How Smoking Affects Skin Health

Smoking is associated with a range of?detrimental health effects, the most well known?of which are?lung cancer and cardiovascular disease. There are many lesser known health effects as well, including effects?on the skin.

In many cases, these changes to skin are not life threatening, though they can change the physical appearance of the smoker. For example, smoking?is associated with premature ageing and wrinkles. Smoking is also associated with very serious skin conditions, including squamous cell carcinoma of the skin (a type of skin cancer) and psoriasis. Awareness of?the?changes to physical appearance and the serious skin conditions associated with smoking may help motivate individuals to quit smoking.

The precise ways in which tobacco smoke damages or changes skin are not fully understood, though scientific studies have produced evidence about a number of possible ways. Studies suggest that tobacco smoke exposure decreases capillary and arteriolar blood flow, possibly damaging?connective tissues?that help maintain healthy?skin. Skin fibroblasts (the cells in connective tissue that form collagen and elastin) are damaged by tobacco smoke.

There is also evidence that tobacco smoke is phototoxic. Smoke becomes more toxic in the presence of ultraviolet light (UV),?such as is found in?sunlight, and causes more damage to skin cells than either smoke or UV would cause on their own.

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

Ageing

As people?age, their skin also ages. The ageing process is influenced by a number of environmental factors. Sun exposure is the most prominent risk factor for premature ageing. Although it is much less well?known, cigarette smoking is also a risk factor for?premature skin ageing.

Several studies have reported that cigarette smoking causes an individual's skin?to age?even more than exposure to sunlight does. Studies have also reported that the effect of exposure to tobacco smoke and sunlight at the same time is more dangerous than the combined effect of either exposure alone, and that women are at greater risk than men.

The ageing of skin can be measured by a number of features. Most obviously, skin becomes wrinkled. Wrinkling is caused by changes to skin elasticity and concentrations of skin components such as collagen and elastin. Differences in skin features between individuals who do and do not smoke can therefore be measured by physical appearance, or by analysing skin tissues for concentrations of components.

Wrinkles

Numerous studies have found that premature wrinkling is associated with smoking. There is evidence that the more an individual smokes, the more the premature ageing effect occurs, so heavy smokers will experience more premature wrinkles than those who only smoke occasionally. One study, in which eight judges individually rated the age of smokers and non-smokers from their photographs, reported that smokers were, on average, rated as being 2.7 years older than their actual age, while non-smokers were rated at?0.7 years younger than their actual age.

Another study reported that moderate smokers were almost twice as likely to wrinkle prematurely than non-smokers,?and?heavy smokers were almost three times more likely to wrinkle prematurely.

Other studies have examined exposure to both cigarettes and sunlight, to assess the relative importance of each of these exposures in the development of wrinkles. Evidence from these studies suggests that smoking may be a more important factor in the development of wrinkles than sun exposure.

There is evidence?that individuals?exposed to both tobacco smoke and sunlight prematurely winkle more than individulas exposed to tobacco smoke or sunlight alone. One study found that smokers were 5.8 times more likely to develop wrinkles than non-smokers, while those with excessive sun exposure (i.e.?more than two?hours per day) were only 2.65 times more likely to wrinkle than those who were not excessively exposed to sunlight. Individuals who smoked heavily (35 pack years or more) and had excessive sun exposure were 11.4 times more likely than non-smokers with?less than?two hours per day of sun exposure to develop wrinkles. This is a considerably greater risk than the combined individual risks of?exposure (i.e. 5.8 for tobacco + 2.65 for sunlight = 8.45 times more likely). As tobacco smoke is phototoxic, this synergistic effect of combined tobacco smoke and sun exposure is unsurprising.

Another study reported that smoking?more than?20 cigarettes per day was associated with an almost 10-year increase in skin ageing. The study found no significant association between sun exposure and wrinkles.

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There is some evidence that women's skin is more affected by tobacco smoke exposure than men's skin. One study reporting a premature ageing effect in both sexes found that smoking men were 2.3 times more likely than non-smoking men, and smoking women more than 3 times as likely?as non-smoking women, to age prematurely. The study did not explore the possible reasons why women's skin was more sensitive to the detrimental effects of tobacco smoke than men's skin.

Skin tissue?composition

As skin ages, the composition of skin tissues changes. A number of studies have examined the skin tissues of smokers and non-smokers as a measure of premature ageing. A Dutch case control study?measuring the extent of elastosis (a condition in which skin loses elasticity as a result of connective tissue degeneration) and telangiectasia (a condition characterised by fine red lines in the skin caused by?the dilation of small blood vessels) in smokers and non-smokers reported that the likelihood of developing either condition increased with the number of cigarettes smoked. This was true for both men and women, although the effect was most apparent in men. Another study, which used computer assisted analysis to assess elastosis in four layers of facial skin, reported significantly greater elastosis in smokers compared to non-smokers.

Skin tone and colour

In addition to wrinkles, smoking increases an individual's risk of gauntness and facial discolouration.

There is evidence that smoking tobacco decreases the ability of skin to regenerate and repair wounds.This is particularly evident in patients undergoing surgery. For example, smokers who undergo face lift surgery are more likely than non-smokers to experience unsatisfactory wound healing.

There are a number of possible ways by which exposure to tobacco smoke may inhibit the skin's ability to regenerate and repair. Nicotine, one of the toxic components of tobacco smoke, is a vasoconstrictor (an agent which causes the blood vessels to contract). When blood vessels are constricted they transport less blood through the body, and therefore reduce the supply of nutrients upon which the skin depends to regenerate. Similarly, carbon monoxide, another toxic component in tobacco smoke, reduces oxygen flow through the body, thus reducing the supply of oxygen needed by damaged cells?to regenerate.

Moisture

Dry skin can feel uncomfortable because it is less flexible than moisturised skin. Unmoisturised skin becomes unattractive and may take on a red, flaky or scaly appearance. Dry skin is also more likely to crack or itch than well-moisturised skin.?

Evidence about the effects of smoking on the moisture content of skin is limited, but the available evidence suggests that smoking reduces moisture in the skin. An Israeli study examining skin moisture found that women who smoked more than?ten cigarettes per day had significantly lower mean moisture values than non-smokers.

Skin blood flow

Cigarette smoking reduces skin blood flow by increasing the release of a hormone called vasopressin.Vasopressin is produced naturally by humans. One of its functions is to reduce blood flow. Studies have shown that concentrations of vasopressin in the blood rise immediately after smoking tobacco.

A review of all published studies examining the associations between skin health and smoking reported that smoking increases the risk of skin lesions in people with diabetes, lupus and AIDS.

Exposure to sunlight is the predominant risk factor for squamous cell carcinoma of the skin (a type of skin cancer). There is considerable evidence that smoking also increases the risk of skin cancer. A Dutch study found that cigarette and pipe smokers were twice as likely as non-smokers to develop squamous cell carcinoma of the skin, when other risk factors (e.g. age and sun exposure) were taken into account. Interestingly, there was no significant association between cigar smoking and squamous cell carcinoma. The same study reported that current smokers were more likely to develop the condition than former smokers.

The Nurses' Health Study, a large study conducted amongst nurses from the US, found that nurses who smoked were 50% more likely to develop squamous cell carcinoma of the skin, compared to non-smoking nurses. A number of other studies have also identified smoking as a risk factor for squamous cell carcinoma of the skin.

Tobacco smoke exposure increases the risk of developing psoriasis, a rare skin condition characterised by the formation of silvery, plaque-like scales on the arms and legs (particularly at?the elbows and knees). Smokers with psoriasis?are less likely than non-smokers?to improve following treatment.

A recent review of literature on the topic reported that women who smoked were 3.3 times more likely to develop psoriasis than non-smoking women. While no significant association between smoking and development of psoriasis in men was found, there was evidence that men who smoked?at least ten cigarettes per day were more likely to have severe psoriasis. Decreased improvement rates following treatment were noted in both men and women.

For more information on smoking and its health effects, and some useful tools, videos and animations, see Smoking. Scollo MM, Winstanley MH [eds]. Tobacco in Australia [3rd edition].?Chapter 3: The health effects of active smoking [online]. Melbourne: Cancer Council Victoria. 21 November?2008 [cited 18 May 2009]. Available from URL: http://www.tobaccoinaustralia.org.au/Grady D, Ernster V. Does cigarette smoking make you ugly and old? Am J Epidemiol. 1992; 135(8): 839-42.Behnam SM, Behnam SE, Koo JY. Smoking and psoriasis. Skinmed. 2005; 4(3): 174-6.Placzek M, Kerkmann U, Bell S, Koepke P, Przybilla B. Tobacco smoke is phototoxic. Br J Dermatol. 2004; 150(5): 991-3.Kennedy C, Bastiaens MT, Bajdik CD, Willemze R, Westendorp RG, Bouwes Bavinck JN. Effect of smoking and sun on the aging?skin. J Invest Dermatol. 2003; 120(4): 548-54.Yin L, Morita A, Tsuji T. Skin aging induced by ultraviolet exposure and tobacco smoking: Evidence from epidemiological and molecular studies. Photodermatol Photoimmunol?Photomed. 2001; 17(4): 178-83.Ernster VL, Grady D, Miike R, Black D, Selby J, Kerlikowske K. Facial wrinkling in men and women, by smoking status. Am J Pub Health. 1995; 85(1): 78-82.Boyd AS, Stasko T, King LE Jr, Cameron GS, Pearse AD, Gaskell SA. Cigarette smoking-associated elastotic changes in the skin. J Am Acad Dermatol. 1999; 41(1): 23-6.Raitio A, Kontinen J, Rasi M, Bloigu R, Roning J, Oikarinen A. Comparison of clinical and computerized image analyses in the assessment of skin ageing in smokers and non-smokers. Acta Derm Venereol. 2004; 84(6): 422-7.Koh JS, Kang H, Choi SW, Kim HO. Cigarette smoking associated with premature facial wrinkling: Image analysis of facial skin replicas. Int J Dermatol. 2002; 41(1): 21-7.Leung WC, Harvey I. Is skin ageing in the elderly caused by sun exposure or smoking? Br J Dermatol. 2002; 147(6): 1187-91.Freiman A, Bird G, Metelitsa AI, Barankin B, Lauzon GJ. Cutaneous effects of smoking. J Cutan Med Surg. 2004; 8(6): 415-23.Wolf R, Tur E, Wolf D, Landau M. The effect of smoking on skin moisture and on surface lipids. Int J Cosmet Sci. 1992; 14(2): 83-8.Waeber B, Schaller MD, Nussberger J, Bussien JP, Hofbauer KG, Brunner HR. Skin blood flow reduction induced by cigarette smoking: Role of vasopressin. Am J Physiol. 1984; 247(6 Pt 2): H895-901.Rowe JW, Kilgore A, Robertson GL. Evidence in man?that cigarette smoking induces vasopressin release via an airway-specific mechanism. J Clin Endocrinol Metab. 1980; 51(1): 170-2.Silverstein P. Smoking and wound healing. Am J Med. 1992; 93(1A): 22-4S.de Hertog SA, Wensveen CA, Bastiaens MT, Kielich CJ, Berkhout MJ, Westendorp RG, et al. Relationship between smoking and skin cancer. J Clin Oncol. 2001; 19(1): 231-8.Grodstein F,?Speizer FE, Hunter DJ. A prospective study of incident squamous cell carcinoma of the skin in the Nurses' Health Study. J Natl Cancer Inst. 1995; 87(14): 1061-6.Aubry F, MacGibbon B. Risk factors of squamous cell carcinoma of the skin. A case-control study in the Montreal region. Cancer. 1985; 55(4): 907-11.Flynn TC, Petros J, Clark RE, Vieham GE. Dry skin and moisturizers. Clin Dermatol. 2001; 19(4): 387-92.

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How to Quit Smoking

Most Australians who take up smoking?regret it and make at least one attempt to quit in their lifetime. Quitting smoking has a very high relapse rate and therefore while many people are able to quit, it's maintaining a smoke-free lifestyle which is the ultimate challenge.

It is normal to make many quit attempts before you succeed in quitting permanently, so do not be discouraged if you are not able to quit the first time around. Statistics have shown that smokers who make attempts to quit without success are more likely to try again, especially if their first attempt lasted a long time.

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

In the past two decades, the number of Australians who have successfully quit smoking has substantially increased. A 2007 Australian survey found that there are more ex-smokers in Australia than smokers aged 14 years or older (4.3 million and 3.1 million respectively).

Studies indicate that the later in life the habit of smoking is developed, the easier it is to quit. That said, it is more common for younger people to make quit attempts.

Surveys among smokers have indicated that the greatest impact on their initial decision to quit smoking comes from anti-smoking television commercials (46%), followed by nicotine replacement therapy (21%) and advice from healthcare professionals (21%).

People who quit without any form of assistance have a 3–5% rate of success, compared to 15–20% success in those who seek support. This is an important point to note for those who have tried quitting without any aids. When making a second attempt to quit, seek a quit strategy that combines some support; your doctor is a good first port of call.

Only 8% of smokers in 2001 admitted to having no intention of ever quitting. That means that 92% of smokers intend to quit.

Cold turkey

Quitting smoking cold turkey refers to abruptly stopping smoking, as?opposed to gradually reducing cigarette intake. Quitting cold turkey is commonly adopted by smokers attempting to quit, and tends to be more effective in the long-term than cutting down.

Cutting down

Cutting down refers to gradually reducing the amount of cigarettes that are inhaled per day until they are eventually stopped altogether.

Psychological smoking interventions refer to help with the emotional, behavioural and mental aspects of quitting. For every smoker, there are many psychological barriers that need to be overcome in order to successfully quit smoking. These will be different for different people, and may include:

Stress and anxiety: Cigarettes are often used as a distraction or as a way to 'manage stress levels'. However, it is uncertain whether the stress relief that smokers feel when they have a cigarette is a genuine effect on mood, or whether it is only a relief from nicotine withdrawal. Smokers tend to report higher levels of stress than non-smokers, suggesting that instead of providing stress relief, cigarettes actually make you more stressed.Depression: People who are depressed will find it harder to quit due to the mood changes associated with nicotine withdrawal.Psychiatric illness: People with psychiatric disorders will find it more difficult to quit smoking.Fear of weight gain: For many smokers, the fear of weight gain provides cause to avoid quitting smoking. The majority of smokers who quit will tend to put on weight, especially in the first year after quitting. This is due to an increased food intake and a decrease in metabolic rate. That said, smokers on average tend to be 4 kg lighter than non-smokers to start with.Self-exempting beliefs: A large majority of smokers have the belief that 'it will never happen to me'. For example, someone who runs?every day and does not drink alcohol?may think that they have less chance of developing lung cancer?than the next smoker because their lifestyle 'balances out' the cigarettes. This is not true. Every smoker has the same risk of negative health outcomes associated with smoking as the next smoker.Perceived disadvantages associated with quitting: By thinking that you are not going to enjoy life without cigarettes, you are providing yourself with a reason not to quit smoking. Do not focus on the negatives associated with quitting, but on the positives.Lifestyle: There may be circumstances in your life which you give priority to quitting, for example having 'bigger' family problems, poverty, or giving in to social norms. This is understandable, but keep in mind that you may be more financially, physically and psychologically able to cope with difficult life circumstances if you are a non-smoker.

For all these reasons, psychological interventions are an important aspect of quitting and have a large impact on success. Studies have indicated that longer and more frequent contact time with a healthcare professional has a significant positive impact on cessation rates. Extended counselling and educational one-to-one sessions are the most successful psychological smoking interventions.

Quitline

Quitline is an inexpensive telephone counselling, information and support service available to smokers in Australia.

Quitline counsellors have tertiary qualifications in psychology and/or counselling, and will provide you with confidential advice, self-help activities and over-the-phone counselling. Quitline also offers a call-back service whereby they can call you at predetermined times to check up on your progress.

Quitline was phoned by 117,174 smokers in 2007.?The majority of people who make an initial call to Quitline make an attempt to quit.

Education

The motivation to quit for many smokers is based on their knowledge that smoking is harmful. Therefore it is important that you are well-educated on the negative effects of smoking. Your doctor will be able to provide you with further information.

Studies have shown that although many smokers know the potential risks, they are still under the illusion that 'it will never happen to me' and other similar self-exempting beliefs. These smokers are less likely to quit than those who accept that the risks apply to them.

Cognitive dissonance is a psychological phenomenon that can help to explain the thinking patterns associated with tobacco addiction. Dissonance occurs when a person holds two inconsistent beliefs. In order to reduce the dissonance, the person may unconsciously 'forget' the attitude that is contrary to their beliefs. For example, people know that tobacco is bad for them, yet act contrary to their knowledge by continuing to smoke. In order to reduce the mental discomfort of having opposing actions and thoughts, the person may develop reasons to justify their behaviour. For example, a smoker watching an anti-smoking TV commercial may develop a belief that the research is untrue or?exaggerated. This makes it very difficult to convince a smoker to quit. Health professionals may try to change these thinking patterns through education.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy?(CBT)?is a relatively short-term form of psychotherapy (a type of counselling) that can be used to help people change their lifestyles.

CBT for quitting underlies many interventions for smoking cessation. Techniques of CBT that relate to smoking intervention include:

Individualised problem-solving strategies used to help cope with difficult environments and situations. This may involve developing behaviours to avoid smoking when you are in environments where you are used to smoking, such as on coffee breaks;Changing thinking patterns: A healthcare professional will help you to cope better emotionally with the mood changes associated with nicotine withdrawal by working on the way you think about certain situations. For example, when you are stressed, the first thought that comes to your mind might be 'I need a cigarette'. If you can change this to 'I need some fresh air' or 'I need to slow my breathing', you will be better able to handle the stress without a cigarette.Education about the quit process: The more you know and understand about nicotine dependence, quit strategies and withdrawal symptoms, the better equipped you will be to face the challenge of quitting.Identifying social or environmental cues that trigger the urge for a cigarette. By determining which situations make you most vulnerable to feeling the need for nicotine, you can try to avoid them. For example, if having a beer is a strong cue for lighting a cigarette, then perhaps drinking a cider instead may be a better option. In order to identify these cues, your doctor may ask you to keep a diary and record each time you feel like a cigarette, what you were doing and how you were feeling at the time. They will then review the diary and try to determine which situations make you feel most vulnerable to taking up a cigarette.

Group courses, internet intervention and one-on-one sessions

One-on-one counselling sessions with your doctor, nurse, psychologist or counsellor are the most successful psychological intervention. Combining one-on-one sessions with freely available aids on the internet, reading material and Quitline will provide you with solid psychological support whenever you need it.

For some smokers, the physical withdrawal from nicotine is more challenging than the psychological withdrawal. If you find the withdrawal from nicotine extremely challenging, then pharmacotherapy may be the best option. However, remember that taking medications will not do the quitting for you. You still need the motivation and desire to quit.

Pharmacotherapy can increase the success of quit attempts. In some cases, it has even been reported to double quit rates. The current first-line smoking cessation medications include nicotine replacement therapy?(e.g. Nicorette, Nicabate), sustained-release bupropion (e.g. Bupropion SR, Zyban) and varenicline (Champix). Studies have shown that all three medicines significantly increase maintenance of smoking cessation when compared to not using the medications. Smoking cessation agents are usually safe and well-tolerated, with very few cases of serious side effects.

A study found that half of relapsed smokers, after one quit attempt with a pharmacological aid, will opt to use the medication again for subsequent quit attempts. Furthermore, those who do not succeed in quitting with a pharmacological agent are likely to quickly engage in another quit attempt.

Research shows that the best quit rates appear to be from quit regimes that combine pharmacotherapy with some form of psychological intervention. The more you use the quit aids that are available, the more likely you will be able to quit and maintain smoking cessation.

There are a number of other methods that are commonly used as interventions for smokers who want to make a solid quit attempt;?however, there is no substantial evidence to support their success. It would be wise to see your doctor and receive information about all the quit options available to you before you try the following:

Hypnotherapy: The hypnotherapist who performs the hypnotherapy will either focus on weakening the desire to smoke or strengthening the will needed to stop smoking;Acupuncture:?Acupuncture therapy works by reducing withdrawal symptoms;Exercise therapy: Exercise can reduce withdrawal symptoms and reduce the desire to smoke; andCounter-conditioning/aversion methods: Counter-conditioning is a psychological therapy that matches smoking with a negative thought, taste, or sensation (such as a small electric shock) to give smoking a negative connotation.

People who receive help and support from family and friends who do not smoke are the most likely to be successful at quitting. If you are the friend or family of a smoker who is trying to quit smoking, your support is extremely important through the quitting process.

In order for you to become a permanent non-smoker you must visualise yourself as a non-smoker. You need to make a quit attempt. Even if you are not successful, it will help you to recognise your individual barriers to smoking cessation. You and your doctor can then use your experience to identify the best quit strategy for you.

Once you have quit, you will recognise the benefits of living a smoke-free lifestyle and you can learn to enjoy and value life without this deadly habit.

?For more information on smoking and its health effects, and some useful tools, videos and animations, see Smoking. Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.0: Introduction. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.1: Quitting activity. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.7: Personal factors associated with quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.4: Assistance with quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.17: Combined interventions. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkCorvette BAB. Conflict management: A practical guide to developing negotiation strategies. New Jersey: Pearson Prentice Hall; 2007: 168-70. [Book]Zwar N, Richmond R, Borland R, et al (eds). Smoking cessation guidelines for Australian general practice [online]. Fairbairn, ACT: quitnow, Australian Government Department of Health and Ageing; 2004 [cited August 2010]. Available from: URL link??Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.11: Methods, services and products for quitting - Methods. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.5: Intensity of intervention. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.14: Methods, services and products for quitting - Telephone advice and assistance. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.13: Methods, services and products for quitting - Cognitive behavioural therapy (CBT). In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.15: Methods, services and products for quitting - More intensive support. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.16: Pharmacotherapy. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.18: Unproven methods. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link Piper ME, Smith SS, Schlam TR, et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry. 2009;66(11):1253-62. [Abstract]Cupertino AP, Wick JA, Richter KP, et al. The impact of repeated cycles of pharmacotherapy on smoking cessation: A longitudinal cohort study. Arch Intern Med. 2009;169(20):1928-30. [Abstract]Raw M, Regan S, Rigotti NA, McNeill A. A survey of tobacco dependence treatment guidelines in 31 countries. Addiction. 2009;104(7):1243-50. [Abstract?| Full text]

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How Smoking Affects the Mouth

The role of smoking in the development of lung cancer and cardiovascular disease is well known. It also has a part to play in several diseases and lesions in the mouth; the most common being gum disease. The chance of dental implant failure is more common among smokers than among non-smokers, and gum disease around these implants in those who smoke is also more prevalent.

The following oral diseases and conditions are caused by, or can be attributed to smoking:

Staining of teeth and dental fillings;Reduction of the ability to smell and taste;Bad breath;Smoker's palate, where the palate becomes white and a number of little spots project from the surface, each bearing a small red spot at the centre that marks the opening of the duct of the gland;Smoker's melanosis, which is associated with cigarette and pipe smoking, and is seen as brown spots inside the mouth;Coated tongue, which is the condition wherethere is a coloured layer composed of mainly food particles, bacteria, and debris from epithelium in the mouth;Oral thrush, which is a type of fungal infection that occurs in the mouth;Gum disease;Tooth decay (dental caries);The failure of dental implants; and/orOral precancer and cancer.

These lesions most likely result from the:

Irritants, and toxic and cancer causing compounds found in the smoke;Dryness in the mouth following high temperatures of inhaling smoke;pH change;Change in immune response; and/orChange in ability to handle viral and fungal infections.

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

Cigarette smoking and its relationship with gum disease has been the topic of interest in the last 10-15 years.

Smokers have a 2.5 to 3.5 times greater risk of severe gum disease, which is recognised by the amount of bone lost around a particular tooth due to gum disease. Smokers also tend to lose more teeth than non-smokers.

The effect of smoking on gum disease is also dependent on the amount of cigarettes or cigars consumed (both quantity and duration of smoking).

Some research in previous decades thought that severe gum disease in smokers was caused by poor dental hygiene, and was made worse by smoking. It is now known that smoking, when adjusted for poor dental hygiene still causes more gum disease than in non-smokers.

How does smoking contribute to gum disease?

Bacteria

Three common bacteria are involved in gum disease. Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Prevotella intermedia, are all present in higher amounts in smokers than non-smokers.

Although we do not know if there is a greater amount of bacteria in total, there is a lot of research that indicates the type of bacteria in smokers is more likely to cause gum disease. This is due to a higher quantity of "bad" bacteria that is present in smokers.

Blood vessels in gums

There is less inflammation and bleeding in smokers than in non-smokers. The reason for this is due to a constriction in blood vessels in the facial area. This constriction does not simply go away once people stop smoking but lasts for a while after smoking has stopped. The reduction in inflammation around the gums may also lead to a false sense of security that the gums are healthy, as one of the indicators dentists use to measure gum health is the amount of inflammation around the gums.??

The way our body responds to bacteria

Smoking alters the way the body responds to the bacteria that is in plaque. It reduces the ability of the body to respond well to the bacteria and thus causes gum disease.

There are many compounds in smoke that can cause a reduction in the immune system (e.g. nicotine).

The main way our body responds to bacteria is through inflammation, and neutrophils are the most critical cell in protection against gum disease. Smokers have more neutrophils in the body in total; however fewer neutrophils reach the gums mainly due to the effects of nicotine. As neutrophils cannot control the bacteria as well as usual (due to the fewer amount reaching the gums), there is a much higher chance gum disease will occur.

The destruction of the gums also occurs much faster in smokers due to the presence of a higher number of matrixmetalloproteinases?(MMPs), elastase, interleukin-1 and prostanglandin-2. These are components of the body's immune response that are involved in inflammation, loss of collagen, and loss of bone.

It is clear that nicotine and various compounds in tobacco may impose detrimental effects on the blood system, inflammatory process and immune system. This results in a progression of gum disease, and a poor response to treatment.

Effects of smoking on gum treatment

Smokers respond less favourably than non-smokers to treatment of any kind to try and control the progression of gum disease. Heavy smokers (smoking > 10 cigarettes per day) in general exhibit a lower degree of healing following treatment for gum disease than ex-smokers and nonsmokers.

Effects of stopping smoking on treatment for gum disease

The effect of smoking on the gums is reversible to some extent when people stop smoking. Stopping smoking will allow for normal healing and repair of the gum tissues when bacteria are introduced to the area (usually in the form of dental plaque).

Significantly greater proportions of implant failures occur in smokers (failure rate 11%) than in non-smokers (failure rate 5%).

We are not sure exactly why there is a poorer rate of success in smokers compared to non-smokers. However, it has recently been suggested that the increase in the number of implant failures in smokers is not the result of poor healing during the surgical part of the implant, but is due to the exposure of tobacco smoke to the gums around the implant. Peri-implantitis is the name given to gum disease around an implant, and chronic peri-implantitis results in implant failure when left untreated.

Programs designed to stop smoking show considerable promise in improving the success rate of dental implants in smokers, with significant differences in failure rates between:

Non-smokers and smokers; andSmokers who adopted the smoking cessation protocol and those who continue smoking.

Smoking tobacco has the following effects on saliva. Smoking:

Immediately stimulates salivary flow;Does not affect saliva flow rates in the long term;In the long-term, slightly reduces pH (makes the mouth more acidic) and buffering power, which means that the chance of getting tooth decay and dental erosion is slightly higher; andIs associated with lower amounts of salivary cystatin (thought to contribute to maintaining good dental health).

Research shows there are higher counts of two bacteria that are linked with tooth decay in smokers than non-smokers, namely, Lactobacillus spp. and Streptococcus mutans.

It is interesting to note that smoking during pregnancy is also associated with a higher chance of tooth decay in preschool children.

Numerous studies in various populations have shown that smokers have a substantially higher risk of oral cancer than nonsmokers. The risk is higher when a greater amount of tobacco smoke is consumed. There is also a clear benefit in cancer risk reduction when people stop smoking.

Although we do not know exactly how smoking causes cancer, the toxic elements of smoking do cause harm to cells, which could easily lead to cancer.

Combining smoking and excessive alcohol intake increases the risk of getting oral cancer,?and it has been estimated that 75-90% of all cases of oral cancer are explained by the combined effect of smoking and alcohol use. This could be because:

Alcohol dissolves certain toxic compounds in tobacco smoke which are linked to cancer; and/orAlcohol increases the permeability of the epithelium inside the mouth.

Oral precancer

Oral leukoplakia, which can be regarded as "pre-cancer" is far more common in smokers than in non-smokers. Leukoplakia is essentially any white lesion whose cause is not known, and there is a chance that these lesions can become cancer.

For more information, see Oral Cancer.

Aesthetics, smell and taste

Smoking causes discolouration of the teeth (more than from the consumption of coffee and tea), dental fillings and dentures. This affects the appearance of the mouth.

Smoking is also a common cause of bad breath and affects the ability for us to be able to taste and smell.

Smoker's melanosis

Smoker's melanosis is associated with cigarette and pipe smoking, and is seen as brown spots inside the mouth. Smoker's melanosis occurs in 5-21.5% of smokers. The pigmentation in the mouth is a result of tobacco smoke causing:

Stimulation of melanin production (brown pigment in our skin and mouth); orThe binding of the melanin to the compounds in tobacco smoke.

The amount of pigmentation is increased in heavy smokers.

Nicotinic stomatitis (smoker's palate)

Nicotinic stomatitis is seen in the mouth as a number of bumps, which may have red centres, and occurs on the top of the mouth, which looks whitish in appearance overall.

This appearance is due to irritated salivary glands with inflamed ducts, which enter into the mouth. Nicotinic stomatitis is a response to heat (not the chemicals in tobacco); thus, there is no chance of cancer as a direct result of this lesion. Nicotinic stomatitis usually goes away once the person stops smoking. The top of the mouth returns to how it should look within 1-2 weeks of stopping smoking.

Hairy tongue

Hairy tongue is characterised by an overgrowth of little "hairs" on the tongue known as papillae. The papillae may be stained white, yellow, brown, green, or black depending on the source of the staining. With tobacco use, the color is generally brown or black. This condition is of concern as it does not look very nice, and also may contribute to bad breath.

Kindly written by Dr Akhil Chandra BDSc. (Hons UWA)

Dentist, Whitfords Dental Centre and Editorial Advisory Board Member of the Virtual Dental Centre

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Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year-old individuals. J Clin Periodontol. 1998; 25(4): 297-305.Sakki T, Knuuttila M. Controlled study of the association of smoking with lactobacilli, mutans streptococci and yeasts in saliva. Eur J Oral Sci. 1996; 104(5-6): 619-22.Williams SA, Kwan SY, Parsons S. Parental smoking practices and caries experience in pre-school children. Caries Res. 2000; 34(2): 117-22.Reibel J. Tobacco and oral diseases. Update on the evidence, with recommendations. Med Princ Pract. 2003; 12 Suppl 1: 22-32.McCoy GD, Hecht SS, Wynder EL. The roles of tobacco, alcohol, and diet in the etiology of upper alimentary and respiratory tract cancers. Prev Med. 1980; 9(5): 622-9.Franceschi S, Talamini R, Barra S, Baron AE, Negri E, Bidoli E, et al. Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy. 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Menstrual phase, history of smoking, and taste discrimination in young women. Percept Mot Skills. 1997; 84(3 Pt 2): 1243-6.Frye RE, Schwartz BS, Doty RL. Dose-related effects of cigarette smoking on olfactory function. JAMA. 1990; 263(9): 1233-6.Taybos G. Oral changes associated with tobacco use. Am J Med Sci. 2003; 326(4): 179-82.Neville BW, Damm DD, Allen CM, Buoquot JE. Oral and Maxillofacial Pathology. Philadelphia: WB Saunders; 1995.Yuca K, Calka O, Kiroglu AF, Akdeniz N, Cankaya H. Hairy tongue: A case report. Acta Otorhinolaryngol Belg. 2004; 58(4): 161-3.

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Factors Affecting Quitting Smoking

Quitting smoking can be very daunting, and people thinking of quitting need to go through several stages of contemplation before they are ready to face the associated physical and psychological challenges. It is estimated that up to 90% of smokers think they should quit, but only 20% are committed to quitting at any one time.

The factors associated with the decision to quit and the difficulty of continuing to not smoke depend upon your personal situation, experience, personality and support network.

For more information on smoking and its health effects, and some useful tools, videos and animations, see Smoking.

Psychologists believe there are five main stages of the quitting process:

Precontemplation: Precontemplation is when the initial thought about quitting comes to mind. You will usually set yourself a quit time within the next 6 months;Contemplation: Contemplation is when you are seriously thinking about quitting in the next 6 months;Preparation: Preparation is when you actually prepare for your quit attempt, which is planned to start within the month;Action: Action is when a quit attempt is made ands lasts at least 24 hours;Maintenance: Maintenance is when you are smoke-free for at least 6 months. This is the hardest step of quitting as you are most vulnerable to relapse.

The level of nicotine dependence is determined by a combination of many different factors that can vary between individuals. Dependence on nicotine (and any other addictive drug) is made up of psychological dependence, physical dependence and tolerance. This means that people become dependent (or 'addicted') to the psychological effects of nicotine (e.g. stress relief) and the body becomes physically dependent on nicotine, such that without it the body experiences withdrawal symptoms. Tolerance is the process whereby smokers become used to nicotine. As they continue smoking, they need more and more nicotine to satisfy the same psychological and physical effects of the drug.

The level of dependence on nicotine is the largest factor determining successful quit attempts. The higher the level of dependence, the harder it will be to quit.

A high level of physical dependence on nicotine is associated with:

A greater exposure to nicotine, which results in further changes to the brain. This is called neuroadaptation. The more nicotine that the brain is exposed to, the more changes the brain will make to its structure and function in order to adapt to the extra nicotine. Once the brain has adapted to high levels of nicotine, it becomes dependent on having nicotine supplied;A greater natural need for nicotine. For example, some people may have a greater natural tendency to develop addictive behaviour, which is defined by their genetic predisposition; andMore severe withdrawal symptoms.

A high level of psychological dependence on nicotine is associated with:

A physical or social environment with strong cues and associations. Many people associate smoking with certain cues. For example, if?you have a cigarette every time you?have a coffee, the coffee becomes a cue. When you go to have a coffee, you will automatically associate this with also?having a cigarette;An environment that has more opportunities to smoke. For example, if you work outside where you can smoke more often than somebody who works in an office, or if you live in a house with other smokers who don't mind smoke in the house; andBeing a learned habit. For many people, smoking is a learned behaviour that comes just as naturally as turning on a light when you walk into a dark room.

Motivation is often thought of as the main reason behind quitting. If someone successfully quits smoking, they are thought to be highly motivated. While motivation is a very important part of quitting, it is not the sole predictor of outcome. If you fail a quit attempt, it does not mean you are not as motivated as somebody who successfully quits –?it means that you have a higher level of nicotine dependence and you may need to try a few more times before you are successful. That said, motivation does play a crucial factor in the quitting process, especially in making the initial decision to quit.

It is hard to define what motivates someone to quit smoking and maintain cessation. The motivation for each person will be brought on by different factors. Some may want to improve fitness and sporting performance, some may be thinking of starting a family, some may want to save money ... the list is endless!

Practise actively thinking about your reason to quit so you remember it every time you feel like a cigarette; it may help you to maintain smoking cessation.

Before you quit, you must believe that you are capable of doing so. This is a concept called self-efficacy. People who are self-efficacious will be more successful in quitting. If you have the motivation, the knowledge and an?understanding of the challenges associated with quitting, you already have the tools you need in order to make a quit attempt. The more faith you have in yourself, then the easier it will be to quit. Remember, in Australia there are more people who have successfully quit smoking than people who still smoke.?If 4.3 million other Aussies can quit smoking, so can you!

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

The physical symptoms of nicotine withdrawal are often associated with relapsing during a quit attempt. Withdrawal symptoms are most intense in the first week of smoking cessation, and last for 2–4 weeks.

Common withdrawal symptoms include:

Mood changes, including agitation, aggression, depression and anxiety;Restlessness;Poor concentration;Increased appetite;Disturbed sleep;Decreased heart rate; andDecreased levels of adrenaline.

Keep in mind that these withdrawal symptoms will not last forever. If you make it past the first week, you are past the worst of it and the?withdrawal symptoms will become less intense!

Whether you are only just thinking about quitting or at the stage where you are completely adamant and prepared to quit, the best place to start is with your doctor. They will be able to provide you with some basic information about quitting and advise you on the best course of action.

Zwar N, Richmond R, Borland R, et al (eds). Smoking cessation guidelines for Australian general practice [online]. Fairbairn, ACT: quitnow, Australian Government Department of Health and Ageing; 2004 [cited 8 September 2010]. Available from: URL link?Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.7 Personal factors associated with quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkBenowitz NL. Clinical pharmacology of nicotine: Implications for understanding, preventing, and treating tobacco addiction. Clin Pharmacol Ther. 2008;83(4):531-41. [Abstract]Winstanley M. Addiction: 6.9 Nicotine withdrawal syndrome. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.3 The process of quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?

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Health Benefits of Quitting Smoking

100 million people were estimated to have died from causes related to smoking in the 20th century. This is around three times more people than those who died in World War I. The 100 million people who died from smoking in the 20th century died from a preventable cause of death.

This trend is continuing into the 21st century, with the World Health Organisation estimating that about 5 million people around the world die from smoking every year. With the extensive knowledge we possess regarding the detrimental health effects associated with this habit, it is time to quit.

Health impact

In 2003, tobacco smoking was the second leading cause of disease burden in Australia, (obesity being the leading cause), with 15,511 smoking-related deaths. The Australian Bureau of Statistics estimates that 8% of the total disease and injury burden in Australia is attributed to tobacco smoking. 20% of all cancer deaths are due to smoking – more specifically, 80% of lung cancer deaths in 2003 were attributed to tobacco smoking.

The most recent smoking statistics have confirmed that daily smoking rates are declining. In 2007, 16.6% of Australians over 14 years smoked daily, which is almost 3% less than the 19.5% of smokers in 2001. The rate was slightly higher for men?at 18%, and was 15.2% for women. The highest rates of smokers were found in the 18–24 age bracket for males, and the 25–34 age?bracket in females. In the 12–17 age bracket, 9% of boys and 10% of girls admitted to smoking in a survey conducted in 2005; these figures peaked at age 17.

Indigenous Australians have the highest smoking rates, with 50% of adults smoking daily in 2005. Manual labourers and factory workers have a higher incidence of smokers (almost 40%) than office workers and professionals (approximately 13%).

Economic impact

In 2004–2005, the cost of smoking to Australia?was $31.5 billion dollars. This figure is thought to be quite conservative, as it does not include hidden social costs such as reduced workplace productivity, litter, extended hospital stays (due to decreased post-operative outcomes), medical costs associated with birth complications, and mental and emotional suffering experienced by smokers and their family and friends.

Treatment of disease is one of the major costs attributed to tobacco use. Lifetime costs for smokers are greater than for non-smokers, even when taking into consideration that non-smokers live substantially longer than smokers. Treatment of disease includes medical costs, hospital, nursing home, pharmaceutical and ambulance. It is not just the individual and the government that bear these costs, but businesses, employers and society as a whole.

The costs borne by businesses include increased rates of absenteeism and loss of labour, which are substantially more in smokers than in non-smokers.

Governments provide mass education and health campaigns in order to deliver information about the dangers of smoking, which add substantially to the overall cost that Australia bears.

No matter what your age or how long you have been smoking, there are many immediate and long-term benefits of quitting. There is comprehensive and conclusive scientific evidence confirming that the risk of disease in former smokers is less than that in smokers of the same age and gender. Quitting smoking slows disease progression and can even reverse some of the acute body changes induced by smoking.

The earlier you quit, the greater?the benefit of quitting. Smokers who quit when they are 30 years old can avoid most of the?excess risk and add about 10 years to their life expectancy. Quitting at 50 can halve the risk of dying from smoking and add 6 years to life expectancy. Even stopping at 60 can have benefits, raising life expectancy by 3 years.

Some health benefits of quitting can be noticed as soon as smoking stops. Within only a few hours without a?cigarette, the carbon monoxide levels in the body are decreased,?followed?a week later by a decline in nicotine?levels. After 5 days without a cigarette, you may notice an improvement in taste and smell.

For some people, the health benefits of quitting continue for years after they quit. In some cases, former smokers may even return to being as healthy as a non-smoker and carry the same risk of disease, although this does not apply to cancer. People who have smoked will always have a greater risk of some cancers than people who have never smoked.

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

After quitting smoking there are a multitude of benefits for your body, some noticeable and some not. Some effects will occur straight away and others may take a number of years. As the amount of time since your last cigarette increases, you will be fitter,?have less risk of developing disease, and feel healthier.

Lungs

Everyone's lungs?stop working as well?the older they get, but for smokers this process happens sooner, faster and more severely. Smoking also causes permanent damage to lung tissue. By quitting smoking, you will give your body the best chance of improving airway functioning and stopping any further damage.

The benefits to the lungs are widespread:

1 month after quitting smoking, improvements in airway function are noticeable;After 2 months tobacco-free, your cilia resume their proper functioning. Cilia are little cells that line the lungs, and their job is to clear the lungs of mucus and debris. Once the cilia start performing their normal duties, the rates of chronic coughing, bronchitis, respiratory infections and pneumonia will also decrease;Quitting slows the increased pulmonary function decline experienced by smokers;Hospitalisation and symptoms of chronic obstructive pulmonary disease?(COPD) are reduced;Post-operative pulmonary complications associated with smoking are reduced;Lung cancer is substantially reduced in those who quit smoking by 30. At 50, the risk for lung cancer is reduced by half, compared with someone who continues smoking for another 25 years; andThe positive effects on the lungs will allow an increase in exercise capacity and therefore fitness will improve.

The positive effect on the lungs will really start kicking in around 2 months after quitting, as long as there is no permanent emphysematous lung damage.

Blood

After not smoking for 24 hours, the levels of carbon monoxide in the body system reduce dramatically, which frees up haemoglobin. Haemoglobin is responsible for transporting oxygen; therefore, if more of it is available, then more oxygen will be transported around the body.

Greater oxygen levels and better oxygen transportation throughout the body have many health benefits:

After 6 weeks, wound infection is less likely; andAfter 6 weeks, blood viscosity is improved, which?has a positive effect on blood flow to the hands and feet. This reduces the risk of peripheral vascular disease. For those who already have the disease, amputations are less likely to be necessary.

Heart

Smoking promotes thickening of the arteries, or atherosclerosis. Atherosclerosis is associated with many negative health outcomes in various body systems, including the heart.

By quitting smoking, atherosclerosis is less likely to occur and therefore the risk of developing heart disease is reduced. After 1 year without smoking, the risk of developing heart disease is half as much as it would otherwise be. Amazingly, after 15 years without smoking, your risk of developing heart disease is equal to that of someone who never smoked, which means you have a chance to reverse the negative effects of smoking on the heart.

Blood pressure returns to normal levels 2 months after smoking cessation.

Brain

Atherosclerosis increases the risk of stroke, which is why smokers have a much higher risk of experiencing a stroke than non-smokers. Therefore, by not smoking for 2–5 years, you will reduce your stroke risk. Amazingly, after 25 years without smoking, your stroke risk is equal to that of?a non-smoker.

Cancer

After 5 years without smoking, your risk of developing throat, mouth and oesophageal cancers is half as much as it would have been had you continued to smoke.

The risk of cancer in general for smokers will always be greater than that?for non-smokers, even 15 years after quitting. This is not to say that there is no point in?quitting. Every cigarette you smoke is exposing you to more carcinogens, and therefore the longer you smoke, the higher your risk of developing cancer. The sooner you stop, the lower your overall risk will be.

Eyes

Rates of blindness are reduced after quitting. After 20 years without smoking, you will have the same risk of age-related macular degeneration (the deterioration of vision with age) as a non-smoker.

Mouth

Smoking has a detrimental impact on oral health, including a reduced ability to smell and taste.?Five days without a cigarette, smokers will notice an improvement in taste and smell.

Smoking tobacco is one of the principle causes of teeth discolouration. Quitting will prevent further staining.

Cosmetic

In addition to?all the negative health impacts of smoking on the body, it also has a negative effect on your appearance. Smoking has been shown to have visible effects on the skin, including:

Increased facial wrinkling;Premature ageing; andDecreased capillary and arteriolar blood flow.

These are effects you can actually see develop. Quitting smoking is the first step you should take in order to keep your appearance radiant and fresh-looking.

Immune system

Within days of stopping smoking, previous smokers will experience improvements in immunity. This means fewer colds and flu, fewer sore throats and fewer infections!

Reproductive system

Tobacco can have detrimental effects on sperm production,?including reduced concentrations of sperm in the semen and reduced concentrations of normal and motile sperm. In order to give yourself the best chance of conceiving, you should stop smoking.

Quitting smoking can also reduce erectile dysfunction caused by smoking.

Females who smoke are twice as likely to be infertile as non-smokers. This effect is reduced after stopping smoking, so quitting should be the first step taken by couples planning to get pregnant.

In order to provide yourself with the best opportunity you can for a good pregnancy outcome you must quit smoking. It is best to quit smoking well before you become pregnant –?this will:

Reduce your chance of miscarriage, premature labour?and placental abruption, all of which are associated with smoking during pregnancy;Mean you have no extra risk of having a low birthweight baby compared to a non-smoker. Lower birthweight babies have more chance of catching illness, developing disease and dying throughout childhood?and adulthood.

While it is best to quit smoking before you conceive, it is still possible to reduce the risk of negative pregnancy outcomes by quitting up to two months after you become pregnant. This is not to say you should wait?two months into the pregnancy before you try to quit. Cutting down on the amount you smoke?without completely quitting will not be of any benefit to you or your baby.

In order to have the best possible pregnancy outcome, you must quit completely.

If you smoke, you are not only exposing yourself to adverse health outcomes, but also exposing your family, your friends and your workmates. In the same regard, quitting smoking will benefit the people closest to you as well as yourself.

Second-hand smoke is the smoke from your cigarette that has the potential to be inhaled by the people around you. Inhaling second-hand smoke, known as passive smoking, is associated with serious health consequences. The risks associated with second-hand smoking increase depending on the length of exposure to the smoke and how often the second-hand smoke is inhaled. For example, if you smoke a lot of cigarettes inside the house, the risk of negative effects on the?health of people who live with you will be high.

People exposed to second-hand smoke have a greater risk of developing:

Research has determined that inhaling second-hand smoke is almost as dangerous as smoking. Within minutes of exposure to second-hand smoke, blood platelets are activated. After time, this can promote thrombosis, cellular artery damage and atherosclerosis.

Children are especially susceptible to the negative health effects associated with second-hand smoke, both physically and environmentally. Children have immature lungs, a greater lung surface and a higher breathing rate than adults, which makes them more vulnerable to the effects of smoking than adults. Children cannot control their environment, so are often put in situations that render them unable to avoid second-hand smoke.

Children and infants exposed to environmental tobacco smoke have an increased risk of developing:

Chronic respiratory symptoms, including asthma, decreased lung function and lower respiratory tract infections;Long term developmental effects;Childhood cancers;Reduced sense of smell;Middle ear infections; andComplications during surgery.

Reducing the amount of cigarettes smoked per day may be helpful as a quit strategy, but there is no evidence that it has a significant improvement on health outcomes or life expectancy.

While you may think you are smoking less, it is believed that once you have developed a nicotine addiction, your brain requires a certain level to feel satisfied. This means that you are more likely to take more puffs and inhale harder if you reduce the number of cigarettes per day. You may not even notice you are doing this. In any case, you will not be reducing your exposure in the long run. In order to experience any benefit from quitting smoking, you must quit completely.

Cigarette smoking affects more than just your health and the health of those around you. The financial impact can be huge; in 2008, pack-a-day smokers spent ~$3,000 per year on cigarettes! That can be a holiday or a new plasma TV! More recently, the Australian government has increased the excise tax on cigarettes by 25%. It is predicted that this tax increase will generate an extra $5 billion over the next 4 years, which will increase the annual cost for an individual smoker even more.

Life insurance and health insurance for smokers also tends to be more expensive. Furthermore, people who do not smoke tend to take fewer sick days, which will financially benefit casual workers.

You spend $ on cigarettes each month.

Which means that you spend $ each year.

With this amount of money you could have:

Since you first started you have spent $.

If you continue smoking, here is how much you will have spent:

Age : $

Age : $

Age : $

Age : $

Age : $

This information will be collected for educational purposes, however it will remain anonymous.

Reference: Smoking cessation guidelines for Australian general practice [online]. Canberra, ACT:?Australian Government Department of Health and Ageing;?2004 [cited 11 January 2011]. Available from: URL link

Quitting smoking will substantially improve your quality of life. Just think about how the following will improve your day-to-day life:

Not having to constantly and intermittently leave social occasions to have a cigarette;Not having bad breath, smelly hair and smelly clothes;Being able to play chasey with your kids for longer; andNot having the extra financial burden of the expensive habit!

Quitting is a truly positive step to take. If you accept the challenge to quit and succeed, you will experience a boost in confidence which will carry over to all areas of your life.

Talk to your doctor about quitting today, and start your new, healthier life as a non-smoker!

?For more information on smoking and its health effects, and some useful tools, videos and animations, see Smoking. Worldwide smoking statistics [online]. Sans Souci, NSW: Think Quit; 2008 [cited 28 July 2010]. Available from: URL linkTobacco smoking in Australia: A snapshot, 2004-05 [online]. Belconnen, ACT: Australian Bureau of Statistics; 9 November 2009 [cited 10 August 2010]. Available from: URL linkSmoking in Australia: Statistics [online]. Woolloomooloo, NSW: Cancer Council NSW; [cited?15 June 2010]. Available from: URL link?Tobacco [online]. Canberra, ACT: Australian Government Department of Health and Ageing; 11 March?2010 [cited 28 July 2010]. Available from: URL linkLal A, Scollo M.?The economics of tobacco control: 17.3 The costs of smoking to Australian society. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkLal A, Scollo M. The economics of tobacco control: 17.1 The economic rationale for intervention in the tobacco market. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of active smoking: 3.6: Reproductive health and smoking. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.2: Health and other benefits of quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkBenefits of quitting [online]. Fairbairn, ACT: quitnow, Australian Government Department of Health and Ageing; 2007 [cited 28 July 2010]. Available from: URL linkYee BE, Ahmed MI, Brugge D, et al. Second-hand smoking and carboxyhemoglobin levels in children:?A prospective observational study. Paediatr Anaesth. 2010;20(1):82-9. [Abstract | Full Text]Benefits of quitting [online].?Carlton South, VIC: Quit Victoria;?2010 [cited August 2010]. Available from: URL linkFertility: Assessment and treatment for people with fertility problems [online]. London: Royal College of Obstetricians and Gynaecologists; 2 January?2004 [cited 30 August 2010]. Available from: URL linkSham AS, Cheung LK, Jin LJ, Corbet EF. The effects of tobacco use on oral health. Hong Kong Med J. 2003;9(4):271-7. [Abstract | Full Text]Winstanley M.?The health effects of secondhand smoke: 4.2: What is in secondhand smoke? In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of secondhand smoke: 4.3: What is in secondhand smoke? In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of secondhand smoke: 4.5: Lung cancer and secondhand smoke. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of secondhand smoke: 4.4: Cardiovascular disease and secondhand smoke. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?Winstanley M.?The health effects of secondhand smoke: 4.6: Cancers of other sites. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of secondhand smoke: 4.7: Health effects of secondhand smoke for infants and children. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?Zwar N, Richmond R, Borland R, et al (eds). Smoking cessation guidelines for Australian general practice [online]. Fairbairn, ACT: quitnow, Australian Government Department of Health and Ageing; 2004 [cited August 2010]. Available from: URL link?Plotino G, Buono L, Grande NM, et al. Nonvital tooth bleaching: A review of the literature and clinical procedures. J Endod. 2008;34(4):394-407. [Abstract | Full Text]Prime Minister of Australia. Media release: Anti-smoking action [online]. Canberra, ACT: Australian Government; 29 April?2010 [cited 8 August 2010]. Available from: URL linkGrady D, Ernster V. Does cigarette smoking make you ugly and old? Am J Epidemiol. 1992;135(8):839-42. [Abstract]Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.7 Personal factors associated with quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.3 The process of quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?

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How Smoking Affects the Eyes

It is well known that the tobacco smoke generated by smoking a cigarette, pipe or other tobacco product can cause damage to the individual who is smoking, and also to the people exposed to the smoke.

The health conditions most commonly associated with tobacco smoke exposure are cancers and cardiovascular disorders. However, there is now a significant body of evidence showing an increased risk of a number of eye disorders, not only in those who smoke, but also in those who are frequently exposed to tobacco smoke.

Tobacco smoke is the smoke generated from smoking tobacco. There are two types of tobacco smoke: Sidestream smoke: Sidestream smoke is the smoke which comes from the tip of a burning cigarette. It contributes about 80% of tobacco smoke-related air pollution, and is 46 times more toxic than mainstream smoke.Mainstream smoke: Mainstream smoke is the smoke which comes from the filter of a burning cigarette, or is inhaled and exhaled by the smoker.

Tobacco smoke contains over 4,000 substances, including many known carcinogens, irritants and inflammatory agents.

Children

While children do not typically smoke cigarettes (at least until adolescence), many are exposed to environmental tobacco smoke, either because their parents smoke at home or in the car, or because they find themselves in environments where adults are smoking. This is commonly known as passive smoking.

Passive smoking has negative effects on the eyes of children exposed to tobacco smoke. The eye diseases and conditions associated with exposure to tobacco smoke in children include:

Strabismus

Strabismus is a condition in which the eyes become misaligned (e.g. crossed eyes). Maternal smoking during pregnancy is associated with a 6.55 times increased risk of strabismus amongst children.

Allergic conjunctivitis

Allergic conjunctivitis isa condition in which the conjunctiva becomes inflamed due to the presence of an allergen.While no studies have been conducted specifically to assess the relationship between allergic conjunctivitis and tobacco smoke exposure, a number of studies of allergic reactions in children have reported that the risk of developing allergic conjunctivitis increased by about 20% in children who are exposed to environmental tobacco smoke.

Adults

In adults, smoking cigarettes is associated with the following eye diseases and disorders:

Cataract

There is strong evidence that smoking particularly pipe smoking increases the risk of cataracts (clouding of the lens of the eye).A review of 27 studies examining the association between cigarette smoking and cataract reported a 3 times increased risk of nuclear cataract, and also evidence of an association between smoking and subcapsular posterior cataract. While studies have not yet demonstrated an association between environmental tobacco smoke exposure and cataract, it remains a potential risk factor.

For more information on cataracts, including the effect of smoking, exercise and nutrition on eyes, as well as some useful animations and tips to keep eyes healthy, see Cataracts.

Uveitis

Uveitis is a condition characterised by inflammation of the uvea (middle section) of the eye. While no studies have been conducted in humans, laboratory studies using rats have determined that endotoxin (a chemical found in tobacco smoke) can induce an inflammatory response and acute uveitis. Thus it is plausible that tobacco-smoke exposure can increase the risk of uveitis in smokers and those exposed to environmental tobacco smoke.

Age related macular degeneration

Smoking is a clearly established risk factor for age related macular degeneration (the deterioration of vision with age). Data from three large cross-sectional studies estimated a 3 times increased risk of age related macular degeneration in smokers compared to nonsmokers.

A review of studies examining the association between age related macular degeneration and smoking reported that smoking actually causes age related macular degeneration, rather than justbeingindirectly associated with the condition. That review also reported that the more people smoked, the more likely they were to develop age related macular degeneration.

The association between environmental tobacco smoke exposure and age related macular degeneration is less clear, and studies to date have presented conflicting results. These conflicting results may be because each of the studies used a different definition of passive smoking.

For more information on age related macular degeneration, including the effect of smoking, exercise and nutrition on eyes, as well as some useful animations and tips to keep eyes healthy, see Macular Degeneration.

Graves' ophthalmopathy (thyroid eye disease)

Graves' ophthalmopathy, also called thyroid eye disease,is a condition characterised by inflammation of the eye and fat in the eye socket. Studies have provided strong evidence of an association betweenthyroid eye disease and how much an individual smokes. Smokers with thyroid eye disease had poorer outcomes than nonsmokers. Data suggests that environmental tobacco smoke exposure increases the risk of Graves' ophthalmopathy, although the data is limited.

Ocular surface disorders

Smoking has been linked to an increase in disorders of the eye's ocular surface which result in symptoms such as itchness, redness and irritation of the eyes. Changes to the eye's ocular surface associated with smoking include changes to the lipid layer of the tear film, reduced tear secretion and reduced corneal and conjunctival sensitivity. Passive smoking can also increase the risk of these disorders. Ocular surface disorders include atopic keratoconjunctivitisand allergic conjunctivitis.

Reducing or eliminating exposure to environmental tobacco smoke and stopping smoking are the key ways to prevent tobacco smoke associated eye disorders.

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Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it.?For more information, see Health Benefits of Quitting Smoking Tool.

You spend $ on cigarettes each month.

Which means that you spend $ each year.

With this amount of money you could have:

Since you first started you have spent $.

If you continue smoking, here is how much you will have spent:

Age : $

Age : $

Age : $

Age : $

Age : $

This information will be collected for educational purposes, however it will remain anonymous.

Reference: Smoking cessation guidelines for Australian general practice [online]. Canberra, ACT:?Australian Government Department of Health and Ageing;?2004 [cited 11 January 2011]. Available from: URL link
?For more information on smoking, its health effects and how to quit smoking,?as well as?some useful tools, videos and animations, see Smoking.Lois N, Abdelkader E, Reglitz K, et al. Environmental tobacco exposure and eye disease. Br J Ophthalmol. 2008;92(10):1304-10. [Abstract]Stone RA, Wilson LB, Ying GS, et al. Associations between childhood refraction and parental smoking. Invest Ophthalmol Vis Sci. 2006;47(10):4277-87. [Abstract | Full text]Cumming RG, Mitchell P. Alcohol, smoking and cataracts: The Blue Mountains Eye Study. Arch Ophthalmol. 1997;115(10):1296-303. [Abstract | Full text]Kelly SP, Thornton J, Edwards R, et al. Smoking and cataract: Review of causal association. J Cataract Refract Surg. 2005;31(12):2395-404. [Abstract]Smith W, Assink J, Klein R, et al. Risk factors for age related macular degeneration: Pooled findings from three continents. Ophthalmology. 2001;108(4):697-704. [Abstract]Thornton J, Edwards R, Mitchell P, et al. Smoking and age-related macular degeneration: A review of association. Eye. 2005;19(9):935-44. [Abstract | Full text]Klein R, Klein BE, Linton KL, DeMets DL. The Beaver Dam Eye Study: The relation of age-related maculopathy to smoking. Am J Epidemiol. 1993;137(2):190-200. [Abstract]Smith W, Mitchell P, Leeder SR. Smoking and age-related maculopathy. The Blue Mountains Eye Study. Arch Ophthalmol. 1996;114(12):1518-23. [Abstract | Full text]Khan JC, Thurlby DA, Shahid H, et al. Smoking and age related macular degeneration: The number of pack years of cigarette smoking is a major determinant of risk for both geographic atrophy and choroidal neovascularisation. Br J Ophthalmol. 2006;90(1):75-80. [Abstract | Full text]Thornton J, Kelly SP, Harrision RA, Edwards R. Cigarette smoking and risk of thyroid eye disease: A systematic review. Eye. 2007;21(9):1135-45. [Abstract | Full text]Edwards R, Thornton J, Ajit R, et al. Cigarette smoking and primary open angle glaucoma: A systematic review. J Glaucoma. 2008;17(7):558-66. [Abstract]

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