Contrary to the implicit -- and
highly deceptive -- message in this 1945 Philip Morris ad that the road to
"prevention" begins with their cigarette, the real road to a healthy old
age begins with a smokefree lifestyle. Free of inhalation of direct and
secondhand smoke -- from cigarettes, cigars or pipes.
Today, women reaching age 65 can expect to live another 19+ years --
white women 19.2 years and black women 17.2 years. Men reaching age 65
can expect to live another 15+ years -- white men 15.4 years and black men
13.4 years. Thus, both men and women at age 65 still have about a fifth
of their lives to lead.1
Yet, how many times have we heard someone say about older smokers,
"what's it matter whether she smokes or not? She's going to die soon
anyhow, let her enjoy her habits; it doesn't matter." But, it does matter
-- both in terms of life span and quality of life.
As former Secretary of Health Education & Welfare Joseph Califano
recently commented about this very issue, "It makes a big difference. In
good health these women [and men] have many years ahead as productive
workers and loving parents and grandparents."2
In their groundbreaking book, Successful Aging, Dr.'s John Rowe
and Robert Kahn defined successful aging "as the ability to maintain three
key behaviors or characteristics: low risk of disease and disease-related
disability; high mental and physical function; and active engagement with
life."3 Recent research indicates that smoking is a direct or
indirect factor in the quality of life surrounding each of these three
Rowe and Kahn point out that "some losses in physical function and in
certain kinds of cognitive capacity are indeed intrinsic to age and
therefore inevitable. However, the losses experienced in the course of
what we have called 'usual aging' are a combination of the inevitable and
the preventable, more often the latter. People often blame aging for
losses that are in fact caused by lifestyle -- overeating and poor
nutrition, smoking, excessive use of alcohol, lack of regular
exercise, and insufficient mental exertion."4
Rowe and Kahn go on to point out
that "the notion that abilities, once lost in old age, are lost forever is
another of the dismal assumptions proved wrong by [recent research on
successful aging]."5 They point out that changes in
lifestyle, such as smoking cessation, can cause immediate and
long-term improvements in health status, and that "by harnessing the power
of proper diet, exercise, smoking cessation, and so on, we can prevent or
defuse" even genetic factors which many people assume pre-determine and
make inevitable diseases such as cancer, heart disease, etc.6
Research by Dr. Anthony Vita and others found that smoking,
body-mass index (weight divided by height), and exercise patterns in
mid-life and late adulthood are predictors of subsequent disability. They
concluded that "not only do persons with better health habits survive
longer, but in such persons, disability is postponed and compressed into
fewer years at the end of life."7 While more research is
needed in this area, virtually all evidence suggests that avoiding major
health risks such as smoking is a key factor in achieving healthy and
Smoking is associated with all three major causes of death among the
elderly -- heart disease, cancer and stroke. These three diseases are
responsible for 70% of deaths among the elderly. Among the 65-74 age
group, heart diseases and cancers are equally prevalent as causes of
death. As age advances, heart disease causes an increasing share of
deaths, making heart disease the leading cause of death among the
In the U.S., about 19% of all deaths in 1990 were due to smoking, or
about 417,000 deaths. Of the smoking-related deaths, about 70% (or
292,000) were to persons aged 65 and over, versus about 62% of all-causes
deaths occurring in the 65 and over age group.9 Another 24%
of the 417,000 deaths were to persons aged 50 to 64, or 100,080
The dramatic impact of smoking in causing premature deaths -- which
happens to 1 out of 3 smokers -- is demonstrated vividly in the data from
1990 which showed that over 26.7% of all deaths in the 35-64 age group
were due to smoking, whereas 19.4% of deaths among all age groups were due
to smoking.11 Among males, 29.6% of the 35-64 deaths were due
to smoking; among females, 21.7%.
Dr. Michael Eriksen, Director of the Office on Smoking & Health of the
federal Centers for Disease Control stated recently that "smokers are
three times more likely to die between the ages of 45 and 64 and two times
more likely to die between the ages of 65 and 84 than those who have never
smoked. ...the fact is that 33% of non-smokers live to age 85, compared
with only 12% of smokers." 12
In other words, smoking-related deaths have their most dramatic impact
on the young-old, especially those in the 50 to 70 year old age range.
These smokers are denied the opportunity to experience an old age, to say
nothing of a healthy old age.
Debilitating Diseases Affect Quality of Life
While death is the ultimate curse of smoking-related diseases, equally
serious results are the pain, suffering, and loss of dignity due to
dependency on others for basic life-care. Heart disease, cancer and
stroke, are associated not just with death, but with suffering, chronic
illness and debilitating lifestyles which erode the quality of the
individual's existence and increase dependency on others.
Smokers have more acute and chronic illnesses as well as more
restricted activity days, more bed disability days and more work
absenteeism than former smokers or those who never smoked; smokers also
make about six more visits to health care facilities annually than
The suffering and pain, the lack of normal physical mobility, and the
dependency which accompany so many smoking-related illnesses cannot be
communicated adequately just with statistics. Anyone who has had to
assist a family member or friend through the final stages of lung cancer,
stroke, heart disease, or emphysema can barely find it possible to
describe the horrible suffering and loss of personal dignity that the
victim endured. These are among the most terrifying effects of tobacco
Perceived Risks of Smoking Unrecognized By Smokers
While there has been increasing public education about the dangers of
smoking in recent decades, this has been more than matched by the $5
billion spent annually by the tobacco industry to promote the "pleasures"
of smoking. One result of this massive advertising and the continual
denials by the tobacco industry of the harms caused by smoking is the lack
of understanding among smokers of the risks they face.
A recent study by Dr.'s Ayanian and Cleary at the Harvard Medical
School showed that "most smokers -- even heavy smokers and those with
other cardiac risk factors -- do not perceive themselves at increased risk
of experiencing [heart disease] or developing cancer....Many smokers
continue to deny their own personal health risks."14
In the above study, of current smokers surveyed, only 29% thought they
had a higher than average risk of heart disease, and only 40% thought they
had a higher than average risk of cancer. Even among heavy smokers (2
packs a day or more), only 39% thought they higher than average risk of
heart disease, and only 49% thought they had a higher than average risk of
cancer. Thus, even among heavy smokers, less than half thought their
smoking behavior put them at greater health risk than the average person.
The study also found that "smokers older than 64 years were less
likely than younger smokers to perceive their risk of [heart disease] as
higher than average." 16
This study confirms similar findings and highlights the need for health
professionals and others working with older persons to educate smokers
about the personal health risks of smoking and to promote smoking
cessation as a key to a healthy old age.
Smoking Cessation ImprovesElders' Health Immediately and Long-Term
Repeated studies have shown that smoking cessation, including among
older smokers, improves health status and reduces the risks associated
with smoking. The "healing" process begins immediately and, over time,
can restore a person's health to the same as if s/he had never smoked for
many tobacco-related diseases.
- Within 20 minutes of quitting, your blood pressure and pulse rates
begin to drop to normal and your body temperature increases to normal.
- Within 24 hours, the chance of heart attack begins to decrease.
- Within 48 hours, food will begin to taste and smell better.
- Within 72 hours, bronchial tubes relax and breathing becomes easier
and lung capacity increases.
- Between 1 and 9 months after quitting smoking, coughing, sinus
congestion, and shortness of breath decreases.
- Self-image and self-esteem improve and the sense of control over ones
life increases during the first year after quitting.
Longer Term Benefits:18
- People who quit smoking before the age of 50 have one-half the risk of
dying over the next 15 years compared to people who continue to smoke.
- The risk of coronary heart disease falls abruptly within months, and
within 3-5 years the risk of coronary heart disease falls to a level
indistinguishable from that of individuals who have never smoked. This is
true no matter how long or how much one smoked.
- The risk of lung cancer declines steadily, so that after 10 years the
risk is 30-50% of that in continuing smokers, and by 15 years, the risk of
lung cancer is almost as low as if you had never smoked.
- Smoking cessation also reduces the risks of other tobacco-related
malignancies, including cancers of the larynx, esophagus, pancreas, and
- Quitting smoking also decreases the effects of other nonmalignant
diseases, such as stroke, peripheral vascular disease, chronic obstructive
pulmonary disease (lung diseases), and pneumonia.
- Diseases like emphysema and bronchitis are 10 times less likely among
nonsmokers, and these diseases can stabilize or improve when a person
- Research suggests that cataract and age-related macular degeneration
may be causally-related to smoking, and that the more pack-years of
smoking, the greater the risk; thus, smoking cessation should be
- Diabetics who quit smoking are much less likely to suffer serious
effects like heart disease, blindness and stroke.
Healthy, successful aging and not smoking clearly go hand-in-hand, no
matter when a person quits smoking.
Dr. Roberta Ferrence, director of the Ontario Tobacco Research Unit at
the University of Toronto, put it very well when she said: "The longer
you smoke, the more likely you are to have permanent damage. Even if
you're still smoking at 60, 70 or even 80, it's always worthwhile
quitting, and it will make a big difference in your health and longevity.
It's not just whether you die or not. It's the quality of your life and
how you recover from surgery, how often you're ill in old age."
1. 65+ in the United States, U. S. Bureau of Census report,
1996, p. 3-1.
2.Califano, J., "The Forgotten Woman," op-ed, Washington Post, p. A17
June 23, 1998.
3. Rowe, J. & Kahn, R., Successful Aging,
1998, p. 38.
4. Rowe & Kahn, p. 44.
5. Rowe & Kahn, p.
6. Rowe & Kahn, pp. 64-65.
7. Vita, A., Terry, R.,
Hubert, H., & Fries, J., "Aging, Health Risks and Cumulative Disability,"
New England Journal of Medicine, Vol. 338, No. 15, April 9, 1998.
8. 65+ in the U.S., p. 3-9.
9. Bolliger, C.T. &
Fagerstrom, K.O., editors, The Tobacco Epidemic, 1997, p. 81.
10. Centers for Disease Control SAMMEC Report, August, 1996.
Bolliger & Fagerstrom, p. 81.
12. Michael Eriksen's Letter to the
Editor of Philadelphia Daily News dated May 14, 1999; unknown whether
letter was published.
13. Bolliger & Fagerstrom, p. 83.
Ayanian, J.Z. & Cleary, P.D., "Perceived Risks of Heart Disease and Cancer
Among Cigarette Smokers," Journal of the American Medical Association,
Vol. 281, No. 11, March 17, 1999, pp. 1019-1021.
15. Ayanian &
Cleary, pp. 1019-1021.
16. Ayanian & Cleary, p. 1021.
Facts from: Centre for Health Promotion, University of Toronto, as
reported in "Calling It Quits: Your Body Will Thank You Immediately," by
Debra Black, Toronto Star, May 7, 1999; also in Clear Horizons, Fox Chase
Cancer Center publication, 1989, p. 3.
18. Facts from: Rowe &
Kahn, pp. 75-78; Bolliger & Fagerstrom, pp. 94-95 & 99; Clear Horizons, p.
19. "Calling It Quits," Toronto Star, May 7, 1999.
SMOKING CESSATION & NICOTINE
One of the most important points to remember about smoking cessation is
"smokers aren't bad people. They're good people who are dependent on a
bad substance. Smokers need support and effective tools to break that
dependence. Recovery is a life-long process," states Dr. Richard Hurt of
the Mayo Clinic's Nicotine Dependence Center in the Spring, 1999 issue of
The Nicotine Challenger.
Fortunately, today's smokers are no longer faced with the alternative
of quitting "cold turkey" or continuing to smoke. Today, smoking
cessation treatments have been approved for over-the-counter sale, and
prescription treatments are available and increasingly effective. Among
the treatments approved by the FDA and available for nicotine dependence
treatment are the following:
- Nicotine patch;
- Nicotine gum;
- Nicotine inhaler;
- Nicotine nasal spray; and,
- Bupropion (sold as Zyban).
Dr. John Slade, Director of the Addictions Program at the School of
Public Health of the UMDNJ, says that "used singly, each of [the above]
products about double the success rate in stopping smoking. This means
that the effectiveness heavily depends on what the person is doing to
address the addiction. If the person is getting support, success is more
likely. However, even without support, success is greater with medicine
Dr. Slade states that "the medicines may work better if they are used
in combination....it seems helpful for many people to use, for instance, a
patch as baseline treatment of nicotine withdrawal and another product as
a supplement, to help cope with urges and difficult situations during the
day. There are also encouraging indications that combining Zyban with a
nicotine product can lead to better results."
Is one smoking cessation treatment better than
"Because we have no head-to-head comparisons of the therapies, because
no treatment has replicated evidence of superior efficacy or adverse event
profiles, and because no method to match smokers to a particular treatment
has been empirically validated,
patient preference should be the primary basis for choice among
treatments," according to a major review of smoking cessation treatments
in the January 6, 1999 Journal of the American Medical Association
The JAMA article made the point that most smokers make many attempts to
stop smoking -- often 5 or more attempts -- before succeeding. Experience
also indicated that repeating the same cessation treatment that failed
previously achieves little success, and that, therefore, new treatments
should be considered. Further, combination treatments, as Dr. Slade
suggested (above) should be considered, as should behavioral treatment in
a group or individually.
Is quitting smoking for everyone?
Yes, quitting smoking is for everyone. But, success at quitting will
vary, depending, in part, on how committed and prepared you are to quit --
and, what assistance you get, as described above.
Everyone agrees successful quitting depends on readiness and planning
ahead. Planning ahead can include the following:
- setting a quit date a few weeks in advance of actually quitting;
- using "nicotine fading," which is switching to cigarette brands which
have lower nicotine levels;
- changing some of your smoking habits, including cutting out some of
your favorite times/places for smoking;
- determining ahead of time which friends you can count on for support
- determining what nicotine treatments to use; and,
- establishing an exercise plan, such as walking, to use to help relieve
stress and to help you feel better.
Quitting smoking is for everyone; and, quitting is healthy for
everyone. However, not succeeding at quitting happens to most people;
don't consider that failure. Each time you try, you're increasing your
chances of succeeding.
For more information on quitting smoking, contact your physician or
your local heart, lung or cancer association. Or, call the Michigan
Resource Center at 800 537-5666 for a free Smoker's Quit Kit.