Tobacco

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 • 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”

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: • 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.

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 • 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. Total Harm Score (Nutt et al, 2010)Lancet article, including harm criteria Figure 2 Source: The Lancet 2010; 376:1558-1565 (DOI:10.1016/S0140-6736(10)61462-6) Terms and Conditions

16. 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

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 • 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 • 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 • 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)

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