Cigarette Smoking

Statistics

Cigarette smoking increases risk for disease, and cessation can reverse this risk. It is estimated that male smokers lose an average of 13.2 years of life and female smokers lose 14.5 years due to smoking. However, cessation can minimize these health risks. Individuals who stop smoking before age 35 avoid 90% of the risks associated with cigarette smoking.

The percentage of people who smoke cigarettes in the United States has declined from highs in the mid-1970s of 42% to approximately 28% today. Trends suggest that there is a deceleration in this decline. There are also some indications that there may be a slight increase in tobacco use among teens and college students. Data from the Monitoring the Future Study conducted at the University of Michigan suggest that in 2005, 1 in 11 eighth graders and 1 in 4 twelfth graders had smoked in the past 30 days. While these rates are lower than in the past, they remain at an unacceptably high level.

Hazards

The harmful effects of cigarette smoking are well documented, and today there is a growing understanding of the harmful effects of involuntary exposure to tobacco smoke in the environment. In June of 2006, the surgeon general issued a report documenting the harmful health effects of exposure to tobacco smoke and urged greater attention to this problem. Data from this report indicate that approximately 60% of non-smokers in the United States show biological markers indicative of environmental exposure to tobacco smoke. It is likely that there will be even greater attention given to this aspect of cigarette smoking in the coming years, and there will be policy changes such as the implementation of smoke-free workplaces. [Page 88]Similar policies are currently being implemented in many healthcare facilities.

Etiology of Tobacco Dependence

Cigarette smoking typically results in nicotine dependence and nicotine withdrawal, two Axis I disorders classified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Compared to other drugs of abuse, such as marijuana, cocaine, or alcohol, tobacco is more likely to cause dependence. Recent studies have documented that more than 80% of individuals who report regular smoking meet criteria for nicotine dependence. Likewise, 32% of all individuals who have ever tried any tobacco products progress to nicotine dependence. Comparable statistics for heroin, cocaine, and alcohol are 23%, 17%, and 15%, respectively. Tobacco has a high risk for dependency. Cigarette smoking is commonplace among psychiatric patients. There are differing perspectives as to why psychiatric patients smoke. Some have suggested that smoking is an attempt to self-medicate emotional symptoms. Research indicates that stress exacerbates urges or cravings to smoke and is associated with relapse. In addition to an association with emotional problems, cigarette smoking is clearly associated with other substance use problems, including use of alcohol, caffeine, and illegal drugs. The more severe the emotional disorder, the more likely that smoking will be present and the greater likelihood of dependence. Additionally, cessation is likely to be more difficult with severe emotional disorders.

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