The Hidden Hazards of Smoking

Anti-smoking campaigns normally focus on the harm caused by cigarette smoke, such as cancer, heart disease, infectious disease, and the dangers of second-hand smoke. We rarely hear about other hazards associated with smoking. A study published in the journal Tobacco Control in 2005 revealed a significant association between smoking and the incidence of death due to accidental injuries. The authors of the study found that smoking can be related to accidental death in a dose-dependent manner, and that individuals who smoked the most had the highest risk. A number of factors can be attributed to this trend. The authors concluded that smoking-related illness is only part of the problem. Smoking, on a global scale, comes with an even greater burden.

The study examined the health records of two groups of Taiwanese men. The first group included 71,361 men who participated in annual government-sponsored physical exams, beginning in 1989. The other group included 66,161 men from both rural and urban areas, who had participated in community-based studies that began in 1982. The massive amount of data was compared with cause-of-death statistics taken from a computerized national database at the end of December 2001. Fatal injuries occurred from traffic accidents, workplace accidents, fires, and other types of accidents. The study focused on men, because female smokers in Taiwan are rare. The authors used statistical methods to adjust their data for alcohol use and the educational levels of participants.

The results of the study demonstrated that smoking was a factor in at least one out of every five accidental deaths. Deaths from accidental injuries ranked as the second leading cause of death in Taiwan. The authors cited several possible reasons for the greater association between smoking and injury. Smokers experience periods of increased irritation and lethargy when not smoking. For example, between 1987 and 1996 "No Smoking Day" in the UK featured an increase in workplace accidents. Data from other smoking studies shows that refraining from nicotine for even a few hours can result in a decline in the mood and cognitive performance of a regular smoker. Smoking while driving is a factor in many traffic accidents, and smokers may also be prone to riskier behavior, such as not wearing seatbelts, reckless driving, or driving under the influence of alcohol. A lit cigarette can be a fire hazard. In the U.S. smoking is the number one cause of death from residential fires. In Taiwan, approximately 1.3 deaths resulting from fires were attributed to smoking. Former smokers in the study showed no elevated risk.

Smokers are more likely to die from injuries, due to a compromised ability to recover. Smokers often do not heal as easily as non-smokers from their wounds. Broken bones take longer to knit themselves back together, blood flow is often weakened, less oxygen is carried to body tissues, and immune responses are diminished, thereby increasing a smoker's vulnerability to infection. For this reason, surgeons often insist that smokers quit smoking altogether before agreeing to perform an elective surgery.

The fact that smoking is a factor in a large number of accidental deaths adds another layer of perspective to the debate over the rights of smokers. It is inevitable that innocent bystanders have become unintentional victims in accidents where smoking may have played a role. The authors only evaluated statistics on fatal injuries. It is only reasonable to assume that an even greater number of non-fatal injuries can be attributed at least in part to smoking. Perhaps anti-smoking campaigns would have a greater influence if they conveyed the fact that smoking-related illness is only part of the picture, that smoking takes an even greater toll on humanity. Non-smokers would never even think of starting, and smokers would try a whole lot harder to quit.

Reference

Wen, C., Tsai, S., Cheng, T., Chan, H., Chung, W., Chen, C.

Excess injury mortality among smokers: a neglected tobacco hazard

http://tobaccocontrol.bmj.com/cgi/content/full/14/suppl_1/i28