Addiction Medicine: Closing the Gap between Science and Practice

(lu) #1

Tobacco ........................................................................................................................


Tobacco use is the leading preventable cause of
death and disability in the United States. An
estimated one in five, or 443,000, deaths each
year are attributable to cigarette smoking and
exposure to tobacco smoke;^116 nearly 400,000
deaths per year are attributable to smoking-
related diseases.^117 (Table 3.10)

Tobacco use contributes to approximately 30
percent of cancer and heart disease-related
deaths^118 and numerous other health conditions
including respiratory illness and chronic kidney
disease.^119 An estimated 8.6 million Americans
suffer from a serious smoking-related illness.^120

Although the prevalence of tobacco use has
declined over the past two decades,^121 mortality
rates have remained constant due to an increase
in population size, the identification of new
diseases linked to smoking and the fact that
cohorts that smoked heavily during their lifetime
are now reaching an age with the highest
incidence of smoking-attributable diseases.^122

Over approximately the past four decades,* an
estimated 94,000 infant deaths have been linked
to prenatal exposure to smoking.^123 Pregnant
women who smoke put their babies at increased
risk for a host of health problems including
placenta previa,† stillbirth and sudden infant
death syndrome (SIDS).^124 Smoking during
pregnancy increases the risk for preterm birth^125
and pregnant smokers are 1.6 times more likely
to have a low birth weight baby than pregnant
nonsmokers (11.9 percent vs. 7.5 percent).^126
Merely reducing the number of cigarettes
women smoke during pregnancy results in birth
weight gain; but even light smokers‡ are twice as
likely as nonsmokers to have low birth weight
infants.§ 127 Low birth weight is a leading risk
factor for neonatal and infant mortality, can
result in restricted childhood development and
increases the risk of chronic disease,
developmental delays and cognitive
impairment.^128

The negative long-term health consequences for
children exposed to prenatal smoking include
increased risk for substance-related problems,
depression,^129 attention deficit/hyperactivity
disorder, conduct disorders and childhood
obesity.^130 The nicotine in tobacco products can
produce structural and chemical changes in the
developing adolescent brain and make young
people who smoke vulnerable to future addiction
and to certain forms of mental illness, including
panic attacks, panic disorder and other anxiety
disorders.^131

* 1964 to 2004.
† The complete or partial obstruction of the cervical
opening by the placenta.
‡ Smoke less than half a pack a day.
§ In a study of low-income black women.

Table 3.10
Average Tobacco-Attributable Deaths Due to
Smoking-Related Disease in the
United States, 2000-2004
Select Examples*
Average Deaths
Per Year
Total 392,683
Cancers: 160,848
Lung, trachea, bronchus 125,522
Esophagus 8,592
Pancreas 6,683
Urinary bladder 4,983
Lip, oral cavity, pharynx 4,893
Kidney, renal pelvis 3,043
Larynx 3,009
Stomach 2,484
Acute myeloid leukemia 1,192
Cervix, uterus (females only) 447
Cardiovascular Diseases: 128,497
Ischemic heart disease 80,005
Other heart disease 21,004
Cerebrovascular disease 15,922
Aortic Aneurysm 8,419
Atherosclerosis 1,893
Other arterial disease 1,254
Respiratory Diseases: 392,683
Chronic airway obstruction 78,988
Bronchitis, emphysema 13,927
Pneumonia, influenza 10,423



  • These data do not reflect all tobacco-attributable deaths.
    For example, deaths due to secondhand smoke and fire
    burn are not included.
    Source: Centers for Disease Control and Prevention
    (2011).

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