Surgeon General Report Details the Biology of Smoking Damage

by U.S. Medicine

January 22, 2011

WASHINGTON, DC—While the overall negative health effects of smoking have been common knowledge for many years, a newly-released Surgeon General’s report goes into unprecedented detail on how tobacco causes disease at a biological and behavioral level. The report gives fuel to a federal effort to reduce smoking in America, which has stalled over the last few years.

“We’ve known the dangers of tobacco smoke for years,” HHS Secretary Kathleen Sebelius said in a press conference held upon the release of the report. “But now we know that inhaling the poisons in tobacco smoke causes immediate damage and leads to death and disease. The message is simple. There is no safe level of exposure to tobacco smoke.”

The report details how the chemicals in tobacco smoke reach the lungs very quickly, how blood then carries those toxins to every organ in the body, damaging blood vessels, and increasing clotting. Those chemicals also damage the lining of the lungs, damaging the lungs’ ability to exchange air efficiently and leading to COPD and emphysema.

“All Americans have some degree of coronary artery disease and don’t know it,” Surgeon General Regina Benjamin said. “But a brief amount of tobacco smoke leads to changes in blood vessel function and clotting, which can lead to a heart attack.”

The report also details how smoking can lead to inflammation and cell damage, which weakens the immune system. White blood cell count rises immediately upon smoking and stays high for as long as a person smokes. “Your body is constantly trying to fight against the damage that’s being caused by smoking,” Benjamin said. “Also, the chemicals and toxins damage your DNA, leading to cancer. And smoking weakens your body to fight cancer.”

Smoking is particularly damaging to diabetics, the report says, making it harder to control blood sugar and increasing the risk of heart attack and nerve damage, which can lead to blindness and limb loss.

In addition to the physical health effects, the report details the addictive properties of smoking. Along with nicotine, a well-known addictive agent, modern cigarettes include flavoring agents and filters that allow for more smoke to enter the lungs at an increased rate—both of which increase addiction.

Benjamin admitted that much of the report is aimed at scientists, detailing not only what happens to the body during smoking, but how and why. “But I think it’s important for Americans to understand what’s happening to their bodies, especially smokers. I’ve had patients come in tired and frustrated [with trying to quit]. They need to know what’s happening to their bodies so they don’t give up.”

The report comes at a time when HHS is making plans to reinvigorate its anti-smoking efforts to combat a leveling out of the decades-long decline in smoking rates. Approximately 20% of Americans smoke and approximately 1,000 young people under the age of 18 become smokers each day. While that level is less than half what it was when the first Surgeon General’s report on smoking came out in 1964, it has remained relatively steady since 2003.

“We’ve been stalled at 20% for over seven years, and that’s not a good place to be,” Sebelius said. “Especially when 1,000 kids become addicted every day.”

In November, HHS released its new tobacco control strategy, which takes advantage of FDA’s new regulatory authority over tobacco products and mandates new graphic warnings on cigarette packages and advertisements. HHS has also targeted “exploitive marketing practices,” such as using recognizable tobacco product icons and color combinations on products marketed to children.

The government is also taking steps to make cessation treatment more accessible, including adding a provision in the Affordable Care Act that mandates private and public health plans give patients access to cessation treatment at no additional cost. Access to cessation treatment has also been expanded within Medicare.

“Medicare, finally, will cover all cessation counseling for beneficiaries,” Sebelius said. “Before, you had to wait and report with a disease before you got cessation help. We thought it might make a little more sense to get help before you get the disease.”

To download the report, click here.

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