Smokers Risk Frostbite for a Fix

Man in Sunglasses and Hat in Snowy Field

This weekend marks the 50th anniversary of the Surgeon General’s landmark Report on Smoking and Health, credited with helping to cut the number of U.S. smokers in half. But will the battle ever reach an endgame?

It’s colder outside than on the surface of Mars, the weather forecast says. No one goes out into the historic freeze, the killer of of at least 21 people, unless they have to.

But you have to. You need a nicotine fix. Never mind that the National Weather Service warns that smoking cigarettes in extremely cold temperatures causes the “blood flow to your hands to practically shut off.” Who’s afraid of a little frostbite?

On Jan. 11, 2014, the nation will mark the 50th anniversary of the Surgeon General’s landmark Report on Smoking and Health, the first in a series of steps, still being taken decades later, to diminish the impact of tobacco on the health of the American people. While smoking prevalence among U.S. adults has been reduced by half, tobacco use remains the leading preventable cause of disease, disability and death in the United States. On Jan. 16, a new Surgeon General’s report on smoking and health will be released.

That new report will demonstrate the sad fact that some people still haven’t learned. They are the people who brave brutal elements, even risk their lives, just to buy a pack of smokes or take a drag off a cigarette outside an office building.

In Coraopolis, Pa., this week, the AP reports, none of the town’s 5,664 residents were outside — except at the Uni-Mart on the corner of Main and Fifth. On the evening of the coldest temperature ever recorded in town, Lupe Bogden shivered behind the counter of the convenience store. Every few minutes, a customer arrived with a cold blast of air and left with a pack of Marlboros or Camels.

It was a cold snap in 2013 that helped Cam Schwab of Waterloo, Iowa, cut down on his smoking. “I smoke a lot less with it being so nasty,” Schwab told The “When it’s cold, I go to four cigarettes a day from 20.”

But frostbite isn’t the only bane of smokers. They cough more when it’s cold, too, according to the American Lung Association.

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Now, seven national public health-advocacy groups have set a goal of reducing adult smoking from 18 percent to below 10 percent by 2024 through actions by Congress, state and local government entities. The groups are the American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Campaign for Tobacco-Free Kids and Legacy.

Nicotine has addictive properties that roughly equal those found in well-known legal and illegal substances of abuse such as alcohol and heroin, according to the federal Centers for Disease Control and Prevention. In the U.S., more people are addicted to nicotine than to any other single substance. With that in mind, the state of South Carolina this week reached out to uninsured smokers with free nicotine replacement therapy, such as gum, lozenges or patches, for callers to the S.C. Tobacco Quitline. Duke University Medical Center researchers recently found that using a nicotine patch before quitting smoking can double success rates.

More good news came this week from the CDC, which reported that from 2005 to 2009, new cases  of lung cancer decreased in men and women, with the biggest decrease seen in people ages 35 to 44. Among this group, lung cancer incidence rates showed the most rapid decrease at 6.5 percent per year among men and 5.8 percent per year among women.

Of course, risking lung cancer isn’t only the gamble smokers take with their health. Smoking also causes cancer of the larynx, bladder, bone marrow, blood, esophagus, kidneys and several other organs. It increases the risk of stroke, heart disease and cataracts. It can damage fetuses, weaken bones and harm teeth and gums.

Why Is It So Hard to Quit?

Nicotine in the brain stimulates the release of a neurotransmitter, or brain chemical, called acetylcholine. The flood of this neurotransmitter gives a smoker a quick burst of energy or wakefulness. It also makes the smoker feel better able to pay attention and react to stimuli.

Key to what makes nicotine addictive is that it also releases a flood of the neurotransmitter dopamine. Dopamine is part of the pleasure pathway in the brain, and makes the smoker feel really good for a little while. This pleasurable feeling, enhanced by the release of another neurotransmitter called glutamate, is what keeps smokers coming back for more and what leads quickly to addiction. Soon, the smoker finds himself unable to feel normal without a cigarette.

Tobacco’s Many Components

Cigarettes contain more than 600 ingredients, and when burned and smoked, they produce more than 4,000 chemical substances that are inhaled by the smoker and anyone around him. Several of these compounds are poisonous, and at least 50 are known to be carcinogens. Some of the surprising chemicals found in cigarette smoke include acetone, a chemical solvent found in nail polish remover; ammonia; carbon monoxide; cadmium, which is a toxic heavy metal; lead, formaldehyde, a substance used for embalming; and tar, which builds up in the lungs.

While no one in the area of smoking research denies that nicotine is the main culprit when it comes to cigarette addiction, scientists believe there is more at work. Studies with rats that were given the choice of tobacco or pure nicotine vapors proved that the animals preferred the mix of chemicals in tobacco. Human studies have shown the same thing. Smokers in one study were offered an IV with pure nicotine or a cigarette, and always chose the latter. Either the experience of smoking, or additional ingredients, contribute to the addictive nature of cigarettes.

We are still learning about the hazards of smoking and other forms of tobacco use. As CDC Director Thomas Frieden put it in a JAMA editorial, “Tobacco is, quite simply, in a league of its own in terms of the sheer numbers and varieties of ways it kills and maims people.”







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