Press backgrounder EURO/04/02
Copenhagen and Warsaw, 18 February 2002
SMOKING KILLS: DON’T BE DUPED
The harm to health

1.1 billion people in the world currently use tobacco. Unless urgent action is taken about
500 million of these people will die prematurely from tobacco use (1).

Every 8 seconds someone dies from tobacco use worldwide. Every hour, 140 Europeans
die from tobacco use (2).

Around 15% of all deaths in Europe are attributable to smoking (3).

Long-term cigarette use has a 50% mortality rate. One half of all people who regularly
smoke will die from the habit, half in middle age and half in old age. Around 100 million
current European smokers will die prematurely if they smoke regularly and do not quit.
(4).

People who start smoking in their teens (as do more than 70%) and continue for two
decades or more will die 20–25 years earlier than those who never smoke (5).
Second-hand smoking

The risk of having lung cancer is 20–30% higher for those living with smokers,
especially if they are exposed to second-hand smoke over the long term (6,7).

The risk of contracting heart disease is 20–25% higher for those exposed to second-hand
smoke. Even a small exposure has a large effect on heart disease (8).

Children’s risk of respiratory illnesses is doubled if the mother is a smoker (9).

Low birth weight and reduced lung function in the newborn are among other health
effects caused by mothers smoking during pregnancy (9).

Risk of sudden infant death syndrome (cot death) is higher for babies born to smoking
mothers (10).

Bronchitis, pneumonia, coughing and wheezing, asthma attacks, middle-ear infection and
possibly cardiovascular and neurobiological impairment are much more likely to appear
in children exposed to second-hand tobacco smoke (10).
Women

There has been a sharp increase in female deaths from cancer of trachea, bronchus and
lung caused by smoking. In the European Union countries, tobacco-related cancer is
rising more rapidly among women than among men. If current smoking patterns persist,
the number of female deaths caused by tobacco will continue to increase throughout the
WHO European Region, enhanced by the rising number of teenage girls smoking over
the last few decades (11,12).
Smoking is an addiction

Dependence on tobacco is a recognized disorder (F17.2) within WHO’s ICD-10
Classification of Mental and Behavioural Disorders. Dependence on cigarettes is a
chronic and relapsing condition (13).

Cigarette smoking usually starts in early age, and most young people underestimate the
potential for tobacco to cause addiction (14).

Most adult smokers say they regret starting to smoke and face considerable difficulties in
stopping, so much so that some people find stopping virtually impossible. Most smokers
who stop have to make several attempts before they succeed, and former smokers remain
vulnerable to resuming smoking in times of stress (15).

The pharmacological and behavioural processes that determine tobacco and nicotine
addiction are similar to those that determine addiction to such hard drugs as heroin and
cocaine (16).
Smoking at the workplace
Smokers are a significant cost to employers, mainly from absence due to illness. Smokers have a
higher susceptibility to coughs, bronchitis, colds and flu. There may be long periods during
which a smoker is unable to work, which lays an additional burden on the non-smoking staff and
thus adds to the cost of sick leave (17). A business may also lose highly valued or vital staff
through illness or death caused by smoking. Smoking can create a number of extra costs for
employers: special ventilation requirements, additional cleaning and redecoration, provision of
special facilities for either smokers or non-smokers, and higher fire insurance premiums than for
premises in which smoking is banned.
One study in Scotland estimated lost productivity at £292 million per year (18). The Canadian
National Health Service has calculated the additional cost to an employer of employing a smoker
at up to C$2565 per year (19).
Reports show that employers are becoming more concerned by the impact on their corporate
image of smoking employees. Rapidly changing attitudes in society and public opinion, even
among smokers, strongly favour a company adopting a no-smoking policy.
The smoker’s body
Cigarettes are among the most harmful of all consumer products. There is clear evidence that the
following conditions are caused by smoking (2).
Hair loss. Smoking weakens the immune system, leaving the body more vulnerable to diseases
such as lupus erythematosus, which can cause hair loss, mouth ulcers and rashes on the face,
scalp and hands.
Cataracts. Smoking is believed to cause or worsen several eye conditions. Smokers have a 40%
higher incidence of cataracts, a clouding of the eye’s lens that blocks light and may lead to
blindness. Smoke causes cataracts in two ways: by irritating the eyes and by releasing chemicals
into the lungs that then travel through the bloodstream to the eyes. Smoking is also associated
with age-related macular degeneration, an incurable eye disease caused by the deterioration of
the central portion of the retina, known as the macula. The macula is responsible for focusing
central vision in the eye and controls our ability to read, drive a car, recognize faces or colours,
and see objects in fine detail.
Wrinkling. Smoking prematurely ages skin by wearing away proteins that give it elasticity,
depleting it of vitamin A and restricting blood flow. Smokers’ skin is dry, leathery and etched
with tiny lines, especially around the lips and eyes.
Hearing loss. Because smoking creates plaque on blood vessel walls, thus reducing blood flow
to the inner ear, smokers can lose their hearing earlier than non-smokers and are more
susceptible to hearing loss caused by ear infections or loud noise. Smokers are also three times
more likely than non-smokers to get middle-ear infections that can lead to further complications
such as meningitis and facial paralysis.
Skin cancer. Smoking does not cause melanoma (a sometimes deadly form of skin cancer), but
it does increase the chances of dying from it. Smokers have a two-fold increased risk of
contracting cutaneus squamous cell cancer – a cancer that leaves scaly, red eruptions on the skin.
Tooth decay. Smoking interferes with the mouth’s chemistry, creating excess plaque, yellowing
teeth and contributing to tooth decay. Smokers are one and half times more likely to lose their
teeth.
Emphysema. In addition to lung cancer, smoking causes emphysema, a swelling and rupturing
of the lung’s air sacs that reduces the lungs’ capacity to take in oxygen and expel carbon dioxide.
In extreme cases, a tracheotomy allows patients to breathe. An opening is cut in the windpipe
and a ventilator introduced to force air into the lungs. Chronic bronchitis creates a build-up of
pus-filled mucus, resulting in a painful cough and breathing difficulties.
Osteoporosis. Carbon monoxide, the main poisonous gas in car exhaust fumes and cigarette
smoke, binds to blood much more readily than oxygen, cutting the oxygen-carrying power of
heavy smokers’ blood by as much as 15%. As a result, smokers’ bones lose density, fracture
more easily and take up to 80% longer to heal. Smokers may also be more susceptible to back
problems: one study shows that industrial workers who smoke are five times as likely to
experience back pain after an injury.
Heart disease. One out of three deaths in the world is due to cardiovascular diseases. Smoking is
one of the biggest risk factors for developing cardiovascular diseases. These diseases kill more
than a million people a year in developing countries. Smoking-related cardiovascular diseases
kill more than 600 000 people each year in developed countries. Smoking makes the heart beat
faster, raises blood pressure, increases the risk of hypertension and clogged arteries, and
eventually causes heart attacks and strokes.
Stomach ulcers. Smoking reduces resistance to the bacteria that cause stomach ulcers. It also
impairs the stomach’s ability to neutralize acid after a meal, leaving the acid to eat away the
stomach lining. Smokers’ ulcers are harder to treat and more likely to recur.
Discoloured fingers. The tar in cigarette smoke collects on the fingers and fingernails, staining
them a yellowish brown.
Uterine cancer and miscarriage. Besides increasing the risk of cervical and uterine cancer,
smoking creates fertility problems for women and complications during pregnancy and
childbirth. Smoking during pregnancy increases the risk of low-weight babies and future ill
health. Miscarriage is 2–3 times more common in smokers, as are stillbirths due to fetal oxygen
deprivation and placental abnormalities induced by carbon monoxide and nicotine in cigarette
smoke. Sudden infant death syndrome is also associated with smoking. In addition, smoking can
lower estrogen levels, causing premature menopause.
Deformed sperm. Smoking can deform sperm and damage its DNA, which could cause
miscarriage or birth defects. Some studies have found that men who smoke have an increased
risk of fathering a child who contracts cancer. Smoking also diminishes sperm count and reduces
the blood flow to the penis, which can cause impotence. Infertility is more common among
smokers.
Psoriasis. Smokers are 2–3 times as likely to develop psoriasis, a non-contagious inflammatory
skin condition that leaves itchy, oozing red patches all over the body.
Buerger’s disease. Buerger’s disease, also known as thromboangiitis obliterans, is an
inflammation of the arteries, veins and nerves in the legs, leading to restricted blood flow. Left
untreated, Buerger’s disease can lead to gangrene (death of body tissue) and the resulting need to
amputate the affected areas.
Cancer. More than 40 elements in tobacco smoke have been shown to cause cancer. Smokers
are 22 times more likely to develop lung cancer than non-smokers. According to a number of
studies, the longer one smokes the greater the risk of developing a number of other cancers,
including those of the nose (2 times greater); tongue, mouth, salivary gland and pharynx (6–27
times); throat (12 times); oesophagus (8–10 times); larynx (10–18 times); stomach (2–3 times);
kidneys (5 times); bladder (3 times); penis (2–3 times); pancreas (2–5 times); colorectum (3
times); and anus (5–6 times). Some studies have also found a link between smoking and breast
cancer.
References
1.
Curbing the epidemic. Governments and the economics of tobacco control. Washington, DC, World Bank,
1999.
2. The Smoker’s Body Poster: NMH Communications. Creating space for public health. WHO, Geneva,
2001; originally COLORS magazine 1997
3. Third Action Plan for a Tobacco-free Europe, 1997–2001, WHO Regional Office for Europe, February
2002, Copenhagen, 1997
4. Doll, R. et al. Mortality in relation to smoking: 40 years’ observations on male British doctors. British
medical journal, 309: 901–911 (1994).
5. PETO, R. ET AL. Mortality from smoking in developed countries, 1950–2000, Oxford University Press,
UK 1999
6. International Consultation on EnvironmentalTobacco Smoke (ETS) and Child Health. Consultation Report,
WHO, 1999
7. Report of the Scientific Committee on Tobacco and Health. London, Stationery Office, 1998.
8. LAW, M.R. ET AL. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of
the evidence. BMJ, 315: 973–980 (1997).
9. COOK, D.G & STRACHAN, D.P. Summary of effects of parental smoking on the respiratory health of
children and implications for research. Thorax, 54: 357–366 (1999).
10. International Consultation on Environmental Tobacco Smoke (ETS) and Child Health. Consultation
Report, World Health Organization, Headquarters Geneva, 1999
11. “Some Like It Light: Women and Smoking in the EU”, European Report, European Network for Smoking
Prevention, Bruxelle, 1999
12. The European report on tobacco control policy, Copenhagen, WHO Regional Office for Europe, 2002
13. The ICD-10 classification of mental and behavioural disorders. Geneva, World Health Organization, 1992.
14. JHA, P. ET AL. The economic rationale for intervention in the tobacco market. In: Jha, P. & Chaloupka, F.,
ed. Tobacco control in developing countries. Oxford, Oxford Medical Publications, 2000, pp. 153–174.
15. PROCHASKA, J.O. & DICLEMENTE, C.C. The transtheoretical approach. Illinois, Dow Jones-Irwin, 1984.
16. US DEPARTMENT OF HEALTH AND HUMAN SERVICES. The health consequences of smoking: a report of the
Surgeon General. Washington, DC, Centers for Disease Control, 1988.
17. Health effects of exposure to environmental tobacco smoke. The report of the California Environmental
Protection Agency. Rockville, MD, National Cancer Institute, 1999 (Smoking and Tobacco Control
Monograph 10).
18. PARROT, S. ET AL. Costs of employee smoking in the workplace in Scotland. Tobacco control, 9:187–192
(2000).
19. CONFERENCE BOARD OF CANADA. Report on incremental costs of employing a worker who smokes. Health
Canada, Canada 1995
For more information contact:
TECHNICAL INFORMATION
PRESS INFORMATION
Haik Nikogosian
Acting Regional Adviser on Tobacco
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark
Tel: +45 39 17 13 53
Fax: +45 39 17 18 54
E-mail: han@who.dk
Franklin Apfel or Albena Arnaudova
Communication and Advocacy
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark
Tel: +45 39 17 13 36 or +45 39 17 12 55
Mirosław Manicki
Director, Department of European Integration and
International Relations
Ministry of Health
15, Miodowa Str., 00952 Warsaw, Poland
Tel: 004822 826 09 47
Fax: 004822 826 21 03
E-mail: m.manicki@mz.gov.pl
Beata Zagańczyk
Political Assistant to the Under-secretary of State
Ministry of Health
15, Miodowa Str., 00952 Warsaw, Poland
Tel: 004822 63 49 235
Fax: 004822 63 49 204
E-mail: b.zaganczyk@mz.gov.pl
Mobiles: (45) 20 14 99 17 or (45) 23 31 95 13
Fax: +45 39 17 18 80
E-mail: fap@who.dk or aar@who.dk
Press releases on World Wide Web site
www.euro.who.int
Krzysztof Szlubowski
Director, Press and Promotion Bureau
Ministry of Health
15, Miodowa Str., 00952 Warsaw, Poland
Tel: 004822 831 30 71
Fax: 004822 826 27 91
E-mail: k.szlubowski@mz.gov.pl