b) What diseases do they cause along the way?

Mouth, throat and lung cancer, chronic bronchitis, emphysema, coronary artery disease, heart attack, stroke and nicotine addiction (which is also classified as a disease). (see Table on pg 56), (see slides a, b, c, d, e, f , y)

c) How do they cause these diseases?

1) Tobacco smoke passes through and chronically damages cells lining the mouth, throat, bronchial tubes and lungs. This leads to mutations (altered DNA) in these cells which, in time, cause cancer of the mouth, throat, bronchial tubes and lungs.

2) The inhaled smoke also chronically irritates and inflames the airways which leads to excessive mucus production. This causes a wet "chronic cough" which is called chronic bronchitis.

3) The inhaled smoke chronically inflames the lungs. The inflammation digests lung tissue and leads to emphysema (over distention and destruction of the air sacs of the lung) which causes severe shortness of breath. Breathe out and then hold your breath as long as you can. Try it! The air hunger and panic that you feel is what emphysema patients feel all the time. It never goes away, and this nightmare comes directly from smoking.

4) Toxic chemicals in inhaled tobacco smoke are absorbed into the blood stream and chronically damage the lining of arteries which supply blood to the heart (coronary arteries) and to the brain (cerebral arteries). Over time, this leads to atherosclerosis (hardening) of the coronary and cerebral arteries which, along with other smoking related toxic effects (arterial spasm and clot formation) obstruct blood flow to the heart and brain leading to heart attacks and strokes. The increased heart rate, blood pressure and blood levels of carbon monoxide from smoking tobacco, further contribute to cardiovascular disease.

5) Nicotine in inhaled tobacco smoke is also absorbed into the blood stream and affects the brain within seconds. After 2-3 years of smoking (but sometimes much shorter) this leads to nicotine addiction.

(see slide y) (See pgs 60-63 for medical demonstrations and disease simulations).

See CD-ROM-1 (Main Menu) for Surgeon General's Warning Interactive Visualizations and Simulations.