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Tobacco

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Also known as

Smokes, shisha, rollies, hubble bubble, hookah, fags, ciggies, baccy, roll-ups, cigs, blem, cancer sticks, straights, darts, durries, butts, cigs, squares

Classification

Stimulant

Overview

Tobacco was brought to Europe from the Americas five centuries ago. It is now considered the world's single biggest cause of preventable death.

Tobacco is the herb /Nicotiana tabacum/. The plant makes the toxic substance nicotine as a chemical defence to stop insects eating it. It is possible that other chemicals in tobacco smoke may add to nicotine's addictive effects (by disrupting the enzyme monoamine oxidase A) [1].

Tobacco-cig.jpeg

Tobacco is found in cigarettes which you smoke. It comes from the leaves of the tobacco plant and contains many different chemicals.

One of the chemicals is nicotine, which gives smokers their 'hit' but is also highly addictive. This means it can be hard to quit smoking even if you want to.

Regular smokers believe that smoking tobacco helps them to relax, to handle stress and to feel less hungry.

But smoking can make your clothes and breath smell and can affect your skin and hair.

It can also cause serious damage to your health - it's a risk factor for emphysema, heart attacks, strokes and lung cancer. It's estimated that smoking tobacco contributes to 100,000 premature deaths in the UK every year.

The green leaves of the tobacco plant are picked, dried and then rubbed to produce a brown, flaky mixture.

It can then be bought loose as rolling tobacco which you use to create hand-rolled cigarettes or in ready-made cigarettes.

It doesn't matter how you smoke tobacco, all forms have risks.

There are many different brands of cigarettes and most come in packs of ten, 14 or 20.

Tobacco is most often smoked as a cigarette or in a pipe, but tobacco is available in a chewable form and in a form, called snuff, that can be sniffed.

Shisha is the smoking of fruit flavoured tobacco using a water pipe. The tobacco is burnt and the smoke is sucked through the water pipe, which cools the smoke down allowing it to be breathed in by the smoker. However, smoking Shisha for one hour can deliver the same health risks as smoking 100 cigarettes

Shisha is a part of Middle Eastern and Indian culture, but it seems to be becoming increasingly popular in the UK among non-Middle Eastern and Indian groups [2].

Tobacco is the ingredient that is present in a number of different products including smoking cigarettes, cigars and pipes, hookah/shisha pipes etc. The most common being the smoking cigarette. This is also the most addictive way to ingest tobacco.

The sought-after effects of tobacco are produced by nicotine, but the production of cigarettes (particularly hand rolled ones) means that other potentially toxic chemicals are also present [3].

Green leaves of the tobacco plant give rise to tobacco after a series of drying and rolling. Tobacco can be found in huge number of different products. These include the more common smoking cigarettes, cigars and pipes, hookah/shisha pipes and also a number of smoke-free products such as snuff and chewing tobacco. There are also a large number of products that contain tobacco that are marketed to try and help people beat their addiction to tobacco, such as skin patches, e-cigarettes and chewing gum.

According to the NHS, there are about 80,000 smoking-related deaths each year in the UK. It is also argued by a number of people, including Patrick Reynolds, whose father founded the RJ Reynolds Tobacco company; that cigarettes kill more people every year, than all the murders, drug overdoses, suicides, car accidents and aids put together [3].

The primary addicting substance in cigarettes is nicotine. But cigarette smoke contains thousands of other chemicals that also damage health. Hazards include heart disease, lung cancer and emphysema, peptic ulcer, disease and stroke. Withdrawal symptoms of smoking include hunger, sleep disturbances and depression.

Nearly 5,000 chemicals have been identified in tobacco smoke to date. Public health authorities have classified between 45 and 70 of those chemicals, including carcinogens, irritants and other toxins, as potentially causing the harmful effects of tobacco use.

Initially, cigarettes were unfiltered, allowing the full 'flavour' of the tar to come through. As the public became concerned about the health effects of smoking, filters were added. While this helped alleviate the public's fears, the result was a cigarette that tasted too bitter. (And filters do not remove enough tar to make cigarettes less dangerous. They are just a marketing ploy to trick you into thinking you are smoking a safer cigarette).

The solution to the bitter-tasting cigarette was easy - add taste-improving chemicals to the tobacco. But once they got rolling they figured out they could really maximize the whole addiction part, what a hook. They found that a chemical similar to rocket fuel helps keep the tip of the cigarette burning at an extremely hot temperature, which allows the nicotine in tobacco to turn into a vapour so your lungs can absorb it more easily. What about ammonia? Adding ammonia to cigarettes allows nicotine in its vapour form to be absorbed through the lungs more quickly. This, in turn, means your brain can get a higher dose of nicotine with each inhalation [4].

Ingredients of cigarettes

For a start, here's the who's who of the most toxic ingredients used to make cigarettes tastier, and more quickly, effectively addictive -

  • Ammonia - Household cleaner,
  • Arsenic - Used in rat poisons,
  • Benzene - Used in making dyes, synthetic rubber,
  • Butane - Gas; used in lighter fluid,
  • Carbon monoxide - Poisonous gas,
  • Cadmium - Used in batteries,
  • Cyanide - Lethal poison,
  • DDT - A banned insecticide,
  • Ethyl Furoate - Causes liver damage in animals
  • Lead - Poisonous in high doses,
  • Formaldehyde - Used to preserve dead specimens,
  • Methoprene - Insecticide,
  • Maltitol - Sweetener for diabetics,
  • Napthalene - Ingredient in mothballs,
  • Methyl isocyanate - Its accidental release killed 2000 people in Bhopal, India, in 1984,
  • Polonium - Cancer-causing radioactive element [4].

What does it look like?

Green leaves of the tobacco plant are dried and rubbed which produces a brown mixture. This mixture is rolled to create ready-made cigarettes or manually rolled by the user to create hand-rolled cigarettes. To crave the addiction to nicotine, there are a number of products that appear in the form of patches, chewing gum and mouth sprays, among others [3].

The green leaves of the tobacco plant are picked, dried and then rubbed to produce a brown, flaky mixture.

It can then be bought loose as rolling tobacco which you use to create hand-rolled cigarettes or in ready-made cigarettes.

There are many different brands of cigarettes and most come in packs of ten, 14 or 20 [2].

Source

Tobacco is a green, leafy plant that is cultivated throughout the world to be sold for various purposes [5].

Prevalence

  • Health Survey for England, 2015 (published December 2016).
    • Latest statistics on adult and child smoking, e-cig use, alcohol use and obesity | NHS Digital, UK
  • Youth Risk Behavior Survey, 2016,
    • Cigarette smoking among high school students dropped to the lowest levels since the National Youth Risk Behavior Survey (YRBS) began in 1991, but the use of e-cigarettes among students poses new challenges according to the 2015 survey results released today by the Centers for Disease Control and Prevention | Center for Disease Control, USA
  • Growing up unequal: gender and socioeconomic differences in young people's health and well-being, 2016,
    • Health Behaviour in School-aged Children (HBSC), a WHO collaborative cross-national study, has provided information about the health, well-being, social environment and health behaviour of 11-, 13- and 15-year-old boys and girls for over 30 years. This latest international report from the study presents findings from the 2013/2014 survey, which collected data from almost 220,000 young people in 42 countries in Europe and North America | WHO, Switzerland
  • State of tobacco control, 2016,
    • The American Lung Association's 'State of Tobacco Control 2016' sounds the alarm about the troubling increase of youth tobacco use in our nation. While significant progress has been made in reducing youth cigarette smoking - an almost 42% decline in high school smoking rates since 2011 - youth use of other tobacco products, including e-cigarettes and hookah, is skyrocketing | American Lung Association, USA

Street price

The financial cost of being a smoker depends on the scale of their habit, but as a rough guide, smoking 20 a day for one year will cost over £2,700 [2].

Why take it?

Sought after effects

  • satisfies cravings,
  • can give a sense of stress relief,
  • oral comfort [3],
  • reduced anxiety,
  • relaxation [7].

Undesired effects

  • dizziness,
  • nausea,
  • increased pulse rate and blood pressure [7].
With short-term use

With short-term use there is potential for -

  • coughing/wheezing due to extra accumulation of phlegm,
  • unpleasant odour [3].
With long-term use

With long-term use there is potential for -

  • addiction,
  • cancer,
  • emphysema,
  • stroke,
  • heart disease [3].

What are the different forms of tobacco and nicotine containing products?

By far the most popular and the most harmful way of consuming nicotine from tobacco is by smoking it. Smoking also seems to be the most addictive way of consuming nicotine, with fewer smokers being able to quit than people who use nicotine in other ways [1].

Smoking Cigarettes

Cigarettes are made of fermented, processed and dried tobacco leaves and stems (with some additives). Smoking them allows the nicotine to be absorbed into the blood through the lungs. Blood carrying nicotine reaches the brain within seconds, producing the mental effects smokers are after and satisfying nicotine craving in addicts. Unfortunately, as tobacco leaves burns, hundreds of harmful chemicals are created or released which are also drawn into the lungs. Half of the people who do not quit will die of a smoking-related disease. Smoke also drifts around, harming other people [1].

Cigars and Pipes

Cigars and pipes are alternative traditional ways of smoking. Some smokers of these do not inhale the smoke deeply into the lungs, but only draw it into the mouth. This causes less damage than cigarette smoking, although such smokers are still harmed by smoking. If users do inhale fully, the harms are likely to be similar to the harms of a similar amount of cigarette smoking [1].

Hookah pipes (shisha)

A hookah or hubble-bubble is a sort of tobacco pipe where smoke is drawn through a bottle of water. The tobacco (shisha) is flavoured and sweetened. People who smoke hookah regularly also have an increased chance of smoking related diseases such as lung cancer [1].

Smoke-free tobacco and other nicotine-containing products

Some forms of tobacco are not smoked, which prevents many, but not all of the harms of smoking. They confine the harm to the user, whereas smoking can harm others. Chewing or dipping tobacco, and snus (snus is illegal to sell in most of Europe) are products which release their nicotine into the mouth. The nicotine fix is achieved with less of the cancer-causing chemicals produced by burning and without the damage smoke causes to the lungs. Snuff is a powdered tobacco product which is inhaled up the nose, often making you sneeze. Whilst it increases the cancer risk for the places it contacts, the nose, mouth and throat, the overall level of risk of harm and death is also lower than with smoking cigarettes.

In the last few years, there have been more products invented that contain nicotine extracted from tobacco. Lozenges, chewing gum and skin patches deliver doses of nicotine with a fraction of the harms associated with smoking. They are mostly used as 'nicotine replacement therapies' to help people wean themselves off cigarettes and eventually quit the drug entirely.

Use of electronic cigarettes is growing. These deliver a puff of vaporised liquid containing nicotine, which simulates smoking without burning. They have not been researched thoroughly, but it is very likely that they are much less harmful than actual cigarettes because they do not produce the range of damaging chemicals found in tobacco smoke, although they are not entirely harmless. It is still a matter of scientific and political controversy whether e-cigarettes and other alternatives to cigarettes can offer benefits to the health of society [1].

Smoked tobacco products

  • cigarettes (regular, light, and menthol) - No evidence exists that 'lite' or menthol cigarettes are safer than regular cigarettes,
  • cigars and pipes - ​Some small cigars are hollowed out to make room for marijuana, known as 'blunts'. Some young people do this to attempt to hid the fact that they are smoking marijuana. either way, they are inhaling toxic chemicals,
  • bidis and kreteks (clove cigarettes) - Bidis are small, thin, hand-rolled cigarettes primarily imported to the United States from India and other Southeast Asian countries. Kreteks - sometimes referred to as clove cigarettes - contain about 60% - 80% tobacco and 20% - 40% ground cloves. Flavoured bidis and kreteks are banned in the United States because of the ban on flavoured cigarettes,
  • hookahs or water pipes - Hookah tobacco comes in many flavours, and the pipe is typically passed around in groups. A recent study found that a typical hookah session delivers approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine, and 10 times the carbon monoxide as smoking a cigarette [8].

Smokeless tobacco products

The tobacco is not burned with these products -

  • chewing tobacco - It is typically placed between the cheek and gums,
  • snuff - Ground tobacco that can be sniffed if dried or placed between the cheek and gums,
  • dip - Moist snuff that is used like chewing tobacco.
  • snus - A small pouch of moist snuff,
  • dissolvable products (including lozenges, orbs, sticks, and strips) [8].

Electronic cigarettes

  • also called e-cigarettes, electronic nicotine delivery systems, or e-cigs. Electronic cigarettes are battery-operated devices that deliver nicotine and flavourings without burning tobacco. In most e-cigarettes, puffing activates the battery-powered heating device, which vapourises the liquid in the cartridge. The resulting vapour is then inhaled (called 'vaping') [8].

How long do its effects last?

Onset of effects

  • smoked - 5 - 60 seconds [9].

Duration of effects

  • smoked - 10 - 30 minutes [9].

After-effects

  • smoked - 1 - 3 hours [9].

Pharmacology

The nicotine in tobacco works by acting on the nicotinic acetylcholine receptors, specifically in the kidneys (adrenal gland) and CNS. It is thought to enhance the sensitivity of several neurotransmitters including acetylcholine, and possibly dopamine which give the user feelings of relaxation and slight euphoria associated with smoking [3].

Nicotine produces its stimulating effects by agonizing nicotinic acetylcholine receptors, causing the liver to release glucose and the adrenal medulla to release adrenaline.

Once it reaches the brain, nicotine stimulates the release of many neurotransmitters and hormones including acetylcholine, norepinephrine, epinephrine, arginine vasopressin, serotonin, dopamine, and beta-endorphin [10], [11], which are responsible for the majority of its psychoactive effects.

By increasing the level of acetylcholine in the brain, nicotine enhances concentration. Norepinephrine release causes enhanced alertness and arousal. With low doses, nicotine enhances the action of norepinephrine and dopamine, which produces typical psycho- stimulation. Nicotine also has sedative effects as produced by the release of beta-endorphin (which reduces anxiety) and enhances the action of serotonin and opioids (which causes sedation) [9].

How does nicotine work as a drug in the body and brain?

Because of its position in our culture, tobacco and the nicotine it contains is often not considered a mind-altering drug. In fact, nicotine affects the brain in several different ways and changes it over the long-term. Nicotine acts to increase the production of other chemicals in the brain known as neurotransmitters that affect brain function. By causing the release of noradrenaline nicotine acts as a stimulant that produces a slight buzz. It is thought to cause improved focus by increasing acetylcholine, whilst its action in increasing beta-endorphin production relieves anxiety, giving nicotine some calming effects as well as stimulating effects. Nicotine also produces long-term effects on the dopamine system, which is involved in reward, mood and addiction [1].

Like other drugs, nicotine increases levels of a neurotransmitter called dopamine. Dopamine is released normally when you experience something pleasurable like good food, your favourite activity, or spending time with people you care about. When a person uses tobacco products, the release of dopamine causes similar effects. This effect wears off quickly, causing people who smoke to get the urge to light up again for more of that good feeling, which can lead to addiction.

A typical smoker will take 10 puffs on a cigarette over the period of about 5 minutes that the cigarette is lit. So, a person who smokes about 1 pack (25 cigarettes) daily gets 250 'hits' of nicotine each day.

Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may increase the effects of nicotine on the brain.

When smokeless tobacco is used, nicotine is absorbed through the mouth tissues directly into the blood, where it goes to the brain. Even after the tobacco is removed from the mouth, nicotine continues to be absorbed into the bloodstream. Also, the nicotine stays in the blood longer for users of smokeless tobacco than for smokers [8].

When nicotine enters the body, it initially causes the adrenal glands to release a hormone called adrenaline. The rush of adrenaline stimulates the body and causes an increase in blood pressure, heart rate, and breathing.

Most of the harm to the body is not from the nicotine, but from other chemicals in tobacco or those produced when burning it - including carbon monoxide, tar, formaldehyde, cyanide, and ammonia. Tobacco use harms every organ in the body and can cause many problems. The health effects of smokeless tobacco are somewhat different from those of smoked tobacco, but both can cause cancer [8].

Secondhand Smoke

People who do not smoke but live or hang out with smokers are exposed to secondhand smoke—exhaled smoke as well as smoke given off by the burning end of tobacco products. Just like smoking, this also increases the risk for many diseases. Each year, an estimated 58 million Americans are regularly exposed to secondhand smoke and more than 42,000 nonsmokers die from diseases caused by secondhand smoke exposure [12]. One in four U.S. middle and high school students say they've been exposed to unhealthy secondhand aerosol from e-cigarettes [13], [8].

Bioavailability

  • oral - 20% - 45%,
  • intranasal - 53%,
  • transdermal - 68% [9].

Half-life

  • 1 - 2 hours [9].

Lethal dosage

Nicotine has an estimated oral LD50 of 6.5 - 13 mg/kg in humans [9].

Toxicity

It is unlikely that overdose can be achieved by smoking tobacco, however, coadministration with other sources of nicotine such as patches or gum may potentially be dangerous [9].

Tolerance

  • full tolerance is reached rapidly develops with prolonged and repeated use,
  • decreases to half after 3 - 7 days,
  • returns to baseline after 1 - 2 weeks [9].

Mode of use

Tobacco is usually smoked or the leaves are chewed and ingested [3].

Tobacco is most often smoked, usually in the form of cigarettes, cigars, or in pipes. Another method of smoking, usually found in India and the Middle East, is through a large waterpipe, usually called a hookah, nargile (nar-gee-leh), or shisha. These types of pipes are commonly used to smoke flavoured tobacco that includes pieces of fruit and is held together with sticky molasses. Other forms of smoking tobacco include bidis (bee-dees) - tobacco wrapped in a leaf and tied with a string - and clove cigarettes, which are basically normal cigarettes but include cloves for flavouring, or just cloves alone. Chewing tobacco or dip is a form of smokeless tobacco, in which the user holds the tobacco in his/her mouth, absorbing nicotine thorough the gums and tongue. Snuff is tobacco that has been dried and processed into a powder. This powder is sniffed into the nose, where it is absorbed through the nasal passages [14].

Signs of usage

  • uncontrollable urge to use tobacco,
  • cravings,
  • tolerance,
  • withdrawal symptoms,
  • thoughts and actions consumed by tobacco use,
  • unable to concentrate without tobacco,
  • difficulty when stopping tobacco use [5].

Effects

Regular smokers believe that smoking tobacco helps them to relax, to handle stress and to feel less hungry.

However, tobacco smoke (tar) contains over 4,000 chemicals and many have effects on various parts of the human body, including the brain, lungs, heart and mouth.

Most of the cancers associated with smoking are due to the tar in the smoke.

Smoking any drug gets it to the brain very quickly. When a tobacco smoker inhales it's estimated that the nicotine in the tobacco smoke reaches the brain in around 8 seconds.

This speed of action contributes to a user becoming hooked to the nicotine in tobacco [2].

Smoking

Smoking is a very different experience depending on whether you are a smoker or non-smoker.

To a non-smoker, smoking can give a pleasant light-headed buzz, but smoke inhalation may be uncomfortable or painful, causing coughing, and making the user feel weak, dizzy and sick. Everyone responds to drugs differently; it seems that some people find their first cigarette revolting, and some find it rewarding, developing cravings in the first weeks of smoking. People who are naturally more sensitive to nicotine, who remember more of a hit of relaxation, dizziness and nausea from their first cigarette, seem more likely to get hooked, though everyone is vulnerable to tobacco addiction.

To an addicted smoker who is tolerant of inhaling smoke, smoking satisfies a craving, may give a buzz, and can give a feeling of enhanced, calm focus. Smokers often say that cigarettes help them relax, but this is only half the story. In fact smokers are more stressed over the day than non-smokers because of their nicotine dependency, and the relaxation a cigarette gives is a temporary relief from that increased stress. After a cigarette, people who are addicted will begin the cycle of gradually worsening mood, increasing irritability and rising craving, until the next cigarette.

The rituals of smoking, including rolling and lighting cigarettes, clipping cigars or preparing a pipe, become an important part of the experience and built into the craving [1].

Smokeless alternatives

The experience of using smoke-free alternatives varies depending on the speed with which the nicotine is delivered. Nicotine patches deliver the drug very slowly, which does the job of reducing cravings without giving the addictive little buzz that nicotine gives when it hits the brain in a rush. Inhaling on an electronic cigarette may be comparable to smoking in delivering nicotine to the brain. Chewing tobaccos, snus and nicotine gum are probably somewhere in between [1].

Short-term effects

  • feeling more alert, happy and relaxed,
  • coughing,
  • dizziness,
  • headaches,
  • fast heart beat,
  • bad breath,
  • tingling and numbness in fingers and toes,
  • reduced appetite,
  • stomach cramps,
  • vomiting [15].
Smoking
  • addiction to nicotine,
  • damage to the respiratory system,
  • decreased lung capacity,
  • chronic cough,
  • bronchitis,
  • asthma,
  • bad breath,
  • bad taste in mouth,
  • smelly hair and clothes,
  • yellow or brown stains on teeth,
  • increased likelihood of drug use and risky behaviour,
  • death from fire - the #1 cause of death from fire is smoking [14].
Chewing tobacco
  • addiction to nicotine,
  • receding gums,
  • permanent gum loss,
  • sensitive teeth,
  • tooth decay,
  • sores, patches, and lumps in mouth,
  • bad breath,
  • bad taste in mouth,
  • stains on clothing,
  • excess saliva production,
  • drooling,
  • stained teeth [14].

Physical effects

  • physical euphoria,
  • pupil constriction,
  • appetite suppression,
  • abnormal heartbeat,
  • dizziness,
  • increased blood pressure,
  • increased heart rate,
  • nausea,
  • vasoconstriction [9].

Cognitive effects

  • anxiety,
  • cognitive euphoria,
  • compulsive redosing,
  • focus enhancement,
  • increased libido,
  • increased music appreciation,
  • memory enhancement,
  • motivation enhancement,
  • thought acceleration,
  • wakefulness [9].

Long-term effects

  • shortness of breath,
  • coughing fits,
  • asthma,
  • lung diseases,
  • regular colds or flu,
  • loss of taste and smell,
  • yellow, rotting teeth,
  • yellow finger tips,
  • early wrinkles,
  • back pain,
  • slower-healing wounds,
  • mood swings,
  • eye disease,
  • hearing loss,
  • stomach ulcers,
  • difficulty having children (males and females),
  • irregular periods and early menopause (females),
  • difficulty getting an erection (males),
  • cancer (in many areas of the body),
  • stroke and brain damage,
  • heart attack and disease,
  • needing to use more to get the same effect,
  • dependence on tobacco,
  • financial, work and social problems [16], [17].
Tobacco kills

Most people think of cancer when they think of tobacco use. Tobacco does cause a wide variety of devastating cancers. However, tobacco kills even more people through heart disease and stroke than it does through cancer! About 181,000 people die each year in the United States from smoking-related heart disease and stroke, and about 158,000 die from smoking-related cancer. The remainder of the smoking-related deaths, 123,000, are from lung diseases other than cancer.

Following is a list of the deadly diseases and other long-term effects of smoking and chewing tobacco [18].

Heart disease
  • hypertension,
  • congestive heart failure - ineffective pumping of the heart leads to an accumulation of fluid in the lungs,
  • coronary heart disease - narrowed arteries lead to heart attack and death,
  • heart attacks and congestive heart failure,
  • blocked blood vessels,
  • strokes - blocked blood-flow to the brain or bleeding in the brain. stroke is a major killer [18].
Cancer
  • lung - primarily smoking-related,
  • upper respiratory tract - primarily smoking-related,
  • larynx - smoking or chewing tobacco,
  • mouth - smoking or chewing tobacco,
  • throat - smoking or chewing tobacco,
  • stomach - primarily chewing tobacco-related,
  • pancreas - smoking or chewing tobacco,
  • kidney - smoking or chewing tobacco,
  • bladder - smoking or chewing tobacco,
  • cervix - primarily smoking-related, since few women chew tobacco [18].
Lung disease
  • emphysema - the very small airways (bronchioles) that join the tiny air sacs (alveoli) in the lungs lose elasticity. patient loses ability to exhale fully, and chemical balance in the blood is disturbed. there is no cure for emphysema.
  • chronic bronchitis - the airways of the lungs change shape and size and the mucous glands are enlarged, causing coughing and production of sputum [18].
Reproductive damage
  • abnormal sperm cells,
  • impotence,
  • difficulty maintaining pregnancy,
  • menstrual disorders and early menopause [18].
Birth defects

Smoking during pregnancy can lead to -

  • miscarriage or stillbirth,
  • low birth weight - babies born to mothers who smoke during pregnancy weigh on the average between 200 to 300 grams less than other babies,
  • premature birth - both low birth weight and premature birth can lead to breathing and other health problems,
  • learning and behaviour problems later in childhood,
  • sudden infant death syndrome or 'cot death' - seemingly healthy babies die without warning,
  • upper respiratory tract problems,
  • ear complications,
  • asthma when exposed to tobacco prior to birth [18].
Other damage
  • prematurely wrinkled skin,
  • permanent gum and tooth loss,
  • lost or weakened sense of taste,
  • weakened immune system,
  • stomach ulcers,
  • unwanted weight loss [18].

There are no other legal products which are as harmful as cigarettes when used as they are designed to be used. Smoking causes gradual damage to your body as well as increasing the risk of various diseases. It also harms other people who breathe the smoke. Below is just a selection of the harms of smoking. Most of these harms are not known to apply to smokeless nicotine products [1].

Quality of Life

Smoking damages many aspects of your quality of life as well as increasing the chance of an early death. It reduces physical fitness, making you get out of breath easily, it damages your lung's ability to self-clean, so you may cough heavily, especially in the morning. It is a major cause of male sexual dysfunction (by damaging blood-flow in the penis). Yellowing and ageing of teeth, hair and skin may mean smokers feel less attractive and the lingering smell of tobacco smoke on clothes and in homes is very unattractive to most non-smokers. Successful public health campaigns have had the side-effect of making some smokers feel guilty and stigmatised. There can be unexpected consequences, for example it may be impossible to adopt children if you smoke. It is also very expensive. Being addicted to other nicotine products may have some smaller impacts [1].

Cancer

Around 7 in every 8 cases of lung cancer and 3 in 4 cases of oral cancer are caused by tobacco, but as well as these more obvious cancers in places the smoke contacts directly, it increases the chance of many others too, such as cervical and pancreatic cancer [1].

Lung disease

Smoking destroys the tiny hairs which sweep mucus up out of the lungs, allowing gunk-like mucus and tar to collect. This increases the chance of infections, and causes persistent coughing. The delicate air sacs in the lungs can break down. Chronic Obstructive Pulmonary Disease (COPD) is the term used for the often fatal disease of the lungs with progressive loss of function caused by smoking. This can potentially spoil your life long before it causes death [1].

Cardiovascular disease

Smoking increases the risks of heart disease, raises blood pressure and damages veins and arteries. This means that the risk of heart attacks and strokes is much increased [1].

Risk of breaking bones

One of many little-known risks of smoking is that it interferes with the mineralisation of bone, particularly in young women who should be storing up the strength of their 'bone bank' for when bones lose density in later life. Smoking leaves bones (notably hips and backbones) a little weaker and so significantly more likely to fracture especially in older age. After quitting, it seems that bone density recovers fairly well [1].

Reproduction

As well as causing erectile dysfunction in men, smoking reduces the fertility of both sexes, and smoking whilst pregnant increases the chance of miscarriage and significantly lowers birth weights. This effect on foetuses is one of the harms which also applies to nicotine-containing products that are not smoked [1].

Risks

First time smokers often feel sick and dizzy.

Smoking tobacco has lots of immediate effects such as making your clothes and hair smell, to costing you lots of money. Smoking stops oxygen getting to the skin making you more prone to spots and a dull complexion. Over time it can lead to premature aging, meaning more wrinkles and a so-called 'cats bum' mouth. Smoking can also make hair less shiny and yellow nails and teeth.

Of the over 4,000 chemicals that tobacco contains many have harsh effects on the human body. Smoking can increase your blood pressure and the heart rate, which can damage the heart and circulation and contribute to heart attacks, strokes and cause cancer [2]. Also -

  • Smokers are more likely to get coughs and chest infections.
  • Long-term use could leave you with cancer, emphysema or heart disease.
  • Smoking when pregnant can harm the foetus and can even cause a miscarriage.
  • It's not uncommon for babies born to mothers who have smoked during pregnancy to have a lower than normal birth weight, which, some have linked to autism and sudden infant death syndrome.
  • Smoking has been linked to the amputation of 2,000 limbs a year.
  • It's estimated smoking contributes to 100,000 premature deaths in the UK every year.
  • Other people breathing in your smoke could end up with breathing difficulties, asthma or even cancer.
  • Smoking Shisha can be more dangerous than smoking a cigarettes, with users at increased risk of picking up diseases such as herpes or tuberculosis from sharing pipes [2].

'Black market' cigarettes and rolling tobacco are either counterfeit or brought into the UK from other countries. There is no way of knowing what is in a counterfeit cigarette or rolling tobacco and what effect it could have on you.

Even if tobacco has not been bought on the black market the smoke contains over 4,000 chemicals and many of them are known to do nasty things to the human body including causing cancer [2].

If a large amount of tobacco is taken the following effects may also be experienced -

Short-term

  • tolerance,
  • burn injuries from fires started accidentally [7].

Long-term

  • dependence,
  • bronchitis,
  • heart disease,
  • damage to circulation,
  • cancers (lungs, throat, tongue) [7].

Addiction

Can you get addicted

Yes. Tobacco contains nicotine, a highly addictive drug. Smokers can get hooked very quickly and it can take years and a huge effort to kick the habit. Many people who smoke wish they had not started in the first place.

Not many people are able to remain occasional smokers because nicotine is a very addictive substance.

For advice on stopping smoking, visit www.nhs.uk/smokefree or call the NHS Smokefree helpline on 0300 123 1044 [2].

Yes. It is the nicotine in tobacco that is addictive. Each cigarette contains about 10 milligrams of nicotine. A person inhales only some of the smoke from a cigarette, and not all of each puff is absorbed in the lungs. The average person gets about 1 to 2 milligrams of the drug from each cigarette.

Studies of widely used brands of smokeless tobacco showed that the amount of nicotine per gram of tobacco ranges from 4.4 milligrams to 25.0 milligrams. Holding an average-size dip in your mouth for 30 minutes gives you as much nicotine as smoking 3 cigarettes. A 2-can-a-week snuff dipper gets as much nicotine as a person who smokes 1½ packs a day.

Whether a person smokes tobacco products or uses smokeless tobacco, the amount of nicotine absorbed in the body is enough to make someone addicted. When this happens, the person continues to seek out the tobacco even though he or she understands the harm it causes [19]. Nicotine addiction can cause -

  • tolerance - Over the course of a day, someone who uses tobacco products develops tolerance - more nicotine is required to produce the same initial effects. In fact, people who smoke often report that the first cigarette of the day is the strongest or the 'best'.
  • withdrawal - When people quit using tobacco products, they usually experience uncomfortable withdrawal symptoms, which often drive them back to tobacco use. Nicotine withdrawal symptoms include -
    • irritability,
    • problems with thinking and paying attention,
    • sleep problems,
    • increased appetite,
    • craving, which may last 6 months or longer, and can be a major stumbling block to quitting [8].

How addictive is nicotine?

Smoking

Nicotine is one of the most addictive drugs. Whilst people vary in their vulnerability to addiction, and a small minority of smokers seem to manage to have the occasional cigarette or cigar without becoming hooked, it is generally easy to become addicted and very hard to end an addiction. If you smoke, the Fagerström test can help you find out how addicted you are.

Nicotine excites the brain's reward circuitry, making cigarettes moreish, but as your brain re-tunes itself to having its chemistry altered over the long-term, the effect of going too long without putting nicotine in your brain becomes increasingly punishing.

Social and cultural factors also make it easy to become a smoker and hard to quit. If you have smokers in your family or social circle you are more likely to end up addicted as you have the drug and drug use around you all the time. If you are trying to quit, or trying not to get into the habit of smoking regularly, friendly offers of a cigarette and seeing/smelling people smoking will make it really hard for you. Shops displaying cigarettes at the checkout make it easy to relapse into addiction [1].

Smokeless alternatives

There is strong evidence that nicotine replacement with patches, lozenges, gum etc. Can help some people stop smoking, and eventually quit nicotine entirely. Quitting smoking but remaining addicted to nicotine delivered through these products is much healthier than smoking, though not as healthy as quitting nicotine entirely.

Different forms of nicotine and tobacco product will differ in their addictiveness even though the drug chemical is the same in all of them. Products which deliver a nicotine hit fast, like cigarettes and e-cigarettes, are likely to be more addictive than those which deliver nicotine slowly.

Alternatives to smoking, like e-cigarettes and snus are not as well studied as cigarettes. It is almost certain that they are less harmful than cigarettes. However, people who don't use nicotine and wouldn't smoke could find these appealing, leading to new nicotine addictions. The process of becoming addicted to cigarettes requires the user to desire each cigarette more than they dislike the effects or fear the results. Alternatives which are less unpleasant than inhaling irritating, hot smoke may smooth the path to addiction. The marketing of fruit-flavoured e-cigarettes can be compared to the development of alcopops, which use appealing flavours to bypass the protective disgust people (especially the young) feel when tasting ethanol [1].

Nicotine in tobacco

Tobacco contains more than 4,000 chemicals. This is the chemical that makes tobacco so addicting, causing many to develop smoking, chewing or snuff habits. Once the tobacco is smoked, chewed, or sniffed the nicotine goes into the users bloodstream. The body craves more shortly after, causing the user to smoke, chew or sniff again. The nicotine found within tobacco makes it one of the most addictive drugs known to main. Millions of people work wide are addicted to tobacco because of this high addictive stimulant chemical, nicotine. It speeds up the nervous system, increasing the users energy, increases heart beat and blood pressure, while relaxing the individual [5].

Withdrawal

Giving up tobacco after using it for a long time is challenging because the body has to get used to functioning without it. Withdrawal symptoms usually start within 2 - 3 hours after you last use tobacco. The symptoms may last from a few days to a few weeks [17].

  • headache,
  • nausea,
  • constipation or diarrhoea,
  • falling heart rate and blood pressure,
  • fatigue, drowsiness, and insomnia,
  • irritability,
  • difficulty concentrating,
  • anxiety,
  • depression,
  • increased hunger and caloric intake,
  • increased desire for the taste of sweets,
  • tobacco cravings [5].

What are the harms of nicotine addiction and withdrawal?

Nicotine withdrawal can be very unpleasant, but is not physically harmful. Just a couple of hours after having a cigarette, someone dependent on nicotine will begin to feel fidgety and stressed, craving the drug, and their heart-rate will rise. Rates of relapse after quitting are extremely high [1].

Harm Reduction

There is a wide range of efforts on cigarette harm reduction. This is done mostly in the shape of educating people about the harms of cigarettes, and products aimed at curbing the craving of nicotine without the added harmful chemicals.

Products aiming to relieve the nicotine craving, including nicotine patches, chewing gum and mouth sprays, but that have little or no other harmful chemicals, have existed for decades. This, along with the more recent efforts in the form of electronic cigarettes have been the key harm reduction tools for tobacco smokers. Electronic cigarettes have proved to be effective, in that they provide the user with the similar experience (in the shape, route of administration), they contain nicotine but not other chemicals that are usually found in a cigarette [3].

To most people's judgement, the balance of harms against benefits from smoking is totally unequal, with a high risk of disease and death for a drug that delivers only rather mild pleasures which decrease over time. This is not just the opinion of health experts; the majority of smokers themselves want to quit [1]. The most important elements of harm reduction for nicotine are therefore -

  • avoiding addiction to smoking tobacco in the first place,
  • if addicted already, quitting as soon as possible,
  • if quitting is not feasible or desired, transferring to less harmful forms of nicotine product [1].

Historical attempts to develop ways for people to continue smoking cigarettes whilst reducing overall harm, for example by using low-tar varieties, have proved ineffective [1].

Quitting

Quitting smoking permanently can be really hard, and many people do not succeed on their first attempt. It is possible for motivated people to quit smoking without any help, either by cutting down gradually or just deciding to never smoke again, called 'going cold turkey'. There is some evidence that 'going cold turkey' is the most likely to work overall, though different methods will work best for different people.

Depending on where you live, there are a range of sources of support to help you quit, from doctors to other community services. The support of family and friends is also helpful.

Nicotine replacement therapies, like patches and nicotine gum, are proven to help some people quit. They may help get out of the habits involved in smoking, allowing you to overcome the nicotine addiction separately [1].

Switching to smokeless nicotine

Quitting tobacco is the way to minimise harm, but in reality, many people struggle and fail to quit, or do not want to. These people may benefit from switching to a form of long-term nicotine addiction which is less likely to cause disease and death. There is very little evidence yet to rank the forms of smokeless tobacco in order of harmfulness, but it is likely that they all offer far less risk than smoking cigarettes [1].

Legality

It's illegal for shopkeepers to sell tobacco or tobacco products to anyone under 18.

Cigarettes must be sold in their original packaging and it is illegal to sell single cigarettes to anyone, adult or child [2].

Mixing with other drugs

The effects of using tobacco with other drugs - including over-the-counter or prescribed medications - can be unpredictable and dangerous, and could cause -

  • Tobacco + benzodiazepines - reduced effectiveness of benzodiazepines.
  • Tobacco + contraceptive pill - increased risk of blood clots forming [20].

It's important to check with your doctor about whether nicotine might affect any medications you are taking [17].

Paraphernalia

Pipes, rolling papers, matches/lighter [7].

History

Tobacco has a very long history with its consumption and use. It was originally used in the Americas, and was first brought to Europe after Columbus's 1492 voyage, but at first, it was not available to all people, only very few had the opportunity to become addicted to this plant.

Fast forward to 1881, after the labour force changed from slavery to sharecropping, the first sight of cigarette industrialisation occurred. James Bonsack had developed a new machine that rolled cigarettes around 13 times faster than a human cigarette roller. This helped increase cigarette use dramatically.

It was not until 1964, when a report was filed by US Surgeon General Luther Terry, that people became aware that cigarette smoking had a direct link to lung cancer, heart disease and emphysema. In 2004 another report was published, by Richard H. Carmona, 40 years after his first report on smoking, that smoking can cause diseases in nearly every organ in the body because cigarette smoke goes everywhere the blood flows [3].

Tobacco is a plant that was originally native to the Americas, and many Native Americans thought of the plant as a gift from the 'Great Spirit' and used it in religious ceremonies. Rodrigo de Jerez, a Spanish explorer, brought tobacco back to Spain in the early 1500's, where the habit of smoking became popular very quickly. As it became more popular, its value skyrocketed, and tobacco was used as money in the early American Colonies [18].

Beginning around the mid-1500's, tobacco was used as a medicine. It was given to patients in a variety of ways, from smoking to enemas. It was believed to be an effective treatment for colic, nephritis, hysteria, hernia, and dysentery, toothache, falling fingernails, worms, bad breath, lockjaw, and cancer, among other illnesses. As early as 1602, however, a connection was made between the cancers and lung diseases suffered by chimney sweeps (caused by soot) and illnesses that could have been caused by tobacco [18].

Snuff use was very popular in 18th Century Europe, but by the 19th century cigars had become the primary tobacco product. In the mid-1800's, Philip Morris, J.E. Liggett, and R.J. Reynolds began their tobacco companies. Then came the invention of matches and cigarette rolling machines. Cigarette use began to skyrocket. During World War I soldiers were provided with free cigarettes. Between 1910 and 1920, per capita consumption of cigarettes increased from 94 to 419 per year [18]. The link between cigarette smoking and cancer was already evident. In 1930, the lung cancer rate for white men in the U.S. was 4.9 per 100,000. By 1948, the rate had increased to 27.1 per 100,000 [18].

The rapid increase in smoking and its health consequences led Congress to mandate in 1965 that a Surgeon General's warning appear on every pack of cigarettes. In the 1970's, airlines began offering nonsmoking sections on flights, and smoking was prohibited in many public spaces. In the 1980's, research revealed that secondhand smoke, as well as smokeless tobacco, have serious health consequences, including cancer. The 1990's saw a great deal of legal action taken against the major tobacco companies as well as numerous campaigns to inform the public about the dangers of smoking. In 1999, the Philip Morris Tobacco Company recognised that there is an overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers... there is no safe cigarette... cigarette smoking is addictive [18]. Around this time, major tobacco companies began to confess to the fact that they had been focusing their advertising campaigns toward young people [14].

The native people of the Americas considered tobacco a gift from the Great Spirit, and they used it in their religious practices. Today, experts believe that the tobacco we know began growing about 8,000 years ago. Although other plants around the world contain small amounts of nicotine, the drug in tobacco, tobacco is native only to the Americas.

An early explorer of the Americas, Rodrigo de Jerez, brought the habit of smoking tobacco back to Spain around 1504. By 1511, smoking was popular throughout Spain, and by 1531, Europeans were cultivating tobacco, the 'sweet' Nicotiana tabacum, in Santo Domingo.

Beginning around the mid-1500's, tobacco was used as a medicine. It was given to patients in a variety of ways, from smoking to enemas. It was believed to be an effective treatment for colic, nephritis, hysteria, hernia, dysentery, toothache, falling fingernails, worms, bad breath, lockjaw, and cancer, among other illnesses. As early as 1602, however, a connection was made between the cancers and lung diseases suffered by chimney sweeps (caused by soot) and illnesses that could have been caused by tobacco.

As its popularity grew, tobacco gained value. In the American Colonies, tobacco was used as money throughout the 17th and 18th centuries. In fact, in Virginia in 1619, the very first American Thanksgiving celebrated a good tobacco crop.

Acceptance of tobacco use was less than unanimous. In 1628, Shah Sefi punished two merchants for selling tobacco by pouring hot lead down their throats. In 1634 Czar Alexis of Russia created new penalties for smoking. For the first offense, the punishment was whipping, a slit nose, and transportation to Siberia. The punishment for the second offense was execution. A Chinese regulation of 1634 made the use or distribution of tobacco punishable by decapitation. By the 1650's, however, snuff became popular throughout China, and it remained popular there until the early 20th century.

In 1753, Swedish Botanist Carolus Linnaeus named the tobacco plant genus, nicotiana, and also described two species, nicotiana rustica and nicotiana tabacum. He named the genus after Nicot de Villemain, an ambassador who introduced the plant to France in about 1550.

Following a long period of the popularity of snuff, cigars became the most popular tobacco product in England in about 1830. In 1826, England imported about 26 pounds of cigars, but in 1830, 250,000 pounds of cigars were imported. Cigars gained popularity in the northern United States not long after, with soldiers bringing Latin American cigars back with them after the Mexican War. In the southern states, chewing tobacco remained the most popular form.

The roots of the modern tobacco industry began in the mid 1800's with Philip Morris beginning to sell Turkish cigarettes in London, and J.E. Liggett establishing his tobacco business in St. Louis, Missouri. Matches, which made smoking more convenient, were also introduced at this time.

The R.J. Reynolds Tobacco Company was founded in 1875. It produced several brands of chewing tobacco.

In 1884 James Bonsack received the patent for the first cigarette-rolling machine. Production speed increased from 2,000 a day to 120,000 a day. Bonsack went into business with the tobacco farmers Washington and James "Buck" Duke. That year, the Dukes alone produced 744,000 cigarettes, more than the national total in 1883.

Still, very little was known about the science of tobacco and its health effects. In 1889, the interaction between nicotine and nerve cells was reported on for the first time. Scientists wrote of the effects of nicotine on the ganglia in the brain. The study hypothesised that the brain has receptors and transmitters that respond to stimulation by specific chemicals, a revolutionary idea that proved to be correct. Unfortunately, the pace of scientific discovery was not as fast then as it needed to be to stop tobacco's deadly march forward. That same year, lung cancer was still an extremely rare disease, with only 140 documented cases worldwide.

The early years of the 20th century were key in establishing Big Tobacco's foothold in the United States. The Federal Food and Drugs Act of 1906 prohibited the sale of adulterated foods and drugs, and mandated honest statement of contents on labels. Originally, nicotine was on the list of drugs, which would have meant that the Food and Drug Administration could have regulated its sale. Tobacco industry lobbying got nicotine removed from the list on the grounds that it was not used to cure, mitigate, or prevent disease, and was therefore not a drug.

World War I, in which the U.S. fought from 1917 - 1918, played a large part in addicting a generation of men. General John J. Pershing said that tobacco was "as indispensable (to the soldiers) as the daily ration (of food,)" and as a result soldiers were provided with all the free cigarettes they could smoke. Between 1910 and 1920, per capita consumption of cigarettes increased from 94 per year to 419 per year. In 1919, medical student Alton Ochsner was called in to observe lung cancer surgery because, he was told, he would probably never see a case of lung cancer again. He didn't see another case for 17 years, but then he saw eight cases in six months. All of those men were smokers who had picked up the habit in World War I.

Cigarette consumption and lung cancer rates continued to grow hand in hand from about that time. For example, in 1930 the lung cancer rate for white men in the U.S. was 4.9 per 100,000, and by 1948 that number had grown to 27.1 per 100,000. During that same period, per capita consumption of cigarettes had gone from roughly 1,500 in 1930 to 3,600 in 1948.

While cigarettes were rapidly gaining popularity, a German scientist published, in 1929, the first statistical evidence of a lung cancer-tobacco link, based on case studies showing that lung cancer sufferers were likely to be smokers. The next convincing study about the connection between smoking and lung cancer was published in 1950 in the /Journal of the American Medical Association/ (JAMA. It definitively linked smoking to lung cancer. Another study in the same issue that found that 96.5% of lung cancer patients interviewed were moderate heavy-to-chain-smokers. By 1955, a major CBS television program broadcast the link between cigarette smoking and lung cancer and other diseases, but the news was slow to sink in. Consumption continued to rise.

Tobacco companies, in the mean time, continued to deny publicly any links between their products and cancer or other diseases, and to deny that nicotine is addictive. However, internal documents told a different story. Tobacco company Brown & Williamson's general counsel wrote in 1963, "…nicotine is addictive. We are, then, in the business of selling nicotine, an addictive drug effective in the release of stress mechanisms."

In 1965, Congress mandated a gentle caution label on each cigarette pack. In 1967, a Surgeon General's Report concluded that smoking is the principal cause of lung cancer, and found evidence linking smoking to heart disease. Congress strengthened the cigarette labeling law in 1969, and again in 1970, when it was changed to read, "Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health." Also in 1970, President Nixon signed a measure banning cigarette advertising on radio and television, to take effect in 1971. However, these laws also gave tobacco companies a comfortable margin to work in to increase their sales. The law read, "No requirement or prohibition based on smoking and health shall be imposed under State law with respect to the advertising or promotion of any cigarettes the packages of which are labeled in conformity with the provisions of this Act." In other words, as long tobacco companies' ads and packaging carried the Surgeon General's warning, they could face no other regulations in any state, and no state was allowed to prohibit any smoking in any area for health reasons.

Regardless, the 1970s saw the rise of nonsmokers' rights in the United States. More and more, nonsmokers began to protest the clouds of cigarette smoke that filled every public space. The airline industry led the way in trying to make nonsmokers more comfortable. Pan American Airlines created the first nonsmoking section in 1969, TWA offered nonsmoking sections on all flights in 1970, and United Airlines followed suit in 1971. Other nonsmokers' rights measures continued to be proposed throughout the 1970's, as it became more clear that nonsmokers suffered from others' smoking. For example, the 1975 Minnesota Clean Indoor Air Act prohibited "smoking in public places and at public meetings, except in designated smoking areas." It was the first law to require separation of smokers' and nonsmokers. A report commissioned by the Tobacco Institute in 1978 stated that the nonsmoker's rights movement was "the most dangerous development to the viability of the tobacco industry that has yet occurred."

Evidence of tobacco's dangers and regulations to protect users and non-users continued to grow. In 1986 the U.S. Surgeon General's Report discussed the health consequences of secondhand smoke and declared that smokeless tobacco is cancer-causing and addictive. Congress banned smoking on U.S. flights of less than two hours beginning in 1988, and by 1990, this ban was extended to all U.S. flights under six hours, except to Alaska and Hawaii. The law also banned smoking on interstate buses. Canadian legislation of 1988 and 1989 prohibited tobacco advertising, ensured smoke-free workplaces, and added one of four strong health warnings to all cigarette packs.

Beginning with the U.S. Environmental Protection Agency's 1993 declaration of cigarette smoke as a Class-A carcinogen, the mid-1990's saw a number of new regulations and subsequent lawsuits. The FDA sought the right to regulate tobacco and its advertising, and the five largest tobacco companies, the advertising industry, and smokeless tobacco manufacturers U.S. Tobacco Co. and Conwood Co filed suit against the FDA proposal immediately.

However, in 1994 a large number of tobacco industry internal documents convinced Liggett Tobacco to settle lawsuits with 22 states. Liggett issued the following statement, "We at Liggett know and acknowledge that, as the Surgeon General and respected medical researchers have found, cigarette smoking causes health problems, including lung cancer, heart and vascular disease and emphysema. Liggett acknowledges that the tobacco industry markets to 'youth,' which means those under 18 years of age, and not just those 18 - 24 years of age."

In 1997, the major tobacco companies offered a settlement that would include FDA regulation, money for anti-smoking campaigns, and bans on vending machines and outdoor advertising. Ultimately the U.S. Senate rejected the settlement on the grounds that it would have protected the tobacco companies too much from other legal action. Lawsuits seeking compensation for tobacco-related pain and suffering and medical costs by individuals, states, insurers, and others have continued to go forward.

The Philip Morris tobacco company acknowledged in 1999 that There is an overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers…there is no safe cigarette…cigarette smoking is addictive, as that term is most commonly used today. However, no laws limit the big tobacco companies' rights to market their products around the world. Many countries, especially developing countries, lack regulations against dishonest advertising strategies. In one of these countries, China, it is predicted that one-third of males now aged 0--29 will eventually die of tobacco-related diseases [18].

Tobacco and nicotine containing products myths and misunderstandings

Smoking reduces stress

Nicotine does make you relax, but nicotine addiction causes stress and worsening mood the longer it has been since the last cigarette, so in fact, a smoker suffers more stress than a non-smoker [1].

Occasional or 'social' smoking is harmless

Whilst occasional smoking is far less harmful than heavy smoking, any amount of smoking increases the risks of suffering from a huge range of diseases, many of them fatal. Occasional smoking is also highly likely to end in regular smoking. Talk to people who are addicted; many smokers who thought they were in control of their habit eventually lost control [1].

Nicotine itself is harmless, it's the smoking that does the damage

This is not that far from the truth; the vast majority of the harms of cigarettes are not caused by nicotine (although you could argue that nicotine is the ultimate cause as it keeps smokers smoking). However, it is important not to disregard nicotine and think that e-cigarettes and similar alternatives to smoking are totally harmless. Nicotine has harmful effects on blood vessels and its many effects on the brain, including addiction, can negatively affect your mood and could alter your behaviour towards other addictive substances or activities [1].


References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 Nicotine, 2016, http://www.drugscience.org.uk/drugs/stimulants/nicotine/
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Tobacco, 2016, http://www.talktofrank.com/drug/tobacco
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Tobacco, 2017, http://www.release.org.uk/drugs/tobacco
  4. 4.0 4.1 Tobacco, 2017, http://www.mobieg.co.za/articles/addiction/types-of-drugs/tobacco/
  5. 5.0 5.1 5.2 5.3 Tobacco: Uses, Symptoms, Signs and Addiction Treatment, 2017, http://addictionlibrary.org/legal/tobacco.html
  6. Prevalence - tobacco, 2016, http://www.drugwise.org.uk/tobacco-harm-reduction/
  7. 7.0 7.1 7.2 7.3 7.4 Nicotine, 2012, http://www.dan247.org.uk/Drug_Nicotine.asp
  8. 8.0 8.1 8.2 8.3 8.4 8.5 8.6 Tobacco, 2017, https://teens.drugabuse.gov/drug-facts/tobacco-nicotine-e-cigarettes
  9. 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 Nicotine, 2017, http://psychonautwiki.org/w/index.php?title=Nicotine&_=
  10. Pomerleau, O. F. and Pomerleau, C. S., Neuroregulators and the reinforcement of smoking: Towards a biobehavioral explanation, Neuroscience & Biobehavioral Reviews, 1984, 8, 4, 503-513, http://dx.doi.org/10.1016/0149-7634(84)90007-1, https://www.ncbi.nlm.nih.gov/pubmed/6151160
  11. Pomerleau, O. F. and Rosecrans, J., Neuroregulatory effects of nicotine, Psychoneuroendocrinology, 1989, 14, 6, 407-423, http://dx.doi.org/10.1016/0306-4530(89)90040-1, http://www.sciencedirect.com/science/article/pii/0306453089900401
  12. CDC, Smoking and Tobacco Use: Fast Facts, 2015, http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm
  13. Wang, T. W. and Marynak, K. L. and Aguku, I. T. and King, B. A., Secondhand Exposure to Electronic Cigarette Aerosol Among US Youths, Journal of the American Medical Association Pediatrics, 2017, https://doi.org/10.1001/jamapediatrics.2016.4973, https://www.ncbi.nlm.nih.gov/pubmed/28319226
  14. 14.0 14.1 14.2 14.3 Tobacco, 2013, http://www.cesar.umd.edu/cesar/drugs/tobacco.asp
  15. Health risks of smoking, 2016, http://www.quit.org.au/reasons-to-quit/health-risks-of-smoking
  16. 16.0 16.1 Brands, B. and Sproule, B. and Marshman, J., Drugs & drug abuse, 1998, 3rd edition, Addiction Research Foundation, Ontario, Canada
  17. 17.0 17.1 17.2 17.3 Tobacco facts, 2016, http://www.druginfo.adf.org.au/drug-facts/tobacco
  18. 18.00 18.01 18.02 18.03 18.04 18.05 18.06 18.07 18.08 18.09 18.10 18.11 18.12 18.13 Tobacco, 2011, http://www.intheknowzone.com/substance-abuse-topics/tobacco.html
  19. Tobacco, 2017, https://teens.drugabuse.gov/drug-facts/tobacco-nicotine-e-cigarettes
  20. Lucas, C. and Martin, J., Smoking and drug interactions, Australian Prescriber, 2013, 36, 3, 102-104, https://doi.org/10.18773/austprescr.2013.037, https://www.nps.org.au/australian-prescriber/articles/smoking-and-drug-interactions