Tobacco

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Tobacco is an agricultural product processed from the fresh leaves of plants in the genus Nicotiana.

Tobacco has been growing on the American Continent since about 6000 BC and began being used by native cultures at about 3000 BC. It has been smoked in one form or another since about 2000 BC. There are pictoral drawings of ancient Mayans smoking crude cigars from 1400 BC. Tobacco has a very long history of use in Native American culture and played an important part in the foundation of the United States of America, going back to colonial times and the original Jamestown settlement.

Commercially available dried, cured and natural forms, it is often smoked (see tobacco smoking) in the form of a cigar or cigarette, or in a stem pipe, water pipe, or hookah. Tobacco can also be chewed, "dipped" (placed between the cheek and gum), or sniffed into the nose as finely powdered snuff. Many countries set a minimum smoking age, regulating the purchase and use of tobacco products.

All methods of tobacco consumption results in varying quantities of nicotine being absorbed into the user's bloodstream. Over time, tolerance and dependence develop. Absorption quantity, frequency, and speed seem to have a direct relationship with how strong a dependence and tolerance, if any, might be created.

Health effects

Main article: Health effects of tobacco smoking

All means of tobacco consumption result in the absorption of nicotine, in varying amounts, into the user's bloodstream. A lethal dose of nicotine is contained in as little as one half of a cigar or three cigarettes. However, only a small fraction of the nicotine contained in these products is actually released into the smoke: most clinically significant cases of nicotine poisoning result from concentrated forms of the compound used as insecticides. Some sources report, however, that even a discarded cigarette butt can contain enough nicotine to kill a small child. Other active alkaloids in tobacco include harmala alkaloids.

Long-term tobacco use carries significant risks of developing various cancers as well as strokes and severe cardiovascular and respiratory diseases. Significantly shorter life expectancies have been associated with tobacco smoking. It has been shown that tobacco may cause lasting brain changes just like morphine or cocaine.

Many jurisdictions have enacted smoking bans in an effort to minimize possible damage to public health caused by tobacco smoking. The substantially increased risk of developing cancer as a result of tobacco usage seems to be due to the plethora of nitrosamines and other carcinogenic compounds found in tobacco and its residue as a result of anaerobic heating, either due to smoking or to flue-curing or fire-curing. The use of flue-cured or fire-cured smokeless tobacco in lieu of smoked tobacco reduces the risk of respiratory cancers but still carries significant risk of oral cancer. In contrast, use of steam-cured chewing tobacco (snus) avoids the carcinogenicity by not generating nitrosamines, though the negative effects of the nicotine on the cardiovascular system and pancreas are not ameliorated. More than 400,000 Americans a year die from smoking: 276,000 men and 142,000 women.

One study from the Aristotle University of Thessaloniki in Greece measured the amount of naturally occurring radium and polonium found in Greece's tobacco leaves. The radiation dose was discovered to be nearly a thousand times more than the amount of Caesium-137 found in the leaves of plant life adjacent to the Chernobyl disaster. Despite the actual radiation dose attained by tobacco smokers being only 10 percent of the mean dose any person receives from the environment, some scientists believe that this radioactive content is a major cause of cancer deaths in smokers, and not nicotine or tar.

Tobacco Use Disorder

Epidemiology and Demographics

Prevalence

The 12month prevalence of tobacco use according to DSM IV criteria is 13,000 per 100,000 (13%) among ages 18 years and older.

Risk Factors

• Anxiety disorder
• Attention-deficit/hyperactivity disorder
• Bipolar disorder
• Conduct disorder
• Depressive disorder
• Externalizing personality traits
• Genetic predisposition
• Individuals with low incomes
• Low educational levels
• Other substance use disorders
• Personality disorder
• Psychotic disorder

DSM-V Diagnostic Criteria for Tobacco Use Disorder

“

A.A problematic pattern of tobacco use leading to clinically significant impairment or distress,as manifested by at least two of the following, occurring within a 12-month period: 1.Tobacco is often taken in larger amounts or over a longer period than was intended. 2.There is a persistent desire or unsuccessful efforts to cut down or control tobacco use. 3.A great deal of time is spent in activities necessary to obtain or use tobacco. 4.Craving, or a strong desire or urge to use tobacco. 5.Recurrent tobacco use resulting in a failure to fulfill major role obligations at work,school, or home (e.g., interference with work). 6.Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco (e.g., arguments with others about tobacco use). 7.important social, occupational, or recreational activities are given up or reduced because of tobacco use. 8.Recurrent tobacco use in situations in which it is physically hazardous (e.g., smoking in bed). 9.Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco. 10.Tolerance, as defined by either of the following: a.A need for markedly increased amounts of tobacco to achieve the desired effect. b.A markedly diminished effect with continued use of the same amount of tobacco. 11.Withdrawal, as manifested by either of the following: a.The characteristic withdrawal syndrome for tobacco (refer to Criteria A and B of the criteria set for tobacco withdrawal). b.Tobacco (or a closely related substance, such as nicotine) is taken to relieve or avoid withdrawal symptoms. Specify if: In early remission: After full criteria for tobacco use disorder were previously met, none of the criteria for tobacco use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use tobacco,” may be met). In sustained remission: After full criteria for tobacco use disorder were previously met, none of the criteria for tobacco use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use tobacco," may be met). Specify if: On maintenance therapy: The individual is taking a long-term maintenance medication,such as nicotine replacement medication, and no criteria for tobacco use disorder have been met for that class of medication (except tolerance to, or withdrawal from,the nicotine replacement medication). In a controlled environment: This additional specifier is used if the individual is in an environment where access to tobacco is restricted.

”

Tobacco Withdrawal

Differential Diagnosis

• Anxiety disorder
• Alcohol withdrawal
• Bipolar disorder

• Caffeine withdrawal
• Caffeine intoxication
• Depressive disorder
• Medication-induced akathisia

• Opioid withdrawal

• Sedative, hypnotic, or anxiolytic withdrawal
• Stimulant withdrawal
• Sleep disorder
• Voluntary smoking cessation

Epidemiology and Demographics

Prevalence

The prevalence of tobacco withdrawal is 50,000 per 100,000 (50%) of the overall population.

Risk Factors

• Attention-deficit/hyperactivity disorder
• Anxiety disorders
• Bipolar disorders
• Genetic predisposition
• Other substance use disorders
• Smokers with depressive disorders

DSM-V Diagnostic Criteria for Tobacco Withdrawal

“

A.Daily use of tobacco for at least several weeks. AND B.Abrupt cessation of tobacco use, or reduction in the amount of tobacco used, followed within 24 hours by four (or more) of the following signs or symptoms: AND 1.Irritability, frustration, or anger 2.Anxiety 3.Difficulty concentrating. 4.Increased appetite. 5.Restlessness. 6.Depressed mood. 7.Insomnia. AND C.The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. AND D.The signs or symptoms are not attributed to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

”

See also

• Chop Chop
• Cigarette
• Shag (tobacco)
• Cigar
• Dipping tobacco
• Tobacco industry
• Tobacco mosaic virus
• Tobacco smoking
• Nicotine
• Health effects of tobacco smoking
• Smoking cessation
  • Quitline
• Smoking ban
• Passive smoking
• Smoking
• Smoking culture

References

• Breen, T. H. (1985). Tobacco Culture. Princeton University Press. ISBN 0-691-00596-6. Source on tobacco culture in eighteenth-century Virginia pp. 46–55
• W.K. Collins and S.N. Hawks. "Principles of Flue-Cured Tobacco Production" 1st Edition, 1993
• Fuller, R. Reese (Spring 2003). Perique, the Native Crop. Louisiana Life.
• Gately, Iain. Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization. Grove Press, 2003. ISBN 0-8021-3960-4.
• Graves, John. "Tobacco that is not Smoked" in From a Limestone Ledge (the sections on snuff and chewing tobacco) ISBN 0-394-51238-3
• Killebrew, J. B. and Myrick, Herbert (1909). Tobacco Leaf: Its Culture and Cure, Marketing and Manufacture. Orange Judd Company. Source for flea beetle typology (p. 243)
• Poche, L. Aristee (2002). Perique tobacco: Mystery and history.
• Tilley, Nannie May. The Bright Tobacco Industry 1860–1929 ISBN 0-405-04728-2. Source on flea beetle prevention (pp. 39–43), and history of flue-cured tobacco
• Rivenson A., Hoffmann D., Propokczyk B. et al. Induction of lung and pancreas exocrine tumors in F344 rats by tobacco-specific and areca-derived N-nitrosamines. Cancer Res (48) 6912–6917, 1988. (link to abstract; free full text pdf available)
• Schoolcraft, Henry R. Historical and Statistical Information respecting the Indian Tribes of the United States (Philadelphia, 1851-57)

External links

• North American Association of Cigarette and Tobacco Smokers
• Timeline of tobacco history
• Growing Nicotiana species (Plot55.com)
• Tobacco Smoke and Involuntary Smoking, Summary of Data Reported and Evaluation 2004 by the IARC.
• BBC report on questions re European Union partial ban on some smokeless tobacco products (i.e. snus)
• Scientists Search for Healthy Uses for Tobacco
• Science behind tobacco - Curing
• UCSF Tobacco Industry Videos Collection