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Health Risks of Tobacco Use and Exposure

Tobacco use (smoking and smokeless) and exposure to second smoke increases the risk of developing various chronic diseases, including diabetes. Tobacco use can increase diabetic complications. GASP developed two powerpoint presentations on the this topic, one for the general public and one for health practitioners. Please contact us for more information on the presentations.

Tobacco control policies across the globe will prevent almost 7.4 million premature deaths by year 2050, according to a Georgetown University study published in Bulletin of the World Health Organization's Volume 91, Number 7, July 2013, 465-544". This U.S. News & World Report's July 1, 2013 news article provides details.

Visit the Surgeon General's tobacco-related report library to learn more on the adverse health consequences of tobacco. Compared with nonsmokers, the Center for Disease Control and Prevention (CDC) identifies the health risks of smoking with an estimated increase in the risk of:

• coronary heart disease by 2 to 4 times
• stroke by 2 to 4 times
• men developing lung cancer by 23 times
• women developing lung cancer by 13 times
• dying from chronic obstructive lung diseases (such as chronic bronchitis and emphysema) by 12 to 13 times

Read the fact sheets as they relate to tobacco use from the CDC's health effects of cigarette smoking and the health risks from secondhand smoke. Read a May 5, 2010 article from the Michigan Department of Public Health entitled "The Impact of Smoking on Chronic Disease".

The CDC Report released on August 3, 2012 shows a decrease in total consumption of all smoked tobacco products declined by 27.5 percent between 2000 and 2011, with a minimal decline of 0.8 percent for 2010-11. Despite the overall decline, the consumption of non-cigarette smoked tobacco products increased by 123 percent, partly attributable to the difference in taxation. A provision signed into law in July will limit the advantage of this price difference. Read more statistics from the CDC report and the press release of the report. Read more about closing the tax loophole at our RYO webpage.

On August 15, 2012, The U.S. Department of Health & Human Services (HHS) issued Ending the Tobacco Epidemic: Progress Toward a Healthier Nation, a progress report on HHS's November 2010 strategic action plan entitled Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan. HHS' 2010 plan outlines actions that serve as a roadmap to achieve the Healthy People objective of reducing the U.S. adult smoking rate to 12 percent by 2020. Unfortunately, the CDC report from November 9, 2012 shows no significant change occurred between 2010 (19.3%) and 2011 (19.0%) towards meeting this 2020 goal, pointing out the need for fuller implementation of evidence-based interventions that are proven to reduce smoking prevalence.HHS' August 2012 progress report provides details about achieving measurable success in transforming goals into action, for all four major action areas: Leading by example, Improving the public’s health, Engaging the public, and Advancing knowledge. The progress report includes a summary of recent federal legislation on tobacco control. Read more about HHS' plan and progress report on their website.

Smoking can increase the risk of heartburn:

• Studies show that cigarette smoking slows the production of saliva, one of your body's defenses against damage to the esophagus. Saliva has acid-neutralizing chemicals called bicarbonates, and smokers have less bicarbonates in their saliva, thus reducing the ability of the saliva to neutralize the acid.
• Smoking stimulates the production of stomach acid by promoting the movement of bile salts from the intestine to the stomach, which makes the stomach acids more harmful.
• Smoking can weaken and relax the lower esophageal sphincter (LES), which is a valve at the junction between esophagus and stomach. If the LES isn't working properly or relaxes inappropriately, stomach contents can reflux back up into the esophagus.

Read more about why smoking can cause heartburn.

Increase in Diabetic Prevalence

Nearly 26 million Americans are estimated to have diabetes, according to a January 26, 2011 press release from the Centers for Disease Control and Prevention (CDC), a 9% increase from the 2008 estimate of 23.6 million Americans with diabetes. Health officials believe diabetes is becoming more common because of the rise in obesity, and people with the disease are living longer. Also, according to this NY Times article, a more widely used blood sugar test to detect diabetes may be responsible for as much as half of the reported increase.

The CDC 2011 report estimates that 79 million U.S. adults have prediabetes, a condition in which blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes. Prediabetes raises a person's risk of type 2 diabetes, heart disease and stroke. In a study published last year, CDC projected that as many as 1 in 3 U.S. adults could have diabetes by 2050 if current trends continue. Type 2 diabetes, in which the body gradually loses its ability to use and produce insulin, accounts for 90 percent to 95 percent of diabetes cases. Learn more about the CDC 2011 National Diabetes Fact Sheet.

Secondhand smoke is a risk factor for developing diabetes. Eliminate your secondhand smoke exposure in your life: at home, in workplaces and cars, and outdoors. Studies confirm that secondhand smoke is a risk factor for diabetes:

• The April 2006 issue of British Medical Journal (BMJ) reported that secondhand smoke exposure increases the risk of developing diabetes. Both active and passive smoking increases the development of glucose intolerance in young adulthood, increasing the risk of developing diabetes later in life. Nonsmokers exposed to secondhand smoke are more likely to develop diabetes than ex-smokers. Click here for a synopsis of the BMJ study.
• The November 2009 issue of Diabetic Medicine published a study concluding that chronic secondhand smoke exposure significantly increases the risk for Type 2 diabetes. 1190 Greek and Cypriot men and women, age 65 years were studied from 2005-2007. "Chronic exposure to secondhand smoke significantly increased the likelihood of having Type 2 diabetes by 63%. Each year of exposure to secondhand smoke was associated with a 2% increased chance of developing the condition after controlling for confounders," as reported by MedWireNews.

Smoking and diabetes are a dangerous combination. Smoking raises your risk for diabetes complications. The American Diabetes Association (ADA) lists why diabetics who smoke have a greater mortality rate:

• Smoking decreases oxygen in the tissues, which can lead to a heart attack or stroke.
• Smoking increases bad (LDL) cholesterol and blood pressure, which raises your risk of heart attack.

The 2010 U.S. Surgeon General's report entitled, How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, states in its Fact Sheet that "the chemicals in tobacco smoke complicate the regulation of blood sugar levels, exacerbating the health issues resulting from diabetes. Smokers with diabetes have a higher risk of heart and kidney disease, amputation, eye disease causing blindness, nerve damage and poor circulation."

The U.S. Centers for Disease Control's (CDC) on Tips from Former Smokers describes how smoking increases your chance of becoming a type-2 diabetic, and that not smoking can help prevent type-2 diabetes. The CDC's Consumer Booklet, How Tobacco Smoke Causes Diseases, on page 14, states that smokers who are diabetic need more insulin than diabetics who don't smoke.

Visit the Partnership for a Tobacco-Free Maine's website with information for health professionals treating smokers with chronic disease. Dlife.com details more risks encountered by chronic disease patients:

• Smoking constricts and damages blood vessels, which can make foot ulcers worse.
• Smoking increases your risk of damage to the nerves and kidneys.
• Smoking increases your risk of colds and other respiratory illnesses.
• Smoking increases blood sugar levels.
• Smoking triples your risk of death from cardiovascular disease, compared to diabetics who don't smoke.
• Smoking increases gum disease, making it more difficult to control diabetes, according to the May 2009 study published in Environmental Microbiology.

Studies confirm that smoking is a risk factor for diabetes.

• An Athens University Medical School study, published online on April 12, 2011 in the journal Metabolism: Clinical and Experimental, showed that smoking cessation reduced microalbuminuria by 72% in new type 2 diabetic patients, vs. only 22.5% in patients who continued to smoke. Microalbuminuria occurs when small amounts of albumin (the main protein in your blood) leak into your urine. Without treatment to slow the leakage of protein, the kidneys may continue to be damaged and eventually fail. Diabetic kidney problems occur in about 20%-40% of all people with diabetes. The study recruited 193 smokers with newly diagnosed Type 2 diabetes and microalbuminuria, average age of 56.4 years, to assess the impact of 1 year of smoking abstinence on various health parameters including blood pressure, microalbuminuric status, and glycemic control. Of the participants, 120 managed to quit smoking for 1 year, while 73 continued to smoke. The participants who quit smoking also had better glycemic control, and reduced their blood pressure and prevalence of peripheral vascular disease and neuropathy. Read the study abstract.
• Researchers discovered that nicotine raised blood sugar levels, and the more nicotine that was present, the higher the blood sugar levels were. Higher blood sugar levels are linked to an increased risk of complications from diabetes, such as eye and kidney disease. The study's findings were presented by researchers from California State Polytechnic University in Pomona, at the American Chemical Society meeting in Anaheim, California, March 27, 2010. Author Xiao-Chuan Liu concluded, "This study should encourage diabetics to quit smoking completely, and to realize that it's the nicotine that's raising [blood sugar levels]."

  The researchers added equal amounts of glucose (sugar) to samples of human red blood cells, added varying levels of nicotine to each sample of red blood cells for either one day or two days, and then tested the hemoglobin A1C (HbA1C) levels of the samples. HbA1C is a measure of what percentage of red blood cells have glucose molecules attached to them. In diabetes management, the HbA1C (also known as A1C) test gives doctors an idea of average blood sugar levels for the past three months or so. Most people with diabetes strive for a level of 7 percent or less, based on American Diabetes Association guidelines. The researchers found that nicotine raised HbA1C. The smallest dose increased HbA1C levels by 8.8 percent. The highest dose -- after two days of nicotine treatment -- increased blood sugar levels by 34.5 percent. Read the news article.

• The February 25, 2011 issue of the journal Diabetes Care published the study, "Association between passive and active smoking and incident type 2 diabetes in women". The Brigham and Women's Hospital study on female nurses (Boston) "suggests that exposure to secondhand smoke and active smoking are positively and independently associated with the risk of type 2 diabetes". The study found that there was an increased risk of diabetes among female nonsmokers who were occasionally or regularly exposed to secondhand smoke, compared to female nonsmokers with no exposure to secondhand smoke. Read the Reuter's news story.
• The April 6, 2010 issue of the European Journal of Epidemiology reported a 7-year German study which concluded that active smoking is a risk factor for developing type 2 diabetes, for patients between the ages of 55-74. Active smoking had a statistically significant effect on diabetes incidence.
• Smoking also increases the risk of vascular disease for patients with diabetes mellitus. To read this May 2009 study, click here.
• Click here to read a 2007 study published in JAMA (Journal of the American Medical Association) which concludes active smoking is associated with an increased risk of type 2 diabetes.
• Click here to read an early study from February, 1993 published in the American Journal of Public Health linking an increased risk for diabetes in women who smoke, identifying it as a targeted lifestyle change for diabetes prevention.
• Click here to read a May 1989 study published in the Journal of Family Practice which links smoking, gum disease and diabetes.
  

If you are pregnant, avoid tobacco and nicotine and secondhand smoke exposure. A Purdue University study published March 18, 2008 in Toxicological Sciences discussed that fetal and neonatal exposure to nicotine use may increase the risk of type 2 diabetes. Pregnant women can develop gestational diabetes. If you are pregnant, click here to learn about pregnancy with diabetes. Las mujeres embarazadas pueden tener diabetes getacional. Si esta embarazada, haga clic aqui para saber sobre el embarazo con diabetes.
Using smokeless tobacco can be detrimental to diabetics. As reported in Center for Prevention's informational brochure, sugar and sodium are added to smokeless tobacco and smokeless tobacco users have higher insulin levels than nonusers. The Mayo Clinic has a leading tobacco cessation program, which discusses the harmful health effects of smokeless tobacco, and types of smokeless tobacco.

Quit tobacco to better manage your diabetes, or to reduce your risk of becoming diabetic. Quitting tobacco (smoked and smokeless) will help lower your risk for heart attack, stroke, nerve, kidney and vascular diseases. Your cholesterol and blood pressure levels and blood circulation may improve when you quit smoking. Quitting smoking also benefits those exposed to secondhand smoke - family, friends, neighbors, home visit workers and pets. Click here for tobacco cessation resources sponsored by the government and private programs, some at no or low cost. Speak to your health practitioner, health care plan and employer about resources to quit tobacco.

For healthcare professionals treating diabetic patients. Tobacco dependence treatment professionals can learn how to integrate treatment of tobacco dependence as a routine component of diabetes care:

• Click here for a May 2009 presentation given by Heather Dacus, DO, MPH, Director, Bureau of Chronic Disease Control for the New York State Department of Health, who describes smoking prevalence in the diabetes population, and gives recommendations.
• Click here to read a July 2007 study published in Diabetes Care (American Diabetes Association) highlighting the disparity in care between diabetic smokers and diabetic non-smokers. The authors "strongly suggest that health care professional be more active in educating about the risks of smoking and assess smoking status of all diabetic patients, advise diabetic smokers to quit smoking, and pay closer attention to diabetic smokers for signs of complications by making sure that all necessary preventive care and examinations are performed."
  

Last update: 12/4/13

This information is created by the Tobacco Control Policy and Legal Resource Center of New Jersey GASP, which provides educational information, educational guidance and educational technical assistance on tobacco control topics. The information presented is not intended as, nor to be construed, or used as legal advice, and should not be used to replace the advice of your legal Counsel. Content, artwork and design © 2014 NJ GASP, Inc.