Smoking in Young Women

Over the last 20 years the rate of new smokers has trailed off a bit, owing in large part to both educational efforts and ever-increasing taxes on cigarettes.  The only demographic where tobacco use seems to be increasing is young women.  This really bothers me, both as a cardiologist and the father of a 9-year-old daughter.  There are so many good reasons young women should avoid cigarettes, but how do you convince them of this?  Below is an open letter from me to any girl who thinks life would be better as a smoker.

Dear young ladies:

I know it's tempting to ignore all the health warnings and start smoking.  Your friends all seem to be able to smoke freely and don't suffer any ill effects.  Lighting up a cigarette is an easy way to rebel against parental authority and make yourself look more urban and edgy.  People tell you it will relax you to take up smoking and it's a good way to stay thin.

It’s all a lie.

If, however, you dismiss me as just another crusty old authority figure and plan to take up the habit anyway, at least pay attention to a few tips I have for you—they might help you throughout the rest of your tobacco-addicted life.

• Pick your boyfriends carefully.  From the outset you'll need to find a guy who, like you, is a smoker because he'll need to have a dulled olfactory nerve.  Why do you want him to have a bad sense of smell?  Because you don’t smell so good.  Your breath stinks, your hair stinks, your apartment stinks, and your car stinks.  The only people who don't seem to notice this are you and other smokers.  This is why you need to find someone who is either genetically anosmic (rare) or has a pack-a-day habit (more prevalent).  But a word of caution here:  At some point in the future you'll finally decide that smoking is dumb and you'll want to quit, but successfully quitting is much harder if you live with someone who is an active smoker.  So, you'll want to find a guy who smokes now but who can turn on a dime and quit whenever you want him to.  Good luck with that.
• You may want to invest in stock in the tobacco industry.  Why?  Because you'll be using their products for many years to come.  I know you don't think so.  I know you believe you'll be able to take up smoking for only a couple years—maybe just during high school or college—then, when it's time to become a more responsible adult, you'll just give it up.  This line of thinking is a fallacy.  There are lots of data showing that young smokers turn into long-term addicts at a rate far higher than you believe.  Odds are really good that the social smoking you're doing now will turn into a permanent habit within only a couple years.
• Don't invest in too many pairs of skinny jeans.  Sure, nicotine suppresses appetite and many people hold to the belief that cigarettes are an effective mode of weight control.  Practically speaking, though, this is a pretty poor way to look thinner.  Smokers tend to exercise less, are more likely to eat unhealthy diets, and some research suggests that the weight loss associated with nicotine use is only transient.  If you really want a verdict on cigarette use as a way to get skinny, just take a look at all the smokers around you.  If smoking were the cure to obesity we wouldn't be seeing any fat smokers.
• Practice meditation.  So, you say, smoking steadies your nerves?  With more and more second-hand smoking laws being passed you're going to find fewer places where you can light up.  Right now in many cities you can't smoke at work, in restaurants, movie theaters, or even in bars.  The only refuge for the die-hard smoker is the home, the car, and a cold windy parking lot out behind the office where you huddle with other smokers during your 5-minute "fresh air" breaks.  What are you going to do for your nerves during the many hours of the day where smoking is prohibited?  You'd better find alternative ways to achieve Zen.
• Get a job with really good health and disability insurance.  You'll end up with more sick days than your nonsmoking colleagues and you're more likely to develop diseases that don't necessarily put your life at risk but which make life miserable and impair your ability to work.  You know about emphysema and heart disease, but you might not think about things like osteoporosis, a condition where your bones lose minerals and transform from solid, sturdy structures into weak and brittle shells with the inner consistency of styrofoam.  By virtue of their lighter frames and hormonal changes, women are already more predisposed to osteoporosis.  Smoking will rapidly accelerate the process.  You should plan on losing a couple inches in height with age as your vertebrae take on the consistency of circus peanuts and collapse into painful compression fractures.  Get yourself a good bed to recuperate on when you suffer the hip fracture that is destined to occur if you don't succumb to something else first.
• Prepare to invest in inhalers for your kids.  I know you would never consider smoking in a home with small children (of course you're more responsible than that!)—or so you believe.  Get yourself hooked on cigarettes at the age of 18 and when you finally have small kids around the home 10 years later you won't have the luxury of deciding not to smoke around them.  You'll smoke at home and you'll smoke in the car, all the while torturing their young lungs with your toxic exhalation.  You may want to start looking for pediatric lung specialists now and save yourself the trouble later.
• Get used to being out of breath.  I want you to go find your self a long set of stairs and try an experiment.  First I want you to simply run the stairs from bottom to top and take note how you feel.  Not bad, I suspect.  This is because you are young, and young people can get away with surprising amounts of bodily damage and neglect without suffering untoward symptoms.  Now run the stairs again, but this time do it while holding your breath.  How do you feel when you reach the top?  Does your chest ache and do your lungs burn?  Good, because this is how it feels for many chronic smokers to perform simple exertion.  Smoke for long enough and you'll wipe out enough air sacs in your lungs so that you never want to take a flight of stairs again.
• Don't worry about your 401K.  I suppose this is the only bright side to smoking: you won't live quite so long and you won't have to invest so much into your retirement plan.  Smokers are more likely to get a slew of diseases at a higher rate and at a younger age: breast cancer, lung cancer, heart attack, stroke, emphysema, peripheral arterial disease.  The list goes on and on.
• Work on having an attractive personality.  Because your looks will fade fast.  Face it, smoking cigarettes stopped looking sexy somewhere around 1963.  How attractive is it to have yellow nails, a wrinkled-up face and a hoarse, hacking cough?  Just last month we learned that smokers' risk of bladder cancer—already high—is actually more significant than we previously suspected.  If you're looking to add to your sex appeal with a bladder catheter and a leg bag then you've picked up the right habit.

In conclusion, young ladies, keep my advice in mind as you light up your first cigarette and begin a life of tobacco addiction.

Sincerely,

Dr. Van De Graaff, COAF (Crusty Old Authority Figure)