I smoke, but hardly ever. Is it killing me?
December 14, 2008 7:00 AM   Subscribe

Very light smoker, otherwise in good shape. Is this really a threat to my overall health and life expectancy?

I've been smoking occasionally for over ten years, since I was in my mid teens. I totally stopped for a few years without even trying, basically because I wasn't drinking and I was on an insane healthy kick. Fine. I don't remember feeling significantly better because I stopped, but I was also in my early 20s and wasn't even smoking that often to begin with. Then I went through a phase where I just started again, maybe once or twice a week. That's usually enough for me. Sometimes I'll go for months at a time too, and not even notice.

I don't have a problem with this, and I really enjoy smoking every now in then. I don't have a highly addictive personality, so I'm not really worried about that.

I just want to know, I'm otherwise really healthy in so many ways. I don't eat fast good, get exercise,have good friendships, laugh a lot, have a great family, see a therapist, try to keep stress down, whatever. Will this occasional cigarette really impact my health over time? I mean do you think the occasional cigarette is worse than say, having a really dysfunctional family, or really high levels or stress, or eating a Big Mac a few times a week?
posted by Rocket26 to Health & Fitness (18 answers total) 5 users marked this as a favorite
It's impossible to quantify. What I tend to see in my practice are the less tangible effects of light/social smoking. Much higher rates of complicated respiratory illnesses, i.e. the simple cold that doesn't clear up in seven days but instead causes a sinus or lung secondary infection. Next, these folks look worse, age-adjusted, than their peers. Granted, the amount matters, but it's never been the case that past thirty I can't tell in a second who has a habit and who doesn't. Your risk of head and neck/lung cancer is definitely higher, also, but no one knows how much. If you need emergency surgery, you may not heal as quickly and will be at higher risk for a post-op infection. If you are a male, it will increase your risk of erectile problems.

I would suggest your paradigm for quantifying the hazards of your habit be less one of "is it as bad as X, or isn't someone doing Y much more at risk" and instead consider it in terms of whether the risk is acceptable to you in the long run, given the above guaranteed risks. If you are truly being honest about the hazards, and don't expect any medical wand-waving if you get into trouble (because there isn't, and what there is you won't like) then you shouldn't try to justify it further to yourself or anyone else.

If you are a fairly active person, at some point in life you will notice even small changes, positive or negative, in your constitutional vigor. A small tobacco habit may be the difference in something as simple as how much you wrestle with your kids/grandkids, or your interest in tackling small projects, or your ability to run down a criminal.
posted by docpops at 7:25 AM on December 14, 2008 [7 favorites]

Hi. IANAD. However, I am the child of a pulmonologist.

Based on what I know, I think this might be the wrong way to frame your analysis of the costs associated with smoking. I don't think it's possible to compare the relative risks of smoking vs. Burger King etc., in part because unhealthy behaviors and risk factors don't act independently but in concert, and the goal is a healthy lifestyle overall.

You sound like you lead a good life and treat your body well, which is great. However, the trouble with smoking is that while more cigarettes + stronger habit = increased chance of lung cancer and emphysema, you can't predict your personal vulnerability to these diseases. Some people with lifetime habits either don't get sick or die of something else first. Some people with relatively innocuous habits, like yours, come down with these disabling and frequently fatal diseases. It's not just about being a statistical outlier; there are different factors in different people that make them more or less susceptible to smoking-related illnesses, and you don't know how susceptible you are until you get sick.

Hope this helps.
posted by foxy_hedgehog at 7:27 AM on December 14, 2008 [2 favorites]

The problem with smoking and its addiction potential is that while it may seem like your habit is minimal, statistics suggest that this is often how worse habits do get started. Perhaps not in everyone, but there are many folks who once smoked socially, thought they didn't have an "addictive personality," and then all of a sudden a few years down the road, they are scratching their heads and wondering how they went from the weekend smoker to 2 packs a day. So when someone tells me they are a light smoker in their twenties seeking reassurance, I tell them that sure, their habit right now could be worse, but it certainly ain't good, and it's more than likely to get much worse over time.

Giving you an exact answer on how bad this is is probably impossible as suggested, but don't fall prey to the assumption that you can control your habit better than countless others who ultimately failed miserably at doing so.
posted by drpynchon at 8:20 AM on December 14, 2008

The previous answers are correct, but it is also true that attempts are made to quantify the risks and costs associated with smoking tobacco. That said, most of the actuarial data I've seen doesn't really segment smokers by intake (though many medical studies do). The data shown in this CDC chart defines "current smoker" as "someone who has smoked at least 100 cigarettes over his or her lifetime and now smokes every day or some days". So you can't say outright that it does not apply to you. At the very least, the chart is a place to start looking at actual data concerning the health risks associated with smoking.

Perhaps you smoke infrequently enough that you don't agree the CDC-referenced data applies to you. Instead, let's say your tobacco intake is similar to someone frequently exposed to second-hand smoke. I was unable to quickly pull up actuarial data for the effects of second-hand smoke (environmental tobacco smoke), but this National Cancer Institute page is an introduction (with sources) to the best scientific data available for second-hand smoke.

Taking a different tack, you may find it easier and more meaningful to quantify real costs associated with smoking rather than potential health consequences. Along with cigarettes and lighters, if applicable, you should include the difference in price for smokers vs. non-smokers in health and life insurance premiums. Other incidental costs may include lost opportunities for renting, dating, and workplace disapproval due to smoking breaks.

I'm not saying "Stop smoking immediately". The risks and costs may be offset by the pleasure it brings to your life. I'm just trying to answer the question by pointing to available data, data you could dig up with a little effort, and another way of considering the impact of smoking.
posted by McGuillicuddy at 8:28 AM on December 14, 2008 [2 favorites]

If you really want to know, ask your doctor to perform a lung-age test. My friend Tom, who was three or less only when drunk smoker, found out that despite only smoking three or four times a month and only 12 cigarettes a month for three years, he had the lungs of 55 year old. He is 29, my age.
posted by parmanparman at 8:41 AM on December 14, 2008

I think it's a very individual thing. I know elderly smokers who are in good health, but I've also known people who died horrible deaths from smoking-related illnesses. For me, personally, the benefits of smoking outweigh the risks (e.g. I'm plagued by intermittent bouts of severe depression and anxiety. Medication doesn't work for me long-term, but smoking is a reliable way to self-medicate and it works for me. It's made my life more bearable at times, and it's probably made me more bearable for my family and friends). That said, I don't recommend it to others and I've tried to quit numerous time (using numerous methods) with varying levels of success.

Also along the lines of it being an individual thing, I've shared this personal anecdote other times here, but I'll share it again...

My father, a lifelong heavy smoker, used to employ the following argument whenever anyone would nag him to quit smoking: You hear all the time about some perfectly healthy person dropping dead of a heart attack, and then you go down to the pool hall and find 90-year-old men who've been smoking unfiltered Camels since they were in kindergarten and they're doing alright, so who knows? (My dad died of cancer at age 51, though, so you can take his health philosophy with a grain of salt)
posted by amyms at 9:26 AM on December 14, 2008

I mean do you think the occasional cigarette is worse than say, having a really dysfunctional family

I am not a doctor or a lecture-y person, but what a weird comparison! I have a fairly dysfunctional family and as far as I know, there is no chance of it giving me lung cancer.

Yeah it may stress me out and I may have a heart attack and die, but we're not talking about me. The thing is, it's not about comparing your chances to other people, because if you do get lung cancer, you are the one who will have to die an incredibly painful death. Of course it's not a sure thing or even likely, but you are increasing your chances.

I think the overall issue is, you need to stop thinking in terms of "it's ok for me to X because other people do Y." Your health is only about yourself, not other people. If you consider the risks and decide you enjoy smoking enough to justify them, that's OK. But you shouldn't rationalize by bringing other people into it.
posted by drjimmy11 at 10:19 AM on December 14, 2008

Everyone believes they won't ever get cancer; everyone thinks they're immune, no matter how many carcinogens they suck in on the average week. You've probably done the google search: light smokers cancer risk. You've done this, right? You've read all those articles about how light smoking causes cancer and heart disease too? But you're healthy, right; you laugh a lot, you see a therapist. Surely you won't get cancer, because only sad, lonely people who stew in their own issues get cancer. People who don't get enough exercise. People who don't share a laugh with a group of friends. People who don't have therapists.

This is a nice little world you're creating for yourself, but it's a pit of denial. Trying to live an otherwise healthy life doesn't make you immune, particularly when you're a regular (if light) smoker. Lots of otherwise healthy people under the age of 35 get cancer (like me). What you need to decide is if the smoking is worth it to you. If you decide that it's worth the risk, that it provides something crucial to your life, and if you end up having to go through cancer treatment, you'll accept that you made the choices that were best for you at the time. If you're doing it just because it's fun, well, you might be kicking yourself someday. Do you want to blame yourself while you're going through treatment?
posted by Hildegarde at 10:24 AM on December 14, 2008 [5 favorites]

The research on light smoking defines light smoking as 1 to 4 cigarettes per day. Are you way, way below this? How many cigarettes do you smoke in a year? 20? 40? How many in an average month? How often have you smoked on consecutive days? If you're going to decide to take on a little risk for some pleasure, be very honest with yourself.

Anecdotally speaking, it is nearly impossible to get medical advice on very occasional smoking. (Where occasional equals, for example, fewer than 5-10 cigarettes in any given month but not smoking at all some months.) Despite many years (10, 15) of not escalating a habit beyond "occasional," the assumption is that one will eventually turn into a regular smoker, and then the risks of being a smoker in terms of smoking-related disease will be referenced as if a regular smoker. I don't deny that this IS a very common pattern, but it doesn't mean that there aren't people who do not fall into this behavior, and those people are not counted. No offense meant to research -- it's awfully difficult to design a good study based on occasional and erratic behavior! (If you really fall into the category of light smoker, disregard this paragraph.)

I think that the answer to your question is that it's impossible to know. Go for regular physicals, get some lung tests to monitor what shape your lungs are in, consider your family history. Keep in mind that it is not uncommon to have metabolism AND lifestyle changes in your thirties -- make sure to adjust your assessment of how you balance your overall healthy behavior with your rationale for occasional smoking -- if you are smoking just as often but aren't getting the same amount of exercise/as healthy of a diet, you're slipping, right?
posted by desuetude at 10:53 AM on December 14, 2008

I posted a slightly related question ages ago, which referenced this study claiming on average, each cigarette reduces your life by 11 minutes.

Of course as everyone says, these figures are amazingly unreliable because the damage doesn't necessarily scale linearly, everyone's at a different risk, it all depends how you smoke and what you smoke, etc etc.

I wouldn't sweat over an occasional cigarette though. There's a lot of puritanical zeal around, but you might get run over and killed on on the street tomorrow, and you don't want to look back on a miserable life of high-fiber self-denial...
posted by TheophileEscargot at 11:23 AM on December 14, 2008

found out that despite only smoking three or four times a month and only 12 cigarettes a month for three years, he had the lungs of 55 year old.

Is that affected by living in an urban environment or anything? I mean, are there other factors besides smoking that have an impact on "lung age"? Asthma? I have never heard of this test and am intrigued, although I have respiratory problems due to things other than smoking (living in NY, maybe 9-11 dust?, and definitely chemo/radiation for lymphoma years ago).

I used to do the occasional social smoke thing, but I stopped (around the time I had to have the chemo - totally unrelated, but, y'know, seemed kinda incongruous to smoke after that). Now I am very sensitive to the smell of stale smoke on other people's hair or clothes, and I notice that people who smoke seem to age faster, so I'm glad to have sidestepped that one. I know someone who used to social-smoke, then quit, but now that she lives alone, she will smoke sometimes to help her think when she is working on something. I don't think she smokes very much, but it might be 5 a day or so.

If your schedule isn't going to change, your habit may very well not either, but if you were to move to a new job where a coworker you liked went for a smoke break every couple hours, would your habit increase? Or if you found yourself with a lot of work to do at home, would you think a cigarette might help you concentrate? The difference between finding a cigarette pleasant vs unpleasant is the first distinction you can make. The next is whether there are cigarettes around. So a habit can grow... If you're just bumming at a party here or there, and your life is pretty settled, you might find it easy to keep things as they are, but remember a lot of people start out with small habits and don't intend to increase them, and it isn't just about personality - it's mostly about chance and environment.

Regarding the health issue - it's your body, it's your life, it's your choice.
I just don't think we have the exact data for one cigarette every couple weeks yet. You're taking a risk, but when we look back, will it be like looking back at pregnant women having an occasional glass of wine (oh, we overreacted, not that big a deal...) or like letting kids play with mercury (how could we let them do that!)? Of course, plenty of pregnant women opt not to drink at all and plenty of kids who played with mercury made it through ok, so it's not as if the lines are ever all that clear... Still, it may be something that really affects data, or it may be statistically invisible; I just don't think that's information we have at the moment, so you get to make the judgment, depending on how important it is to you.
posted by mdn at 11:26 AM on December 14, 2008 [1 favorite]

Agree with docpops. A lot of the poeple I see don't seem to really get that their smoking -- even socially -- likely kills off the cilia and other protective factors in the lung. They come in with pneumonias or hacking coughs that just don't seem to go away or even dry coughs that seem to linger -- and don't really make the connection that their smoking has anything to do with it.
posted by gramcracker at 11:32 AM on December 14, 2008

I sympathize, we've all got vices that fuck us up one way or another. I've done worse.

The point to take home is probably that if you can avoid the cigarettes altogether, you should, or at least keep consumption as low as you possibly can. No one knows how little you can get away with, but people who smoke 1-3 cigarettes per day increase their risk of all-cause mortality by 40-75%, and their risk of death from lung cancer by 250%-500%. And that's just the death part. It doesn't count disease incidence or minor things like how many cases of bronchitis they get every year.

I add to what docpops said that your risk of heart disease is also higher. Regrettably, there are some studies suggesting that light and heavy smokers suffer from similar drops in endothelial vasodilation function, for example. Down the road, that leads to atherosclerosis, hardening of the arteries.

To what drpynchon said that, I add that yes, up to 40% of people who smoke lightly will have bumped up their cigarette consumption 5, 10, 15 years later. (Fortunately, many of the others quit altogether.)

If you want anecdotal experience, nearly all of my close family members, their friends, and now their children too are physicians of one kind or another (I'm not). I just got off the phone with a cardiologist, an allergist, and a vascular (blood vessel) surgeon who were having brunch together. I asked each one of them independently if they saw social smokers, and/or people smoking less than a pack per month, in their medical practice offices every day. I also asked them how they felt the very light smokers compared to their non-smoking and heavy smoking (>1 pack/day) patients. Here is what they said.

Do you see social smokers, or people smoking less than a pack of cigarettes per month, in your medical practice?
Cardiologist — "Yes, a few. Out of my smoker patients they're very much outnumbered by the heavier smokers. Also, I feel like a lot of people who are smoking half a pack a week when I first get to know them end up smoking half a pack a day by ten years in. Say a third of them. Another third smoke the same as they did before, and another third manage to quit, and God bless 'em." *

Allergist — "Most of my smoking patients go through a pack a day or more. I'd say about 10% of them are in the very-light-smoking category, but a fair number of them don't stay there because they start needing more. I haven't seen very many who've been able to quit, but most of mine haven't had a heart attack yet. Oh, I also have a lot of patients who have asthma or decreased lung function because of secondhand smoke exposure. Especially young people, mostly kids or teens with smoking parents but some twenty-somethings with heavy smoking friends."

Vascular surgeon — "The vast, vast majority of mine who smoke are heavy smokers. I haven't known too many who didn't smoke more cigarettes at 60 than they did at 30. Most of my patients are smokers or have smoked at some time in their lives, but I serve a lot of old people."
How do the very light smokers compare to your other patients?
Cardiologist — "Well, it's interesting, I have a split population of light smokers. There are some who have a long family history of heart disease and all that, and they end up in my office at a young age. I've had some as young as thirty-five. Then there are the others, and I think they show up a little later than the average heavy smoker does, age-wise, but I couldn't tell you by how much. By the time a lot of people come in to see me, they're pretty sick, so to me at least it's not too meaningful to compare. I would say that the light smokers probably have a better prognosis long-term than the heavy ones, but that might be because a lot more of them manage to quit after the heart attack."

Allergist — "The more they smoke, the worse the lung function, obviously, but to me there's a fairly steep jump in the magnitude of reported symptoms even from the non-smokers to the lightest smokers. More asthma, more and longer respiratory infections in winter, more sinusitis. They look older. They're the ones who start getting pneumonia. They pick up more bugs and spread them around to their friends. The young people and kids in particular — the earlier their smoking or secondhand exposure started, and the more consistent, the worse they report. Yet the parents persist in smoking around them. But certainly, heavy smokers are worse off."

Vascular surgeon — "It's all dose-dependent, but I wouldn't be surprised if the dose threshold for smoking is low. I have so few patients who qualify as light smokers that it's hard for me to tell whether they end up with the same level of blockage or not. The journals don't have much good news for them. We see damage to blood vessel linings and vessel flexibility and strength in light smokers."
The allergist also added an important aside, which is that a lot of infrequent smokers don't tell their doctors that they smoke at all. So it's possible that some of the asthmatics and cardio patients who tell their doctors that they're non-smokers don't believe that a few cigarettes once a week counts as smoking.

* This got my attention because his numbers aren't too far off from what's been seen in large-scale studies.
posted by jeeves at 12:14 PM on December 14, 2008 [1 favorite]

As a piece of anecdotal evidence, I quit smoking totally nearly four and a half years ago. I feel great, but when I get a cold (which occurs much less often than when I was a smoker) and it goes to my chest I remember that I'm an ex-smoker. This may get better after more years, but I think there's a good chance that I'll have this issue for the rest of my life.
posted by ob at 12:17 PM on December 14, 2008

Response by poster: Hildegarde: of course I don't think only sad, lonely people get cancer or sick or anything. I have a friend who is 29 that has cancer and another friend who is 30 who just got diagnosed with MS; I truly believe it can happen to anyone at any age. I think life is precious and would love to live long and live with pleasure and occasionally do things I'm not supposed to, because I'm a human being and I like whiskey and benandjerrys and salt and sex and watching too much television sometimes. Not ALL the time, but sometimes.

I just think this is really interesting, because we live in a world where there are so many variables for getting sick, and sooooo many things that can make you sick, from cellphones, to transfat, to genes to traffic jams, I mean, you just don't know for sure. So if my vice is an occasional smoke and I'm otherwise healthy and happy, I just want to know what I'm in for, especially as I get a bit older. (just had a birthday, so I've been wondering)
posted by Rocket26 at 1:37 PM on December 14, 2008

Response by poster: drjimmy: you're right, it was a weird comparison.

I guess I just meant, I do think there's a connection between mind/body/spirit, and it's hard to say what exactly affects our physical and mental health. I know I feel like crap if I eat fast food, and I mean crap, but a few cigarettes doesn't bother me at all. I feel bad if I don't exercise in a few days, but I feel worse if I've been lonely or really stressed out or whatever.

But I'm probably just trying to rationalize the smoking and I'm trying to be frank with myself and that's why I'm asking you guys!
posted by Rocket26 at 1:52 PM on December 14, 2008

Feeling like crap isn't the same as getting cancer, though. I felt fine until I got my diagnosis. Cancer creeps up on you like that. Just because doing something feels good to you doesn't mean it's good for your health. Sticking a q-tip in your ear and rolling it around feels fantastic, but it's not very good for your ears. Heroin feels pretty good too. You see what I mean.

Lots of things are bad for you. Smoking is one of them. There's no getting around that. You can justify it any way you want, but "it's not that bad" isn't the justification you're looking for. It might be something you're willing to factor into your life plan. But it's not because it's not a dangerous thing to do. Driving a car is a dangerous thing to do, and people opt to do it every day, twice a day. If what you get out of it makes it worth the risk, then so be it.

Yes, it will increase your risk of cancer and heart disease. Will it kill you? Who knows? Anything could kill you. We all have a deadline; most of us just don't know when it is. If you're going down in a fiery plane, are you going to regret NOT smoking?
posted by Hildegarde at 2:52 PM on December 14, 2008 [1 favorite]

Think of it this way: Pretend you work in a place that is generally safe but sometimes, not often (maybe once or twice a week or once every few months), they burn up their waste including plants, tar, chemicals, carcinogens, and other ingredients. The smoke from this fire gets piped through the air vents and since your desk is right next to the air vent, you breathe it in for minutes at a time. It's not entirely unpleasant and you breath it in on a light basis over years of working there.

Do you think working there will effect your health and longevity? Would you ask that your desk be moved? What would OSHA think? What would a doctor think? What would a lawyer think? Would you want to sue your company if you eventually developed cancer? Do you think you would have a case?

What everyone is saying above is right, but if you didn't have any control over it, or someone else was doing it to you on purpose, how would you feel then? Just trying to give you a different perspective.
posted by CoralAmber at 4:33 PM on December 15, 2008

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