Download Tobacco Use - The Citadel

Chapter 10
Tobacco
The Tobacco Dilemma

Tobacco is an interesting
social dilemma—a product
that is legal for adults to use,
and that a significant
proportion of adults enjoy
using and expect to continue
using, yet a substance that is
responsible for more adverse health consequences
and death than any other.
TOBACCO USE: SCOPE OF THE PROBLEM
Tobacco use is the leading preventable cause of
disease and premature death in the United
States.
443,000 deaths annually in United States
( hyperlink- review web page)
Tobacco is the single largest cause of
preventable death and a risk factor for 6/8 of the
leading causes of death.
TOBACCO USE: SCOPE OF THE PROBLEM

In 2009, 69.7 million Americans, or 27.7%
of the population age 12 or older,
reported current use of a tobacco product.

Approximately 33.5 percent of males and
22.2% of females age 12 or older were
current users of any tobacco product.
ANNUAL DEATHS ATTRIBUTABLE TO
CIGARETTE SMOKING (LINK)
CIGARETTE SMOKING: A COSTLY
ADDICTION
Cigarette smoking is the leading
preventable cause of death in the United
States.
 More deaths are caused each year by
tobacco use than by HIV, illegal drug use,
murders, alcohol use, suicides, and motor
vehicle injuries combined.
 Overall mortality rates decline the longer
ex-smokers abstain from smoking.

Early History

Cultivated and used by Native
Americans for centuries


Presented tobacco leaves as a gift to
Columbus in 1492
The word “tobaco” was adopted
by the Spanish


Possibly from the Arabic word “tabbaq”
meaning “medicinal herbs”
Europeans discovered that Amerindians
sometimes put tobacco into tubes made
from reeds, started a fire at one end of
the reed, and “ drank” the smoke from
the other end. Or, they did a similar thing
with tobacco leaves rolled up like a cigar,
or they “ drank” smoke from stone or clay
pipes.
Early History


Commercial importation of
tobacco into Europe in
large quantities began
around 1600.
It was the use of the of
tobacco by the respected
“affluent” members of
society that eventually
made tobacco a desired
commodity for the masses
Early Medical Uses

1500s:


Beginning with a few trials by physicians, recognition of
the potential of tobacco grew during the middle of the
1500s.
French physician Jean Nicot: early proponent

He was successful in “ curing” the migraine headaches of
Catherine de Medici, queen of Henry II of France, which
made tobacco use very much “ in.”

Tobacco was called the herbe sainte, “ holy plant,”
By 1565, the plant had been called nicotiane, after Nicot. In 1753,
Linnaeus, the Swedish “ father of taxonomy,” named the plant genus
Nicotiana. When a pair of French chemists isolated the active
ingredient in 1828, they acted like true nationalists and called it
nicotine.

Early Medical Uses

16th and 17th centuries


Tobacco viewed as having many positive medical
uses but as having a negative reproductive effect
1890s:

The slow advance of medical science through the
18th and 19th centuries gradually removed
tobacco from the doctor’s black bag, and nicotine
was dropped from The United States
Pharmacopoeia in the 1890s.
10-10
Two Major Species

Two major species grown today (out of more than
60)


Nicotiana tobacum: large-leaf species indigenous only
to South America but now cultivated widely
Nicotiana rustica: small-leaf species from the West
Indies and eastern North America
10-11
SPREAD OF TOBACCO USE



Tobacum was indigenous only to South America, so the
Spanish had a monopoly on its production for over a
hundred years. Nicotiana rustica (see previous slide) is a smallleaf species and was the plant existing in the West Indies
and eastern North America when Columbus arrived.
The Jamestown colonist tried to grow the rustica variety
without luck, In 1612, John Rolfe somehow got some
seeds of the Spanish tobacum species. This species grew
beautifully and sold well. The colony was saved, and every
available plot of land was planted with tobacum
By 1619, as much Virginia tobacco as Spanish tobacco
was sold in London..
10-12
Types of Tobacco Products

Snuff




18th century: Snuff use became
widespread as smoking decreased
The middle and lower classes only
gradually changed over, but by 1770 very
few people were smoking. The reign of
King George III ( 1760– 1820) was the
time of the big snuff.
In U.S., perceived as a British product;
American use declined after the
Revolution
Chewing tobacco



19th century: Most tobacco used in the
U.S. was chewing tobacco
Popularity rose from “snuff” rebellion and
fear of fire hazard from smoking
Smoking did not surpass chewing until the
1920s
10-13
Types of Tobacco Products

Cigars



A combination of chewing and smoking
Peaked in popularity in 1920
The introduction of the cigarette-rolling machine spurred
cigarette consumption because cigarettes became
cheaper than cigars.
Types of Tobacco Products

Cigarettes

Thin reeds filled with tobacco had been seen by the Spanish
in Yucatan in 1518.
In 1844, the French were using them, and the Crimean War
circulated the cigarette habit throughout Europe.
The first British cigarette factory was started in 1856 by a
returning veteran of the Crimean War, and in the late 1850s
an English tobacco merchant, Philip Morris, began producing
handmade cigarettes.
In the United States, cigarettes were being produced during
the same period ( 14 million in 1870), but their popularity
increased rapidly in the 1880s.



Types of Tobacco Products

Cigarettes

The date of the first patent on a cigarette-making machine
was 1881, and by 1885 more than a billion cigarettes a year
were being sold.
At the start of the 20th century, there was a preference for
cigarettes with an aromatic component— that is, Turkish
tobacco.
Camels, a new cigarette in 1913, capitalized on the lure of the
Near East while rejecting it in actuality. The Camel brand
contained just a hint of Turkish tobacco.
The first ad showing a woman smoking appeared in 1919.
Filter cigarettes, beginning in 1954, captured an increasing
share of the market and now constitute over 90 percent of all
U. S. cigarette sales.




History: Cigarettes

Product milestones:



1913 - Camels: low-priced domestic tobacco
1939 - Pall Mall: king-size cigarettes
1954 - Winston: filter cigarettes
Tobacco Under Attack
 1604: King James of England
published an anti-tobacco pamphlet
 “harmful to the brain, dangerous to the
lungs”
 However, he also supported the American
tobacco trade in 1610

1908: New York made it illegal for a
woman to use tobacco in public

“protect women from themselves”
Tobacco Under Attack

1930s and 40s: Reports linking smoking and cancer

1952: A 1952 article in Readers’ Digest called “ Cancer by the
Carton” drew public attention to the issue, and led to a temporary
decline in cigarette sales.

Tobacco companies’ response:


1. Formation of the Council for Tobacco Research
 Not independent and tried to undermine health risk claims
2. Mass-marketing of filter cigarettes and cigarettes with lowered tar and
nicotine content
 Promoted as a “safer” alternative
Tobacco Under Attack

1964: Surgeon General’s
report states that smoking
causes lung cancer in men

Tobacco sales began a decline
that continued for 40 years (see
below)

1965: Congress required
warning labels on cigarette
packages
Tobacco Under Attack

1971: TV and radio cigarette ads banned

1990: Smoking banned on interstate buses and
domestic airline flights

1995: FDA proposed further regulation of tobacco
and ads - After a year of discussion, rules were proposed that further limited
advertising on billboards and other public displays, sponsorship of sporting events,
promotional giveaways of caps and T- shirts, and advertising in magazines with
significant youth readership.

Many additional state and local bans passed
Tobacco Under Attack

Lawsuits seeking compensation for the health
consequences of smoking



Unsuccessful for many years- cigarette companies clamed that
consumers were responsible for their own health behaviors
Then several victories -with the disclosure of internal tobacco
company documents demonstrating both the companies’
knowledge of the adverse health consequences of smoking and
their efforts to hide that knowledge from customers.
Possible reasons for legal victories


Changing legal climate
Revelation of tobacco companies’ actions in hiding information on
the adverse effects of smoking
Tobacco Under Attack

1998 settlement between 46 states and major
tobacco companies




$205 billion in payments to the states
Advertising regulations
Enforcement of laws prohibiting sales to minors
In exchange, the companies received a cap on certain
aspects of their legal liability, which otherwise
threatened to bankrupt the industry.
Quest for “Safer” Cigarettes

Lower levels of nicotine

Nicotine appears to be the constituent in tobacco that keeps smokers
coming back for more—



Lower levels of tar



People adjust their smoking behavior to obtain a consistent amount of
nicotine
By taking more puffs and inhaling more deeply
Tar is the sticky brown material seen on the filter of a smoked cigarette
Based on changes in smoking behavior, there may be no advantage to
switching to a low tar–low nicotine cigarette
Does “safer” mean safe? - Beginning in the mid-1950s with the mass
marketing of filter cigarettes, the tobacco companies began to promote the idea of a
“ safer” cigarette, without actually admitting that there was anything unsafe about
their older products.
Quest for “Safer” Cigarettes



Does “safer” mean safe? –
The problem with all this is that “ safer” doesn’t mean “ safe,” and it wasn’t at
all clear how much safer these low tar and nicotine cigarettes actually are for
people over a life-time of smoking.
A major blow to the “ healthier cigarette” notion was dealt in 2006 when the U.
S. Government obtained a conviction against nine tobacco companies and two
tobacco industry trade organizations for racketeering and fraud. The purposeful
manipulation of nicotine levels to increase nicotine dependence was one
charge, but another was that for years the tobacco companies promoted low tar
and nicotine cigarettes as safer alternatives, when their own research and other
evidence showed these claims to be misleading.
Current Cigarette Use

Percentage of smokers by gender



Men: 25%
Women: 21%
Education is the single biggest influence on
smoking rates

Percentage of smokers by education
 High school diploma only: 30%
 Non-college students: 15%
 Undergraduate degree: 13%
 Full time college students: 7%
This difference in cigarette smoking based on college education
probably reflects the considerable influences of socioeconomic
status, family background, and expectations, and apparently has little
to do with any knowledge a college graduate might have obtained.
Smokeless Tobacco

1970s: use increased as smokers looked for an
alternative with a lower risk of lung cancer

Most common form



Moist snuff (Skoal, Copenhagen)
Nicotine absorbed through mucous membranes
Advantages over cigarettes



Unlikely to cause lung cancer
Less expensive
More socially acceptable in some circumstances
Smokeless Tobacco
 Smokeless tobacco has its hazards
 Smokeless tobacco packages carry warning labels
 Health concerns
 Increased risk of dental disease and oral cancer
 Contains potent carcinogens such as nitrosamines
 Causes leukoplakia
 Can lead to nicotine dependence
Other Tobacco Products
 In recent years (mid 1990’s), cigar smoking had
increased
 In 2008, 9% of males and 2% of females reported smoking a
cigar in the past month

Hookahs:



Large, ornate water pipes
imported from Arab countries
Hookahs produce milder,
water-filtered tobacco smoke
Prevalence of hookah smoking
is unclear
Smoking: Adverse Health Effects

Major diseases linked to smoking




Risk increases for those who:




Lung cancer
Cardiovascular disease
Chronic obstructive lung diseases
 including emphysema
Start young
Smoke many cigarettes
Continue to smoke for a long time
Smoking is the single greatest avoidable cause of death
Smoking: Adverse Health Effects
 Cigarette packages and advertisements are required to rotate
among different warning labels
Secondhand Smoke

Secondhand smoke


Cigarette smoke inhaled from the
environment by nonsmokers
Components of environmental
smoke


Mainstream smoke: the smoke
inhaled/exhaled by the smoker
Sidestream smoke: the smoke rising from
the ash of a cigarette
 More carcinogens in smoke
 But smoke is more diluted
Secondhand Smoke

Health effects difficult to fully determine but
include



Lung cancer
Cardiovascular disease
(Increased risk of COPD like symptoms in children)

1993: Environmental Protection Agency classified
secondhand smoke as a known human carcinogen

Many recent laws and regulations have been
passed to protect nonsmokers
Smoking and Heath in Other Countries

Five million deaths worldwide each year


Perhaps as high as 8 million by 2030
Demand for American cigarettes in Asia has increased
markedly

Demand has also increased in Third World countries
Smoking and Pregnancy

Increased risk of:




Miscarriage
Low birth weight
Sudden infant death syndrome (SIDS)
Several studies indicate effects on
physiological and cognitive
development



Neurological problems
Problems with reading and mathematical skills
Hyperactivity
Nicotine Pharmacology

Nicotine



Active ingredient in tobacco
A naturally occurring liquid alkaloid that is colorless and volatile
On oxidation, it turns brown and smells like burning tobacco

Tolerance and dependence develop quickly

Highly toxic in large enough doses

Lethal dose = 60 mg
 A cigar contains twice that much

Typically not delivered fast enough or in a high enough dose to be lethal
Absorption and Metabolism
 Inhalation is very effective
 90% of inhaled nicotine is absorbed
 80–90% of nicotine is deactivated in the liver
and then excreted via the kidneys

Use of nicotine increases the activity of liver
enzymes responsible for nicotine deactivation


Contributes to tolerance
May decrease the effects of other medication –
benzodiazepines and some antidepressants and analgesics
Physiological Effects

Mechanism of action:




Mimics acetylcholine
First stimulates and then blocks receptor sites
Also causes the release of adrenaline and has an indirect
sympathomimetic effect
Symptoms of nicotine poisoning:


Low-level
 nausea, dizziness, and general weakness
 Often experienced by beginning smokers
Acute poisoning
 tremors, convulsions, paralysis of breathing muscles, death
 Relatively rare
Physiological Effects

CNS and circulatory system effects






Increased heart rate and blood pressure
Increased oxygen need of the heart
Decreased oxygen-carrying ability of blood
 Causes shortness of breath
Increased platelet adhesiveness
 Increases the tendency to clot
Increased electrical activity in the cortex
Reduced hunger



Inhibition of hunger contractions
Increased blood sugar
Deadening of taste buds
Behavioral Effects

Nicotine is the primary reinforcing substance in
tobacco

Smokers report that nicotine has both stimulant
and calming effects

User expectation probably plays an important role in the effects
Nicotine Dependence
 Tobacco industry claims that its products do
not cause dependence
 Conclusions made in the Surgeon General’s
report (1988):
1.
2.
3.
Cigarettes and other forms of tobacco are addicting
Nicotine is the drug in tobacco that causes addiction
The processes that determine tobacco addiction are similar
to those that determine addiction to drugs like heroin and
cocaine
How to Stop Smoking

There are more than 40 million exsmokers in the U.S.


90% report no formal treatment program
Yet there are many challenges to quitting

Nicotine is a strongly reinforcing drug
 And a pack-a-day smoker gets 50,000 reinforcing nicotine
puffs per year
How to Stop Smoking

Replacement therapy




Delivering nicotine without the tar and
carbon monoxide
Produced in many forms:
Gum, patches, nasal spray, inhalers,
lozenges
Pharmacological Therapy

Example: Bupropion (Zyban)
 Combining counseling and pharmacological
treatments increases the odds of quitting
Tobacco
End of Lecture