Healthy Living
Cigarette Smoking - Trends
By David Perlmutter, MD, FACN
Despite the fact that cigarette smoking is now recognized as the leading preventable cause of morbidity and mortality in the United States, we are now observing an alarming increase in the incidence of cigarette smoking among college students. A landmark study conducted at the Department of Health and Social Behavior, Harvard School of Public Health in conjunction with the Tobacco Research and Treatment Center, Division of General Medicine at Harvard Medical School, published in the November 18, 1998 issue of the Journal of the American Medical Association, revealed an astounding 27.8% rise in incidence of cigarette smoking among college students between the years 1993 and 1997. Further, the authors call to our attention the sobering fact that cigarette smoking among high school students increased about 32% between the years 1991 and 1997. These statistics indicate that we will likely see a reversal of a decline in smoking prevalence among adults that has been the trend since 1965.
Cigarette smoking accounts for more than 400,000 deaths in the United States per year. And, whereas some may argue about the relationship between certain lifestyle choices such as diet and exercise, and such disease entities as cardiovascular disease, the data supporting cigarette smoking as a direct cause of death are scientifically sound (despite the pathetic efforts of the tobacco lobbyists).
But should we be surprised that adolescents and college students now feel more compelled than ever to expose themselves to a drug which has an annual death rate 100 times greater than that of cocaine? Not hardly. Despite new sanctions placed upon the tobacco industry, advertisements continue to proliferate, glamorizing tobacco use - making it appear sexy and mature.
But the allure of tobacco may operate on an even deeper level than simply a behavioral response to advertising. It has long been known that adolescent cigarette smoking has increased among children whose mothers smoke. While it had been concluded that this behavior simply represented an example of a child modeling a parental figure, new research indicates that adolescent cigarette smoking may actually involve learning of specific flavors during infancy. A fascinating report entitled, "Smoking and the Flavor of Breast Milk," appearing in the November 19, 1998 issue of the New England Journal of Medicine, revealed that breast milk from cigarette smoking women could easily be identified when compared to breast milk from non-smoking women by its distinctive "cigarette smell." Further, the report demonstrated very high levels of nicotine in breast milk within thirty minutes of cigarette smoking which persisted for the next three hours.
As the authors stated, "These findings raise the possibility that in addition to the effects of nicotine on the developing brain, early experiences with the flavor of tobacco in breast milk (and perhaps even in amniotic fluid) pinpoints the likelihood that exposed children will find these flavors appealing later in life. We do not suggest that lactating women who smoke occasionally should stop nursing, however, the knowledge that the milk of mothers who smoke smelled and may taste like cigarettes, provides an additional reason to avoid smoking."
Over the past decade, a large number of research publications have appeared indicating a profound increased risk of respiratory diseases in children as a consequence of exposure to second hand smoke. Now it is clear that the various activities of adults including cigarette smoking while breast feeding and complacency regarding cigarette advertising can lead to the most deadly respiratory disease of all - tobacco addiction.