How many ways can we say that cigarette smoking is bad for you?

H ow many different ways are there to say that cigarette smoking is bad for you? Smoking is an epidemic that affects one in three adults in the world, 23% of adults and 28% of high school students in the United States. 1 Nearly 450,000 persons will die every year of a disease attributable to tobacco use. 2 In the United States, tobacco use kills more people each year than AIDS, suicide, murder, car accidents, and illicit drugs combined. The economic impact of the diseases caused by smoking is significant. It is estimated that 8% of all annual health-care expenditures in the United States are used in the treatment of smoking-related diseases. 2 The loss of productivity is more difficult to define. It has long been known that smoking causes lung cancer. 3 Recent evidence has strengthened the view that current smoking is an independent predictor of shortened lung cancer survival. 4 In this issue of CHEST (see page 1733), Garces et al provide evidence that smoking also affects the quality of life (QOL) of lung cancer survivors. They report the results of a cross-sectional study in which 1,028 survivors of lung cancer responded to a lung cancer QOL survey, with the results analyzed to determine the impact of tobacco use on the QOL of these patients. The findings of the study are straightforward and disturbing. As expected, the QOL was better for the survivors who never smoked and for former smokers when compared with survivors that were currently smoking. Never-smokers and former smokers had better appetite; less fatigue, cough, and dyspnea; and less distress. Unfortunately, 30% of patients who were smoking at the time of their lung cancer diagnosis continued to smoke afterwards, and 5% who were former smokers restarted the deadly habit. Tobacco use has been known to decrease the QOL in other settings (nicely outlined in the article by Garces et al). Whether this study provides novel information or not is not entirely clear. As there was no baseline (at the time of diagnosis) survey administered , it is possible that the tobacco-related reduction in QOL was present well before lung cancer was known to be present. Nonetheless, we have been provided with yet another reason why smoking is bad. So with all of this evidence available, why do so many continue to smoke, even in circumstances in which it is hard to imagine that they would …