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: 1900s: 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 (Univ. Miami Med. School) Video: tar extraction (YouTube) Tars carry carcinogenic (cancer-causing) materials Tars contribute to chronic bronchitis

Nicotine Nicotine (YouTube) 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 Source: The Lancet 2010; 376:1558-1565 (DOI:10.1016/S0140-6736(10)61462-6) Terms and Conditions

Gases in Tobacco Smoke Carbon monoxide Hydrogen cyanide 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 Cigar and pipe smoke more irritating 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 Snuff Orbs 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 79 pairs of twins Wrinkles 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)