Smoking and Health, 1973

By John H. Holbrook, M.D.

In 1833 when the Prophet Joseph Smith received the revelation that tobacco “is not good for man” (D&C 89:8), there was virtually no scientific evidence to support this view. Since then many reports have appeared that have established a strong case against smoking. For example, in the past 20 years the United States Public Health Service has published seven major reports on smoking and health. The most recent of these are: The Health Consequences of Smoking, A Report of the Surgeon General: 1972, and The Health Consequences of Smoking: 1973. These documents review and evaluate several hundred scientific papers that have been published in recent months. The following is a resumé of the data contained in these reports.

Tobacco “tar,” nicotine, and carbon monoxide are the three most hazardous substances found in tobacco smoke. Tobacco tar, which is collected by condensing tobacco smoke, contains hundreds of compounds, including several cancer-producing substances. Carbon monoxide, produced by incomplete burning of organic material, passes into the blood of smokers in significant amounts. It acts as a poison by reducing the amount of oxygen available to cells in the body. Nicotine is a potent stimulant of the central nervous system, the heart, and other systems of the body. It is found only in the tobacco plant and has no beneficial uses.

Both nicotine and carbon monoxide are thought to contribute to coronary artery disease, one of the most frequent causes of death in the United States. Cigarette smokers have high death rates and a much greater susceptibility to early death from coronary artery disease than nonsmokers. Recent population studies from several countries demonstrate that cigarette smoking, together with high blood pressure, and high serum cholesterol are “major risk factors” leading to the development of coronary artery disease.

A group of “irritant” compounds found in tobacco smoke contribute to the health hazards of smoking. Such substances cause paralysis of hair-like structures in the lungs that serve to cleanse the lungs of foreign materials. These irritants also cause increased mucus secretion by the bronchial tree.

Chronic bronchitis and emphysema are the chronic lung diseases of greatest health importance in the U.S., and cigarette smoking is the most important cause of these diseases. Cigarette smokers have higher death rates from emphysema and chronic bronchitis and more frequently have impaired lung function and lung symptoms when compared to nonsmokers. Even teenage cigarette smokers, as a group, have abnormal lung function and lung symptoms when compared to nonsmokers of the same age group.

Cigarette smoking is the major cause of lung cancer in men and a significant cause of lung cancer in women. Cigarette smoking is also associated with cancer in several other sites, including oral cavity, larynx, esophagus, bladder, and pancreas. Reports from a recent large population study in Japan confirm these relationships; this is important because up to now such conclusions were based largely on studies of Caucasian populations in North America and Europe.

The unborn child of a smoking mother has been referred to as an involuntary, passive smoker who is exposed to substances such as carbon monoxide and nicotine. As a result of exposure to the toxic constituents of tobacco smoke, babies born to smoking mothers weigh, on an average, six ounces less than babies born to nonsmokers. The risk of infant death is higher for low-birth-weight infants, and, in fact, women who smoke during pregnancy have a significantly greater risk of an unsuccessful pregnancy than those who do not. If a smoking mother chooses to nurse her newborn child, exposure to harmful substances continues because nicotine passes into breast milk.

Millions of individuals suffer from allergic disorders. Although allergy to tobacco itself appears to be unusual, tobacco smoke may produce a flare-up of allergic symptoms in nonsmokers who are suffering from allergies of diverse causes. In addition, tobacco smoke may produce unpleasant, allergic-like symptoms.

The significance of public exposure to air pollution from tobacco smoke was brought to general attention for the first time in the 1972 Report of the Surgeon General. In experiments using rooms filled with tobacco smoke, the level of carbon monoxide was shown to equal and at times exceed the legal limits recently set as national ambient air quality standards. Exposure to such levels of carbon monoxide may, on occasion, be harmful to the health of the exposed person. This would be particularly true for those who are already suffering from chronic lung disease or coronary artery disease.

Evidence that secondhand inhalation of cigarette smoke by the nonsmoker frequently produces unpleasant symptoms and may be harmful to his health supports the view that smoking should be restricted in places that are confined.

In the U.S., pipe and cigar smokers, as a group, experience overall death rates that are substantially lower than those of cigarette smokers and only slightly higher than those of nonsmokers. This appears to be due to the relatively low total exposure to tobacco smoke that a pipe or cigar smoker receives, as most pipe and cigar smokers report that they do not inhale the smoke. At those sites directly exposed to cigar and pipe smoke, such as the oral cavity, larynx, pharynx, and esophagus, cancer death rates of pipe and cigar smokers are approximately equal to those of cigarette smokers.

Recently there has been a sharp increase in the production of small cigarette-sized cigars. If these little cigars are smoked in amounts and with patterns of inhalation similar to those used by cigarette smokers, their use may be associated with health hazards similar to those seen with cigarette smoking.

For those Saints who follow the Word of Wisdom, the promise is given that they “shall run and not be weary, and shall walk and not faint.” (D&C 89:20.) Recent studies have shown that cigarette smoking impairs exercise performance, especially for many types of athletic events and activities involving maximal work capacity. These adverse effects are due in part to impaired heart and lung function and to reduced oxygen transport.

It should be emphasized that cessation of smoking or a reduction in the amount smoked is beneficial. The ex-smoker’s risk of suffering disability or death from the diseases caused by or associated with smoking diminishes with time until in some cases it approaches the nonsmoker’s risk. Some insurance companies have recognized this and offer reduced-premium policies to nonsmokers and to smokers who have given up the habit for a specified period.

Millions of Americans have recognized the benefits accruing to those who “kick the habit,” and there are now 30 million ex-smokers in the country. Smoking is now a habit indulged in by a minority of the population: 42 percent of the adult males and 31 percent of the adult females. Teenagers appear to be the only group taking up smoking at an increased rate. This is a disturbing trend, because tobacco-related death and disease will continue to be a major health problem until large numbers of an informed younger generation make the decision not to start smoking. In this respect, the example set by thousands of youthful Latter-day Saints is worthy of emulation.

• Dr. Holbrook was medical staff director for the 1972 report to the U.S. Congress on “The Health Consequences of Smoking” and served as consulting editor for the 1973 report. He now lives in Valley View First Ward, Valley View Stake, in Salt Lake City.