Section 4 - Smoking and Health
This section covers:
- Introduction
- Why people smoke / continue to smoke
- Chemicals in tobacco
- Effects of smoking on the body
- Target groups
- Key points
- Second-hand smoke
- Health benefits of stopping smoking
Introduction
The information in this section will increase your knowledge of smoking and oral health and will enable you to discuss the health risks of smoking when delivering brief advice to stop smoking.
There is a wealth of information around the health risks of smoking and this section will just touch on some of the issues. As such, each section provides you with links to further optional reading, should you wish to explore any topics further.
Why people smoke / continue to smoke
There are many different reasons why people smoke and find it difficult to stop. These include a combination of social or behavioural factors, as well as physical factors. Below are some examples of the types of reasons which smokers have reported for their continued tobacco use:
- ‘I’m addicted’
- ‘Cigarettes keep me company when I feel lonely or bored’
- ‘It’s a habit’
- ‘Smoking helps me cope with stress’
- ‘I like smoking’
- ‘I started smoking because it was cool and all my friends were doing it’
- ‘Everyone else in my family smokes, it would be too difficult to stop’
One of the main reasons people give for continuing to smoke is addiction. Addiction refers to when an individual has impaired control over their behaviour which has harmful consequences. reference 1
Nicotine is a highly addictive drug and The Royal College of Physicians (2000) states that nicotine addiction is comparable with addiction to drugs such as heroin or cocaine.
Smoking is a complex addiction which includes a PHYSICAL addiction to nicotine as well as BEHAVIOURAL and PSYCHOLOGICAL aspects of smoking. When someone is addicted to nicotine it can result in them experiencing urges to smoke which are relieved by having a cigarette.
These urges are often referred to as cravings. Cravings ‘teach’ a smoker to smoke to relieve any urges or withdrawal symptoms such as restlessness and low mood. The relief that a smoker gains through having a cigarette and alleviating these cravings and withdrawals, forms the foundation for addiction to cigarettes.
Due to the physical and behavioural nature of nicotine addiction, there are additional difficulties in quitting smoking. Recognising this complex addiction can help us to understanding why many people find it difficult to quit, even though they really want to.
For further reading around addiction please refer to:
http://bookshop.rcplondon.ac.uk/details.aspx?e=131
Chemicals in tobacco
Tobacco contains many substances that are harmful to health with over 4000 chemicals in one cigarette. Over 60 of these chemicals are known to be carcinogenic (i.e. they cause cancer including oral cancer). Although cigarettes contain a filter, this does not prevent harmful chemicals being breathed into the lungs.
Click on the links below to explore the 3 main chemicals found in tobacco:
Tar
- Tar is a brown sticky substance which contains a mixture of many chemicals
- Tar can stain smokers’ teeth and fingers a yellow/brown colour
- Tar is known to cause cancer
- The tar content varies between different brands of cigarettes, however all cigarettes (even those with a lower tar content) are harmful to health.
Carbon monoxide
- Carbon monoxide is a poisonous gas that is found in cigarette smoke. It is also the main gas in car exhaust fumes and high levels of carbon monoxide can kill.
- Carbon monoxide lowers the blood’s ability to transport oxygen around the body. reference 7
- Carbon monoxide can be measured in a person’s breath using a machine called a carbon monoxide monitor. These monitors are often used by smoking cessation services to show individuals the reduction in carbon monoxide levels after they stop smoking.
Nicotine
- Nicotine is an extremely addictive drug.
- It is inhaled when a cigarette is smoked.
- It takes about 10-19 seconds for nicotine to reach the brain. reference 18
- It is a stimulant drug which increases the heart rate and central nervous system’s activity.
| Chemical in cigarette | Other uses |
|---|---|
| Formaldehyde | Embalming bodies |
| Acetone | Nail polish remover |
| Methanol | Rocket fuel |
| Carbon monoxide | Car exhaust fumes |
| Methane | Sewer gas |
| Tar | Road surface |
| Ammonia | Cleaning products |
| Arsenic | Poison |
| Benzene | Petrol Fumes |
| Nicotine | Insecticide |
| Polonium-210 | Radioactive element |
| Lead | Batteries |
| Sulphuric acid | Power station emissions |
Further online reading
http://info.cancerresearchuk.org/healthyliving/smokingandtobacco/whatsinacigarette/
Effects of smoking on the body
Smoking causes many health problems and around 13, 500 people in Scotland die each year from smoking related problems.
Click on the links below to explore some of the main causes of smoking related deaths reference 3
Lung cancer
Lung cancer develops as a result of abnormal cell growth which can form into a tumour. Lung cancer develops in the tubes that carry air in and out of the lungs and the cancer tumour could eventually spread to other areas of the body. Smoking causes around 90% of all cases of lung cancer.
Coronary heart disease
Coronary heart disease is when the arteries that supply blood and oxygen to the heart become narrowed and fatty material builds up on the artery wall. This can result in angina and heart attacks.
COPD
Chronic Obstructive Pulmonary Disease (COPD) is a term to describe a number of conditions, including chronic bronchitis and emphysema. COPD damages the airways in the lungs and makes it harder for air to be breathed in and out.
As well as lung cancer, coronary heart disease and COPD, smoking also causes a range of other life-threatening health problems.
These include stroke, problems with circulation and cancer of various organs including the bladder, oesophagus, kidney and stomach.
Smoking is also the cause of a wide range of oral health problems including oral cancer, potentially malignant lesions, periodontal disease, implant failure, staining of teeth and halitosis. Further detail about these specific conditions is given in Part 2 of this training package.
Other non-fatal problems related to smoking include fertility problems, skin problems, wrinkles, diabetes, hearing loss, angina, vascular disease, osteoporosis and sight problems.
Despite these many risks to health, many of the diseases and health complaints resulting from smoking can be alleviated, or the risk of contracting them reduced, by stopping smoking.
The health benefits of quitting smoking should therefore be highlighted when providing brief advice to stop smoking.
We will learn about the health benefits of quitting smoking later in this section.
Further reading
For further reading on these, please click on the links below.
Tobacco Inofrmation Scotland
British Lung Foundation
British Heart Foundation
Health Scotland
Target groups
The Smoking Cessation Guide 2010 reference 1 has identified some target groups to whom brief interventions should be delivered as a priority. Often this is due to the increased or additional health risks smoking creates for these groups. Click on the buttons below to find out more.
Click links below to view their definition:
Socio-Economically Deprived Groups
Health outcomes for people in this group are generally less favourable than for more affluent groups. In the period 2000-04, almost a third (32%) of deaths in the most deprived quintile of Scotland were attributed to smoking, compared with 15% in the least deprived quintile reference 2. Given these statistics, it is important that every effort is made to provide appropriate brief interventions with smokers who fall into this group.
Pregnant women
Smoking during pregnancy can risk the health of the woman, the foetus and can affect the baby once it is born. Carbon monoxide in cigarettes reduces the amount of oxygen carried to the foetus and this leads to increased risk of miscarriage, premature birth, low birth weight and even increases the risk of Sudden Infant Death Syndrome. Smoking can also cause fertility problems in both men and women. reference 8
Young People
Childhood smokers are at high risk of immediate health problems, including respiratory illness. They are also at very substantial risk of developing life-shortening conditions and those who begin to smoke at younger ages suffer tobacco related diseases earlier. reference 8
The earlier children become regular smokers and persist in the habit as adults, the greater the risk of developing lung cancer or heart disease reference 8
Tobacco smoking diminishes the rate of growth of the lungs when exposure occurs before the age of 18 in females and approximately 24 in males. reference 21
Nicotine has been shown to be disruptive to adolescent brain development reference 9
The 2010 Guide advises that young smokers, who express a serious intention to quit and a desire for support to do so should be encouraged to use local stop smoking services. reference 1
Other Priority Groups
Other priority groups are:
- Hospital in-patients who will have to endure enforced smoking cessation due to their stay in hospital ;
- People with heart or respiratory diseases who should be made aware of the increased risks smoking exposes them to;
- People with diabetes who have a considerably increased risk of developing cardiovascular disease and complications from it;
- Black and minority ethnic people are at increased risk of developing diabetes, asthma and coronary heart disease. Because the use of oral tobacco is more prevalent in some cultures, there is also an increased risk of mouth and throat cancer. For further reading on this topic, please refer to: http://www.ashscotland.org.uk/ash/7166.1582.html
- Older adults for whom stopping smoking still provides health benefits and increases recovery time from other illnesses.
Key points
This section has focussed on the health effects of smoking, however there are also social and economic consequences of smoking.
Have a think about some examples of these social and economic effects of smoking.
Calculate how much a 20-a-day smoker spends on cigarettes in a year (based on spending approximately £6.25 per day on cigarettes). Just think what else someone could do with that money...
Second-hand smoke
Second-hand smoke is also sometimes referred to as passive smoking or environmental tobacco smoke. Research has shown that people often underestimate the risks of second-hand smoking.
The British Medical Association estimates that at least 1000 people die each year in the UK as a result of exposure to other people’s tobacco smoke. reference 22
There are two types of second-hand smoke. These are:
- Sidestream smoke i.e. smoke coming from the end of a lit cigarette
- Mainstream smoke i.e. inhaled by smoker and then breathed out.
- More toxic gases are released from sidestream smoke than from mainstream smoke reference 12
- 85% of the smoke in an enclosed room is sidestream smoke reference 23
- Children and young people are especially susceptible to the risks of passive smoking and may be exposed to this within the home or when travelling in cars
- Second-hand smoke around children, increases a child’s risk of asthma, ear infections, respiratory infections and Sudden Infant Death Syndrome (SIDS) reference 11. Despite this, 4 in 10 Scottish children live in a home where at least one person smokes inside. reference 25
- There is growing interest in a potential link between second-hand smoking and oral diseases such as oral cancer and periodontal disease.
- When non-smoking adults are exposed to long-term second-hand smoke their risk of heart disease and lung cancer increases reference 12
- Non-smokers exposed to second-hand smoke in the home have a 25% increased risk of heart disease and lung cancer reference 13
- In fact, just 30 minutes exposure to second-hand smoke is enough to reduce the blood flow to the heart in a healthy adult. reference 13
The legislation that banned smoking in enclosed public places in Scotland has reduced exposure to second hand smoke.
Despite this, there still remains a significant number of adults and children who live in a home where a family member smokes inside, therefore still exposing them to the harmful effects of tobacco smoke.
Further reading
For further reading on these, please click on the links below.
www.ashscotland.org.uk/media/3809/Smokinginhome_Briefing_Feb11.pdf
www.ashscotland.org.uk/information/tobacco-related-research/research-2011/second-hand-and-third-hand-smoke
Health benefits of stopping smoking
It is never too late for someone to stop smoking as the body starts to repair itself almost immediately reference 3. As such all smokers (irrespective of age, how long they have been smoking or if they have a smoking related disease) should be encouraged to quit.
Click on the links below to explore the health benefits of stopping smoking:
Days
Within days of stopping smoking
- the heart rate drops
- carbon monoxide and oxygen levels in the blood return to a level similar to that of a never-smoker
- nicotine levels in the blood disappear
- the senses of taste and smell sharpen.
Weeks
Within a few weeks of quitting
- Lung function begins to improve
- The risk of post-operative complications lowers
- Coughing and shortness of breath decreases reference 15
- Complexion improves.
Months
Within a few months of stopping smoking
- Symptoms of chronic bronchitis improve
- Risk of gastric and duodenal ulcers drops with improved short-term healing.
Years
Within the first year of having quit, the progression of cardiovascular and respiratory disease is slowed and the risk of recurrence is reduced. Within 5 years of stopping smoking, the decline in lung function age slows to match that of a never-smoker. Being quit in the longer-term (more than 5 years) reduces the risk of lung and other cancers and of cardiovascular disease including stroke.
Smoking cessation contributes to reducing the risk of oral cancer, with a 50% reduction in risk within 5 years. Ten years after stopping smoking, the risk for ex-smokers approaches that for a life-long non-smokers.
Around six years after stopping smoking, the risk for former smokers of developing periodontal disease approaches that of non-smokers.
Further reading
For further reading on these, please click on the links below.
www.canstopsmoking.com/why-quit
www.ash.org.uk/ash_fx8ciaxy.htm
www.ash.org.uk/files/documents/ASH_116.pdf
You can now proceed to section 5