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How dangerous is smoking a little bit?
August 30, 2005 6:28 PM   Subscribe

How dangerous is smoking a little bit?

I smoke no more than 5 cigarettes a day, never in my house and rarely on the weekend. All told I smoke less than 20 cigarettes a week. Can I quantify the risk of this behaviour? I've quit completely a few times, but I enjoy smoking at this level.
posted by tcskeptic to Health & Fitness (37 answers total) 1 user marked this as a favorite
 
Most things in life and on this Earth are good in moderation. Smoking is not one of them. You do not have the slightest clue how your body will react to the amount of smoke you take in.
posted by raysmj at 6:36 PM on August 30, 2005


Well smoking less is less risky than smoking more. And someone will probably find a study with a nice regression formula you can use to calculate the risk based no how much you smoke. I would say that you smoke more than "a little bit" if you smoke daily.

When you get that regression formula, calculate your risk, and then don't forget to add all the associated risks, not just the risk directly caused by inhaling toxic chemicals at the rates you do.

For example smoking 5 cigarettes a day increases the probability that you'll at some point be smoking more. So figure if smoking a pack a day reduces your average life span by 5 years. Then figure that smoking 5 cigs a day increases your risk of eventually smoking a pack a day by 3 percent (i assume the increased risk isn't high since it sounds like you've been at that level for some time). Then in addition to the effects of the smoking you actually do, there's a 3 percent chance you'll decrease your lifespan by 5 years (so expected value of additional lifespan reduction risk: .03*5).

Other risks would be the risk that your kids (if you have any) will smoke, which would probably increase regardless of how many a day you smoke.

There are surely other associated risks specific to your own situation (e.g. if you smoked in the house, I would factor in risk of fire) . Don't forget to try to take these into account.
posted by duck at 6:42 PM on August 30, 2005


Do you think that, because you smoke outdoors and on weekdays, it's somehow less dangerous?

Here's a list of smoking-related illnesses (from
this
site):

Atherosclerosis, hypertension, perpheral, vascular disease, myocardial infarction, stroke, polycythemia, alzheimers
disease, tongue cancer, varicose veins, hiatal hernia, senility, and impotence.


Why would you want to increase your chances, even slightly, of getting any of these diseases?
posted by Dr. Wu at 6:46 PM on August 30, 2005


Ooooh, a per cigarette calculator.

I'm willing to bet with that "few" you'll die only 1 year early.
posted by shepd at 6:48 PM on August 30, 2005


The results of a 50-year British epidemiological study, reported last year, suggested that those who quit by age 30, suffered no increased mortality, by 35, 1 year, by 40, 2 years, and then once you continue into the 50s, the risks grow multifold.
posted by Gyan at 6:56 PM on August 30, 2005


Heh, when you said a little I was expecting two or three a week, not five a day. That's once every three hours while you're awake.
posted by furtive at 7:04 PM on August 30, 2005


What furtive said: I felt really bad about my one pipe a week when I quit.
posted by mendel at 7:06 PM on August 30, 2005


My doctor told me that every time you smoke, there's a tiny risk. Obviously, the more you smoke, the riskier it is, but there is no threshold under which it is safe.

I have no idea if that's the truth or not, but it's what he told me.
posted by callmejay at 7:24 PM on August 30, 2005


Medel (and OP) — I've had a lot of doctor's visits lately because I'm getting middle-aged and my health isn't what I'd like. One of the possible contributing factors is my two-three pipes per month habit. I voiced this concern to my doctor. For what it's worth, he actually laughed and then told me that a pipe a week was nothing to worry about.

Five cigarettes a day, on the other hand, is not light smoking. It's 35x the amount I smoke, and my doctor may have cautioned me if my habit were at that level.
posted by jdroth at 7:38 PM on August 30, 2005


Do you think that, because you smoke outdoors and on weekdays, it's somehow less dangerous?

No, I think it's less frequent than it would be if I smoked in my house as well as all weekend long.

Why would you want to increase your chances, even slightly, of getting any of these diseases?

Because smoking gives me pleasure. People often engage in risky behaviour in return for pleasure. I am simply interested in quantifying that risk.

Heh, when you said a little I was expecting two or three a week, not five a day. That's once every three hours while you're awake.

I guess I think of it being "a little" relative to smoking a pack a day or more. And 5 is about my max, my average is probably 3.3 or so.

You do not have the slightest clue how your body will react to the amount of smoke you take in.

But based on that answer, neither do you, which is clearly not an answer to the question. I know that "Smoking is Bad" but cumulatively I just wonder if it is any worse for me than living in Manila for 4 years.

Shepd -- 223 days. Sold!

Also, anyone have any idea about risk differentials (if any) for unfiltereds, regulars, and lights?
posted by tcskeptic at 7:56 PM on August 30, 2005


I'm willing to bet with that "few" you'll die only 1 year early.

Also consider that lung cancer - though you're in no way guaranteed to get it, you're at a much higher risk even just smoking a pack a week - is not a pleasant way to die. You may quantitatively only lose a year off your life, but if you wind up spending your last 5 years in and out of chemo, your life will also have been much worse qualitatively.
posted by joshuaconner at 8:04 PM on August 30, 2005


tcskpetic: Yeah, you're right: I was being a bit judgmental. I apologize.

I guess what struck me was that you seemed interested in the health risks of smoking, but not that interested, which is an odd sort of stance to take. Many of my friends are or have been smokers, and the lengths they've gone to in order to rationalize their smoking (I only smoke on weekends; I never buy my own cigs; I only smoke when I drink) never fail(s/ed) to impress/baffle me. To me, five cigarettes a day is not "a little."

Obviously, you know smoking is bad for you - otherwise you wouldn't've asked this question. You also already more or less knew the answer: smoking less is not as bad for you as smoking more, but it's still fairly bad for you. I guess it just sounded to me like what you were really asking was, "How can I quit?"

I may be - and probably am - totally off base here, and I admit it may be partly selfish: I find cigarettes repulsive. One less smoker in the world means that the chance of my having to inhale cigarette smoke is a teensy bit lower.

In any case, I do sincerely hope you find a balance between your sources of pleasure and your interest in remaining healthy. I really do mean that.
posted by Dr. Wu at 8:20 PM on August 30, 2005


Risk comparisons are notoriously difficult to make, especially for risks that are fairly low. I was once giving a lecture on the risk of contracting AIDS from visiting an HIV-infected dentist, and looking for comparable risks (in terms of epidemiology) were eating a peanut butter sandwich every day (aflotoxin), living in NYC for a year (pollution), and living near a nuclear power plant.

Our psychology interprets risk in a very multi-dimensional way, including all kinds of factors that don't relate to the actual risks. For example, you probably underestimate the risks of cigarette smoking, because you believe you can stop when you want, and you believe that the bad outcome is far enough off that it's hard to believe it will really occur (compared to the reward which occurs immediately). Paul Slovic is a very readable and excellent author about these issues.

There is no question that smoking is related to all kinds of bad health outcomes. Heck, we could solve the social security problem by encouraging smoking as it so effectively reduces lifespan.
posted by jasper411 at 8:30 PM on August 30, 2005


If you had entered 'smoking risk' into Google and pressed 'I'm Feeling Lucky', you would have arrived at the very wonderfulNational Cancer Institute's smoking risk calculator. I'm just guessing at your age and the age you started smoking, but it looks like you're only increasing your cancer risk a little bit - maybe 800% increase - over those like you who have never smoked.

That's right. You're 9 times as likely to get lung cancer than the general population. Popular specific ways to die from lung cancer - and virtually no one is cured of smoking related lung cancers - include:

  • Drowning in your own blood after a tumor-feeding artery ruptures into your bronchus
  • Tumor invades your hip, causing it to fracture while you are walking, you break your neck from the fall
  • You cannot fill your lung with air due to tumorous obstruction, so you spend your last 3 weeks awake, pumping your diaphragm but moving no air, air hunger feeding the anxiety that bulges your eyes, claws your hands on the bedrails, the terrible splitting headache of hypoxia pounding on the inside of your skull as the O2 sat monitor at bedside tolls out the ticking clock of your eventual demise
  • Dozens of cancerous tumors grow inside the very matter of your brain, over a six month robbing you of your sight, ability to walk, ability to speak, ability to think straight, and finally losing ability to recognize your children and wife. This is the way my father died.
  • After the 36th documented bone fracture due to metastasis, hospitalized, spending 100% of your hours either screaming in pain or narcotized into a coma, you grow tired of it, leave a note, crawl over your bedrail and out the 8th floor hospital window. I lost a patient this way, and quietly thanked her for making the right decision.

    After some thought I soft-pedaled the above, taking a couple of the really bad stories out. I wouldn't want to give anyone nightmares.

    I celebrate your freedom to continue smoking!

    Now: quit.

  • posted by ikkyu2 at 8:35 PM on August 30, 2005 [2 favorites]


    I was blown away when a friend of mine recounted a story to me once.

    My friend, while riding the bus one day, noticed one of those ads that UPenn puts up to advertise medical studies. This particular one wanted light to moderate smokers to participate in a medium-term study (three years or something) to gauge the effects of said amounts of smoke intake on people's health. They offered to pay some honorarium while they did the battery of initial tests.

    So, he calls up the folks at UPenn and says he's interested. They take down some demographic stuff, and then ask him how much he smokes. He tells them, "Around a pack a day, give or take one or two."

    The nice young lady on the other end of the line replies, "Oh, I'm terribly sorry, sir. The study is only for light to moderate smokers. Thank you for your interest, but we can't fit you into our study. Have a good day."

    "Wait a moment," my friend says, "What is the cutoff for number of cigarettes?"

    "Well, we consider 1-2 cigarettes a day a light smoker, and 3-5 cigarettes a day a moderate smoker."

    I've subsequently talked to physicians about it, informally. Most of them agree that while many smokers do indeed inhale a pack a day, nobody considers that light smoking. Their upper bounds on light smoking vary from 3 to 10, but most of them consider any amount of smoking on a daily basis a serious health risk. I've gotten a few of them to admit that a cigarette or two a week, or a half dozen when you're out drinking on Friday nights, probably don't constitute much of a risk. But, as everybody in the developed world knows, those tasty little twists of CNS stimulant will fucking kill you.

    Here's the other risk that you should consider: while you may only smoke 5 coffin-nails a day now, it's not hard at all to escalate the habit without even consciously noticing that you're doing so. When I started smoking at 17, a pack of Luckies would last me at least two days. Now, at 21, I smoke at least 15 to 20 rollups a day. Way, way, way more if I'm drinking, deep into a hacking run (for which I stock up on soda and anutritonal finger-food also), or hanging out amongst chainsmokers.

    Also, don't fool yourself into thinking that those filters are doing a damn thing to protect your lungs. They do keep your teeth looking better, but they certainly don't keep you from killing yourself.

    My suggestion? If you're at all worried about it, stop smoking now, before you've fully integrated it into your lifestyle. If you like the process of smoking, especially if it's an after-meals-and-with-your-morning-coffee thing, try substituting in bidis instead of cigarettes. Or, there're a couple of nicotine-free tobacco cigarettes out there.

    Do it slowly, and with your least important cigarettes. For instance, your morning and bedtime cigarettes might be difficult to swap out immediately, but your after-meal ones might be easier. The idea here is to decouple the habit from the addiction, allowing you more control over what you're doing. It's not a "quit smoking" method, since you're definitely still inhaling vaporized polycyclic organics and you're maintaining the habit. But, it's a lot easier to quit when you decide you want to.

    Many people find the addiction side of things relatively easy to get over, since most of it is irritability and physical illness. Take a week's vacation, go cold turkey from nicotine, and it's over. The bigger problem for most people seems to be the habitual use and sensual response we get from the cigarettes. I know that I smoke to kill time, after meals, when I'm nervous, on walks, and on the phone. In addiction-decoupled experiments I've run, I find that I smoke during these times not strictly because my body craves nicotine, but because I crave the process of smoking.

    Anyway, if you're trying to be "safe" about your smoking, hoping that a little bit won't hurt you, you really should examine if it wouldn't be better to just quit smoking altogether.

    Unless you're smoking seriously tasty cigarettes (Nat Shermans or Benson and Hedges, anyone?) and enjoying them in the same way you do a good beer or a fine cognac, then you're not really gaining anything by smoking. If you're using them for stress-relief, there're far more effective herbal, pharmaceutical, and mental solutions out there. If you're smoking for social reasons, you should evaluate whether or not comitting suicide to fit in is worth it.

    If it's all about the oral fixation, as it is for me, I don't know what to suggest. If you find a solution there, drop me an email. (P.S. Gum has never worked for me for this, but you might try it.)
    posted by Netzapper at 8:36 PM on August 30, 2005 [1 favorite]


    After some thought I soft-pedaled the above, taking a couple of the really bad stories out. I wouldn't want to give anyone nightmares.


    Um, ikkyu2, I need to quit. I'd like to hear the really bad stories.
    posted by Savannah at 9:07 PM on August 30, 2005


    ikkyu2: I'm just guessing at your age and the age you started smoking, but it looks like you're only increasing your cancer risk a little bit - maybe 800% increase - over those like you who have never smoked.

    What's the baseline?
    posted by Gyan at 9:10 PM on August 30, 2005


    This question is one I have sort of wanted to ask, along the lines of "Is smoking one cigarette a night better or worse for me than drinking a beer or taking a sleeping pill?" It's become my nighttime routine lately. I never smoke at any other time. According to ShepD's calculator, I have lost ten days of my life. I think I'll go read Paul Slovic, thanks for the advice jasper411.
    posted by jessamyn at 9:50 PM on August 30, 2005


    My suggestion? If you're at all worried about it, stop smoking now, before you've fully integrated it into your lifestyle. If you like the process of smoking, especially if it's an after-meals-and-with-your-morning-coffee thing, try substituting in bidis instead of cigarettes. Or, there're a couple of nicotine-free tobacco cigarettes out there.

    I was under the impression that bidis weren't healthy either.
    posted by angry modem at 10:23 PM on August 30, 2005


    What's the baseline?

    About 10% of cases in men and 20% of cases in women of lung cancer occur in non-smokers. Risk factors include second hand smoke, radon, genetic predisposition, and probably other things. According to here lung cancer kills 15000 nonsmoking women a year.

    It may be hard to quit smoking, but lung cancer is incredibly nasty. And don't forget your huge risk for oral and esophageal cancers as well. Those are also horrible and often also have a terrible prognosis.
    posted by sevenless at 10:34 PM on August 30, 2005


    sevenless : "About 10% of cases in men and 20% of cases in women of lung cancer occur in non-smokers. Risk factors include second hand smoke, radon, genetic predisposition, and probably other things.

    This doesn't say anything new compared to what ikkyu2 said, as 9 times as likely, means that 90% of cases will occur in smokers.

    According to here lung cancer kills 15000 nonsmoking women a year. "

    But what's the prevalence rate? Out of 100,000 non-smokers, how many will eventually acquire lung cancer?
    posted by Gyan at 10:49 PM on August 30, 2005


    I would consider "a little bit" to be 5 cigarettes a year.
    posted by delmoi at 11:27 PM on August 30, 2005


    Also, remember, it's not like Smoking takes a specific amount of time off your life. You're simply increasing the probability of a horrendous, painful, early demise. That when averaged out over several thousand people will result in one year less of life. Some will live to ripe old age, and some will die of Lung cancer.

    You can also get a raft of nasty diseases, although you will lower your risk for alzheimer's, but you can do that with Caffeine.
    posted by delmoi at 11:35 PM on August 30, 2005


    But what's the prevalence rate? Out of 100,000 non-smokers, how many will eventually acquire lung cancer?

    If there are 150,000,000 million women in the US, and the smoking rate is 20%, there should be about 110,000,000 million female non-smokers, if 15,000 of them get lung cancer, then each probably has a 1/7,333 chance or so of getting lung cancer. Then I would suspect that a female smoker has a 1/814 chance of getting lung cancer.
    posted by delmoi at 11:42 PM on August 30, 2005


    It's all a genetic crap shoot. My mother, who smoked from the time she was in her early teens, was diagnosed at age 57 with non-small cell carcinoma - lung cancer. She was dead 10 months later. (By the time you have symptoms, it's too late to treat you.)

    On the other hand, my grandmother and great-grandmother both lived to ripe old ages in spite of their smoking.

    My mother met a man during chemo who had quit smoking 15 years prior and had just been diagnosed with lung cancer.

    Total genetic crap shoot.
    posted by Serena at 12:24 AM on August 31, 2005


    delmoi : "and the smoking rate is 20%, there should be about 110,000,000 million female non-smokers, if 15,000 of them get lung cancer, then each probably has a 1/7,333 chance or so of getting lung cancer. Then I would suspect that a female smoker has a 1/814 chance of getting lung cancer."

    a) it's 15,000 women dying of lung cancer, each year.

    b) it seems for females, smoking increases the risk even higher, yet 20% of lung cancers in females occur among nonsmokers, compared to 10% in males. So we need the absolute number of smokers and absolute number of those with lung cancers. Assuming proportionality among deaths per year and total incidence i.e. (annual deaths from lung cancer among female smokers) / (annual deaths from lung cancer among female nonsmokers) = (incidence of lung cancer among female smokers) / (lung cancer among nonsmokers), and assuming 20% smoking rate, of 40 million (smoking) women, 60,000 die of lung cancer every year which translates to 3/2000 or 1 in 667.

    So, in order to answer the OP's question, we need a curve plotting total lifetime dosage vs. rates of lung cancer. Anyone know of one?

    Serena: it's not quite total genetic crap-shoot, but the genetic background can make it more likely. This book is a decent primer.
    posted by Gyan at 12:44 AM on August 31, 2005


    You smoke at about the same level that I used to smoke at. I could feel the effects on my health of this after about a decade.

    I spent a years worth of cigarette money on treatment from a psychologist over a 2-3 month period. Very effective. Just get a good psychologist, and write yourself a timetable for treatment.
    posted by singingfish at 3:45 AM on August 31, 2005


    There's a big problem here with the fact that for a long time, physicians and others trying to encourage people to butt out had a kind of essentialist verve - NO amount of smoking can ever be acceptible.

    It is clear though that this was a political and strategic decision, not a medical one - they didn't want to water down the message, because smokers are among the greatest rationalizers in the world.

    Now, however, research is changing because they have found that although smoking rates have decreased a great deal, there are people who, not due to weak will or any other factor, simply cannot quit. Again, as great rationalizers this is a difficult message, because every smoker will immediately think him/herself part of this cohort, potentially blunting the effects of past anti-smoking messages.

    But if you're in a social situation (and not in a consultation) speaking with a doctor about this - as I have done many times, most of them will very freely admit that if you have 1 or 2 cigarettes a day and have proven that you aren't at risk of increasing your rate, then sure you're marginally at more risk for certain things than a non-smoker but it's nothing to get too worked up about. They will also say that being an ex-smoker who has NO cigarettes most days or even for weeks on end but then at a bar has a cigarette - that's actually dangerous behaviour because the physiological effects of the first cigarette are quite acute.
    posted by mikel at 4:40 AM on August 31, 2005


    If you like a little tobacco now and then, try a cigar or a pipe (and smoke them correctly, not pulling the smoke down into your lungs.)

    If you are like me, this will help you make the leap from smoking every day to smoking once in a while in celebration or to facilitate sulking. It helps psychologically because I always feel I have the option to go smoke and that compulsive feeling of "needing a smoke" becomes a non-compulsive "wanting a smoke."
    posted by sonofsamiam at 9:06 AM on August 31, 2005


    wow. so almost nobody answered the question he posed. i heard somewhere that under 2 a day is basically "nonsmoking", in that living in a large city affects you the same way, chemically.
    posted by yonation at 9:25 AM on August 31, 2005


    I just quit smoking - never had more than 2 a day and frequently went several days in between smokes - due to high blood pressure. I kid you not, it went down SIGNIFICANTLY within a month of quitting, no other changes in my behavior at all. So yeah, smoking just a little really can mess you up.
    posted by luriete at 10:13 AM on August 31, 2005


    [I cleaned this thread up some in response to some aggressive flagging. If you want to debate the content of this post, please bring it to metatalk.]
    posted by jessamyn at 11:38 AM on August 31, 2005


    I already linked to the NCI's smoking-risk calculator, but let me just plug the NCI again:

    Every question that's been asked in this thread so far is answered on the National Cancer Institute's website. They have it in layman's terms, medical jargon, Excel databases of cancer incidence and prevalence rates indexed according to every risk factor you can imagine and some you can't, and also very nice graphical presentations of this information in PDF format.

    So a lot of folks might get more information by visiting that site.
    posted by ikkyu2 at 12:58 PM on August 31, 2005


    what's the numbers on people who smoke who DON'T get cancer.

    i mean, that's what the smoker wants to know -- it's nice to know how much one is *increasing* their risk, but it's also nice to have a number that says, well, out of 1000 smokers, we're gonna have 200 that get lung cancer, and another 200 or so that die from heart disease, so basically, you're looking at a 40% chance of smoking directly causin' you to kick the bucket.*

    huh, and while i was trying to make an argument about this being a similar calculated risk like choosing whether to, you know, drive an automobile, i ran across this statistic:

    "Only 26% of smokers live to age 80 -- in contrast with 57% of nonsmokers"

    - from " CAUSES OF DEATH" by Ben Best

    which is more along the lines of answers that i believe would be a reasonable response to this question.

    75% chance of not making it to 80 years old is probably enough for me to think reeeal seriously about staying off ol' killstick mcgee.

    * numbers pulled, as always, out of my ass. **

    ** yes my butt is magical
    posted by fishfucker at 6:41 PM on August 31, 2005


    pedants: i'm sure my mathematical probability heebie jeebies aren't correct, but it's kosher because i'm down with es en oh oh single pizzee d oh double gizzle.

    SNOOP DOGGY DOOOOOGGGG

    snoop dogg
    posted by fishfucker at 6:43 PM on August 31, 2005


    fishfucker : "'Only 26% of smokers live to age 80 -- in contrast with 57% of nonsmokers'

    "- from ' CAUSES OF DEATH' by Ben Best

    "which is more along the lines of answers that i believe would be a reasonable response to this question."


    No it's not. It's not quantified by dose. If you take 100 smokers. 60 of whom smoke a pack a day for 40 years (say, 20 to 60), 20 smoke a pack a day for 20 years (20 to 40) and 20 smoke a pack a day for 5 years (20 to 25), and say, all the 40-yr group die at 70, all the 20-yr at 75, and 5-yr at 80, then only 20% of smokers will have lived till 80. The example is contrived, but the point remains.
    posted by Gyan at 1:44 PM on September 1, 2005


    I meant to post this a few months ago.

    One of the definitive studies on cigarette-smoking related mortality is the British Doctors Study i.e. Mortality in relation to smoking: 50 years' observations on male British doctors (referred above)

    In that study, mortality impact is assessed for those who are non-smokers, continuing smokers and those who stopped smoking. Consumption patterns and duration were noted.

    Figure 4 below is the money shot, so to speak.



    Those who stopped between the ages of 25-34 has consumed an average of 65,000 cigarettes (mean starting age=18, mean daily consumption=15*) and had no excess mortality.

    Those who stopped between the ages of 35-44 has consumed an average of 120,000 cigarettes (same mean starting age & daily consumption) and "avoided most of the excess mortality".


    *The mean daily cigarette consumption among smokers was 18. The age 25-34 and 35-44 stoppers are characterized as having daily consumption as "only slightly lower".
    posted by Gyan at 2:19 PM on July 7, 2006


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