Changes in Patterns of Substance Use ─ Tobacco Lars Ramström Institute for Tobacco Studies Stockholm, Sweden 49th International ICAA Conference on Dependencies.

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Changes in Patterns of Substance Use ─ Tobacco Lars Ramström Institute for Tobacco Studies Stockholm, Sweden 49th International ICAA Conference on Dependencies Edinburgh (Scotland, UK) Sept 2006

BEFORE CHRISTOFER COLUMBUS Smoking tobacco played a prominent role in the religious life of many indian tribes in America. Tobacco was also smoked for pleasure, and the medicine men used it to cure a range of illnesses.

BEFORE CHRISTOFER COLUMBUS Smoking tobacco played a prominent role in the religious life of many indian tribes in America. Tobacco was also smoked for pleasure, and the medicine men used it to cure a range of illnesses. AFTER COLUMBUS had brought home tobacco seeds, cultivation of tobacco started in Europe.

THE 16TH CENTURY Jean Nicot ( ) French ambassador in Lisbon, Portugal from 1559 to He brought tobacco plants to France and in 1560 he introduced tobacco in the form of snuff to the French court. The queen mother, Catherine de’ Medici, became an instant tobacco convert. The tobacco plant, Nicotiana, is named after him, as is nicotine.

THE 17TH CENTURY Snuff (DRY for NASAL use) use is popular among members of the upper classes. Pipe smoking is gaining popularity and there is also some manufacturing of cigars. Cigarettes, are ”invented” in Spain as a means of using waste tobacco to make cheap smoking products.”

THE 17TH CENTURY Snuff (DRY for NASAL use) use is popular among members of the upper classes. Pipe smoking is gaining popularity and there is also some manufacturing of cigars. Cigarettes, are ”invented” in Spain as a means of using waste tobacco to make cheap smoking products. THE 18TH CENTURY Snuff holds its leading position, and the various kinds of smoking remain less dominant.

THE 19TH CENTURY The cigar becomes increasingly popular among members of the upper classes. MOIST snuff, for ORAL use, is introduced and reaches its way to broader population groups, especially in Sweden. In the late 1870s the first machine for cigarette manufacturing is constructed. This makes it possible to start mass production – and mass consumption.

CHANGES IN GLOBAL PATTERNS OF CIGARETTE CONSUMPTION

According to a recent Nationwide survey: More Doctors smoke Camels than any other cigarette Quoted from the text: "Doctors in every branch of medicine - 113,597 in all - were queried in this nationwide study of cigarette preference” US advertisement in 1951

Country Cigarette consumption Smoking prevalence Men at largePhysicians EthiopiaLow, rising 6 % 9 % BulgariaHigh, still rising44 %52 % LuxembourgHigh, falling39 % 5 % AustraliaLow, falling19 % 3 % Physicians vs men at large Examples of patterns in different countries according to the stage of the smoking epidemic

Proportion of daily smokers in : Swedish population Swedish physicians % Source: Bolinder et al. Svenska läkare röker minst i världen. (Smoking doctors – a rarity in Sweden). Läkartidningen 2002;99:

Advertisements USA 1948/1950

1972 advertisement USA. Carlton is lowest. U.S. Government laboratory tests confirm, no cigarette lower in tar than Carlton

1976 advertisement USA. In the mid 1970s manufacturing of smokeless tobacco started to go up. (See Surgeon General’s report 1986, Figure 1).

Major types of Smokeless Tobacco (in the Western world) CHEWING TOBACCO (LOOSE-LEAF TYPE) MOIST SNUFF (SNUS) (LOOSE GRAINS) MOIST SNUFF (SNUS) (PORTION PACKS)

Changing patterns of Smokeless tobacco use, USA Chewing tobacco:down 5.2 % a year Moist snuff:up 3.6 % a year Source: US Alcohol and Tobacco Tax and Trade Bureau

EXAMPLES OF NEW SMOKELESS TOBACCO PRODUCS

the bowl or head, which contains the tobacco, the heating apparatus is placed on top the pipe, which connects the bowl to the base by a tube that plunges into the water the hose, which connects to a second tube in the pipe and does not plunge into the water, but only the air of the smoke chamber the base or smoke chamber, which is partially filled with water the mouthpiece Hookah (Hubble-Bubble, Waterpipe) Egyptian type

SUMMARY (1) DURING 16TH THROUGH 18TH CENTURY tobacco use, occurring mainly in the upper classes, is dominated by dry oral snuff and there is also pipe and cigar smoking. IN THE 19TH CENTURY moist oral snuff is introduced and reaches broader population groups. DURING THE 20TH CENTURY cigarette consumption incraeses 100-fold and the epidemic is spread all over the world.

SUMMARY (2) Global cigarette consumption is still going up, despite decrease in developed countries since the 1980s. In individual countries the smoking epidemic usually follows a pattern of prevalence rising, passing a peak and then falling. Typically, men are passing through these stages earlier than women, and high educated earlier than low educated people. Around 1950 filter cigarettes started a rapid increase, from around 1970 focusing on low tar delivery (later found useless from health risk reduction point of view). Along with decreasing cigarette smoking there has been an increased interest for smokeless tobacco. Among smokeless tobaccos chewing tobacco is going down, moist snuff is going up, especially in Sweden, where more men use snuff (in Swedish ”snus”) than smoke. New habits, e.g. water-pipe smoking, may be coming.