Tobacco
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”
Tobacco History
Late 1400’s: explorers “discover” tobacco
 1500’s: tobacco use spreads to Europe
 1600’s: tobacco grows in popularity &
unpopularity

– Addiction
– Religion
– Tax

1700’s: first American tobacco manufacturing
(Virginia)
Tobacco History

1800s:
– Women begin smoking in public
– Phillip Morris business
– Academics become concerned about tobacco’s
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): 292–296.
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
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
Tobacco Use Across the World

Tobacco Atlas
– Cigarette consumption
– Cigarettes: annual price
change
– Cigarettes: annual tax
change
Source: tobaccoatlas.org


Map (Washington Post, 2012)
WHO: Country profiles
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
• Who is using (Tobacco Atlas)
The World is Up in Smoke (continued)


Bidis, worldwide, esp. India
Kreteks (clove smokables),
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)
– Case dropped in October 2014


Chewing tobacco, snuff,
smokeless & spitless
Electronic cigarettes
(Tobacco Atlas)
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)
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 (8:50)
Components of Tobacco Smoke
Generally, 4,000 chemicals (About.com)
 Tar
 Nicotine
 Gases

Tar
Sticky, black substance produced from
burning tobacco
 Video: tar extraction
 Tars carry carcinogenic (cancercausing) materials
 Tars contribute to chronic bronchitis

(Univ. Miami Med. School)
(YouTube)
Nicotine

A stimulant drug
– Increased heart rate
– Increased vessel resistance
• Increased blood pressure
– Decreased skin temperature (vessel resistance)

Nicotine (YouTube)

The addictive substance in tobacco
(druglibrary.org)
– Henningfield & Benowitz data
– Other dangers (drugwarfacts.org)
Figure 2
Total Harm Score (Nutt et al, 2010)
Lancet article, including harm criteria
Gases in Tobacco Smoke

Carbon monoxide
– Colorless, odorless
– Binds to hemoglobin, preventing oxygen binding
– Oxygen-carrying capacity in blood compromised
(YouTube)

Hydrogen cyanide
– Impairs cilia in bronchioles

Nitrogen oxides
– Lung damage, perhaps leading to emphysema
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
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)
Harvester’s perspective
Cigarette excise taxes
– “Grow Your Own” report, CBS News
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, 2:23)
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)
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
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)
Media: Chronic Effects of
Tobacco Smoking

Patients: The
Nightmares (Miller
School of Medicine,
University of Miami)