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THE HEALTH BENEFITS OF STOPPING SMOKING

(March 2001)

As educational efforts, regulations, laws, and increasing costs of cigarettes combine to reduce the percentage of smokers, those who quit want to know how long they must stay off cigarettes to get back to the health risks of those who never smoked. And at least some young people who are thinking of regular tobacco use may want to know the health consequences for them while they smoke and after they eventually quit.

An article in the journal Epidemiology by James E. Enstrom and Clark W. Heath, Jr, both respected epidemiologists, provides additional sobering information. The article is entitled, "Smoking Cessation and Mortality Trends among 118,00 Californians, 1960-1997". They analyzed deaths from all causes and for lung cancer among both men and women, about 90 percent of whom were between the ages of 40 and 69 at the start of the study.

Their findings are as follows:

The article concludes the excess mortality associated with smoking can be avoided by never smoking and can be reduced among smokers only by becoming a long-term former smoker.

Commentary: These are important and useful data. The study would have been even more valuable if deaths from heart attacks had been specifically studied rather than just all causes together and lung cancer separately. The evidence from many studies indicates persuasively that within two years of quitting smoking, the smoking-related increased risk of heart attack (fatal and non-fatal) declines. And, by five years after quitting, the risk of fatal and non-fatal heart attack is similar to the person who never smoked.

It is folly to think you can smoke for a considerable number of years and then return to a healthy non-smoking status in a year or two. The risk to the heart does virtually disappear somewhere between two and five years after quitting, but to get to the health status of your never-smoking neighbors will take two decades.

Though this is a sobering article that is convergent with many other studies, there are two somewhat hopeful points for smokers. One is that this study does not take into account the reduced dangers, at least in regard to cancer, from smoking only low-tar filtered cigarettes. That almost certainly significantly reduces the risk of cancer, though it does not help at all in regard to smoking-induced heart attacks. The other is that the dangers of smoking are much less for those who smoke less than ten cigarettes a day - in this study, an increased risk of death from all causes of 24 percent for men and virtually none for women. It just might be (not proved) that for those who only smoked one to nine cigarettes a day (especially if they used only low-tar filtered cigarette brands), a return to the health status of the non-smoker might occur a lot quicker.

The evidence is clear. Not smoking is best. There are long-term consequences even if you stop; it is likely to take twenty years before your health status is similar to the person who never smoked. If you must smoke, it is a lot less dangerous if you limit the smoking to less than one-half pack a day, using only low-tar, filtered cigarettes. The Scientific Advisory Board of Healthful Life does not like the last statement. They do not want, in any way, to seem to be condoning smoking of any amount, and they point out that the overwhelming majority of smokers cannot limit themselves to one-half a pack a day or less. It is a good point. So let’s make it clear. Healthful Life is adamantly opposed to smoking!

So, if you are a smoker, the sooner you stop, the sooner you will restore your health status to that of a non-smoker. If you do not now smoke, you had better realize the health burden you are taking on, both while you smoke and for a long time after you quit.

Enstrom, J.E. and Heath, C.W. Jr. Smoking Cessation and Mortality Trends Among 118,000 Californians 1960-1997. Epidemiology. Vol 10 (September) Pgs 500-512. 1999.

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