I naively thought that the hazards of smoking tobacco products, particularly cigarettes, were sufficiently established AND known to the point that the number of people smoking cigarettes and the number of cigarettes consumed in the Unites States would decline, and that would be the end of the story.
So far, so good: The number of cigarettes sold in the United States AND the number of people smoking cigarettes have, indeed, declined:
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014. Figure 16.1, Total cigarette consumption, United States, 1900–2012. Available from: https://www.ncbi.nlm.nih.gov/books/NBK294312/figure/ch16.f1/
Lo and behold, we have people who PROMOTE smoking cigarettes because it looks cool, and you can see pictures of these people if you key in @cigfluencers in a search box, like the following:
Images from https://www.interviewmagazine.com/culture/jared-oviatt-of-cigfluencers-lives-and-dies-by-camel-blues. Anna Taylor-Joy, Ben Affleck, Shelley Duvall.
What’s behind the trend?
Let’s start with this video:
So perhaps the attitude towards cigarettes and cigarette smoking has changed, particularly for Gen Z. One may argue that their generation has had to deal with a lot of uncertainty: 9-11, the economic crash of 2008, wars in Iraq and Afghanistan, and concern about whether AI will block their ability to get a job.
At the same time, however, there may be another dynamic which is driving this return to smoking cigarettes, particularly for young women. One of the guest speakers for my Biology of Addiction class was a scientist from the University of Tennessee Health Science Center Department of Pharmacology who was a member of a team conducting research on nicotine and its effects. After giving her lecture, she mentioned that adolescent girls are known to initiate smoking in order to retard weight gain, and this was about 20 years ago.
Actually, we know quite a bit about the relationship between cigarette smoking, nicotine and body weight (Audrain-McGovern and Benowitz, 2011):
- Adults smokers weigh, on average, 4-5 kg less than nonsmokers, are less likely to be overweight or obese, and tend to gain weight when they quit smoking;
- Individuals who successfully quit smoking typically gain between 7 and 19 pounds within 8 years of quitting, whereas those who continue to smoke gain an average of 4-5 pounds;
- Approximately 10% of smokers who quit smoking gain close to 30 pounds in weight.
Copeland, et. al. (2016) describe fear of fatness (FF) and drive for thinness (DT) as two related but distinct motivations for smoking. In a study of 289 female college undergraduate students, daily smokers had the highest scores on measures of DT and FF, followed sequentially by infrequent smokers, “triers”, and never smokers. Furthermore, more frequent smokers also reported greater levels of body dissatisfaction and eating pathology (anorexia nervosa and bulimia nervosa) than less frequent and never-smokers. A detailed analysis of data showed that a greater desire for thinness (DT) predicted a higher likelihood of smoking on a daily basis, but surprisingly, higher fear of fatness predicted fewer cigarettes smoked per day.
What are the mechanisms by which smoking cigarettes retards weight gain? Nicotine reduces body weight by raising the resting metabolic rate by ~10% and by suppressing appetite. One may think that a 10% increase in metabolic rate, corresponding to an average expenditure of 200 kcal per 24 hours seems small, but if there is no change in caloric intake, this increase in energy expenditure caused by nicotine can result in the loss of 10 kg in body weight over 1 year.
Women pay a terrible price for smoking cigarettes. In 1995, Schmeiser-Rieder et. al. reported “Of the 300,000 deaths attributable to smoking among women in developed countries in 1985, 21% were coded to lung cancer, for example, 41% to cardiovascular diseases, primarily coronary heart disease and stroke, and 18% to chronic obstructive pulmonary disease. Overall, female deaths rates from lung cancer in developed countries increased by almost 200% between 1957 and 1987.”
Furthermore, they state the following regarding women who smoke:
- They typically go through menopause 2 or 3 years earlier than non-smokers;
- Cigarette smoking increases the risk of estrogen-deficiency diseases, such as postmenopausal osteoporosis and increased cardiovascular risk.
Audrain-McGovern, J.; Benowitz, N.L. (2011). Cigarette Smoking, Nicotine, and Body Weight. Clin Pharmacol Ther 90(1):164-168. doi:10.1038/clpt.2011.105.
Copeland, A.L.; Spears, C.A.; Baillie, L.E.; McVay, M.A. (2016). Fear of fatness and drive for thinness in predicting smoking status in college women. Addic Behav. 54:1-6. doi:10.1016/j.addbeh.2015.11.010.
Schmeiser-Rieder, A.; Schoberberger, R.; Kunze, M. (1995). Women and smoking. Wien Med Wochenshcr. 145(4):73-76.
