Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products (2015) / Chapter Skim
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4 The Effects of Tobacco Use on Health
4 The Effects of Tobacco Use on Health
Pages 91-128
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From page 91... ...
A policy change that reduces the prevalence of cigarette smoking will result in a commensurate reduction in the population burden of disease and death caused by cigarette smoking. The associations between cigarette smoking and the adverse health effects caused by smoking are dose-dependent (HHS, 2014)
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From page 92... ...
Nevertheless, they are important public health indicators because they lead to suboptimal health status throughout the life course in smokers and because many of the short-term physiologic effects mechanistically contribute to the etiology of smoking-caused diseases that usually do not become clinically apparent until later adulthood. The short-term adverse health effects caused by cigarette smoking can be observed in smokers immediately or soon after they begin smoking.
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From page 93... ...
. In the short run, cigarette smoking causes the smoker to have overall diminished health status as measured by a diverse array of indices, including biomarkers of physiologic disadvantage, lower self-reported health, susceptibility to acute illnesses and respiratory symptoms, and absence from school and work.
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From page 94... ...
cigarette smoking causes an incredibly broad spectrum of short-term and long-term deleterious health effects, and (2) a large proportion of the population is exposed (i.e., the prevalence of smoking is very high)
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From page 95... ...
In assessing the potential public health impact of enacting a new tobacco policy such as raising the minimum age of legal access to tobacco products (MLA) , it is worth keeping in mind that this lengthy catalogue of well-established consequences of cigarette smoking will continue to expand as scientific knowledge advances and more definitive evidence is generated
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From page 96... ...
As described below, these immediate adverse health effects include increased oxidative stress; depletion of selected bioavailable antioxidant micronutrients; increased inflammation; impaired immune status; altered lipid profiles; poorer self-rated health status; respiratory symptoms, including coughing, phlegm, heezing, w and dyspnea; and nicotine addiction. Taken in combination, these detrimental effects detract from a smoker's overall health status and lead to what has been referred to as "diminished health status" (HHS, 2004)
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From page 97... ...
By looking at the immediate and intermediate adverse health effects of cigarette smoking, it is clear that cigarette smoking contributes in important ways to suboptimal health beginning shortly after smoking initiation -- long before the chronic diseases that smoking causes at older ages become clinically apparent (HHS, 2004)
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From page 98... ...
Eye Disease ü (opthalmopathy associated with Graves' disease) Peptic Ulcer ü Complications Physiologic Markers of Diminished Health Status Increased oxidative stress Cigarette smoke contains free radicals and other oxidants in abundance.
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From page 99... ...
Cigarette smokers experience measurable and immediate oxidative damage. This oxidative damage, experienced over long periods of time, is one pathway contributing to smoking-caused disease and death (HHS, 2010)
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From page 100... ...
Cigarette smoking causes depletion of antioxidant micronutrients, leading smokers to have lower circulating concentrations of these antioxidant micronutrients than nonsmokers. The direct immediate result on the smoker's lower concentrations of antioxidant micronutrients such as vitamin C is to reduce the smoker's antioxidant defenses, and thus the smoker's cells throughout the body are more prone to the damaging effects of oxidative stress.
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From page 101... ...
. The impact of the adverse effects on immune status would be to make smokers more susceptible to disease, which in turn contributes to the etiology of acute infectious and chronic diseases above and beyond the way in which cigarette smoking contributes to acute and chronic inflammation.
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From page 102... ...
The often long-term, sustained addiction to nicotine is the underlying factor driving the long-term, sustained exposure to the toxins in tobacco smoke that drive the adverse health effects of cigarette smoking. Finding 4-1: Cigarette smoking is causally associated with a broad spectrum of adverse health effects that begin soon after the onset of regular smoking and that, in total, significantly diminish the health status of the smoker compared to nonsmokers.
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From page 103... ...
Cigarette smoking cessation diminishes the risk of experiencing these intermediate adverse health effects, but individuals with a past history of cigarette smoking still have greater risks than those who never smoked. Absenteeism Another indicator of diminished health status is absence from work.
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From page 104... ...
Impaired Lung Development and Accelerated Decline in Function In addition to smoking's long-term health effects on the respiratory system from diseases such as lung cancer and COPD, some adverse respiratory effects experienced by adolescent cigarette smokers manifest themselves shortly after smoking initiation. Compared to nonsmokers, adolescents who smoke cigarettes are more likely to experience impaired lung growth, early onset in the decline of lung function, and asthma-related symptoms (HHS, 2004)
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From page 105... ...
A strong statistical association has been observed between cigarette smoking and risk of M tuberculosis infection and also the risk, once infected, of progressing to tuberculosis disease, but showing a clear causal connection between smoking and risk of tuberculosis has been challenging because cigarette smokers often have a much higher risk profile than nonsmokers for these outcomes because of other social determinants of health.
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From page 106... ...
. Finding 4-2: Cigarette smoking causes many adverse health effects classified as "intermediate," which include increased absence from work, the increased use of medical services, subclinical atherosclerosis, impaired lung development and function, an increased risk of lung in fections, diabetes, periodontitis, the exacerbation of asthma in adults, subclinical organ injury, and adverse surgical outcomes.
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From page 107... ...
. Vascular Disease Cigarette smoking is associated with numerous clinical cardiovascular disease endpoints, including coronary heart disease, stroke, and abdominal aortic aneurism.
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From page 108... ...
Cigarette smoking is causally associated with hip fractures. In postmenopausal women, a causal association has been established between cigarette smoking and low bone density (HHS, 2004)
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From page 109... ...
It is estimated that more than 400,000 infants are exposed each year to maternal smoking in utero. Furthermore, recent data indicate that more than 1.2 million births each year in the TABLE 4-6 Maternal, Fetal, and Infant Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports Health Outcome Maternal Fetal Infant/Child Immediate Health Effects on All Smokers, Including During Pregnancy (selected)
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From page 110... ...
. Cigarette smoking is causally associated with stunted fetal growth and is an important cause of shortened gestation.
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From page 111... ...
via parental smoking suffer numerous adverse health effects as a consequence. In infants, symptoms associated with SHS exposure include increased lower respiratory illnesses, otitis media, middle ear effusion, reduced lung function, and the respiratory symptoms of coughing, phlegm, wheezing, and dyspnea (HHS, 2006)
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From page 112... ...
A further negative consequence of starting to smoke at younger ages is that tissues and organ systems that are still in the growth and maturation phase may be particularly vulnerable to the toxicants in smoke, so that even a given exposure dose to cigarette smoke may be more harmful when exposure occurs during childhood and adolescence than during adulthood. Younger age of initiation has been found to be associated with one short-term health effect in particular: an increased risk of hospital inpatient stay during the previous year (Lando et al., 1999)
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From page 113... ...
The adverse consequences of a younger age of initiation appear to manifest at young ages and be sustained over the life course. Finding 4-5: A younger age of initiation is associated with an increased risk of many adverse health outcomes, such as a hospital inpatient stay in the past year and lifetime risk of respiratory disease, especially chronic obstructive pulmonary disease and lung cancer.
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From page 114... ...
. SHS exposure has now been linked with a host of adverse health effects in addition to the longestablished causal associations with lung cancer and heart disease.
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From page 115... ...
For example, Table 4-8 summarizes health outcomes for which the evidence summarized in the 2014 Surgeon General's report is currently considered strong enough to be considered suggestive of a causal association but not yet strong enough to be rated as causal. Smoking of Pipes, Cigars, and Other Combustible Tobacco Products Combustible tobacco products other than cigarettes are also associated with the same sort of chronic disease outcomes associated with cigarette smoking, such as cancer and cardiovascular disease.
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From page 116... ...
116 TABLE 4-7 Adverse Health Outcomes Causally Associated with Secondhand Smoke Exposure Based on Surgeon General's Reports Stage of Life Childhood/ Young Middle Older Health Outcome Infancy Adolescence Adulthood Adulthood Adulthood Short-Term and Intermediate-Term Health Effects Maternal/Fetal Development (low birth weight) ü Ear Ear Problems ü ü Middle Ear Disease ü Respiratory Acute Respiratory Infections ü ü Slower Lung Growth ü ü Respiratory Tract Injury ü ü ü ü ü
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From page 117... ...
ü Cardiovascular ü Stroke, Coronary Heart Disease ü Endothelial Cell Dysfunctions ü ü ü ü ü 117
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From page 118... ...
ü Dental Carries ü Respiratory Incidence of asthma ü ü ü ü Worsening of asthma control and symptoms ü ü ü ü Coughing, wheezing, chest tightness, and breathlessness ü ü ü ü COPD ü Chronic respiratory symptoms ü ü ü ü Small decrement in lung function ü ü ü ü Cardiovascular (angina, sudden coronary death, stroke, ü atherosclerosis) Cancer Breast cancer ü Childhood leukemias ü Childhood lymphomas ü Childhood brain tumors ü Nasal sinus cancer ü
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From page 119... ...
. The available evidence indicating that pipe and cigar smoking have similar adverse health effects to cigarette smoking thus supports the conclusion that the impact of a policy change that resulted in lower uptake or delayed initiation of pipes or cigars would have a significant impact on public health but would be expected to be less than a similar reduction in cigarette smoking because of the lower exposure to tobacco toxins due to the manner in which pipes and cigars are smoked.
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From page 120... ...
This concept is also critical to thinking about the health risks of dual use or poly-use of combustible tobacco products and ENDS, an exposure pattern that will likely increase in the future but for which data on health risks are needed. Finding 4-7: Smoking of combustible tobacco products other than cigarettes, such as pipes and cigars, is causally associated with a broad spectrum of adverse health effects.
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From page 121... ...
IMPACT OF CIGARETTE SMOKING ON MORTALITY Cigarette smoking contributes significantly to the population burden of many of the leading causes of chronic disease deaths that typically occur in middle and late adulthood, such as cancer, cardiovascular disease, and COPD (HHS, 2004)
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From page 122... ...
are due to coronary heart disease, but smoking also causes 25,500 deaths from other forms of heart disease. Furthermore, cigarette smoking causes 15,300 deaths from cerebrovascular disease and 11,500 deaths from other forms of vascular disease.
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From page 123... ...
IMPACT OF EXPOSURE TO SECONDHAND SMOKE ON MORTALITY Due to its causal associations with coronary heart disease and lung cancer, secondhand smoke exposure is estimated to cause more than 41,300 deaths per year in the United States (HHS, 2014)
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From page 124... ...
1995. Dietary antioxidants and cigarette smoke-induced biomolecular damage: A complex interaction.
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From page 125... ...
Atlanta GA: 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.
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From page 126... ...
2005. Active smoking causes oxidative stress and de creases blood melatonin levels.
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From page 127... ...
2011. Biomarkers of oxidative damage in cigarette smokers: Which biomarkers might reflect acute versus chronic oxidative stress?
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