Tobacco use - smoking and smokeless tobacco
Alternative names:
cigar smoking; cigarette smoking; pipe smoking; second-hand smoke; smokeless snuff; smoking
Information:
DEFINITION
Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects. It is considered an addictive substance because it contains the chemical nicotine.
HISTORY AND INCIDENCE
The tobacco plant is believed to have originated in the Western Hemisphere. The cultivated species most often grown for North American and European tobacco products is Nicotiana tabacum. The leaves of the plant are prepared for smoking, chewing, or sniffing. In addition nicotine tobacco contains over 19 known carcinogens (most collectively known as "tar") and more than 2,000 chemicals.
Prior to European influence in the Americas, tobacco was used by the Indians of Mexico and Peru for ceremonies, medicinal purposes, and to alleviate hunger pangs during famines. Columbus is credited with introducing tobacco into Europe. Tobacco use became widely accepted by the Portuguese, Spanish, French, British, and Scandinavians. Explorers and sailors who became dependent upon tobacco began planting seeds at their ports of call, introducing the product into other parts of Europe and Asia.
The colonists introduced tobacco on the American continent in the early 1600s. It became a major crop and trading commodity of the Jamestown colony. Over the years, tobacco has been claimed as a cure for a wide range of ailments with varying forms of administration (for example, used in poultices, pastes, smoked, chewed, sniffed, or placed in any body cavity). Its social importance also grew over the years, even to the point of denoting the "modern or liberated woman" during the first part of the twentieth century.
It was not until the 1960s, with the introduction of medical research related to cigarette smoking, that the adverse health effects of tobacco became widely publicized. Unfortunately, most of the health hazards were associated only with cigarette smoking. While the number of cigarette smokers in the United States has continually decreased over recent years, the number of smokeless tobacco users has steadily increased. Since the 1970s, a 15-fold increase in smokeless tobacco has been noted in adolescents 17 to 19 years old. This has most likely been related to the emphasis on smoke-free environments; availability; increased advertising of smokeless products; macho, athletic role models who use and advertise for smokeless products; and the false belief that smokeless tobacco is a safe alternative for those convinced they should stop smoking but who still want (are addicted to) the nicotine effects of tobacco.
Although over 38 million people in the United States have quit smoking, about 50 million continue to smoke (about 25.7% of the adult population). Each year, approximately 1.3 million Americans quit smoking. In addition, about two-thirds of current smokers state that they would like to quit and only 19% of the current U.S. smokers report they have never tried to quit. About 30 to 40% of those who have not tried to quit say they do not believe that the health risks of smoking are real, or they do not believe that quitting smoking will ultimately decrease their risks for disease.
It is estimated that about 5.5 million people use smokeless tobacco daily and another 6 million use it at least weekly. Young men are at highest risk for using tobacco products but the incidence in women is increasing. Smokeless tobacco use is highest in the Southeast region, followed by the Central Plains and Western states. Its use is lowest in the Northeast region of the United States. Smokeless tobacco use patterns are higher within the following occupations: athletes, ranchers, farmers, fishermen, lumberjacks, and industrial workers who have repetitive jobs requiring hand freedom.
EFFECTS
Nicotine has both stimulant and depressant effects upon the body. Bowel tone and activity increases along with saliva and bronchial secretions. Stimulation of the central nervous system may cause tremors in the inexperienced user, or even convulsions with high doses. Stimulation is followed with a phase that depresses the respiratory muscles. As a euphoric agent, nicotine causes arousal as well as relaxation from stressful situations. On the average, tobacco use increases the heart rate 10 to 20 beats per minute, and it increases the blood pressure reading by 5 to 10 millimeters of mercury (because it constricts the blood vessels). Nicotine may also increase diaphoresis (sweating), nausea, and diarrhea because of its effects upon the central nervous system. Nicotine's effects upon hormonal activities of the body is also evident. It elevates the blood level of glucose and increases insulin production. Nicotine also tends to enhance platelet aggregation, which may lead to thrombotic (blood clot) events.
The "positive" effects of nicotine upon the body may also be noted. It stimulates memory and alertness, enhancing cognitive skills that require speed, reaction time, vigilance and work performance. As a mood-altering agent, it tends to alleviate boredom and reduce stress and reduces aggressive responses to stressful events. It also tends to be an appetite suppressant, specifically decreasing the appetite for simple carbohydrates (sweets) and inhibiting the efficiency with which food is metabolized. Peoples who use tobacco products frequently depend upon it providing these side effects to help them accomplish certain tasks at specific levels of performance.
The addictive effects of tobacco have been well documented. It is considered mood and behavior altering, psychoactive, and abusable. As a multisystem pharmacological agent that is voluntarily administered, tobacco is believed to have an addictive potential comparable to alcohol, cocaine, and morphine.
ASSOCIATED HEALTH RISKS
In general, chronic exposure to nicotine may cause an acceleration of coronary artery disease, peptic ulcer disease, reproductive disturbances, esophageal reflux, hypertension, fetal illnesses and death, and delayed wound healing. Tobacco, the vehicle of nicotine delivery, contains tar (numerous chemicals that cause a thick, sticky substance when smoked) and about 2,000 chemicals total. Tobacco and its various components have been associated with an increased risk for cancer of various body organs.
Some of the chemicals identified in the gas phase of tobacco smoke include:- Acetone
- Acetonitrile
- Acethylene
- Ammonia
- Carbon Dioxide
- Carbon Monoxide
- Dimethylinitrosamine
- Hydrogen Cyanide
- Methane
- Propane Propene
- Pyridine
- Methylchloride
- Methylfuran
- Nitrogen Oxides
- Nitrospyrrolidine
- Propionaldehyde
- 2-Butane
- 3-Picoline
- 3-Vinylpyridine
- Some of the chemicals in the particulate phase:
- Aniline
- Benz(a)pyrene
- Catechole
- Hydrazine
- Napthalene
- Methylnapthalene
- Methylquinolines
- Nicotine
- N'-Nitrosonornicotine
- NNK
- Phenol
- Pyrene
- Quinoline
- Stigmasterol
- Toluene
- "Tar"
- Water
- 2-Naphthylamine
- 4-Aminopiphyenyl
For smokers, the specific health risks of tobacco use include:For nonsmokers exposed regularly to second hand smoke, the specific health risks include:- increased risk of lung cancer over those not exposed to smoke
- in infants and children, an increased frequency of respiratory infections (such as bronchitis and pneumonia), asthma, and decreases in lung function as the lungs mature
- may experience (upon exposure to smoke) acute, sudden, and occasionally severe, reactions including eye, nose, throat, and lower respiratory tract symptoms
For smokeless tobacco users the specific health risks include:- nicotine addiction, decreased senses of taste and smell
- increased infant death and diseases, if mothers use
- oral/tooth/gum diseases--including a 50 times greater risk for oral cancer with long term or regular use
- coronary artery disease--angina, heart attacks
- atherosclerotic and peripheral vascular disease--aneurysms, hypertension, blood clots, strokes
STOPPING SMOKING
A wide range of methods exist for quitting smoking. Family members, friends, and work associates may be supportive or encouraging but the desire and commitment to quit must be a personal decision. It may prove helpful to write up a specific list of the reasons why one wants to quit. A 1990 Gallup poll of smokers revealed that two-thirds of smokers state they would like to quit.
Past attempts to quit tobacco use should be viewed as learning experiences, not failures. Information from people who have been able to successfully quit smoking shows that 70% had made 1 to 2 previously unsuccessful attempts; 20% had made 3 to 5 previously unsuccessful attempts; and 9% had made 6 or more previously unsuccessful attempts before actually quitting.
Like other addictive behaviors, tobacco use is difficult to stop and maintain, particularly if acting totally alone. The best success in quitting has been noted with comprehensive programs that may combine various strategies, over time (usually 4 to 8 weeks with 1 or 2 hours of support per week) including education, peer support, behavior recognition, behavior modification methods, recognition of potential relapse situations, and strategies for confronting such situations. Medications that are nicotine substitutes, such as transdermal nicotine or nicotine gum, may be used temporarily in conjunction with such programs. These medications require a prescription, therefore seek the support and cooperation of the primary care provider for their use.
Comprehensive programs for quitting smoking have a successful rate of about 20 to 40% of participants. In contrast, 2.5% of people who choose to quit smoking spontaneously, without help, achieve success. Once a person has chosen to quit using tobacco products, it may prove beneficial to elicit a broad range of collaborative methods and support persons to enhance optimal success. If success is not reached initially, simply look at what occurred or what didn't work, develop new strategies, and try again. Multiple attempts are frequently necessary to "beat the habit."
BENEFITS OF QUITTING- within 20 minutes of quitting
- blood pressure and pulse rate drop to normal
- body temperature of extremities (hands/feet) increases to normal
- within 8 hours of quitting
- carbon monoxide level in blood drops to normal
- oxygen level in blood increases to normal
- within 24 hours of quitting
- within 48 hours of quitting
- nerve endings begin to regenerate
- senses of smell and taste begin to return to normal
- within 2 weeks to 3 months of quitting
- circulation improves
- walking becomes easier
- lung function increases up to 30%
- within 1 to 9 months of quitting
- overall energy typically increases
- symptoms associated with chronic use decrease (such as coughing, nasal congestion, fatigue, and shortness of breath)
- cilia (fine, hair-like projections lining lower respiratory tract) function begins to return to normal, which increases the body's ability to handle mucus, clean the respiratory tract, and reduce respiratory infections
- within 1 year of quitting
- within 5 years of quitting
- lung cancer death rate (for average 1 pack/day former smoker) decreases by nearly 50%
- risk of cancer of the mouth is half that of a tobacco user
- within 10 years of quitting
- lung-cancer death rate becomes similar to that of a nontobacco user
- precancerous cells are replaced with normal cell growth
- risk of stroke is typically lowered, possibly to that of a nontobacco user
- risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases
- within 15 years of quitting
- risk of coronary heart disease is that of a nonsmoker
CALL YOUR HEALTH CARE PROVIDER IF- you are a current tobacco user interested in an individual health risk profile, methods to stop tobacco use, help and support for ceasing tobacco use, more information regarding tobacco related health risks (or second-hand smoke) and benefits of quitting tobacco use
- you are a woman using tobacco products who is currently pregnant or planning a pregnancy in the future
- you are experiencing signs or symptoms of specific diseases associated with tobacco use (even if you are a nonsmoker exposed regularly to second-hand smoke)
Other resources include local chapters of the American Lung Association and the American Cancer Association. Both organizations have a wide range of resource materials and formalized, comprehensive smoking cessation programs.
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The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2000 adam.com, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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