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How Long Do Tobacco Users Live?

Tobacco Related Mortality. Published in Nature (Volume 370, page 184, July 1994) by Brad Rodu and Philip Cole.

Despite widespread knowledge of the health risks of cigarette smoking, many smokers do not quit because they are addicted to nicotine. As abstinence is not a realistic goal for these inveterate smokers, traditional quit-smoking programs are of limited efficacy. Rodu (See The Proposal above) proposed that inveterate smokers switch to the use of smokeless tobacco, which satisfies the smoker's nicotine addiction but poses a much smaller threat to health than does continued smoking. The only consequential hazard posed by smokeless tobacco use is cancer of the oral cavity. Here, we show that the risk of oral cancer from smokeless use is so small as to comprise no meaningful objection to its substitution for the inveterate smoker.

The results of our analysis reveal that the average remaining life expectancy of a 35 year old nonuser of tobacco is 45.96 years, which is 0.04 year more than that of a smokeless tobacco user. The reduction in life expectancy of a smokeless user amounts to 15 days and is in sharp contrast to the average loss of 7.8 years experienced by the smoker. Thus, the 35 year old tobacco abstainer and smokeless tobacco user will both live on average to be 80.9 years of age compared with 73.1 years of age for the smoker. Only 67% of smokers will be alive at age 70 compared with over 87% of smokeless tobacco users and nonusers of tobacco.

The negligible impact by smokeless use on life expectancy may be surprising. In fact, the risk of developing oral cancer from smokeless tobacco use is small and the disease is not uniformly fatal. In addition, smokeless tobacco is not associated with any of the other common causes of smoking-related deaths such as lung cancer, emphysema and heart diseases.

Awareness of health risks and access to current quit-smoking programs cannot reduce smoking among inveterate smokers for one compelling reason: these strategies require tobacco (and thus nicotine) abstinence, which is not attainable for many smokers. This study suggests that abstinence is not the only approach to reducing tobacco-related mortality -- a switch to smokeless tobacco accomplishes virtually the same thing.

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