Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects. It is considered an addictive substance because it contains the chemical nicotine.
The tobacco plant is believed to have originated in the Western Hemisphere. The cultivated species most often grown for North American and European tobacco products is Nicotiana tabacum. The leaves of the plant are prepared for smoking, chewing, or sniffing. In addition to nicotine, tobacco contains over 19 known carcinogens (most are collectively known as "tar") and more than 4,000 chemicals.
Prior to European influence in the Americas, tobacco was used by the Indians of Mexico and Peru for ceremonies, medicinal purposes, and to alleviate hunger pangs during famines. Columbus is credited with introducing tobacco into Europe. Tobacco use became widely accepted by the Portuguese, Spanish, French, British, and Scandinavians. Explorers and sailors who became dependent upon tobacco began planting seeds at their ports of call, introducing the product into other parts of Europe and Asia.
The colonists introduced tobacco on the American continent in the early 1600s. It became a major crop and trading commodity of the Jamestown colony. Over the years, tobacco has been claimed as a cure for a wide range of ailments with varying forms of administration (for example, used in poultices, pastes, smoked, chewed, sniffed, or placed in any body cavity). Its social importance also grew over the years, even to the point of denoting the "modern or liberated woman" during the first part of the twentieth century.
It was not until the 1960s, with the introduction of medical research related to cigarette smoking, that the adverse health effects of tobacco became widely publicized.
SMOKELESS TOBACCO
Unfortunately, most of the publicity focused only on the health hazards associated with cigarette SMOKING. While the number of cigarette smokers in the United States has continually decreased over recent years, the number of smokeless tobacco users has steadily increased.
Since the 1970s, a 15-fold increase in smokeless tobacco has been noted in adolescents aged 17 to 19. This has most likely been related to the emphasis on smoke-free environments; availability of tobacco products; increased advertising of smokeless products; macho, athletic role models who use and advertise for smokeless products; and the false belief that smokeless tobacco is a safe alternative for those convinced they should stop smoking but who still want (are addicted to) the nicotine effects of tobacco.
TOBACCO USE
Although over 38 million people in the United States have quit smoking, about 50 million continue to smoke (about 25.7% of the adult population). Each year, approximately 1.3 million Americans quit smoking. In addition, about two-thirds of current smokers state that they would like to quit and only 19% of the current U.S. smokers report they have never tried to quit. About 30% to 40% of those who have not tried to quit say they do not believe that the health risks of smoking are real, or they do not believe that quitting smoking will ultimately decrease their risks for disease.
It is estimated that about 5.5 million people use smokeless tobacco daily and another 6 million use it at least weekly. Young men are at highest risk for using tobacco products but the incidence in women is increasing. Smokeless tobacco use is highest in the Southeast region, followed by the Central Plains and Western states. Its use is lowest in the Northeast region of the United States. Smokeless tobacco use patterns are higher within the following occupations: athletes, ranchers, farmers, fishermen, lumberjacks, and industrial workers who have repetitive jobs requiring hand freedom.
EFFECTS
Nicotine has both stimulant and depressant effects upon the body. Bowel tone and activity increases along with saliva and bronchial secretions. Stimulation of the central nervous system may cause tremors in the inexperienced user, or even convulsions with high doses.
Stimulation is followed with a phase that depresses the respiratory muscles. As a euphoric agent, nicotine causes arousal as well as relaxation from stressful situations.
On the average, tobacco use increases the heart rate 10 to 20 beats per minute, and it increases the blood pressure reading by 5 to 10 mmHG (because it constricts the blood vessels).
Nicotine may also increase diaphoresis (sweating), nausea, and diarrhea because of its effects upon the central nervous system. Nicotine's effects upon hormonal activities of the body is also evident. It elevates the blood level of glucose and increases insulin production. Nicotine also tends to enhance platelet aggregation, which may lead to thrombotic (blood clot) events.
The "positive" effects of nicotine upon the body may also be noted. It stimulates memory and alertness, enhancing cognitive skills that require speed, reaction time, vigilance, and work performance. As a mood-altering agent, it tends to alleviate boredom and reduce stress and reduces aggressive responses to stressful events.
It also tends to be an appetite suppressant, specifically decreasing the appetite for simple carbohydrates (sweets) and inhibiting the efficiency with which food is metabolized. (For this reason, fear of weight gain also influences the willingness of some people to stop smoking.) People who use tobacco products frequently depend upon it providing these side effects to help them accomplish certain tasks at specific levels of performance.
The addictive effects of tobacco have been well documented. It is considered mood and behavior altering, psychoactive, and abusable. As a multisystem pharmacological agent that is voluntarily administered, tobacco is believed to have an addictive potential comparable to alcohol, cocaine, and morphine. CHEMICAL COMPONENTS
Tobacco, the vehicle of nicotine delivery, contains tar (numerous chemicals that cause a thick, sticky substance to form in the lungs when smoked) and over 4,000 chemicals in total.
Some of the chemicals identified in the gas phase of tobacco smoke include:
- acetone
- acetonitrile
- acethylene
-
ammonia
- carbon dioxide
-
carbon monoxide
- dimethylinitrosamine
- hydrogen cyanide
- methane
-
propane propene
- pyridine
- methylchloride
- methylfuran
- nitrogen oxides
- nitrosopyrrolidine
- propionaldehyde
- 2-butane
- 3-picoline
- 3-binylpyridine
Some of the chemicals in the particulate phase include:
- aniline
- benz(a)pyrene
- catechol
- hydrazine
- napthalene
- methylnaphthalene
- methylquinolines
- nicotine
- NNK
- phenol
- pyrene
- quinoline
- stigmasterol
- toluene
- "tar"
- water
- 2-naphthylamine
- 4-aminopiphyenyl
HEALTH RISKS
In general, chronic exposure to nicotine may cause an acceleration of coronary artery disease, peptic ulcer disease, reproductive disturbances, esophageal reflux, hypertension, fetal illnesses and death, and delayed wound healing.
Tobacco and its various components increase the risk of cancer (especially in the lung, mouth, larynx, esophagus, bladder, kidney, pancreas, and cervix), heart attacks and strokes, and chronic lung disease. Tobacco use during pregnancy increases the risk of miscarriage, intrauterine growth retardation (resulting in the birth of an infant small for gestational age), and the infant's risk for SIDS (sudden infant death syndrome).
For smokers, the specific health risks of tobacco use include:
- nicotine addiction
- decreased senses of taste and smell
- in pregnancy, increased fetal death, premature labor, low birthweight infants, and SIDS (sudden infant death syndrome)
- lung disease--emphysema, chronic bronchitis, lung cancer
- coronary artery disease--angina, heart attacks
- atherosclerotic and peripheral vascular disease--aneurysms, hypertension, blood clots, strokes
- oral/tooth/gum diseases--including oral cancer
- other cancers--kidney, bladder, and pancreas
For nonsmokers exposed regularly to secondhand smoke, the specific health risks include:
- increased risk of lung cancer over those not exposed to smoke
- in infants and children, an increased frequency of respiratory infections (such as bronchitis and pneumonia), asthma, and decreases in lung function as the lungs mature
- may experience (upon exposure to smoke) acute, sudden, and occasionally severe, reactions including eye, nose, throat, and lower respiratory tract symptoms
For smokeless tobacco users, the specific health risks include:
- nicotine addiction
- decreased senses of taste and smell
- in pregnancy, increased fetal death, premature labor, low birthweight infants, and SIDS (sudden infant death syndrome)
- oral/tooth/gum diseases--including a 50 times greater risk for oral cancer with long-term or regular use
- coronary artery disease--angina, heart attacks
- atherosclerotic and peripheral vascular disease--aneurysms, hypertension, blood clots, strokes
STOPPING SMOKING
A wide range of methods exist for quitting smoking. Family members, friends, and work associates may be supportive or encouraging but the desire and commitment to quit must be a personal decision. It may prove helpful to write up a specific list of the reasons why one wants to quit. A 1990 Gallup poll of smokers revealed that two-thirds of smokers state they would like to quit.
Past attempts to quit tobacco use should be viewed as learning experiences, not failures. Information from people who have been able to successfully quit smoking shows that 70% had made one to two previously unsuccessful attempts; 20% had made three to five previously unsuccessful attempts; and 9% had made six or more previously unsuccessful attempts before actually quitting.
Like other addictive behaviors, tobacco use is difficult to stop and maintain, particularly if acting totally alone. The best success in quitting has been noted with smoking cessation programs that may combine various strategies, including education, peer support, behavior recognition, behavior modification methods, recognition of potential relapse situations, and strategies for confronting such situations. Counseling by telephone is as effective as smoking cessation classes. Medications that are nicotine substitutes, such as transdermal nicotine (Nicorette patch) or nicotine gum, may be used temporarily in conjunction with such programs. Short-term use of the antidepressant medication bupropion along with a smoking cessation program has been shown in studies to further increase the success rate. Buproprion requires a prescription from your health provider and should not be used by people with a history of seizures or renal failure.
Programs for quitting smoking have a success rate of about 20% to 40% of participants. In contrast, 2.5% of people who choose to quit smoking spontaneously, without help, achieve success. Once a person has chosen to quit using tobacco products, it may prove beneficial to elicit a broad range of collaborative methods and support persons to enhance optimal success. If success is not reached initially, simply look at what occurred or what didn't work, develop new strategies, and try again. Multiple attempts are frequently necessary to "beat the habit." See also Smoking--tips on how to quit .
BENEFITS OF QUITTING
- within 20 minutes of quitting
- blood pressure and pulse rate drop to normal
- body temperature of extremities (hands/feet) increases to normal
- within 8 hours of quitting
- carbon monoxide level in blood drops to normal
- oxygen level in blood increases to normal
- within 24 hours of quitting
- within 48 hours of quitting
- nerve endings begin to regenerate
- senses of smell and taste begin to return to normal
- within 2 weeks to 3 months of quitting
- circulation improves
- walking becomes easier
- lung function increases up to 30%
- within 1 to 9 months of quitting
- overall energy typically increases
- symptoms associated with chronic use decrease (such as coughing, nasal congestion, fatigue, and shortness of breath)
- cilia (fine, hairlike projections lining lower respiratory tract) function begins to return to normal, which increases the body's ability to handle mucus, clean the respiratory tract, and reduce respiratory infections
- within 1 year of quitting
- within 5 years of quitting
- lung cancer death rate (for average one pack/day former smoker) decreases by nearly 50%
- risk of cancer of the mouth is half that of a tobacco user
- within 10 years of quitting
- lung cancer death rate becomes similar to that of a nonuser
- precancerous cells are replaced with normal cell growth
- risk of stroke is typically lowered, possibly to that of a nonuser
- risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases
- within 15 years of quitting
- risk of coronary heart disease is that of a nonuser
CALL YOUR HEALTH CARE PROVIDER IF
- you are a current tobacco user interested in an individual health risk profile, methods to stop tobacco use, help and support for ceasing tobacco use, more information regarding tobacco related health risks (or secondhand smoke) and benefits of quitting tobacco use
- you are a woman using tobacco products who is currently pregnant or planning a pregnancy in the future
- you are experiencing signs or symptoms of specific diseases associated with tobacco use (even if you are a nonsmoker exposed regularly to secondhand smoke)
Other resources include local chapters of the American Lung Association and the American Cancer Association. Both organizations have a wide range of resource materials and formalized, comprehensive smoking cessation programs.
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