Why Do We Smoke?


Smoking is the largest preventable cause of illness and premature death. It is the leading cause of several types of cancer, including cancers of lung, larynx, bladder and cervix. Smoking also causes various diseases of heart and blood vessels. However, despite the numerous risks associated with smoking and the numerous health benefits of quitting, some many people currently smoke and the figure is getting higher every year all around the world. Unfortunately, the harmful effects of smoking do not end with the smoker. Smoking during pregnancy can have harmful effects on the developing fetus. Exposure to secondhand smoke causes nonsmokers to die of lung cancer and to suffer from respiratory tract infection. Lancet has reported that more than 1.2 lakh deaths in India occur due to tobacco-related cancer deaths. It has been estimated that more than one-third of adults use tobacco in India. The prevalence of overall tobacco use among males is 48 percent and among females is 20 percent. Globally six million people die each year due to tobacco consumption related diseases. The death toll is estimated to rise to eight million by 2030. Nearly 30 percent of cancers in males in India and more than 80 percent of all oral cancer are related to tobacco use.

Public health officials are particularly concerned about recent changes in smoking trends. One concern stems from the fact that the percentage of smokers has remained fairly constant. Another concern is that smoking is rising among people of the developing nations.

Possible Reasons  

Given the overwhelming evidence against smoking, then, why do people smoke? Genetic, psycho social and cognitive factors all appear to play a role. Individual differences in our reaction to nicotine, the addictive substance in tobacco, suggest that some people are biologically predisposed to become addicted to nicotine whereas others remain unaffected.

Genetic Reasons  

Evidence suggests that our genes play an important role in determining who will become a smoker. Nicotine enhances the availability of certain neurotransmitter substances including acetylcholine, norepinephrine, dopamine and endogenous opioids. These substances produce temporary improvement in concentration, recall, alertness, arousal and psycho motor performance that can be extremely pleasurable for some people. Perhaps the best evidence for a genetic association for cigarette smoking behaviour comes from the recent studies of genes involved in dopamine transmission. Individuals with a particular gene characteristic, which is termed as SLC6A3-9, are significantly less likely to be a smoker. Moreover, smokers with the SLC6A3-9 gene type are also significantly less likely to start smoking before sixteen years of age and are more likely to quit smoking than smokers without the gene type.

Psychological and Cognitive Reasons  

Finally, cognitive factors appear to influence people’s tendency to continue smoking. Research suggests that smokers frequently hold inaccurate perceptions about the risks of smoking. Smokers consistently acknowledge that smoking increases their health risks, but compares to nonsmokers, they tend to underestimate these risks. Smokers also tend to minimize the personal relevance of the risks of smoking. For example, they tend not to believe that they are as much at risk as other smokers of becoming addicted or of suffering negative health effects. However, some research reveals that cultural differences in the degree of risk associated with smoking. In one study, Vredenburgh and Cohen found that Asian participants perceived smoking to be less risky than African American, White, or Hispanic American participants.

Possible Solutions  

Unfortunately, efforts to get people to quit smoking have not been very effective. Although more than 40 percent of adult smokers, on average attempt to quit smoking each year, only a few of them can maintain abstinence even for a short period. What makes a treatment program effective? A recent review of smoking cessation programs revealed that certain key characteristics are associated with better treatment outcomes. First, interventions delivered by trained health care providers tend to be more effective than self-help programs. Second, the content of smoking cessation interventions and the specific behaviour change programs used also appear to make a difference. Third, the intensity of person to person contact as measured by the amount of time the clinician spends with smokers has a direct influence on treatment effectiveness. More contact leads to higher cessation rates. Finally, the use of nicotine replacement therapies, especially when combined with intensive psycho social intervention tailored to the need of individual smokers, tends to improve smoking cessation rates considerably.