Why Smoking Right after Waking Up Is Harmful to Health

Smoking is a well-documented risk factor of cardiovascular diseases (CVD) and premature death. Previous studies have focused on smoking duration and total cigarette consumption, but a 2024 paper by Li et al. highlights the time between waking up and smoking the first cigarette as a risk factor of mortality, noting that smoking ≤5 minutes after waking is strongly linked to a higher risk of mortality and a higher chance of incident myocardial infarction or stroke, and may be a sign of nicotine dependence. Another study by Hu et al. (2024) states that early-morning smoking more strongly correlates with incident type 2 diabetes than total cigarette consumption, adding to preceding evidence that early-morning smoking is linked to type 2 diabetes and chronic obstructive pulmonary disease (COPD). The demonstrated association with adverse health outcomes and early-morning smoking suggests delayed time to first cigarette can be a useful target as part of smoking interventions. These findings indicate the necessity of public health policies targeting smoking behaviour in addition to cessation as a way to decrease the associated disease burden.

Dear Editor,

I am responding to the interesting paper "Time from Waking to the First Cigarette and Mortality and Incident Cardiovascular Disease" by Li et al. (2024) [1], posted in The Journal of Public Health. Smoking is known by the public as a significant risk factor for cardiovascular diseases (CVD) and premature death. Other previous research studies primarily concentrated on the total number of cigarette packs consumed and the smoking period in years (West, 2007) [2], (Flanders et. al., 2003) [3]. However, this study is interesting because it explores and clarifies in detail the connection between the duration of time a person lights the first cigarette of the day upon waking up and the mortality and development of cardiovascular diseases (CVD), which makes a substantial contribution to the public. This specific factor, the smoking timing and how soon a person lights up after waking, may be a sign of nicotine dependency and other health threats to our bodies. People are aware that smoking brings a lot of adverse effects on our health, but are they aware that the smoking timing upon waking up, how soon a person lights up their first cigarette, has a more significant impact on health? The findings of this study offer an understanding of the connection between smoking behavior and an increased risk of developing heart disease and even sudden or early death.

The World Health Organization (2019) [4] reported that annually, around 17.9 million people have cardiovascular disease, a leading cause of worldwide death. Among the various cardiovascular conditions are coronary heart disease, cerebrovascular illness, rheumatic heart disease, and others. Over 80% of cardiovascular disease (CVD) deaths are related to strokes and coronary-associated heart attacks, and one-third of all deaths related to cardiovascular disease occur early in people under the age of seventy. The cardiovascular system is impaired and damaged by tobacco use and second-hand smoke exposure, of which 21% of all CHD fatalities worldwide are related to these. Over 1.9 million untimely fatalities from coronary heart disease (CHD) are documented annually (WHO, 2020). Nicotine included in tobacco is highly addictive, it increases the likelihood of cardiovascular and respiratory diseases, more than 20 different types and subtypes of cancer, and a plethora of other crippling medical disorders when used regularly. Yearly, more than 8 million people die as a result of tobacco use (WHO 2020, September 22) [5].

In their research study, Li et al. (2024) [1] discovered that smoking five minutes after waking up is a reliable indicator of more significant death rates and a higher possibility of heart attack as well as stroke. This factor matters because the quantity of cigarette smoking, including the time of smoking, might be a risk of developing life-threatening illnesses. The findings of their research also add to the body of knowledge that early morning smoking reflects a person's nicotine dependency, and it has related profound adverse effects on health in the long run.

Besides, Li et al.’s (2024) [1] findings corresponded to other recent research studies examining the general negative effects of smoking timing on health, especially concerning other chronic health diseases. Hu et al. (2024) [6] published "Smoking Timing, Genetic Susceptibility, and the Risk of Incident Type 2 Diabetes: A Cohort Study from the UK Biobank” This study focuses on the association between the timing of the first cigarette of the day and genetic susceptibility with the increased risk of type 2 diabetes (T2D). The findings indicate that, particularly for people with a family history of type 2 diabetes (T2D), the risk that early-in-the-morning smokers of first cigarettes will contract the disease is higher. The findings of Hu et al. (2024) [6] shed light on the combination of smoking and type 2 diabetes by Li et al. (2024) [1], thus reinforcing the necessity of urgent and consistent assessment of the risk of development of chronic diseases.

Another research from Guertin et al. (2015) [7], "Time to First Morning Cigarette and Risk of Chronic Obstructive Pulmonary Disease: Smokes in the PLCO Cancer Screening Trial" provides more insight to how early morning cigarette smoking is linked to the potential of attaining a serious lung disease called chronic obstructive pulmonary disease (COPD). Research shows that smokers with smaller time gaps between awakening and their first cigarette have a significantly higher risk of having COPD. Like the Li et al. (2024) [1] article, this study also illustrates how early morning smoking is a marker for both nicotine addiction and consequences, lung damage. The more rapidly that one smokes upon waking up, the more likely the subject is to develop conditions such as COPD that will impair them or even cause early deaths.

Taken together, these findings provide evidence that the time of smoking, specifically the urgency with which a person reaches for the first cigar of the day, significantly influences the risk of developing cardiovascular disease, type 2 diabetes, and COPD. Early and strong associations with such diseases suggest that effective interventions that tackle such behavior early may help prevent or delay the onset of these chronic diseases. Smokers who smoke immediately after waking may benefit from targeted interventions to delay or postpone smoking and reduce nicotine dependence overall. Smoking cessation programs may also incorporate strategies to delay the time to first morning smoking as an adjunct to quitting to reap health benefits.

Taken together, the study by Li et al. (2024) [1] provides a useful insight into how smoking at a given time in the day, especially immediately upon arousal, may increase susceptibility to chronic disease or mortality in the worst of scenarios. Other studies, i.e., Hu et al. (2024) and Guertin et al. (2015) [6, 7], have pointed out how smoking initiation at a younger age is an early indicator of nicotine addiction and predisposes individuals to several long-term pathological conditions. Thus, programs that target the timing of the first smoking for the day may be useful in delaying and reducing such incidence of smoking-related disease. This research should aid in the improvement of smoking cessation programs and policies related to public health, and thus improve prevention and treatment strategies for those who are at risk. Thank you for having considered this significant matter. It is interesting to witness new studies come in, which will keep helping provide additional data about the complicated connection that exists between smoking and long-term health.