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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Man to Man Man to Man

Light Smoking -- Unsafe in Any Dose

October 23, 2014

By Harvey B. Simon M.D.

Harvard Medical School

The dangers of smoking are well known. It is a major cause of:

  • Heart attacks
  • Strokes
  • Dementia
  • Aortic aneurysms
  • Emphysema, asthma and lung infections
  • Cancers of the mouth, throat, lung and many other organs

Over the years, scientists have discovered that filtered cigarettes, low-tar and nicotine cigarettes, pipes, cigars, smokeless tobacco and secondhand smoke are also major health hazards.

Smoking and Sexuality

If the risk of heart disease, emphysema, cancer, stroke and dementia isn't enough to convince you to quit, consider tobacco's toll on male sexuality and reproductive function.


  • Impairs sperm function
  • Doubles the risk of erectile dysfunction(ED)
  • Doubles the risk of bladder cancer, a predominantly male disease
  • Boosts a man's chances of dying from prostate cancer

The landmark U.S. Surgeon General's report on Smoking and Health blew the whistle on cigarettes in 1964. Since then, the percentage of Americans who smoke has been cut in half. Yet smoking is still a huge problem.

  • More than one of every five American adults still smoke.
  • Thousands of teenagers take up the habit every day.
  • Despite all of the bans on smoking in public places, about 40% of non-smoking Americans are still significantly exposed to secondhand smoke.

Why? Nicotine is highly addictive and despite many restrictions, tobacco companies continue to push their products.

And in a curious way, doctors may have contributed to persistent tobacco use by encouraging the belief that light smoking is safe, or at least not that harmful.

A recent study shatters that illusion.

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Eye-Opening Study Results

To evaluate the effects of light smoking, researchers from the University of California, San Francisco reviewed over 800 published studies of smoking in adults age 18 and older. They homed in on 45 studies that met tough standards for scientific excellence. Although the individual studies used different criteria for light and intermittent ("social") smoking, each carefully looked at the health risks of low-dose cigarettes.

The results are startling and convincing. All in all, light and intermittent smoking is nearly as dangerous as heavy smoking. When compared with non-smokers:

People who smoke up to 14 cigarettes a day have:

  • 4 times the risk of esophageal cancer

People who smoke up to 9 cigarettes a day have:

  • 2.7 times the risk of heart disease
  • 2.3 times the risk of aortic aneurysms
  • 1.8 times the risk of pancreatic cancer
  • 1.7 times the risk of cataracts

People who smoke up to 4 cigarettes a day have:

  • 2.8 times the risk of lung cancer
  • 2.4 times the risk of stomach cancer

Men who smoke even occasionally have an overall death rate that is 1.6 times higher than the death rate of non-smokers.

There is no safe dose of smoking. It's up to each smoker to decide to quit. And it's up to his doctor to provide whatever help it takes. And it's up to all of us to encourage everyone to quit and to encourage community standards, legislation and peer pressure that will put smoking in its proper place in the history books. The only safe cigarette is one that's never been smoked.

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How To Break the Habit

Avoiding tobacco in all its forms may sound like an easy solution. However, quitting is hard. Most men start out by trying to quit on their own. Here are some tips that can help.

Getting ready

    • Make a list of reasons to quit and another list of people who have kicked the habit. The first list will remind you why quitting is important. The second one will show you that folks who are no stronger or smarter than you have succeeded. Keep your lists handy and refer to them whenever you begin to waver.
    • Pick a quit date and stick to it. Plan to quit on a special day, such as a birthday or the American Cancer Society's Great American Smokeout (the third Thursday of each November). Steer clear of stressful periods. And avoid holidays if you are likely to be invited to smoke-filled parties.
    • Try to get other smokers in your household or circle of friends to join you in quitting. An important study found that smoking behavior spreads through both close and distant social ties; your resolve and success can help your friends and, ultimately, your community.
    • As your quit day approaches, throw out your ashtrays, clean your house, car, clothes and your teeth. Once you're away from smoking, you'll see that it stinks.

Coping strategies

    • Anticipate withdrawal symptoms, such as grumpiness, restlessness, irritability, hunger, headache, anxiety and drowsiness or insomnia. The discomfort usually peaks one to three weeks after you quit, and then gradually diminishes. To get through the rough patches, stock up on low-calorie snacks and sugarless gum or candy to keep your mouth busy. Plan enjoyable diversions to keep your mind busy. Think of ways to keep your hands busy; doodling and using worry beads are examples.
    • If you feel tense, try meditation, deep breathing or yoga.
    • Begin an exercise program. It will relieve tension, promote good sleep and help control weight gain. Walking for 30 minutes a day can really help.
    • Eat a healthy diet.
    • Stay away from secondhand smoke. Don't even think about smoking "just one." Even a single puff will set you back.
    • Reward yourself. Put your tobacco money aside in a kitty, and then spend it on a special treat.
    • Think positively. You can quit, just like the 45 million Americans who have already done it. Take one day at a time. And if you slip, try, try again. Remember that most people who kick the habit need to try several times before they succeed.

Getting help

Don't think you have to do this alone. Professional counseling and support groups can help. Your doctor, hospital or local chapter of the American Cancer Society or American Lung Association can put you in touch with programs in your community.

Nicotine replacement therapy can help you break the addiction. Nicotine gum, patches and inhalers are available over the counter; nicotine lozenges are available by prescription. And prescription drugs such as bupropion (Zyban, Wellbutrin) and varenicline (Chantix) can also help. As with all medications, they can have side effects, so ask your doctor if they are right for you.

Schane et al. "Health effects of light and intermittent smoking." Circulation. 2010; 121:1518.

Centers for Disease Control and Prevention. "Currrent cigarette smoking among adults 18 years, United States 2009." MMWR Morb Mortal Wkly Rep. 2010; 59:1135¨C1140.

Centers for Disease Control and Prevention. "Vital Signs: Nonsmokers'; exposure to secondhand smoke—United States, 1999–2008." MMWR Morb Mortal Wkly Rep. 2010; 59:1141–1146.


Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.

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