Risk Behaviors

The impact of tobacco use in the United States and worldwide is staggering. According to the World Health Organization, 1.1 billion people worldwide regularly smoke tobacco products, and smoking accounts for 10,000 deaths per day. In 1990 there were 418,000 deaths in the United States alone attributed to smoking and its effects. Smoking kills two and one-half times more people than alcohol and drug use combined. In the United States 25 percent of the population regularly uses tobacco, with 6,000 new adolescent smokers each day–half of whom will go on to be regular smokers. Every day more than 15 million children are exposed to smoke in their homes. Environmental tobacco smoke (ETS), also known as "second hand smoke," poses significant risks to children. The United States Environmental Protection Agency (EPA) has classified ETS as a class A carcinogen, which means that ETS is known to cause cancer in humans. Exposure to ETS before the age of ten will increase a child's chances of developing lymphoma and leukemia (i.e., cancers of the blood) as an adult. The effects of ETS are actually worse than those acquired from smoking cigarettes directly.

Pregnancy/Perinatal/SIDS

It has been estimated that 19 percent to 27 percent of pregnant women smoke during their pregnancy. The pregnant woman who smokes not only affects her own health, but she harms the baby she is carrying as well. A major risk of smoking during pregnancy is the increased rate of premature delivery of the baby. Infants who are born prematurely can have many severe medical problems, including lung immaturity and brain injury. Maternal smoking contributes to 5 percent of all perinatal deaths (i.e., 2,800 deaths per year). Pregnant women who smoke are at a greater risk of miscarriage and low-birth-weight infants, as well as higher rates of long-term behavioral and mental problems in her child. Infants born to mothers who smoked during pregnancy have a much higher rate of Sudden Infant Death Syndrome (SIDS) than infants born to mothers who did not smoke during pregnancy. There is a dose-dependent relationship between ETS exposure during pregnancy and the rate of SIDS: The greater the exposure of cigarette smoke to an unborn baby, the higher their risk of SIDS. Cigarette smoke exposure is one of the few preventable risk factors for SIDS.

Newborn infants are in a unique situation when it comes to exposure to their mothers' smoke. Cotinine, a metabolite of nicotine, is found in newborn babies' blood at levels almost equivalent to their mothers'. There are significant levels of cotinine in a newborn's blood even if the mother herself does not smoke, but simply lives in a household where there is ETS exposure. There is a direct relationship between the maternal and newborn infant's blood levels of cigarette smoke products. The mother who smokes during pregnancy transfers the products in cigarette smoke to the fetus through the placenta, as well as to the newborn infant though breast-feeding. In fact, breast-fed infants have the same urinary cotinine levels as active adult smokers.

Childhood Diseases

The risks of ETS are not simply restricted to the newborn infant. There are many childhood illnesses that are dramatically worsened by exposure to smoke. A 1994 study by Joan Cunningham and colleagues showed that there was an increased risk of colds, wheezing, shortness-of-breath, and emergency room visits by children living in households where there is a smoker. There is also a significant increase is the risk of ear infections in children who live in households where there are smokers. Children born to mothers who smoke have a higher risk of developing asthma. Along with an increased risk of asthma, children of mothers who smoked during pregnancy will be at a greater risk of have problems with environmental allergies (e.g., hay fever). These effects can be seen in newborn infants as well as school-aged children.

Adolescence

Between 4 million and 5 million adolescents in the United States smoke daily. Each year more than 1 million people under eighteen years of age become daily smokers. Ninety percent of adults who regularly smoke began smoking before they were nineteen years of age. Throughout the 1990s the age at which children began smoking became increasingly younger. In 1990, 31 percent of all twelfth graders reported recent (within the last month) tobacco use while 21 percent were daily smokers. Shockingly, 8 percent of all eighth graders reported daily tobacco use. By the end of the 1990s the percentages of twelfth and eighth graders who recently used cigarettes was up to 36 percent and 21 percent, respectively. The younger and younger beginning smoker is reflected in the higher percentage of adolescent smokers as compared to the adult population. Besides the negative health effects of smoking itself, adolescents who smoke are fifteen times more likely to use drugs than their peers who do not smoke.

There are many reasons why a child or adolescent will begin to smoke. The most common influence is family and peer pressures, but the most potent factor is the media portrayal of "glamorous" smoking. The top three most popular brands of cigarettes amongst adolescents were the top three companies that spent the most on advertising. In 1993 these companies collectively spent $153 million dollars on advertising. Many popular sporting events are still sponsored by tobacco companies, and there is some evidence that advertising had been directed toward recruiting new child or adolescent smokers. To combat the draw of the media for adolescents to begin smoking, the Centers for Diseases Control and Prevention (CDC) began, in the fall of 2000, the Surgeon General's Report for Kids on Smoking. This was an attempt to enlist celebrities and sports figures to promote an antismoking message to young people. It involves posters and media advertisements directed toward children and adolescents, informing them of the health damages caused by cigarette smoking.

Costs

The true cost of smoking is incalculable, but there are some very practical measures that can be seen. In 1997 American children made more than 500,000 doctor visits for asthma, and 1.3 million visits for cough that were directly attributed to smoke exposure. This does not include the 115,000 cases of pneumonia, 260,000 cases of bronchitis, and more than two million ear infections. The annual cost of ear infections in children in the United States caused by smoke exposure is $1.5 billion. The actual total financial costs, directly related to the exposure of American children to ETS, are broken into direct medical costs and the loss of life costs. In 1997 the total medical cost of the complications of cigarette smoke on American children was $4.6 billion. The loss of life cost (calculated based upon loss of earnings and costs needed to prevent disease) was $8.2 billion. The true cost of cigarette smoking, however, is in the impact smoking has on the health of infants and children.