Quitting smoking: it’s a personal decision and a lifestyle choice

Being aware of the risks is certainly a first step towards giving up tobacco. But the true key to success lies in your personal motivation.

So you want an example? During pregnancy, 75% of expectant mothers who smoke succeed in giving up.

Unfortunately, the majority of them resume the habit after giving birth.


Because they stopped for the benefit of their baby, whereas long-term cessation is the result of a personal choice which you make for yourself, for your own well-being and for your own future.

One billion tobacco-related deaths by the end of the 21st century

According to an article published in the journal Nature Reviews Cancer, Robert Proctor, a professor of the history of science from the state of Pennsylvania, predicts that there will be more than a billion deaths caused by smoking before the end of this century.

This prediction by Professor Proctor is the result of a series of historical analyses of mortality rates caused by tobacco and of global smoking levels and the effects of smoking.

Proctor has shown in particular that lung cancer was an extremely rare disease before the 20th century, so rare in fact that doctors at the time were surprised when they saw it.

The link between the occurrence of lung cancer and the number of smokers was realised for the first time by Isaac Adler in 1912. However, the first quantitative analysis of this link was not made until 1929, in Germany. In that same year, global cigarette consumption had already reached 600 billion per year.

Consumption has since increased tenfold, reaching a peak in 1990. In his article, Proctor gives a description of the different studies on the smoking epidemic, its links to lung cancer, the obstacles to tobacco control, and the growth in cancer rates worldwide.

Proctor’s results present statistics that show there is about one lung cancer death for every three million cigarettes consumed. Professor Proctor says that, as consumption rates are carefully recorded by governments, it is fairly easy to predict the long-term cancer consequences of a given level of consumption.
Source: Nature Reviews Cancer 2001;1:82-86.

COPDs (Chronic Obstructive Pulmonary Diseases)

Although underestimated, still extremely prevalent . . .

In France, 2.5 million people are affected by chronic obstructive pulmonary diseases, or COPDs. And the reason . . . yet again . . . is smoking!

The French-language Society of Pneumology (Société de pneumologie de langue française – SPLF) is launching a massive communication campaign so that people are better informed about these complaints. The campaign does, of course, target the public at large, but also . . . . doctors! The reason for this is that COPDs are still diagnosed too late and their treatment is badly managed.

Indeed, they are all too often confused with asthma. They are characterised by progressive obstruction of the bronchial tubes and result in a progressive but nonetheless irreversible reduction in respiratory output. Ultimately, this develops into chronic obstructive respiratory insufficiency. And once the patient has reached that state, he has to be treated at home with oxygenotherapy.

According to the WHO, COPDs are the world’s 6th biggest killer! And they appear to be very widely under-diagnosed. To such an extent in fact that 12% of the population of the developed world are said to be affected. In France, COPDs claim 15,000 victims each year. The majority of these are smokers, given that one in five smokers after the age of 40 contracts chronic obstructive pulmonary disease.

Source: Le Quotidien du Médecin, 29 November 2001, Fédération ANTADIR [Association Nationale pour le Traitement A Domicile de l’Insuffisance Respiratoire – (French National Association for the Treatment of Respiratory Insufficiency at Home), 21 November 2001.

Are light cigarettes really less harmful?

More and more people are attempting to quit smoking using patches and other nicotine substitutes. Numerous information and prevention campaigns outlining the risks linked to tobacco consumption have increased general awareness of the detrimental effects of tobacco addiction. But not everyone has the necessary willpower to successfully complete the ambitious undertaking of giving up. In addition, certain smokers settle for “light” cigarettes, in the belief that they are less harmful to health than so-called “normal” cigarettes.

Unfortunately, at the present time, no one can say with certainty that these light cigarettes are less harmful to health than normal cigarettes. At the request of the American FDA (Food and Drug Administration), the US Institute of Medecine looked into this question and issued its report at the end of February. There is no evidence to suggest that these cigarettes expose the consumer to carcinogenic substances to a lesser degree. While it may be thought that these light cigarettes enable the smoker to inhale fewer carcinogenic substances than if he were smoking traditional cigarettes, smokers of light cigarettes tend to smoke more and to take larger puffs. In short, then, don’t be led into believing that smoking light cigarettes constitutes a lesser evil; after all, smoking “light” is still smoking!

Great Britain: 57 users of the smoking-cessation drug Zyban die

The UK Medicines Control Agency did, however, emphasise that the contribution of Zyban to the 57 deaths was ‘‘unproven’’ and that “in most cases, the individuals’ underlying condition may provide an alternative explanation” for their deaths. The government agency also noted that in 14 cases, patients had no longer been taking Zyban at the time of death. Zyban is a drug produced by the British pharmaceutical group GlaxoSmithKline. Up to 30 November 2001, it had been prescribed to approximately 500,000 people in Great Britain. By 10 January 2002, the MCA had received reports of nearly 7 000 cases of suspected “adverse reactions” to Zyban, including, in particular, insomnia, rashes, headache, nausea and giddiness.

Women who smoke: the risks that they choose to neglect

The majority of women are aware of the dangers associated with smoking during pregnancy: miscarriage, premature birth, low birth weight. On the other hand, though, they too often are unaware that outside of pregnancy, they are subjecting themselves to the harmful effects of tobacco on their health; in particular, they are unaware of the potentially dangerous interactions between tobacco and the female hormone system.

An immediate risk: cigarettes and contraception

The combination of smoking and the pill is conducive to the formation of blood clots, while also damaging the walls of and narrowing blood vessels. The risks of cardiovascular accident (heart attack, cerebrovascular accident), phlebitis or deep vein thrombosis (DVT) are therefore significantly increased in women who use an oral contraceptive. After the age of 35, this risk is even greater.

Delayed-action effects: cigarettes and female hormones, cigarettes and skin-ageing.

In the long term, tobacco disturbs the functioning of the female hormone system and causes the following:

– a decrease in fertility before the menopause
– early onset of the menopause (two years earlier on average)
– an increase in bone decalcification (osteoporosis, brittle bones).

Furthermore, tobacco reduces blood and oxygen flow to the skin; this has several visible consequences: the skin becomes dull, it loses its softness and wrinkles occur earlier and are more pronounced. The effects are all the more obvious as well, as the efficacy of facial care products is reduced by the action of cigarettes. Consequently, by not smoking, you are contributing to a slowing-down of the skin-ageing process.

While actors are smoking, it’s the youngsters who are getting hooked!

There is no shortage of footage showing stars with a cigarette between their lips, both on television and in the cinema. And it seems that this has a direct influence on adolescents starting to smoke.
James Sargent and his colleagues studied 4,919 youngsters aged between 9 and 15 at school in the state of Vermont in the USA.

They asked the youngsters if they had ever tried smoking and if they had seen any of the films featured in a list of 600 titles. All of these films included scenes – five on average – where cigarette smoking was particularly highlighted.

And the results are unequivocal! Among students who had watched films with 50 or fewer occurrences of smoking, only 4.9% had ever tried smoking. The figure was 13.7% for those who had watched between 51 and 100 scenes. Of those who had watched films with more than 150 occurrences of smoking, 31.3% had tried smoking.

It is thus proven that the film industry does have a direct responsibility for smoking among juveniles. In addition, certain actors have no hesitation in signing extremely juicy contracts with certain cigarette brands! Is it not time, therefore, to start reversing the trend?
Source: British Medical Journal, 15 December 2001.

Tobacco wreaking havoc in Switzerland

In Switzerland, around 8,000 people die each year from tobacco-induced diseases. Cigarette addiction costs the Swiss 10 billion Swiss francs per annum, whereas taxes on tobacco bring in only 1.7 million billion francs which are not allocated to smoking prevention. (…) (A proposal aimed at strenghtening smoking prevention was not endorsed by the Federal Council, which was) which was clearly afraid to get on the wrong side of the tobacco industry “.

Note: The following bodies take action on nicotine prevention; they are represented onthe Bureau pour une politique de santé [body examining the setting up of a health policy involving the setting up of a fund for prevention of smoking and the increase of taxation on tobacco products]: The Swiss Association for Smoking Prevention (AT), the Swiss Pulmonary League, the Swiss Institute for the Prevention of Alcoholism and other Addictions (ISPA), the Swiss Cancer League (LSC), Promotion santé suisse, the Swiss Society for Public Health (SSSP), the Federation of Swiss Doctors (FMH), the Federation of Swiss Health Insurers, the Foundation for the Protection of Consumers.
Source: The Swiss Association for Smoking Prevention.(AT)

Are menthol cigarettes more dangerous than other cigarettes?

by Erin McClam
ATLANTA (AP) – Are menthol cigarettes more dangerous for a smoker’s health than traditional cigarettes? Recent studies have failed to settle the question of whether menthol makes cigarettes more dangerous, and the scientists who are finding it difficult to reach a conclusion are calling for further investigation.

Some experts suspect that the smoother, cooler sensation created by menthol leads smokers to drag more deeply on their cigarettes, causing them to absorb more nicotine into their lungs. Some suspect menthol may damage cells and allow cigarette toxins to seep through and cause cancer.

“For decades we took the approach that tobacco products were so deadly, the ingredients were basically a side issue,” said Jack Henningfield of Johns Hopkins University. “We’re recognizing that ingredients can make a lot of difference.”

Menthol is an alcohol extract from peppermint oil and is often used as a local anaesthetic. It is added to a variety of products, such as shaving cream, mouthwash and breath-freshener mints. In cigarettes, it is advertised as giving a cooler taste.

Conflicting studies on whether menthol makes cigarettes more dangerous were reviewed at a conference held in Atlanta by the local Center for Disease Control and Prevention (CDC).

A study presented by Dr Neal Benowitz, a clinical pharmacologist at the University of California at San Francisco, found that menthol was not associated with higher intake of nicotine or carbon monoxide.
But Karen Ahijevych of Ohio State University presented preliminary data showing that menthol increases exposure to carbon monoxide, at least in men, and causes higher levels of nicotine in plasma.

And some other studies suggest that menthol may help damage cells, making them more permeable to cancerous toxins.

The possible dangers of menthol are all the more alarming as they particularly concern sectors of the population who already have higher than average smoking rates. According to Dr Benowitz, 75 percent of black smokers prefer menthol cigarettes, compared with 20 percent of white smokers. First-time teen smokers are more likely to choose menthol cigarettes as well.

The CDC called the conference to encourage more research on the dangers of menthol. The agency itself has just begun a comprehensive study examining nicotine levels in people who switch from regular cigarettes to menthol.

For the time being, the scientists do agree on one point at least: menthol makes it easier for smokers to take deep drags, which may lead them to smoke faster and finish more cigarettes in a shorter time.
“Menthol may make the cigarette more addictive,” said Dr Steve Sidney, a Kaiser Permanente researcher. “And anything that would make smoking more addictive would be bad for your health.”

Philip Morris accused of selling defective filters

American researchers are accusing the tobacco giant Philip Morris Inc. of having marketed cigarettes with defective filters for 40 years.

Scientists from the Roswell Park Cancer Institute in Buffalo (New York) claim that the filters of the offending cigarettes release potentially harmful filter fibres and carbon particles.

“The filter of today’s cigarette is defective; Philip Morris Inc. has known of this filter defect for more than 40 years,” Roswell’s Dr John Pauly said in a report published in the journal Tobacco Control.

But Philip Morris, one of the world’s leading manufacturers of cigarettes, said the filters do not increase the health risks of cigarettes and the company has not tried to hide the issue from scientists.
“We take very seriously scientific reports claiming that an aspect of our products could increase the health risks of smoking, but, based on our assessment of the available data, I do not believe that the filters we use pose additional health risks to smokers,” a spokesman for the company said.

Ninety percent of cigarettes sold worldwide are filter-tipped.

Pauly and his colleagues based their findings on 61 documents from Philip Morris, US patents and court documents and information from scientific and medical databases.

Nicotine attacks neuron production

PARIS (AFP) – Nicotine is the component of cigarettes considered to be responsible for making them addictive. Now, for the first time, a French study published in the May edition of the American magazine Journal of Neuroscience has revealed that nicotine also appears to have a negative impact on the production of new neurons.

The work of the researchers from the French National Institute for Health and Medical Research (INSERM) was conducted on rats, on an area of the brain known as the dentate gyrus. The special feature of this part of the brain is that it produces new neurones throughout the brain’s lifespan and also has an effect on learning and memorisation.

The stimulating effects of nicotine on the cognitive functions have long been demonstrated. However, it appears that heavy smokers experience an alteration in their learning and memorisation mechanisms in a withdrawal situation as well. This would seem to suggest that chronic exposure to nicotine has harmful effects on the brain that disturb cognitive performance.

In an attempt to explain this observation, which has thus far not been biologically proven, the researchers from INSERM chose to study the plasticity (changes in function or structure) of a particular area of the brain of the rat.

Analysis of the data gathered from these rodents shows that nicotine consumption reduces neuron production, and all the more so if the rats gave themselves even higher doses of nicotine.

During the experiment, which lasted 42 days, the rats that took the median dose, as determined by the researchers (0.04 mg per kg), suffered more than a 50% higher loss in the production of new brain cells than the non-nicotine group.

Similarly, the biologists noticed that there was a 44% reduction in the characteristic protein level (PSA-NCAM) normally produced during neuron migration between the group of rats taking nicotine and those that did not. In addition, when the absorbed dose of nicotine was high, there was also a significantly higher rate of brain cell death.

The authors of the study, Djoher Nora Abrous and Pier-Vincenzo Piazza, from INSERM Unit 259 based in Bordeaux and led by Michel Le Moal, underlined that the doses administered to the rats were similar to those absorbed by smokers.

Up to now, very little research has been conducted into the negative effects of nicotine on the brain, and this component of cigarettes has even in some cases been recognised for its beneficial action on the nervous system and, therefore, on the neurons.

Could smoking be making us stupid?

Tobacco is damaging for our lungs, our heart, our arteries and . . . our brain!

INSERM [the French National Institute for Health and Medical Research] is publishing a study which claims that when heavy smokers decide to quit smoking, their learning and memorisation mechanisms undergo a change. In simple terms, the higher the dose of nicotine consumed, the more neurons will have been destroyed. And at the same time, the production of new cells will have been slowed down . . .
You can’t even remember any more why you started smoking? Then it really is time to give up!

Smoker or non-smoker: it’s a question of lifestyle

Playing a sport is an activity associated far more with non-smokers, especially among men. Similarly, more non-smokers than smokers tend to avoid over-fatty/sugary foods.

Cigarette addicts are also not keen on vegetables such as green beans or carrots. And they’re not crazy about cruciferous vegetables – cabbages, radishes, cress and turnips – either. And finally, they consume between 20% and 50% less fruit than non-smokers. ..

So-called “heavy smokers” – those who smoke more than 20 cigarettes per day – absorb less calcium, less vitamin C and less fibre. They also have a higher cholesterol rate than any other section of the population . . .
In short, then, smokers eat badly. . . And they know it! Around one in three of them acknowledges that his eating habits are “not very well balanced, or even “not at all balanced”. The same is true for only one in four non-smokers on average. But it is perhaps not really astonishing, given that smoking itself is the result of a behavioural disturbance linked to addiction to a drug.

Children becoming more and more hooked on tobacco

Children very quickly become “hooked” on nicotine, even by smoking relatively few cigarettes. According to an American study published in the specialist journal Tobacco Control, two cigarettes per week are sufficient to get a youngster hooked.

The authors have written in this quarterly journal, published by the British Medical Journal Publishing Group, that “children become nicotine-dependent at an astonishing speed, and even with such low quantities of tobacco that no one would have thought this possible.”

The researchers questioned 679 schoolchildren aged between 12 and 13 on several occasions over a 30-month period. Among 332 of the students who had tried smoking – even just one puff – 40% reported symptoms of addiction (an absolute need to smoke, difficulty in quitting, irritability or anxiety when not smoking . . .) The girls who were “hooked” became addicted more quickly than the boys (three weeks on average, as opposed to 183 days for the boys) after they had starting smoking occasionally.

The person in charge of the study, Dr Joseph DiFranza from the University of Massachusetts, pointed out that “some of these children were snared within just a few days of starting to smoke.”

“But the speed at which signs of addiction set in is perhaps even more surprising”, the report’s authors added. Until now, according to the authors, it had been thought that addiction did not begin until teenagers were smoking 10 or more cigarettes a day.

According to the study, half of the youngsters who showed signs of tobacco addiction smoked two cigarettes per week on average; and in two-thirds of the study group addiction occurred before they started daily smoking. By the time of the last interview, however, only 75 of 332 youngsters were still smoking, as the others had all quit.

The authors suggested that children and adults developed addictions to nicotine at different rates. As the adolescent brain was still developing, it was more vulnerable to addiction than the adult brain, and the impact of nicotine was stronger and longer lasting among adolescents.

“The findings of studies into the effects smoking on humans and animals led me to suspect that in many cases nicotine addiction kicks in with the first cigarette,” Dr DiFranza concluded.

Tribune de Genève of 23 September 2002 – My red-letter day (Encre bleue column)

This Monday is a great day for me! I’m celebrating three and a half months of having a clear complexion and nice baby-pink lungs again.

Yes, that’s right! It’s now three and a half months since I stopped smoking. Since I said Cheerio, Good-Bye and Ciao to those wretched fags that turned my fingers yellow and my teeth black for so many years. Every dog-end brought me to my wits’ end. My owned stained digits were under the thumb of that evil weed. All those drags had become one big drag! And God knows, I got through enough in my time! How many? As they say, if you’re in love, you don’t count the cost . . .

I said to myself: “I want to quit, but I’ll never be able to manage on my own.” And that was when I discovered the website “TABAC STOP Center” on the Internet. They explain how they will wean you off the “Gauloises”, using their 100% natural and painless “soft laser” programme. And they assure you that “the laser will increase the endorphin rate again to a level that is sufficient to reduce physical dependence on nicotine”. The treatment comprises two 30-minute sessions and one year’s free follow-up, just in case you fall by the wayside. At the rate I was puffing my cash away, the sum they were asking would be paid off within two months.

So, one fine day in June, I turned up at the centre in Chêne-Bougeries. Jean-Louis ran a device no larger than a packet of cigarettes over various points on my body. This was to rid me of the desire to smoke, to prevent me from eating to excess and getting stressed to death. “Huh!” I thought. How sceptical I was during the session, while he was explaining to me that the method had an 80% success rate…

That meant 20% failure. So which bracket was I going to fall into?

Amazing! Since 5.30 pm on that day, I haven’t taken another puff. There have been a few minor sufferings along the way, but much less than I imagined.

I can finally breathe again. Crack open a bottle! It’s celebration time!


Sudden Infant Death Syndrome (SIDS): Smoking called into question

Researchers from the Institut Pasteur, the Karolinska Institute and the Hôpital Robert-Debré in Paris have discovered how nicotine can lead to sudden death in infants by altering breathing reflexes during sleep.

– To what can these sudden deaths in infants be attributed, and do they occur frequently?

SIDS is the number one cause of death in France among infants in their first year: there are between 300 and 400 cases annually. While the causes are still not known, certain risk factors are. These include the way in which the baby lies in the cot, whether the mother has smoked during pregnancy and, to a lesser extent, whether there is cigarette smoke around the cot after birth (a parent who smokes creates an added risk).

– What exactly did the study carried out by the Institut Pasteur involve?

The studies looking into the link between smoking and sudden infant death were carried out by three laboratories: the Institut Pasteur, the Karolinska Institute in Stockholm and the Hôpital Robert-Debré (part of INSERM [the French National Institute for Health and Medical Research]). The analysis was conducted on adult mice in which a component of the acetylcholine receptor (and also of the nicotine receptor), the beta-2 subunit, had been genetically inactivated from the time of the animals’ conception (all these mice had therefore lost this receptor in the brain at the foetal stage). These mice were placed, together with normal mice (the control group), in a plethysmograph, a device where their breathing can be measured, and in which the animals fall asleep and wake up spontaneously. During their sleep, the oxygen rate is drastically reduced to induce a state of hypoxia. Their reaction on waking is then studied. It was noticed that the genetically modified mice found the waking process far more laborious compared to the normal mice. Once they had woken up, the breathing of those mice without the acetylcholine receptor was different. As if to compensate, their respiratory amplitude had increased in an unusual manner.

– So what have you learned from these results?

“We have seen proof that the beta-2 subunit of the acetylcholine receptor, which is also the receptor for nicotine, is vital if the waking reflex is to kick in properly. The hypothesis is that chronic exposure to nicotine during the foetal state alters the properties of this receptor; this will also change this survival reflex in the infant after birth. A baby in whom the receptor may have been altered by nicotine from its mother during its foetal development will show a predisposition towards respiratory arrest during its sleep . . . A pregnant woman who smokes!! That really should be a thing of the past! Especially if you bear in mind that, in addition to nicotine, other toxic agents are liable to damage the foetus and affect its health, namely the tars and a variety of gases . . .

– What studies are being carried out at the Institut Pasteur into the harmful effects of tobacco?

We are working very particularly on the mechanisms of nicotine addiction, given that nicotine is a drug, and also on the consequences of being weaned off smoking that lead ex-smokers to resume the habit.
(Paris Match, 17 October 2002)

Tobacco: and now it’s breast cancer as well

Does your daughter smoke? If so, you should now warn her that, in addition to the risks of developing cardiovascular complaints, colorectal cancer, lung cancer, cancer of the mouth, of the pharynx, of the larynx, of the oesophagus, of the pancreas, kidney cancer and bladder cancer, she could develop breast cancer as well.

Pierre Band and his colleagues from the British Columbia Cancer Agency in Vancouver (Canada) compared the smoking history of women who had had breast cancer and those had not. Those women who began smoking within five years of starting their periods were around 70% more likely to develop cancer later in life than non-smokers.

These results reinforce how important smoking prevention is, and from a young age as well. As Pierre Band explains, “the damage is all the more significant as adolescent breast tissue is more sensitive to the effect of environmental carcinogens.”
Sources: The Lancet, 3 October 2002.

560 deaths per hour, 13,400 per day. . .

. . .This is the alarming toll of worldwide smoking, as drawn up in Geneva by the authors of the WHO’s Tobacco Atlas. “With 4.9 million deaths per year, no nations and no populations are spared by the world’s largest avoidable epidemic.

Dr Gro Harlem Brundtland, Director General of the WHO, recently announced in Geneva that “by presenting complex statistical and epidemiological data in a straightforward manner, this atlas enables each of us to understand the facts more clearly and to be able to use them efficiently.”

The atlas, which is, unfortunately, available in English only, shows that tobacco consumption is increasing everywhere in the world. The 4.9 million deaths that occur at the moment are set to become 8.4 million in 2020! The document was even published while the WHO member states were gathered in Geneva to negotiate the draft of a Framework Convention on Tobacco Control (FCTC).

This was, of course, no mere coincidence. Dr Judith McKay is co-author of the atlas with Dr Michael Eriksen, a former director of the US Office on Smoking and Health, and she explains that: “the measures taken today will determine tomorrow’s reality. And the Atlas must be used as a valuable tool to fight against the smoking epidemic.” To find more information and access to all the maps and statistics, go to
(Destination Santé)

Cancer patients: it’s never too late to stop smoking!

“Strategies to help cancer patients quit smoking should start as soon as possible after diagnosis of the cancer.”

To achieve this, Dr Ian Olver, from the Royal Adelaide Hospital Cancer Centre in Australia, conducted a study among 384 cancer patients into the effectiveness of self-motivation techniques to encourage them to give up smoking.

The results were not particularly convincing. However, this method could make it possible to predict which patients are most likely to quit smoking. Especially those who think that their smoking habit is the reason for their illness. “Healthcare providers need great sensitivity when discussing smoking with a patient and to understand the reason why they smoke. For instance, if the patient smokes because they are stressed, the cause of the stress should be tackled,” Ian Olver emphasises.

Dr Olver also wanted to dispel a commonly held viewpoint: “Many patients believe that once they have been diagnosed with cancer, it is beyond the point at which giving up smoking can make any difference. That is just not true. It is never too late to stop. Quitting smoking can improve not only your outcome, but also the quality of the patient’s life.”

Sources: Congress of the European Society for Medical Oncology, October 2002.
(Destination Santé)

Cannabis more damaging to the lungs than tobacco

LONDON (AFP) – Cannabis is more dangerous than tobacco, and smoking three pure cannabis joints is now as harmful for the lungs as smoking 20 cigarettes. This is one of the findings of a British medical study published recently. The study, conducted by the British Lung Foundation and entitled A Smoking Gun, adds that when cannabis is mixed with tobacco, the effects are dramatically worse. The tar found in cannabis contains 50% more carcinogens (agents likely to cause cancer) than tobacco. The study shows that the dangers linked to the consumption of cannabis are greater today than they were in the 1960s, as cannabis is “15 times stronger” today than it was at that time, since it now contains an ever increasing level of D9-tetrahydrocannabinol (THC), the psychoactive ingredient of cannabis. The consequence of this, according to the authors of the report, is that studies conducted in the 1960s are no longer applicable today. “These statistics will come as a surprise to many people, especially those who choose to smoke cannabis rather than tobacco in the belief it is safer for them,” the chairman of the British Lung Foundation, Dr Mark Britton, commented. “It is vital that people are fully aware of the dangers so they can make an educated decision and know the damage they may be causing,” he added. “This report is not about the moral rights and wrongs of cannabis, but [we] simply wanted to make sure people were completely clear about the respiratory health risks involved,” he stressed. The foundation’s chief executive, Dame Helena Shovelton explained that “the puff and inhaled volume of cannabis smoke is up to four times larger with a cannabis cigarette than with tobacco.” “In other words you inhale deeper and hold your breath with the smoke for longer before exhaling. This results in more poisonous carbon monoxide and tar entering the lungs,” she concluded.