Tobacco-Caused Diseases

Smokers are more susceptible to hearing loss than non-smokers, including hearing loss due to ear infections and loud noise. This is a result of restricted blood flow to the middle and inner ear (Cruickshanks, Klein, Klein, Wiley, Nondahl, & Tweed, 1998). SHS can cause middle ear disease (including acute and recurrent otitis media) in children (The Lung Association, 2012).

People who smoke are more likely to experience hyposmia (reduced sense of smell). Smoking also increases the risk of cancers of the nasal and paranasal sinuses. SHS causes irritation of the nasal mucosa in those exposed (Berkow & Fletcher, 1992).

Smoking and chewing tobacco are a major cause of periodontal disease, dental caries, discolouration of teeth, oral lesions and cancers (CDC, 2004). It has been estimated that smoking accounts for about one-third to one-half of all periodontitis cases among adult smokers (Health Canada, 2011).

The risk of oral cancer is about five to ten times greater among people who smoke compared to people who do not smoke. Thirty-seven (37%) of people diagnosed with oral cancer are expected to die within five years after diagnosis (Health Canada, 2011). Squamous cell carcinoma (SCC) is the most common cancer of the oral cavity. SCC most commonly presents on the floor of the mouth and tongue in men; in women, the most common sites are the gums and tongue (Barasch, Morse, Krutchkoff, & Eisenberg, 1994).

Smoking is the major cause of cancers of the esophagus, pharynx, larynx and trachea. The evidence is sufficient to infer a causal relationship between smoking and these specific cancers (CDC, 2004). The risk of developing cancers of the throat directly increases with the duration and frequency of smoking. Smoking is the main risk factor for SCC - which is the most common type of tracheal tumour (Barasch et al., 1994).

Smoking causes lung disease, including chronic obstructive pulmonary disease (COPD). COPD includes chronic bronchitis and emphysema. Smoking damages the cilia lining in the bronchioles, making them less effective at keeping the lungs clear. Smokers may develop a habitual cough in an effort to remove mucus from the lungs (Health Canada, 2011). People who smoke are also more likely to acquire pneumonia and other respiratory infections (CDC, 2004).

Cigarette smoking and SHS are important triggers of asthma. Smoking or exposure to SHS among asthmatics increases asthma-related morbidity and disease severity. Smoking accounts for 87% of lung cancer deaths (National Institutes of Health, 2007). Lung cancer is the leading cause of cancer death in both men and women, and is one of the hardest cancers to treat. Nonsmokers who are exposed to SHS at home increase their lung cancer risk by 30–50% (Health Canada, 2006).

Smoking has several deleterious effects on the skin such as increased risk for discolouration of the hands and fingernails, facial wrinkling, poor wound healing, and psoriasis (Health Canada, 2011). Some oral cutaneous manifestations of smoking are gingival enlargement, oral candidiasis (thrush), lingua villosa nigra (black hairy tongue), and leukoplakia. Smokers have twice the risk of developing squamous cell carcinoma (SCC) (DemNet, 2011).

Cigarette smoking harms the digestive system; increasing risk for gastroesophageal reflux disease (GERD), peptic ulcer, Crohn’s disease, colon cancer, and possibly gallstones. Smoking is a major risk factor for abdominal aortic aneurysm and has been linked to cancers of the bladder, stomach, kidney, pancreas, and stomach (National Digestive Diseases Information Clearninghouse, 2013).

Some studies suggest an increased breast cancer risk with smoking of long duration, smoking before a first full-term pregnancy, and exposure to secondhand smoke (Terry & Rohan, 2002).

Smoking causes coronary heart disease, atherosclerosis, and increased risk of developing atherosclerotic peripheral vascular disease (PVD). Mortality due to rupture of aortic aneurysm is more common among smokers than nonsmokers (CDC, 2004). Nonsmokers who are exposed to SHS at home or work increase their risk for coronary heart disease (Health Canada, 2012).

Smoking among women contributes to infertility, cervical cancer and issues surrounding menstruation and menopause. Women who smoke during pregnancy are more likely to experience miscarriage, placental abruption, and premature birth. Furthermore, smoking during and after pregnancy, increases risk of Sudden Infant Death Syndrome (SIDS) (CDC, 2004). Babies born to women exposed to SHS during pregnancy are more likely to experience premature delivery and low birth weight and SIDS (Health Canada, 2011).

Studies have shown decreased bone mineral density (BMD) and increased fracture risk in both older men and women who smoke. The increase in fracture risk is greatest for hip fracture. Postmenopausal bone loss is greater in current smokers than non-smokers (Compston, 2007).

Smoking is a risk factor for cancers of the bone marrow, such as acute myeloid leukemia (AML) (CDC, 2004).

Smoking is a major cause of cerebrovascular disease (stroke). In fact, the risk of stroke is approximately 2 to 4 times greater among smokers than non-smokers (Health Canada, 2011).

Babies and children are particularly vulnerable to second-hand and third-hand smoke due to increased respiratory rate, less developed immune systems, and general lack of independence. SHS is the most common reason for surgery in young children, resulting in 16,500 tympanostomies in Canada each year. SHS is estimated to be responsible for as many as 13% of all cases of middle ear disease in pre-schoolers in Canada, or about 220,000 cases each year.

In Canada, it is estimated that secondhand smoke is responsible for: 13% of ear infections (220,000 ear infections per year in children), 26% of tympanostomy tube insertions (16,500 per year), 24% of tonsillectomies and adenoidectomies (approximately 2,100 operations per year), 13% of asthma cases (52,200 cases per year), 16% of physician visits for cough (200,000 visits per year), 20% of all lung infections in children under 5 (43,600 cases of bronchitis and 19,000 cases of pneumonia per year), 136-212 childhood deaths from lower respiratory infection, 148 childhood deaths from fires started by tobacco products and about 180-270 deaths per year from Sudden Infant Death Syndrome (SIDS) (The Lung Association, 2012).

1. Barasch A, Morse DE, Krutchkoff DJ and Eisenberg E. Smoking, gender, and age as risk factors for site specific intraoral squamous cell carcinoma. A case series analysis. Cancer. 1994;73(3):509-13.
2. Berkow, R., & Fletcher, A. J. (Ed.). (1992). The Merck manual of diagnosis and therapy. (16th ed.). Retrieved Feb 26, 3013 from: http://www.merckmanuals.com/professional/index.html
3. Buhrmann, R., Hodge, W., Beardmore, J., et al. (2007). Foundation for a Canadian Vision Health Strategy: Towards Preventing Avoidable Blindness and Promoting Vision Health 2007. Canada: National Coalition for Vision Health.
4. Centre for Addiction and Mental Health (2011). Smoking Fact Sheets for Clinicians: Eye Care and Smoking Fact Sheet for Healthcare Providers. Retrieved Feb 26, 2013 from: https://www.nicotinedependenceclinic.com/English/teach/Pages/Smoking-Fact-Sheets2.aspx
5. Compston J. Editorial: smoking and the skeleton. J Clin Endocrinol Metab. 2007;92:428–29. [PubMed]
6. Cruickshanks, K., Klein, R., Klein, B., Wiley, T., Nondahl, D., & Tweed, T. (1998). Cigarette smoking and hearing loss: the epidemiology of hearing loss study. Journal of the American Medical Association, 279, 1715-1719.
7. DermNet NZ. Smoking and its effects on the skin (updated 2011, Jul 01). Available at: www.dermnetnz.org/reactions/smoking.html (accessed 2013, Mar 1)
8. Health Canada, Health Concerns: Exposure to second-hand smoke during pregnancy (updated 2011-09-21). Available at: www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/preg-gross-eng.php (accessed 2013, Mar 1)
9. Health Canada, Health Concerns. Healthy Living: Lung Cancer (updated 2006-03-28). Available at: www.hc-sc.gc.ca/hl-vs/pubs/women-femmes/cancer-eng.php (accessed 2013, Feb 26)
10. Health Canada, Health Concerns. Smoking and Age-Related Macular Degeneration (updated 2011-09-22). Available at: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac.legislation/label-etiquette/macul-eng.php (accessed 2013, Feb 26)
11. Health Canada, Health Concerns. Smoking and Chronic Obstructive Pulmonary Disease (updated 2011-09-22). Available at: www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/pulmon-eng.php (accessed 2013, Mar 12)
12. Health Canada, Health Concerns. Smoking and Heart Disease (updated 2012-08-21). Available at: www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/heart-coeur-eng.php (accessed 2013. Mar 1)
13. Health Canada, Health Concerns. Smoking and Oral Cancer (updated 2011-09-21). Available at: www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/oral-bouche-eng.php (accessed 2013, Feb 26)
14. Health Canada, Health Concerns: Smoking and Strokes (updated 2011-09-22). Available at www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/stroke-avc-eng.php (accessed 2013, Mar 14)
15. Health Canada, Health Concerns: The Visible Consequences of Smoking (updated 2011-09-22). Available at www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/visible-eng.php (accessed 2013, Mar 14)
16. National Institutes of Health. Expert Panel Report. 3. Guidelines for the diagnosis and management of asthma. NIH Publication No. 07-4051 Bethesda, MD: National Institutes of Health; 2007.
17. Terry PD, Rohan TE. Cigarette smoking and the risk of breast cancer in women: a review of the literature. Cancer Epidemiol, Biomarkers Prev. 2002;11:953–971. [PubMed]
18. The Lung Association (2012). Smoking & Tobacco. Second-hand smoke (Children & second-hand smoke). Retrieved Feb 26, 2013 from: www.lung.ca/protect-protegez/tobacco-tabagisme/second-secondaire/children-enfants_e.php
19. U.S. Department of Health and Human Services, Centres for Disease Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health (2004). The Health Consequences of Smoking: what it means to you. Retrieved Mar 1, 2013 from: www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/executivesummary.pdf
20. Health Canada, The Visible Consequences of Smoking (updated 2011-09-21). Available at: www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/visible-eng.php (accessed 2013, Feb 26)
21. U.S. Department of Health and Human Services, National Digestive Diseases information Clearinghouse (NDDIC). Smoking and Your Digestive System. Retrieved Mar 8, 2013 from: http://digestive.niddk.nih.gov/ddiseases/pubs/smoking/