essay on harmful effects of smoking

Essay on Smoking

500 words essay on smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

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Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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Health Effects of Cigarette Smoking

Smoking and death, smoking and increased health risks, smoking and cardiovascular disease, smoking and respiratory disease, smoking and cancer, smoking and other health risks, quitting and reduced risks.

Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general. 1,2

Quitting smoking lowers your risk for smoking-related diseases and can add years to your life. 1,2

Cigarette smoking is the leading cause of preventable death in the United States. 1

Cigarette smoking causes more than 480,000 deaths each year in the United States. This is nearly one in five deaths. 1,2,3
Human immunodeficiency virus (HIV)
Illegal drug use
Alcohol use
Motor vehicle injuries
Firearm-related incidents
More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States. 1
Smoking causes about 90% (or 9 out of 10) of all lung cancer deaths. 1,2 More women die from lung cancer each year than from breast cancer. 5
Smoking causes about 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease (COPD). 1
Cigarette smoking increases risk for death from all causes in men and women. 1
The risk of dying from cigarette smoking has increased over the last 50 years in the U.S. 1

Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer. 1

For coronary heart disease by 2 to 4 times 1,6
For stroke by 2 to 4 times 1
Of men developing lung cancer by 25 times 1
Of women developing lung cancer by 25.7 times 1
Smoking causes diminished overall health, increased absenteeism from work, and increased health care utilization and cost. 1

Smokers are at greater risk for diseases that affect the heart and blood vessels (cardiovascular disease). 1,2

Smoking causes stroke and coronary heart disease, which are among the leading causes of death in the United States. 1,3
Even people who smoke fewer than five cigarettes a day can have early signs of cardiovascular disease. 1
Smoking damages blood vessels and can make them thicken and grow narrower. This makes your heart beat faster and your blood pressure go up. Clots can also form. 1,2
A clot blocks the blood flow to part of your brain;
A blood vessel in or around your brain bursts. 1,2
Blockages caused by smoking can also reduce blood flow to your legs and skin. 1,2

Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs. 1,2

Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis. 1,2
Cigarette smoking causes most cases of lung cancer. 1,2
If you have asthma, tobacco smoke can trigger an attack or make an attack worse. 1,2
Smokers are 12 to 13 times more likely to die from COPD than nonsmokers. 1

Smoking can cause cancer almost anywhere in your body: 1,2

Blood (acute myeloid leukemia)
Colon and rectum (colorectal)
Kidney and ureter
Oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils)
Trachea, bronchus, and lung

Smoking also increases the risk of dying from cancer and other diseases in cancer patients and survivors. 1

If nobody smoked, one of every three cancer deaths in the United States would not happen. 1,2

Smoking harms nearly every organ of the body and affects a person’s overall health. 1,2

Preterm (early) delivery
Stillbirth (death of the baby before birth)
Low birth weight
Sudden infant death syndrome (known as SIDS or crib death)
Ectopic pregnancy
Orofacial clefts in infants
Smoking can also affect men’s sperm, which can reduce fertility and also increase risks for birth defects and miscarriage. 2
Women past childbearing years who smoke have weaker bones than women who never smoked. They are also at greater risk for broken bones.
Smoking affects the health of your teeth and gums and can cause tooth loss. 1
Smoking can increase your risk for cataracts (clouding of the eye’s lens that makes it hard for you to see). It can also cause age-related macular degeneration (AMD). AMD is damage to a small spot near the center of the retina, the part of the eye needed for central vision. 1
Smoking is a cause of type 2 diabetes mellitus and can make it harder to control. The risk of developing diabetes is 30–40% higher for active smokers than nonsmokers. 1,2
Smoking causes general adverse effects on the body, including inflammation and decreased immune function. 1
Smoking is a cause of rheumatoid arthritis. 1
Quitting smoking is one of the most important actions people can take to improve their health. This is true regardless of their age or how long they have been smoking. Visit the Benefits of Quitting page for more information about how quitting smoking can improve your health.
U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General . Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2017 Apr 20].
U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: What It Means to You . Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2017 Apr 20].
Centers for Disease Control and Prevention. QuickStats: Number of Deaths from 10 Leading Causes—National Vital Statistics System, United States, 2010 . Morbidity and Mortality Weekly Report 2013:62(08);155. [accessed 2017 Apr 20].
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States . JAMA: Journal of the American Medical Association 2004;291(10):1238–45 [cited 2017 Apr 20].
U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General . Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001 [accessed 2017 Apr 20].
U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General . Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1989 [accessed 2017 Apr 20].

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Essay on Effects of Smoking

Students are often asked to write an essay on Effects of Smoking in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Effects of Smoking

Introduction.

Smoking is a harmful habit that affects the smoker and those around them. It’s a leading cause of various health problems.

Health Risks

Smoking damages almost every organ in the body. It causes lung diseases, heart problems, and increases the risk of stroke.

Effects on Non-smokers

Secondhand smoke exposes non-smokers to the same risks. It’s especially harmful to children, causing respiratory infections and sudden infant death syndrome.

Long-term Consequences

Smoking leads to addiction and can reduce life expectancy. It also affects the quality of life due to the health issues it causes.

To lead a healthy life, it’s crucial to stay away from smoking.

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Paragraph on Effects of Smoking

250 Words Essay on Effects of Smoking

Smoking, a widely prevalent habit, is a significant public health issue. Despite the known deleterious effects, many people continue to smoke, highlighting the addictive nature of nicotine. This essay delves into the effects of smoking on individual health and society.

Health Implications

Smoking is a primary risk factor for numerous diseases, including cancer, cardiovascular disease, and respiratory disorders. It harms nearly every organ in the body, reducing overall health. The carcinogens in tobacco smoke damage DNA, leading to mutations that can cause cancer, particularly lung cancer. Moreover, smoking affects the heart and blood vessels, increasing the risk of heart disease and stroke.

Social and Economic Impact

Beyond the health implications, smoking has profound social and economic effects. The habit often leads to social isolation as non-smokers may avoid smokers due to the unpleasant smell and secondhand smoke. Economically, smoking imposes a substantial burden on healthcare systems due to the high cost of treating smoking-related illnesses.

Psychological Consequences

Smoking also has psychological effects. Nicotine addiction can lead to increased stress and anxiety. Withdrawal symptoms can be severe, making quitting a daunting task. This dependency can affect an individual’s quality of life and mental wellbeing.

In conclusion, the effects of smoking are far-reaching, affecting not just the smoker’s health but also their social interactions, economic status, and mental health. It is imperative to continue efforts in education and legislation to reduce the prevalence of this harmful habit.

500 Words Essay on Effects of Smoking

Smoking, a widespread habit with serious health implications, is a topic of concern that merits significant attention. Despite the known dangers, millions globally continue to smoke, affecting not only their health but also those in their vicinity. This essay delves into the effects of smoking, focusing on health, environmental, and social impacts.

Health Effects of Smoking

Smoking is unequivocally linked to numerous health issues. The most well-known and severe is lung cancer, with smoking accounting for approximately 85% of all cases. However, the health implications extend beyond just lung disease. Smoking is a major risk factor for heart disease, stroke, and chronic obstructive pulmonary disease (COPD). It also affects the entire cardiovascular system, increasing the likelihood of blood clots, which can lead to life-threatening conditions.

The chemicals in tobacco smoke harm nearly every organ in the body, leading to a wide range of diseases and reducing the smoker’s overall health. Notably, nicotine, a primary component of tobacco, is highly addictive, making smoking cessation challenging and often leading to long-term dependence.

Environmental Impact

The environmental effects of smoking are often overlooked but are significant. Cigarette production involves deforestation for tobacco farming, pesticide use, and water pollution from manufacturing processes. Furthermore, cigarette butts, the most littered item globally, contain non-biodegradable filters that can take years to decompose, releasing toxic chemicals into the environment.

Secondhand smoke also contributes to air pollution. It contains over 4000 chemicals, many of which are carcinogenic, posing risks to non-smokers, especially in enclosed spaces. This highlights the broader environmental implications of smoking, extending its impact beyond the individual smoker.

Social Consequences

Smoking also has profound social effects. It places a significant financial burden on healthcare systems due to the treatment of smoking-related diseases. This burden extends to families, as the cost of maintaining the habit and the potential medical costs associated with smoking can cause financial stress.

Moreover, smoking can lead to social isolation as society becomes more aware of the risks of secondhand smoke. Many public spaces now prohibit smoking, and smokers may find themselves excluded from social gatherings to protect the health of others. The addictive nature of smoking can also lead to strained relationships and emotional distress.

In conclusion, the effects of smoking are multifaceted, extending far beyond the individual smoker’s health. It has severe environmental consequences and significant social implications, affecting both the smoker and those around them. While efforts to reduce smoking prevalence have had some success, it remains a pressing public health issue. As such, it is crucial to continue education and prevention efforts, emphasizing the far-reaching effects of this damaging habit.

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The Harmful Effects of Smoking: Physical, Social, and Economic Consequences

Categories: Habits Smoking

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Published: Feb 7, 2024

Words: 621 | Page: 1 | 4 min read

Cause 1: physical health effects, cause 2: psychological and mental health effects, cause 3: social and economic consequences.

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National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012.

Cover of Preventing Tobacco Use Among Youth and Young Adults

Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.

1 introduction, summary, and conclusions.

Introduction

Tobacco use is a global epidemic among young people. As with adults, it poses a serious health threat to youth and young adults in the United States and has significant implications for this nation’s public and economic health in the future ( Perry et al. 1994 ; Kessler 1995 ). The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for 75% of American spending on health care ( Anderson 2010 ), is well-documented and undeniable. Although progress has been made since the first Surgeon General’s report on smoking and health in 1964 ( U.S. Department of Health, Education, and Welfare [USDHEW] 1964 ), nearly one in four high school seniors is a current smoker. Most young smokers become adult smokers. One-half of adult smokers die prematurely from tobacco-related diseases ( Fagerström 2002 ; Doll et al. 2004 ). Despite thousands of programs to reduce youth smoking and hundreds of thousands of media stories on the dangers of tobacco use, generation after generation continues to use these deadly products, and family after family continues to suffer the devastating consequences. Yet a robust science base exists on social, biological, and environmental factors that influence young people to use tobacco, the physiology of progression from experimentation to addiction, other health effects of tobacco use, the epidemiology of youth and young adult tobacco use, and evidence-based interventions that have proven effective at reducing both initiation and prevalence of tobacco use among young people. Those are precisely the issues examined in this report, which aims to support the application of this robust science base.

Nearly all tobacco use begins in childhood and adolescence ( U.S. Department of Health and Human Services [USDHHS] 1994 ). In all, 88% of adult smokers who smoke daily report that they started smoking by the age of 18 years (see Chapter 3 , “The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”). This is a time in life of great vulnerability to social influences ( Steinberg 2004 ), such as those offered through the marketing of tobacco products and the modeling of smoking by attractive role models, as in movies ( Dalton et al. 2009 ), which have especially strong effects on the young. This is also a time in life of heightened sensitivity to normative influences: as tobacco use is less tolerated in public areas and there are fewer social or regular users of tobacco, use decreases among youth ( Alesci et al. 2003 ). And so, as we adults quit, we help protect our children.

Cigarettes are the only legal consumer products in the world that cause one-half of their long-term users to die prematurely ( Fagerström 2002 ; Doll et al. 2004 ). As this epidemic continues to take its toll in the United States, it is also increasing in low- and middle-income countries that are least able to afford the resulting health and economic consequences ( Peto and Lopez 2001 ; Reddy et al. 2006 ). It is past time to end this epidemic. To do so, primary prevention is required, for which our focus must be on youth and young adults. As noted in this report, we now have a set of proven tools and policies that can drastically lower youth initiation and use of tobacco products. Fully committing to using these tools and executing these policies consistently and aggressively is the most straight forward and effective to making future generations tobacco-free.

The 1994 Surgeon General’s Report

This Surgeon General’s report on tobacco is the second to focus solely on young people since these reports began in 1964. Its main purpose is to update the science of smoking among youth since the first comprehensive Surgeon General’s report on tobacco use by youth, Preventing Tobacco Use Among Young People , was published in 1994 ( USDHHS 1994 ). That report concluded that if young people can remain free of tobacco until 18 years of age, most will never start to smoke. The report documented the addiction process for young people and how the symptoms of addiction in youth are similar to those in adults. Tobacco was also presented as a gateway drug among young people, because its use generally precedes and increases the risk of using illicit drugs. Cigarette advertising and promotional activities were seen as a potent way to increase the risk of cigarette smoking among young people, while community-wide efforts were shown to have been successful in reducing tobacco use among youth. All of these conclusions remain important, relevant, and accurate, as documented in the current report, but there has been considerable research since 1994 that greatly expands our knowledge about tobacco use among youth, its prevention, and the dynamics of cessation among young people. Thus, there is a compelling need for the current report.

Tobacco Control Developments

Since 1994, multiple legal and scientific developments have altered the tobacco control environment and thus have affected smoking among youth. The states and the U.S. Department of Justice brought lawsuits against cigarette companies, with the result that many internal documents of the tobacco industry have been made public and have been analyzed and introduced into the science of tobacco control. Also, the 1998 Master Settlement Agreement with the tobacco companies resulted in the elimination of billboard and transit advertising as well as print advertising that directly targeted underage youth and limitations on the use of brand sponsorships ( National Association of Attorneys General [NAAG] 1998 ). This settlement also created the American Legacy Foundation, which implemented a nationwide antismoking campaign targeting youth. In 2009, the U.S. Congress passed a law that gave the U.S. Food and Drug Administration authority to regulate tobacco products in order to promote the public’s health ( Family Smoking Prevention and Tobacco Control Act 2009 ). Certain tobacco companies are now subject to regulations limiting their ability to market to young people. In addition, they have had to reimburse state governments (through agreements made with some states and the Master Settlement Agreement) for some health care costs. Due in part to these changes, there was a decrease in tobacco use among adults and among youth following the Master Settlement Agreement, which is documented in this current report.

Recent Surgeon General Reports Addressing Youth Issues

Other reports of the Surgeon General since 1994 have also included major conclusions that relate to tobacco use among youth ( Office of the Surgeon General 2010 ). In 1998, the report focused on tobacco use among U.S. racial/ethnic minority groups ( USDHHS 1998 ) and noted that cigarette smoking among Black and Hispanic youth increased in the 1990s following declines among all racial/ethnic groups in the 1980s; this was particularly notable among Black youth, and culturally appropriate interventions were suggested. In 2000, the report focused on reducing tobacco use ( USDHHS 2000b ). A major conclusion of that report was that school-based interventions, when implemented with community- and media-based activities, could reduce or postpone the onset of smoking among adolescents by 20–40%. That report also noted that effective regulation of tobacco advertising and promotional activities directed at young people would very likely reduce the prevalence and onset of smoking. In 2001, the Surgeon General’s report focused on women and smoking ( USDHHS 2001 ). Besides reinforcing much of what was discussed in earlier reports, this report documented that girls were more affected than boys by the desire to smoke for the purpose of weight control. Given the ongoing obesity epidemic ( Bonnie et al. 2007 ), the current report includes a more extensive review of research in this area.

The 2004 Surgeon General’s report on the health consequences of smoking ( USDHHS 2004 ) concluded that there is sufficient evidence to infer that a causal relationship exists between active smoking and (a) impaired lung growth during childhood and adolescence; (b) early onset of decline in lung function during late adolescence and early adulthood; (c) respiratory signs and symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea; and (d) asthma-related symptoms (e.g., wheezing) in childhood and adolescence. The 2004 Surgeon General’s report further provided evidence that cigarette smoking in young people is associated with the development of atherosclerosis.

The 2010 Surgeon General’s report on the biology of tobacco focused on the understanding of biological and behavioral mechanisms that might underlie the pathogenicity of tobacco smoke ( USDHHS 2010 ). Although there are no specific conclusions in that report regarding adolescent addiction, it does describe evidence indicating that adolescents can become dependent at even low levels of consumption. Two studies ( Adriani et al. 2003 ; Schochet et al. 2005 ) referenced in that report suggest that because the adolescent brain is still developing, it may be more susceptible and receptive to nicotine than the adult brain.

Scientific Reviews

Since 1994, several scientific reviews related to one or more aspects of tobacco use among youth have been undertaken that also serve as a foundation for the current report. The Institute of Medicine (IOM) ( Lynch and Bonnie 1994 ) released Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, a report that provided policy recommendations based on research to that date. In 1998, IOM provided a white paper, Taking Action to Reduce Tobacco Use, on strategies to reduce the increasing prevalence (at that time) of smoking among young people and adults. More recently, IOM ( Bonnie et al. 2007 ) released a comprehensive report entitled Ending the Tobacco Problem: A Blueprint for the Nation . Although that report covered multiple potential approaches to tobacco control, not just those focused on youth, it characterized the overarching goal of reducing smoking as involving three distinct steps: “reducing the rate of initiation of smoking among youth (IOM [ Lynch and Bonnie] 1994 ), reducing involuntary tobacco smoke exposure ( National Research Council 1986 ), and helping people quit smoking” (p. 3). Thus, reducing onset was seen as one of the primary goals of tobacco control.

As part of USDHHS continuing efforts to assess the health of the nation, prevent disease, and promote health, the department released, in 2000, Healthy People 2010 and, in 2010, Healthy People 2020 ( USDHHS 2000a , 2011 ). Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities. Each iteration of Healthy People serves as the nation’s disease prevention and health promotion roadmap for the decade. Both Healthy People 2010 and Healthy People 2020 highlight “Tobacco Use” as one of the nation’s “Leading Health Indicators,” feature “Tobacco Use” as one of its topic areas, and identify specific measurable tobacco-related objectives and targets for the nation to strive for. Healthy People 2010 and Healthy People 2020 provide tobacco objectives based on the most current science and detailed population-based data to drive action, assess tobacco use among young people, and identify racial and ethnic disparities. Additionally, many of the Healthy People 2010 and 2020 tobacco objectives address reductions of tobacco use among youth and target decreases in tobacco advertising in venues most often influencing young people. A complete list of the healthy people 2020 objectives can be found on their Web site ( USDHHS 2011 ).

In addition, the National Cancer Institute (NCI) of the National Institutes of Health has published monographs pertinent to the topic of tobacco use among youth. In 2001, NCI published Monograph 14, Changing Adolescent Smoking Prevalence , which reviewed data on smoking among youth in the 1990s, highlighted important statewide intervention programs, presented data on the influence of marketing by the tobacco industry and the pricing of cigarettes, and examined differences in smoking by racial/ethnic subgroup ( NCI 2001 ). In 2008, NCI published Monograph 19, The Role of the Media in Promoting and Reducing Tobacco Use ( NCI 2008 ). Although young people were not the sole focus of this Monograph, the causal relationship between tobacco advertising and promotion and increased tobacco use, the impact on youth of depictions of smoking in movies, and the success of media campaigns in reducing youth tobacco use were highlighted as major conclusions of the report.

The Community Preventive Services Task Force (2011) provides evidence-based recommendations about community preventive services, programs, and policies on a range of topics including tobacco use prevention and cessation ( Task Force on Community Preventive Services 2001 , 2005 ). Evidence reviews addressing interventions to reduce tobacco use initiation and restricting minors’ access to tobacco products were cited and used to inform the reviews in the current report. The Cochrane Collaboration (2010) has also substantially contributed to the review literature on youth and tobacco use by producing relevant systematic assessments of health-related programs and interventions. Relevant to this Surgeon General’s report are Cochrane reviews on interventions using mass media ( Sowden 1998 ), community interventions to prevent smoking ( Sowden and Stead 2003 ), the effects of advertising and promotional activities on smoking among youth ( Lovato et al. 2003 , 2011 ), preventing tobacco sales to minors ( Stead and Lancaster 2005 ), school-based programs ( Thomas and Perara 2006 ), programs for young people to quit using tobacco ( Grimshaw and Stanton 2006 ), and family programs for preventing smoking by youth ( Thomas et al. 2007 ). These reviews have been cited throughout the current report when appropriate.

In summary, substantial new research has added to our knowledge and understanding of tobacco use and control as it relates to youth since the 1994 Surgeon General’s report, including updates and new data in subsequent Surgeon General’s reports, in IOM reports, in NCI Monographs, and in Cochrane Collaboration reviews, in addition to hundreds of peer-reviewed publications, book chapters, policy reports, and systematic reviews. Although this report is a follow-up to the 1994 report, other important reviews have been undertaken in the past 18 years and have served to fill the gap during an especially active and important time in research on tobacco control among youth.

Focus of the Report

Young People

This report focuses on “young people.” In general, work was reviewed on the health consequences, epidemiology, etiology, reduction, and prevention of tobacco use for those in the young adolescent (11–14 years of age), adolescent (15–17 years of age), and young adult (18–25 years of age) age groups. When possible, an effort was made to be specific about the age group to which a particular analysis, study, or conclusion applies. Because hundreds of articles, books, and reports were reviewed, however, there are, unavoidably, inconsistencies in the terminology used. “Adolescents,” “children,” and “youth” are used mostly interchangeably throughout this report. In general, this group encompasses those 11–17 years of age, although “children” is a more general term that will include those younger than 11 years of age. Generally, those who are 18–25 years old are considered young adults (even though, developmentally, the period between 18–20 years of age is often labeled late adolescence), and those 26 years of age or older are considered adults.

In addition, it is important to note that the report is concerned with active smoking or use of smokeless tobacco on the part of the young person. The report does not consider young people’s exposure to secondhand smoke, also referred to as involuntary or passive smoking, which was discussed in the 2006 report of the Surgeon General ( USDHHS 2006 ). Additionally, the report does not discuss research on children younger than 11 years old; there is very little evidence of tobacco use in the United States by children younger than 11 years of age, and although there may be some predictors of later tobacco use in those younger years, the research on active tobacco use among youth has been focused on those 11 years of age and older.

Tobacco Use

Although cigarette smoking is the most common form of tobacco use in the United States, this report focuses on other forms as well, such as using smokeless tobacco (including chew and snuff) and smoking a product other than a cigarette, such as a pipe, cigar, or bidi (tobacco wrapped in tendu leaves). Because for young people the use of one form of tobacco has been associated with use of other tobacco products, it is particularly important to monitor all forms of tobacco use in this age group. The term “tobacco use” in this report indicates use of any tobacco product. When the word “smoking” is used alone, it refers to cigarette smoking.

Organization of the Report

This chapter begins by providing a short synopsis of other reports that have addressed smoking among youth and, after listing the major conclusions of this report, will end by presenting conclusions specific to each chapter. Chapter 2 of this report (“The Health Consequences of Tobacco Use Among Young People”) focuses on the diseases caused by early tobacco use, the addiction process, the relation of body weight to smoking, respiratory and pulmonary problems associated with tobacco use, and cardiovascular effects. Chapter 3 (“The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”) provides recent and long-term cross-sectional and longitudinal data on cigarette smoking, use of smokeless tobacco, and the use of other tobacco products by young people, by racial/ethnic group and gender, primarily in the United States, but including some worldwide data as well. Chapter 4 (“Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth”) identifies the primary risk factors associated with tobacco use among youth at four levels, including the larger social and physical environments, smaller social groups, cognitive factors, and genetics and neurobiology. Chapter 5 (“The Tobacco Industry’s Influences on the Use of Tobacco Among Youth”) includes data on marketing expenditures for the tobacco industry over time and by category, the effects of cigarette advertising and promotional activities on young people’s smoking, the effects of price and packaging on use, the use of the Internet and movies to market tobacco products, and an evaluation of efforts by the tobacco industry to prevent tobacco use among young people. Chapter 6 (“Efforts to Prevent and Reduce Tobacco Use Among Young People”) provides evidence on the effectiveness of family-based, clinic-based, and school-based programs, mass media campaigns, regulatory and legislative approaches, increased cigarette prices, and community and statewide efforts in the fight against tobacco use among youth. Chapter 7 (“A Vision for Ending the Tobacco Epidemic”) points to next steps in preventing and reducing tobacco use among young people.

Preparation of the Report

This report of the Surgeon General was prepared by the Office on Smoking and Health (OSH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), USDHHS. In 2008, 18 external independent scientists reviewed the 1994 report and suggested areas to be added and updated. These scientists also suggested chapter editors and a senior scientific editor, who were contacted by OSH. Each chapter editor named external scientists who could contribute, and 33 content experts prepared draft sections. The draft sections were consolidated into chapters by the chapter editors and then reviewed by the senior scientific editor, with technical editing performed by CDC. The chapters were sent individually to 34 peer reviewers who are experts in the areas covered and who reviewed the chapters for scientific accuracy and comprehensiveness. The entire manuscript was then sent to more than 25 external senior scientists who reviewed the science of the entire document. After each review cycle, the drafts were revised by the chapter and senior scientific editor on the basis of the experts’ comments. Subsequently, the report was reviewed by various agencies within USDHHS. Publication lags prevent up-to-the-minute inclusion of all recently published articles and data, and so some more recent publications may not be cited in this report.

Evaluation of the Evidence

Since the first Surgeon General’s report in 1964 on smoking and health ( USDHEW 1964 ), major conclusions concerning the conditions and diseases caused by cigarette smoking and the use of smokeless tobacco have been based on explicit criteria for causal inference ( USDHHS 2004 ). Although a number of different criteria have been proposed for causal inference since the 1960s, this report focuses on the five commonly accepted criteria that were used in the original 1964 report and that are discussed in greater detail in the 2004 report on the health consequences of smoking ( USDHHS 2004 ). The five criteria refer to the examination of the association between two variables, such as a risk factor (e.g., smoking) and an outcome (e.g., lung cancer). Causal inference between these variables is based on (1) the consistency of the association across multiple studies; this is the persistent finding of an association in different persons, places, circumstances, and times; (2) the degree of the strength of association, that is, the magnitude and statistical significance of the association in multiple studies; (3) the specificity of the association to clearly demonstrate that tobacco use is robustly associated with the condition, even if tobacco use has multiple effects and multiple causes exist for the condition; (4) the temporal relationship of the association so that tobacco use precedes disease onset; and (5) the coherence of the association, that is, the argument that the association makes scientific sense, given data from other sources and understanding of biological and psychosocial mechanisms ( USDHHS 2004 ). Since the 2004 Surgeon General’s report, The Health Consequences of Smoking , a four-level hierarchy ( Table 1.1 ) has been used to assess the research data on associations discussed in these reports ( USDHHS 2004 ). In general, this assessment was done by the chapter editors and then reviewed as appropriate by peer reviewers, senior scientists, and the scientific editors. For a relationship to be considered sufficient to be characterized as causal, multiple studies over time provided evidence in support of each criteria.

Four-level hierarchy for classifying the strength of causal inferences based on available evidence.

When a causal association is presented in the chapter conclusions in this report, these four levels are used to describe the strength of the evidence of the association, from causal (1) to not causal (4). Within the report, other terms are used to discuss the evidence to date (i.e., mixed, limited, and equivocal evidence), which generally represent an inadequacy of data to inform a conclusion.

However, an assessment of a casual relationship is not utilized in presenting all of the report’s conclusions. The major conclusions are written to be important summary statements that are easily understood by those reading the report. Some conclusions, particularly those found in Chapter 3 (epidemiology), provide observations and data related to tobacco use among young people, and are generally not examinations of causal relationships. For those conclusions that are written using the hierarchy above, a careful and extensive review of the literature has been undertaken for this report, based on the accepted causal criteria ( USDHHS 2004 ). Evidence that was characterized as Level 1 or Level 2 was prioritized for inclusion as chapter conclusions.

In additional to causal inferences, statistical estimation and hypothesis testing of associations are presented. For example, confidence intervals have been added to the tables in the chapter on the epidemiology of youth tobacco use (see Chapter 3 ), and statistical testing has been conducted for that chapter when appropriate. The chapter on efforts to prevent tobacco use discusses the relative improvement in tobacco use rates when implementing one type of program (or policy) versus a control program. Statistical methods, including meta-analytic methods and longitudinal trajectory analyses, are also presented to ensure that the methods of evaluating data are up to date with the current cutting-edge research that has been reviewed. Regardless of the methods used to assess significance, the five causal criteria discussed above were applied in developing the conclusions of each chapter and the report.

Major Conclusions
Cigarette smoking by youth and young adults has immediate adverse health consequences, including addiction, and accelerates the development of chronic diseases across the full life course.
Prevention efforts must focus on both adolescents and young adults because among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
Advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults.
After years of steady progress, declines in the use of tobacco by youth and young adults have slowed for cigarette smoking and stalled for smokeless tobacco use.
Coordinated, multicomponent interventions that combine mass media campaigns, price increases including those that result from tax increases, school-based policies and programs, and statewide or community-wide changes in smoke-free policies and norms are effective in reducing the initiation, prevalence, and intensity of smoking among youth and young adults.
Chapter Conclusions

The following are the conclusions presented in the substantive chapters of this report.

Chapter 2. The Health Consequences of Tobacco Use Among Young People

The evidence is sufficient to conclude that there is a causal relationship between smoking and addiction to nicotine, beginning in adolescence and young adulthood.
The evidence is suggestive but not sufficient to conclude that smoking contributes to future use of marijuana and other illicit drugs.
The evidence is suggestive but not sufficient to conclude that smoking by adolescents and young adults is not associated with significant weight loss, contrary to young people’s beliefs.
The evidence is sufficient to conclude that there is a causal relationship between active smoking and both reduced lung function and impaired lung growth during childhood and adolescence.
The evidence is sufficient to conclude that there is a causal relationship between active smoking and wheezing severe enough to be diagnosed as asthma in susceptible child and adolescent populations.
The evidence is sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and early abdominal aortic atherosclerosis in young adults.
The evidence is suggestive but not sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and coronary artery atherosclerosis in adulthood.

Chapter 3. The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide

Among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
Almost one in four high school seniors is a current (in the past 30 days) cigarette smoker, compared with one in three young adults and one in five adults. About 1 in 10 high school senior males is a current smokeless tobacco user, and about 1 in 5 high school senior males is a current cigar smoker.
Among adolescents and young adults, cigarette smoking declined from the late 1990s, particularly after the Master Settlement Agreement in 1998. This decline has slowed in recent years, however.
Significant disparities in tobacco use remain among young people nationwide. The prevalence of cigarette smoking is highest among American Indians and Alaska Natives, followed by Whites and Hispanics, and then Asians and Blacks. The prevalence of cigarette smoking is also highest among lower socioeconomic status youth.
Use of smokeless tobacco and cigars declined in the late 1990s, but the declines appear to have stalled in the last 5 years. The latest data show the use of smokeless tobacco is increasing among White high school males, and cigar smoking may be increasing among Black high school females.
Concurrent use of multiple tobacco products is prevalent among youth. Among those who use tobacco, nearly one-third of high school females and more than one-half of high school males report using more than one tobacco product in the last 30 days.
Rates of tobacco use remain low among girls relative to boys in many developing countries, however, the gender gap between adolescent females and males is narrow in many countries around the globe.

Chapter 4. Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth

Given their developmental stage, adolescents and young adults are uniquely susceptible to social and environmental influences to use tobacco.
Socioeconomic factors and educational attainment influence the development of youth smoking behavior. The adolescents most likely to begin to use tobacco and progress to regular use are those who have lower academic achievement.
The evidence is sufficient to conclude that there is a causal relationship between peer group social influences and the initiation and maintenance of smoking behaviors during adolescence.
Affective processes play an important role in youth smoking behavior, with a strong association between youth smoking and negative affect.
The evidence is suggestive that tobacco use is a heritable trait, more so for regular use than for onset. The expression of genetic risk for smoking among young people may be moderated by small-group and larger social-environmental factors.

Chapter 5. The Tobacco Industry’s Influences on the Use of Tobacco Among Youth

In 2008, tobacco companies spent $9.94 billion on the marketing of cigarettes and $547 million on the marketing of smokeless tobacco. Spending on cigarette marketing is 48% higher than in 1998, the year of the Master Settlement Agreement. Expenditures for marketing smokeless tobacco are 277% higher than in 1998.
Tobacco company expenditures have become increasingly concentrated on marketing efforts that reduce the prices of targeted tobacco products. Such expenditures accounted for approximately 84% of cigarette marketing and more than 77% of the marketing of smokeless tobacco products in 2008.
The evidence is sufficient to conclude that there is a causal relationship between advertising and promotional efforts of the tobacco companies and the initiation and progression of tobacco use among young people.
The evidence is suggestive but not sufficient to conclude that tobacco companies have changed the packaging and design of their products in ways that have increased these products’ appeal to adolescents and young adults.
The tobacco companies’ activities and programs for the prevention of youth smoking have not demonstrated an impact on the initiation or prevalence of smoking among young people.
The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people.

Chapter 6. Efforts to Prevent and Reduce Tobacco Use Among Young People

The evidence is sufficient to conclude that mass media campaigns, comprehensive community programs, and comprehensive statewide tobacco control programs can prevent the initiation of tobacco use and reduce its prevalence among youth.
The evidence is sufficient to conclude that increases in cigarette prices reduce the initiation, prevalence, and intensity of smoking among youth and young adults.
The evidence is sufficient to conclude that school-based programs with evidence of effectiveness, containing specific components, can produce at least short-term effects and reduce the prevalence of tobacco use among school-aged youth.
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Cite this Page National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012. 1, Introduction, Summary, and Conclusions.
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Persuasive Essay Guide

Persuasive Essay About Smoking

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.

It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.

A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:

Simple persuasive essay about smoking

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Persuasive Essay Examples About Smoking

Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.

A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.

Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

Check out some more persuasive essay examples on various other topics.

Argumentative Essay About Smoking Examples

An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.

If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

Check out the video below to find useful arguments against smoking:

Tips for Writing a Persuasive Essay About Smoking

You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.

Choose a Specific Angle

Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.

Think about how you want to approach the topic. For instance, you could write about why smoking should be banned.

Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!

Research the Facts

Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.

You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies.

For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.

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Make an Outline

The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.

Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.

Use Persuasive Language

When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.

Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.

Introduce Opposing Arguments

Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.

By doing this, your essay will come off as more balanced and objective, making it more convincing.

Finish Strong

Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.

A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.

To conclude,

By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.

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Five Takeaways From Nikole Hannah-Jones’s Essay on the ‘Colorblindness’ Trap

How a 50-year campaign has undermined the progress of the civil rights movement.

By Nikole Hannah-Jones

Nikole Hannah-Jones is a staff writer at the magazine and the creator of The 1619 Project. She also teaches race and journalism at Howard University.

Last June, the Supreme Court ruled that affirmative action in college admissions was not constitutional. After the decision, much of the discussion was about its impact on the complexions of college campuses. But in an essay in The Times Magazine, I argue that we were missing the much bigger and more frightening story: that the death of affirmative action marks the culmination of a radical 50-year strategy to subvert the goal of colorblindness put forth by civil rights activists, by transforming it into a means of undermining racial justice efforts in a way that will threaten our multiracial democracy.

What do I mean by this? Here are the basic points of my essay:

The affirmative-action ruling could bring about sweeping changes across American society.

Conservatives are interpreting the court’s ruling broadly, and since last summer, they have used it to attack racial-justice programs outside the field of higher education. Since the decision, conservative groups have filed and threatened lawsuits against a range of programs that consider race, from diversity fellowships at law firms to maternal-health programs. One such group has even challenged the medical school of Howard University, one of the nation’s pre-eminent historically Black universities. Founded to educate people who had been enslaved, Howard’s mission has been to serve Black Americans who had for generations been systematically excluded from American higher education. These challenges to racial-justice programs will have a lasting impact on the nation’s ability to address the vast disparities that Black people experience.

Conservatives have co-opted the civil rights language of ‘colorblindness.’

In my essay, I demonstrate that these challenges to racial-justice programs often deploy the logic of “colorblindness,” the idea that the Constitution prohibits the use of race to distinguish citizens and that the goal of a diverse, democratic nation should be a society in which race does not determine outcomes for anyone. Civil rights leaders used the idea of colorblindness to challenge racial apartheid laws and policies, but over the last 50 years, conservatives have successfully co-opted both the rhetoric and the legal legacy of the civil rights era not to advance racial progress, but to stall it. And, I’d argue, reverse it.

Though the civil rights movement is celebrated and commemorated as a proud period in American history, it faced an immediate backlash. The progressive activists who advanced civil rights for Black Americans argued that in a society that used race against Black Americans for most of our history, colorblindness is a goal. They believed that achieving colorblindness requires race-conscious policies, such as affirmative action, that worked specifically to help Black people overcome their disadvantages in order to get to a point where race no longer hindered them. Conservatives, however, invoke the idea of colorblindness to make the case that race-conscious programs, even to help those whose race had been used against them for generations, are antithetical to the Constitution. In the affirmative-action decision, Chief Justice John G. Roberts Jr., writing for the majority, embraced this idea of colorblindness, saying: “Eliminating racial discrimination means eliminating all of it.”

The Supreme Court’s decision undermines attempts to eliminate racial inequality that descendants of slavery suffer.

But mandating colorblindness in this way erases the fact that Black Americans still suffer inequality in every measurable aspect of American life — from poverty to access to quality neighborhoods and schools to health outcomes to wealth — and that this inequality stems from centuries of oppressive race-specific laws and policies. This way of thinking about colorblindness has reached its legal apotheosis on the Roberts court, where through rulings on schools and voting the Supreme Court has helped constitutionalize a colorblindness that leaves racial disparities intact while striking down efforts to ameliorate them.

These past decisions have culminated in Students for Fair Admissions v. Harvard, which can be seen as the Supreme Court clearing the way to eliminate the last legal tools to try to level the playing field for people who descend from slavery.

Affirmative action should not simply be a tool for diversity but should alleviate the particular conditions of descendants of slavery.

Part of the issue, I argue, is that the purpose of affirmative action got muddled in the 1970s. It was originally designed to reduce the suffering and improve the material conditions of people whose ancestors had been enslaved in this country. But the Supreme Court’s decision in the 1978 Bakke case changed the legally permissible goals of affirmative action, turning it into a generalized diversity program. That has opened the door for conservatives to attack the program for focusing on superficial traits like skin color, rather than addressing affirmative action's original purpose, which was to provide redress for the disadvantages descendants of slavery experienced after generations of oppression and subordination.

Working toward racial justice is not just the moral thing to do, but it is also crucial to our democracy.

When this country finally abolished slavery, it was left with a fundamental question: How does a white-majority nation, which wielded race-conscious policies and laws to enslave and oppress Black people, create a society in which race no longer matters? After the short-lived period of Reconstruction, lawmakers intent on helping those who had been enslaved become full citizens passed a slate of race-conscious laws. Even then, right at the end of slavery, the idea that this nation owed something special to those who had suffered under the singular institution of slavery faced strident opposition, and efforts at redress were killed just 12 years later with Reconstruction’s end. Instead, during the nearly 100-year period known as Jim Crow, descendants of slavery were violently subjected to a dragnet of racist laws that kept them from most opportunities and also prevented America from becoming a true democracy. During the civil rights era, when Black Americans were finally assured full legal rights of citizenship, this question once again presented itself: In order to address the disadvantage Black Americans faced, do we ignore race to eliminate its power, or do we consciously use race to undo its harms? Affirmative action and other racial-justice programs were born of that era, but now, once again, we are in a period of retrenchment and backlash that threatens the stability of our nation. My essay argues that if we are to preserve our multiracial democracy, we must find a way to address our original sin.

Nikole Hannah-Jones is a domestic correspondent for The New York Times Magazine focusing on racial injustice. Her extensive reporting in both print and radio has earned a Pulitzer Prize, National Magazine Award, Peabody and a Polk Award. More about Nikole Hannah-Jones

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Published: 01 April 2024

Exercise effect on pain is associated with negative and positive affective components: A large-scale internet-based cross-sectional study in Japan

Kenta Wakaizumi 1 , 2 ,
Yuta Shinohara 1 , 2 ,
Morihiko Kawate 1 , 2 ,
Ko Matsudaira 3 ,
Hiroyuki Oka 4 ,
Keiko Yamada 5 , 6 ,
Rami Jabakhanji 7 , 8 , 9 &
Marwan N. Baliki 7 , 8 , 9

Scientific Reports volume 14 , Article number: 7649 ( 2024 ) Cite this article

Metrics details

Epidemiology

Pain is a global health problem that leads to sedentary behavior and tends to cause negative emotion. In contrast, exercise is widely recommended for a health promotion, while pain often worsens with physical activity. Although exercise therapy is often prescribed to people with pain, the mechanisms of exercise effect on pain remains unclear. In this study, we tried to identify a universal association factor between regular exercise and pain intensity utilizing a cross-sectional web-based survey involving 52,353 adult participants from a large national study conducted in Japan. Using principal component analysis, we uncovered a mediation model of exercise effect on pain through psychological components. Analyses were performed in half of the population with pain ( n = 20,330) and validated in the other half ( n = 20,330), and showed that high-frequency exercise had a significant association with reduction in pain intensity. We also found Negative Affect and Vigor, two psychological components, are fully associating the exercise effect on pain (indirect effect = − 0.032, p < 0.001; association proportion = 0.99) with a dose-dependent response corresponding to the frequency of exercise. These findings were successfully validated (indirect effect of high-frequency exercise = − 0.028, p < 0.001; association proportion = 0.85). Moreover, these findings were also identified in subpopulation analyses of people with low back, neck, knee pain, and the tendency of the exercise effect on pain was increased with older people. In conclusion, the effect of exercise on pain is associated with psychological components and these association effects increased in parallel with the frequency of exercise habit regardless pain location.

Introduction

Pain is a global health problem with a high prevalence. It contributes to physical disability and reduces the motivation toward work, resulting in loss of productivity represented by presenteeism and absenteeism 1 , 2 . People suffering from pain tend to exhibit sedentary behavior and negative emotions such as depression and anxiety 3 , 4 , which significantly affect their quality of life and daily living. Exercise on the other hand, is beneficial for health, and moderate exercise habits are recommended for improving lifestyle diseases. World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. Regular physical activity prevents several health problems, including reduced motor function, frailty, and cognitive dysfunction 5 . In addition, exercise is also known to effectively prevent and treat anxiety, depression, and stress-related symptoms, and is known to improve mental health 6 .

However, pain can be worsened with physical activity, and given the psychological effects of pain mentioned above, people with pain symptoms find it difficult to maintain the habit of regular exercise. In fact, factors such as lack of social support, decreased physical activity, decreased physical function, depression/anxiety, and decreased self-efficacy have been reported to inhibit the acquisition of exercise habits 7 , 8 . However, it is a well-known fact that a single session of exercise can result in reduced pain intensity and a higher threshold of pain 9 . This phenomenon is referred to as exercise-induced hypoalgesia (EIH). Although the effect of EIH resulting from a single bout of exercise is not sustained, regular exercise can exert pain relief effects in patients with chronic pain, and also prevent the transition to chronic pain 10 . It has also been reported that increasing the frequency of exercise per week is likely to result in pain relief 11 .

Epidemiological studies also support the fact that physical activity possibly prevents the development of chronic pain. A population-based study from Norway showed that people who indulged in moderate leisure-time activity one to three times per week, were significantly less likely to experience chronic musculoskeletal pain compared to those without any leisure-time activity 12 . Thus, there definitely exists a relationship between pain and regular physical activity. A review paper has suggested the involvement of the central nervous system in the effect of exercise on pain in patient populations 10 . However, there is little evidence for emotional involvement of the pain modulation effect caused by regular exercise. Therefore, we hypothesized that emotional factors associated with development of chronic pain such as stress, negative emotions, and positive emotions are involved in the relationship between pain and exercise habits and conducted a mediating analysis using data from a large-scale epidemiological survey. We also investigated on the effect of frequency of exercise habits, the site of painful symptoms, and background factors on this relationship.

Ethical concerns

The present study was conducted in accordance with the tenets of the declaration of Helsinki, 1975, and its revision in 2013, as well as an ethical guideline for medical and health research involving human subjects that has been issued by the Japanese Ministry of Health, Labor, and Welfare. The Japanese survey study was approved by the University of Tokyo Research Ethics Committee (approval number: 2018132NI).

Study population

A web-based epidemiological survey was conducted for the general Japanese population, aged 20–64 years in February 2015 as described previously 13 . After an informed consent was obtained from all the study participants, 52,353 people voluntary responded to the survey, and 653 individuals suffering from cancer were excluded from this study. A total of 51,701 participants were included in the present study; mean age and standard deviation were 42.7 and 12.1 years respectively, and the proportion of women was 49.9%.

In the web-based epidemiological study, participants were asked to choose one among the following four levels of frequency of at least 30-min exercise habits over the past year; high frequency (at least twice per week), moderate frequency (once per week), low frequency (a couple of times per month), or no exercise at all. Average pain intensity in the past four weeks was measured using the numerical rating scale (NRS) 14 , where “0” corresponded to no pain and “10” indicated worst possible pain. All individuals also completed the 11-scale subjective stress questionnaire (0: no stress, to 10: worst imaginable stress), 11-scale subjective current health condition questionnaire (0: worst, to 10: best), and the Profile of Mood States (POMS)–Brief Form, Japanese version regarding the levels of stress, health, and mood over the past four weeks 15 . The POMS is a 30-item questionnaire assessing the mood of the individuals, based on six mood construct domains as follows: tension–anxiety, depression–dejection, anger–hostility, fatigue, confusion, and vigor. Each item is rated on a five-point scale, and the score for each domain ranges from 0 to 20; higher scores indicate more disturbances, except for the vigor domain. Individuals who reported an educational level lower than high school degree were classified as the low education group. The following characteristics were investigated as well: body mass index (BMI), smoking status (current smoker or non-smoker), marital status (married, never married, divorced, or widowed), living status (alone or with family), living area (47 Japanese prefectures), sleep duration (< 5 h; ≥ 5, < 6 h; ≥ 6 h; < 7 h; ≥ 7 h, < 8 h; ≥ 8 h; < 9 h; or ≥ 9 h). One-way analysis of covariance (ANCOVA), chi-squared test, and Kruskal–Wallis test were used for comparing the demographic characteristics and behavioral measures among people without pain (NRS = 0), those with mild pain (NRS = 1–3), and those with moderate-to-severe pain (NRS ≥ 4). We performed post-hoc analyses between people with painful condition (mild and moderate-to-severe pain) and those without pain as a control using the Dunnett’s method for parametric multiple comparison, the Steel’s method for nonparametric multiple comparison, and chi-squared test for categorical data. Participants reported pain duration (< 3 or ≥ 3 months) and painful sites (multiple answers allowed out of three major pain sites: low back, neck, and knees). Chi-squared test was used to compare the pain characteristics between individuals with mild pain and those with moderate-to-severe pain.

Principal component analysis of psychological measures

A principal component analysis (PCA) was performed with orthogonal rotation to the subjective stress and the five subscales were assessed on the basis of POMS to reduce the dimensionality of psychological measures and obtain more reliable effective variables generated by the central nervous system. Criteria of > 1 eigenvalue and > 10% explained variance were used for determining the principal components.

Multivariable regression models of pain intensity

Exercise habit (model 1) and the psychological components identified by the PCA (model 2) were analyzed using multivariable regression models of pain intensity, with adjustment for age, sex, BMI, low education, smoking status, marital status, living status, living area, sleep duration, and pain duration. The model included three levels of exercise frequency. The psychological components derived from the PCA were also incorporated in the model. Standardized regression coefficient (std-β) was calculated as a comparable value. The F-test and adjusted R-square were used for comparing the improvement of model fitting between the first and second models. Associations of the psychological components to pain intensity in the subpopulations with low back, neck, knee, and multi-site pain were analyzed using the second model.

Development of a mediation model for the influence of exercise on pain

The participants with pain ( n = 40,660) were randomly divided into two groups, termed Discovery ( n = 20,330) and Validation ( n = 20,330), and the mediation model of the effect of exercise on pain intensity was examined through the psychological components in these two groups. Bootstrap multivariable regression analyses were used with 10,000 permutations under adjustments for age, sex, BMI, low education, smoking status, marital status, living alone, living area, sleep duration, and pain duration. The two central components derived from the PCA were theoretically independent, making the construction of a parallel mediation model possible. First, the effect of three frequent levels of exercise habit were examined and compared with no exercise in the Discovery group. The magnitude of path effects was represented by std-β, and the cumulative indirect effect was computed as a summation of individual indirect effects of the first ( a 1 × b 1 ) and second ( a 2 × b 2 ) components. The mediation proportion was calculated as the cumulative indirect effect out of the total effect. An identical mediation analysis was then performed in the Validation group to test the reproducibility of the model.

Mediation analysis for effect of exercise on subjective health

Subjective health was applied to the mediation model of the exercise effect through the identified components in the Discovery group, instead of pain intensity. A two-tailed, unpaired t-test was performed under a null hypothesis that both proportions were indifferent after log-transformation of the proportional values, in order to demonstrate a difference in the mediation proportion from the model of pain intensity.

Sub-population studies of the developed mediation model

The mediation model was also applied to the subpopulations corresponding to the pain sites and impacts: low back, neck, knee, and multi-site. In addition, the cumulative indirect and total effects were computed in subpopulations stratified according to participant characteristics, including age (20–29, 30–39, 40–49, 50–59, and 60–64 years), sex (women and men), BMI (< 20, ≥ 20 and < 25, and ≥ 25 kg/m 2 ), educational level (low and high), smoking status (current and the others), living status (alone and with family), marital status (married and single including divorced and widowed), and pain duration (< 3 or ≥ 3 months).

Statistical software and map visualization

All statistical tests were two-sided. MATLAB 2016a was used for mediation analyses. PCA, multiple regression analyses, and the other statistical analyses were performed using JMP Pro version 13.2 (SAS Institute, Cary, NC).

Pain prevalence, severity, and associated demographics and behavioral characteristics

Of the 51,701 participants, 11,041 (21.4%) reported no pain, 25,119 (48.6%) reported mild pain (NRS = 1–3), and 15,541 (30.1%) reported moderate-to-severe pain (NRS ≥ 4). Relative to the other groups, the group with moderate-to-severe pain included people who were elderly. Also, a greater proportion of this group consisted of women. The other characteristics of participants in this group were: low educational level, currently smoking, short sleep duration (< 6 h), increased BMI, subjective stress, tension–anxiety, depression–rejection, anger–hostility, fatigue, and confusion. This group also included a lower proportion of participants with high-frequency exercise habit (more than twice per week), lower subjective health, and lower vigor (Table 1 ). In addition, the group with moderate-to-severe pain included a more participants with persistent pain (pain duration ≥ 3 months) and multi-site pain versus the group with mild pain.

Relationships of pain intensity with exercise and behavioral characteristics

First and foremost, based on multivariable regression analysis, a significant association was observed between reduced pain intensity and high-, moderate-, and low-frequency exercise habits compared with no exercise, with the other parameters such as age, sex, BMI, low education, smoking status, marital status, living status, living area, sleep duration, and pain duration as controls (Table 2 , model 1). Two principal components were identified using PCA, which was used to reduce the psychological variables. The first principal component (PC1), which met the criteria with 4.47 eigenvalue and 63.8% of explained variance (Fig. 1 A), was named Negative Affect, because variables with high loadings above 0.7 for the PC1 included subjective stress, tension-anxiety, depression-dejection, anger-hostility, fatigue, and confusion (Fig. 1 B). The second principal component (PC2) with 1.09 eigenvalue and 15.6% of explained variance (Fig. 1 A) was mainly composed of vigor, a domain of the POMS. Loading of vigor for the PC2 was 0.98, and the other variables showed small loadings for it (Fig. 1 B). These two psychological components were significantly associated with pain intensity (Table 2 , model 2), as well as in the four subpopulations of back, neck, knee, and multi-site pain (Table 3 ). On the other hand, significant effects of exercise habits, which were identified in the model in the absence of the psychological components, disappeared when Negative Affect (PC1) and Vigor (PC2) were included, implying that these components may be associated with the effect of exercise on pain.

Principal component analysis of the Subjective Stress and five subscales of the POMS ( n = 51,701). (A) A screen plot of eigenvalues and a bar graph of explained variances corresponding to the possible principal components. The number of components was determined by the criteria of > 1 eigenvalue and > 10% variance explained. (B) Loading plot of the measures for the identified two principal components.

Psychological effects associated with effect of exercise on pain

High-frequency exercise significantly decreased Negative affect (PC1) and increased Vigor (PC2), and each indirect effect to pain intensity showed significance in terms of both psychological components (Fig. 2 A). The direct effect of high-frequency exercise on pain was nearly zero, and the cumulative indirect effect was nearly equal to the total effect (association proportion = 0.99), implying that the effect of exercise on pain reduction was fully associated with Negative affect (PC1) and Vigor (PC2). Furthermore, dose-dependent responses were identified in the total and indirect effects, as well as the effects of exercise on each psychological component corresponding to the frequency of exercise habit (Fig. 2 B and Supplementary Table 1 ). In addition, even in people with low- and moderate-frequency exercise, the cumulative indirect effects were nearly equal to the total effects, suggesting full association effects. The total and indirect effects increased in parallel with the frequency of exercise habit. The dose–response and the full association effect were replicated in the validation group (Fig. 2 C and Supplementary Table 2 ).

Dose–response of the full association effect of exercise on pain intensity through the psychological components. (A) Mediation model and computed path effects of the high-frequency exercise in half of our participants, the Discovery group ( n = 20,330). The cumulative indirect effect, an overall psychological effect, was − 0.032 (95% confidence intervals [CI]; − 0.038 to -0.026) regarding high-frequency exercise on pain intensity, while the direct effect (c’) was nearly zero (95% CI; − 0.015 to 0.011). The thickness of the path represents the absolute value of the effect, and the dot line indicates statistical indifference from zero. *** p < 0.001. (B) Dose-dependent increase of absolute path effects of the mediation model in the Discovery group. The indirect and total effects increased with three levels of exercise: low, moderate (mod), and high frequency. ( C) Replication of the full mediation model and frequency-dependent increase of the absolute path effects in the other half of the participants, the Validation group ( n = 20,330). Bootstrap mediation analyses were performed with 10,000 permutations. Error bars represent 95% CI.

Psychological association effects of subjective health with exercise

A similar analysis to examine the association effects of Negative affect (PC1) and Vigor (PC2) on subjective health was performed. Overall, the association proportion of these psychological components was observed to be lower on subjective health (0.52) than on pain intensity, whereas indirect effects were significantly high (Supplementary Fig. 1 , Supplementary Table 3 ). Furthermore, statistically significant differences of any standardized regression coefficients between the mediation models on pain intensity and subjective health were absent, although direct effect of high-frequency exercise on subjective health was significantly higher than that on pain intensity (Supplementary Table 4 ).

Robustness of the mediation model across different pain conditions and demographic characteristics

Of 40,660 participants with pain, 2,926 (7.2%), 8,040 (19.8%), and 1,134 (2.9%) reported pain at only one of the three popular pain sites: low back, neck, and knees. 8,045 (19.8%) people reported pain at all three sites and were categorized as people with multi-site pain. The participants experiencing low back, neck, knee, as well as multi-site pain showed consistent dose-dependent responses (Fig. 3 A and Supplementary Table 5 ). Full association was also demonstrated in all of them in terms of high- and moderate-frequency exercise.

Stratified sub-populational analyses for the mediation model of central effects on exercise-related pain reduction. (A) Both indirect and total effects increased in parallel with the frequency of exercise in individuals with low back, neck, knee, and multi-site pain. The indirect effects showed at least 85% and 69% of the total effects of high- and moderate-frequency exercise respectively. (B) Summary table of the mediation analyses applied to the stratified subpopulations of demographic characteristics. Bootstrap mediation analyses were performed with 10,000 permutations, with adjustment for age, sex, BMI, low education, smoking status, marital status, living alone, living area, sleep duration, and pain duration. Error bars represent 95% confidence intervals. LF: low frequency, MF: moderate frequency, HF: high frequency.

Stratified mediation analyses identified an increasing tendency of the effect of exercise on pain reduction in parallel with the increasing age (Fig. 3 B and Table 4 ). Especially, significant indirect as well as total effects of high- and moderate-frequency exercise were observed in participants aged > 40 years. Another important finding was that the significant indirect effects of high- and moderate-frequency exercise were consistent across all stratified populations. On the other hand, there were no significant total effects of exercise in younger people (aged < 40 years), current smokers, and people with chronic pain (pain duration ≥ 3 months).

Several participants who mentioned having moderate-to-severe pain, had chronic pain (≥ 3 months) and multi-site pain indicating that these participants were more likely to have severe pain and a lower status of the overall subjective health. 16.9% of the participants with moderate-to-severe pain reported exercising at least twice a week, although this percentage was lower compared to participants without pain or those with mild pain, which is suggestive of the fact that people with more severe pain might have difficulty in establishing an exercise routine. However, the proportion of participants who exercised less than twice a week was not as low as those without pain, suggesting that these participants were more motivated to maintain an exercising habit. Additionally, the significant association of severe pain with risk factors such as women, high BMI, low education, smoking habits, stress and negative affect and short sleep was consistent with previous studies 16 , 17 .

The rate of high-frequency exercise was similar in participants with mild pain and those without pain, however, the rate of moderate-frequency and low-frequency exercise was higher in participants without pain, potentially resulting in higher scores on the vigor scale compared to those without pain. This suggests that the presence or absence of exercise habits in people with pain is associated with both pain intensity and emotion, and lack of exercise is not decided only by presence of pain.

The fact that two components, Negative affect (PC1) and Vigor (PC2), were extracted by PCA suggests that positive and negative emotions are not simply two sides of the same coin, but rather should be evaluated separately. This finding reinforces the importance of evaluating pain-related fear as well as functional self-efficacy, when implementing treatments for chronic low back pain patients 18 .

While pain is one aspect of subjective health, the fact that the mediation model in this study showed partial association with regards to subjective health (Supplementary Fig. 1 ), but full association with regards to pain intensity (Fig. 2 A), indicates that the emotional effects of exercise on pain intensity are more prominent than those on subjective health. In other words, the association effects of exercise on subjective health may be controlled by other aspects such as physical improvement as well and not only the emotional aspect.

Although the effects of EIH depend on the type, amount, intensity of exercise, and the presence of pain during exercise, this study did not conduct the investigation of the detailed types of exercise and performed the analyses with heterogeneity in background. Unsupervised or voluntary exercise, whose proportion might be majority in this study, show small effect as a treatment for pain compared to supervised exercise therapy 19 . Therefore, we considered that our findings showed small amount of absolute standardized coefficients of exercise habit to pain intensity and small adjusted coefficient of determination in the model 1, Table 2 . On the other hand, the fact that the significant associations of exercise habit disappeared in the model 2 made us come up with the mediation model of Negative affect (PC1) and Vigor (PC2). As a result, the full association model of Negative affect (PC1) and Vigor (PC2) was established and successfully validated with a dose-dependent response even for participants with pain in the low back, neck, knee, and pain in all three locations, indicating that the impact of exercise habits on emotional aspects may be an important universal point in the effect of exercise habits on pain regardless of the pain site. Nobel point of this study was the development of the full association model of exercise effect on pain, even though absolute values of coefficients were small. Our findings interpret that improvements of negative affect and positive one should be paid attention to in an exercise habit for people with pain.

According to our recently reported study of brain functional connectivity associated with exercise effect on pain 20 , exercise habit is associated with decreased functional connections in the left thalamus and right amygdala, and increased ones in the medial prefrontal cortex (MPFC). Thalamus plays the role of a central nucleus on the sensory pathway, and the amygdala and MPFC are involved in recognition of negative emotion and/or unpleasantness. Our findings in the mediation analyses might clinically correspond to these neurological modifications induced by exercise habit.

EIH, a consistent phenomenon of pain attenuation following exercise, is possibly an important factor of exercise-related pain reduction. Although the mechanisms responsible for EIH are not entirely understood 21 , central modifications, (e.g., serotonergic 22 , 23 , dopaminergic 24 , endocannabinoid 25 , 26 , and opioid systems 27 ), and involvement of conditioned pain modulation through the descending pathways are thought to be the responsible factors 28 . The improvements in Negative affect (PC1) and Vigor (PC2) after exercise might be a result of these central mechanisms. On the other hand, people with chronic pain are generally associated with impairments of these systems 29 . Complex pathophysiology involving psychological factors and alterations in the central nervous system are the characteristics of chronic pain 30 . Therefore, although exercise therapy is an appropriate treatment for chronic pain, the effective extent of pain improvement is limited 31 . Similarly, in this study, the group with chronic pain tended to have a limited improvement in pain, leading to the belief that the impact of exercise on pain intensity was minimal.

This study indicated an increasing effect of exercise on pain relief with increasing age, suggesting the involvement of the endogenous pain inhibition mechanisms, that decrease in function with age 32 . However, this function is reversible. A previous study investigating central sensitization and the descending pain inhibitory system using quantitative sensory testing in older adults has demonstrated that those with higher physical activity levels have better functioning pain inhibition mechanisms 33 . Such biological mechanisms may lead to differences by age group in pain relief responsiveness.

Women are generally associated with increased pain sensitivity, lower pain threshold, and increased risk of developing clinical pain, as compared to men 34 , 35 . On the other hand, although gender differences with respect to response to pain treatment have not been clearly understood, few reports suggest that women respond better to interdisciplinary treatment compared to men, and that gender is a factor that is related to responsiveness to pain treatment 36 . The results of this study also suggest that women may have a higher tendency for the psychological factors of exercise to influence pain intensity compared to men.

This study has also indicated that married people tended to have higher indirect effects of Negative affect (PC1) and Vigor (PC2) on pain intensity in relation to exercise, compared to unmarried people. However, according to previous studies, the presence or absence of a spouse does not affect unpleasantness or suffering related to pain 37 , and is not a determining or predictive factor for quality of life, and therefore, need not be considered during rehabilitation 38 . Therefore, the effects of marital status on exercise and pain needs to be further investigated.

Severity of chronic pain is affected by lifestyle factors such as smoking and high body weight 39 . Studies investigating patients with lumbar disc herniation have identified that smoking and high body weight are risk factors for motor deficits and delayed pain improvement 40 . In fact, smoking and high body weight have been shown to adversely affect responsiveness to exercise therapy on treatment 41 , 42 , which is consistent with our findings that the total effect of exercise habits on pain was lesser in people with BMI ≥ 25 kg/m 2 or in people who practiced smoking.

Some limitations of the study need to be addressed. Firstly, the nature of the web-based survey may reduce the external validity of the results because access to the internet is necessary for the online recruitment. However, the study was conducted with a large sample size, corresponding to the general population in Japan, in terms of age and sex composition ratio. Therefore, the selection bias may not be a critical problem in this study. Secondly, the influence of pain intensity on exercise frequency was not assessed, although a bidirectional causal relationship may be present between these two factors. In this study, participants reported exercise frequency over the past year, and the pain intensity reported was over the past four weeks. Therefore, the directionality from pain intensity to exercise habit could not be considered. Thirdly, the detailed properties of exercise were not assessed in the study. Data for the duration, intensity, and type of exercise was not collected, since we assumed that these parameters were optimized by people who exercise. From the viewpoint of exercise optimization, exercise therapy supervised by a professional therapist is beneficial 19 . Fourthly, subjective stress and health were assessed by an original measurement without scientific validation. However, the 11-point numerical rating scale that we used is a measurement widely used for assessing a single item and convenient to assess it for many people in a limited time. Although further confirmations may be required for our findings, this data collection way for subjective stress and health is considered to be acceptable for scientific researches.

Fifthly, a recall bias can potentially affect the retrospective questions. Finally, only adults under 65 years old were included in this study and the effects in the elderlies are still unclear. Although greater effects according to aging are expected from the findings in the subpopulation analyses of the age category, further study is required to identify them in elderlies. Thus, the responses should be interpreted with caution.

In conclusion, this study has demonstrated that the effect of exercise on pain reduction is associated with psychological components, namely Negative Affect and Vigor. These association effects increased in parallel with the frequency of exercise habit. Furthermore, the full mediation model with a dose-dependent response was successfully validated regardless of the pain site, suggesting improvement of the negative and positive emotion is comprehensive factor of the exercise effect on pain.

Data availability

Data are available upon reasonable request. Analyzed data in this study are considered to be available under the permission of the corresponding author and data manager.

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Acknowledgements

We are grateful to all the participants in this survey. We also thank Dr. Tomoko Fujii, Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, the University of Tokyo, for providing data and supporting the ethical process. The authors would like to thank Enago ( www.enago.jp ) for the English language review.

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Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

Kenta Wakaizumi, Yuta Shinohara & Morihiko Kawate

Interdisciplinary Pain Center, Keio University Hospital, Tokyo, Japan

Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan

Ko Matsudaira

Division of Musculoskeletal AI System Development, Faculty of Medicine, The University of Tokyo, Tokyo, Japan

Hiroyuki Oka

Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan

Keiko Yamada

Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan

Shirley Ryan AbilityLab, Chicago, IL, USA

Rami Jabakhanji & Marwan N. Baliki

Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

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Contributions

K. W. designed and conducted the study, analyzed the data, and wrote the manuscript. K. W. and Y. S. wrote the first draft. M. K. and R. J. generated figures and tables. K. M. and H. O. participated in the data collection of the Japanese survey. K. Y. critically revised the first draft for important intellectual content. M. N. B. supervised the data analysis and revised the first draft. All authors contributed to the final manuscript.

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Correspondence to Kenta Wakaizumi .

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Competing interests.

This research was partially supported by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (21K16564), the Health Labour Sciences Research Grant (19FG1001), and the Foundation for Total Health Promotion. All authors have declared potential conflicts of interest as follows: KM reports receiving grants from the Ministry of Health, Labor and Welfare during the conduct of the study; grants and personal fees from AYUMI Pharmaceutical Corporation, Nippon Zoki Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd, Shionogi Co., Ltd., Eli Lilly Japan, Astellas Pharma Inc., Toto Ltd., Eisai Co., Ltd., Teijin Pharma Limited, Japan Inc., and Hisamitsu Pharmaceutical Co., Inc.; personal fees from Pfizer Inc., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co., Ltd., Mochida Pharmaceutical Co., Ltd., and Daiichi Sankyo Company, Limited; grants from Sompo Holdings, Inc., MTG, NuVasive Japan , and Murata Manufacturing Co., Ltd.; grants from Okamura Corporation; and non-financial support from Trunk Solution Co., Ltd. outside the submitted work. HO received grants from Teijin Pharma Limited, grants from Pfizer Inc., grants from Fujifilm Medical Co., Ltd., grants and personal fees from AYUMI Pharmaceutical Corporation, Nippon Zoki Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Sompo Holdings, Inc., NuVasive Japan, and grants from Eli Lilly Japan. KW, YS, MK, KY, RJ, MNB have no competing interests to report.

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Wakaizumi, K., Shinohara, Y., Kawate, M. et al. Exercise effect on pain is associated with negative and positive affective components: A large-scale internet-based cross-sectional study in Japan. Sci Rep 14 , 7649 (2024). https://doi.org/10.1038/s41598-024-58340-z

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Smoking Habit, Its Causes and Effects Essay

Smoking is one of the factors that are considered the leading causes of several health problems in the current society. As Fritz (2008) says, there is a need to encourage people to adopt a lifestyle that would help in protecting the health of an individual. The above scholar is of the view that many professionals, including doctors, support the need to maintain a healthy lifestyle. Other professionals, such as psychologists and teachers, have firsthand experience of how some health complications would negatively affect some users. The cost of living is on the rise, while employment opportunities are shrinking. The health facilities are under pressure to increase their capacity, but due to the limited resources, the government has not been possible to meet the demands needed in the hospitals. This has seen the cost of accessing proper medical attention skyrocket within the past decade. This has been the main reason why people are constantly advised to adopt healthy lifestyles that would ensure that they keep doctors away.

Most smokers would develop the smoking habit out of the fun. They consider this behavior a form of lifestyle that would help them be categorized in a specific group of people. Some start smoking as a way of gaining acceptance to a certain group of people. As Wong (2000) says, no one is born a smoker. Similarly, smoking is not medicinal, and as such, it is not possible that one could have been addicted because of a medical condition. Getting into addiction as a chain smoker always starts of one’s own willingness to be a smoker. However, after a successful introduction into the habit, the behavior of an individual would change forever. Smoking will cease being an activity done to generate fun. It would be a necessity without which the body might not function properly. Indeed, there has always been a massive global campaign against smoking. A section of the society may be wondering why this vice has attracted the attention of various professionals and the public in general. Smoking has several severe health conditions that make it unfit for people. It affects the health of an individual to the extent that it might lead to amputation. Several individuals have lost some parts of their bodies simply because of smoking.

Liver cirrhosis is one of the main health complications that result from smoking. Have you ever wondered where all smoke that one inhale goes? The best physical test would be to study the chimneys or the car exhaust for a while. When the car is newly taken from the showroom, the exhaust is sparkling clean. After driving the car for a while, the exhaust would develop black soot. The same would be the case with the chimney. As time goes by and as the chimney or the exhaust is continually put into use, the soot gets bigger and uglier. It reaches a time when the soot has to be scraped off to increase the efficiency and make the exhaust or the chimney more effective.

Similarly, this is what happens to the lungs and the entire respiratory organs as one persists with the smoking habit (Hawkins, Mothersbaugh, & Best, 2010). The soot would start developing in the lungs as one continues to smoke. When this habit is not changed as soon as possible, the individual would have an infection of the lungs as the smoke accumulates. The soot would settle in the chambers of the lungs, blocking them from functioning completely. This would render the lungs ineffective. The liver would face difficulties in ensuring that the lung is cleaned to allow it to perform its functions. This means that the soot will be transferred into the liver. The liver will try to eliminate this contamination for a while. However, as their volume becomes unbearable, it would affect the liver to the extent that it would not be functioning. This contaminant will negatively affect the liver leading to what is always referred to as liver cirrhosis. This health complication can lead to death if it is not addressed appropriately.

Smoking is also known to contribute to other health conditions. According to Graham (2010), smoking has been confirmed to be the leading cause of some forms of cancer. The above scholar says that smoking always increases the chances of one developing such cancers as cancer of the throat and mouth. Cancer is a medical condition that has been considered the leading cause of death in the world today. A case in point is the death of Apple Inc’s founder and former chief executive, Steve Jobs. Steve Jobs was a chain smoker who heavily relied on smoking to make the body system function properly. Since this habit is welcome in society, the famous CEO did not consider it a factor that could complicate his health. When this realization dawned on him, it was too late. The smoke had massively affected him, and he was diagnosed with cancer. He ignored the advice of the medics to quit smoking and adopt a different behavior that would save his life, but he was reluctant to do so.

Consequently, he was brought to his humbling knees by this complication. The demise of Steve Jobs should be a wakeup call to all smokers and those planning to join smoking. These people should know that smoking is dangerous. There are other consequences of smoking, such as changing the coloration of the teeth. The smoke makes the teeth to develop a brown coloration that may not be pleasant, especially among the youth and the middle-aged individuals who would always want to be presentable to others. Smoking may also make one be alienated from friends. Some people hate smoking with a passion. This may force one to drop trusted friends because of this habit.

Smoking is a habit that may be easy to start, but getting out of this vice might be one of the biggest challenges in one’s lifetime. Psychologists have always stated that quitting smoking is not as easy as quitting other addictions, such as alcoholism. Although it is not an impossibility, the process of quitting this habit is always complex and may be accompanied by some pain, especially when an individual reaches an advanced stage. As such, it is always important that this habit should not be started in the first place. One gains no advantage by being a smoker. However, the health and social complications that are accompanied by this are always devastating. One faces a possibility of rejection from trusted friends, besides developing the dreaded cancer disease. This may change the lifestyle of an individual permanently.

Fritz, R. (2008). The power of a positive attitude: Discovering the key to success . New York: American Management Association.

Graham, J. (2010). Critical thinking in consumer behavior: Cases and experiential exercises . Boston: Prentice Hall.

Hawkins, D., Mothersbaugh, D., & Best, R. (2010). Consumer behavior: Building marketing strategy . Boston: McGraw Hill.

Wong, R. (2000). Motivation: A bio-behavioral approach . Cambridge: Cambridge University Press.

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