In what conditions is smoking cigarettes (tobacco use) potentially protective?

From the Guidelines

Smoking cigarettes is not protective in any medical conditions. The most recent and highest quality study, 1, published in 2023, provides convincing evidence to support the causal link between cigarette smoking and health risks, including cardiovascular diseases, premature death, microvascular complications, and worse glycemic outcomes.

Key Points

• The study 1 recommends advising all individuals not to use cigarettes and other tobacco products or e-cigarettes, and to include smoking cessation counseling and other forms of treatment as a routine component of diabetes care.
• Results from epidemiologic, case-control, and cohort studies provide convincing evidence to support the causal link between cigarette smoking and health risks.
• People with diabetes who smoke have a heightened risk of CVD, premature death, microvascular complications, and worse glycemic outcomes when compared with those who do not smoke.
• Smoking may have a role in the development of type 2 diabetes.

Recommendations

• Advise all patients not to use cigarettes and other tobacco products or e-cigarettes.
• Include smoking cessation counseling and other forms of treatment as a routine component of diabetes care.
• Address smoking cessation as part of diabetes education programs for those in need. The addictive nature of nicotine further complicates cessation efforts, but numerous large randomized clinical trials have demonstrated the efficacy and cost-effectiveness of brief counseling in smoking cessation, including the use of telephone quit lines, in reducing tobacco use 1. For anyone seeking to improve their health, there are always safer, evidence-based interventions available than smoking. Medical professionals universally recommend against smoking for any purpose, as its harms far exceed any possible benefit in all circumstances.

From the Research

Conditions Where Smoking Cigarettes May Be Protective

There are no conditions where smoking cigarettes is proven to be protective, according to the provided studies 2, 3, 4, 5, 6.

Health Risks Associated with Smoking

• Smoking is associated with increased overall morbidity and mortality 4
• Smoking is a cause of cancer of the lung, oral cavity, larynx, bladder, and renal pelvis and a contributing factor in the development of cancer of the pancreas, stomach, cervix, liver, penis, and rectum 4
• Smokers are at greater risk for coronary artery disease, cerebrovascular disease, and atherosclerotic peripheral vascular disease 4
• Cigarette smoking is the single most important risk factor for chronic obstructive pulmonary disease and is associated with lower levels of FEV1 and increased respiratory symptoms and infections 4

Reduction of Smoking and Health Risks

• Substantial smoking reduction may decrease lung cancer risk 5
• Reduction from heavy to light smoking may lower the risk of cardiovascular disease (CVD) 5
• However, the relationships between smoking reduction and other endpoints, including all-cause mortality and cardiovascular disease, remain unclear 5

Global Burden of Neurological Disorders

• Neurological disorders are the leading cause of disability and the second leading cause of death worldwide 6
• The absolute numbers of deaths and people with disabilities owing to neurological diseases have risen substantially, particularly in low-income and middle-income countries 6