Second-hand smoke and lung cancer While active smoking has been shown to be the main preventable cause of lung cancer, secondhand smoke contains the same carcinogens that are inhaled by smokers [30]. Consequently, there has been a concern since release of the 1986 US Surgeon General’s report [31] concluding that secondhand smoke causes cancer among nonsmokers and smokers. Although estimates vary by exposure location (e.g., workplace, car, home), the 2000 National Household Interview Survey estimates that a quarter of the US population is exposed to secondhand smoke [32]. Second-hand smoke is the third leading cause of preventable deaths in the United States [33], and it has been estimated that exposure to second-hand smoke kills more than 3000 adult nonsmokers from lung cancer [34]. According to Glantz and colleagues, for every eight smokers who die from a smoking-attributable illness, one additional nonsmoker dies because of second-hand smoke exposure [35]. Since 1986, numerous additional studies have been conducted and summarized in the 2006 US Surgeon General’s report on “The Health Consequences of Involuntary Exposure of Tobacco Smoke.” The report’s conclusions based on this additional evidence are consistent with the previous reports: exposure to second-hand smoke increases risk of lung cancer. More than 50 epidemiologic studies of nonsmokers’ cigarette smoke exposure at the household and/or in the workplace showed an increased risk of lung cancer associated with second-hand smoke exposure [34]. This means that 20 years after second-hand smoke was first established as a cause of lung cancer in lifetime nonsmokers, the evidence supporting smoking cessation and reduction of second-hand smoke exposure continues to mount. Eliminating second-hand smoke exposure at home, in the workplaces, and other public places appears to be essential for reducing the risk of lung cancer development among nonsmokers.
Smoking among lung cancer patients Tobacco use among patients with cancer is a serious health problem with significant implications for morbidity and mortality [36–39]. Evidence indicates that continued smoking after a diagnosis with cancer has substantial adverse effects on treatment effectiveness [40], overall survival [41], risk of second primary malignancy [42], and increases the rate and severity of treatment-related complications such as pulmonary and circulatory problems, infections, impaired would healing, mucositis, and Xerostomia [43,44]. Despite the strong evidence for the role of smoking in the development of cancer, many cancer patients continue to smoke. Specifically, about one third of cancer patients who smoked prior to their diagnoses continue to smoke [45] and among patients received surgical treatment of stage I nonsmall cell lung cancer [46] found only 40% who were abstinent 2 years after surgery. Davison and Duffy [47] reported that 48% of former smokers had resumed regular smoking after surgical treatment of lung cancer. Therefore, among patients with smokingrelated malignancies, the likelihood of a positive smoking history at and after diagnosis is high. Patients who are diagnosed with lung cancer may face tremendous challenges and motivation to quit after a cancer diagnosis can be influenced by a range of psychological variables. Schnoll and colleagues [48] reported that continued smoking among patients with head and neck and lung cancer is associated with lesser readiness to quit, having relatives who smoke at home, greater time between diagnoses and assessment, greater nicotine dependence, lower self-efficacy, lower risk perception, fewer perceived pros and greater cons to quitting, more fatalistic beliefs, and higher emotional distress. Lung cancer patients should be advised to quit smoking, but once they are diagnosed, some might feel that there is nothing to be gained from quitting [49]. Smoking cessation should be a matter of special concern throughout cancer diagnosis, treatment, and the survival continuum, and the diagnosis of cancer should be used as a “teachable moment” to encourage smoking cessation among patients, family members, and significant others [37]. The medical, psychosocial, and general health benefits of smoking cessation for cancer patients provide a clear rationale for intervention.
Forms of tobacco Smoked tobaccoCigarettes have been the most widely used form of tobacco in the United States for several decades [51], yet in recent years, cigarette smoking has been declining steadily among most population subgroups. In 2005, just over half of ever smokers reported being former smokers [3]. However, a considerable proportion of the population continues to smoke. In 2005, an estimated 45.1 million adult Americans (20.9%) were current smokers; of these, 80.8% reported to smoking every day, and 19.2% reported smoking some days [7]. The prevalence of smoking varies considerably across populations (Table 1.2), with a greater proportion of men (23.9%) than women (18.1%) reporting current smoking. Persons of Asian or Hispanic origin exhibit the lowest prevalence of smoking (13.3 and 16.2%, respectively), and American Indian/Alaska natives exhibit the highest prevalence (32.0%). Also, the prevalence of smoking among adults varies widely across the United States, ranging from 11.5% in Utah to 28.7% in Kentucky [51]. Twenty-three percent of high school students report current smoking, and among boys, 13.6% report current use of smokeless tobacco, and 19.2% currently smoke cigars [52]. These figures are of particular concern, because nearly 90% of smokers begin smoking before the age of 18 years [53]. Other common forms of burned tobacco in the United States include cigars, pipe tobacco, and bidis. Cigars represent a roll of tobacco wrapped in leaf tobacco or in any substance containing tobacco [54]. Cigars’ popularity has somewhat increased over the past decade [55]. The latter phenomenon is likely to be explained by a certain proportion of smokers switching cigarettes for cigars and by adolescents’ experimentation with cigars [56]. In 1998, approximately5%of adults had smoked at least one cigar in the past month [57]. The nicotine content of cigars sold in the United States ranged from 5.9 to 335.2 mg per cigar [58] while cigarettes have a narrow range of total nicotine content, between 7.2 and 13.4 mg per cigarette [59]. Therefore, one large cigar, which could contain as much tobacco as an entire pack of cigarettes is able to deliver enough nicotine to establish and maintain physical dependence [59]. Pipe smoking has been declining steadily over the past 50 years [60]. It is a form of tobacco use seen among less than 1% of Americans [60]. Bidi smoking is a more recent phenomenon in the United States. Bidis are hand-rolled brown cigarettes imported mostly from Southeast Asian countries. Bidis are wrapped in a tendu or temburni leaf [61]. Visually, they somewhat resemble marijuana joints, which might make them attractive to certain groups of the populations. Bidis are available in multiple flavors (e.g., chocolate, vanilla, cinnamon, strawberry, cherry, mango, etc.), which might make them particularly attractive to younger smokers. A survey of nearly 64,000 people in 15 states in the United States revealed that young people (18–24 years of age) reported higher rates of ever (16.5%) and current (1.4%) use of bidis then among older adults (ages 25 plus years). With respect to sociodemographic characteristics, the use of bidis is most common among males, African Americans, and concomitant cigarette smokers [62]. Although featuring less tobacco than standard cigarettes, bidis expose their smokers to considerable amounts of hazardous compounds. A smoking machine-based investigation found that bidis deliver three times the amount of carbon monoxide and nicotine and almost five times the amount of tar found in conventional cigarettes [63].
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