The harmful chemicals found in tobacco products affect each organ of the circulatory system. The heart, blood, and blood vessels all become damaged over time from over 4,000 harmful chemicals found in tobacco products. Each of these organs suffers a slightly different effect, but they are all devastating, and some are potentially fatal.

Blood. Changes in the blood that are caused by smoking are increased stickiness, clumping of platelets, and shorter platelet survival. Thus, the smoker experiences a slower clotting time. Smoking increases the amount of fat, sugar, and hormones in the blood. This makes the blood thicker, and the heart must work harder to pump this thick blood through the body.

Blood Vessels. Over time, the effects of nicotine in all tobacco products and carbon monoxide found in cigarettes lead to a condition known as atherosclerosis, or hardening of the arteries. Scientists believe that carbon monoxide may damage the inner walls of the arteries. This encourages the buildup of fat on the walls, much like a clogged drainpipe. After years of tobacco use, this buildup of fat causes the blood vessels to narrow and harden. They lose their ability to bend and stretch. Nicotine may contribute to this process.

Scientists believe all arteries in the body of a tobacco user can be affected this way. When arteries in the legs become hard and narrow, people can have a lot of pain with walking. This is because the large muscles in the legs need oxygen to facilitate walking, and the arteries are not able to supply it. When they don’t have enough oxygen while being used for walking, the person experiences severe pain. This pain is called intermittent claudication.

There is no cure for this painful and debilitating condition, but sometimes a surgeon can perform surgery on the vessels of the legs. Healthy blood vessels are taken from another part of the body and transplanted in the legs, while the diseased blood vessels are removed. This surgery can give the patient some temporary relief from the pain of intermittent claudication, but it is not a permanent cure. More than 400,000 deaths occur in the United States every year from smoking, and almost half of those are due to cardiovascular disease, including the effects from atherosclerosis.

Heart. When someone smokes a cigarette, the body immediately feels the effects of chemicals in the tobacco and smoke. The heart rate accelerates, blood pressure rises, and breathing rate increases. This means more oxygen is needed by all organs of the body.

Smokers with atherosclerosis are at increased risk of heart attack (myocardial infarction) after years of tobacco use. A heart attack happens when the heart muscle is starved for oxygen. Constricted and narrowed blood vessels that supply the heart muscle, diseased by atherosclerosis, are unable to deliver sufficient oxygen and other nutrients to the heart. Portions of the heart muscle become starved for oxygen and will actually begin to die. A heart attack may cause severe pain (mostly in the middle of the chest but sometimes in the arms, throat, back, and abdomen) or not be felt at all. A heart attack could result in death.

Digestive System

There are three organs in the digestive system that scientists say are most harmed by the effects of tobacco use. The first one is the mouth and that includes the lips, oral cavity, and tongue. The second one is the esophagus and the third is the pancreas.

Studies have shown that the stomach is also included in this list, but scientists are not exactly sure the mechanism by which tobacco causes stomach cancer They do know, however, that there is a link between the two. We explore this piece of information further in the Virtual You section.

Mouth. The single greatest risk factor for cancers found in the mouth is tobacco use. Cancer of the mouth can be found in smokers of cigarettes, pipes, and cigars, and in users of spit tobacco and snuff (smokeless tobacco). People who smoke cigars and pipes are at high risk of developing lip cancer because they generally hold the cigar or pipe between their lips for long periods of time. The constant pressure against delicate lip tissue causes the skin cells to break down and become cancerous. The use of snuff is linked to cancer of the cheek and other forms of mouth cancer because the snuff is held in the mouth for a long time. When a tobacco user “snorts” snuff (sniffs it through his nose), this can damage the delicate tissues of the lining of the nose, increasing the possibility of cancer forming at some point in time. Juice from chew and snuff is absorbed directly through the lining of the mouth and this creates sores that often lead to cancer of the mouth.

Symptoms of mouth cancer are white or red sores or patches in the mouth. That is why it is very important for users of tobacco to see their dentist regularly, so a complete mouth examination can be done. Unfortunately, because pain is usually not an early symptom of mouth cancer, someone can have it for a while and not know it. When someone has had mouth cancer for a while without knowing it, he or she may begin to notice that food tastes different than it used to. He or she might have bad breath that doesn’t go away. And he or she might begin to lose weight.

Smokers have bad breath that doesn’t go away with brushing or flossing. Some have said that kissing a smoker is like licking the bottom of an ashtray. This bad breath is caused by the constant assault on the inside of the mouth by cigarette smoke with over 4,000 dangerous chemicals, including tar, nicotine, and pesticides (bug spray) or smokeless tobacco with its battery of chemicals and brown leaf juice.

Tobacco causes the teeth to be stained yellow or brown, and the stains are not removed by brushing or flossing. Spit tobacco or snuff causes gum disease and it causes the gums to pull away from the teeth because of extra tartar buildup. Because the gums have pulled away from the teeth, they are more prone to getting cavities. Tobacco users can also expect early tooth loss as time goes on.

Esophagus. People who smoke cigarettes, pipes, and cigars, and those who use chew or snuff are all at the risk of getting cancer of the esophagus. Eighty percent of all cases of cancer of the esophagus occur in people who smoke. The cancer is caused by constant contact of the delicate lining of the esophagus over time with smoke and other chemicals found in tobacco products.

Esophageal cancer is almost always associated with excess alcohol intake or tobacco use. The person usually complains of difficulty swallowing solids over several weeks, associated with weight loss. The overall prognosis is poor, with a less than 5% long-term survival. Chemotherapy may prolong survival in some patients, and sometimes surgery or radiation therapy is done.

There were an estimated 12,300 new cases of esophageal cancer in 1998 in the United States and approximately 11,900 people died from this cancer

Pancreas. Smoking causes 30% of all cancer of the pancreas. Studies have shown that smokers have a 70% increased risk of pancreas cancer compared with non-smokers. Most patients are between 60 and 80 years old at the time that they are found to have this type of cancer.

There were an estimated 29,000 new cases of pancreatic cancer in the United States and approximately 28,900 people died from this cancer. Cancer of the pancreas generally occurs without symptoms until it is in advanced stages. Very little is known about what causes the disease or how to prevent it. Scientists know risk increases after age 50 and that smoking is a risk factor. Some studies have suggested associations with chronic pancreatitis, diabetes, or cirrhosis. In countries where the diet is high in fat, like the United States, the rates of pancreatic cancer are higher. Treatment options include surgery, radiation therapy, and chemotherapy, but these generally have little influence on the outcome.

Stomach. Tobacco use has been shown to increase the risk of stomach cancer Also, smoking delays the healing of stomach ulcers, a condition that occurs frequently among smokers. Scientists believe that constant inflammation of the lining of the stomach, as in the case of stomach ulcers, leads to cancer, but they do not know exactly how this happens.

There were an estimated 22,600 new cases of stomach cancer in 1998 in the United States and approximately 13,700 people died from this cancer.

The dramatic decline of stomach cancer in the last 60 years is thought to be a result of people reducing many of the dietary risk factors involved in stomach cancer This includes greater use of refrigeration for food storage instead of salting, pickling, and smoking. To reduce risk, people should avoid diets high in smoked and pickled foods and salted meats and fish.

Integumentary System (Skin).

British doctors studying identical twins have shown that smoking can cause wrinkles and make people look older than they really are. The studies found that the skin of the twin who smoked was, on average, 25% thinner than the non- smoking twin. Thinner skin wrinkles easier because the inner layer of connective tissue (collagen layer) that adds support to the skin is thinner than normal.

According to one study cited by the American Academy of Dermatology, the skin of one 40-year-old smoker was virtually the same as the skin of a 70-year-old non-smoker. Tobacco smoke narrows blood vessels, thereby depriving the skin of a normal flow of oxygen. Like a plant deprived of water during a drought, the skin withers and droops.

Tobacco smoke also depletes the body’s supply of Vitamin C, a vital ingredient in the formation of collagen. Collagen is a key component in connective tissue that supports the skin.

Physicians also report that smoking causes red eyes and fine lines around the eyes and mouth. It also makes the skin more vulnerable to psoriasis, a disease that causes scaly sores on the scalp, knees, elbows, chest, back, arms, and legs.

Nervous System (Brain)

Two of the three most predominant chemicals found in tobacco, over time, can change the shape of the blood vessels in the brain, as well as the rest of the body. Nicotine and carbon monoxide in tobacco products cause them to become narrower and less flexible. Carbon monoxide (with the help of nicotine) causes degradation of the blood vessels supplying blood, oxygen, and nutrients to the brain. When these arteries become clogged and hardened, in a condition called, less blood, oxygen, and nutrients get to the brain and the person can have a stroke. Strokes can also be caused by blood clots which block off blood supply within a blood vessel or an aneurysm, a localized abnormal dilatation of a blood vessel, usually an artery.

Each artery carries blood, oxygen, and nutrients to different parts of the brain. When an artery is damaged from tobacco use, the part of the brain it nourishes does not get what it needs to function properly. Within minutes, it begins to die. If someone suffers a stroke, he or she could die, become paralyzed, or have trouble talking or understanding speech. Vision could be affected. There could also be a loss of control of emotions or depression. Not all people are affected in the same way by a stroke. Approximately 23,000 people die every year in the United States from strokes linked to cigarette smoking.

Ear. The Archives of Pediatric and Adolescent Medicine, a journal of pediatricians, in July, 1997 announced that secondhand smoke by parent's accounts for 3.4 million visits to the doctor for ear infections and 110,000 treatments for insertion of ear tubes because of frequent ear infections in children.

Ear infections are also known as otitis media (middle ear inflammation). While they can occur at any age, they are most common in young children, especially from age three months to three years. They are usually bacterial or viral in origin. Symptoms of ear infection are pain, loss of hearing, fever, nausea, vomiting, and diarrhea. Ear infections usually respond to antibiotic treatment. Serious complications can include facial paralysis, brain abscess, meningitis, and profound hearing loss.

Respiratory System

Harmful chemicals in tobacco products and cigarette smoke are capable of doing extreme damage to the respiratory system, especially the lungs. Tobacco use also causes cancer of the pharynx and larynx.

Pharynx. Scientists have found that cancer of the pharynx is linked to smoking. These types of cancer form over time when the delicate tissues of the throat are constantly assaulted by smoke and chemicals found in tobacco. About 2,100 people in the United States die every year from cancer of the pharynx.

Larynx. Scientists have found that cancer of the larynx (voice box) is linked to smoking. These types of cancer form over time when the delicate tissues of the throat are constantly assaulted by smoke and chemicals found in tobacco. Twice as many men as women develop cancer of the larynx, and the risk in men is greatest in those over the age of 40. Treatment for this type of cancer is usually surgery.

Treatment for laryngeal cancer can be radiation or surgery, or a combination of the two. Treatment varies according to location, size, and stage of the tumor, and individual characteristics, such as age and physical condition. If removal of the larynx is indicated, the person must breathe, cough, and sneeze through an opening in front of his neck. He or she must learn to talk in a new way. He or she may even require the aid of a mechanical device that he or she must hold to his or her throat in order to speak.

There were an estimated 19,700 new cases of pharyngeal and laryngeal cancer in the United States in 1998 and approximately 6,400 people died from these cancers.

In addition to the diseases we discuss in this section, smoking causes a person to easily become short of breath. A smoker cannot run as far or as long as someone who does not smoke. Smokers take longer to recover from a cold or a sore throat. And they cough more than non-smokers do. Read on to find out about four major problems or diseases that tobacco use can cause in the lung: cancer, emphysema, smoker's cough, and asthma.

Lung. Smoking causes a variety of lung ailments: emphysema, cancer, smoker's cough, and asthma. Emphysema (em-fuh-see-muh) is a lung disease that is not cancer It begins when the alveoli in the lungs are destroyed from regular cigarette, cigar, or pipe smoking after a number of years. It is in the alveoli that oxygen from the air is exchanged for carbon dioxide in the blood. The walls of healthy alveoli are thin to allow for the gas exchange. The chemicals in smoke (including tar) easily destroy the alveoli, causing them to be unable to do their work. Damage to the alveoli is not reversible and results in permanent “holes” in the lower part of the lungs. As the alveoli begin to die, the lungs are less and less able to transfer oxygen to the bloodstream, and this causes shortness of breath. As the process continues, emphysema develops. People with emphysema get tired very easily, and lead very inactive lives. Some are confined to wheelchairs or beds. Smoking is responsible for 82% of chronic lung diseases, which includes emphysema.

Emphysema is a chronic, incurable disease. People with emphysema cannot do much physical activity because their lungs cannot provide enough oxygen for energy. Treatment for emphysema includes the use of inhalers and pills taken by mouth, and as someone with this disease nears the end of his or her life, he or she frequently requires oxygen flowing from an oxygen tank into his or her nostrils so he or she can breathe a bit better. Over 65,000 people in the United States die every year from chronic lung diseases.

In 1990 in the U. S., there were 120,000 lung cancer deaths related to cigarette smoking. When someone smokes every day over a period of several years, cells in the lung can divide without control and form tumors. Tumors may invade or destroy normal tissue and require removal by surgery.

Lung cancer does not happen overnight. It takes a number of years to develop. How many years depends on the amount of tobacco smoked, how healthy the person is in general, and the strength of his or her immune system (which tries to protect the person from disease the best it can). Nine out of ten cases of lung cancer in men and almost eight out of ten cases in women are caused by cigarette smoking.

The symptoms of lung cancer are difficulty breathing, coughing, and coughing up blood. Some smokers have lung cancer and are not aware of it until they go to the doctor for something else. The doctor does an x-ray of the chest, and the tumor is detected. Studies on the effects of environmental tobacco smoke (ETS) have shown that breathing someone else’s exhaled smoke or breathing the smoke from a burning cigarette that is just sitting in an ashtray can cause lung cancer The United States Environmental Protection Agency tells us that 3,000 lung cancer deaths every year among non-smokers are caused by ETS. ETS contains twice as much tar and nicotine per unit volume as does smoke inhaled from a cigarette. It is also possible to get lung cancer and not be a smoker or someone who breathes ETS, although it is rare.

In 1998 in the United States, there were an estimated 171,500 new cases of lung cancer and approximately 160,100 people died of the disease. The three states with the highest number of lung cancer cases are California, Florida, and Texas. Smoking interferes with respiration, both short-term and long-term. The constant assault of cigarette smoke on the cells lining the bronchi of the respiratory system of a smoker can cause the mucus-secreting cells to become larger and more active. They produce too much mucus. The cilia (small, hair-like projections) lining the air passages become worn away and are then not able to sweep foreign particles out of the throat. This causes what is known as “smoker’s cough.”

Tar, the common name for a mixture of substances that is produced as the tobacco in a cigarette burns, enters the lungs of a smoker and never leaves. Brown and sticky, it coats the inner surfaces of the lung and decreases the amount of surface area through which gas exchange can occur. It causes the breakdown of alveoli (air sacs) in the lungs, and it also promotes lung cancer .

Asthma is a chronic disease that causes severe breathing problems. The small air passages in the lungs become narrow, making breathing difficult. Smoking cigarettes can cause asthma and worsen already existing asthma. Also, being asthmatic and breathing ETS can cause an asthma attack. According to the United States Environmental Protection Agency, ETS worsens the condition of up to one million asthmatic children per year.

When someone has an asthma attack, he or she may notice an itching sensation over the front part of the neck or upper chest. He or she might have a dry cough. As the attack progresses, he or she will begin to wheeze, cough, and have shortness of breath. If untreated, these symptoms progress to more difficult respiration, fast breathing, cough, and tightness or pressure in the chest. There might be wheezing at this time. These attacks may go away quickly or last for hours or days. They are very frightening for the person having the asthma attack because he or she has a feeling of suffocation.

Skeletal System

Smoking increases the risk of a woman developing osteoporosis in her later years. Osteoporosis causes bones to become more porous, gradually making them weaker and more brittle. The bones thin out and become fragile, making them more likely to break. As the disease progresses, fractures can occur, especially in the spine, wrists, and hip bones. This can lead to pain, loss of height, restricted mobility, or a curved backbone.

These physical effects can result in a loss of confidence and strength. They can also mean a loss of freedom, including the ability to lead a healthy, active lifestyle. There are ways to combat these effects. One is early detection and another is treatment.

Women who have gone through menopause are most at risk. Most prone to osteoporosis are women with a family history. Caucasian and Asian women, and women who are thin or small-boned also have a higher risk. Smoking, excess alcohol intake, too little impact exercise, and too little calcium and vitamin D either presently or as a child are other risk factors. Osteoporosis is difficult to detect. Because of this, if a woman feels she is at risk or may have the disease, her health care provider may recommend a bone density test, which is safe, fast, painless, and non-invasive. Treatment for osteoporosis is often estrogen replacement therapy or calcitonin(the hormone responsible for initiating calcium uptake by the bones). In addition, a calcium-rich diet, exercise, and healthy lifestyle are important components of treatment.

There are 20 million American women with osteoporosis.

Men can also have osteoporosis, and most do as they approach their elder years. Scientists are studying the effects of tobacco use on bones of both men and women. Some studies are beginning to suggest that bones of smokers, if broken, may heal slower. More research is needed in this area before definite and clear relationships can be determined.

Note to Teacher: The following information is presented to teachers as background information only. It is included here because of its relevance to reproductive system health. This section is not meant for young students, as it is felt this somewhat technical information may not be fully understood.

Reproductive System

According to the American Cancer Society, smoking is a risk factor for cancer of the cervix, the opening to the uterus. Scientists have found tobacco by-products (substances produced as tobacco is used) in the cervical mucus of women who smoke. Researchers believe that these by-products damage the DNA of cells in the cervix, and so contribute to the development of cancer .

The Pap test is highly effective in detecting cancer of the cervix at an early stage. Women 18 and over should have an annual pelvic exam by a health care provider. Uterine cancers are usually treated with surgery, radiation, hormones, and/or chemotherapy, depending upon the stage of the disease.

There were an estimated 13,700 new cases of cervical cancer in 1998 in the United States, and approximately 4,900 women died from this cancer The three states with the highest number of cervical cancer deaths are California, New York, and Texas.

Fetus

An expectant mother plays an important role for her unborn baby. During pregnancy, the fetus (unborn baby) obtains all nutrients from its mother. The fetus is exposed to everything the mother encounters, such as anxiety and stress. Scientists have found that if the mother smokes, her fetus is affected.

Studies by scientists have found that smoking during pregnancy increases the risk of miscarriage (losing the baby before it's ready to be born), stillborn babies (babies born dead), premature birth (babies born too early), and low birth weight babies (those born smaller than normal). Smoking during pregnancy is also believed to be related to Sudden Infant Death Syndrome (SIDS), a situation where the baby dies suddenly for no reason, and asthma in early childhood.

Smoking by an expectant mother will have an effect on the how the fetus grows. Research shows that the more the mother smokes during the pregnancy, the lower the weight of the newborn. According to the American Lung Association, smoking increases the risk (by more than 50% in light smokers and 100% in heavy smokers) that the baby's birth weight will be less than 2500 grams. Nicotine and carbon monoxide are inhaled by the mother, and reach the baby through the placental walls. This reduces the flow of oxygen to the baby, and ultimately inhibits the growth of the fetus. Babies born under these conditions are more likely to be stillborn or to require intensive care in the hospital. Findings confirm that smoking tobacco reduced weight, length, and cranial and thoracic perimeters at birth when exposure was due to environmental tobacco smoke. Other research has investigated a connection between smoking during pregnancy and birth defects. It has been found, in limited research, that there is an association between maternal smoking and limb reduction malformations.

Every year, about 6,000 babies die from SIDS in the United States alone. Maternal tobacco use has been linked to the occurrence of SIDS, but researchers remain unclear on the underlying cause. This phenomenon is the leading killer of babies between the ages of two weeks and one year and is responsible for half of the deaths of children between two and four months of age. Because the cause is unknown, all infants are potentially at risk for SIDS. However, research shows that infants and fetuses that are exposed to secondhand smoke are more likely to die from SIDS than babies not exposed to secondhand smoke. The risk for SIDS is increased when the mother smokes during pregnancy or when the fetus is exposed to smoke from the father.

It is recommended that health care providers educate prospective parents about the risk of tobacco smoke exposure during pregnancy. Various public health interventions, such as focusing on smoking cessation among pregnant women and primary smoking prevention efforts among teenage girls, may lead to a substantial decrease in SIDS.

Other deleterious effects of smoking during pregnancy include a decrease in the quantity and quality of breast milk. During pregnancy, hormones (primarily oxytocin) cause tissues in the breast to grow and become ready to secrete milk. After birth, the act of suckling by the baby stimulates the action of the same hormones,which cause milk to be produced and secreted from the breast. The milk provides all the energy and nutrients needed by the baby for growth, development, and maintenance. Smoking by the expecting mother interferes with this process. In addition, nicotine is transferred directly to the baby by way of the mother's breast milk.

Smoking during pregnancy also increases health risks for the mother. Occurrences of placental abnormalities and bleeding during the pregnancy are both increased with smoking. These are in addition to the increased risk of developing the more common tobacco-related health problems, such as heart disease and lung cancer These health consequences will interfere with the mother's ability to raise the child once it is born. Recent research has asserted that smoking by the mother during pregnancy increases the risk of the child becoming addicted to nicotine later on in life. In conclusion, when a woman plans to conceive a child, quitting smoking is essential.

Urinary System

Two organs of the urinary system are affected by the chemicals in tobacco products. They are the bladder and the kidneys. Over time, tobacco’s chemicals cause damage to these important structures. Continue on to find out about how scientists have linked smoking and cancer of these two organs.

Kidney. Kidney cancer in the United States has increased dramatically since 1973. Studies have shown that smoking non-filter cigarettes and long-term cigarette smoking (30 years or more) can cause kidney cancer in men. The studies showed no connection between smoking and kidney cancer in women. Smoking doubles a person’s risk of getting cancer of the kidney.

There were an estimated 29,900 new cases of kidney cancer in 1998 and approximately 11,600 people died from this cancer in the United States.

Bladder. Smoking is the greatest risk factor for bladder cancer, with smokers experiencing twice the risk of non-smokers. Scientists estimate that smoking is responsible for about 47% of bladder cancer deaths among men and 37% among women. Overall, bladder cancer incidence is nearly four times higher in men than in women, and two times higher in whites than in African Americans. Most bladder cancer appears after the age of 50.

Bladder cancer can be treated with surgery. Chemotherapy or radiation therapy before bladder removal has improved some results. When diagnosed at a localized stage, the 5-year relative survival rate is 94%. Three-quarters of all cases are detected this early.

There were an estimated 54,400 new cases of bladder cancer in 1998 and approximately 12,500 people died from this cancer The three states with the highest number of bladder cancer cases are California, New York, and Florida.