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PS268 - Midterm Two Notes.docx

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Bruce Mc Kay

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Chapter 10 – Tobacco TOBACCO HISTORY -Tobacco is responsible for more adverse health consequences and death than any other th -Aboriginal peoples were among the first to use tobacco 1400s, 15 century -It wasn’t originally called tobacco, and it wasn’t called smoking. Inhaling smoke was called drinking. In that period you either ‘took’ (used snuff) or ‘drank’ (smoked) tobacco. -Tobacco referred to a two-pronged tube used by the Aboriginal people to take snuff. -Province of Tobacos in Mexico, where everyone used the herb. TOBACCO USE IN MOVIES -In 1989 U.S. tobacco companies voluntarily agreed to halt the long standing practice of directly paying film producers for what is known as ‘product placement.’ -Research indicates that tobacco use by an adolescent’s favourite actor does influence the adolescent’s smoking behaviour. -Canadian youth, because of Canada’s film rating system, are exposed to 60% more images of tobacco than are American Youth. -130000 of 300000 youth smokers began smoking as a result of exposure to on screen tobacco use -Non smoking teens whose favourite stars frequently smoke on screen are 16 times more likely to have positive attitudes about smoking in the future EARLY MEDICAL USES -Tobacco was formally introduced to Europe as a herb useful for treating almost everything…persistent headaches, cold or catarrh and abscesses and sores on the head -French Physician, Jean Nicot -by 1565 the plant was called nicotiane, after Nicot -1753, Linneaus, the Swedish ‘father of taxonomy,’ named the plant genus Nicotiana -Tobacco: herbe sainte “holy plant,” herbe a tous les maux, “the plant against all evils.” -Pair of French chemists isolated the active ingrediant in 1828, they called it nicotine. -Dr. Vaughn was ahead of his time. Tobacco’s adverse effects on reproductive functioning in both men and women. -Nicotine was dropped from the US Pharmacopoeia in the 1980s. THE SPREAD OF TOBACCO USE -Nicotiana tobacum: the major species grown today in more than a hundred countries, is a large-leaf species. Tobacum was indigenous only to South America, so the Spanish had a monopoly on its production for than hundred years. -Nicotiana Rustica: small leaf species, and the less desirable species of tobacco. It existed in the West Indies and eastern N.A. when Columbus arrived. It is not widely grown in N.A. now. -From 1610 to 1612 Rolfe tried to cultivate rustica, but the small leaf plant was weak and poor in flavour, and it had a sharp taste. -In 1612, Rolfe got some new seeds of the Spanish tobacum species. It grew beautifully and sold well. -By 1619, ad much Virginia tobacco as Spanish tobacco was sold in London. -Tobacco became one of the major exports of the American Colonies to England. -Bavaria in 1652 probably slowed down tobacco use, but only momentarily. This law said that “tobacco-drinking was strictly forbidden to the peasants and other common people” and made tobacco available to others only on a doctor’s prescription filled by a pharmacist. By 1800, tobacco was also being commercially grown in Canada. -Canada has three major tobacco companies: Imperial Tobacco Canada Limited Rothmans, Benson & Hedges Incorporated JTI - MacDonald Corporation -Imperial Tobacco was founded in the 19 century in Montreal. About 90% of the tobacco grown in Canada is produced in a highly concentrated area in southwestern Ontario, close to the north shore of Lake Erie near the towns of Delhi and Tillsonburg. -Tillsonburg was home to Stompin’ Tom Connors, who wrote a song about working in the tobacco fields and name it after the town -The remainder of the tobacco grown in Canada is grown in Quebec, PEI, Nova Scotia and New Brunswick. SNUFF -During the eighteenth century, smoking gradually diminished, but the use of tobacco did not, Snuff replaced the pipe in England. -King George III (1760-1820) -- time of the big snuff. His wife, was such a heavy user they called her “Snuffy Charlotte” On the continent, Napoleon had tried smoking once, gagged horribly, and returned to his seven pounds of snuff per month. CHEWING TOBACCO -Peaked in Canada in 1980 -Chewing was a suitable activity for a country on the go; it freed the hands, and the wide- open spaces made an adequate spittoon. -In 1860, only 7 of 348 tobacco factories in Virginia and North Carolina manufactured smoking tobacco. The amount of tobacco for smoking did not equal the amount for chewing until 1911 and did not surpass it until the 1920s. -Many brands of Canadian cigarettes are from 100% pure Virginia tobacco. -Chewing tobacco has remained a big part of MLB over the years. Today there is a push to ban chewing tobacco on and off the field, both for the health of the players, and to promote them as positive role models for young fans. Luis Gonzalez is an active advocate against the use of tobacco products both on the field and off. CIGARS -A combination of both smoking and chewing -Cigarette smoking was becoming popular, and cigar manufacturers did their best to keep cigarettes under control. They suggested that cigarettes were drugged with opium and people could not stop using them and that the paper was bleached with arsenic, and thus was harmful. Thomas Edison in 1914 helped. -Cigar sales reached their highest level in 1920, when 8 billion were sold. As sales increased, though, so did the cost of the product. Lower cost and changing styles led to the emergence of cigarettes as the leading form of tobacco use. CIGARETTES -Thin reeds filled with tobacco had been seen by the Spanish in Yucatan in 1518. -In 1844, the French were using them, and the Crimean War circulated the cigarette habit throughout Europe. The first British cigarette factory was started in 1856 by a returning veteran of the Crimean War, and the late 180w and English tobacco merchant, Phillip Morris, began producing handmade cigarettes. -Popularity increased rapidly in the 1880s. -By 1885 more than 1 billion cigarettes a year were being sold. th -At the start of the 20 century The Camel brand arose. It contained just a hint of Turkish tobacco, eliminating most of the imported tobacco made the price lower. In 1918, Camels had 40% of the market and stayed in front until after WWII. -The first ad showing a woman smoking a cigarette appeared in 1919. -King size cigarettes appeared in 1939 in the form of Paul Mall, which became the top sellers. -Filter Cigarettes appeared in 1954 with Winston, which rapidly took over the market and continues to be the number one unto the mid-1970s. -Filter cigarettes captured and increasing share of the market and now constitute more than 90% of all U.S. cigarette sales. TOBACCO UNDER ATTACK -1604, King James of England wrote and published a strong anti-tobacco pamphlet stating that tobacco was “harmefull to the braine, dangerous to the lungs.” He also supported the growing of tobacco in Virginia in 1610, and when the crop prospered, he declared the tobacco trade a royal monopoly. -New York City made it illegal in 1908 for a woman to use tobacco in public, and in the Roaring Twenties women were expelled from schools and dismissed from jobs for smoking. “Every boy appearing before him that had lost the faculty of blushing was a cigarette fiend.” -1930s/1940s indicated a possible link between smoking and cancer temporary decline in cigarette sales -Tobacco companies responded vigorously in two important ways. Supposedly independent Council for Tobacco Research to look into the health claims (later investigations revealed this council was not independent of tobacco company influence and served largely to try to undermine any scientific evidence demonstrating the negative health consequences of tobacco use). The other response was the mass marketing of filter cigarettes and cigarettes with lowered tar and nicotine content. Public had faith in these ‘less hazardous’ cigarettes, because cigarette sales began to climb. -In 1964 - US surgeon general’s office formed and Advisory Committee on Smoking and Health. Its first official report stated clearly that cigarette smoking was a cause for increased lung cancer in men (at the time, the evidence for women was less extensive). Per capita sales of cigarettes in Canada began a decline that continues over the next 20yrs. -1965 – Surgeon’s General Warning – all television and radio advertising of cigarettes was banned in 1971, and smoking was banned on intercity buses and domestic airline flights in 1989. -Almost 6300 nonsmokers die each year in Canada from second hand smoke -In Canada, a key target of harm reduction measure in smoking is the protection of nonsmokers from second-hand some in workplaces, restaurants, cars, and even homes. TOBACCO HISTORY IN CANADA -1908 – Tobacco Restraint Act was passed which banned sales of cigarettes to those younger than 16 years of age, this Act was never enforced. -The years between 1920 and 1950 were three golden decades for cigarette consumption in Canada. Cigarettes were custom packaged and shipped to Canadian soldiers over seas. Cards showed in textbook, told families and organizations how they could order cigarette packages to be shipped to Canadian soldiers over seas. -The link between smoking and lung caner was established in the medical literature in the 1950s, yet the tobacco industry cast doubt and made great strides to publicly hide the negative health effects of tobacco. -In 1974, the Canadian Council on Smoking and Health was formed. The Non-Smokers’ Rights Association was also formed. -In 1988-89 federal laws were enacted to prohibit tobacco advertising and ensure smoke- free workplaces. -1989 – cigarette manufacturers had to list the additives and their amounts in each brand -1989 – Tobacco Products Control Act (TPCA), which prohibited all tobacco advertising, required health warnings on tobacco packaging, and restricted promotional activities, came into effect. The TPCA covered smoking and smokeless tobacco. -In 1993 – federal law was enacted to raise the legal age for buying tobacco to 18, and in 1994 bigger and stronger warning messages were required on cigarette packs. -1994 – scientists from Canada reported finding evidence of cigarette smoke in fetal hair, the first biochemical proof that the offspring of nonsmoking mothers can be affected by passive cigarette smoke. -1995, the Supreme Court of Canada squashed the federal ban on tobacco advertising campaigns, using billboards, newspapers ads, and event sponsorships. 1997 the Tobacco Act was passed and its associated regulations imposed general restrictions on manufacturers and distributors; restricted promotion, packaging, and products; and imposed point of sale restrictions. -The Canadian Council for Tobacco Control is the national organization that specializes in Tobacco and health THE QUEST FOR SAFER CIGARETTES -If the nicotine content of cigarettes is varied, people tend to adjust their smoking behaviour, taking more puffs and inhaling more deeply when given low-nicotine cigarettes, and reporting no satisfaction if all the nicotine is removed. -Tar – sticky brown stuff that can be seen on the filer after a cigarette is smoked -The public listened to all this talk abut safer cigarettes and bought in – sales of filter cigarettes took off, and by the 1980s low tar and nicotine cigarettes dominated the market -Some early studies had indicated that those who had smoked lower-yield cigarettes for years were at less risk for cancer and heart disease than those who smoked high-yield brands. -IF a smoker switched from a high-yield brand to a low-yield brand, changes in puff rate and depth of inhalation would compensate for the lower yield per puff, and there might be no advantage to switching. -1960s, Liggett developed a cigarette that, in the laboratory, signigicanlty reduced the number of tumours in mice comared with the company’s standard brand. Lawyers advised Liggett against reporting these results because the data would confirm that the standard brand was hazardous. Liggett suppressed the information and did not market the ‘safer’ cigarette, a fact that was revealed in a lawsuit during the 1980s. -1988, Reynolds attempted to market Premier, a sort of non-cigarette cigarette. Product contained catalytic crystals coated with tobacco extract but no obvious tobacco. When lit with a flame, these cigarettes produced no smoke, but inhaling through them allowed the user to absorb some nicotine. US FDA could not accept this as a traditional agricultural product rather than a nicotine ‘delivery device’ Perhaps the company could have tested and marketed it as a nicotine replacement to help smokers who wanted to quit, but that wasn’t it’s goals. -Raising the issue led to some to suggest that the FDA should review all cigarettes as if they were drugs. It’s hard to imagine how such a prudct could get approved, with demonstrated toxicity and dependence potential and no indicated medical use. -In 2004, Reynolds marketed Eclipse, another high-tech, ‘cigarette’ that it was said ‘may present less risk’ and produces up to 80% less smoke than a regular cigarette. Contains tobacco, but is not burned. Instead, the user lights a carbon element that heats a small aluminum tube that in turn heats the tobacco, releasing vapours and a small amount of smoke. CURRENT CIGARETTE USE -There is almost a perfectly inverse relationship between the number of years of education and the percentage of that group that smokes cigarettes. -Since 1985, smoking prevalence has significantly decreased in all age groups, with an overall average decrease of 14%. Despite antismoking education, 8% of young people aged 15-19 still become regular smokers. -In 2008-2009, 3% of students in grades 6-9 smoked, and 13% of students in grades 10-12 were regular smokers. -A 2005 study of a First Nations community in Manitoba revealed that 82% of adolescents ages 15-19 years and 70% of Inuit ages 18-45 years are current smokers. SMOKELESS TOBACCO -Pipe and cigar smoking enjoyed a brief, small increase, followed by a long period of decline. -Sales of smokeless tobacco products – specifically, different kinds of chewing tobacco – began to increase -The most common types of oral smokeless tobacco are loose leaf, which is sold in a pouch, and moist snuff, which is sold in a can. -When you see a baseball player with a big wad in his cheek, it’s most likely composed of loose-leaf tobacco. Sales of loose-leaf tobacco, growing from a traditional base in the Southeast and Midwest US, increase by about 50% during the 1970s and the declined through the 1980s&1990s. MOIST SNUFF is finally chopped tobacco, held in the mouth rather than snuffed into the nose. A small pinch is dipped of the can and placed beside the gum, often behind the lower lip. One form of moist snuff also comes in a little teabag type of packet, so that loose tobacco fragments don’t stray out onto the teeth. -Moist snuff, which has its traditional popularity base in the rural West, continued to show sales gains through the 1980s, until a federal excise tax was imposed. -Users achieve blood nicotine levels comparable to those of smokers. -Smokeless tobacco enjoys many advantages over smoking: 1. Unlikely to cause lung cancer. 2. Less expensive than cigarettes, only a few dollars a week. 3. More convenient to keep some tobacco in their mouths than to try to light cigarettes in the wind and then have ashes blowing their faces. 4. Chewing is more socially acceptable. -Quid: piece of chewing tobacco -Smokeless tobacco hazards: 1. Increased risk of cancer of the mouth, pharynx, and esophagus. Snuff and chewing tobacco do contain potent carcinogens, including high levels of tobacco-specific nitrosamines. Many users experience tissue changes in the mouth, with leukoplakia - a whitening and thickening of the mucous tissue in the mouth, considered to be a precancerous tissue change. 2. Irritation of gums can cause them to become inflamed or to recede, exposing the teeth to become inflamed or to recede, exposing the teeth to disease. The enamel of the teeth can also be worn down by the abrasive action of the tobacco. 3. Lead to nicotine addiction and dependence. -The overall prevalence of smokeless tobacco use in Canada is low, at around 8% for those having ever used it and less than 1% for recent use in 2005. SMOKING AMONG FIRST NATIONS ADOLESCENTS -The average age for first smoking a whole cigarette was 12.9 years and that 28% of students in grade 7-12 reported they had smoked at least one whole cigarette in their lifetime. -Males and females were equally likely to have smoked cigarettes during the year, although cigarette smoking was more common among older (25% in grade 12) than younger students (4% in grade 7). -In Alberta and Nova Scotia, people under age 18 who are caught smoking or in possession of tobacco products can have their cigarettes seized by police, but only in Alberta can minors also be fined up to $100. -Fines of up to $4000 for a store owner and $10000 for a corporation for the first offence. -Rates of smoking are highest among First Nations and Inuit youth. -Haudenosaunee First Nations speak of tobacco in their Creation story, while the Cree profess tobacco to be a natural product and not just one plant -The smoking and chewing of tobacco have no place in Aboriginal ceremonies. -First Nations are almost three times as likely to smoke and less likely-although they self report being more willing – to use a smoking cessation aid, such as the nicotine patch, relative to other Canadians. ARE CIGARS BACK? -appeared back on the scene in the 1990s. -made in Florida from tobacco supposedly grown from Cuban seeds -Cigarillos and flavoured cigarettes have also become popular with Canadian youth. -1954: the Council for Tobacco Research provided funds to ‘independent’ scientists to study the health effects of tobacco use. 1993 showed the detailed manipulation of this independent research by tobacco industry lawyers, who arranged direct funding for research casting doubt on smoking-related health problems and who suppressed the publication of findings that threatened the industry. -It was not until the late 1990s, that a tobacco manufacturer finally admitted in public that cigarettes have seriously adverse effects on health. ADVERSE HEALTH EFFECTS -85% of all lung cancers occur in smokers. -The cancer-causing agent in tobacco is likely not nicotine but rather the aromatics, such as benzo(a)pyrene, that arise from the burning tobacco. They damage DNA, resulting in cancerous mutations. Every 11 minutes, a Canadian dies from tobacco use; that’s 47000 people every year. Almost 11000 of these deaths are related to heart disease and stroke. -Smoking is estimated to be related to 17% and to an estimated 515600 expected years of life lost in 2002. -Mortality rate is predicated on the age at which smoking started and the number of cigarettes smoked. -The earlier the age at which you start smoking, the more smoking you do, and the longer you do it, the greater the impairment. PASSIVE SMOKING: THE DANGER OF SECOND-HAND SMOKE -Passive smoking – the inhaling of cigarette smoke from the environment by nonsmokers. -risk of lung cancer was increased in nonsmoking Japanese women married to men who smoked compared with nonsmoking couples. Risk increased with the number of cigarettes smoked and the amount of second hand smoke exposure. -Heather Crowe: At the time only about 5% of Canadians were protected from second hand smoke; that number rose to 80% four years later with new laws in place to protect Canadians. -Research is complicated: the smoke rising from the ash of the cigarette (sidestream smoke) is higher in many carcinogens than is the mainstream smoke delivered to the smoker’s lungs. -US Environmental Protection Agency in 1993 declared second hand smoke to be a known carcinogen and estimated that passive smoking is responsible for several thousand lung cancer deaths each year. -Town of Truro, Nova Scotia, has passed legislation banning smoking on Inglis Place, a street populated with numerous shops and restaurants. -In April 2008, Nova Scotia outlawed smoking in vehicles carrying children. Second hand smoking increased risk of pneumonia, asthma, and even cancer. SMOKING AND HEALTH IN OTHER COUNTRIES -Smoking is killing three million people per year worldwide, by the year 2020 it is estimated the rate might be as high as 10million per year. -Asians, in particular, seemed to want American cigarettes, and one of the major efforts was to open Japanese, Taiwanese, Korean, and Chinese cigarette markets to US imports. SMOKING AND PREGNANCY -Nicotine, hydrogen cyanide, and carbon monoxide in a smoking mother’s blood also reach the developing fetus and have significant negative consequences there. Infants born to smokers: -Are about 250 grams lighter There is a dose response relationship. The more the woman smokes during pregnancy, the greater the reduction in her baby’s birth weight. -Smoking shortens the gestations period by an average of only two days, and when gestation length is accounted for, the smokers still have smaller infants. -Ultrasounds show smaller fetuses in smoking women for at least the last two months of pregnancy. The infants of smokers are normally proportioned, but are shorter and smaller and have smaller head circumference than the infants of nonsmokers. -Reduced birth weight of infants of women smokers is not related to how much weight the mother gains during pregnancy, and the consensus is that a reduced availability of oxygen is responsible for the diminished growth rate. -Women who give up smoking early in pregnancy (by fourth month) have infants with weights similar to infants of nonsmokers. -Several studies also indicate small but consistent differences in body size, neurological problems, reading and math skills, and hyperactivity at various ages. -Long lasting effects on both the intellectual and the physical development of the child. The increased perinatal (close to time of birth) smoking attributable mortality associated with sudden infant death syndrome (SIDS), low birth weight and respiratory difficulties adds up to about 10000 infant deaths per year. -Smokers have more spontaneous abortions -Congenital malformations, evidence for a relationship to maternal smoking is not as clear. If there is a small effect here, it could be either related to or obscured by the fact that make smokers also drink alcohol and coffee. -Increase risk of SIDS if the mother smokers, but it is not clear if this is related more to the mother’s smoking during pregnancy or to passive smoking (the infant’s breathing of smoke) after birth. -Several studies have reported an increased risk for nicotine dependence in adolescents whose mothers smoked during pregnancy. Relationship due to cultural or social similarities Prenatal nicotine exposure produces changes in brain chemistry in the offspring and differences in behavioural response to nicotine in adolescence. -Demonstrated effects of cigarette smoking on the developing child are of the same magnitude and type as those reported for babies born to mothers who used crack during their pregnancies, and many more pregnant women are smoking cigs than are using coke. PHARMOCOLOGY OF NICOTINE -nicotine – Central Nervous System stimulant – is a naturally occurring liquid alkaloid that is colourless and volatile. On oxidation it turns brown and smells like burning tobacco. -Nicotine has two forms, one with a positive charge and that is electrically neutral. The neutral form is more easily absorbed through the mucous membranes of the mouth, nose and lungs. -Tobacco industry knows this and deliberately manipulates the pH of their products to shift more of the nicotine into the noncharged, easily absorbed state. ABSORPTION AND METABOLISM …. Physiological Effects Blood – increased clotting tendency Lungs – bronchospasm Muscular – tremors, pain Gastrointestinal – nausea, dry mouth, dyspepsia, diarrhea, heartburn Joints – pain Central Nervous System – light headedness, headache, sleep disturbances, abnormal dreams, irritability, dizziness Heart – Increased or decreased heart rate, Increased blood pressure, Tachycardia, More (or less) arrhythmias, Coronary artery constriction Endocrine - Hyperinsulinemia (too much insulin to the blood), insulin resistance BEHAVIOURAL EFFECTS Nicotine is the primar
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