Everyone says it is a bad idea to use tobacco. But just how bad is it? For starters, according to the US Department of Health and Human Services smokers have a 33 per cent lifetime chance of dying from a smoking-related cause. Smoking causes diseases in three main areas: cardiovascular, respiratory and cancer-related. While tobacco use is associated with cardiovascular deaths more than cancer deaths, there is enough evidence that tobacco causes cancer of the mouth, lungs, esophagus, kidney, bladder, pancreas, and stomach.

Tobacco smoking promotes fatty blockages in the blood vessels (atherosclerosis) which can lead to heart attacks, strokes and an entity called peripheral vascular disease. Severe peripheral vascular disease, for example, will cause pain in the legs even with ordinary walking because of restrictions in the blood supply to the legs. Smoking is also a very important cause of chronic lung disease, rampant in our country.

Smoking also has adverse effects on both a pregnant mother and fetus. In addition, smoking delays healing of peptic ulcers and increases the risk of cataract, osteoporosis (brittle bones), wrinkling of the skin and male impotence. There are even problems caused by passive or second-hand smoking. A meta-analysis (pooled data for analysis) of the best data has shown a 25 per cent increase in mortality associated with lung cancer, respiratory illness and cardiac diseases in people exposed to second hand smoking in households compared to households without such exposure. Children with smoking parents have increased prevalence of respiratory illnesses. The list is endless.

In the face of massive negative publicity against smoking, the tobacco industry has tried to improvise to maintain its profit. This tactical change by the industry is exemplified by promoting smokeless tobacco which is the fastest growing part of the tobacco industry and carries with it substantial risk for dental and gingival disease as well as oral and esophageal cancer. In Nepal, using moist snuff which consists mostly of tobacco with a scented flavor deposited between the cheek and gum is very common. This leads to gum disease, oral and pancreatic cancer as well as heart disease.

The good news is that many of these diseases can be controlled and even reversed if tobacco use is stopped. But because tobacco use is so addictive, there are counseling and behaviour change strategies including pharmacological adjuncts. But at the end of the day it is the individual who needs to be strongly motivated to kick the habit, we don't need the surgeon general anymore to tell us it is injurious.