TOBACCO

     Classification:        Mild stimulant
     Method of Use:         Smoked, Orally, Inhaled
     Dependence Potential:  Physically and psychologically addictive

What is Tobacco?

Tobacco is a plant which grows in a wide range of soil and climate conditions. Its nonedible leaf is dried and used to produce cigarettes, pipe tobacco, cigars, chewing tobacco and snuff.

Tobacco contains over 4,000 different gases, particles and compounds including tar, nicotine and carbon monoxide. Tobacco smoke "tar" is composed of several thousand chemicals that can damage lung tissue and cause several diseases. Some of these chemicals include: acids, alcohols, aldehydes, ketones, aromatic hydrocarbons and corrosive gases such as cyanide and nitrogen oxide.

Nicotine is found only in tobacco. It acts as a mild stimulant to the central nervous system and is what causes the addiction to tobacco products. Like other stimulants, nicotine makes blood vessels constrict, causing an increase in the heart rate and blood pressure and decreasing the user's appetite. In new smokers, nicotine often causes nausea. In large doses, nicotine can also cause tremors, quickened breathing and a decrease in the production of urine.

Carbon monoxide, which makes up about four percent of tobacco smoke, impairs the oxygen-carrying capacity of the blood to the body's tissues, literally driving the oxygen out of the red blood cells. At the same time nicotine is causing the heart to work harder, it is depriving the heart of the extra oxygen it needs. Carbon monoxide also promotes cholesterol deposits in arteries, impairs vision and judgment, and reduces attentiveness to sounds.

Cigarettes, Pipes and Cigars

Smoking is the single largest preventable cause of premature death and disability in the United States and is related to 390,000 deaths each year. According to the American Cancer Society, the average smoker consumes about a pack and a half of cigarettes a day at a cost of $900.00 a year.

Costs for medical care related to smoking are estimated at $22 billion annually, and the cost to the economy from lost productivity is about twice as much as direct health care costs.

The moment the smoke from a cigarette, pipe or cigar is inhaled, it attacks the tissues of the mouth, tongue, throat, esophagus, air passages and lungs. In the lungs, most of the inhaled compounds are retained. Once nicotine is absorbed into the lungs, its effects reach the brain within six seconds - twice as fast as mainlining heroin.

Smoking can produce a feeling of well being in habitual users; however, smoking releases epinephrine, a hormone which creates physiological stress in the smoker rather than relaxation.

Low Tar/Nicotine, Filtered and Mentholated Cigarettes

Research shows that there is no "safe" cigarette; however, the American Cancer Society suggests that those who cannot quit smoking should switch to brands with low tar and nicotine (T/N). Low T/N smokers seem to find it easier to quit smoking altogether than high T/N smokers, and research indicates that the mortality rate of low T/N smokers is 16% lower than that of high T/N smokers.

Yet, it is important to remember that low tar and nicotine cigarettes contain other poisonous compounds. Many low T/N brands have reduced taste. In an effort to satisfy smokers, manufacturers add a variety of flavoring compounds, some of which are known to be carcinogenic (cancer-causing) or toxic.

Filtered cigarettes have been shown to reduce the risks of lung cancer in smokers; however, some brands have been found to produce more carbon monoxide than unfiltered cigarettes, thereby increasing the risks of heart disease.

Mentholated cigarettes produce a cool sensation in the throat when smoke is inhaled. Research so far has not shown if menthol has any effect on the risks of cigarette smoking.

Smokeless Tobacco

The use of smokeless tobacco is increasing, especially among young males. Recent reports from the American Cancer Society indicate that smokeless tobacco is used by at least 12 million people in the United States, half of these regular users.

There are two types of smokeless tobacco: chewing tobacco and snuff. Chewing tobacco is used orally and is treated with "saucing compounds" which contain sugar, honey, or molasses and flavorings such as licorice. Users usually put a golf ball-size wad of tobacco in the pouch of their cheek and suck on it. The user spits frequently to get rid of the tobacco. Snuff is processed into a coarse, moist powder and is "dipped" or placed between the cheek and gum where it stimulates the flow of saliva and mixes with it. Again, the user spits frequently to get rid of the snuff. Snuff can also be inhaled through the nose. Nicotine from the tobacco is readily absorbed in the mouth and nose and distributed throughout the body. Users become as addicted to nicotine's effects as smokers do.

Health hazards associated with smokeless tobacco include: white patches in the mouth (leukoplakia); a diminished sense of taste and smell; dental problems such as receding gums, tooth discoloration, weakened tooth enamel and bad breath; and an increased risk of cancers of the mouth. Another negative aspect is that smokeless tobacco users often turn to cigarettes because nicotine gets into the system faster when it is inhaled in cigarette smoke.

Passive Smoking

Passive or second-hand smoking is the involuntary inhaling of tobacco smoke by nonsmokers in a smoke-filled atmosphere. These nonsmokers inhale a great deal of sidestream smoke - smoke that is not drawn through the cigarette. Side-stream smoke contains much higher percentages of tar, nicotine, and noxious gases than the smoke that is exhaled by a smoker.

To some, second-hand smoke causes breathing difficulties; to others it may set off a severe allergic reaction. A report from the National Academy of Sciences says that about 2,400 lung cancer deaths a year may be caused by second-hand smoke. Other studies have found that nonsmoking wives of smoking husbands have a 35 percent higher risk of lung cancer compared with women whose husbands don't smoke.

Children in households where one or both parents smoke have a greater chance of developing certain illnesses such as colds, bronchitis, pneumonia, chronic coughs, ear infections, allergic reactions and reduced lung function. As with adults, the more smoke a child is exposed to, the higher the risk is that the child will develop complications. Also, children who grow up in homes with parents who smoke are twice as likely to become smokers themselves.

In the workplace, smoke can spread throughout the office and each workday is enough time to expose coworkers to the risk of second-hand smoke. Many business and industries have begun to restrict smoking to certain areas in an effort to combat these health hazards.

Long Term Effects of Tobacco Use

The use of tobacco has been implicated in cancers of the mouth, larynx, pharynx, esophagus, pancreas, cervix, uterus and bladder. Smoking accounts for approximately 30 percent of all cancer deaths, is a major cause of heart- disease, an is linked to colds, gastric ulcers, chronic bronchitis, and emphysema The American Cancer Society estimates that smoking cigarettes accounts for 85 percent of lung cancer cases among males and 75 percent among females.

Tobacco and The Lungs

In the lungs, cancerous agents of tobacco smoke attack tissue and tiny air sacs where the oxygen/carbon dioxide exchange takes place. As damage to the lungs continues, breathing capacity is destroyed, leading to emphysema. Emphysema is a noncancerous lung disease that destroys the elasticity of the lungs and impairs its ability to inhale and exhale properly. Tissue affected by emphysema can be repaired or replaced, and the smoker eventually has to gasp for breath. Emphysema kills approximately 16,000 Americans each year.

Lung cancer begins with the constant irritation of smoke on the lining of the bronchi. These hairlike cilia which filter air disappear from the lining and a mucos is secreted to take its place. This mucus then becomes trapped and is forced out of the lung by "smoker's cough."

If a smoker gives up smoking before cancerous cells are present, the bronchial lining can repair itself. Its abnormal cell growth has begun, the cancer will spread, blocking the bronchi and attacking other lung tissue. As the cancer progresses, the abnormal cells break loose from the lung and are carried by the lymphatic system to other vital organs, where new cancers begin.

The five-year survival rate for lung cancer is less than ten percent. The disease is rarely detected early enough for cure because lung cancer often shows no symptoms until it is far advanced.

Tobacco and the Heart

The American Heart Association estimates that about one-fourth of fatal heart attacks are caused by cigarette smoking, about 120,000 heart attack deaths per year.

Tobacco smoke is a major independent risk factor for fatal and non-fatal heart attacks in both men and women. The risk of heart attacks, strokes, and blood clots increases tenfold for women who both smoke and use oral contraceptives.

Smoking and Pregnancy

Tobacco has significant adverse-effects for pregnant women. Smoke in the mother's bloodstream alters the heart rate, blood pressure, oxygen supply, and acid balance of the unborn child. An expectant mother who smokes two packs a day blocks off the equivalent of 25 percent of the oxygen supply to the fetus.

Pregnant smokers experience more stillbirths, spontaneous abortions, premature births, and low-weight babies than nonsmoking mothers. Children born to mothers who smoke during pregnancy may have measurable deficiencies in physical growth, learning disabilities. birth defects and chronic breathing difficulties.

Dependency and Withdrawal

The use of tobacco is addictive. According to the National Institute on Drug Abuse (NIDA), most users develop tolerance to nicotine - the need for greater amounts to produce a desired effect. Smokers become physically and psychologically dependent, and will suffer withdrawal symptoms when use is stopped. The severity of the symptoms differs from person to person. Generally symptoms subside in about seven days, but may last for weeks or months. Physical withdrawal symptoms include changes in body temperature, heart rate, digestion, muscle tone and appetite. Psychological symptoms include irritability, anxiety, sleep disturbances, nervousness, headaches, fatigue, nausea and a craving for tobacco which can continue for a long time. Reports show that one out of every five smokers has occasional cravings for more than five years after quitting.

Damage to tissues caused by smoking can be reversed if smoking stops before the onset of lung, heart or circulatory disease. After a year of nonsmoking, the risk of a heart attack begins to decline; after ten years of not smoking, the risk is about the same as that of a nonsmoker. The risk of lung cancer begins to decrease as soon as smoking stops and steadily drops to about that of a nonsmoker after 10 to 15 years.

Source: Valencia Community College Project Infusion Module, Orlando, FL. Reprinted with permission.

[33;1m                                 Tobacco and Youth[37;0m

Deborah E. Smith, M.D.

July 15, 1992

[1mCigarette Smoking in High School Seniors[37;0m

63% lifetime prevalence 28% smoked past 30d 19% smoke daily 11% smoke > 1/2 ppd

Johnson et al 1991 (Monitoring the future)

[1mHistory of Tobacco[37;0m

1492:       Columbus introduced to tobacco; tobacco comes to Europe
1500's:     "Medical" uses, "herbe sainte"
            Jean Nicot treats the migraines of Catherine de Medici,
            Queen of France
1600's:     Smoking is very popular in England
            Tobacco trade declared a royal monopoly
            Awareness of related problems
1700's:     Upper class Europeans prefer snuff
            George III of England's wife "Snuffy Charlotte"
            Napoleon used 7 lb. snuff/month
1800's:     Americans prefer chewing tobacco
1881:       First patent on cigarette making machine
l900's:     Cigarettes prefered
1913:       Camel cigarette; 40% market by 1918
1950's:     Clear evidence linking smoking and lung cancer
1963:       Peak year for per capita sales
1964:       Surgeon General declares smoking is a health hazard
1971:       TV ads banned
            Increased use of chewing tobacco

[1mIdeas for Intervention[37;0m

Model for nonsmoking behavior - by family, peer leaders, other adults Educate about negative consequences (preadolescent) Educate about addiction using smoking as a model Teach skills - refusal; coping with peer pressure Cessation programs, including relapse-prevention Community issues - supply; enforce sales restrictions

public nonsmoking areas

public education

[1mReferences[37;0m 1604 King James

Smoking is "a custome lothesome to the Eye, hatefull to

the Nose, harmefull to the Braine, dangerous to the Lungs".

1617      Dr. William Vaughn
          Tobacco that outlandish weede
          It spends the braine and spoiles the seede
          It dulls the spirite, it dims the sight
          It robs a woman of her right

[1mGeneral[37;0m

1.   Ray O, Ksir C.  Drugs, Society, and Human Behavior (5th edition).
     Times Mirror/Mosby College Publishing.  St. Louis, 1990 ($28.95).
2.   Tobias A. Kids say don't smoke.  Posters from the New York City smoke-free
     contest.  Workman Publishing.  NY, 1991.
3.   Fielding JE.  Smoking: Health effects and control.  Professional Education
     Publication, American Cancer Society Inc.  NY NY, 1986.

[1mAdolescents and Tobacco[37;0m

1.   Presti DE, Ary DV, Lichtenstein E.  The context of smoking initiation and
     maintenance: findings from interviews with youths.  J Subst Abuse
     1992;4:35-45.
2.   Kandel DB, Logan JA.  Patterns of drug use from adolescence to young
     adulthood: I. periods of risk for initiation, continued use, and
     discontinuation.  Am J Public Health 1984;74:660-666.
3.   Yamaguchi K, Kandel DB.  Patterns of drug use from adolescence to young
     adulthood:  II. Sequences of progression.  Am J Health 1984;74:668-672. 4.
     Psychosocial predictors of smoking among adolescents.  Morbidity and
     Mortality Weekly Report, Supplement.1987;36 (4S)  DHHS.

[1mTobacco and Advertising[37;0m

1.   Fischer PM, Schwartz MP, Richards JW, Goldstein AO, Rojas TH.  Brand
     logo recognition by children aged 3 to 6 years.  Mickey Mouse and Old Joe
     the Camel.  JAMA 1991:266:3145-3148.
2.   Connolly D. Kids' concepts of cigarette code.  Letter to the editor.  JAMA
     1991;266:3126.
3.   Pierce JP, Gilpin E, Burns DM, Whalen E, Rosbrook B, Shopland D, Johnson M.
     Does tobacco advertising target young people to start smoking?  Evidence
     from target young people to start smoking?  Evidence from California.  JAMA
     1991;266:3154-3158.
4.   Difranza JR, Richards JW, Paulman PM, Wolf-Gillespie N, Fletcher C, Jaffe
     RD, Murray D.  RJR Nabisco's cartoon camel promotes Camel cigaretts to
     children.  JAMA 1991;266:3149-3153.

[1mHigh Risk Teens[37;0m

Dryfoos J. Adolescents at risk. Prevalence and prevention. Oxford

University Press. New York, 1990. [1m^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ END OF FILE ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^[0m