The Medical Minute: The Great American Smokeout 2004

November 17, 2004

By John Messmer
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine

Smoking kills 440,000 Americans annually -- almost one person every minute. Most smoking deaths are from lung cancer, heart disease and chronic lung disease. In fact, more women die each year from smoking related lung cancer than from breast cancer. Smoking also contributes significantly to cancers of the stomach, bladder, larynx, cervix and breast.

Everyone knows smoking causes lung cancer, but many people do not know that stroke risk is two and a half times higher in smokers. Dementia risk is increased, and it is a major contributor to impotence in men and osteoporosis in women. It doubles the risk of cataracts and macular degeneration, a significant cause of visual loss in older people. Smoking parents increase the risk of bronchitis, pneumonia and ear infections in their children even if they smoke outside only. Pregnant smokers have infant mortality rates one-third higher than nonsmoking women. Quitting early in pregnancy will reduce the risk.

Before the first surgeon general's report on the hazards of smoking in 1964, about half of adult Americans smoked. Fortunately today that number is about 22 percent overall. Rates of smoking are higher among teens, who are more likely to become addicted. Although a minority of Americans smoke, the CDC reports that 90 percent of us have nicotine in our blood from secondhand smoke, which causes about 3,000 lung cancer deaths yearly among non-smokers.

Smoking is costly. A carton a week costs almost $2,000 annually to the smoker, but society's costs are much higher. About 20 percent of health-care costs are for smoking-related illness. That's about $3,400 per smoker annually. Put another way, one fifth of the amount Americans pay for health insurance is to pay for the care of smokers. With health-care costs rising rapidly, it is sobering to consider that much of it is for illness that could be prevented simply by not smoking.

The American Cancer Society's Great American Smokeout is Thursday, Nov. 18. This is a good time for those who smoke to become non-smokers. The first step is to decide to quit. It helps for smokers to make a list of all the reasons they want to quit. Perhaps it's the health risk, the cost or the effect on family members and others. Maybe it's just the smell, but smokers have to decide that they WANT to quit.

Smokers need to change the way they think about smoking. they need to consider themselves non-smokers, rather than reformed smokers. They need to have nothing to do with tobacco in any form. They need to plan what they will do at all the times when they previously would have smoked so that they don't find themselves craving a cigarette with no alternative. They can consider an oral substitute, such as gum or mints. They need to have something else to do with their hands and to keep their minds active -- a hand held game, a crossword or a small object such as a pen, for example. They can ask friends and family to encourage them or agree to pay a modest sum if they are caught smoking. They can make a pledge never to start smoking.

It takes a just few days to withdraw from nicotine. Smokers might consider using a non-prescription nicotine patch or gum to provide nicotine while they learn to live their lives without tobacco. The prescription medication bupropion has been able to reduce the craving for nicotine in many people. Bupropion can double a person's chance of successfully quitting when properly motivated. Using a counselor in addition to medication increases success even more.

While becoming a non-smoker, people can use the opportunity to improve their overall health. They should eat a well-balanced diet and minimize junk food to reduce the risk of weight-gain. Regular exercise improves heart and lung function and relieves stress. Drink plenty of water. Try to encourage a smoking spouse to quit also, but don't be discouraged if he or she will not quit. There's a good chance he or she will follow once their spouse successfully becomes a non-smoker.

It's not a question of whether to quit; it's only a matter of when. Why not today?

For more information on quitting go to or

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Last Updated March 19, 2009