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Smoking: The new Russian roulette game?

by Pedro Marques-Vidal, Prevention, Epidemiology & Population Science (PEP) Section

Risk Factors and Prevention

Russian roulette is a lethal game of chance in which a player places a single round in a revolver, spins the cylinder, places the muzzle against their head, and pulls the trigger [1]. If we change the outcome and consider that, instead of killing, each “successful” shot takes you 11 minutes of your life [2], then we have the effect of occasional smoking.

Smoking kills. There is no way denying. In 2015, over one out of ten deaths worldwide was attributable to smoking [3]. This is 6 times more than HIV [4] and almost 40 times more than all military conflicts in 2016 [5]. Smoking ranks among the five leading risk factors by disability-adjusted life-years in 109 countries [3]. Despite this evidence, still one quarter of the world adult population smokes [3].

While the effects of regular smoking have been definitively established, less known was the effect of occasional smoking. In a recent paper, Maja-Lisa Løchen and colleagues assessed the impact of occasional smoking on total mortality in 4020 women and 3033 men in Norway [6]. Compared to never smokers, occasional smokers had an increased mortality of 38%. The authors acknowledged the difficulty in precisely defining occasional smokers by stating that “Occasional smokers is an unstable and heterogeneous group of former daily smokers trying to quit, persistent occasional smokers and former quitters who are occasional smokers for a period”. Still, their results show that even some puffs from time to time reduce your chances of living, just like if each cigarette was reducing your life by some minutes.

Therefore, the message is (even more) clear: there has never been, there isn’t, and there will never be safe smoking. Each single cigarette pushes you closer to death. Never initiating or definitely quitting smoking are the only safe issues for a baneful outcome.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


Pedro Marques-Vidal commented on this article:

[6] Lochen ML, Gram IT, Mannsverk J, Mathiesen EB, Njolstad I, Schirmer H, Wilsgaard T, Jacobsen BK (2017) Association of occasional smoking with total mortality in the population-based Tromso study, 2001-2015. BMJ Open 7 (12):e019107. doi:10.1136/bmjopen-2017-019107

Additional references:

[1] Wikipedia (2018) Russian roulette. Accessed 11 January 2018

[2] Shaw M, Mitchell R, Dorling D (2000) Time for a smoke? One cigarette reduces your life by 11 minutes. Bmj 320 (7226):53

[3] Collaborators GBDT (2017) Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 389 (10082):1885-1906. doi:10.1016/S0140-6736(17)30819-X

[4] World Health Organization (2017) HIV/AIDS fact sheet. World Health Organization. Accessed 11 January 2018

[5] World Bank (2017) Battle-related deaths (number of people). Accessed 11 January 2018