"I'm a healthy active guy, but when I go out to bars or clubs with my friends I like to smoke a cigarette or two with my drink — is that really that bad for me since I'm not a pack-a-day smoker or anything like that?" — G. McKofke, Staten Island, NY
There is risk inherent in risky behavior; the question is how much exposure do you have to have to increase your risk by a measurable amount? The answer, in your case, is hard to quantify because the data for tobacco use at such low levels isn't very robust.
Tobacco abuse (since there is no level of exposure that's considered good for you, there is no such thing as "tobacco use" . . . it's all abuse) has been linked in the medical literature to numerous conditions including emphysema, heart attack, stroke, lung cancer, and oral cancer. Cigarette smoking accounts for 90% of the lung cancer cases in the world, and there are an estimated 38,000 cases from second hand smoke each year. Smoking is the No. 1 preventable cause of "the three D's": disease, death, and disability in modern times.
Smoking risk is stratified by using the "pack-year" equation; take the number of packs you smoke a day and multiply it times the number of years you've smoked. For example, a two-pack per day smoker who smoked for 30 years would have a "60 pack-year history." Since a pack has 20 smokes in it, someone who inhales 4 cigarettes a day for 50 years would have a 4/20x50 = 10 pack year history.
Leaving aside all other conditions, the risk of lung cancer increases with tobacco use. Several studies have shown that smoking a few cigarettes over a long period of time is worse than smoking a lot of cigarettes over a short time. There is very little data out there for people who just smoke a few butts a week, but the numbers do show one thing: if you smoke at all, you increase your risk of disease. The odds are lower if you smoke less, but they're never zero.
I used to smoke 3 packs a day myself and looking back on it, other than making instant (but smelly) friends in the smoking lounge at the airport, there was no benefit to it whatsoever. Knowing I was increasing my risk of heart attack, stroke, cancer, and emphysema didn't scare me enough to quit, but a stray factoid did (and I hope it will for you, too): tobacco abuse is the chief reversible cause of impotence in young men. Think about that the next time you light up in a bar — looking cool now may make you look really goofy later on.
**Remember, don't do anything you read here without first consulting with your own health care provider.**
Dr. Steve is the resident medical expert for the Opie and Anthony and Ron and Fez shows, and the host of his own Sirius XM Radio program, Weird Medicine.