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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 3
TOBACCO
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
INTRODUCTION
Tobacco is a product prepared from the
leaves of the tobacco plant by curing them.
The plant is part of the genus Nicotiana
and of the Solanaceae (nightshade) family.
While more than 70 species of tobacco
are known, the chief commercial crop
is N. tabacum. The more potent variant
N. rustica is also used around the world.
Tobacco contains the alkaloid nicotine,
which is a stimulant. Dried tobacco leaves
are mainly used for smoking in cigarettes,
cigars, pipe tobacco, and flavored shisha
tobacco. They can be also consumed as
snuff, chewing tobacco, dipping tobacco
and snus. Tobacco use is a risk factor
for many diseases, especially those
affecting the heart, liver, and lungs, as
well as many cancers. In 2008, the World
Health Organization named tobacco as
the world’s single greatest preventable
cause of death.
Tobacco use is a leading cause of cancer
and of death from cancer. People who
use tobacco products or who are regularly
around environmental tobacco smoke
(also called secondhand smoke) have an
increased risk of cancer because tobacco
products and secondhand smoke have
many chemicals that damage DNA.
Tobacco use causes many types of cancer,
including cancer of the lung, larynx
(voice box), mouth, esophagus, throat,
bladder, kidney, liver, stomach, pancreas,
colon and rectum, and cervix, as well
as acute myeloid leukemia. People who
use smokeless tobacco (snuff or chewing
tobacco) have increased risks of cancers
of the mouth, esophagus, and pancreas.
Ciattion: http://images.medicaldaily.com/sites/medicaldaily.com/files/2016/03/29/smokeless-
tobacco-e-cigarette.JPG
There is no safe level of tobacco use. People who use any type of tobacco product
are strongly urged to quit. People who quit smoking, regardless of their age, have
substantial gains in life expectancy compared with those who continue to smoke.
Also, quitting smoking at the time of a cancer diagnosis reduces the risk of death.
Tobacco
Tobacco up to 10% of hospital admissions in those aged 35 years smoking causes
an estimated 19,000 deaths and Tobacco and over, each year in Australia. Lifelong
smokers have a 50% chance of dying from a tobacco-related disease with half these
deaths occurring prematurely. No other single avoidable factor accounts for such a
high proportion of deaths, hospital admissions or GP consultations.
Smoking starts young with one in seven 12–15 year olds smoking.
■ 21% of males and
■ 18% of females currently smoke.
Nicotine is the agent responsible for physical dependence. It is a toxic alkaloid,
with a half life of 1–2 hours, that rapidly crosses the blood brain barrier to stimulate
both the dopaminergic and noradrenergic pathways in the brain.
Nicotine effects on the cardiovascular system are mediated by sympathetic neural
stimulation together with an increase in levels of circulating catecholamines. It
has the apparent paradoxical effect of being both a stimulant (at low doses) and a
relaxant (at high doses). Nicotine produces a range of toxic effects.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
BASIC CONCEPT OF TOBACCO
Tobacco is a green, leafy plant that is grown in warm climates. After it is picked,
it is dried, ground up, and used in different ways. It can be smoked in a cigarette,
pipe, or cigar. It can be chewed (called smokeless tobacco or chewing tobacco)
or sniffed through the nose (called snuff).
Nicotine is one of the more than 4,000 chemicals in cigarettes and its smoke. It is
the chemical that makes tobacco addictive or habit forming. Once we smoke, chew,
or sniff tobacco, nicotine goes into our bloodstream, and our body wants more.
The nicotine in tobacco makes it a drug. This means that when we use tobacco, it
changes our body in some way. Because nicotine is a stimulant, it speeds up the
nervous system, so we feel like we have more energy. It also makes the heart beat
faster and raises blood pressure.
Citation: http://www.tbo.com/storyimage/TB/20140511/ARTICLE/140519868/AR/0/AR-
140519868.jpg
Chewing Tobacco
Chewing tobacco is a form of tobacco product that is often referred to as smokeless.
Rather than mincing tobacco leaves for use in cigars or cigarettes, it is coarsely
shredded and often moistened. This tobacco is typically sold loose in a packet or
formed into small squares that are known as plugs.
The practice of chewing tobacco leaves can be traced back to Native Americans
in both North and South America. The leaves were usually torn into manageable
sections and alternately chewed or held between the teeth and the cheek. Early
colonists quickly adopted the practice, especially in what would become the United
Tobacco
States. By the 19th century, this form of tobacco was so popular that spittoons were
common sights in many public buildings as well as courtrooms and any facilities
where politicians gathered. By the early 20th century, cigarettes had overtaken
chewing tobacco in many circles. Still, the product enjoyed continued popularity
among sports figures. To this day, the practice is associated with baseball players.
In the form of plugs and loose shredded tobacco, the product remains a favorite
in many rural sections of the United States, especially in the Deep South.
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Citation: http://images.wisegeek.com/man-in-purple-shirt-with-cigarette-and-tray.jpg
There are several types of tobacco that are prepared specifically for chewing. Loose
leaf and plug tobacco are by far the most enduring forms. The loose leaf product
consists of moistened leaves that are packaged in a simple aluminum lined pouch.
A small amount of sweetener is added to the shredded leaves as a flavor enhancer.
To enjoy the tobacco, the consumer simply removes a small portion of the contents
of the pouch and places the tobacco in the mouth. Chewing the leaves releases
the flavor as well as providing an ample dose of nicotine.
Plug tobacco is processed tobacco leaves that are sweetened and pressed into
sheets. The sheets are then cut into squares or plugs and individually wrapped.
Considered a very convenient way to carry tobacco, the consumer simply bites off
a section of the plug in order to enjoy a quick chew.
Twist tobacco and tobacco bits are less common forms. The twist product is simply
leaves that are woven into long strands similar to those of a rope. The ends are
tied off in order to maintain the twist. While the primary form of chewing tobacco
during the 19th Century, the product does not pack the moisture content or the
added sweetening found with plugs or loose leaf tobacco products.
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Citation: http://images.wisegeek.com/woman-in-green-shirt-coughing.jpg
The tobacco bits are small rolled sections of leaves that are moistened, sweetened,
and formed into bite size pieces. Usually sold in a simple tin, the consumer simply
removes one piece from the tin and chews the product in a manner similar to
chewing gum. While not widely available, this type of tobacco does have a loyal
group of supporters who prefer it over other options.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
As the general public has become aware of the dangers of tobacco usage, many
products made with the plant have decreased in popularity. Along with chewing
tobacco, products like snuff, cigarettes, and cigars have become less acceptable in
public places. While not enjoying the popularity of days past, this form remains a
profitable business and is likely to remain so for many years to come.
Tobacco Industry
The tobacco industry is an industry that manufactures and sells tobacco-based
products. Any person or company that grows, supplies, ships, advertises, or distributes
tobacco or tobacco-based products is directly involved in the tobacco industry.
Tobacco became a major commodity during the 1500s, when the Spanish introduced
the crop to Western Europeans; in the 1600s, when colonists arrived in present
day America, tobacco became a major export. For years, the tobacco industry has
been one of the planet’s leading agricultural industries. Tobacco grows in warm,
moist environments, so it can be grown globally.
The tobacco industry is a controversial one, because tobacco is highly addictive
and connections have been made between tobacco use and death. Those who are
active in the tobacco industry defend tobacco production as an essential part of
the global economy. Others work to show the harmful effects of tobacco use.
Tobacco
The World Health Organization has concluded that half of all those who use
tobacco will die of tobacco-related causes. They also argue that tobacco can cause
lingering health problems that result in higher healthcare costs. There is a strong
link between tobacco and cancer, and many believe smoking is a contributing
factor to the development of lung cancer and oral cancer. Smokeless tobacco is
not immune from the fight.
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Citation: http://images.wisegeek.com/woman-in-red-coat-and-man-in-gray-coat-smoking.jpg
Controversy over the tobacco industry mounted in the late 1900s and early 2000s,
so the World Health Organization started a Global Treaty on Tobacco Control. The
treaty restricting nearly every aspect of tobacco production and sales has been signed
by more than 100 countries around the world. China, India, Brazil, and the United
States lead in the production of unprocessed tobacco, and restrictions on tobacco
may alter the total sales and production for these countries. The sales are altered
by high taxation in many of the countries that signed the treaty. Meanwhile, many
of the leading tobacco companies have been in and out of litigation and lawsuits.
There is a significant amount of controversy surrounding tobacco, so it has
become a political issue globally. The United States and Canada are among those
countries that have been engaged in political discord over how tobacco is used and
produced. Although tobacco is not as widely advertised in the early 21st Century,
the entertainment industry was used often in the 20th Century to promote tobacco.
Hollywood stars and other celebrities were frequently shown smoking in movies.
After anti-smoking groups became a major force against tobacco, many actors and
filmmakers began making it a point either not to use tobacco or not to be seen
using it.
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History of Tobacco
Tobacco has a long history in the Americas. The Mayan Indians of Mexico carved
drawings in stone showing tobacco use. These drawings date back to somewhere
between 600 to 900 A.D. Tobacco was grown by American Indians before the
Europeans came from England, Spain, France, and Italy to North America. Native
Americans smoked tobacco through a pipe for special religious and medical purposes.
They did not smoke every day.
Tobacco was the first crop grown for money in North America. In 1612 the settlers
of the first American colony in Jamestown, Virginia grew tobacco as a cash crop.
It was their main source of money. Other cash crops were corn, cotton, wheat,
sugar, and soya beans. Tobacco helped pay for the American Revolution against
England. Also, the first President of the U.S. grew tobacco.
Citation: http://www.smchealth.org/sites/main/files/imagecache/lightbox/main-images/
depositphotos_30374091_l-2015.jpg
By the 1800’s, many people had begun using small amounts of tobacco. Some
chewed it. Others smoked it occasionally in a pipe, or they hand-rolled a cigarette
or cigar. On the average, people smoked about 40 cigarettes a year. The first
commercial cigarettes were made in 1865 by Washington Duke on his 300-acre
farm in Raleigh, North Carolina. His hand-rolled cigarettes were sold to soldiers
at the end of the Civil War.
It was not until James Bonsack invented the cigarette-making machine in 1881 that
cigarette smoking became widespread. Bonsack’s cigarette machine could make
120,000 cigarettes a day. He went into business with Washington Duke’s son, James
“Buck” Duke. They built a factory and made 10 million cigarettes their first year
and about one billion cigarettes five years later. The first brand of cigarettes were
packaged in a box with baseball cards and were called Duke of Durham. Buck
Duke and his father started the first tobacco company in the U.S. They named it
the American Tobacco Company.
Tobacco
Credit: An 1892 Duke of Durham box of machine-rolled cigarettes Tobacco Biology
& Politics
The American Tobacco Company was the largest and most powerful tobacco
company until the early 1900’s. Several companies were making cigarettes by the
early 1900’s. In 1902 Philip Morris company came out with its Marlboro brand.
They were selling their cigarettes mainly to men. Everything changed during World
War I (1914-18) and World War II (1939-45). Soldiers overseas were given free
cigarettes every day. At home production increased and cigarettes were being
marketed to women too. More than any other war, World War II brought more
independence for women. Many of them went to work and started smoking for the
first time while their husbands were away.
By 1944 cigarette production was up to 300 billion a year. Service men received
about 75% of all cigarettes produced. The wars were good for the tobacco industry.
Since WW II, there have been six giant cigarette companies in the U.S. They are
Philip Morris, R.J. Reynolds, American Brands, Lorillard, Brown & Williamson, and
Liggett & Myers (now called the Brooke Group). They make millions of dollars
selling cigarettes in the U.S. and all over the world.
In 1964 the Surgeon General of the U.S. (the chief doctor for the country) wrote a
report about the dangers of cigarette smoking. He said that the nicotine and tar in
cigarettes cause lung cancer. In 1965 the Congress of the U.S. passed the Cigarette
Labelling and Advertising Act. It said that every cigarette pack must have a warning
label on its side stating “Cigarettes may be hazardous to your health.”
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BAH-p24.png
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By the 1980’s, the tobacco companies had come out with new brands of cigarettes
with lower amounts of tar and nicotine and improved filters to keep their customers
buying and to help reduce their fears. The early 1980’s were called the “tar wars”
because tobacco companies competed aggressively to make over 100 low tar and
“ultra” low tar cigarettes. Each company made and sold many different brands of
cigarettes.
In 1984 Congress passed another law called the Comprehensive Smoking Education
Act. It said that the cigarette companies every three months had to change the
warning labels on cigarette packs. It created four different labels for the companies
to rotate.
Credit: Smoking Tobacco & Health, Centers for Disease Control
Since the 1980’s, federal, state, local governments, and private companies have
begun taking actions to restrict cigarette smoking in public places. The warning labels
were the first step. Tobacco companies cannot advertise cigarettes on television or
radio. It is against a law that was passed by Congress in 1971. Many cities across
the U.S. do not allow smoking in public buildings and restaurants. Since 1990,
airlines have not allowed smoking on airplane flights in the U.S. that are six hours
or less. State taxes on cigarettes have increased.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
As it becomes more difficult for tobacco companies to sell their products in the
U.S., they are looking outside. U.S. tobacco companies are now growing tobacco
in Africa, South America (Brazil and Paraguay), India, Pakistan, the Phillipines,
Greece, Thailand, and the Dominican Republic. Fifty percent (50%) of the sales
of U.S. tobacco companies go to Asian countries, such as Thailand, South Korea,
Malaysia, the Phillipines, and Taiwan.
Economics of Tobacco
Economics deals with the making and selling of products and services to consumers.
Products are things like chewing tobacco, cigarettes, televisions, houses, and cars.
Services include medical care, education, and insurance. Consumers are the people
like ourselves who buy or receive the products and services.
The U.S. has a capitalist economic system. Under this system, one or more people
get together and form a company to make and sell something. They do this to make
money. The money that they make after paying off their bills or expenses is called
profit. In other words, a profit is the money they have for themselves after paying
rent, salaries, utility bills (electricity, gas, telephone) and buying machines/computers
and any other equipment they need to make their product and run their business.