It is estimated that 29% of adults in the UK smoke tobacco (Office for National Statistics, 2000). Each year smoking kills 120 000 people (13 deaths per hour), making it the single most common preventable cause of death in Britain (Callum, 1998). Around half of all smokers will die prematurely because of their addiction (Peto et al, 1994). Their overall life expectancy is, on average, 8 years less than for non-smokers (Callum, 1998). About a decade ago it was estimated that smoking cost the National Health Service (NHS) £1500 million per year, with around 1000 admissions every day for smoking-related illnesses (Parrott et al, 1998). At the same time, the UK treasury earned £8 billion in tax on tobacco sold in the UK alone, in addition to the enormous revenue from overseas markets.

Smoking is a major risk factor for at least 20 diseases, including coronary and peripheral vascular disease, chronic bronchitis and at least 80% of lung cancers (Callum, 1998). Blood coagulates in smokers more easily than in non-smokers, fibrinogen levels are higher and platelets are more likely to aggregate. These effects all contribute to thromboembolic diseases. Although nicotine itself is not carcinogenic, tobacco smoke contains over 200 other compounds that are potential carcinogens and smoking itself is the greatest single risk factor for lung cancer. Cigarette smoking significantly contributes to several other nasopharyngeal and upper gastrointestinal carcinomas (Benowitz, 1988).

Is nicotine addictive?

A 1988 US Surgeon General's report stated that nicotine is as addictive as drugs such as heroin and cocaine (Stolerman & Jarvis, 1995). This represents the culmination of a gradual political shift from viewing smoking as a bad habit to seeing it as a behavioural form of habituation and, ultimately, a formal addiction (Box 8.1).