The Tobacco DilemmaEarly HistoryEarly Medical UsesTwo Major SpeciesTypes Of Tobacco ProductsHistory: CigarettesTobacco Under AttackQuest for “Safer” CigarettesCurrent Cigarette UseSmokeless TobaccoOther Tobacco ProductsSmoking: Adverse Health EffectsSecondhand SmokeSmoking and Health In Other CountriesSmoking and PregnancyNicotine PharmacologyAbsorption and MetabolismPhysiological EffectsBehavioral EffectsNicotine DependenceHow to Stop SmokingTobacco The Tobacco Dilemma- A legal product used by a significant proportion of adults- But a substance responsible for more adverse health consequences and death than any other drugEarly 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”Early Medical Uses- 1500s: Recognition of the medical potential grew- French physician Jean Nicot: early proponent Nicotine (the active ingredient) and Nicotiana (the plant genus were named after him- 16th and 17th centuries Viewed as having many positive medical uses but as having a negative reproductive effect - 1890s: Nicotine dropped from the U.S. PharmacopoeiaTwo 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 AmericaTypes Of Tobacco Products- Snuff 18th century: Snuff use became widespread as smoking decreased 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 Smoking did not surpass chewing until the 1920s- Cigars A combination of chewing and smoking Peaked in popularity in 1920- Cigarettes Native Americans used thin reeds filled with tobacco Factories appeared in 19th century Habit spread widely with the advent of inexpensive machine-produced cigarettes Currently most popular form of tobacco useHistory: Cigarettes- Product milestones: 1913 - Camels: low-priced domestic tobacco 1939 - Pall Mall: king-size cigarettes 1954 - Winston: filter cigarettes- Filter cigarettes have over 90% of the U.S. cigarette marketTobacco Under Attack- 1604: King James of England published an anti-tobacco pamphlet “harmefull to the braine, dangerous to the lungs” Note that he also supported the American tobacco trade- 1908: New York made it illegal for a woman to use tobacco in public “protect women from themselves”- 1930s and 40s: Reports linking smoking and cancer 1952: Readers’ Digest article “Cancer by the Carton”- Tobacco companies’ response: Formation of the Council for Tobacco Researcho Not independent and tried to undermine health risk claims Mass-marketing of filter cigarettes and cigarettes with lowered tar andnicotine contento Promoted as a “safer” alternative- 1964: Surgeon General’s report states that smoking causes lung cancerin men Tobacco sales began a decline that continued for 40 years- 1965: Congress required warning labels on cigarette packages- 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- Many additional state and local bans passed- Lawsuits seeking compensation for the health consequences of smoking Unsuccessful for many years Then several victories- 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- Possible reasons for legal victories Changing legal climate Revelation of tobacco companies’ actions in hiding information on the adverse effects of smokingQuest for “Safer” Cigarettes- Lower levels of nicotine Caveat: people adjust their smoking behavior to obtain a consistent amount of nicotine By taking more puffs and inhaling more deeply- Lower levels of tar 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?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 educationo High school diploma only: 30%o Undergraduate degree: 13%o Full time college students: 7%o Non-college students: 15%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 has its hazards Smokeless tobacco packages carry warning labels- Health concerns Increased risk of dental disease and oral cancer Contains potent carcinogens such as nitrosamineso Causes leukoplakia Can lead to nicotine dependenceOther Tobacco Products- In recent years, cigar smoking has 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 unclearSmoking: Adverse Health Effects- Major diseases linked to smoking Lung cancer Cardiovascular disease Chronic obstructive lung diseaseso including emphysema- Risk increases for those who: Start young Smoke many cigarettes Continue to smoke for a long time- Smoking is the single greatest avoidable cause of death- Cigarette packages and advertisements are required to rotate among different warning labelsSecondhand 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 cigaretteo More carcinogens in smokeo But smoke is more diluted- Health effects difficult to fully determine but include Lung cancer Cardiovascular disease- 1993: Environmental Protection Agency
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