1. Tobacco

2. 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
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”

3. 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)

4. 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
: independence promotion for women
Virginia Slims cigarette commercials
Sources: tobacco.org, J R Soc Med. Jun 2004; 97(6): 292–296.

5. 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

6. 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

7. 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

8. 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)

9. 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)

10. 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)

11. 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)

12. Components of Tobacco Smoke
Generally, 4,000 chemicals (About.com)
Tar
Nicotine
Gases

13. 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

14. 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)

15. Figure 2
Total Harm Score (Nutt et al, 2010) Lancet article, including harm criteria
Source: The Lancet 2010; 376: (DOI: /S (10) )
Terms and Conditions

16. 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

17. 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

18. 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

19. 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)

20. 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)

21. 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

22. 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)

23. Media: Chronic Effects of Tobacco Smoking
Patients: The Nightmares (Miller School of Medicine, University of Miami)