Tobacco

1
Tobacco
2
Tobacco History

• 2.5 million years ago In 2010 fossilized tobacco
  found in South America
• 1 BC Native Americans begin to use tobacco
• 1 CE Tobacco was readily available in Americas
• 600-1000 CE First pictorial record of smoking
• Mayan pottery
• Sources Imperial Tobacco Canada, tobacco.org,
  Physorg.com (November 20, 2010, Peruvian Diggers
  Find 2.5 Million-Year-Old Tobacco

3
Tobacco History

• Late 1400s explorers discover tobacco
• 1500s tobacco use spreads to Europe
• 1600s tobacco grows in popularity
  unpopularity
• Addiction
• Religion
• Tax
• 1700s first American tobacco manufacturing
  (Virginia)

4
Tobacco History

• 1800s
• Women begin smoking in public
• Phillip Morris business
• Academics become concerned about tobaccos
  health-related effects
• 1900s
• Most states develop anti-tobacco legislation
• Lung cancer and smoking link early 1900s
• 1940 Americans smoke 2558 cigarettes/year
• Winston cigarette commercial
• 1960-1970 independence promotion for women
• Virginia Slims cigarette commercials
• Sources tobacco.org, J R Soc Med. Jun 2004
  97(6) 292296.

5
Tobacco

• Arises from Nicotiana tabacum plant
• Contributes to an estimated 480,000 deaths a year
  in US
• Secondhand 42,000 (CDC, 2013)
• Worldwide 6 million (WHO, 2013)
• 1979 Surgeon General identified tobacco as the
  one most preventable cause of death

6
Tobacco Consumption

• Primary forms of consumption include
• Cigarettes
• Cigars and pipes
• Chewing tobacco and snuff
• Differences in tobacco contents across the globe
• Quality, blending, manufacturing practices

7
Tobacco Use Across the World

• Tobacco Atlas
• Percentage of males
• Percentage of females
• Percentage of health professions students
• Cigarette consumption
• Cigarette prices
• Cigarette affordability
• Source tobaccoatlas.org
• Map (Washington Post, 2012)
• WHO Country profiles

8
The World is Up in Smoke

• Internationally, tobacco consumed in many ways
• Manufactured cigarettes, available worldwide
• WHO Cigarette consumption
• Did You Smoke Yesterday? (Gallup.com, 2007)
• Cigars, smoked worldwide
• Reverse smoking e.g. India
• Informal YouTube video clip
• Pipes, worldwide
• Clay, water pipes (shisha), other materials

9
The World is Up in Smoke

• Internationally, tobacco consumed in many ways
  (continued)
• Bidis, worldwide, esp. India
• Kreteks (clove smokeables), worldwide, esp.
  Indonesia
• Cigarette or cigar
• FDA 09 ban of flavored cigarettes
• Menthol (no ban) vs vanilla strawberry
• WTO and Indonesia (arbitration suspended, June
  2014)
• Chewing tobacco, snuff, smokeless spitless
• Electronic cigarettes

10
Non-Smoking Stimulant Areca Nut/Betel Nut

• Seed from areca palm wrapped in betel leaves
  (Betel Nuts)
• Found in Asia, Pacific Islands
• Nuts combined with leaves, other materials to
  make red paste
• Lips of betel nut chewer are red
• Teeth appear black
• Australian Screen - Market Scene (YouTube)

11
Non-Smoking Stimulant Areca Nut/Betel Nut

• Betel nut sales similar to espresso stand issues
  in Puget Sound region
• Scantily clad young women
• Selling betel nuts
• Taiwan
• Video
• Taiwan Chewing Gum betel nut documentary (850)

12
Tobacco Acute Effects

• Oxygen-carrying capacity in blood compromised
  (YouTube)
• Nicotine (YouTube)

13
Components of Tobacco Smoke

• Generally, 4,000 chemicals (About.com)
• Tar
• Nicotine
• Gases

14
Tar

• Sticky, black substance produced from burning
  tobacco (Univ. Miami Med. School)
• Video tar extraction (YouTube)
• Tars carry carcinogenic (cancer-causing)
  materials
• Tars contribute to chronic bronchitis

15
Nicotine

• The addictive substance in tobacco
  (druglibrary.org)
• Henningfield Benowitz data
• Other dangers (drugwarfacts.org)
• A stimulant drug
• Increased heart rate
• Increased vessel resistance
• Increased blood pressure
• Decreased skin temperature (vessel resistance)

16
Total Harm Score (Nutt et al, 2010)
Figure 2
Source The Lancet 2010 3761558-1565
(DOI10.1016/S0140-6736(10)61462-6)
Terms and Conditions
17
Gases in Tobacco Smoke

• Carbon monoxide
• Colorless, odorless
• Binds to hemoglobin, preventing oxygen binding
• Hydrogen cyanide
• Impairs cilia in bronchioles
• Nitrogen oxides
• Lung damage, perhaps leading to emphysema

18
Tobacco Chronic Effects (CDC)

• Heart disease 2-4 x increased risk
• Stroke 2-4 x increased risk
• Lung cancer (13-23 x increased risk)
• Connections many cancers, lung disease,
  reproductive issues, osteoporosis
• Interactive Biopsy (sensitive)

19
Cigarettes

• Mature leaves are harvested, dried, shredded,
  remoisturized, aged in barrels
• Includes stems and leaf scraps
• Tobacco varieties are blended for flavor
• Chemicals added flavor, maintain burn
• Rolled in paper (most with filters)
• Harvesters perspective
• Cigarette excise taxes
• Grow Your Own report, CBS News

20
Cigars Pipes

• Cigars
• Made with rolled, fermented, unshredded leaves
• Wrapped in a leaf
• Many shapes and sizes
• Hand rolling cigars
• Video Don Pepin-Garcia (viddler.com)
• Cigars, other alternative products becoming more
  popular among kids (CBS Boston, 2012, 223)

21
Cigars Pipes

• Pipe tobacco
• Leaves are shredded and flavored
• Cigar and pipe smoke more irritating
• Less inhalation
• Generally, reduced lung cancer risk, unless
  smoking five or more cigars/day (American Lung
  Association)

22
Smokeless Tobacco

• Chewing tobacco
• After leaves are shredded, are treated with
  flavoring and moisturizing agents
• Typically, tobacco placed in mouth where it is
  held, chewed, sucked
• Snuff
• Placed in mouth
• Inhaled
• Orbs
• Placed in mouth, dissolves

23
Twin Study

• Smoking and Skin Damage
• Wrinkles
• 79 pairs of twins
• Pictures taken at Twins Days Festival, OH
• Smokers had more wrinkles in lips, more bags
  under eyes
• New York News, 10/30/13
• Longer presentation (chacha.com, slides 1-6)

24
Media Chronic Effects of Tobacco Smoking

• Patients The Nightmares (Miller School of
  Medicine, University of Miami)