A Flurry of New Health Pluses for Smokers Who Quit
Elderly smokers and women hoping to conceive both can experience substantial health gains from giving up tobacco, according to a flurry of new medical findings that continue to emphasize the dangers of smoking.
On the one hand, a team at a Veterans Administration hospital in Houston has found that older smokers--even if they have smoked several packs of cigarettes a day for as long as 50 years--still have a great deal to gain by giving up tobacco.
Delaying Senility
If they quit, the Houston scientists say, elderly smokers will feel noticeably better within a year. More important, though, they will apparently reduce their chances of having a stroke and potentially will delay the onset of a variety of forms of senility--including Alzheimer’s disease.
At the other end of the life cycle, two researchers at the federal government’s National Institute of Environmental Health Sciences in North Carolina say they have uncovered new evidence that cigarette smoking can markedly reduce a woman’s fertility and delay her ability to conceive.
While tobacco falls far short of being a contraceptive, said one of the researchers, Dr. Donna Day Baird, the new study clearly tells women that, if they smoke, they should stop before starting to try to conceive--and not wait until after they know they are pregnant.
Still a third study of smoking indicates that Baird’s message apparently is not being received by women in the United States. An analysis of cigarette consumption patterns from 1981 to 1983 indicates that, while most sex and age groups in the United States are recording gradual reduction in smoking per capita, women in general--and young white women, in particular--are becoming an ever greater proportion of all smokers because their consumption is not falling as quickly as that of men and other women.
For the 18- to 22-year-old group, in fact, women now have a higher smoking rate than men--34.9% versus 34%.
If present trends continue, concluded the government’s Centers for Disease Control in Atlanta, smoking rates for men and women may be identical by 1990 and the lung cancer rate for women may exceed that of men by the turn of the century.
The cluster of new reports--led by the studies of the effects of smoking cessation in the elderly and the effect of smoking on conception--appears today in a special issue of the Journal of the American Medical Assn. devoted almost entirely to major new smoking research. It represents the second time in six months that the journal--one of the nation’s best known--has devoted a whole issue to smoking studies.
This week’s publication date is almost exactly 35 years after the Journal of the AMA published the landmark study that first proved the causal link between cigarette smoking and lung cancer. The historic paper, which has become a classic in public health circles, is being reprinted in the same issue with the new research reports.
The journal’s editor, Dr. George Lundberg, said the devotion of so much space to one subject in two issues only a few months apart--unprecedented, he said, in the journal’s history--occurred for several reasons. He noted that more promising smoking and health work is now under way than at any time in the past and that the AMA is considering for adoption--perhaps as soon as next month--a major new policy statement on tobacco use and addiction.
Long-Term Smokers
In the study of the benefits of quitting among the elderly, the Houston team, led by Dr. John S. Meyer, used new techniques to measure blood flow to the brains of 258 subjects, including non-smokers, smokers who had quit and people still smoking. The subjects are all over 55 and had been smoking an average of 30 to 40 years--some as long as more than 50 years.
Using the new methods--which permit precise calculation of the amounts of blood entering the brain without the need to insert instruments inside the skull--Meyer and his team found that, even in elderly smokers who have smoked heavily for decades, many of the harmful effects of smoking reverse themselves within 12 months after stopping smoking.
The discovery is a pointed contradiction of the beliefs of many elderly smokers, who often say they continue to smoke both because they have been at it so long that stopping isn’t possible and because they would not realize any benefit if they did.
On the contrary, Meyer said, the amounts of blood reaching brain tissue increased dramatically within 12 months after elderly smokers quit. While brain blood supply can’t affect a person’s risk of developing lung cancer, Meyer said, providing more blood to the brain can markedly decrease a person’s risk of having a stoke.
Alzheimer’s Disease
And, Meyer said, older people who quit also cut down on the chances they will become senile because the onset of various forms of dementia is related to the amount of blood available to brain cells. The reduction of risk apparently specifically applies to Alzheimer’s disease, Meyer said, which in recent months has been recognized as a major health problem among the old--leading to often complete loss of ability to reason and think.
In addition, Meyer said, older smokers who quit report “a feeling of well being.” He said the general sense of feeling better is accompanied by loss of the morning cough that plagues many older smokers and a noticeable decrease in feelings of nervousness and shaking of the extremities.
“They generally feel better,” Meyer said. “They think they’re sharper.”
That smokers show less blood flow to the brain than non-smokers suggests, said Meyer, that tobacco use causes hardening of the crucial arteries leading to the brain. “We feel it (smoking, especially among the elderly) is a definite risk factor,” Meyer said, “and we think it’s a risk factor in senility and dementia. We have not been able to show this previously.”
Most Visible Factor
He said that a number of health risk factors reduced brain blood flow, including a history of high blood pressure, diabetes and, “probably,” abnormally high levels of fat in the blood. He said heavy alcohol consumption also was implicated. But, said Meyer, smoking was the most clearly identifiable risk factor.
He noted that, as a person grows older, blood flow to the brain decreases naturally, by a small amount. The natural aging process, Meyer contended, makes quitting smoking especially important for the elderly.
In the study of smoking and women’s fertility, the government research team examined the ability to conceive of 678 pregnant women. While 28% of smokers were able to conceive during the first menstrual cycle after they started attempting to, 38% of non-smokers did so. Heavy smokers had lower fertility than light smokers, the team found, though the smoking habits of their husbands had no apparent relationship to conception and the actual significance of the differences in smoking levels was not clear.
“These data provide evidence that reduced fertility should be added to the growing list of reproductive hazards of cigarette smoking,” the team concluded.
Baird, who directed the research, said she worried, however, that women smokers might misconstrue the results to mean that they can rely on cigarettes for some contraceptive effect. “That is really something that concerns me,” Baird said, noting that smokers who tried to get pregnant still were able to during the first cycle more than a quarter of the time.
Spontaneous Abortion
Baird said women “who are contemplating pregnancy would be better off stopping smoking before they start trying (to conceive), rather than waiting until after they find out (they are pregnant).” Smoking has been previously proven to cause abnormally high rates of spontaneous abortion among women and to cause low birth weight among newborns.
In all, smoking women were only 72% as fertile as non-smokers, the team concluded. The researchers, however, were unable to determine for how long a woman’s reduction in fertility lasts after she quits using tobacco.
Unfortunately, though, noted a second team of government analysts, women seem to be slipping, overall, from their status as a group that doesn’t smoke as much as men. Though the trend toward greater parity in smoking rates between men and women and the possible predictable rise in lung cancer among women had been noted before, the Centers for Disease Control team found new evidence that women--especially young white women--are not paying enough attention to the dangers of what some physicians believe is the most potent addictive drug used in Western society.
The CDC researchers noted that overall cigarette consumption per capita is still dropping among all population categories--continuing a trend that began in about 1965. But because women are not recording decreases of the same magnitude as men, smoking rates for the two sexes are moving closer together--making women an obvious priority for future initiatives to cut down on tobacco use.
‘Equality’ in Smoking
Between 1965 and the end of 1982, the team noted, the proportion of adult men who smoke dropped from 51% to 34%, while the rate for women dropped only from 33% to 29%. Rates for women have decreased only slightly, moreover, since 1978. “If these trends continue,” the team warned, “it is certain that there will be ‘equality’ in the rate of smoking for men and women by 1990.”
Smoking among high-school-age boys and girls peaked in the mid-1970s, decreased after that but leveled off from 1980 to 1983, the CDC researchers found. The highest smoking rate--43%--of all was among black men from 30 to 44. Black men over 45 were close behind at 40.1% and Latino men over 45 had a rate of 42.2%. The smallest smoking rates were for Latino women over 45 (12%) and Latinas from 30 to 44 (13.8%).
There were clear contrasts among younger people, with black women from 18 to 22 smoking at a rate of 21.1%. The figure differed markedly from the rate for white women of the same age--34.9%. Latino women in the age group recorded a 22.7% smoking rate. For men the same age, the rates were: white, 34%; blacks, 23.7% and Latino, 30.8%.
One expert who has watched with interest as research on smoking and health has vastly increased in the last few years is Dr. Ernst Wynder, head of the New York-based American Health Foundation, a prominent center for cancer research of all types. It was a paper written while Wynder was a medical student that focused the first clear, scientific proof that smoking has potentially catastrophic health consequences.
Witnessing an Autopsy
As a medical student in the late 1940s, Wynder became interested in the link between smoking and health after he witnessed the autopsy of a man who had died of lung cancer. The young George Washington University medical student was curious that there was no mention in the man’s medical records of his smoking habits. Only when Wynder questioned the dead man’s wife could he confirm that the cancer victim had smoked heavily.
The curiosity, Wynder recalled in a telephone interview, was intensified because he had just read a speculative article raising the possibility that lung cancer and smoking might be linked.
In the summer of 1948, Wynder devised a questionnaire to be given to lung cancer patients and, at the start of the next school year, he approached Dr. Evarts A. Graham, a high-ranking surgeon, with the proposal for a major research study. The idea had only limited precedent since few medical students had ever directly participated as principal researchers in such an ambitious undertaking.
First Positive Link
“After we talked to the first 20 people, we knew we had something,” Wynder recalled. By the time the research had been concluded, 658 patients had been interviewed and the positive link between smoking and lung cancer had been made for the first time in a scientifically valid way.
“We knew it would be an important finding,” Wynder said of the conclusions reached by him and Graham, who died in 1957. “But we didn’t know how long it would take for the effects of smoking on health to be widely recognized.
“We discussed the possibility that our findings could (spark a controversy) and Graham said, ‘We’re going to face many problems, but you have one thing on your side.
“ ‘You’re right.’ ”
