; Glantz 2000 ). Presumably because this exposure is a great public health concern, the findings of studies that do not have statistically significant outcomes continue to be published ( Kawachi and Colditz 1996 ).

The quantitative results of the meta-analyses, however, were not determinate in making causal inferences in this Surgeon General’s report. In particular, the level of statistical significance of estimates from the meta-analyses was not a predominant factor in making a causal conclusion. For that purpose, this report relied on the approach and criteria set out in the 1964 and 2004 reports of the Surgeon General, which involved judgments based on an array of quantitative and qualitative considerations that included the degree of heterogeneity in the designs of the studies that were examined. Sometimes this heterogeneity limits the inference from meta-analysis by weakening the rationale for pooling the study results. However, the availability of consistent evidence from heterogenous designs can strengthen the meta-analytic findings by making it unlikely that a common bias could persist across different study designs and populations.

Confounding

Confounding, which refers in this context to the mixing of the effect of another factor with that of secondhand smoke, has been proposed as an explanation for associations of secondhand smoke with adverse health consequences. Confounding occurs when the factor of interest (secondhand smoke) is associated in the data under consideration with another factor (the confounder) that, by itself, increases the risk for the disease ( Rothman and Greenland 1998 ). Correlates of secondhand smoke exposures are not confounding factors unless an exposure to them increases the risk of disease. A factor proposed as a potential confounder is not necessarily an actual confounder unless it fulfills the two elements of the definition. Although lengthy lists of potential confounding factors have been offered as alternatives to direct associations of secondhand smoke exposures with the risk for disease, the factors on these lists generally have not been shown to be confounding in the particular data of interest.

The term confounding also conveys an implicit conceptualization as to the causal pathways that link secondhand smoke and the confounding factor to disease risk. Confounding implies that the confounding factor has an effect on risk that is independent of secondhand smoke exposure. Some factors considered as potential confounders may, however, be in the same causal pathway as a secondhand smoke exposure. Although socioeconomic status ( SES ) is often cited as a potential confounding factor, it may not have an independent effect but can affect disease risk through its association with secondhand smoke exposure ( Figure 1.2 ). This figure shows general alternative relationships among SES, secondhand smoke exposure, and risk for an adverse effect. SES may have a direct effect, or it may indirectly exert its effect through an association with secondhand smoke exposure, or it may confound the relationship between secondhand smoke exposure and disease risk. To control for SES as a potential confounding factor without considering underlying relationships may lead to incorrect risk estimates. For example, controlling for SES would not be appropriate if it is a determinant of secondhand smoke exposure but has no direct effect.

Model for socioeconomic status (SES) and secondhand smoke (SHS) exposure. Arrows indicate directionality of association.

Nonetheless, because the health effects of involuntary smoking have other causes, the possibility of confounding needs careful exploration when assessing associations of secondhand smoke exposure with adverse health effects. In addition, survey data from the last several decades show that secondhand smoke exposure is associated with correlates of lifestyle that may influence the risk for some health effects, thus increasing concerns for the possibility of confounding ( Kawachi and Colditz 1996 ). Survey data from the United States ( Matanoski et al. 1995 ) and the United Kingdom ( Thornton et al. 1994 ) show that adults with secondhand smoke exposures generally tend to have less healthful lifestyles. However, the extent to which these patterns of association can be generalized, either to other countries or to the past, is uncertain.

The potential bias from confounding varies with the association of the confounder to secondhand smoke exposures in a particular study and to the strength of the confounder as a risk factor. The importance of confounding to the interpretation of evidence depends further on the magnitude of the effect of secondhand smoke on disease. As the strength of an association lessens, confounding as an alternative explanation for an association becomes an increasing concern. In prior reviews, confounding has been addressed either quantitatively ( Hackshaw et al. 1997 ) or qualitatively ( Cal/EPA 1997 ; Thun et al. 1999 ). In the chapters in this report that focus on specific diseases, confounding is specifically addressed in the context of potential confounding factors for the particular diseases.

Tobacco Industry Activities

The evidence on secondhand smoke and disease risk, given the public health and public policy implications, has been reviewed extensively in the published peer-reviewed literature and in evaluations by a number of expert panels. In addition, the evidence has been criticized repeatedly by the tobacco industry and its consultants in venues that have included the peer-reviewed literature, public meetings and hearings, and scientific symposia that included symposia sponsored by the industry. Open criticism in the peer-reviewed literature can strengthen the credibility of scientific evidence by challenging researchers to consider the arguments proposed by critics and to rebut them.

Industry documents indicate that the tobacco industry has engaged in widespread activities, however, that have gone beyond the bounds of accepted scientific practice ( Glantz 1996 ; Ong and Glantz 2000 , 2001 ; Rampton and Stauber 2000 ; Yach and Bialous 2001 ; Hong and Bero 2002 ; Diethelm et al. 2004 ). Through a variety of organized tactics, the industry has attempted to undermine the credibility of the scientific evidence on secondhand smoke. The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus ( Garne et al. 2005 ). These tactics are not a topic of this report, but to the extent that the scientific literature has been distorted, they are addressed as the evidence is reviewed. This report does not specifically identify tobacco industry sponsorship of publications unless that information is relevant to the interpretation of the findings and conclusions.

Armstrong BK, White E, Saracci R, editors. Monographs in Epidemiology and Biostatistics. Vol. 21. New York: Oxford University Press; 1992. Principles of Exposure Measurement in Epidemiology.
Benowitz NL. Biomarkers of environmental tobacco smoke. Environmental Health Perspectives. 1999; 107 (Suppl 2):349–55. [ PMC free article : PMC1566286 ] [ PubMed : 10350520 ]
Bero LA, Glantz SA, Rennie D. Publication bias and public health policy on environmental tobacco smoke. Journal of the American Medical Association. 1994; 272 (2):133–6. [ PubMed : 8015124 ]
California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. Sacramento (CA): California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Reproductive and Cancer Hazard Assessment Section and Air Toxicology and Epidemiology Section; 1997.
California Environmental Protection Agency. Part B: Health Effects. Sacramento (CA): California Environmental Protection Agency, Office of Environmental Health Hazard Assessment; 2005. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant.
Copas JB, Shi JQ. Reanalysis of epidemiological evidence on lung cancer and passive smoking. British Medical Journal. 2000; 320 (7232):417–8. [ PMC free article : PMC27286 ] [ PubMed : 10669446 ]
Coultas DB, Peake GT, Samet JM. Questionnaire assessment of lifetime and recent exposure to environmental tobacco smoke. American Journal of Epidemiology. 1989; 130 (2):338–47. [ PubMed : 2750729 ]
Diethelm PA, Rielle JC, McKee M.The whole truth and nothing but the truth? The research that Phillip Morris did not want you to see. Nov 11, 2004. [accessed: January 6, 2005]. http://image .thelancet .com/extras/03art7306web.pdf [ PubMed : 15993237 ]
Emerson JA, Hovell MF, Meltzer SB, Zakarian JM, Hofstetter CR, Wahlgren DR, Leaderer BP, Meltzer EO. The accuracy of environmental tobacco smoke exposure measures among asthmatic children. Journal of Clinical Epidemiology. 1995; 48 (10):1251–9. [ PubMed : 7561987 ]
Fleiss JL, Gross AJ. Meta-analysis in epidemiology, with special reference to studies of the association between exposure to environmental tobacco smoke and lung cancer: a critique. Journal of Clinical Epidemiology. 1991; 44 (2):127–39. [ PubMed : 1995774 ]
Flue-Cured Tobacco Cooperative Stabilization Corp. v. United States Environmental Protection Agency (M.D.N.C. June 22, 1993), cited in 8.2 TPLR 3.97 (1993).
Flue-Cured Tobacco Cooperative Stabilization Corp. v. The United States Environmental Protection Agency, No. 98–2407 (4th Cir., December 11, 2002), cited in 17.7 TPLR 2.472 (2003) (Overturning lower court’s decision invalidating EPA’s findings that secondhand smoke is a “known human carcinogen”).
Fontham ET, Correa P, Reynolds P, Wu-Williams A, Buffler PA, Greenberg RS, Chen VW, Alterman T, Boyd P, Austin DF, Liff J. Environmental tobacco smoke and lung cancer in nonsmoking women: a multicenter study. Journal of the American Medical Association. 1994; 271 (22):1752–9. [ PubMed : 8196118 ]
Garne D, Watson M, Chapman S, Byrne F. Environmental tobacco smoke research published in the journal Indoor and Built Environment and associations with the tobacco industry. Lancet. 2005; 365 (9461):804–9. [ PubMed : 15733724 ]
Glantz SA. The ledger of tobacco control. Journal of the American Medical Association. 1996; 276 (11):871–2. [ PubMed : 8782631 ]
Glantz SA. Lung cancer and passive smoking: nothing new was said. British Medical Journal. 2000; 321 (7270):1222–3. [ PubMed : 11073523 ]
Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco smoke. British Medical Journal. 1997; 315 (7114):980–8. [ PMC free article : PMC2127653 ] [ PubMed : 9365295 ]
Hammond SK, Leaderer BP. A diffusion monitor to measure exposure to passive smoking. Environmental Science & Technology. 1987; 21 (5):494–7. [ PubMed : 22296139 ]
Hong MK, Bero LA. How the tobacco industry responded to an influential study of the health effects of secondhand smoke. British Medical Journal. 2002; 325 (7377):1413–6. [ PMC free article : PMC1124865 ] [ PubMed : 12480862 ]
International Agency for Research on Cancer. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans: Tobacco Smoking. Vol. 38. Lyon (France): International Agency for Research on Cancer; 1986.
International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Tobacco Smoke and Involuntary Smoking. Vol. 83. Lyon (France): International Agency for Research on Cancer; 2004. [ PMC free article : PMC4781536 ] [ PubMed : 15285078 ]
Jaakkola MS, Jaakkola JJ. Assessment of exposure to environmental tobacco smoke. European Respiratory Journal. 1997; 10 (10):2384–97. [ PubMed : 9387970 ]
Jaakkola MS, Samet JM. Environmental tobacco smoke: risk assessment. Environmental Health Perspectives. 1999; 107 (Suppl 6):823–904. [ PMC free article : PMC1566195 ] [ PubMed : 10592138 ]
Kawachi I, Colditz GA. Invited commentary: confounding, measurement error, and publication bias in studies of passive smoking. American Journal of Epidemiology. 1996; 144 (10):909–15. [ PubMed : 8916501 ]
Klepeis NE. An introduction to the indirect exposure assessment approach: modeling human exposure using microenvironmental measurements and the recent National Human Activity Pattern Survey. Environmental Health Perspectives. 1999; 107 (Suppl 2):365–74. [ PMC free article : PMC1566279 ] [ PubMed : 10350522 ]
Lee PN. Difficulties in assessing the relationship between passive smoking and lung cancer. Statistical Methods in Medical Research. 1998; 7 (2):137–63. [ PubMed : 9654639 ]
Lee PN. Simple methods for checking for possible errors in reported odds ratios, relative risks and confidence intervals. Statistics in Medicine. 1999; 18 (15):1973–81. [ PubMed : 10440880 ]
Lee PN, Forey BA. Misclassification of smoking habits as determined by cotinine or by repeated self-report—summary of evidence from 42 studies. Journal of Smoking-Related Diseases. 1995; 6 :109–29.
Lee PN, Forey B, Fry JS. Revisiting the association between environmental tobacco smoke exposure and lung cancer risk. III: Adjusting for the biasing effect of misclassification of smoking habits. Indoor and Built Environment. 2001; 10 (6):384–98.
Lubin JH. Estimating lung cancer risk with exposure to environmental tobacco smoke. Environmental Health Perspectives. 1999; 107 (Suppl 6):879–83. [ PMC free article : PMC1566203 ] [ PubMed : 10592146 ]
Matanoski G, Kanchanaraksa S, Lantry D, Chang Y. Characteristics of nonsmoking women in NHANES I and NHANES I Epidemiologic Follow-up Study with exposure to spouses who smoke. American Journal of Epidemiology. 1995; 142 (2):149–57. [ PubMed : 7598114 ]
Misakian AL, Bero LA. Publication bias and research on passive smoking: comparison of published and unpublished studies. Journal of the American Medical Association. 1998; 280 (3):250–3. [ PubMed : 9676672 ]
Morabia A, Bernstein MS, Bouchardy I, Kurtz J, Morris MA. Breast cancer and active and passive smoking: the role of the N -acetyltransferase 2 genotype. American Journal of Epidemiology. 2000; 152 (3):226–32. [ PubMed : 10933269 ]
National Health and Medical Research Council. A scientific information paper. Canberra (Commonwealth of Australia): Canberra ACT; 1997. The Health Effects of Passive Smoking.
National Research Council. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington: National Academy Press; 1986. [ PubMed : 25032469 ]
National Research Council. Human Exposure Assessment for Airborne Pollutants: Advances and Opportunities. Washington: National Academy Press; 1991.
Ong EK, Glantz SA. Tobacco industry efforts subverting International Agency for Research on Cancer’s second-hand smoke study. Lancet. 2000; 355 (9211):1253–9. [ PubMed : 10770318 ]
Ong EK, Glantz SA. Constructing “sound science” and “good epidemiology”: tobacco, lawyers, and public relations rms. American Journal of Public Health. 2001; 91 (11):1749–57. [ PMC free article : PMC1446868 ] [ PubMed : 11684593 ]
Pron GE, Burch JD, Howe GR, Miller AB. The reliability of passive smoking histories reported in a case-control study of lung cancer. American Journal of Epidemiology. 1988; 127 (2):267–73. [ PubMed : 3337082 ]
Rampton S, Stauber J. Trust Us, We’re Experts: How Industry Manipulates Science and Gambles with Your Future. Los Angeles: J.P. Tarcher; 2000.
Rothman KJ, Greenland S. Modern Epidemiology. 2nd ed. Philadelphia: Lippincott-Raven; 1998.
Samet JM, Jaakkola JJK. The epidemiologic approach to investigating outdoor air pollution. In: Holgate ST, Samet JM, Koren HS, Maynard RL, editors. Air Pollution and Health. San Diego: Academic Press; 1999. pp. 431–60.
Scientific Committee on Tobacco and Health . Report of the Scientific Committee on Tobacco and Health. London: The Stationery Office; 1998.
Thornton A, Lee P, Fry J. Differences between smokers, ex-smokers, passive smokers and non-smokers. Journal of Clinical Epidemiology. 1994; 47 (10):1143–62. [ PubMed : 7722548 ]
Thun M, Henley J, Apicella L. Epidemiologic studies of fatal and nonfatal cardiovascular disease and ETS exposure from spousal smoking. Environmental Health Perspectives. 1999; 107 (Suppl 6):841–6. [ PMC free article : PMC1566204 ] [ PubMed : 10592140 ]
Tweedie RL, Mengersen KL. Meta-analytic approaches to dose-response relationships, with application in studies of lung cancer and exposure to environmental tobacco smoke. Statistics in Medicine. 1995; 14 (5–7):545–69. [ PubMed : 7792447 ]
US Department of Health and Human Services . The Health Consequences of Smoking: Cancer A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health; 1982. DHHS Publication No. (PHS) 82–50179.
US Department of Health and Human Services. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health; 1984. The Health Consequences of Smoking: Chronic Obstructive Lung Disease. DHHS Publication No. (PHS) 84–50205.
US Department of Health and Human Services. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health; 1986. The Health Consequences of Involuntary Smoking. DHHS Publication No. (CDC) 87–8398.
US Department of Health and Human Services. A Report of the Surgeon General. Atlanta: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1994. Preventing Tobacco Use Among Young People.
US Department of Health and Human Services. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1998. Tobacco Use Among US Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics.
US Department of Health and Human Services. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001. Women and Smoking.
US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
US Department of Health, Education, and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington: U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control; 1964. PHS Publication No. 1103.
US Department of Health, Education, and Welfare. A Report of the Surgeon General: 1972. Washington: U.S. Department of Health, Education, and Welfare, Public Health Service, Health Services and Mental Health Administration; 1972. The Health Consequences of Smoking. DHEW Publication No. (HSM) 72–7516.
US Department of Health, Education, and Welfare. A Report of the Surgeon General, 1975. Washington: U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control; 1975. The Health Consequences of Smoking. DHEW Publication No. (CDC) 77–8704.
US Department of Health, Education, and Welfare. A Report of the Surgeon General. Washington: U.S. Department of Health, Education, and Welfare, Public Health Service, Office of the Assistant Secretary for Health, Office of Smoking and Health; 1979. Smoking and Health. DHEW Publication No. (PHS) 79–50066.
U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Washington: U.S. Environmental Protection Agency, Office of Research and Development, Office of Air Radiation; 1992. Report No. EPA/600/6-90/0006F.
Vandenbroucke JP. Passive smoking and lung cancer: a publication bias? British Medical Journal (Clinical Research Edition). 1988; 296 (6619):391–2. [ PMC free article : PMC2544973 ] [ PubMed : 3125912 ]
Wald NJ, Nanchahal K, Thompson SG, Cuckle HS. Does breathing other people’s tobacco smoke cause lung cancer? British Medical Journal (Clinical Research Edition). 1986; 293 (6556):1217–22. [ PMC free article : PMC1341990 ] [ PubMed : 3096439 ]
World Health Organization. International Consultation on Environmental Tobacco Smoke (ETS) and Child Health: Consultation Report. Geneva: World Health Organization; 1999.
Wu AH. Exposure misclassification bias in studies of environmental tobacco smoke and lung cancer. Environmental Health Perspectives. 1999; 107 (Suppl 6):873–7. [ PMC free article : PMC1566193 ] [ PubMed : 10592145 ]
Yach D, Bialous SA. Junking science to promote tobacco. American Journal of Public Health. 2001; 91 (11):1745–8. [ PMC free article : PMC1446867 ] [ PubMed : 11684592 ]
Cite this Page Office on Smoking and Health (US). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2006. 1, Introduction, Summary, and Conclusions.
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On Why One Should Stop Smoking Essay (Speech)

1. introduction.

The dangers of smoking and the benefits of quitting is a comprehensive guide that explores the various health risks associated with smoking and highlights the importance of addressing this issue. The first section provides an overview of the topic and emphasizes the significance of quitting smoking. Smoking and other tobacco use can cause many health problems. These problems can be deadly. For this reason, quitting smoking is really important not only for the health of the person who is smoking, but also for the health of those around who don't smoke. Smoking can lead to a variety of ongoing complications in the body, as well as long-term effects on your body systems. These can include but are not limited to heart disease, stroke, and lung cancer. Such a huge amount of health problems can be caused by smoking and tobacco, it is also important to find the best way to quit smoking. This is also necessary to know that there are multiple benefits to quitting smoking at any age. It is good and improves health due to quitting smoking but an individual can also lengthen his or her lifespan, especially those who quit at a younger age. Challenges of smoking are also presented in the text. Respiratory disease, which is the same as chronic obstructive pulmonary disease. Also, the lesser authentic health programs are at greater risk for baby. This is another great challenge in itself for the community. The primary purpose of this program is to benefit the community by eliminating secondhand smoke, provide a safe environment for those who do not smoke, and also educate individuals about the impact of tobacco and tobacco use. If a pregnant female or someone is smoking, she should stop in order to reduce the adverse effects of tobacco. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease. Also, several more facts allergy, cold, pneumonia, and respiratory syncytial virus are the adverse impacts of smoking. Smoking can also reduce the blood flow and this can prevent oxygen and nutrients from reaching the skin properly. As a result, the skin will age faster and wrinkle up. One of the major long-term impacts of smoking is an increase in heart rate, arterial blood pressure, and tightening of the coronary arteries and others. A drop in blood oxygen level which also leads to myocardial infarction, respiratory disease, and other diseases can be caused by smoking. Well, one greater important decision is that commitment to quit. Starting to feel a little better and a little happier each day at each step is another success in quitting smoking. Of course, with the support from healthcare provider and the family members, the success will come more easily each day. In concluding the passage, it is to a greater extent that smoking is the biggest challenge of public health nowadays. A community that is smoke-free will enjoy a healthier environment. It may take time to find the right treatment, but a community that is proactive in changing life and protecting the youth will help to create a better smoke-free society for the future.

1.1. Overview of the topic

Smoking is a practice that dates back to the 16th century, when the indigenous people of the Americas used tobacco for its supposed medicinal properties. However, it would be another 300 years before cigarettes became a fashionable commodity in the 20th century. This was a time when the harmful effects of smoking were unknown, and it was common for people to smoke in enclosed public spaces. Nowadays, it is well established that smoking has significant health implications. There are over 5,000 different chemicals found in cigarette smoke - many of which are poisonous or cancer-causing. Cigarette smoke contains carbon monoxide, which prevents the blood from bringing oxygen to bodily tissues. It also damages the tiny hairs in your lungs, increasing the chance of an infection. The smoke clogs up the small air sacs in the lungs, leading to a very serious and debilitating disease called emphysema, which is a condition affecting an individual's ability to rid the body of carbon dioxide. Emphysema can also contribute to a narrowing of the arteries in the heart, resulting in potential cardiac failure. Smoking is the number one cause of lung cancer - a condition which affects the lung's ability to function correctly. Remarkably, a single cigarette can contain over 4,000 chemicals; 43 of which are known cancer-causing agents, or carcinogens - this includes acetone, the inflammable liquid used in nail varnish remover, and methanol, used in rocket fuel. The consequences of lung cancer can be fatal; out of all types of cancer, it claims more lives each year than any other. It's not only the lungs that are affected - smoking is a leading cause of mouth cancer, where tumors develop on the surface of the tongue, the lining of the mouth and lips. This can result in difficulty eating and speaking, and may even lead to facial disfigurement. It is not only smokers who are affected from the consequences of smoking - passive smoking can result in serious health effects on people who breathe in second-hand smoke. Some of the health risks are increased risk of heart disease and lung cancer, exacerbation of asthma and interstitial lung disease, as well as increased frequency and severity of asthma attacks. There are many debilitating, far-reaching, and distressing consequences of smoking, and it isn't only adults that are affected - children, families, and communities suffer, and society as a whole. For example, babies born to mothers who smoke during pregnancy are more likely to be born underweight, too early, and with an increased risk of Sudden Infant Death Syndrome. Smoking during pregnancy doubles the risk of stillbirth or premature birth. All these stark facts about smoking show how much better off we would all be if we took the decision to end this harmful and destructive habit. It is my hope that, in this guide, the links between smoking and the many serious consequences it has for society as a whole are evident. I aim to demonstrate the very much life-threatening impact of smoking through information and presentational techniques, although both my aim and method are open to change during the project.

1.2. Importance of addressing the issue

The health risks of smoking are well known, yet this knowledge might encourage some to avoid addressing the issue. This is because learning about the health risks of smoking can be a frightening experience, and in some cases could even lead to denial about your smoking-related health issue. However, it is important to know and research your enemy. When you smoke, you are not only at risk of developing lung cancer, but many other smoking-related health issues too, such as coronary heart disease, strokes, and damage to the lining of your veins and arteries. Smoking also can affect your blood, with the chemicals in the smoke causing the plaques (fatty deposits) to build up in your blood, which can be very dangerous and often fatal. On a positive note, you do not have to face these risks alone. The NHS Stop Smoking Service is there to provide you with help, advice, and support - as well as trained professionals who are dedicated to helping you quit. By tackling the issue head-on, society as a whole can make a positive step towards eradicating the damaging effects of smoking. Smokers need to understand that the damage from the health risks of smoking is often irreversible. For example, studies have shown that smokers who have been through heart bypass surgery are less likely to have a successful surgery compared to non-smokers. This is because the chemicals in tobacco smoke can react with the plaque deposits in the blood and cause them to break down, which can result in blood clots, severe chest pain, and even a heart attack. I hope that my essay has highlighted the health risks of smoking so that you may reconsider your decision to continue with this hazardous activity.

2. Health Risks of Smoking

Smoking is a major cause of lung cancer and respiratory diseases. Smoking also increases the chance of heart disease, which is a term that covers coronary heart disease, stroke, and blood vessel disease. In fact, smoking is said to be the biggest preventable cause of death and disability in the UK. Lung cancer is cancer of the lining of the lungs. Telephone counselling is also available, where a smoker will have a number of individual sessions with a counsellor over the phone. One of the benefits of counselling is that it can deal with underlying fears and concerns and help with behavioral changes. Google and Experience Online Counselling in many countries. This online facility is available to anybody, and mobile apps are also available where you could use the internet-based version. Devices containing nicotine, such as e-cigarettes, are available via prescription on the NHS. Nicotine replacement therapy is also available to help smokers quit. It provides an alternative source of nicotine, which helps reduce the withdrawal symptoms people often feel when they stop smoking. Gov reports that research shows that benefits from using these therapies increase if guidance from a healthcare professional is provided. Expert data reviews have shown that using the nicotine inhalator can approximately double the chance of stopping smoking successfully. Nicotine gum can also help, with around one in four users that also have support and counseling stopping smoking. The research also concluded that patches and tablets also work well and again can double the chances of stopping smoking successfully. However, research also suggests that the vapor from e-cigarettes is much less harmful than the tar and toxic gases found in tobacco smoke. It can help you manage the nicotine withdrawal symptoms. Nicotine replacement therapy comes in various forms, including patches, gum, inhalators, tablets, oral strips, and sprays. For smokers looking to quit, a combination of these treatments can be more successful in managing symptoms of withdrawal.

2.1. Lung cancer and respiratory diseases

An additional major health impact of smoking is the main cause of cancer death for both men and women, lung cancer. Smoking is also associated with a higher frequency of developing and dying from several other cancers such as cancers of the mouth, larynx, pharynx, esophagus, pancreas, uterus, kidney, bladder, stomach, liver, colon, rectum, cervix, ovary, and acute myeloid leukemia. Also, it could result in the person living with emphysema, a condition of the lungs that causes shortness of breath, because of smoking, and over time, the air sacs in the lungs are destroyed and this causes shortness of breath and a person becomes disabled. Furthermore, there is a chronic non-curable disease called chronic bronchitis resulting in the production of a lot of mucus and "smoker's cough". In this disease, the lining of the lung is constantly destroyed and then is repaired again. This process causes excessive mucus and a chronic cough, and over time, the cells that line the lung will have drastic changes and the risk of cancers increase as well. Moreover, it could lead to another chronic disease called COPD, which causes the lung narrowing and makes it hard to breathe. COPD will also cause emphysema and the statistics from Centers for Disease Control and Prevention show that 80% of the death was due to COPD and the percentage was increasing by 8.5% from 1998 to 2013. Deeply affecting the other organs and systems, there are about four million Americans getting this disease that is in an advanced and disabling stage and half of them dying within approximately five years. Also, smoking has more than twenty-five active chemicals that could lead to heart disease, the most general type of smoking-related cardiovascular condition. Constant exposure to those chemicals like nicotine will damage the heart and blood vessels, and the cholesterol level also would be changed because it narrows the blood vessels. The chemicals will provide a higher chance of atherosclerosis, which is a disease where the arteries harden and fill with the build-up of plaque, very cluttered and chaotic inside. And this will lead to a higher risk of heart attacks, abnormal heart rhythms, or a risk of a stroke. Last but not least, peripheral artery disease is another common type of cardiovascular disease which the build-up of plaque leads to pain in the torso, the arm or even worse, amputation. And this disease is the sign of a widespread plaque accumulation in the body that could reduce the blood circulation drastically and hope patients will not have to go through amputation. These are major health impacts of smoking that are resulted by every single puff of cigarettes and each of them will have different degrees of harm to the human body.

2.2. Cardiovascular diseases

Some of the most severe cardiovascular diseases that you can incur are coronary heart disease, stroke, and peripheral arterial disease. Coronary heart disease occurs when the coronary arteries become narrowed by a gradual buildup of fatty material within their walls. Over time, this buildup of fatty deposits, which are also known as atheroma, limits the flow of oxygen-rich blood to the heart muscle. This could lead to angina, which is a severe chest pain caused by a lack of oxygen to the heart muscles. If the blood flow is completely blocked, the heart muscle becomes starved of oxygen, which can cause parts of the muscle to die. This is called a heart attack. Stroke is a result of the blood supply to the brain being reduced or blocked, which can cause brain cells to become damaged or die. There are two types of strokes – ischemic, which is caused by a blockage in the blood supply to the brain, and hemorrhagic, which is caused by bleeding in or around the brain. Spouses of people who smoke are about 20% to 40% more likely to develop lung cancer simply because of being exposed to second-hand smoke. A survey has shown that non-smokers who suffer from the effects of second-hand smoke at work are 20% to 30% more likely to get lung cancer. However, stopping smoking can lead to health benefits at any stage, regardless of how long you have smoked for. In particular, people who stop smoking before the age of 50 cut their risk of dying in the next 15 years of their life by 50% compared with those who continue to smoke.

2.3. Other smoking-related health problems

In addition to the above, smoking is also associated with a number of other oral health problems, including gum disease, tooth loss, and chronic bad breath. Gum disease, which means swelling of the gums, can affect the supporting bone in your mouth which in turn can lead to tooth loss - it is the main cause of tooth loss in adults. A study has shown that smokers can be up to six times more likely to have periodontal disease than non-smokers. Gum disease is preventable but without treatment, it can progress - in the first stage, which is gingivitis, the gums become red and swollen and bleed easily. In the second stage, that is periodontitis, visible damage is done to the bone and tissue that support the teeth. This can become very painful and result in tooth loss and expensive and time-consuming treatment. Finally, chronic bad breath, or halitosis, is also associated with smoking. Research has shown that smoking can affect the normal function of the cells in the gum tissue, which in turn can leave smokers more prone to infections, including in the mouth. The mouth is warm and moist and so creates perfect conditions for bacteria to grow. Bacteria in the mouth is the main cause of most gum diseases. Also, when someone smokes, a lot of saliva gets reduced in their mouth, which is really important for keeping the mouth clean; for example, saliva helps to dilute and wash away the acid that is produced by the bacteria in plaque. If the amount of saliva is reduced, the bacteria in plaque increases and this, combined with the presence of tar and nicotine, etc. in the mouth because of smoking, can cause the gum tissue to become damaged. Also, research has shown that the chemicals in tobacco can also affect the type of bacteria that is found in the mouth, and so lead to an increase in plaque and other debris that can cause gum disease. Finally, a lack of oxygen in the bloodstream caused by smoking can also affect how cells in the mouth function - in some cases, cells can be damaged and this can impact on the quicker spread of infections.

3. Reasons to Quit Smoking

There are many good reasons why it is important to quit smoking. These revolve around the impact that smoking has on the body and the subsequent complications and health implications that occur both in the short term and the long term. One of the biggest reasons is the effect that the chemicals in cigarettes can have on the overall well-being of an individual. From the damage that these chemicals can cause to the skin (much more than just premature aging) such as psoriasis and the reduced ability to heal; to conditions such as asthma because smoking irritates the airways and can increase the sensitivity of the body's immune system. It is clear that quitting smoking has immediate benefits on the body and these are mirrored by the statistics that show quitting - at any age - offers large improvements in life expectancy. Experts have estimated that smokers will lose ten years of their natural life, largely due to the toxic smoke that is taken in on a regular basis. Many of the 7,000 chemicals in tobacco smoke are chemically active and trigger profound and damaging changes in the body. It is no surprise, then, that there are so many serious health problems that can be caused by smoking such as heart disease. This is a term that refers to any type of disorder that affects the heart. It is the number one cause of death in America and it is caused by the buildup of fatty substances within the walls of the arteries - including those of the heart - which can lead to restricted or blocked blood flow. This can result in a heart attack where the affected muscle begins to die without the oxygenated blood it needs to function or circulation issues that can lead to a stroke. The list of health conditions arising from smoking is extensive; coronary thrombosis, cerebrovascular diseases, aortic aneurysm, peripheral arterial diseases, heart failure and sudden cardiac death are all identified on the CDC website as being caused by smoking.

3.1. Improved overall health and well-being

From the very first puff, cigarette smoke begins to damage the body. Inhaling smoke causes plaque to build up in the blood. This increases the chances of clots forming in the bloodstream, which can lead to strokes and heart attacks. Over time, the constant pressure of the increased blood in the small vessels means that the vessels can burst. When this happens, it can lead to very serious health conditions such as kidney failure, blindness, and amputations. Smoking harms nearly every organ in the body, and if the health risks don't scare people enough, the changes that the habit makes to appearance should. First of all, smoking encourages the process of premature aging. This is evident in the skin. Smokers are prone to a number of skin conditions, and they can have thin, gaunt features. The toxins present in smoke cause the skin to develop an orange and grey complexion as a result of the lack of oxygen. And then there are teeth and hair. Smokers are very prone to gum disease, and teeth can become unsightly and brown, perhaps orange in heavy smokers. The habit also affects the hair, leaving it greasy and giving it a smell. But after quitting smoking, the improvements to health are noticeable almost immediately. Pulse rate and blood pressure, which may have been abnormally high, begin to return to normal. In fact, blood carbon monoxide levels and body temperature begin to return to normal just 8 hours after quitting. After 24 hours, the level of carbon monoxide in the blood is halved, and the oxygen levels begin to return back to normal. Five years without smoking means that the chances of getting heart disease are greatly reduced. And after ten years, the chances of getting lung cancer are halved. So considering the damage that smoking inflicts on the body and the changes that can occur when quitting, the benefits of improved health and well-being are substantial.

3.2. Increased life expectancy

Statistical data has shown that smokers who quit have an overall better quality of life and a higher life expectancy compared to those who continue to smoke. This is because when a person smokes, their lungs have an impaired gas exchange. This means that their lungs become less efficient at delivering oxygen to the body and removing carbon dioxide. Carbon monoxide, a poisonous gas which is also present in exhaust fumes, is taken into the body in the smoke of cigarettes. This gas disrupts the oxygen that is carried around the body in the red blood cells. When a person quits smoking, the levels of carbon monoxide in their body fall and the amount of oxygen in the bloodstream increases to normal levels. In turn, this reduces the risk of heart attacks and the rates of heart and lung diseases are significantly lower in non-smokers. From the moment a person stops, the risk of heart attacks starts decreasing. After 3-9 months, the person's lung function begins to improve and this makes physical activity, such as walking and running, a lot easier. This is due to the fact that the airways in the lungs begin to relax and the person's lung capacity improves by up to 10%, leading to an increase in energy levels and an overall better quality of life. While everyone knows that smoking is the leading cause of lung cancer, not many are aware that many of the diseases caused by smoking affect a person's heart, such as the increased risk of having a stroke. By making the decision to quit, a person is making a huge commitment to their health and this will not only increase their life expectancy but also improve their cardiovascular health and reduce their risk of developing heart disease. When a person stops smoking, the risk of a heart attack falls and this will continue to fall over time. By quitting at the age of 30, people can avoid dying from smoking-related diseases and the amount of average life lost to smoking will be 2 months. However, if a person quits at the age of 50, they will lose 4 months of average life and if they quit at 60, they will lose 6 months of average life. Smoking does not only affect the life of the person smoking, but it also places the lives of those who don't smoke - known as passive smoking - at risk. This includes an increased number of colds, bronchitis and pneumonia, especially in children. By making a decision to quit smoking, the years the person and their family will gain together far outweighs the time the person spends smoking. Who wouldn't want to have a better quality of life, more energy and live for longer? Give up smoking and add years to the life. Lend a hand today.

3.3. Financial savings

Financial savings can be achieved quite significantly upon stopping smoking. Smoking is an expensive habit. For example, if you smoke a pack a day, with each pack costing $10, you spend $300 each month. In one year, you spend $3,740 and in ten years, $37,400. The actual spend may be even higher considering the health issues developed as a result of smoking may demand more money for treatment. How much is spent yearly on smoking can be compared with the averages of bills for basic needs of a standard American family. Housing bills are an average of $10,080, utility bills an average of $3,456, health insurance policies an average of $8,520, groceries for four people an average of $10,500 and so on. It seems smokers are spending way more money just to fill in the gaps resulted by smoking. A situation has shown that smokers fail to meet financial needs of their family due to the wastage of household budget on items like cigarette. Heavier cigarette taxes result in higher costs for the smoker. The term used to describe the increase in price due to higher taxes is called "tax incidence". As a result of a high tax incidence due to a rise in cigarette taxes, the demand for cigarettes decreases as more consumers buy less or quit. This will then lead to a fall in the total spending on cigarettes which is good for the health and personal finance. In summary, the essay is going to emphasize on the financial drawbacks of smoking which is caused by high health care costs and expenses on health enhancing activities. Lastly, the financial aspect will also help to open how and why the people can stop smoking. With the cessation of smoking, an individual can save so much money and use it for alternative purposes. For example, saving costs on cigarettes can in turn give the chance of going for holidays, a recreational activity enjoyed in tropical destinations like snorkeling in the warm coastal waters of the Florida. Enroll in a one to two credit adventure program that offers a fun in an action-packed wilderness adventure in the Marin Headlands of the Golden Gate National Recreation. Treat yourself to an exploration of the marine life around the world in a case of taking three credits of snorkeling at key largo in Florida. Wouldn't that be just wonderful? On the other hand, the saved money can be used to help the children and family in the health and education. With so much money spent on tobacco, isn't it a waste for the smoker to decrease the financial ability of the family? The example will show how practical the financial benefit for the individual as well as the state and its society and ultimately be one of the main reasons for people to kick the smoking habit.

4. Strategies and Support for Quitting

Moreover, studies have shown that we are over five occasions extra likely to quit for good in the usage of these facilities. When involved in a smoker's support team, sufferers each grant and reap help from their peers. As properly as this, supportive counselling via a educated nurse or adviser has seen to drastically increase probabilities of success in quitting smoking. These closed give up smoking organizations are counseled with the aid of the use of studies and have been proven to be over twice as effective as going cold turkey and four cases extra powerful than certainly slicing down the quantity of cigarettes smoked. It has additionally been shown that humans who smoke cigarettes seeking to quit are more healthy and have add-ons in temper specifically virtual reality given up cigarettes where the aid is on hand. Virtual actuality has presented itself a present day-day and properly enough resource to scientific doctors in disposal of ailments and pains. Recently, the British government has given the go in advance to prescribe this trendy and unique structure of treatment as phase of attempts to make the clinical gadget continue to be friend with the rapidly advancing digital age. This innovation may in the close to future pass on from being a system of treatment for smokers to an fantastic quit smoking probability for a range of absolutely fantastic addictions and awful habits. But in the meantime, whatever your preference of technique, have confidence that there are heaps of choices out there designed to information you in your route to a more proper and smoke-free life. Whether digital, like nicotine patches, or more personal, such as nurse sessions, give up smoking guide suppliers are most effective a contact away and are extraordinarily really helpful to get in contact with.

4.1. Nicotine replacement therapies

Nicotine replacement therapies (NRTs) are a commonly utilized treatment in helping people to stop smoking. NRTs work on the principle of giving the body nicotine without the damaging effects of tobacco, and they can help to relieve some of the withdrawal symptoms often associated with quitting smoking, such as feeling irritable. NRT is, therefore, a more controlled way of introducing nicotine into the bloodstream without the harmful chemicals found in cigarettes, and it is much safer to use a regulated product where the dose is controlled than to smoke, where there are over 5000 chemicals created when a cigarette is lit, many of which are very harmful to the body. This fact is a key point in the NRTs argument to be used as a smoking cessation aid, and it has been proven by research that NRTs are a valuable and effective tool in promoting abstinence from smoking cigarettes. The first form of NRT to be licensed for general use was nicotine chewing gum, and this and the other forms of NRT that have been developed in the years since are part of a controlled medication, which was initially only available on prescription from a healthcare professional. However, this is no longer the case, and NRTs can be bought over the counter, although it is still recommended that help and advice are sought from a Stop Smoking Service or a doctor to decide on the most suitable type of NRT and to ensure that the chosen product is used in the best way. This 2012 Drug Therapy article considers NRT to be a 'safe' form of medication when compared to the high risk of smoking and any resulting conditions.

4.2. Behavioral therapies and counseling

re trying to quit smoking. It is important to note that these therapies are not a one-size-fits-all solution, and what works for one person may not work for another. However, with persistence and a willingness to try different approaches, many people are able to successfully quit smoking and improve their overall health and well-being.

4.3. Support groups and resources

In addition to professional help, there are many different support groups that can provide additional encouragement and help for people who are trying to quit smoking. These groups may be led by a health professional, such as a nurse or a doctor, but more commonly, they are run by people who have quit smoking themselves with the help of a support group. Many people find that joining a support group and talking to other people who are trying to quit can be an important part of the process. It can give them a valuable opportunity to share experiences and get advice, and provide them with support and encouragement outside of a clinical setting. Support groups can also be particularly useful in situations that may trigger the urge to smoke, such as at social events or parties, as members can help to give each other distractions and to reinforce each other's motivation. Some support groups provide additional help or services to smokers who are trying to quit, alongside regular meetings. For example, one common feature of support groups is the chance to create a 'support plan', tailored to an individual's personal triggers for smoking and their lifestyle. This plan helps people to identify when they are most at risk of having a cigarette, and to find alternative coping strategies for these moments. Many groups also offer access to support and advice over the phone or online, throughout the week and outside of regular meeting times. This flexibility makes support groups a practical option for many people and can be an important lifeline for those who do not have access to other forms of professional help. There are many different types of support group, ranging from community groups run by volunteers, to more structured 'stop smoking services' provided by healthcare organizations and local authorities. These services offer a wide range of options for seeking help, designed to cater to the differing needs of smokers and to support people in finding a service that suits them. These could be group-based or individual, and some services offer treatments such as therapy or medication alongside support. Some stop smoking services also run special programs, such as targeted help for pregnant women, people living with a mental health condition, or those wanting to quit using e-cigarettes.

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Essay on Quitting Smoking

Students are often asked to write an essay on Quitting Smoking in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Quitting Smoking

Introduction.

Quitting smoking is a crucial step towards a healthier life. Smoking harms nearly every organ in the body, leading to various diseases.

Why Quit Smoking?

Smoking increases the risk of lung cancer, heart disease, and stroke. Quitting reduces these risks and improves overall health.

Challenges in Quitting

Quitting smoking can be hard due to nicotine addiction. However, with determination, support, and the right tools, it is possible.

Ways to Quit Smoking

There are several methods to quit smoking, like nicotine replacement therapy, medications, and counselling.

Quitting smoking is a journey towards a healthier life. It’s never too late to quit and start living a healthier lifestyle.

250 Words Essay on Quitting Smoking

The relevance of quitting smoking.

Smoking is a global public health concern, with millions succumbing to its ill effects annually. Despite the known dangers, the addiction is challenging to overcome due to nicotine’s addictive nature. However, quitting smoking is a crucial step towards improved health and quality of life.

Health Implications of Smoking

Smoking is linked to numerous diseases, including lung cancer, heart disease, and chronic obstructive pulmonary disease (COPD). It also increases the risk of stroke and harms nearly every organ in the body. The harmful effects extend to second-hand smokers, who are exposed to the same health risks.

The Process of Quitting

Quitting smoking is a journey that requires commitment, patience, and resilience. It often involves multiple attempts and various strategies such as nicotine replacement therapy, medication, counseling, and lifestyle changes. The process can be made easier with the support of friends, family, and healthcare professionals.

Benefits of Quitting

Quitting smoking leads to immediate and long-term health benefits. Within hours of quitting, heart rate and blood pressure drop. Over time, the risk of cancer and heart disease decreases. Additionally, it improves lung function and physical performance.

Quitting smoking is a challenging yet rewarding journey. Overcoming the addiction not only enhances personal health but also contributes to a healthier society. It is a testament to the human spirit’s resilience and the power of determination.

500 Words Essay on Quitting Smoking

Smoking has been identified as a leading cause of numerous health issues, ranging from lung cancer to heart diseases. Despite these well-documented health risks, quitting smoking remains a significant challenge for many individuals due to the addictive nature of nicotine. This essay aims to explore the process of quitting smoking, highlighting the benefits, challenges, and strategies to overcome those challenges.

The Benefits of Quitting Smoking

The benefits of quitting smoking are immediate and long-term. Almost instantly, the body begins to repair the damage caused by smoking. Within 20 minutes of quitting, heart rate and blood pressure drop. After a year, the risk of heart disease is half that of a smoker’s. Long-term benefits include reduced risks of stroke, lung cancer, and other respiratory diseases.

The Challenges of Quitting Smoking

Despite the clear benefits, quitting smoking is often a daunting task. Nicotine addiction is a complex issue, involving both physical and psychological aspects. Physically, the body becomes dependent on nicotine, leading to withdrawal symptoms when one tries to quit. Psychologically, smoking often becomes a coping mechanism for stress, making it harder to quit.

Strategies to Overcome Challenges

Overcoming the challenges of quitting smoking requires a comprehensive approach. Firstly, it’s important to recognize and understand the triggers that make one want to smoke. These could be stress, alcohol, caffeine, or certain social situations. Identifying these triggers can help in developing strategies to avoid or deal with them without resorting to smoking.

Secondly, seeking professional help can be beneficial. There are numerous smoking cessation programs and therapies available that can provide the necessary support and guidance. Nicotine replacement therapy (NRT), for instance, can help manage withdrawal symptoms.

Lastly, a strong support system is crucial. Encouragement and understanding from friends, family, and support groups can make the journey easier.

Quitting smoking is a journey that requires commitment, patience, and resilience. It’s not easy, but the benefits far outweigh the challenges. With the right strategies and support, quitting smoking is not only achievable but can significantly improve one’s quality of life. The journey of quitting is a testament to the human capacity for change and improvement.

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People Should Quit Smoking Essay

Introduction, works cited.

Although many people recognize the health hazards related to smoking, a few take bold steps in quitting the act. Jorenby (346) asserts that smoking is a “disease” like any other, but can be cured when fitting strategies are observed. Besides draining one financially, smoking is a major cause of killer diseases such as; heart and lung cancer.

Hammerle (86) also cites destructions such as; bushfires, environmental degradation and decreased production as sometimes resultants of smoking activities. It is important that one quits smoking in order to lead a normal and healthy life. Besides contributing to increased production, people who quit smoking will reduce the much felt pressure in the healthcare systems.

Cigarette smoking can be mitigated when suitable strategies are fixed and followed. Smoking a cigarette is addictive; hence a person who withdraws from smoking experiences a series of symptoms. The symptoms vary and they may include; depression, irritability, anger and restlessness. However, Jorenby (346) argument some of the strategies which can help smokers adapt and ultimately quit smoking. In his view, victims should fast seek the services of a counseling specialist to guide them through the steps of quitting the habit.

He illustrates that, within the counseling field, specialized units such as self-help groups and individual counseling are best experienced to assist smokers cope with withdrawal behaviors’ and adjust adequately to normal life. Other counseling strategies such as telephone calls and social support also serves the ultimate goal of providing a modern approach in which counseling can be tailored to suit the counseling needs of an individual smoker (Jorenby 364).

Besides counseling, smokers can also seek for medical treatment or therapy. Jorenby (346) suggests some medications available to help to deal with dependence. These medications are efficient when they are checked by a doctor and integrated in a comprehensive stop smoking program (Carr 57). In this case, one should seek for the help of his or her doctor (Jorenby 353). The nicotine replacement therapy is of equal importance of medication. This strategy serves as a substitute for cigarette smoking.

Using this strategy, the cigarette nicotine used by one is replaced by other nicotine based substitutes. The used substitute majorly includes the nicotine patch or gum. The substitutes work better when they are delivered in small but in steady doses. They help the body of a smoker to relieve some major withdrawal symptoms. They achieve this goal by avoiding the tars and the poisonous gases that are present in the cigarettes.

Non nicotine based medication also exists in treating smoke related complications. These medications help a person to stop smoking. They are succeed in their role by decreasing the cravings and withdrawal symptoms, without the influence of nicotine.

Jorenby (347) notes that other nicotine alternative therapies such as nasal sprays, gum and the patch inhaler can also be embraced during the therapeutic process. This is because their nature relieves the patient in dealing with nicotine withdrawal syndromes and they do not expose a person to any danger from toxic substances.

Smoking has undesirable effect to the family. As Kick Butts notes, it brings about suffering and smoke related pain in the family (Kick Butts). A member of a family who smokes makes the whole family smoke either passive or involuntary; this is because side-stream and mainstream smoke is passed to them. Besides the nicotine and tar mentioned earlier, the cigarette smoke contains harmful substances such as arsenic, butane and acetone.

These substances are exposed to children making them to develop asthma, pneumonia, colds and coughs and bronchitis. In adults, heart problems are prevalent, poor blood circulation and lung cancer is noted. Treating these medical conditions entails hospitalizations which drain the family finances which could be better used to carry out important roles in the family (Kick Butts).

Parents serve as a role model for their children. However, when they smoke in-front of their children’s, they prompt them to attempt smoking. Children who smoke develop nicotine addiction much quicker, the more they smoke or exposed to smoking the more likely to develop other health related complications.

Hammerle (36) explains that smoking is costing the society more resources. These costs range from purchasing a pack of cigarette to medication. Hammerle (65) illustrates that other than the usual accidents, smokers are exposed to cancer, heart diseases and strokes. Noting the high cost of healthcare and financial obligations to the family, it causes a major financial drain for smokers.

Smoking contributes to reduced production. Reduced production is a major problem which can cripple any country in the world. Smoking reduces the production of an economy because of sustained sickness or deaths. Hence, it is indeed hard to find a replacement for an employee, especially when the smoker had unique skills about a given job. Besides sickness and deaths, absenteeism is a major problem connected to smoking. Absenteeism contributes to low on-the-job productivity because of health related diseases.

Hammerle (95) explain that smoking is the major cause of fires in workplaces and homes. It is also credited to the forest and bushfires, as smokers throw haphazardly the cigarette butts. The assets or property loss resulting from these fires suggests a social cost. Besides fires, pollution and littering is a common issue connected with smoking. Smoking creates enormous litter and pollution because smokers discard the cigarette butts and its packaging.

The costs associated with these issues are felt in different ways. In intangible form, cleaning packaging materials and cigarette butts is costly. It drains the taxpayers’ money in keeping the environment clean. On intangible aspect, if the litter is made to amass, the costs due to environmental degradation is obvious.

Kelley notes that procrastination is one of the reasons that have made it impossible for many people to quit smoking (Kelley). Procrastinating behavior is life threatening in all aspects of life. Smokers believe that it is easier for them to quit after taking one more puff and this is pushed forward over and again, to the point where it becomes impossible to stop (Kelley).

People who procrastinate are even affected psychologically because they know the right yet they keep on promising themselves that they will do it another day. When the effects finally happen, they suffer twice and the greatest of them is regretting not quitting the first time they ran into the idea. The best way to deal handle procrastination is just to make it today rather than wait for another day since there will be nothing.

People who smoke are at risk of smoking related complications such as heart, cancer and lung diseases. Besides, the money that could be saved to solve other personal and family issues is catered for their hospitalization and purchase of expensive drugs. Therefore, the only solution to avoid these smoking related complications is to quit smoking.

Carr, Allen. The Easy Way to Stop Smoking: The Easy Way Method to Becoming a Non Smoker. New York: Amazon, 2010. Print.

Hammerle, Nancy. Private Choices, Social Costs, and Public Policy: An Economic Analysis of Public Health Issues . Westport, CT: Praeger Publishers, 2002. Print.

Jorenby, Douglas. “Smoking Cessation Strategies for the 21 st Century”. Cardiology Patient . (2011): 324 – 367. Print.

Kelley, Fred. “I’m not ready To Quit! – What Are You Waiting For?” Quit Smoking , 1999. Web.

Kick Butts. “Quit smoking and take charge of your Health.” American Cancer Society. Stop smoking articles. Web.

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