Cigarette smoking is the leading preventable cause of death in the United States, responsible for an estimated 438,000 deaths per year, or one in every five deaths. Physicians often take care of the health consequences of their patients' tobacco use. It is equally important for them to prevent smoking-related disease by treating their patients' smoking habits.
The prevalence of cigarette smoking in the United States rose rapidly in the first half of the twentieth century and peaked in 1965, when 40% of adult Americans smoked cigarettes. Since then, smoking rates have declined, reflecting growing public awareness of the health risks of tobacco use and public health efforts to discourage tobacco use. By 2006, adult smoking prevalence had fallen to 20.9%. Smoking starts during childhood and adolescence; nearly 90% of smokers begin to smoke before the age of 20. The rates of tobacco use in men and women, once very different, are converging. In 2006, 18.1% of adult women and 23.9% of men smoked cigarettes. In the United States, smoking is more closely linked to education than it is to age, race, occupation, or any other sociodemographic factors. Educational attainment is a marker for socioeconomic status, and these data indicate that smoking is a problem that is concentrated in lower socioeconomic groups.
Cigarette smoking increases overall mortality and morbidity rates and is a cause of cardiovascular disease (including myocardial infarction and sudden death), cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, and cancers at many sites, including the lung, larynx, oral cavity, esophagus, bladder, kidney, pancreas, and uterine cervix. Lung cancer, once a rare disease, has increased dramatically. It has been the leading cause of cancer death in men since 1955 and in women since 1986.
Smoking is associated with many pregnancy complications, especially low birth weight (<2500 g). This is primarily attributable to intrauterine growth retardation (IUGR), although smoking in pregnancy also increases the risk of preterm delivery. Other adverse pregnancy outcomes linked to smoking are miscarriage (spontaneous abortion) and stillbirth. Smoking during pregnancy affects children even after birth. Sudden infant death syndrome is two to four times more common in infants born to mothers who smoked during pregnancy. Cognitive deficits and developmental problems in childhood are also linked to maternal smoking during pregnancy.
Cigarette smoking also increases a woman's risk of postmenopausal osteoporosis and fracture. Smokers have higher rates of upper and lower respiratory infections, peptic ulcer disease, cataracts, macular degeneration, and sensorineural hearing loss than nonsmokers. Smokers have more prominent skin wrinkling than nonsmokers, independent of sun exposure. The majority of residential fire deaths are caused by smoking.
There is no safe level of tobacco use. Smoking as few as one to four cigarettes per day increases the risk of myocardial infarction and cardiovascular mortality. Smoking cigarettes with reduced tar and nicotine content does not protect against the health hazards of smoking.
The health hazards of smoking are not limited to those who smoke. Nonsmokers are harmed by chronic exposure to environmental tobacco smoke (ETS). The children of parents who smoke have more serious respiratory infections during infancy and childhood, more respiratory symptoms, and a higher rate of chronic otitis media and asthma than the children of nonsmokers. Secondhand smoke exposure increases a nonsmoker's risk of lung cancer and coronary heart disease. A 2005 California Environmental Protection Agency study identified ETS as a ...