Seconhand Smoking

Emma's friend Megan lights up a cigarette every chance she gets — while she's cruising around with their friends on Friday nights, during breaks at the pizza place, before soccer scrimmages, even as she babysits her brother. Emma's worried — both for her friend's health and for her own. She's not sure Megan realizes how her habit could be affecting the health of the people she smokes around.

Everyone knows smoking is a bad idea. And by now you've probably heard that breathing in someone else's secondhand smoke is also hazardous to your health.

What Is Secondhand Smoke?

Secondhand smoke comes from both the smoke that smokers exhale (called mainstream smoke) and the smoke floating from the end of the cigarette, cigar, or pipe (called sidestream smoke).

It may seem pretty harmless, but secondhand smoke actually contains thousands of chemicals — from arsenic and ammonia to hydrogen cyanide — many of which have been proven to be toxic or to cause cancer (called carcinogens). High concentrations of many of these chemicals are found in secondhand smoke. In fact, secondhand smoke significantly increases a person's risk for:

• respiratory infections (like bronchitis and pneumonia)
• asthma (secondhand smoke is a risk factor for the development of asthma and can trigger attacks in those who already have it)
• coughing, sore throats, sniffling, and sneezing
• cancer
• heart disease

So secondhand smoke doesn't just impact a person in the future. It can cause problems right now, like affecting someone's sports performance or ability to be physically active.

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Smoking

When your parents were young, people could buy cigarettes and smoke pretty much anywhere — even in hospitals! Ads for cigarettes were all over the place. Today we're more aware about how bad smoking is for our health. Smoking is restricted or banned in almost all public places and cigarette companies are no longer allowed to advertise on TV, radio, and in many magazines.

Almost everyone knows that smoking causes cancer, emphysema, and heart disease; that it can shorten your life by 10 years or more; and that the habit can cost a smoker thousands of dollars a year. So how come people are still lighting up? The answer, in a word, is addiction.

Once You Start, It's Hard to Stop

Smoking is a hard habit to break because tobacco contains nicotine, which is highly addictive. Like heroin or other addictive drugs, the body and mind quickly become so used to the nicotine in cigarettes that a person needs to have it just to feel normal.

People start smoking for a variety of different reasons. Some think it looks cool. Others start because their family members or friends smoke. Statistics show that about 9 out of 10 tobacco users start before they're 18 years old. Most adults who started smoking in their teens never expected to become addicted. That's why people say it's just so much easier to not start smoking at all.

How Smoking Affects Your Health

There are no physical reasons to start smoking. The body doesn't need tobacco the way it needs food, water, sleep, and exercise. In fact, many of the chemicals in cigarettes, like nicotine and cyanide, are actually poisons that can kill in high enough doses.

The body is smart. It goes on the defense when it's being poisoned. For this reason, many people find it takes several tries to get started smoking: First-time smokers often feel pain or burning in the throat and lungs, and some people feel sick or even throw up the first few times they try tobacco.

he consequences of this poisoning happen gradually. Over the long term, smoking leads people to develop health problems like heart disease, stroke, emphysema (breakdown of lung tissue), and many types of cancer — including lung, throat, stomach, and bladder cancer. People who smoke also have an increased risk of infections like bronchitis and pneumonia.

These diseases limit a person's ability to be normally active, and they can be fatal. Each time a smoker lights up, that single cigarette takes about 5 to 20 minutes off the person's life.

Smokers not only develop wrinkles and yellow teeth, they also lose bone density, which increases their risk of osteoporosis (pronounced: ahs-tee-o-puh-row-sus), a condition that causes older people to become bent over and their bones to break more easily. Smokers also tend to be less active than nonsmokers because smoking affects lung power.

Smoking can also cause fertility problems and can impact sexual health in both men and women. Girls who are on the pill or other hormone-based methods of birth control (like the patch or the ring) increase their risk of serious health problems, such as heart attacks, if they smoke.

The consequences of smoking may seem very far off, but long-term health problems aren't the only hazard of smoking. Nicotine and the other toxins in cigarettes, cigars, and pipes can affect a person's body quickly, which means that teen smokers experience many of these problems:

• Bad skin. Because smoking restricts blood vessels, it can prevent oxygen and nutrients from getting to the skin — which is why smokers often appear pale and unhealthy. An Italian study also linked smoking to an increased risk of getting a type of skin rash called psoriasis.
• Bad breath. Cigarettes leave smokers with a condition called halitosis, or persistent bad breath.
• Bad-smelling clothes and hair. The smell of stale smoke tends to linger — not just on people's clothing, but on their hair, furniture, and cars. And it's often hard to get the smell of smoke out.
• Reduced athletic performance. People who smoke usually can't compete with nonsmoking peers because the physical effects of smoking (like rapid heartbeat, decreased circulation, and shortness of breath) impair sports performance.
• Greater risk of injury and slower healing time. Smoking affects the body's ability to produce collagen, so common sports injuries, such as damage to tendons and ligaments, will heal more slowly in smokers than nonsmokers.
• Increased risk of illness. Studies show that smokers get more colds, flu, bronchitis, and pneumonia than nonsmokers. And people with certain health conditions, like asthma, become more sick if they smoke (and often if they're just around people who smoke). Because teens who smoke as a way to manage weight often light up instead of eating, their bodies lack the nutrients they need to grow, develop, and fight off illness properly.

Kicking Butts and Staying Smoke Free

All forms of tobacco — cigarettes, pipes, cigars, and smokeless tobacco — are hazardous. It doesn't help to substitute products that seem like they're better for you than regular cigarettes, such as filtered or low-tar cigarettes.

The only thing that really helps a person avoid the problems associated with smoking is staying smoke free. This isn't always easy, especially if everyone around you is smoking and offering you cigarettes. It may help to have your reasons for not smoking ready for times you may feel the pressure, such as "I just don't like it" or "I want to stay in shape for soccer" (or football, basketball, or other sport).

The good news for people who don't smoke or who want to quit is that studies show that the number of teens who smoke has dropped dramatically. Today, about 23% of high school students smoke.

If you do smoke and want to quit, you have lots of information and support available. Different approaches to quitting work for different people. For some, quitting cold turkey is best. Others find that a slower approach is the way to go. Some people find that it helps to go to a support group especially for teens. These are sometimes sponsored by local hospitals or organizations like the American Cancer Society. The Internet offers a number of good resources to help people quit smoking.

When quitting, it can be helpful to realize that the first few days are the hardest. So don’t give up. Some people find they have a few relapses before they manage to quit for good.

Staying smoke free will give you a whole lot more of everything — more energy, better performance, better looks, more money in your pocket, and, in the long run, more life to live!

Reviewed by: Larissa Hirsch, MD
Date reviewed: August 2007

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• For Kids
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Stress Coping: Stress in Today's Workplace

Job stress has become a common and costly problem in the American workplace, leaving few workers untouched. For example, studies report the following:

* One-fourth of employees view their jobs as the number one stressor in their lives.
* Three-fourths of employees believe the worker has more on-the-job stress than a generation ago.
* Problems at work are more strongly associated with health complaints than are any other life stressor-more so than even financial problems or family problems.

What is job stress?
Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury.

Job stress is often confused with challenge, but these concepts are not the same. Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. But job stress is different - the challenge has turned into job demands that cannot be met, relaxation has turned to exhaustion, and a sense of satisfaction has turned into feelings of stress. In short, the stage is set for illness, injury, and job failure.

What causes job stress?
According to one school of thought, differences in individual characteristics such as personality and coping style are most important in predicting whether certain job conditions will result in stress-in other words, what is stressful for one person may not be a problem for someone else. This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions.

Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. Excessive workload demands and conflicting expectations are good examples. Such evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.

Approach to job stress
Examples of individual and situational factors that can help to reduce the effects of stressful working conditions include the following:

* Balance between work and family or personal life
* A support network of friends and coworkers
* A relaxed and positive outlook

Job conditions that may lead to stress

* The design of tasks. Heavy workload, infrequent rest breaks, long work hours, and shiftwork are stressful. So are hectic and routine tasks that have little inherent meaning, do not utilize workers' skills, and provide little sense of control.

* Management style. Lack of participation by workers in decision-making, poor communication in the organization, lack of family-friendly policies.

* Interpersonal relationships. Poor social environment and lack of support or help from coworkers and supervisors.

* Work roles. Conflicting or uncertain job expectations, too much responsibility, too many "hats to wear."

* Career concerns. Job insecurity and lack of opportunity for growth, advancement, or promotion; rapid changes for which workers are unprepared.

* Environmental conditions. Unpleasant or dangerous physical conditions such as crowding, noise, air pollution, or ergonomic problems.

Job stress and health
Mood and sleep disturbances, upset stomach and headache, and disturbed relationships with family and friends are early signs of job stress. But the effects of job stress on chronic diseases are more difficult to see. Chronic diseases take a long time to develop and can be influenced by many factors other than stress. Nonetheless, evidence is rapidly accumulating to suggest that stress plays an important role in several types of chronic health problems-especially cardiovascular disease, musculoskeletal disorders, and psychological disorders. Some studies suggest a relationship between stressful working conditions and suicide, cancer, ulcers, and impaired immune function. Health care expenditures are nearly 50 percent greater for workers who report high levels of stress.

Stress prevention and job performance
Some employers assume that companies must turn up the pressure on workers and set aside health concerns to remain productive and profitable in today's economy. But studies show that stressful working conditions are actually associated with increased absenteeism, tardiness, and turnover--all of which have a negative effect on the bottom line. According to data from the Bureau of Labor Statistics, workers who must take time off work because of stress, anxiety, or a related disorder will be off the job for about 20 days.

Recent studies of so-called healthy organizations suggest that policies benefiting worker health also benefit the bottom line. A healthy organization is defined as one that has low rates of illness, injury, and disability in its workforce and is also competitive in the marketplace.In one study, the frequency of medication errors declined by 50 percent after prevention activities were implemented in a 700-bed hospital. In a second study, there was a 70 percent reduction in malpractice claims in 22 hospitals that implemented stress prevention activities.

What can be done about job stress?

* Stress management
Nearly one-half of large companies in the United States provide some type of stress management training for their workforce. Some have employee assistance programs (EAPs) to provide individual counseling for employees with both work and personal problems. Stress management training is inexpensive, easy to implement, and may rapidly reduce stress symptoms such as anxiety and sleep disturbances. However, the beneficial effects on stress symptoms are often short-lived. Such programs often ignore important root causes of stress because they focus on the worker and not the environment.

* Organizational change
Bringing in a consultant to recommend ways to improve working conditions is the most direct way to reduce stress at work. It involves the identification of stressful aspects of work (e.g., excessive workload, conflicting expectations) and the design of strategies to reduce or eliminate the identified stressors. It deals directly with the root causes of stress at work. However, managers are sometimes uncomfortable with this approach because it can involve changes in work routines or production schedules, or changes in the organizational structure.

As a general rule, actions to reduce job stress should give top priority to organizational change to improve working conditions. But even the most conscientious efforts to improve working conditions are unlikely to eliminate stress completely for all workers. For this reason, a combination of organizational change and stress management is often the most useful approach for preventing stress at work.

Strategies for preventing job stress

* Ensure that the workload is in line with workers' capabilities and resources.
* Design jobs to provide meaning, stimulation, and opportunities for workers to use their skills.
* Clearly define workers' roles and responsibilities.
* Give workers opportunities to participate in decisions and actions affecting their jobs.
* Improve communications and reduce uncertainty about career development and future employment prospects.
* Provide opportunities for social interaction among workers.
* Establish work schedules that are compatible with demands and responsibilities outside the workplace.

How to get started
Low morale, health and job complaints, and employee turnover often provide the first signs of job stress. But sometimes there are no clues, especially if employees are fearful of losing their jobs. Lack of obvious or widespread signs is not a good reason to dismiss concerns about job stress or minimize the importance of a prevention program.

Developing a stress prevention program consists of three stages:

1. gathering data to pinpoint specific problems
2. designing an intervention
3. conducting an ongoing program evaluation

Group discussions among managers, labor representatives, and employees can provide rich sources of information about employee perceptions of job conditions and perceived levels of stress, health, and satisfaction. Formal surveys can be used in larger organizations. Objective measures such as absenteeism, illness and turnover rates, or performance problems can also be examined. Survey design, data analysis, interventions, and evaluation of a stress prevention program may require the help of experts from a local university or consulting firm.

UPMC Healthy Lifestyle Program

Stress Coping

Stress is your body’s natural reaction to the perceived consequences of an event — something that happens to you or something you observe — that you believe you cannot cope with. Stress is psychological, but causes physical changes in your body such as an increase in stress hormones in your blood.

People experience stress differently. The people, places, or events that one person is exposed to may not bother them, but others in the same situation may experience stress. The individual must perceive an event as being a stress for it to have an effect on his or her health. The perception of stress depends on many factors, including our life experiences, socioeconomic status, education, and how happy we were as children.

A small amount of stress is not harmful. Indeed, a small amount of stress often increases the ability to perform mental tasks. That is why people often wait until the last minute to complete certain tasks. However, once a certain level of stress is experienced, negative health effects can occur. Stress coping increases the amount of stress we can experience before there is a large increase in stress hormone levels.

Our goal is to work with you to train your mind to become less responsive to stress. You will benefit by enhancing the quality of your mental and physical health, and experiencing:

* More patience
* More restful sleep
* Better interpersonal communication
* Improved sense of well-being
* Greater peace of mind
* An increased ability to see change as a natural part of life
* An improved self-confidence during stressful situations
* Decreased depression and anxiety

It is not our purpose to make the stress in your life go away. We cannot do that. However, we can help you lessen the impact of stress on your mental and physical health. We will do this by increasing your ability to cope with stress.
UPMC Lifestyle Program