Intended for healthcare professionals

Rapid response to:


Stress disorder is common among prostitutes

BMJ 1998; 317 doi: (Published 29 August 1998) Cite this as: BMJ 1998;317:558

Rapid Response:

Smoking Underlying Prostitutes' Behavior and Stress

Underlying prostitutes' behavior and stress is a deeper factor,
cigarette smoking. Smoking is linked to the prostitution behavior
pattern, including alcoholism, drug abuse, promiscuity, preceding history
of child abuse, and customer assault and rape.

Cigarettes contain high illegal levels of toxic chemicals, example,
carbon monoxide, 42,000 parts per million (ppm) though unsafe above 50
average ppm. Smokers typically are exposed to 500 - 1,500 ppm. See
Pletten, Smoking as hazardous conduct, N Y St J Med 1986;86:493 and US
Dept of Health, Educ and Welfare, Smoking and Health: Surgeon General
Report (1964), p 60. Central nervous system dysfunction results. See
Silvette, et al., Actions of Nicotine on Central Nervous System Function,
Pharmacol Rev 1962;14:137-173, and Ott, et al., Smoking, Dementia, and
Alzheimer's Disease, Lancet 1998;351:1840-1843.

Cigarettes are the gateway to the drug lifestyle, starting average
age 12, then alcohol 12.6, marijuana, 14. See Fleming, et al.,
Cigarettes' Role in Initiation and Progression of Early Substance Use,
Addictive Behaviors 1989;14:261-272. Alcoholism is about 90% by smokers.
See Hayes, et al., Alcoholism and Nicotine Dependence Treatment, J
Addictive Diseases 1996;15:135. Crime, whether against or by prostitutes,
is about 90% by smokers. See McKinney v Anderson, 924 F2d 1500, 1507 n 21
(CA 9, 1991).

Cigarettes' toxic chemicals cause addiction, abulia, impairment of
willpower despite unwanted consequences. The law term is a "state of
dethronement of reason from its governing power," People v Carmichael, 5
Mich 10, 21; 71 Am Dec 769 (1858). Tobacco distributors causing that is,
in law, criminal assault. Enforcement of the Carmichael legal concept is
essential in tobacco control. See Pletten, Alternative Models for
Controlling Smoking among Adolescents, Am J Pub Health 1997;87:869-870.

Lead Author Melissa Farley says, "These findings lead me to conclude
that prostitution is intrinsically traumatising." We can add the
preceding extrinsic trauma, smoking and its correlatives. For solution
via prevention, enforcement of the People v Carmichael, 5 Mich 10,
concept, supra, to protect adolescents before they are assaulted, rendered
abulic and turned to results including prostitution, is essential.

Competing interests: No competing interests

18 January 1999
Leroy J Pletten
Medicine and Law History Substance Abuse Issues Counselor and Lecturer
The Crime Prevention Group