'On the Web' is an internet-based supplement that provides additional web content to supplement the material in Concepts of Fitness and Wellness. Browse through the whole document to explore web content related to this concept. If you know the specific 'On the Web' number or page number of the web icon in the text you can click on the direct link you are looking for below.

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On the Web - Concept 18

Web18-01: Smoking and Health

Web18-02 – Societal Impact of Smoking

Web18-03: Second Hand Smoke

Web18-04 Society Trends Regarding Smoking

Web18-05: Children and Tobacco

Web 18-06 – Effect of Policies on Smoking

Web18-07: Smoking Cessation

Web18-08 Behavioral Skills for Smoking Cessation

Web18-09 – Web Resources

Web18-10 - Supplemental Readings

Web18-01: Smoking and Health

Smoking is the number one cause of preventable mortality. It has been estimated that smoking causes more than 400,000 deaths a year. The percentage of deaths attributable to smoking is estimated at almost 20% and is greater than all other behavioral factors or environmental conditions. More Americans than are killed each year by AIDS, alcohol, car accidents, murders, suicides, illegal drugs, and fires combined. The American Cancer Web site provides the following statements about the risks associated with smoking:

• Lung cancer mortality rates are about 23 times higher for current male smokers and 13 times higher for current female smokers compared to lifelong never-smokers.
• Approximately 87% of lung cancers are related to smoking. Smoking is also associated with cancers of the mouth, pharynx, larynx, esophagus, pancreas, uterine cervix, kidney, and bladder.
• Smoking accounts for at least 30% of all cancer deaths, is a major cause of heart disease, and is associated with conditions ranging from colds and gastric ulcers to chronic bronchitis, emphysema, and cerebrovascular disease (related to blood circulation).

Because of the clear health risks posed by smoking there are major public health efforts to reduce smoking in the population. One of the most comprehensive sites for information on tobacco and health is the Center for Disease Control and Prevention (CDC) site called Tobacco Information Prevention and Services (TIPS) - http://www.cdc.gov/tobacco/.

Because it is now clear that tobacco companies add some nicotine to the cigarettes to maintain the addictive properties of the product, the way in which tobacco is perceived has changed drastically. The properties of tobacco products were originally assumed to be caused by the plant and therefore it was regulated more as a food product. Now, there are efforts to treat tobacco for what it really is a drug. A bill has recently been proposed to Congress called The FDA Tobacco Authorities Amendments Act. This bill would treat tobacco as a drug, and grant the FDA authority to require that consumers be informed of what is in tobacco products, allow the agency to regulate any harmful ingredients in tobacco products and to restrict marketing that may have a major appeal to children. Information on this proposed amendment is available from an American Heart Association Press Release

Web18-02 – Societal Impact of Smoking

According to the American Cancer Society (ACS), smoking can reduce life expectancy by approximately 14 years. Some other societal impacting statistics from the website are listed below:

• $167 billion in health related economic costs are caused by smoking annually.
• $1623 in excess medical expenditures are spent each year per adult smoker.
• $366 million are spent each year on smoking attributed cost for newborns born to mothers that smoke.
• $12 billion were spent by states on treating smoking related diseases.
• $7.18 is the total spent by society per pack of cigarettes to care for medical costs related to smoking.

Some key statistics on smoking and its impact on cancer can be found at the American Cancer Socitey's website: http://www.cancer.org

The ACS has developed a web calculator to help people calculate the personal financial cost of smoking. Click here to access this site.

Web18-03: Second Hand Smoke

Environmental tobacco smoke (ETS) or "second-hand" smoke refers tobacco products that can be inhaled by non-smokers simply by being around others who smoke. ETS has been linked to an increasing number of health problems. A number of recent studies have indicated that ETS is a cause of lung cancer in persons who have never smoked. ETS also has been identified as a risk factor for ischemic heart disease. Even in a pediatric population ETS increases risk of disease. Meta-analysis of studies involving children have shown that ETS exposure in the home is linked to lower respiratory tract illness causing death. ETS in the home is also associated with as many as 2.2 million episodes of otitis media, and over 3 million doctor visits for asthma, bronchitis, and pneumonia in children. Click here to see a list of resources on ETS:

Because of the documented findings on the hazards of ETS and a new report by the Surgeon General entitled "The health consequences of involuntary exposure to tobacco smoke", there is now greater public control and regulation on smoking. For example, nearly all public buildings now have no smoking policies. There have been additional efforts to ban smoking in restaurants, bars and other places. Read up on the following policy initiatives related to second hand smoke:

• A non-profit agency called 'Action on Smoking and Health' (http://www.ash.org/) provides resources and information about the effect of smoking on the public and on policy efforts to curb smoking in society.
• The Centers for Disease Control and Prevention provide an online resource called 'Taking Action against Second Hand Smoke' at http://www.cdc.gov/tobacco/ETS_Toolkit/index.htm
• Universities have also proposed guidelines for smoking on campuses. See the position statement by the American College Health Assocation on smoking on campus.

Web18-04 Society Trends Regarding Smoking

The prevalence of smoking varies considerably across the country and by age. The states with the largest prevalence of smoking tend to be clustered in the southeast region of the country. Not by coincidence, these states are where the majority of tobacco is grown. Trends have shown dramatic declines in prevalence of smoking during the 1970s and 1980's and smaller declines across the 1990's. See the figure below that was obtained from the Behavioral Risk Factor Surveillance System (BRFSS) website - http://apps.nccd.cdc.gov/brfss/index.asp. This website provides updated information on both prevalence in individual states or trends over time. Visit the website directly to see how your state compares to the national average.

Web18-05: Children and Tobacco

Current evidence suggests that smoking is a pediatric problem. The majority of adult smokers begin smoking as a child or adolescent and find it hard to quit. In fact, 82% of adults who ever smoked report having had their first cigarette by their 18th birthday. Between 1991 and 1995, the percentage of eighth- and 10th-graders who smoked increased by 34 percent. Results from the Monitoring the Future studies conducted by the University of Michigan reveal that the prevalence of smoking among youth has decreased in recent years. In 2002, the percentage of students reporting smoking in the past 30 days were 15%, 24%, and 31% for 8^th, 10^th, and 12^th graders, respectively. The proportion of students who were daily smokers was 7%, 14% and 21%. These levels represent considerable declines over the values reported earlier in the decade. Click here to see the press release.

There have been a number of policy and programming efforts that may be contributing to these recent trends. Laws now limit exposure to cigarettes, minimize advertising and provide better education programs. See the information below for details:

• In 1998 the Food and Drug Administration (www.fda.gov) proposed policies to restrict access to tobacco and tobacco ads. Some of the components of the policies included no outdoor advertising within 1,000 feet of schools and playgrounds, only black and white, text-only advertising allowed in youth-related publications, no sale or giveaway of products (e.g. caps, shirts) with tobacco brand names or logos) and no brand-name sponsorship of sporting or entertainment events by tobacco companies. These policies greatly reduce the exposure of youth to tobacco advertising and products.
• In 2001, several senators reintroduced strong bipartisan legislation to protect kids and the public from the harms of tobacco. The legislation called 'The Kids Deserve Freedom From Tobacco Act of 2001' (S.247)' reestablishes the FDA's authority over tobacco by allowing the agency to resume enforcement of youth identification checks. The bill also authorizes additional youth access restrictions such as requiring tobacco products to be kept behind store counters, banning vending machines in areas where children could access them, and advertising limits. Lastly, the legislation treats tobacco as a drug, and therefore allows the FDA to more actively regulate tobacco products.
• Social marketing campaigns have also been effective at changing perceptions of youth regarding smoking. Many have emphasized the dishonesty of the tobacco industry or the erroneous perceptions that smoking is cool.

Visit the CDC webpage called Tips4Youth on smoking for great links on smoking cessation resources for youth.

Web 18-06 – Effect of Policies on Smoking

All 50 states have instituted smoking policies or regulations along with communities across the country. Some of these policies range from simple restrictions on smoking in certain buildings or areas to completely prohibiting smoking in all public places. All states have also taxed cigarette purchases with the average state cigarette tax standing at almost $0.917 per pack with Rhode Island having the highest tax at $2.46 per pack. The state and city tax in New York City ($3.00) makes a pack of cigarettes the most expensive in the country at over $7 per pack

In 2005, six states passed laws strengthening their smoking policies: Georgia, Montana, North Dakota, Rhode Island, Vermont, and Washington. The following states are "smoke free" as of January 1, 2006: California, Connecticut, Delaware, Massachusetts, Maine, New York, Rhode Island, Vermont, and Washington.

The following restrictions on smoking shows the number of states that have adopted these policies:

• Restricted smoking in public places: 46 states
• Restricted smoking in government buildings: 48 states
• Restricted smoking in private workplaces: 31 states

To view the report by the American Lung Association visit this link: http://slati.lungusa.org

Web18-07: Smoking Cessation

There are various techniques that are available to assist smokers in breaking the addiction to smoking. One of the most popular methods is to provide small doses of nicotine to reduce the symptoms of nicotine withdrawal. Nicotine patches have generally been found to be effective in promoting smoking cessation. (click here to see example of these types of results). Several new antidepressant drugs (bupropion and nortriptyline) have recently been found to enhance the effectiveness of quit attempts made by both the nicotine patch and a placebo treatment. The antidepressants apparently act by stimulating some of the same brain chemical as cigarettes do. The fact that they helped people quit even without using the patch suggests that they may provide an additional option for individuals interested in quitting their smoking habit. For additional information see Consumer Reports on Health (March 2003).

Click here to learn more about resources for quitting smoking.

Web18-08 Behavioral Skills for Smoking Cessation

Smoking has severe effects on health but the effects are somewhat reversible if the individual is able to quit smoking. Estimates suggest that after 1 year of not smoking, the excess risk of heart disease is cut in half. After 10 years, the risk of lung cancer is cut in half. Because of the addictive properties of nicotine, strong behavioral skills are needed to activate and maintain efforts at smoking cessation. There are a variety of valuable commercial and free websites available to help consumers quit smoking.

• QuitNet is an online support group that provides resources to help people quit smoking. Visit the QuitNet site
• The America Lung Assocation has now made their popular 'Freedom From Smoking' program available for free online. Click here to access the information site on Freedom from Smoking.
• The USPHS Guide to Quitting Smoking

Web18-09 – Web Resources

Agency for Health Care Policy and Research - www.ahrq.gov

American Cancer Society - www.cancer.org

American Heart Association -http://www.americanheart.org/

American Lung Association - www.lungusa.org

Campaign for Tobacco Free Kids - www.tobaccofreekids.org

Dr. Koop - Tackling Tobacco Abuse - http://www.drkoop.com/tobacco

National Center for Chronic Disease Prevention and Promotion – Tobacco links – www.cdc.gov/tobacco

Quitnet.org – http://www.quitnet.org/

Surgeon General's Report on Smoking - www.surgeongeneral.gov/tobacco

You Can Quit Smoking, Consumer Guide – www.surgeongeneral.gov/tobacco/consquits.htm

You Can Quit Smoking Now http://www.smokefree.gov

Web18-10 - Supplemental Readings

References new to 7e/14e:

American Cancer Society. 2006. Tobacco product advertising and promotion fact sheet. Quit Smoking. Available at www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=44462

Bjartveit, K. and Tverdal, A. (2005). Health consequences of smoking 1-4 cigarettes per day. Tobacco Control 14: 315-320.

Becklake, M.R., Ghezzo, H., and Ernst, P. (2005). Childhood predictors of smoking in adolescence: A follow-up study of Montreal schoolchildren. Canadian Medical Association Journal 173: 377-379

DiFranza, J.R., Aligne, C.A., and Weitzman, M. (2004). Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics 113: 1007-1015.

Godtfredsen, N.S., Prescott, E., and Osler, M. Effect of smoking reduction on lung cancer risk. Journal of the American Medical Association 294: 1505-1510.

Grover, S.A. et al. (1994). Life expectancy following dietary modification or smoking cessation. Estimating the benefits of a prudent lifestyle. Archives of Internal Medicine 154: 1697-1704.

\Hahn, D. B. et al. 2007. Focus on Health (8^th ed.). New York: McGraw-Hill Higher Education, Chapter 9.

Iestra, J.A. et al. (2005). Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: A systematic review. Circulation 112: 924-934.

Johnston, L.D. et al. (2006). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings (NIH Publication No. 06-5882). Bethesda, MD: National Institute on Drug Abuse.

Koch, W. (2005). 39% live in areas limiting smoking: Six more states pass restrictions in 2005. USA Today, December, 2005.

Kuiper, N. et al. (2005). State-specific prevalence of cigarette smoking and quitting among adults – United States, 2004. Morbidity and Mortality Weekly Reports 54: 1124-1127.

Mitchell, T. (2005). New hope for smokers: A promising new drug may help those who want to quit. USA Today, Dec. 23.

Moran, S., Wechsler, H., and Rigotti, N.A. (2004). Social smoking among US college students. Pediatrics 114: 1028-1034.

Op Reimer, W.S. et al. (2006). Smoking behavior in European patients with established coronary artery disease. European Heart Journal 27: 35-41.

Patterson, F. et al. (2004). Cigarette smoking practices among American college students: Review and future directions. Journal of American College Health 52: 203-210.

Pronk, N.P. et al. (1999). Relationship between modifiable health risks and short-term health care charges. Journal of the American Medical Association 282: 2235-2239.

Rigotti, N.A., Moran, S.E., and Wechsler, H. (2005). US college students' exposure to tobacco promotions: Prevalence and association with tobacco use. American Journal of Public Health 95: 138-144.

Steptoe, A. et al. (2002). An international comparison of tobacco smoking, beliefs and risk awareness in university students from 23 countries. Addiction 97: 1561-1571.

Stockdale, M.S., Dawson-Owens, H.L., and Sagrestano, L.M. (2005). Social, attitudinal, and demographic correlates of adolescent vs college-age tobacco use initiation. American Journal of Health Behavior 29: 311-323.

Travers, M.J. et al (2004). Indoor air quality in hospitality venues before and after implantation of a clean indoor air law – Western New York, 2003. Morbidity and Mortality Weekly Reports 53: 1038-1041.

Teague, M. L. et al. 2007. Your Health Today: Choices in a Changing Society. New York: McGraw-Hill Higher Education, Chapter 13.

U. S. Department of Health and Human Services. 2006. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotions, National Center for Chronic Disease prevention and Health Promotion, Office on Smoking and Health.

USA Today. (2005). Once workers punch out, companies need to butt out. USA Today, Feb. 8.

USA Today (2005). Last-minute smoking retreat leaves anti-smoking plan in ashes. USA Today, June 12.

Weitzman, M. et al. (2005). Tobacco smoke exposure is associated with metabolic syndrome in adolescents. Circulation 112: 862-869.

Weitzman, E.R. and Chen, Y.Y. (2005). The co-occurrence of smoking and drinking among young adults in college: National survey results from the United States. Drug and Alcohol Dependence 80: 377-386.

Yancey, K.B. (2005). Westin hotels ban smoking. USA Today, December 5.

Yolton, K. et al. (2005). Exposure to environmental tobacco smoke and cognitive abilities among U.S. children. Environmental Health Perspectives 113: 98-103.

References from Past Editions:

• American Cancer Society. Cancer Facts and Figures—1997. New York: The American Cancer Society, 1998.
• American Cancer Society, "CPSII and Tobacco Control," CPSII, Newsletter 12(1995):1.
• American Heart Association. "Active and Passive Tobacco Exposure. A Serious Pediatric Health Problem." (Scientific Statement) Circulation Nov. (1995).
• Bowles, W., et al. "Abrasive Particles in Tobacco Products: A Possible Factor in Dental Attrition." Journal of the American Dental Association 126(1995):327.
• Centers for Disease Control. "Cigarette Smoking Among Adults." Epidemiology Branch, Office on Smoking Health. National Center for Chronic Disease Prevention and Health Promotion. Journal of the American Medical Association 273(1995):369.
• CDC. Cigarette smoking among adults—United States. Morbidity and Mortality Weekly Reports. 18(43).: 993, 1999.
• CDC. Cigarette smoking among high school students—United States. Morbidity and Mortality Weekly Reports. 47: 229, (1998).
• Facts About Cigarette Smoking. New York: American Lung Association, n.d.
• Facts About Nicotine Addiction and Cigarettes. New York: American Lung Association, 1990.
• Facts About Secondhand Smoke. New York: American Lung Association, 1990.
• Facts About the Nicotine Transdermal Patch. New York: American Lung Association, 1992.
• "FDA Examines Danger of Patch Plus Cigarettes." Santa Ana, CA: Orange County Register, June 19, 1992.
• Freedman, A.M. "Philip Morris Draft Report May Help U.S. Case Against Tobacco." Orange County Register, Dec. 9, 1995.
• Glantz, S.A., & W.W. Parmley. "Passive Smoking and Heart Disease: Mechanism and Risk." Journal of the American Medical Association 273(1995):1047.
• Gulliver S., et al. "Interrelationship of Smoking and Alcohol Dependence, Use and Urges to Use." Journals of Studies on Alcohol 56(1995):202–6.
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• Howard, G. Cigarette Smoking and Progression of Atherosclerosis, Journal of the American Medical Association. 279(2)(1998):119.
• Is There a Safe Tobacco? Take a Look at the Facts. New York: American Lung Association, 1990.
• Johnston, L. D., O'Malley, P. M. and Buchman, J. G. The Monitoring of the Future National Survey Results on Adolescent Drug Use: Key Findings 1999 (NIH Publication No. 00-4690). Rockville, MD: National Institute on Drug Abuse, 2000
• National Center for Health Statistics. Health, United States, 1998: With Socioeconomic Statistics and Health Chartbook. Hyattsville, MD: National Center for Health Statistics, 1998.
• Payne, W. A. & Hahn, D.B. Understanding Your Health (5^th Ed.). St. Louis: WCB/McGraw-Hill, 1998, Chapter 9: Rejecting Tobacco Use.
• Pierce, J. P. et al. Tobacco Industry Promotion of Cigarettes and Adolescent Smoking. Journal of the American Medical Association. 279(7)(1998):511.
• "Secondhand Smoke:Is it a Hazard?" Consumer Reports 60:1(1995):142.
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• Shelton et al. "State Laws on Tobacco Control – United States, 1995." Morbidity and Mortality Weekly Report. 44(1995), 1-7.
• Spence, W.R. Smokeless Tobacco: A Chemical Time Bomb. Waco, TX: Health EDCO, n.d.
• U.S. Department of Health and Human Services. Healthy People 2010 Objectives: Draft for Comment. Washington, DC: U.S. Department of Health and Human Services, 1998, Objective Chapter 3: Tobacco.
• U.S. Department of Health and Human Services. Reducing tobacco use: A report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.
• U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
• US Department of Health and Human Services. Healthy People 2010. (Conference Edition in Two Volumes). Washington, DC: USDHHS, 2000, Chapter 27, Tobacco Use.
• Van Duser, B.L., & P.B. Raven. "The Effects of Oral Smokeless Tobacco on the Cardiorespiratory Response to Exercise." Medicine and Science in Sports and Exercise 24(1992):389.
• Werner, R. M. and Pearson, T. A. What's so passive about passive smoking? Second hand smoke as a cause of atherosclerotic disease. Journal of the American Medical Association. 279(2)L1998), 157-158.
• What You Should Know About Smoking and Cancer. New York: American Lung Association, n.d.