Maternal smoking increases the risk of spontaneous abortions and preterm births and results in intrauterine growth retardation (Chapter 7); however, birth weights of infants born to mothers who stopped smoking before pregnancy are normal.
Fig. 8.8 Theriskoflungcancerisdeterminedbythenumberofcigarettessmoked.(Data from Stewart BW, Kleihues P, editors: Worldcancerreport,Lyon, 2003, IARC Press.)
Fig. 8.9 Multiplicativeincreaseintheriskoflaryngealcancerfromtheinteractionbetweencigarettesmokingandalcoholconsumption.(Data from Stewart BW, Kleihues P, editors: Worldcancerreport, Lyon, 2003, IARC Press.) 0–40 http://ebooksmedicine.net • Passive smoke inhalation is also associated with detrimental effects. It is estimated that the relative risk of lung cancer in nonsmokers exposed to environmental smoke is about 1.3 times that in nonsmokers who are not exposed to smoke. In the United States, approximately 3000 lung cancer deaths in nonsmokers older than 35 years can be attributed each year to environmental tobacco smoke. Even more striking is the increased risk of coronary atherosclerosis and fatal myocardial infarction. Studies report that 30,000 to 60,000 cardiac deaths annually in the United States are associated with passive exposure to smoke. Children living in a household with an adult who smokes have an increased frequency of respiratory illnesses and asthma. Passive smoke inhalation in nonsmokers can be estimated by measuring the blood levels of cotinine, a metabolite of nicotine. In the United States, median cotinine levels in nonsmokers have decreased by more than 60% since around 2000 because of the adoption of nonsmoking policies in public places. However, passive exposure to tobacco smoke in the home remains a major public health concern, particularly for children. It is clear that the transient pleasure a puff may provide comes with a heavy long-term price.
Smokingisthemostpreventablecauseofhumandeath.
Tobaccosmokecontainsmorethan2000compounds.Amongthesearenicotine,whichisresponsiblefortobaccoaddiction,andstrongcarcinogens—mainly,polycyclicaromatichydrocarbons,nitrosamines,andaromaticamines.
Approximately90%oflungcancersoccurinsmokers.Smokingisalsoassociatedwithanincreasedriskofcancersoftheoralcavity,larynx,esophagus,stomach,bladder,andkidney,aswellassomeformsofleukemia.Cessationofsmokingreducestheriskoflungcancer.
Smokelesstobaccouseisanimportantcauseoforalcancers.Tobaccointeractswithalcoholinmultiplyingtheriskoforal,laryngeal,andesophagealcancerandincreasestheriskoflungcancersfromoccupationalexposurestoasbestos,uranium,andotheragents.
Tobaccoconsumptionisanimportantriskfactorfordevelopmentofatherosclerosisandmyocardialinfarction,peripheralvasculardisease,andcerebrovasculardisease.Inthelungs,inadditiontocancer,itpredisposestoemphysema,chronicbronchitis,andchronicobstructivedisease.
Maternalsmokingincreasestheriskofabortion,prematurebirth,andintrauterinegrowthretardation.
Ethanol is consumed, at least partly, for its mood-altering properties, but when used in moderation its effects are socially acceptable and not injurious. When excessive amounts are used, alcohol can cause marked physical and psychologic damage. Here we describe the lesions that are directly associated with the abuse of alcohol.