Ethics News
Smoking
>> = Important Articles; ** = Major Articles
Supplemental Articles in a separate file (click here to read)
>>Study: Smokers Have Lower IQs Than Non-Smokers (Foxnews, 100223)
>>Smoking Fact Sheet (American Lung Association, 031100)
**More than 600,000 people killed by 2nd-hand smoke (Foxnews, 101125)
**CDC: Smoking Bans Protect the Hearts of Nonsmokers (Foxnews, 091015)
**Smoke affects child behaviour: study: No risk threshold (National Post, 060501)
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NEW YORK — Cigarette smokers have lower IQs than non-smokers, and the more a person smokes, the lower their IQ, a study in over 20,000 Israeli military recruits suggests.
Young men who smoked a pack of cigarettes a day or more had IQ scores 7.5 points lower than non-smokers, Dr. Mark Weiser of Sheba Medical Center in Tel Hashomer and his colleagues found.
“Adolescents with poorer IQ scores might be targeted for programs designed to prevent smoking,” they conclude in the journal Addiction.
While there is evidence for a link between smoking and lower IQ, many studies have relied on intelligence tests given in childhood, and have also included people with mental and behavioral problems, who are both more likely to smoke and more likely to have low IQs, Weiser and his team note in their report.
To better understand the smoking-IQ relationship, the researchers looked at 20,211 18-year-old men recruited into the Israeli military. The group did not include anyone with major mental health problems, because these individuals are disqualified from military service.
According to the investigators, 28% of the study participants smoked at least one cigarette a day, around 3% said they were ex-smokers, and 68% had never smoked.
The smokers had significantly lower intelligence test scores than non-smokers, and this remained true even after the researchers accounted for socioeconomic status as measured by how many years of formal education a recruit’s father had completed.
The average IQ for non-smokers was about 101, while it was 94 for men who had started smoking before entering the military. IQ steadily dropped as the number of cigarettes smoked increased, from 98 for people who smoked one to five cigarettes daily to 90 for those who smoked more than a pack a day. IQ scores from 84 to 116 are considered to indicate average intelligence. [KH: This proves that smoking might cause lower IQ.]
Recruits aren’t allowed to smoke while intelligence tests are administered, the researchers note, so it’s possible that withdrawal symptoms might affect smokers’ scores. To address this issue, they also looked at IQ scores for men who were non-smokers when they were 18 but started smoking during their military service. These men also scored lower than never-smokers (97 points, on average), “indicating that nicotine withdrawal was probably not the cause of the difference,” the researchers say.
The researchers also compared IQs for 70 pairs of brothers in the group in which one brother smoked and the other did not. Again, average IQs for the non-smoking sibling were higher than for the smokers.
The findings suggest that lower IQ individuals are more likely to choose to smoke, rather than that smoking makes people less intelligent, Weiser and his team conclude.
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Smoking-related diseases claim an estimated 440,000 American lives each year, including those affected indirectly, such as babies born prematurely due to prenatal maternal smoking and some of the victims of “secondhand” exposure to tobacco’s carcinogens. Smoking costs the United States over $150 billion each year in health-care costs including $81.9 billion in mortality-related productivity loses and $75.5 billion in excess medical expenditures.
* Cigarettes contain at least 69 distinct cancer-causing chemicals. Smoking is directly responsible for 87% of lung cancer cases and causes most cases of emphysema and chronic bronchitis. Smoking is also a major factor in coronary heart disease and stroke; may be causally related to malignancies in other parts of the body; and has been linked to a variety of other conditions and disorders, including slowed healing of wounds, infertility, and peptic ulcer disease.
* Smoking in pregnancy accounts for an estimated 20 to 30% of low-birth weight babies, up to 14% of preterm deliveries, and some 10% of all infant deaths. Even apparently healthy, full-term babies of smokers have been found to be born with narrowed airways and curtailed lung function. Only about 30% of women who smoke stop smoking when they find they are pregnant; the proportion of quitters is highest among married women and women with higher levels of educational attainment. In 2001, 12% of women who gave birth smoked during pregnancy.
* Smoking by parents is also associated with a wide range of adverse effects in their children, including exacerbation of asthma, increased frequency of colds and ear infections, and sudden infant death syndrome. An estimated 150,000 to 300,000 cases of lower respiratory tract infections in children less than 18 months of age, resulting in 7,500 to 15,000 annual hospitalizations, are caused by secondhand smoke.
* Secondhand smoke involuntarily inhaled by nonsmokers from other people’s cigarettes is classified by the U.S. Environmental Protection Agency as a known human (Group A) carcinogen, responsible for approximately 3,000 lung cancer deaths annually in U.S. nonsmokers.
* Approximately 20.7 million American women are smokers. Current female smokers aged 35 years or older are 12 times more likely to die prematurely from lung cancer than nonsmoking females. More American women die annually from lung cancer than any other type of cancer; for example, lung cancer will cause an estimated 65,700 female deaths in 2002, compared with 39,600 estimated female deaths caused by breast cancer.
* As smoking has declined among the White non-Hispanic population, tobacco companies have targeted both African Americans and Hispanics with intensive merchandising, which includes billboards, advertising in media targeted to those communities, and sponsorship of civic groups and athletic, cultural, and entertainment events.
* The prevalence of smoking is highest among Native American Indians/Alaskan Natives (32.7%), intermediate among non-Hispanic whites (24%), and non-Hispanic blacks (22.3%), and lowest among Hispanics (16.7%) and Asians and Pacific Islanders (12.4%).
* Tobacco advertising plays an important role in encouraging young people to begin a lifelong addiction to smoking before they are old enough to fully understand its long-term health risk. It is estimated that at least 4.5 million U.S. teenagers are cigarette smokers; 20.6% of high school seniors smoke on a daily basis. Approximately 90% of smokers begin smoking before the age of 21.
* Workplaces nationwide are going smoke-free to provide clean indoor air and protect employees from the life-threatening effects of secondhand smoke. Nearly 70% of the U.S. workforce worked under a smoke free policy in 1999, but the percentage of workers protected varies by state, ranging form a high of 83.9% in Utah to 48.7% in Nevada.
* Employers have a legal right to restrict smoking in the workplace, or implement a totally smoke-free workplace policy. Exceptions may arise in the case of collective bargaining agreements with unions.
* Nicotine is an addictive drug, which when inhaled in cigarette smoke reaches the brain faster than drugs that enter the body intravenously. Smokers become not only physically addicted to nicotine; they also link smoking with many social activities, making smoking a difficult habit to break.
* In 2001, an estimated 44.8 million adults were former smokers. Of the current 46.2 million smokers, more than 32 million persons reported they wanted to quit smoking completely. Currently, both nicotine patches and nicotine gum are available over-the-counter, and a nicotine nasal spray and inhaler, as well as a non-nicotine pill, are currently available by prescription; all help relieve withdrawal symptoms people experience when they quit smoking. Nicotine replacement therapies are helpful in quitting when combined with a behavior change program such as the American Lung Association’s Freedom From Smoking® (FFS), which addresses psychological and behavioral addictions to smoking and strategies for coping with urges to smoke.
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LONDON – Second-hand smoke kills more than 600,000 people worldwide every year, according to a new study.
In the first look at the global impact of second-hand smoking, researchers analyzed data from 2004 for 192 countries. They found 40% of children and more than 30% of non-smoking men and women regularly breathe in second-hand smoke.
Scientists then estimated that passive smoking causes about 379,000 deaths from heart disease, 165,000 deaths from lower respiratory disease, 36,900 deaths from asthma and 21,400 deaths from lung cancer a year.
Altogether, those account for about 1% of the world’s deaths. The study was paid for by the Swedish National Board of Health and Welfare and Bloomberg Philanthropies. It was published Friday in the British medical journal Lancet.
“This helps us understand the real toll of tobacco,” said Armando Peruga, a program manager at the World Health Organization’s Tobacco-Free Initiative, who led the study. He said the approximately 603,000 deaths from second-hand smoking should be added to the 5.1 million deaths that smoking itself causes every year.
Peruga said WHO was particularly concerned about the 165,000 children who die of smoke-related respiratory infections, mostly in Southeast Asia and Africa.
“The mix of infectious diseases and second-hand smoke is a deadly combination,” Peruga said. Children whose parents smoke have a higher risk of sudden infant death syndrome, ear infections, pneumonia, bronchitis and asthma. Their lungs may also grow more slowly than kids whose parents don’t smoke.
Peruga and colleagues found the highest numbers of people exposed to second-hand smoke are in Europe and Asia. The lowest rates of exposure were in the Americas, the Eastern Mediterranean and Africa.
Second-hand smoke had its biggest impact on women, killing about 281,000. In many parts of the world, women are at least 50% more likely to be exposed to second-hand smoke than men.
While many Western countries have introduced smoking bans in public places, experts said it would be difficult to legislate further.
“I don’t think it is likely we will see strong regulations reaching into homes,” said Heather Wipfli of the Institute for Global Health at the University of Southern California in Los Angeles, who was not connected to the study. She said more public smoking bans and education might persuade people to quit smoking at home.
In the U.K., the British Lung Foundation is petitioning the government to outlaw smoking in cars.
Helena Shovelton, the foundation’s chief executive, said smoking parents frequently underestimate the danger their habit is doing to their children.
“It’s almost as if people are in denial,” she said. “They absolutely would not do something dangerous like leaving their child in the middle of the road but somehow, smoking in front of them is fine.”
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A major report confirms what health officials have long believed: Bans on smoking in restaurants, bars and other gathering spots reduce the risk of heart attacks among nonsmokers.
More than 126 million nonsmoking Americans are regularly exposed to someone else’s tobacco smoke. The surgeon general in 2006 cited “overwhelming scientific evidence” that tens of thousands die each year as a result, from heart disease, lung cancer and a list of other illnesses.
Yet smoking bans have remained a hard sell in Ohio and elsewhere, as lawmakers and business owners debate whether such prohibitions are worth the anger of smoking customers or employees.
Thursday’s hard-hitting report from the Institute of Medicine promises to influence that debate here and abroad.
“The evidence is clear,” said Dr. Thomas Frieden, head of the federal Centers for Disease Control and Prevention, which requested the study. “Smoke-free laws don’t hurt business ... but they prevent heart attacks in nonsmokers.”
Among the IOM report’s conclusions: While heavier exposure to secondhand smoke is worse, there’s no safe level. And it cited “compelling” if circumstantial evidence that even less than an hour’s exposure might be enough to push someone already at risk of a heart attack over the edge — as the smoke’s pollution-like small particles and other substances can quickly affect blood vessels.
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A study found no threshold below which children exposed to tobacco smoke did not have behavioural problems, including fidgeting, acting out and not paying attention in school. [KH: bad English: it means that even a small amount of smoking will have adverse effects.]
Parents who smoke not only risk making themselves sick, they could be making their children depressed, anxious or aggressive.
Cincinnati scientists who studied 225 children, ages five to 11, found those with the highest levels of exposure to tobacco smoke had more behaviour problems, such as fidgeting, acting out and not paying attention in school.
There was a clear dose-response effect: The bigger the exposure, the bigger the problems. However, children breathing in even low levels of cigarette smoke had behaviour issues.
“With tobacco, we’re not really seeing a threshold where there’s no effect,” said Kimberly Yolton, an assistant professor of pediatrics at Cincinnati Children’s Medical Center, who presented her data yesterday at the annual meeting of the Pediatric Academic Societies in San Francisco.
“We’re seeing effects on these outcomes at levels that are very low.”
All the children had asthma, but Dr. Yolton suspects the results would apply to any child living in a smoky home.
“Even when we controlled for the asthma symptoms and the severity of the children’s asthma, we still found an effect. What we’re saying is, all children should avoid exposure to tobacco smoke.”
According to a 1999 study commissioned by Physicians for a Smoke-Free Canada, more than 1.6 million Canadian children under the age of 12 are regularly exposed to cigarette smoke in their homes.
Second-hand smoke has already been linked with ear infections, croup, bronchitis, tonsillitis and even cancers and leukemias in children. Now, “exposure to environmental tobacco smoke is increasingly recognized as a risk factor for child behaviour problems,” Dr. Yolton said.
In a rat brain, exposure to nicotine or tobacco changes the structure and function of the nervous system. The brain looks different, and it reacts differently. Scientists hypothesize the same thing happens in humans. Young children may be especially vulnerable.
According to Physicians for a Smoke-Free Canada, young children breathe more air relative to their body weight, so they take in more toxins than an older child would from the same level of exposure.
Dr. Yolton last year published a study showing exposure to second-hand smoke affects a child’s reading and math skills.
In the new study, the Cincinnati developmental psychologist and colleagues scoured hospital billing records, looking for children with asthma.
“We then made a million and a half phone calls,” screening the families to see which children were living in houses where they were exposed to at least five cigarettes a day (the average was 14 cigarettes per day).
The researchers took blood and hair samples, measuring cotinine — a substance the body produces when it breaks down nicotine — to get an accurate measure of how much tobacco smoke the children were exposed to. They interviewed parents and also took reports from the children’s teachers.
“What we found was that the children with the highest levels of exposure to tobacco smoke in their homes or around them or wherever they got it from had more behaviour problems,” Dr. Yolton said.
The problems were of two different varieties: There was the acting out, hyperactive, disruptive types of behaviours “that people mostly notice.” But children exposed to higher levels also had more depression, withdrawal and anxiety-type behaviours. Some found it hard to make new friends or adapt to new social situations.
The team did not find a cause-and-effect link. As well, the finding needs to be tested on children without asthma.
Even so, “it’s just one more reason not to smoke,” Dr. Yolton said.
“It just shows you how strong this addiction is” that some parents would continue smoking around children with asthma.
Opening a window, or smoking outside, diminishes a child’s exposure somewhat, but it doesn’t eliminate it “because all these particles remain on your clothing,” Dr. Yolton said. “If you can smell it, it’s there.”
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Supplemental Articles in a separate file (click here to read)