The Negative Effects of Smoking

The Negative Effects of Smoking

Literature Review
The intent of this review of literature is to show the needs of the further research in how smoking effects the health of the smokers and their families, their financial state, the environment, and people around them. In order to help smokers quit smoking by showing them the reasons of why they should quit smoking and how they can quit. The literature review has shown a gap in the literature and the needs for the further research “the negative effects of smoking.”

How smoking hurts your health. (2012, 9 24). Retrieved from http://www.lung.ca/protect-protegez/tobacco-tabagisme/facts-faits/hurts-nuit_e.php In this web page they talked about how smoking hurts the smoker’s health by damaging the lungs ' cleaning and damaging the repair system and air sacs in the lungs. They also talked about the signs of lung damage from smoking which are feeling out of breath when walking up a short flight of stairs, coughing, spitting up mucous, and repeat chest infections. And they also talked about how smoking will hurt the rest of the smoker’s body.

(n.d.). Smoking 's effects on the lungs. Retrieved from http://www.allsands.com/health/smokingeffects_srw_gn.htm In this article they talked about the effects of smoking on the lungs which are mainly caused by tar and nicotine the two main ingredients of cigarette smoke. They mentioned that nicotine can wreak havoc on the heart because it makes the smoker’s blood vessels smaller in diameter for a while which make the heart pump harder to provide the body with the oxygen it needs. They mentioned also that smoking disturb the balance within the lungs because the lungs work to rid the tubes of tar by stimulating its owner to cough. And the gas exchange is hampered because nicotine has constricted the blood vessels, pumping the blood too far away from the air sacs. When the lungs cannot clean out the tar, the air sacs can collapse.

(n.d.). How smoking affects the environment?. Retrieved from http://smoking.ygoy.com/smoking-and-the-environment/ In this article they talked about how smoking affects the environment by causing air pollution because of the harmful substances which is released in the air from the cigarette and by causing land and water pollution. Also they talked about how the manufacturing process affects the environment by decreasing the amount of trees to produce paper for rolling and packaging of the cigarettes and less trees means less filtered air.

Gilchrist, R. (2007). How Best to Quit Smoking: Interview with Dr. Randy Gilchrist. Retrieved from: http://www.trans4mind.com/counterpoint/index-health-fitness/gilchrist.shtml

In this article Dr. Randy Gilchrist stated that quitting smoking is hard for the smokers because smoking is considered as a habit for the smokers that offers them relaxation and comfort. And because of the addiction of the nicotine. Then he mentioned three advices that can help smokers to quit. After that he gave an advice to help them stay motivated. His advice was that smokers should write a list of their reasons of quitting and keep this list close to them which will help them quit smoking by remembering all the reasons they mentioned in the list.

References
How smoking hurts your health. (2012, 9 24). Retrieved from: http://www.lung.ca/protect-protegez/tobacco-tabagisme/facts-faits/hurts-nuit_e.php

(n.d.). Smoking 's effects on the lungs. Retrieved from: http://www.allsands.com/health/smokingeffects_srw_gn.htm

Ygoy. (2008). How Smoking Affects the Environment? Retrieved from: http://smoking.ygoy.com/smoking-and-the-environment/
Gilchrist, R. (2007). How Best to Quit Smoking: Interview with Dr. Randy Gilchrist. Retrieved from: http://www.trans4mind.com/counterpoint/index-health-fitness/gilchrist.shtml

Introduction Most of the people have their own habits that they get used to do in different situations. Some people when they feel happy, sad or bored, they do certain habits that they get used to depends on their mood such as playing, reading or sleeping. Smoking is one of the most popular habits over the world. When we go outside, we see many people smoke from different ages and in different places and at different time. Some of them smoke just because they are addicted, and others do that just to relax their moods. Actually, most of the smokers want to quit smoking because they know that smoking is bad for health, but it is hard for them to quit. Therefore, understanding more about the effects of smoking can help them in quitting.
This research paper talks about the negative effects of smoking. It explains the effects of smoking on the smokers’ eyes, oral health, lungs, heart, brain, skin, bones and muscles and the digestive systems. It explains also how smoking affect smokers psychologically and financially and the harms of smoking on the environment and other people. It also contains a survey which is done with smokers and non-smokers to communicate with respondents about the problem. It includes also an interview with a psychologist to support the information and to give some advices about quitting smoking.

Effects of smoking on the smokers Smoking has many negative effects on the whole body starting from the eyes and ends up with the digestive system, muscles and bones.
1. On the eyes: Smoking increases the risk of eyes disorders. It causes the following eyes diseases:
Cataract: smoking, especially pipe smoking causes cataract which is a clouding of the eye’s lens.
Age related macular degeneration: this is one of the eyes diseases that are caused by smoking. Age related macular degeneration is the deterioration of the smokers’ vision as they get older.
Graves ' ophthalmopathy (thyroid eye disease): This is classified by “the inflammation of the eye and fat in the eye socket”. Studies have shown that smokers are at more risk of thyroid eye disease than non-smokers.
Ocular surface disorders: smoking increases the disorders of the eye’s ocular surface causing itchiness, redness and irritation of the eyes. The disorder of eye’s ocular surface includes changing the lipid layer in the tear film and reducing in the tear secretion, corneal and conjunctival sensitivity (virtual Medical Center, 2009)
2. On the oral health: When the smoker smokes a cigarette, not all the substances will go inside his/her lungs. Some of the components of the cigarette stay in the smoker’s mouth and stain the smoker’s teeth and changing their color to yellow or brown. This yellowish cannot be removed with the toothpaste. Also, based on a study published in the Journal of Periodontology proves that there is a direct relationship between the number of cigarettes that smokers smoke and the incidence of oral cancer. The study also showed that people who smoke less than half pack per day are three times more likely to have oral cancer while the people who smoke more than that are six times more likely. In addition to the oral cancer, smoke causes the failure of the oral surgeries, because smoke hampers the healing of the wound. Moreover, the smoke causes bad breath. The reason of getting this bad breath is that the cigarette smoke dries the smokers’ mouths and decreases the salivation which works as anti-bacteria and reduce the bad breath. Also, the smoke affects the smokers’ gums because of the bacteria that grow up in the smokers’ mouth (Cristian Stan, 2008; Good Gums, 2010).
3. On the lungs: As explained in the Canadian Lung Association and All Sands articles about the effects of smoking on the lungs, smoking effects on the lungs are mainly caused by tar and nicotine the two main ingredients of cigarette smoke. The tar is the black solid substance (the same substance that is used in constructing roads). The nicotine is the chemical substance that the human body absorbs and carries through the blood. The nicotine reduces the diameter of the smoker’s blood vessels for a while. In this situation, the heart has to pump harder to provide the body with the oxygen it needs. In addition, the effects of the cigarette disturb the balance of the respiratory system. The tar plugs up the bronchiole tubes, because it becomes deposited inside them. As a result, the lungs stimulate its owner to cough to get rid the bronchiole tubes of this dangerous substance. At the same time, the exchange of the gases is prevented because of the small size of the blood vessels caused by the nicotine. That will make the blood pumped far away from the air sacs. Moreover, the nicotine damages the cilia which is tiny hairs covers the upper airways. The cilia work with the mucous together to protect the lungs from infection and to get rid of tar and other dirt. When the cilia are damaged, the tar and the other dirt will stay inside your lungs. Also, when the lungs cannot get rid of the tar, the alveoli which are the small stretchy air sacs at the tips of the lungs will be damaged. The alveoli helps the body to absorbs the oxygen and get rid of carbon dioxide in the breathing process. The smoke makes the alveoli less stretchy, and that will make the breathing process slower and harder. That causes COPD and makes the smoker feel tired and has short breath.
4. On the heart: Based on Heart Stats Organization article, the British doctors’ cohort study showed that the mortality rate from cardiovascular disease was about 60-85% higher in smokers than non-smokers (2008). Smoking causes many cardiovascular diseases such as atherosclerosis, coronary heart diseases, strokes, high blood pressure and high cholesterol levels. Smoking increases the level of fibrinogen which is the protein that clots the blood and makes it stock around the blood vessels. Also, Carbon monoxide, which is one of the most harmful chemicals in the smoke, combines with hemoglobin and gets absorbed in the blood faster than the oxygen so that will reduce the level of the oxygen in the blood. As a result, the heart will work very hard trying to get the oxygen. In addition, smoking affects the heart rate for smokers. Smoking raises the heart rate for smokers. These are some of the dangerous heart diseases that are caused by smoking:
Atherosclerosis: is one of the heart diseases that are caused by smoking. The main reason for this condition is the deposition of the fatty plaques which result from the nicotine and cholesterol in the arteries. This deposition of plaques reduces the oxygen in the blood because of the blocked arteries.
Strokes: this condition happens when the brain is starved of the oxygen or blood or when the blood arteries burst inside the brain leading to death.
Heart attack: the main reason for this condition is the blockage of the coronary artery because of the deposition of plaques in the blood. In this situation, the heart beat stops.
Abdominal Aorta Aneurysm: this situation happens when the aorta becomes abnormally larger and bursts (Deo, 2010).
5. On the skin: The author states in the Virtual Medical Center’s article about how smoking effect your skin, that smoking reduces the blood flow in the arteries which damages the connective tissues and the Skin fibroblasts (skin cells that produce collagen and elastin). In addition, smoking causes skin ageing which leads to wrinkling. The cause of wrinkling is the changing in the skin elasticity and the concentration of skin components such as collagen and elastin. In addition to the skin ageing, smoking hampers the healing of skin wounds. The main causes of the poor wound healing are the nicotine and carbon monoxide. They reduce the supply of the blood and the oxygen and therefore decrease the nutrients and the oxygen that cells need to regenerate. Moreover, many studies have shown that smoking leads to skin cancer. Based on the Nurses’ Health Study, which has done on nurses in the US, the smoking nurses were at 50% more risk of squamous cell carcinoma of the skin (a type of skin cancer) than non-smoker nurses (2009).
6. On the digestive system: When the smoker smoked, the tar which is left in his mouth and the smoke enter his digestive system through the mouth causing many diseases for the digestive systems.
Mouth, stomach and rectal cancers: the tar in the cigarette cause the abnormally growth of cells which leads to cancer.
Liver diseases: the main function of liver is to filter the body from the waste substances. Smoking contains only harmful substances which the liver has to remove. That increases the pressure on the liver to remove these harmful substances.
Peptic Ulcer: when the smoke enters the stomach, it irritates the stomach. Therefore, the production of gastric acids increases and damages the linings of the stomach causing peptic ulcer (Uy, 2009).
7. On bones and muscles: Smoking weakens the bones in the body causing Brittle Bones (osteogenesis imperfecta) and many other diseases. Also, nicotine damages the calcium element in the bones which is important for the strength of the bones. Moreover, the density of bones reduces causing the poor healing of fracture, sprain and hairline cracks (No to Smoke, 2010).
According to Susan Drew article, the muscles in our body need oxygen to do their functions. Reducing the oxygen which is caused by smoking make your muscles work harder. He says:
A study published in the "American Journal of Endocrinology and Metabolism" in 2007 found that smoking impairs skeletal muscle protein synthesis and increases the expression of genes associated with impaired muscle maintenance. The authors concluded that smoking likely increases the risk of a condition called sarcopenia, or age-related loss of lean muscle mass. Sarcopenia is a major cause of disability and frailty in the elderly, but it begins as early as age 40.
8. On the brain: The brain is the center of the nervous system. Based on researchers from the Indian National Brain Research Center, there is a substance in the tobacco cigarettes harms the brain cells called NNK. When this substance enters the smoker’s body, its interactions convert it to carcinogen which causes cancer. Moreover, NNK converts the function of Microglia cells (the cells that protect the brain from damages) to the opposite side. Therefore, the microglia cells will work to damage the healthy cells because of harmful proteins produced by NNK. According to researchers from the University of Michigan, the reason of relaxing and less sensation of pain that smokers feel when they smoke is opioid and dopamine. These two substances are released by the cigarette smoke in the brain. These chemicals make it harder for the smokers to quit (surya, 2010).

9. Psychologically: The most obvious psychological effect of smoking is the addiction. Addiction is when someone addicts to a habit or activity and can’t stop it. The main reason for addiction is the Nicotine. When the nicotine molecules enter the brain through bloodstream, it locks into the brain receptors. The shape of the nicotine molecules look like the acetylcholine. Acetylcholine is a natural neurotransmitter which controls muscle movements, breathing, heart rate, learning and memory. It also releases the chemicals that regulate mood, appetite, memory, and stimulate the pleasure centers of the brain. Therefore, the nicotine works instead of the acetylcholine and stimulates the brain to release a big amount of dopamine in the body. As a result, that gives the smoker feeling of relaxation and calm. In this way, the smoker addict to smoking because he links this feeling with smoking (online essays, 2010).

Effects of smoking on the environment Smoking does not only affect the smokers, it affects the environment as well. First of all, smoking causes air pollution because of the harmful substances which is released in the air from the cigarette. These harmful substances pollute the water in the environment as well. When smokers left their cigarette on the ground, most of them end up in the rivers and seas. As a result, these thrown cigarettes kill the fishes and others animal in the water. Moreover, the cigarette butts which is left on the ground take more than 20 years to decompose, and it pollute the soil as well. When the soil is polluted, the plants will be damaged too (smoking Ygoy, 2010). Smoking may cause fires in houses and forests when the smokers left their lit cigarette on the ground which will affect the environment. Also, the manufacturing process of 300 cigarettes requires a whole tree which decreases the amount of trees on the ground. The result of destroying trees is having less filtered air which is very dangerous (Hicks, 2009).

Effects of smoking on the other people (Passive smoking) In addition to all these harms of smoking, smoking affects the people around the smoker. Based on the results of the survey I conducted that, (see appendix A for the survey), 58% of the people (non-smokers) don’t want to sit beside a smoker.

This is called passive smoking or secondhand smoke. The non-smokers inhale the smoke from the smoker beside him, so most of the substances including the nicotine in the smoke enter their bodies. Secondhand smoke causes cancer, premature death and many other harmful diseases in non-smokers especially children. Children who are usually exposed to their parents’ smoke are at more risk of respiratory system problems such as asthma and slowed lungs grow. In addition, passive smoking causes sudden infant death syndrome in children. Moreover, exposing pregnant women to passive smoking affects the weight of their babies (Cancer, 2010).

Financial effects of smoking Smoking is a huge waste of smokers’ money. One packet of cigarette costs 10 to 15 Saudi riyals which is not small number. Let’s say that a smoker finishes a packet per day, which means that he spends 300 to 450 Saudi Riyal per month and 3600 riyals per year which considered a huge number and the smoker can buy many useful things instead of wasting money on these cigarettes. Moreover, smoking causes many harmful diseases as I mentioned before, so the smoker has to spend more and more money for the treatment. (Tips to quit smoking habit, 2009)

Quit smoking Although quit smoking is not that easy for most of the smokers, it is important for their health and the people around them to quit as soon as possible. According to an interview with Dr. Randy Gilchrist, a psychologist and the creator of the Non-Smoker 's Edge (see appendix B for the interview questions), he states that quitting smoking is hard for the smokers for two main reasons. First, smoking is considered as a habit for the smokers that offers relaxation and comfort for them and affects every activity they do every day and every time. The second reason is the addiction of the nicotine. When the body get used to nicotine, the smokers feel like uncomfortable when they stop smoking for a while which forces them to return back to smoke.
Gilchrist also mentioned three advices that can help smokers to quit. First of all, smokers should go to their primary care physician to know how much smoking affects their body and to treat all the diseases that were caused by smoking. Second, ask their families, their friends to help them quitting by encouraging them and supporting them. Third, he asked them to take care of their health by doing more exercises, sleeping early and eating healthier food.
He gave also an advice to help them stay motivated. Smokers should write a list of their reasons of quitting. The most important reasons are helping smokers live longer by decreasing the risk of the diseases that are caused by smoking and helping smokers to save their money and time. Also, by quitting smoking, smokers are protecting their children and family’s life. And the smokers should keep this list close to them which will help them quit smoking by remembering all the reasons they mentioned in the list.

Conclusion Smoking has many negative effects on the smokers’ eyes, oral health, lungs, heart, skin, digestive system and brain. Also, it also affects the smokers psychologically and financially. The effects of smoking not only affect the smokers themselves, it affects also the environment and the people around them. Therefore, smokers should quit smoking to save their life and prevent all these damages to their family and to the whole environment.

References
(n.d.). Smoking 's effects on the lungs. Retrieved from: http://www.allsands.com/health/smokingeffects_srw_gn.htm

How smoking hurts your health. (2012, 9 24). Retrieved from: http://www.lung.ca/protect-protegez/tobacco-tabagisme/facts-faits/hurts-nuit_e.php

Stan, C. (November 18, 2008). Smoking and Oral Health. Retrieved from: http://ezinearticles.com/?Smoking-and-Oral-Health&id=1703070

Good- gums. (2010). Smoking and Gum Disease. Retrieved from: http://www.good-gums.com/smoking.cfm
Deo, M. (August 23, 2010). Smoking Effects on Heart. Retrieved from: http://www.buzzle.com/articles/smoking-effects-on-heart.html
Hearstats. (August 12, 2008). Smoking and cardiovascular disease. Retrieved from: http://www.heartstats.org/datapage.asp?id=3851
Uy, R. (2009). Smoking and Your Digestive System. Retrieved from: http://www.hemorrhoidinformationcenter.com/smoking-and-your-digestive-health/
No to Smoke. (2010). Brittle Bones – Smoking Could Be The Reason. Retrieved from: http://www.notosmoke.com/herbal-smoking-articles/smoking-and-bones.htm

Virtual Medical Center. (29 Dec, 2010). How Smoking Affects Skin Health. Retrieved from: http://www.virtualmedicalcentre.com/healthandlifestyle.asp?sid=205

Drew, S. (October 9, 2010). What Does Smoking Do to the Muscles of the Body? Retrieved from: http://www.livestrong.com/article/239268-what-does-smoking-do-to-the-muscles-of-the-body/

Virtual Medical Center. (May 11, 2010). How Smoking Affects the Eye? Retrieved from: http://www.virtualmedicalcentre.com/healthandlifestyle.asp?sid=199
Surya. ( November 14, 2010). Effects of Smoking on the Brain. Retrieved from: http://www.instah.com/quit-smoking/effects-of-smoking-on-the-brain/

Online Essays. (2010). The Psychological Effects of Smoking. Retrieved from: http://onlineessays.com/essays/disease/the-psychological-effects-of-smoking.php

American Heart Association. (2010). Cigarette Smoking and Cardiovascular Diseases. Retrieved from: http://www.americanheart.org/presenter.jhtml?identifier=4545

Ygoy. (2008). How Smoking Affects the Environment? Retrieved from: http://smoking.ygoy.com/smoking-and-the-environment/

Arab News. (May 23, 2009). Numbers of Smokers Surges in Saudi Arabia. Retrieved from: http://www.tobacco.org/news/284505.html

American Cancer Society. (September 11, 2010). Secondhand Smoke. Retrieved from: http://www.cancer.org/cancer/cancercauses/tobaccocancer/secondhand-smoke

Gilchrist, R. (2007). How Best to Quit Smoking: Interview with Dr. Randy Gilchrist. Retrieved from: http://www.trans4mind.com/counterpoint/index-health-fitness/gilchrist.shtml

Hicks, B. (Aug 24, 2009). How Does Smoking Affect The Environment. Retrieved from: http://www.clivir.com/lessons/show/how-does-smoking-affect-the-environment.html
Appendix A
Survey Questions Form
The goal of the survey is to survey the smokers and non-smokers and how much they know about all the negative effects of smoking.
The survey is done with 12 persons (6 males and 6 females)
Please answer these questions:
1) Age:
17-20
20-23
Above 23
2) Gender:
Male
female
3) Do you smoke? yes no
4) Does any of your family smoke?
No
Only 1
2-3
More
5) Do you have smokers among your friends?
No
Yes
6) Is it ok with you to sit beside a person while he is smoking?
Yes
No
7) What do you think about the people who smoke?
Attractive
Unattractive
8) What do you know about smoking?
Dangerous
Normal
Healthy
9) Do you know that smoking may cause cancer?
Yes
No

10) Have you ever tried to help someone to quit smoking?
Yes
No

Thank you for your help

Appendix B
The Interview
How Best to Quit Smoking
Interview with Dr. Randy Gilchrist
Q. Randy, you have worked with people to overcome their bad habits, especially smoking. Can you tell me why people continue to smoke even though they know that this is slowly eroding their health?
There are two main reasons as I understand it. First, smoking is a stubborn habit that naturally connects with many everyday activities, times of day, social interactions, and emotional states that continually "trigger" the urge to smoke—often at an unconscious level. In this way, smoking becomes like a reliable, old friend that offers relaxation, comfort, and focus with every interaction (puff). It 's like the old song goes—"breaking up is hard to do."
Second, smoking acts as an addiction as well. Because the body and mind become used to the "rush" from regular nicotine fixes, quitting can immediately trigger strong and uncomfortable physical and psychological withdrawal cravings to pressure a return to smoking. This discomfort can last for several weeks or even months. Typical withdrawal symptoms include irritability, restlessness, sadness, nervousness, coughing, a slight sore throat, constipation, insomnia, fatigue, difficulty concentrating, a decreased heart rate, and/or an increased appetite. With all of this, it 's no wonder most people have a hard time quitting on their own!
Q. If there were three things that a cigarette smoker could right now to help them drop the habit, what would they be?
First, smokers should immediately have a physical examination with their primary care physician to learn the extent to which smoking has already begun to affect their health. An examination should also include recommendations to do to start reversing any present damage. This one is essential.
Second, ask several supportive, understanding family members and friends to give the emotional encouragement and listening ears you 'll need during your change process. Make sure these supportive people aren 't smokers themselves. It can be hard to quit with someone always lighting up in front of you!
Third, get healthier! Strategically improve your diet, exercise, and sleeping patterns. Study it. Plan it. Do it. Because quitting smoking can involve temporary lapses in energy, lowered concentration, and increased moodiness, you will need to take better care of yourself to replace your "nicotine highs" with "natural highs" and better self-control. Healthier living is what makes this possible. Remember, there are no feelings that nicotine gives you that the brain can 't also generate through healthier means. You just need to plan more, be creative, and commit to the process.
Q. People often give up their attempt to quit smoking. Do you have some advice to help them stay motivated?
You know you want to quit smoking. But do you know WHY? For many people who are trying to quit smoking, it helps to have a list of reasons why -- a kind of map that you can turn back to when the going gets tough.
What are YOUR reasons to quit?
You want to add more years to your life, by decreasing your health risks.
You want to stop spending money on cigarettes, and save that extra spending money for yourself.
You want to prove to yourself that you can meet this challenge . . . so you can go on to improving your lifestyle in other ways.
You want to experience more natural energy, better health, and better quality of life.
You want to model healthy living for your children and grandchildren.
(Insert your own reasons here -- and keep the list.)
Whatever your reasons are, you should write them down and keep them close. Have them in front of you. Repeat them to yourself again and again. Keep a 3"x5" card in your pocket or purse with the list. In doing so, you 'll be laying the psychological groundwork to make quitting easy.
I 'd like to tell you about a comprehensive hypnosis program for smoking cessation, The Non-Smoker 's Edge [http://www.hypnosisnetwork.com/hypnosis/quit_smoking.php?hn=1040]. This program uses new techniques in cognitive behavioral therapy and clinical hypnosis to help you truly want to quit smoking ... with your mind, body, and soul. Using a holistic approach, it helps you keep your goal in mind at all times. And not just your goal, but the reasons for this goal.
Desire is critical to action. Maybe that 's why multi-session hypnosis has a 66% success rate at helping people quit smoking. That 's higher than any other smoking cessation method that there is.
I think hypnosis works so well with smoking cessation because habits and addictions in general tend to be very psychological in nature. Among other things, hypnosis helps to change and improve the way a person thinks about his or her "problem." It also helps people gain greater access to the tools and resources they 'll need during the change process. In fact, many of my clients acknowledge at the beginning that their habit/addiction is "mostly psychological" and that they just need to "change the way they think about it."
Interview Copyright © 2007, The Hypnosis Network.
Randy Gilchrist, Psy.D., is a fully qualified psychotherapist with a master’s degree and license in marriage and family therapy, and a doctoral degree and license in clinical psychology. He specializes in strategic multi-session hypnosis programs for complex issues such as smoking cessation, and is the creator of The Non-Smoker 's Edge, published by The Hypnosis Network.

References: Stan, C. (November 18, 2008). Smoking and Oral Health. Retrieved from: http://ezinearticles.com/?Smoking-and-Oral-Health&id=1703070 Good- gums Deo, M. (August 23, 2010). Smoking Effects on Heart. Retrieved from: http://www.buzzle.com/articles/smoking-effects-on-heart.html Hearstats Uy, R. (2009). Smoking and Your Digestive System. Retrieved from: http://www.hemorrhoidinformationcenter.com/smoking-and-your-digestive-health/ No to Smoke Virtual Medical Center. (29 Dec, 2010). How Smoking Affects Skin Health. Retrieved from: http://www.virtualmedicalcentre.com/healthandlifestyle.asp?sid=205 Drew, S Virtual Medical Center. (May 11, 2010). How Smoking Affects the Eye? Retrieved from: http://www.virtualmedicalcentre.com/healthandlifestyle.asp?sid=199 Surya Online Essays. (2010). The Psychological Effects of Smoking. Retrieved from: http://onlineessays.com/essays/disease/the-psychological-effects-of-smoking.php American Heart Association Ygoy. (2008). How Smoking Affects the Environment? Retrieved from: http://smoking.ygoy.com/smoking-and-the-environment/ Arab News American Cancer Society. (September 11, 2010). Secondhand Smoke. Retrieved from: http://www.cancer.org/cancer/cancercauses/tobaccocancer/secondhand-smoke Gilchrist, R Hicks, B. (Aug 24, 2009). How Does Smoking Affect The Environment. Retrieved from: http://www.clivir.com/lessons/show/how-does-smoking-affect-the-environment.html Appendix A