By Linda M. Guhe, MSW, LCSW
 

The History of Tobacco and Health in America

Tobacco has been around since ancient times and it has been significant throughout American history. When Christopher Columbus discovered America in 1492 he also discovered smoking tobacco. Tobacco proved to be quite appealing to those early explorers. As a result, tobacco from America spread to other parts of the world. Tobacco was first grown commercially in America in the early 1600s. In the 1800s, the revenue from taxed tobacco helped finance the Civil War. In the early 1900s, RJ Reynolds began producing and selling the first brand-name cigarette, Camel.

While popular and appealing, tobacco use has led to serious health problems in the United States and world-wide. Today, approximately 25 percent of Americans smoke. Fifty percent of those who use tobacco will die from a smoking-related illness, approximately 450,000 people each year. The number of Americans using smokeless tobacco ranges from two percent to 9 percent. Financial costs of treating tobacco-related illnesses in the US are more than  50 billion dollars a year.

Health Care Providers and Tobacco Dependence

It may be surprising to learn that tobacco dependence is actually under-diagnosed by providers in the health care community. However, because of an increasing awareness in recent years of the physical dangers to health, along with financial burden for society, tobacco has been gaining more attention in public health education and research. For example, the federal government is focussing on the problem with its Healthy People 2010 initiative. Among the government’s health objectives for the years 2000 through 2010 is a campaign to promote the cessation of tobacco use.

There are reasons why healthcare professionals have failed in the past to recognize, diagnose, and treat tobacco dependence. For one thing, until recently, the subject of tobacco dependence as a treatable disorder has been limited in the formal training of health care professionals. As a result, in comparison to experts in other kinds of disorders, there are only a small number of researchers and specialists who provide scientific information about the effects of tobacco use and effective methods of treatment.

Money became available to fund tobacco dependence research as a result of the financial settlement of lawsuits filed against the tobacco companies by 46 states in 1994 and 1995.  The lawsuits were filed in response to financial burdens experienced by states in treating tobacco-related illnesses. Money and publicity from the 1998 Master Settlement Agreement (MSA) made between tobacco companies and the states that filed the lawsuit has helped fund, draw interest to, and generate tobacco research.

Because of an increase in research in the last several years, we now have a better understanding of tobacco. We now know that tobacco products contain both (1) harmful toxins that damage health and (2) nicotine, which is a powerful addictive drug. Research has also led to the development of evidence-based methods of tobacco cessation treatments. As a result, the number of specialists in tobacco and the treatment of tobacco addiction have been increasing.

Tobacco researchers and specialists are now providing health care providers with the necessary tools and guidelines to talk with their patients about smoking, and for offering tobacco cessation treatment. In addition, there are multiple agencies providing information to the public on smoking and tobacco addiction, and help for quitting.

Forms of Tobacco

Common forms of tobacco include cigarettes, cigars, pipe, snuff, and chewing tobacco. Tobacco products come in smoked (inhaled) and smokeless forms. Cigarettes, cigars, and pipe tobacco are inhaled. Both the harmful chemical toxins and the nicotine in tobacco smoke enter the body through the lungs when inhaled.

Snuff and chewing tobacco are used orally. The harmful chemical toxins and the nicotine in the tobacco enter the body through the mucus linings of the mouth and jaw.

Some other more exotic forms of smoking tobacco are produced in other parts of the world and imported to the United States. These forms of tobacco imported to the United States include: kreteks, bidis, and hookahs. These forms of tobacco are often flavored and appeal to adolescents and college students.

Kreteks, known as clove cigarettes, contain a mixture of tobacco and cloves. Bidis are grape, strawberry, vanilla and other candy-flavored or non-flavored cigarettes. Hookah, also called waterpipe smoking, is smoking flavored tobacco through a pipe.

Many people believe that these forms of tobacco are non-toxic and contain no nicotine. However, while these products may appear safe, especially to young people, they can contain even higher levels of toxins and nicotine than the types of tobacco sold in the United States. Simply put: There are no forms of tobacco that are safe and non-addictive.

How Tobacco Damages Heath

Smoking tobacco contains nicotine and a mixture of harmful chemicals and gases. The nicotine in tobacco smoke (cigarettes, cigars, and pipes) is absorbed in the lungs and quickly (10-19 seconds) travels to the brain.

In addition to nicotine, the smoke inhaled from tobacco contains substances that cause cancer, and that cause damage to vital organs such as the heart, lungs, and kidneys. There are over 4,000 various chemical substances and gases in tobacco smoke, including tar. Sixty of these chemicals are known to cause cancer.

Poisonous gases include nitrogen oxide and carbon monoxide. Nicotine is a powerful addictive drug that produces pleasurable feelings in the brain. Toxic chemicals in cigarette smoke are destructive to health and can be lethal.

Chewing tobacco contains over 2,000 chemicals, of which many are cancer-causing nitrosamines. These harmful chemicals are absorbed orally through the mouth. The treatment for oral cancer is aggressive and often leads to physical disfigurement. Nicotine in chewing tobacco reaches the brain more slowly than in cigarette smoke. However, smokeless tobacco contains more nicotine than cigarettes and can lead to an intensely strong addiction. Smokeless tobacco is a major cause of gum disease.

Secondhand Smoke

Secondhand smoke or passive smoke is another serious health problem that affects non-smokers, many of them children. Also called Environmental Tobacco Smoke (ETS), secondhand smoke is a mixture of exhaled smoke and smoldering smoke from the lighted tobacco product. Exhaled smoke is also called mainstream smoke. The smoldering smoke from a burning tobacco product is called sidestream smoke. Secondhand smoke also contains nicotine.

Secondhand tobacco smoke, like inhaled smoke, also contains harmful chemicals and substances that cause cancer. Constant or significant exposure to secondhand smoke is a danger to the health of non-smokers.

Exposure to secondhand smoke is especially harmful to children. Children breathing secondhand smoke have increased chances of suffering from decreased lung capacity, asthma, SIDS, ear infections, pneumonia, and bronchitis.

References:

• Database & Educational Resource for Treatment of Tobacco Dependence: www.treatobacco.net/home/home.cfm
• Healthy People 2010: www.healthypeople.gov
• National Cancer Institute: www.cancer.gov/cancertopics/tobacco
• National Center for Tobacco-Free Kids: www.tobaccofreekids.org
• National Institute on Drug Abuse: www.nida.nih.gov/DrugPages/Nicotine.html
• Office on Tobacco Information and Prevention Source (TIPS) Centers for Disease Control and Prevention: www.cdc.gov/tobacco

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