NICOTINE ADDICTION

August 28, 2011 by Dr Rajiv Desai

NICOTINE ADDICTION:

Mirror shows the harm caused by smoking.

Prologue:

On 3^rd December 2007, I posted comments “Tobacco and Smoking cigarettes” on www.ourbollywood.com highlighting evil effects of tobacco smoking. I also stated “Cigarette and tobacco industries defend themselves for providing employment to thousands. You cannot earn livelihood by killing innocent people because then, you become criminals. Smoking cigarette is not a personal matter as passive smoking also kills innocent bystanders.” Later on, I posted the same comments on my website but yet I see tobacco epidemic everywhere. So I decided to revisit the topic again in public interest. For long time, people did not realize that smoking was an addiction and that nicotine was the cause; in fact, cigarette smoking was widely perceived as a glamorous behavior. When your parents were young, people could buy cigarettes and smoke pretty much anywhere — even in hospitals! Ads for cigarettes were all over the place. Soldiers who fought in the two world wars were given cigarettes as food supplements. Today we’re more aware about how bad smoking is for our health. The addicted adult user, the adolescent novice, and the innocent bystander are all vulnerable to the harms of tobacco. The epidemic is shifting to the developing world. More than 80% of the world’s smokers live in low- and middle-income countries. Even though smoking is restricted or banned in almost all public places and cigarette companies are no longer allowed to advertise on TV, radio, and in many magazines; the epidemic of tobacco use is spreading in developing nations notwithstanding the fact that tobacco use is reduced in developed nations. Almost everyone who watches TV, read newspaper or surf internet knows that smoking causes cancer, emphysema, and heart disease; that it can shorten your life by 10 years or more; and that the habit can cost a smoker thousands of dollars a year. And yet these enlightened people light up cigarettes because they are addicted to nicotine in tobacco. What about un-enlightened people? Millions of people in developing world are illiterate, do not have access to TV or internet and in fact do not know that tobacco kills. What about them? What about addiction to smokeless tobacco?

Shocking tobacco statistics:

1) The tobacco epidemic is one of the biggest public health threats the world has ever faced. Smoking is the world’s single biggest preventable cause of death.

2) Tobacco caused 100 million deaths in the 20th century. If current trends continue, it will cause up to one billion deaths in the 21st century.

3) Tobacco kills nearly 6 million people a year—more than HIV, tuberculosis, and malaria combined. To put it differently, more deaths are caused each year by tobacco use than by all deaths of HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Additionally, it causes hundreds of billions of dollars of economic damage worldwide each year. Out of 6 million tobacco deaths every year, more than 5 million are users & ex users of tobacco, and more than 600,000 are nonsmokers exposed to second-hand smoke.

4) Tobacco kills up to half of its users. Approximately one person dies every eight seconds due to tobacco and this accounts for one in 10 adult deaths.

5) For every eight smokers who die from smoking, one innocent bystander dies from secondhand smoke. Almost half of the world’s children breathe air polluted by tobacco smoke. Globally, about one third of adults are regularly exposed to second-hand tobacco smoke.

6) There are about 1.35 billion people worldwide who smoke regularly. The world population in 2010 was roughly 6.8 billion, so it is an alarming fact that almost 20% of the world’s population is smokers. About a third of the male adult global population smokes. Statistics also show that ninety percent of smokers start as children and adolescents. Among young teens (aged 13 to 15), about one in five smokes worldwide. Between 80,000 and 100,000 teens worldwide start smoking every day – roughly half of whom live in Asia. Every two seconds, one Indian child tries tobacco for the first time. Evidence shows that around 50% of those who start smoking in adolescent years go on to smoke for 15 to 20 years.

7) Most tobacco users are unaware of the harms caused by tobacco use.

8) Addiction to tobacco is no different from addiction to cannabis, marijuana, cocaine, heroin or any other drug. Tobacco is far more addictive than heroin or marijuana and the addiction is almost instant (after the first cigarette).

9) Over 57,000 reports worldwide have examined the link between cigarette smoking and disease, making it the most researched cause of disease ever investigated in the history of Biomedical Research.

10) About 15 billion cigarettes are sold daily – or 10 million every minute. Cigarettes are the single-most traded item on the planet, with approximately 1 trillion being sold from country to country each year. At a global take of more than $400 billion, it’s one of the world’s largest industries. According to the World Health Organization, approximately 25% of cigarettes sold around the world are smuggled.

11) Every cigarette smoked cuts at least five minutes of life on average – about the time taken to smoke it. Life expectancy is reduced by as many as 12 years in case of smokers.

12) Cigarette advertising does make smoking more appealing or socially acceptable to children. Through advertising, tobacco firms try to link smoking with athletic prowess, sexual attractiveness, success, adult sophistication, adventure and self-fulfillment.

13) The World Health Organization (WHO) states that “Much of the disease burden and premature mortality attributable to tobacco use disproportionately affect the poor”.

14) If the amount of nicotine in 5 cigarettes is condensed into liquid and injected intravenously, it will kill you instantly.

Don’t you get angry after reading tobacco statistics?

Don’t you feel that something needs to be done?

If you are a smoker yourself, don’t you feel ashamed?

Don’t you think that tobacco is a bigger problem than terrorism, poverty and corruption?

Think over it.

Smoking is the most common method of consuming tobacco, and tobacco is the most common substance smoked. Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects. It is considered an addictive substance because it contains the chemical nicotine. Tobacco also contains more than 19 known cancer-causing chemicals and more than 4,000 other chemicals.

The above picture shows tobacco plant with flowers, leaves and buds.

The above picture shows farming and cultivation of tobacco crop.

Tobacco was first cultivated and enjoyed by the indigenous inhabitants of the Americas, who used it for medicinal, religious, and social purposes long before the arrival of Columbus. But when Europeans began to colonize the American continents, it became something else entirely — a cultural touchstone of pleasure and success, and a coveted commodity that would transform the world economy forever. It is an epic story of an unusual plant and its unique relationship with the history of humanity, from its obscure ancient beginnings, through its rise to global prominence, to its current embattled state today. The tobacco trade was the driving force behind the growth of the American colonies, the foundation of Dutch trading empire, the underpinning cause of the African slave trade, and the financial basis for the victory in the American Revolution.

Tobacco cultivation has a history of 8000 years when the agricultural product began to be cultivated in South America. The history of smoking can be dated to as early as 5000 BC, and has been recorded in many different cultures across the world. Many ancient civilizations, such as the Babylonians, Indians and Chinese; burnt incense as a part of religious rituals, as did the Israelites and the later Catholic and Orthodox Christian churches. Smoking in the Americas probably had its origins in the incense-burning ceremonies of shamans but was later adopted for pleasure, or as a social tool. Tobacco is a South American discovery first started by Brazilians who rolled up tobacco in leaves for the purpose of smoking it. The word tobacco was originally used to denote a “Y” shaped piece of cone or pipe called tobago or tobaca that was used by Mexican Indians to inhale powdered leaves of a plant. Later, the plant came to be known by the name of the device, as “tobacco”. The use of tobacco leaf to create and satisfy nicotine addiction was introduced to Columbus by Native Americans in 1492 and spread rapidly to Europe. After the European exploration and conquest of the Americans, the practice of smoking tobacco quickly spread to the rest of the world. Portuguese traders introduced tobacco in India during 1600. By the mid-17th century every major civilization had been introduced to tobacco smoking and in many cases had already assimilated it into the native culture, despite the attempts of many rulers to stamp the practice out with harsh penalties or fines. Tobacco, both product and plant, followed the major trade routes to major ports and markets, and then on into the hinterlands. The generic name of the tobacco plant Nicotiana, is derived from the name of the French Ambassador to Portugal, Jean Nicot, who introduced tobacco into the French Court in 1560. Nicotiana is one of the five large genera of Solanaceae and is represented by 68 recognized species, of which tabacum and rustica are cultivated extensively. The use of tobacco as cigarettes, however, is predominantly a twentieth century phenomenon, as is the epidemic of disease caused by this form of tobacco. Nicotine is the principal constituent of tobacco responsible for its addictive character. Unburned cured tobacco contains nicotine, carcinogens and other toxins capable of causing gum disease and oral cancer. When tobacco is burned, the resultant smoke contains, in addition to nicotine, carbon monoxide and 4000 other compounds that result from volatilization, pyrolysis and pyrosynthesis of tobacco and various chemical additives used in making different tobacco products.

Tobacco is an agricultural product processed from the fresh leaves of plants in the genus Nicotiana. The genus contains a number of species; however, Nicotiana tabacum is the commonly grown. Nicotiana rustica follows as second containing higher concentrations of nicotine. There are more than 70 species of tobacco in the plant genus Nicotiana. It can be consumed, used as an organic pesticide and, in the form of nicotine tartrate, used in some medicines. It is most commonly used as a recreational drug. Because of the addictive properties of nicotine in tobacco, tolerance and dependence develop. Absorption quantity, frequency, and speed of tobacco consumption are believed to be directly related to biological strength of nicotine dependence, addiction, and tolerance. Nicotine is a powerful neurotoxin to insects which protects tobacco plant from pests. Tobacco is cultivated similarly to other agricultural products. Seeds are sown in cold frames or hotbeds to prevent attacks from insects, and then transplanted into the fields. Tobacco is an annual crop, which is usually harvested mechanically or by hand. After harvest, tobacco is stored for curing, which allows for the slow oxidation and degradation of carotenoids. This allows for the agricultural product to take on properties that are usually attributed to the “smoothness” of the smoke. Following this, tobacco is packed into its various forms of consumption, which include smoking, chewing, sniffing, and so on. Every year 6.7 million tons of tobacco is produced throughout the world. The top producers of tobacco are China (39.6%), India (8.3%), Brazil (7.0%) and the United States (4.6%). Before packaging, the tobacco is often combined with other additives in order to: enhance the addictive potency, shift the products pH, or improve the effects of smoke by making it more palatable.

Tobacco is consumed in many forms and through a number of different methods. Below are examples including, but not limited to, such forms and usage.

1) Bidis are thin, often flavored, south Asian cigarettes made of tobacco wrapped in a tendu leaf, and secured with colored thread at one end.

2) Chewing tobacco is the oldest way of consuming tobacco leaves. It is consumed orally, in two forms: through sweetened strands, or in a shredded form. When consuming the long sweetened strands, the tobacco is lightly chewed and compacted into a ball. When consuming the shredded tobacco, small amounts are placed at the bottom lip, between the gum and the teeth, where it is gently compacted, thus it can often be called dipping tobacco. Both methods stimulate the saliva glands, which led to the development of the spittoon.

3) Cigars are tightly rolled bundles of dried and fermented tobacco, which is ignited so its smoke may be drawn into the smoker’s mouth.

4) Cigarettes are a product consumed through inhalation of smoke and manufactured from cured and finely cut tobacco leaves and reconstituted tobacco, often combined with other additives, then rolled or stuffed into a paper cylinder.

5) Creamy snuffs are tobacco paste, consisting of tobacco, clove oil, glycerin, spearmint, menthol, and camphor, and sold in a toothpaste tube. It is marketed mainly to women in India.

6) Dipping tobaccos are a form of smokeless tobacco. Dip is occasionally referred to as “chew”, and because of this, it is commonly confused with chewing tobacco, which encompasses a wider range of products. A small clump of dip is ‘pinched’ out of the tin and placed between the lower or upper lip and gums.

7) Gutka is a preparation of crushed betel nut, tobacco, and sweet or savory flavorings. It is manufactured in India and exported to a few other countries. A mild stimulant, it is sold across India in small, individual-size packets.

8) Hookah is a single or multi-stemmed (often glass-based) water pipe for smoking. Originally from India, the hookah has gained immense popularity, especially in the Middle East. A hookah operates by water filtration and indirect heat. It can be used for smoking herbal fruits or cannabis.

9) Kreteks are cigarettes made with a complex blend of tobacco, cloves and a flavoring “sauce”. It was first introduced in the 1880s in Kudus, Java, to deliver the medicinal eugenol of cloves to the lungs.

10) Roll-Your-Own, often called rollies or roll ups, are very popular, particularly in European countries. These are prepared from loose tobacco, cigarette papers and filter all bought separately. They are usually much cheaper to make.

11) Pipe smoking typically consists of a small chamber (the bowl) for the combustion of the tobacco to be smoked and a thin stem (shank) that ends in a mouthpiece (the bit). Shredded pieces of tobacco are placed into the chamber and ignited.

12) Snuff is a nicotine containing product made of ground or pulverised tobacco leaves. It is an example of smokeless tobacco. It originated in the Americas and was in common use in Europe by the 17th century. It is generally insufflated (inhaled) or “snuffed” through the nose either directly from the fingers or by using specially made “snuffing” devices. This is a classical traditional dry snuff but nowadays moist snuff is also available which is put between gums and lips.

13) Snus is a steam-cured moist powder tobacco product that is not fermented, and does not induce salivation. It is consumed by placing it in the mouth against the gums for an extended period of time. It is a form of snuff used in a manner similar to American dipping tobacco, but does not require regular spitting.

14) Topical tobacco paste is sometimes recommended as a treatment for wasp, hornet, fire ant, scorpion, and bee sting. An amount equivalent to the contents of a cigarette is mashed in a cup with about a 0.5 to 1 teaspoon of water to make a paste that is then applied to the affected area.

15) Tobacco water is a traditional organic insecticide used in domestic gardening. Tobacco dust can be used similarly. It is produced by boiling strong tobacco in water, or by steeping the tobacco in water for a longer period. When cooled, the mixture can be applied as a spray, or ‘painted’ on to the leaves of garden plants, where it kills insects.

Smoking:

Smoking refers to the action of lighting a cigarette, a pipe, a cigar, a hookah, or any other object made from tobacco or materials of similar effects. The object is then sucked on with the lips to extract smoke. This smoke is inhaled into the chest and then exhaled from the nose and mouth as a thick white smoke. Smoking is a practice in which a substance is burned and the smoke is tasted or inhaled. This is primarily practiced as a route of administration for recreational drug use but it can also be done as a part of rituals, to induce trances and spiritual enlightenment. Smoking generally means smoking tobacco through cigarettes but smoking can include smoking cannabis and opium. In this article, smoking means tobacco smoking. Besides cigarettes, other methods of tobacco smoking include pipes, cigars, bidis, hookahs, vaporizers and bongs. Smoking releases nicotine, which is then available for absorption through mouth, airways and lungs; and via bloodstream, it reaches brain to satisfy addiction.

The above picture shows percentage of males smoking any tobacco products in various countries.

Smoking prevalence by gender (2000)
	Percent smoking
Region	Men	Women
Africa	29%	4%
United States	35%	22%
Eastern Mediterranean	35%	4%
Europe	46%	26%
Southeast Asia	44%	4%
Western Pacific	60%	8%

The above table shows prevalence of cigarette smoking by gender as estimated by WHO in 2000. It is clear that western industrialized nations have higher percentage of women smokers. The United States is the only major cigarette market in the world in which the percentage of women smoking cigarettes (22%) comes close to the number of men who smoke (35%). Europe has a slightly larger gap (46% of men smoke, 26% of women smoke), while most other regions have few women smokers.

The graph below shows that over 2/3 of the entire number of smokers in the world are situated in just 10 countries, based on the report of World Health Organization.

Smoking prevalence varies widely around the world and is increasing rapidly in many developing countries, creating huge health problems for the future if unchecked. Worldwide approximately 1.35 billion people currently smoke cigarettes or other tobacco products. The majority of the world’s smokers (80%) live in low or middle income countries. The figure below shows stages of worldwide tobacco epidemic by describing first the rise and decline in smoking prevalence, followed by a similar trend for smoking-related diseases.

The western countries are in the fourth stage of the tobacco epidemic with smoking prevalence below 30%. In Asia, which contains a third of the world’s population and over half the world’s smokers, male smoking prevalence is in excess of 50%, for example, 53% in Japan, 63% in China and 73% in Vietnam.

Smoking in public was for a long time something reserved for men, and when done by women was considered a sign of promiscuity. Following the American Civil War the usage of tobacco, primarily in cigarettes, became associated with masculinity and power, and was an iconic image associated with the stereotypical capitalist. Today, tobacco is often rejected; this has spawned quitting associations and anti-smoking campaigns. Bhutan is the only country in the world where tobacco sales are illegal. China is the world’s largest producer and consumer of tobacco. It grows a third of the world’s tobacco crop and manufactures a third of its cigarettes. China is also home to some 320 million smokers — about a third of the world’s total — and suffers around one million tobacco-related deaths per year. As of 2010, smoking is practiced by some 1.35 billion people, of whom men are more likely to smoke than women (however the gender gap declines with age), poor more likely than rich, and people in developing countries or transitional economies are more likely than people in developed countries. Rates of smoking have leveled off or declined in the developed world. Smoking rates in the United States have dropped by half from 1965 to 2006, falling from 42% to 20.8% in adults. In the developing world, tobacco consumption is rising by 3.4% per year. Much of the disease burden and premature mortality attributable to tobacco use disproportionately affect the poor, and of the 1.35 billion smokers, more than 1 billion of them live in developing or transitional economies.

The image of a smoker can vary considerably, but is very often associated, especially in fiction, with individuality and aloofness. Even so, smoking of tobacco can be a social activity which serves as a reinforcement of social structures and is part of the cultural rituals of many and diverse social and ethnic groups. Many smokers begin smoking in social settings and the offering & sharing of a cigarette is often an important rite of initiation or simply a good excuse to start a conversation with strangers in many settings; in bars, night clubs, at work or on the street. Lighting a cigarette is often seen as an effective way of avoiding the appearance of idleness or mere loitering. For adolescents, it can function as a first step out of childhood or as an act of rebellion against the adult world. Also, smoking can be seen as a sort of camaraderie. It has been shown that even opening a packet of cigarettes, or offering a cigarette to other people, can increase the level of dopamine (the “happy feeling”) in the brain, and this causes people to smoke for relationships with fellow smokers, in a way that only proliferates the habit, particularly in countries where smoking inside public places has been made illegal. Other than recreational drug use, it can be used to construct identity and a development of self-image by associating it with personal experiences connected with smoking.

Smoking has been accepted into culture, in various art forms, and has developed many distinct, and often conflicting or mutually exclusive meanings, depending on time, place and the practitioners of smoking. Pipe smoking, until recently one of the most common forms of smoking, was often associated with solemn contemplation, old age and is often considered quaint and archaic. Cigarette smoking, which did not begin to become widespread until the late 19th century, has more associations of modernity and the faster pace of the industrialized world. Cigars have been, and still are associated with masculinity, power and an iconic image associated with the stereotypical capitalist. In fact, some evidence suggests that men with higher than average testosterone levels, are more likely to smoke.

A lengthy study conducted in order to establish the strong association necessary for legislative action. The risk of dying from lung cancer before age 85 is 22.1% for a male smoker and 11.9% for a female smoker, in the absence of competing causes of death. The corresponding estimates for lifelong nonsmokers are a 1.1% probability of dying from lung cancer before age 85 for a man, and a 0.8% probability for a woman.

The tobacco smoke is composed of a fine aerosol which consists of two phases: the vapor (or gaseous) and particulate phases. The particulate phase has a particle size distribution predominantly in the range to deposit in the airways and alveolar surfaces of the lungs. Of the estimated 4800 compounds in tobacco smoke, the majority are found in the particulate phase. Nicotine, a natural substance found in tobacco leaves, is the major component of the particulate phase. Nicotine comprises 1.5% of the total weight of a commercial cigarette and is the primary alkaloid found in tobacco. Nicotine is a strong poisonous drug. It is the main ingredient in insecticides or bug sprays. Indeed, there have been reports of gardeners who have died from handling nicotine, and their death from respiratory failure occurred within a few minutes. In its pure form, just one drop (50 – 60 mgs) on a person’s tongue would kill him. The carcinogens are found in tar, which is the particulate matter minus nicotine and water. So tar means particulate matter of the smoke without nicotine & moisture. Of the 69 carcinogens identified in tobacco smoke, 11 are known human carcinogens and 7 are probably carcinogenic in humans. The bulk of the toxicities and carcinogenicity of the smoke reside in the aerosolized particulate matter which contains a large number of toxic constituents and carcinogenic compounds. The vapor phase contains carbon monoxide, respiratory irritants, and ciliotoxins as well as many of the volatile compounds responsible for the distinctive smell of cigarette smoke.

Familiar Chemicals in Cigarettes
Chemical	Found in:
carbon monoxide	car exhaust
nicotine	bug sprays
tar	material to make roads
arsenic	rat poison
ammonia	cleaning products
hydrogen cyanide	gas chamber poison
cyanide	deadly poison
acetone	nail polish remover
butane	cigarette lighter fluid
DDT	insecticides
formaldehyde	to preserve dead bodies
sulfuric acid	car batteries
cadmium	used to recharge batteries
freon	damages earth’s ozone layer
geranic acid	a fragrance
methoprene	a pesticide
maltitol	a sweetener not permitted to be used in foods in the U.S.

The active substances in tobacco, especially cigarettes, are administered by burning the leaves and inhaling the vaporized gas that results. This quickly and effectively delivers substances into the bloodstream by absorption through the alveoli in the lungs. The lungs contain some 300 million alveoli, which amounts to a surface area of over 70 square meters (about the size of a tennis court). Pipe and Cigar smoke are not inhaled because of its high alkalinity, which are irritating to the trachea and lungs. Also, the alkaline pH of smoke from blends of tobacco utilized for pipes and cigars allows sufficient absorption of nicotine across the oral mucosa to satisfy the smokers need for this drug. Because of its higher alkalinity (pH 8.5) compared to cigarette smoke (pH 5.3), un-ionized nicotine is more readily absorbed through the mucous membranes in the mouth. Therefore, smokers of pipes and cigars tend not to inhale the smoke into the lung, confining the toxic and carcinogenic exposure and the increased rates of diseases, largely to the upper airways for most users of these products. Consequently nicotine absorption from cigar and pipe is much less than that from cigarette smoke. The acidic pH of the smoke generated by the tobacco used in cigarettes dramatically reduces absorption of nicotine in the mouth, necessitating inhalation of the smoke into the larger surface of the lungs in order to absorb quantities of nicotine sufficient to satisfy the smoker’s addiction. The shift of using tobacco as cigarettes, with resultant increased deposition of smoke in the lungs, has created the epidemic of heart diseases, lung diseases and lung cancer that dominated current disease manifestation of tobacco use.

Of the more than 7,000 chemicals in tobacco smoke, at least 250 are known to be harmful, including hydrogen cyanide, carbon monoxide, and ammonia. Among the 250 known harmful chemicals in tobacco smoke, at least 69 can cause cancer. When these chemicals get deep into your body’s tissues, they cause damage. Your body must fight to heal the damage each time you smoke. Over time, the damage can lead to disease. The chemicals in tobacco smoke reach your lungs quickly when you inhale. They go quickly from your lungs into your blood. Then the blood flows through your arteries. It carries the chemicals to tissues in all parts of your body. Your lungs, blood vessels, and other delicate tissues become inflamed and damaged when you smoke. When you keep smoking, the damage cannot heal. Smoking makes your immune system work overtime. Your body makes white blood cells to respond to injuries, infections, and even cancers. Blood tests show that your white blood cell numbers stay high when you smoke. High numbers mean that your body is constantly fighting against the damage caused by tobacco smoke. This constant stress disrupts how your body works. New research shows that stress can lead to disease in almost any part of your body. The poisons in smoke pose a danger right away. Sudden blood clots, heart attacks, and strokes can be triggered by tobacco smoke. Poisons in tobacco smoke disrupt the way your body heals itself. Even smoking a cigarette now and then is enough to hurt you. The more years you smoke, the more you hurt your body. Scientists now know that your disease risk surges even higher after you have smoked for about 20 years. But research shows that if you quit by age 30, your health could become almost as good as a nonsmoker’s. At any age, the sooner you quit, the sooner your body can begin to heal.

There are 69 chemical carcinogens in tobacco smoke out of which 18 are human carcinogens which can cause cancer in humans. DNA damage leads to cancer. DNA is the cell’s “instruction manual.” It controls a cell’s normal growth and function. When DNA is damaged, a cell can begin growing out of control and create a cancer tumor. This happens because poisons in tobacco smoke can destroy or change the cell’s instructions. Normally, your immune system helps to protect you from cancer. It sends out tumor fighters to attack and kill cancer cells. However, new research shows that the poisons in cigarette smoke weaken the tumor fighters. When this happens, cells keep growing without being stopped. For this reason, smoking can cause cancer and then block your body from fighting it. Breathing tobacco smoke when you already have cancer is especially dangerous. New research shows that tobacco smoke helps tumors grow. It can undo the benefits of chemotherapy.

Smoke contains several carcinogenic pyrolytic products that bind to DNA and cause many genetic mutations. Tobacco also contains nicotine, which is a highly addictive psychoactive chemical. When tobacco is smoked, nicotine causes physical and psychological dependency. Smoking also causes genetic changes in smoker. A study revealed that cigarette smoke can turn on or off some of the genes, which otherwise would remain inactive or active respectively. Some changes on genetic level could be reversed after the smoking was quit, yet others could not. Examples of reversible genes involved are the so-called xenofobic functions, nucleotide metabolism and mucus secretion. Smoking turns off some DNA repair genes that cannot be reversed. It also switches off some genes responsible from protection from cancer growth in the body.

U.S. Surgeon General Dr Regina M. Benjamin recently announced that smoking one cigarette can kill you. In fact, she says, just breathing in the smoke from someone else’s cigarette can also kill you. It’s all part of a just-released report entitled A Report of the Surgeon General: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease (http://www.surgeongeneral.gov/libra…) “The chemicals in tobacco smoke reach your lungs quickly every time you inhale, causing damage immediately,” Dr Benjamin says. “Inhaling even the smallest amount of tobacco smoke can also damage your DNA, which can lead to cancer.”

Adverse health effects of tobacco especially first-hand smoking (direct smoking):

“First-hand smoking” term is coined to differentiate from second-hand smoke and third-hand smoke (vide infra).

At age 61, identical twins Jeanne (left) and Susan no longer look exactly alike. A Study of identical twins reveals how habits like smoking can dramatically age skin. Smoking can speed up the normal aging process of your skin, contributing to wrinkles. These skin changes may occur after only 10 years of smoking. The more cigarettes you smoke and the longer you smoke, the more skin wrinkling you’re likely to have — even though the early skin damage from smoking may be hard for you to see. The nicotine in cigarettes causes narrowing of the blood vessels in the outermost layers of your skin. This impairs blood flow to your skin. With less blood flow, your skin doesn’t get as much oxygen and important nutrients, such as vitamin A. Many of the over 4,000 chemicals in tobacco smoke also damage collagen and elastin, which are fibers that give your skin its strength and elasticity. As a result, skin begins to sag and wrinkle prematurely because of smoking.

PET scans in smokers:

Imaging studies have already revealed that smoking alters the chemistry of cells throughout the body in unexpected ways. PET scans compare the distribution of the enzyme MAO-B in a nonsmoker and smoker. Circled areas indicate the highest MAO-B concentrations, areas captured in squares show intermediate levels, and areas with the lowest concentrations are unmarked. The smoker has lower MAO-B concentrations in peripheral organs than the nonsmoker.

Tobacco is the single greatest cause of preventable death globally. Tobacco-related diseases are some of the biggest killers in the world today. A recent study estimated that as much as 1/3 of China’s male population will have significantly shortened life-spans due to smoking. Male and female smokers lose an average of 13.2 and 14.5 years of life, respectively. Tobacco may be consumed by either smoking or other smokeless methods such as chewing but the World Health Organization (WHO) usually collects data on smoked tobacco. Smoking has therefore been studied more extensively than any other form of consumption.

The above graph shows tobacco as a risk factor for six of the eight leading cause of deaths in the world. Hatched areas indicate proportions of deaths that are related to tobacco use and are colored according to the column of the respective cause of death. Smoking is directly responsible for approximately 90 percent of lung cancer deaths and approximately 80-90 percent of COPD (emphysema and chronic bronchitis) deaths.

There are plenty of studies since 1930 onwards which demonstrates strong negative correlation between smoking and health, and between smoking and life span. A team of British scientists headed by Richard Doll carried out a longitudinal study of 34,439 medical specialists from 1951 to 2001, generally called the British Doctors Study. The study demonstrated that about half of the persistent cigarette smokers born in 1900–1909 were eventually killed by their addiction and about two thirds of the persistent cigarette smokers born in the 1920s would eventually be killed by their addiction. On the other hand, after a ban on smoking in all enclosed public places was introduced in Scotland in March 2006, there was a 17 percent reduction in hospital admissions for acute coronary syndrome and 67% of the decrease occurred in non-smokers. A person’s increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired. A year after quitting, the risk of contracting heart disease is half that of a continuing smoker.

A landmark study examined intimal ultrastructure of human umbilical arteries from newborn children of smoking and nonsmoking mothers. The umbilical artery was chosen as a possible model for evaluating the vascular injury provoked by tobacco smoking in humans. Cords from newborn children delivered by 15 nonsmoking and 13 smoking mothers were studied in the transmission & scanning electron microscope. Pronounced intimal changes were seen in the arteries from smoking mothers; the most important findings were degenerative changes of the endothelium such as swelling, blebbing, contraction, and subsequent opening of the endothelial junctions with formation of subendothelial edema. Other observations included dilation of the endoplasmic reticulum in the endothelium and reparative changes such as a considerable widening of the basement membrane. Since similar changes can be induced in arteries of animals by exposure to carbon monoxide or perfusion with nicotine, it is concluded that the present study supports the concept that tobacco smoking is harmful to the vascular endothelium. This study also contributes to an understanding of the mechanism through which vascular injury is provoked in heavy smokers.

The term “smoker” is used to mean a person who habitually smokes tobacco on a daily basis. This category has been the focus of the vast majority of tobacco studies. However, the health effects of less-than-daily smoking are far less well understood. A recent European study on occasional smoking published findings that the risk of the major smoking-related cancers for occasional smokers was 1.24 times that of those who have never smoked at all but the result was not statistically significant. However, according to American surgeon general’s report, even smoking a single cigarette can kill a person.

Upon a physical exam, a doctor may find various conditions associated with chronic tobacco use. Nicotine causes a characteristic brown staining of the hard palate, teeth, fingers, and fingernails. A smoker’s skin may wrinkle prematurely. Smokers have a typical odor to their hair and clothing. People with emphysema may have a large, barrel-shaped chest and a chronic cough that produces thick green sputum.

Smoking and Increased Health Risks:

Compared with nonsmokers, smoking is estimated to increase the risk of

1) Coronary heart disease by 2 to 4 times

2) Stroke by 2 to 4 times

3) Men developing lung cancer by 23 times

4) Women developing lung cancer by 13 times

5) Dying from chronic obstructive lung diseases (such as chronic bronchitis and emphysema) by 12 to 13 times

Cancer:

Experts agree that smoking is the single biggest cause of cancer in the world. Smoking causes over a quarter of cancer deaths in developed countries. The primary risks of tobacco usage include many forms of cancer, particularly lung cancer, kidney cancer, cancer of the larynx and head & neck, breast cancer, bladder cancer, cancer of the esophagus, cancer of the pancreas and stomach cancer. There is some evidence suggesting an increased risk of myeloid leukaemia, squamous cell sinonasal cancer, liver cancer, cervical cancer, colorectal cancer, cancers of the gallbladder, the adrenal gland, the small intestine, and various childhood cancers. A new study published in September 2009 found that breast cancer survivors who smoke increase their risk of a second breast cancer by as much as 120%. Doctors have known for years that smoking causes most lung cancers. Nearly 9 out of 10 men who die from lung cancer smoke. About 3,000 nonsmokers die each year from lung cancer caused by secondhand smoke in the U.S. Ten years after you quit smoking, your risk for dying from lung cancer drops by half. If you smoke, the risk of contracting mouth cancer is four times higher than for a non-smoker. Cancer can start in many areas of the mouth, with the most common being on or underneath the tongue, or on the lips. Within 5 years of quitting, your chance of cancer of the mouth, throat, esophagus, and bladder is cut in half. If nobody smoked, 1 of every 3 cancer deaths in the United States would not happen. The last results from the Doctors’ Study show that stopping smoking at 50 halved the excess risk of cancer overall, while stopping at 30 avoided almost all of it. However, it’s never too late to quit. One study found that even people who quit in their sixties can experience health benefits and gain valuable years of life.

Pulmonary:

In smoking, long term exposure to compounds found in the smoke such as carbon monoxide, cyanide, and so forth—, are believed to be responsible for pulmonary damage and for loss of elasticity in the alveoli, leading to emphysema and COPD. The carcinogen acrolein and its derivatives also contribute to the chronic inflammation present in COPD. Chronic obstructive pulmonary disease (COPD) caused by smoking, known as tobacco disease, is a permanent incurable reduction of pulmonary capacity characterized by shortness of breath, wheezing, persistent cough with sputum, and damage to the lungs which includes emphysema and chronic bronchitis. 80 to 90 % of all COPD are caused by smoking. Smoking causes the airways to become swollen, narrow, and filled with sticky mucus — the same problems that cause breathing trouble in people with asthma. For this reason, a smoker who has asthma is more likely to have more frequent and severe flare-ups. It’s estimated that 94 per cent of 20-a-day smokers have some emphysema when the lungs are examined after death, while

more than 90 per cent of non-smokers have little or none. An estimated 90% of all deaths from chronic obstructive lung disease are caused by smoking.

Researchers at University of Sydney have found that smoking fundamentally alters airway tissue in people with chronic obstructive pulmonary disease (COPD), and even while other aspects of health improve, the lung damage lasts long after a smoker quits. In their study, the researchers found that smoking lays the groundwork for airway thickening and precipitates precancerous changes in cell proliferation that may be self-perpetuating long after cigarette smoke exposure ends. They have demonstrated for the first time that the extracellular matrix (ECM) produced by fibroblasts following stimulation with cigarette smoke extract is functionally different than non-exposed ECM, and that the cigarette smoke itself may prime the airways in such a way to create an environment whereby airway remodeling is encouraged.

Cardiovascular:

Inhalation of tobacco smoke causes several immediate responses within the heart and blood vessels. Within one minute the heart rate begins to rise, increasing by as much as 30 percent during the first 10 minutes of smoking. Smoking causes blood flow to the extremities decreased (cold hands and feet).One puff lowers the temperature in the fingertips 1ºF to 3ºF in 3 minutes. Several ingredients of tobacco lead to the narrowing of blood vessels, increasing the likelihood of a blockage, and thus a heart attack or stroke. According to a study by an international team of researchers, people under 40 are five times more likely to have a heart attack if they smoke. Latest research of the American biologists has determined that cigarette smoke also influences the process of cell division in the cardiac muscle and changes the heart’s shape. The usage of tobacco has also been linked to Buerger’s disease (thromboangiitis obliterans), the acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. Smoking tends to increase blood cholesterol levels. Two to four cigarettes in a row increase blood fats 200 to 400%. Furthermore, the ratio of high-density lipoprotein (the “good” cholesterol) to low-density lipoprotein (the “bad” cholesterol) tends to be lower in smokers compared to non-smokers. Smoking also raises the levels of fibrinogen and increases platelet production (both involved in blood clotting) which makes the blood viscous. Carbon monoxide binds to haemoglobin (the oxygen-carrying component in red blood cells), resulting in a much stable complex than haemoglobin bound with oxygen or carbon dioxide—the result is permanent loss of red blood cell functionality causing reduced oxygen carrying capacity of blood. Blood cells are naturally recycled after a certain period of time, allowing for the creation of new, functional erythrocytes. However, if carbon monoxide exposure reaches a certain point before they can be recycled, hypoxia (and later death) occurs. All these factors make smokers more at risk of developing arteriosclerosis. As the arteriosclerosis progresses, blood flows less easily through rigid and narrowed blood vessels, making the blood more likely to form a thrombosis (clot). Sudden blockage of a blood vessel may lead to an infarction (heart attack or stroke depending on which blood vessel is blocked). However, it is also worth noting that the effects of smoking on the heart may be more subtle. These conditions may develop gradually given the smoking-healing cycle (the human body heals itself between periods of smoking), and therefore a smoker may develop less significant disorders such as worsening or maintenance of unpleasant dermatological conditions, e.g. eczema, due to reduced blood supply to skin. Smoking also increases blood pressure and weakens blood vessels.

In a nutshell smoking harms your heart in a number of different ways:

1) Smoking damages the lining of your arteries, leading to a buildup of fatty material (atheroma) and a reduced space for blood to pass through.

2) The carbon monoxide in cigarette smoke reduces the amount of oxygen that the blood can carry to your heart and body.

3) The nicotine in cigarettes stimulates your body to produce adrenaline, which makes your heart beat faster and raises blood pressure, and results in your heart having to work harder.

4) Your blood is more likely to clot.

All of these things increase the risk of developing coronary artery disease (heart attack) and a stroke.

Heart disease risk greater for women smokers:

Huge US study published in the Lancet finds risk of heart disease linked to smoking is 25% higher for women. Toxic chemicals in tobacco smoke may have a more potent effect on women due to biological differences, scientists believe.

US researchers analyzed pooled data on around 4 million individuals from 86 studies. After adjusting for other risk factors, they found the increased risk of heart disease linked to smoking was 25% higher for women. Women might extract a greater quantity of carcinogens and other toxic agents from the same number of cigarettes than men. Despite women generally smoking fewer cigarettes a day than men, women appear to be substantially more at risk of getting heart disease. _

Infection

Tobacco is also linked to susceptibility to infectious diseases, particularly in the lungs. Smoking more than 20 cigarettes a day increases the risk of tuberculosis by two to four times, and being a current smoker has been linked to a fourfold increase in the risk of invasive pneumococcal disease. It is believed that smoking increases the risk of these and other respiratory tract infections both through structural damage and through effects on the immune system. The effects on the immune system include an increase in CD4+ cell production attributable to nicotine, which has tentatively been linked to increased HIV susceptibility.

Smoking and HIV:

People with HIV disease are more likely to smoke than healthy people. Smoking can interfere with normal lung function in healthy people. In people with HIV, smoking can make it more difficult to fight off serious infections. Smoking weakens the immune system. It can make it harder to fight off HIV-related infections. This is especially true for infections related to the lungs. Having HIV increases the risk of chronic lung disease. Smoking can interfere with processing of medications by the liver. It can also worsen liver problems like hepatitis. People with HIV who smoke are more likely to suffer complications from HIV medication than those who don’t. For example, those who smoke are more likely to experience nausea and vomiting from taking HIV medications. Smoking increases the risk of some long-term side effects of HIV disease and treatment. People with HIV disease who smoke are more likely to develop several opportunistic infections related to HIV. A recent study found that smoking among people with HIV was linked to a higher rate of death. This was true for current smokers and ex-smokers.

Oral

Perhaps the most serious oral condition that can arise is that of oral cancer. Smokers are up to six times more at risk of getting cancer of the oral cavity than non-smokers. However, smoking also increases the risk for various other oral diseases, some almost completely exclusive to tobacco users. The National Institutes of Health, through the National Cancer Institute, determined in 1998 that cigar smoking causes a variety of cancers including cancers of the oral cavity (lip, tongue, mouth, and throat), esophagus, larynx, and lung. Pipe smoking involves significant health risks particularly oral cancer. Roughly half of periodontitis or inflammations around the teeth cases are attributed to current or former smoking. Smokeless tobacco causes gingival recession and white mucosal lesions. Up to 90% of periodontitis patients who are not helped by common modes of treatment are smokers. Smokers have significantly greater loss of bone height than nonsmokers, and the trend can be extended to pipe smokers to have more bone loss than nonsmokers. Smoking has been proven to be an important factor in the staining of teeth. Halitosis or bad breath is common among tobacco smokers. Tooth loss has been shown to be 2 to 3 times higher in smokers than in non-smokers. In addition, complications may further include leukoplakia, the adherent white plaques or patches on the mucous membranes of the oral cavity, including the tongue, and a loss of taste sensation or salivary changes. Halitosis, discoloration of the teeth, lips and tongue, caries, oral mucosal changes, poor wound healing or loss of implants are typical problems affecting smokers.

Male infertility & Impotence:

In a study of men aged 24 to 36 seeking treatment for infertility, researchers confirmed that smoking harms sperm quality in every way, from longevity to motility. Researchers also found that smoking affected sexual behavior. The smokers had sex an average of 5.7 times per month, while the nonsmokers reported an average of 11.6 encounters. And on a scale of 1 to 10, the smokers rated the quality of sex at a lackluster 5.2, compared to 8.7 for nonsmokers. Risk of impotence is increased to nearly 50% by smoking cigarettes for men in their 30s and 40s. Nicotine causes vasospasm of blood vessels in penis resulting in impotence.

Some people (mostly males) can be aroused by the sight of smoker smoking (usually females). This is called the Smoking Fetish, and affects a small number of the population. As with most fetishes, the reason for this arousal can usually be traced back to incidents in childhood. However, nicotine in smoke forces blood away from the penis if smoked while aroused.

Female infertility

Smoking is harmful to the ovaries, potentially causing female infertility, and the degree of damage is dependent upon the amount and length of time a woman smokes. Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to create estrogen, a hormone that regulates folliculogenesis and ovulation. Also, cigarette smoking interferes with folliculogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and the uterine myometrium. Some damage is irreversible, but stopping smoking can prevent further damage. Smokers are 60% more likely to be infertile than non-smokers. Smoking reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.

In pregnancy:

In addition to increasing risk for miscarriage, stillborn or premature infants, and low birth weight, maternal smoking predisposes children to a host of long-term behavioral problems, some of which only become apparent later in life. Children whose mothers smoke during pregnancy are also more likely to become dependent on tobacco if they start smoking. Understanding the persistent, deleterious effects of nicotine on the developing fetal brain should be a priority for researchers.

A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other threats to the health of the fetus. This can especially be a problem with women who have family history of smoking and live in a smoke filled environment. Women who quit smoking and then return to it also develop an increased sensitivity to the effects of smoking on their fetus. Once a woman who was previously a smoker quits and then returns to it while pregnant, the increased sensitivity to it has a very high chance of suffocating the fetus over a period of days in a slow cruel process eventually causing a miscarriage with a heavy flow to it. Continued smoking after this can cause a woman to become completely infertile altogether preventing them from ever being able to have children by causing permanent damage. Every cigarette smoked as well as being around second hand smoke after the miscarriage increase the chances of infertility. Smoking in pregnancy accounts for an estimated 20 to 30 percent of low-birth weight babies, up to 14 percent of preterm deliveries, and some 10 percent of all infant deaths. Even apparently healthy, full-term babies of smokers have been found to be born with narrowed airways and reduced lung function.

Women who smoke during pregnancy are more likely to have:

An ectopic pregnancy

Vaginal bleeding

Placental abruption (placenta peels away, partially or almost completely, from the uterine wall before delivery)

Placenta previa (a low-lying placenta that covers part or all of the opening of the uterus)

A stillbirth

Smoking during pregnancy affects you and your baby’s health before, during, and after your baby is born. The nicotine (the addictive substance in cigarettes), carbon monoxide, and numerous other poisons you inhale from a cigarette are carried through your bloodstream and go directly to your baby. Smoking while pregnant will:

Lower the amount of oxygen available to you and your growing baby.

Increase your baby’s heart rate.

Increase the chances of miscarriage and stillbirth.

Increase the risk that your baby is born prematurely and/or born with low birth weight.

Increase your baby’s risk of developing respiratory (lung) problems.

Increases risk of baby having birth defects such as cleft lip or palate.

The more cigarettes you smoke per day, the greater your baby’s chances of developing these and other health problems. There is no “safe” level of smoking while pregnant.

Smoking during pregnancy linked to persistent asthma in childhood:

Children with severe asthma are 3.6 times more likely to have been exposed to tobacco smoking before birth – even without later exposure – than children with a mild form of the disease, according to a multicenter study led by researchers at University of California, San Francisco. The prenatal exposure also was associated with three times the number of daily and night-time asthma symptoms later in the child’s life, as well as nearly four times the number of asthma-related emergency room visits, even when the researchers controlled for other risk factors, such as current tobacco exposure, ethnicity and allergies.

Renal:

In addition to increasing the risk of kidney cancer, smoking can also contribute to additional renal damage. Smokers are at a significantly increased risk for chronic kidney disease than non-smokers. A history of smoking encourages the progression of diabetic nephropathy.

Influenza:

Smoking may substantially contribute to the growth of influenza epidemics affecting the entire population. However the proportion of influenza cases in the general non-smoking population attributable to smokers has not yet been calculated.

Smoking and the Gastrointestinal Tract

Smoking increases acid production in the stomach. It also reduces blood flow and production of compounds that protect the stomach lining. Smoking can harm all parts of the digestive system, contributing to such common disorders as heartburn and peptic ulcers. Smoking increases the risk of Crohn’s disease, gall stones and damage to liver.

Smoking and Thyroid Disease:

Cyanide, a chemical found in tobacco smoke, interferes with thyroid hormone synthesis. Smoking triples the risk for developing thyroid disease, particularly hyperthyroidism and hypothyroidism. Women smokers with subclinical hypothyroidism (a symptom-free condition in which the thyroid gland is mildly underactive) have a higher risk for developing full-blown hypothyroidism than their nonsmoking peers. Smoking has also been linked to goiter, a swelling of the thyroid that occurs in people who do not get enough iodine.

Psychological:

Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. Several studies have monitored feelings of stress over time and found reduced stress after quitting. The deleterious mood effects of abstinence explain why smokers suffer more daily stress than non-smokers, and become less stressed when they quit smoking. Deprivation reversal also explains much of the arousal data, with deprived smokers being less vigilant and less alert than non-deprived smokers or non-smokers.

Social and behavioral:

Medical researchers have found that smoking is a predictor of divorce. Smokers have a 53% greater chance of divorce than nonsmokers.

People have a culture of viewing horoscopes of prospective partners before marriage. How about no smoking horoscope?

Bodyweight:

Studies suggest that smoking decreases appetite, but did not conclude that overweight people should smoke or that their health would improve by smoking. This is also a cause of heart diseases. However due to some new processes of treating tobacco, especially in the case of cigarette, heavy smokers tend to become overweight as the processing involves large quantities of starch. This effect is not seen in occasional smokers. Smoking also decreases weight by over expressing the gene AZGP1 which stimulates lipolysis.

Fires and accidents:

Cigarettes are the most frequent source of fires in private homes, which has prompted the European Union and the United States to ban cigarettes that are not fire standard compliant by 2011. Smoking causes about 10% of the global burden of fire deaths, and smokers are placed at an increased risk of injury-related deaths in general, partly due to also experiencing an increased risk of dying in a motor vehicle crash. Some 120 persons have died in two airline crashes that have been attributed to ashtray and lighter-fluid fires. Smokers get into more auto accidents due to being less alert, having slower reflexes, and also due to fussing around while driving (lighting up etc.). In Czechoslovakia it’s illegal to smoke while driving.

Miscellaneous:

New research has found that women who smoke are at significantly increased risk of developing an abdominal aortic aneurysm, a condition in which a weak area of the abdominal aorta expands or bulge. Smokers not only develop wrinkles and yellow teeth, they also lose bone density, which increases their risk of osteoporosis, a condition that causes older people to become bent over and their bones to break more easily. Smoking also causes cataracts, poor wound healing especially after surgery, decreased ability to taste and smell, hearing loss, incontinence and loss of sight due to an increased risk of macular degeneration. Sugar approximates to roughly 20% of a cigarette, and many diabetics are unaware of this secret sugar intake. Smoking destroys vitamins, particularly vitamin C and the B’s.

Work and time loss:

The smoker is sick more often, explaining why he misses an average of 7½ work days per year, usually with a loss of pay, while the non-smoker will miss only 4½ days. The smoker must spend valuable time looking for ashtrays, cigarettes, matches, retail stores, vending machines, or change for these machines. He experiences displeasure if they aren’t immediately at hand. Just the process of deciding on “which brand” wastes vast amounts of mental, physical, and financial resources.

Interaction of smoking and prescription drugs:

Cigarette smoking interacts with variety of other drugs. Cigarette smoking induces the cytochrome P450 system, which may alter the metabolic clearance of many drugs including theophyllin. Serum levels of theophyllin may rise when smokers are hospitalized and not allowed to smoke. Smokers may also have higher first-pass clearance for drugs such as lidocaine, and the stimulant effects of nicotine may reduce the effects of benzodiazepines or beta blockers.

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Bidi:

Bidis are small, thin hand-rolled cigarette, consist of tobacco wrapped in a tendu or temburni leaf (plants native to Asia), and may be secured with a colorful string at one or both ends. Bidis can be flavored (e.g., chocolate, cherry, and mango) or unflavored. Around 1 billion Bidis are sold in India every year. Bidis contain more tar, nicotine and other toxic substances but less tobacco than traditional cigarettes. Research studies from India indicate that bidi smoking is associated with cancer and other health conditions. Smoke from a bidi contains 3 to 5 times the amount of nicotine as a regular cigarette and places users at risk for nicotine addiction. Bidi smoking increases the risk for oral cancer, lung cancer, stomach cancer, and esophageal cancer. Bidi smoking is associated with a more than threefold increased risk for coronary heart disease and acute myocardial infarction (heart attack). Bidi smoking is associated with emphysema and a nearly fourfold increased risk for chronic bronchitis.

Hookah:

Hookahs originated in ancient Persia & India and have been used extensively for centuries. Today, hookah cafés are gaining popularity around the globe, including Britain, France, Russia, the Middle East, and the United State. Hookahs—sometimes called water pipes—are used to smoke specially made tobacco that is available in a variety of flavors. A typical modern hookah comprises a head (with holes in the bottom), a metal body, a water bowl, and a flexible hose with a mouthpiece. While many hookah smokers may consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks as cigarettes. Water pipe smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke. Due to the mode of smoking—including frequency of puffing, depth of inhalation, and length of the smoking session—hookah smokers may absorb higher concentrations of the toxins found in cigarette smoke. A typical 1-hour-long hookah smoking session involves inhaling 100–200 times the volume of smoke inhaled from a single cigarette. And that smoke has all the cancer-causing stuff as smoke from a cigarette. Hookah smokers are at risk for the same kinds of diseases as are caused by cigarette smoking, including oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility. Babies born to women who smoked one or more water pipes a day during pregnancy have lower birth weights (were at least 3½ ounces less) than babies born to nonsmokers and are at an increased risk for respiratory diseases. Secondhand smoke from hookahs poses a serious risk for nonsmokers, particularly because it contains smoke not only from the tobacco but also from the heat source (e.g., charcoal) used in the hookah. The fact that the tobacco is burned with charcoal doesn’t help. It just adds to the carbon monoxide, metals and cancer-causing chemicals. Sharing a hookah may increase the risk of transmitting tuberculosis, viruses such as herpes or hepatitis, and other illnesses. So in fact, hookah is worse than cigarettes.

Is smoking associated with high crime rate and low income?

Using a 10-Town study in Finland, researchers examined the relations of average household income and crime rate measured at the local area level, with smoking status and intensity by linking census data of local area characteristics from 181 postal zip codes to survey responses to smoking behavior in a cohort of 23,008 municipal employees. Gender-stratified multilevel analyses adjusted for age and individual occupational status revealed an association between low local area income rate and current smoking. High local area crime rate was also associated with current smoking. Both local area characteristics were strongly associated with smoking intensity. Among ever-smokers, being an ex-smoker was less likely among residents in areas with low average household income and a high crime rate. In the fully adjusted model, the association between local area income and smoking behavior among women was substantially explained by the area-level crime rate.

Smokeless tobacco:

Smokeless tobacco is tobacco that is not burned. It is also known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, and snuff. Most people chew or suck (dip) the tobacco in their mouth and spit out the tobacco juices that build up, although “spitless” smokeless tobacco has also been developed. Nicotine in the tobacco is absorbed through the lining of the mouth. There are two main types of smokeless tobacco:

1) Chewing tobacco, which is available as loose leaves, plugs (bricks), or twists of rope. A piece of tobacco is placed between the cheek and lower lip, typically toward the back of the mouth. It is either chewed or held in place. Saliva is spit or swallowed.

2) Snuff, which is finely cut or powdered tobacco. It may be sold in different scents and flavors. It is packaged moist or dry; most American snuff is moist. It is available loose, in dissolvable lozenges or strips, or in small pouches similar to tea bags. The user places a pinch or pouch of moist snuff between the cheek and gums or behind the upper or lower lip. Another name for moist snuff is snus (pronounced “snoose”). Some people inhale dry snuff into the nose.

Chewing is one of the oldest methods of consuming tobacco. Native Americans in both North and South America chewed the leaves of the plant, frequently mixed with the mineral lime. Chewing tobacco was the most prevalent form of tobacco use in the United States until it was overtaken by cigarette smoking in the early 20th century. Chewing tobacco has been known to cause cancer, particularly of the mouth and throat. In India, especially rural North India tobacco is not chewed but kept between lip and gum after being mixed with highly basic lime. This is called “jarda”. This form of tobacco is even more dangerous and has extreme health hazards. It mainly causes decaying of gums at very high rate. It is commonly done by males, who often carry small plastic or metal containers with compartments for lime and tobacco. Whether it’s snuff or chewing tobacco, you’re supposed to let it sit in your mouth and suck on the tobacco juices, spitting often to get rid of the saliva that builds up. This sucking and chewing allows nicotine, which is a drug you can become addicted to, to be absorbed into the bloodstream through the tissues in your mouth. You don’t even need to swallow. The more immediate effects can disrupt your social life: bad breath and yellowish-brown stains on your teeth. You’ll also get mouth sores (about 70% of spit tobacco users have them). But, it gets a lot more serious than that. Consequences of chewing and spitting tobacco include: cracking and bleeding lips and gums, receding gums, which can eventually make your teeth fall out, increased heart rate, high blood pressure, and irregular heartbeats, all leading to a greater risk of heart attacks and brain damage (from a stroke) and cancer especially oral cancer. Oral cancer means cancer of the mouth and can happen in the lips, the tongue, the floor of the mouth, the roof of the mouth, the cheeks, or gums.

The pictures below show cancer caused by tobacco chewing in the mouth.

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All forms of tobacco are harmful and addictive. There is no safe tobacco product. Although most research has focused on the harms of cigarette smoking, all forms of tobacco are harmful. All tobacco products contain nicotine and cancer-causing substances. Both smokeless tobacco and smoking tobacco are known to cause cancer in humans. These products may also cause heart attacks, mouth problems, and other diseases. Evidence suggests that smokeless tobacco produces an increase in the risk of oral cancer, gingivitis, and tooth loss. The risk of cancer in people using smokeless tobacco is lower than that of smokers, but is still higher than that of people who do not use tobacco at all. A 2009 analysis of 11 past studies indicates that using smokeless tobacco increases the risk of fatal heart attacks and strokes. There is no safe level of tobacco use. People who use any type of tobacco product should be urged to quit. In fact, the amount of nicotine absorbed from smokeless tobacco can be 3 to 4 times the amount delivered by a cigarette. The nicotine in smokeless tobacco may increase the risk for sudden death from a condition where the heart does not beat properly (ventricular arrhythmias) and, as a result, the heart pumps little or no blood to the body’s organs.

Some studies on smokeless tobacco products show they are considerably less risky than smoking cigarettes and cigars, which raises the risk of lung and a variety of other cancers, respiratory illness and heart disease. Nonetheless, smokeless tobacco products are not a safe substitute for tobacco smoking. Harmful health effects include:

Mouth, tongue and throat cancer

Cancer in the esophagus (the swallowing tube that goes from your mouth to your stomach)

Stomach cancer

Pancreatic cancer

Increased risk of heart disease, heart attacks, and stroke

Addiction to nicotine

Leukoplakia (white sores in the mouth that can become cancer)

Receding gums (gums slowly shrink from around the teeth)

Bone loss around the roots of the teeth

Abrasion (scratching and wearing down) of teeth

Tooth loss

Stained teeth

Bad breath

Infertility and harm to fetus

Will a switch from cigarettes to smokeless tobacco benefit public health?

Yes. Because all forms of tobacco are not equally risky.

1) Smokeless tobacco use is less harmful than cigarette smoking. Thus, it can save the lives of smokers.

2) Another major health benefit: smokers who switch to smokeless tobacco produce no passive smoke to harm others and therefore it can save live of those persons who breathe second-hand smoke.

3) Smokeless tobacco effectively provides the nicotine kick smokers crave.

4) Smokeless tobacco causes neither lung cancer nor other diseases of the lung. In fact, the most consequential adverse health effect of smokeless tobacco use is oral cancer.

5) Smokeless tobacco prevents cigarette litter.

In the Table below, researchers have compared directly the annual mortality of 46 million smokers and an equal number of smokeless tobacco users. The number of deaths from smoking is almost 70 times higher than the number from smokeless tobacco use. In terms of life expectancy, the smokeless-tobacco user loses only about 15 days on average, compared with the eight years lost by the smoker.

Deaths	Smokers	Smokeless tobacco users
From cancer	151,000	6,000
(mouth cancer)	(11,500)	(6,000)
From heart & circulatory disease	180,000	0
From respiratory disease	85,000	0
Miscellaneous	3,000	0
Total	419,000	6,000
Years of life lost (average)	7.8	0.04

Will non-users of tobacco, especially teenagers, misinterpret this message and begin smokeless tobacco use? It is possible, so I have directed this message carefully and specifically to adult smokers. I am opposed to tobacco initiation by anyone. But I recognize that tobacco initiation is a complicated matter, more influenced by peer pressure and parental usage than by a scientific discussion of tobacco risks. History tells us that in spite of society’s best efforts, some portion of the population has always been addicted to tobacco. In its concern over tobacco initiation, society cannot deny adult smokers medical information permitting them to lead longer and healthier lives. This message does not represent tobacco promotion, but tobacco pragmatism. All forms of tobacco use are harmful and must be discouraged. However, if a smoker has failed to quit smoking despite best efforts, switching to smokeless tobacco will reduce health risk to him & society.

After discussing first-hand smoking (direct smoking) and smokeless tobacco, let me discuss second & third hand smoking. During consumption of first-hand smoke, an individual is himself smoking and harming himself. On the other hand, during consumption of second or third hand smoke, an individual himself is not smoking but exposed to smoke of a first hand smoker by virtue of being in the proximity of a smoker or being present in environment where someone has already smoked. In other words, experience of second or third hand smoke is nothing but victimization of an innocent bystander. As far as consumption of smokeless tobacco is concerned, there is no second or third hand tobacco effect.

Second-hand smoke (SHS):

Passive smoking is the inhalation of smoke, called secondhand smoke (SHS) or environmental tobacco smoke (ETS), from tobacco products used by others. It occurs when tobacco smoke permeates any environment, causing its inhalation by people within that environment. Exposure to SHS causes disease, disability, and death. Currently, the health risks of SHS are a matter of scientific consensus, and these risks have been a major motivation for smoking bans in workplaces and indoor public places, including restaurants, bars and night clubs, as well as some open public spaces. SHS causes many of the same diseases as direct smoking, including cardiovascular diseases, lung cancer, and respiratory diseases.

SHS is a combination of Mainstream smoke exhaled by smokers and Sidestream smoke given off by the burning end of a cigarette, cigar, or pipe. Between 70% and 90% of non-smokers in the American population, children and adults are regularly exposed to secondhand smoke. It is estimated that only 15% of cigarette smoke gets inhaled by the smoker. The remaining 85% lingers in the air for everyone to breathe. If a person spends more than two hours in a room where someone is smoking, the nonsmoker inhales the equivalent of four cigarettes.

In 1860, SHS was viewed as an inconvenience. A 2001 study found that 95% of adults agreed that SHS was harmful to children, and 96% considered tobacco-industry claims that SHS was not harmful to be untruthful. Most exposure to SHS occurs in homes and workplaces. SHS exposure also continues to occur in public places such as restaurants, bars, and casinos and in private vehicles.

Second-hand smoke (SHS) consists mainly of sidestream smoke, which is about four times more toxic than mainstream smoke, although people inhale it in a more diluted form. 2004 study by the International Agency for Research on Cancer of the World Health Organization concluded that nonsmokers are exposed to the same carcinogens as active smokers. SHS contains twice as much tar and nicotine per unit volume as does smoke inhaled from a cigarette. Sidestream smoke contains more than 4,000 chemicals, including 69 known carcinogens. Of special concern are polynuclear aromatic hydrocarbons, tobacco-specific N-nitrosamines, and aromatic amines, such as 4-Aminobiphenyl, all known to be highly carcinogenic. The sidestream smoke contains much higher levels of many of the poisons and cancer-causing chemicals in cigarettes as compared to smoke inhaled by smoker, including:

1) up to three times as much carbon monoxide

2) five times more cadmium

3) 3 – 10 times more polycyclic aromatic hydrocarbons

4) 10 -40 times more nitrosamines

5) about 15 times more benzene

6) 40-70 times more ammonia

7) three times as much cancer-causing benzpyrene

SHS has been shown to produce more particulate-matter (PM) pollution than an idling low-emission diesel engine. In an experiment conducted by the Italian National Cancer Institute, three cigarettes were left smoldering, one after the other, in a 60 cubic meter garage with a limited air exchange. The cigarettes produced PM pollution exceeding outdoor limits, as well as PM concentrations up to 10-fold that of the idling engine.

There is widespread scientific consensus that exposure to SHS is harmful. The link between passive smoking and health risks is accepted by every major medical and scientific organization. Even short exposures to SHS can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk of heart attack. Nonsmokers who are exposed to SHS at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%. In 2004, the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) reviewed all significant published evidence related to tobacco smoking and cancer. It concluded: “These meta-analyses show that there is a statistically significant and consistent association between lung cancer risk in spouses who are exposed to secondhand tobacco smoke from their partner who smokes. The excess risk is of the order of 20% for women and 30% for men and remains after controlling for some potential sources of bias and confounding.” The National Asthma Council of Australia cites studies showing that SHS is probably the most important indoor pollutant, especially around young children and smoking by either parent, particularly by the mother, increases the risk of asthma in children. There is good observational evidence that smoke-free legislation reduces the number of hospital admissions for heart disease. In 2009 two studies in the United States confirmed the effectiveness of public smoking bans in preventing heart attacks. The first study, done at the University of California, San Francisco and funded by the National Cancer Institute, found a 15 percent decline in heart-attack hospitalizations in the first year after smoke-free legislation was passed, and 36 percent after three years. The second study, done at the University Of Kansas School Of Medicine, showed similar results. Overall women, nonsmokers, and people under age 60 had the most heart attack risk reduction. Many of those benefiting were hospitality and entertainment industry workers.

The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have classified secondhand smoke (SHS) as a known human carcinogen (cancer-causing agent). Inhaling SHS causes lung cancer in nonsmoking adults. Approximately 3,000 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke. The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30 percent. SHS causes disease and premature death in nonsmoking adults and children. Exposure to SHS may increase the risk of heart disease by an estimated 25 to 30 percent. In the United States, exposure to SHS is thought to cause about 46,000 deaths from heart disease each year. Pregnant women exposed to SHS are at risk of having a baby with low birth weight. Children exposed to SHS are at an increased risk of SIDS, ear infections, colds, pneumonia, bronchitis, and more severe asthma. Being exposed to SHS slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless.

A study published in the lancet found that worldwide 40% of children, 33% of male non-smokers, and 35% of female non-smokers were exposed to second-hand smoke (SHS) in 2004. This exposure was estimated to have caused 379000 deaths from ischaemic heart disease, 165000 from lower respiratory infections, 36900 from asthma, and 21400 from lung cancer. 603000 deaths were attributable to SHS in 2004, which was about 1·0% of worldwide mortality.

Secondhand smoke during pregnancy can cause a baby to be born at low birth weight. Secondhand smoke is also dangerous to young children. Babies exposed to secondhand smoke:

Are more likely to die from SIDS (Sudden Infant Death Syndrome).

Are at greater risk for asthma, bronchitis, pneumonia, ear infections, and respiratory symptoms.

May experience slow lung growth.

In children, secondhand smoke causes the following:

Ear infections

More frequent and severe asthma attacks

Respiratory symptoms (e.g., coughing, sneezing, shortness of breath)

Respiratory infections (i.e., bronchitis, pneumonia)

Scientists at the University of Rochester Medical Center have found that women exposed to second hand smoke, either as adults or children, significantly diminished their chances of being able to have children. A study of almost 5000 women who were non-smokers indicated that they faced a 68% greater chance of having difficulty getting pregnant and suffering one or more miscarriages if they had been exposed to second hand smoke six or more hours a day either as children or during adulthood.

Hearing Loss in Teens Linked to SHS:

Unusual as it sounds, a recent analysis shows secondhand smoke may harm areas other than the respiratory system in teens.

Data taken from 1,533 U.S. participants between 12 and 19 years of age revealed that individuals with higher levels of one nicotine compound in their blood were also more likely to have a common type of hearing loss in at least one ear. Among the 799 participants exposed to SHS, 11.8 percent showed noticeable levels of hearing loss compared to 7.5 percent from the 754 participants not exposed to smoke. The risk of hearing loss among participants exposed to secondhand smoke was 1.5 times that of the non-exposure group.

SHS can be evaluated either by directly measuring tobacco smoke pollutants found in the air or by using biomarkers an indirect measure of exposure. As of 2005, Nicotine, cotinine, thiocyanates and carbon monoxide are the most specific biological markers of tobacco smoke exposure. 2007 study in the Addictive Behaviors Journal found a positive correlation between SHS exposure and concentrations of nicotine and/or biomarkers of nicotine in the body. Significant biological levels of nicotine from SHS exposure were equivalent to nicotine levels from active smoking and levels that are associated with behavior changes due to nicotine consumption. Cotinine, the metabolite of Nicotine is a biomarker of SHS exposure. Typically, cotinine is measured in the blood, saliva, and urine. Cotinine levels of the skin, such as the hair and nails, reflect tobacco exposure over the previous three months and are a more reliable biomarker. Carbon monoxide monitored via breath is also a reliable biomarker of SHS exposure as well as direct tobacco smoking (vide infra).

SHS and animals:

Dogs, cats and even birds are not impervious to the damage from cigarettes. Even very small amounts of inhaled smoke can have damaging effects on your pets. One reason cats are so vulnerable to the carcinogens in tobacco smoke is they are meticulous groomers. Daily grooming over a long period of time can expose their delicate oral tissues to hazardous amounts of carcinogens. Animals like dogs, cats, squirrels, and other small animals are affected by not only second-hand smoke inhalation, but also nicotine poisoning. Domestic pets, especially dogs, usually fall ill when owners leave nicotine products like cigarette butts, chewing tobacco, or nicotine gum within reach of the animal. The IARC monographs concluded that sidestream smoke condensates had a significantly higher carcinogenic effect on mice than did mainstream smoke condensates. Passive smoking may cause mutations in the DNA of sperm, according to a study in mice. The corollary suggests that men exposed to second-hand smoke could pass on any resulting genetic abnormalities to their children. Multiple studies have been conducted to determine the carcinogenicity of SHS to animals.

1) A 2002 Tufts University study linked second-hand smoke to cancer in cats. The study found that cats living with smokers are twice as likely to develop malignant lymphoma—the most common feline cancer–as those in non-smoking households. Lymphoma kills 3 out of 4 afflicted cats within 12 months.

2) A 2007 University of Minnesota study showed that cats who live with smokers have nicotine and other toxins in their urine.

3) A 2007 Tufts School of Veterinary Medicine study linked second-hand smoke to oral cancer in cats (squamous cell carcinoma.) Cats living with more than one smoker and cats exposed to environmental tobacco smoke for longer than five years had even higher rates of this cancer.

4) A 1998 Colorado State University study, published in the American Journal of Epidemiology, found a higher incidence of nasal tumors and cancer of the sinus in dogs living in a home with smokers, compared to those living in a smoke-free environment. The nasal/sinus tumors were specifically found among the long-nosed breeds such as retrievers and German shepherds. Unfortunately, dogs with nasal cancer do not usually survive more than one year.

5) The same study showed higher lung cancer rates in short to medium nosed dogs who live with smokers, such as boxers and bulldogs. Their shorter nasal passages made it easier for cancer-causing particles to reach the lungs.

6) Another study published in the American Journal of Epidemiology found that dogs in smoking households have a 60 percent greater risk of lung cancer.

7) A bird’s respiratory system is hypersensitive to any type of airborne pollutant. The most serious consequences of smoke exposure in birds are pneumonia and lung cancer, but they can also develop eye, skin, heart and fertility problems. Coughing and wheezing are common reactions.

______________________

The above picture shows that allowing someone to smoke in only one room does not protect nonsmokers. Smoke from halls and stairs gets inside, too. There is no safe level of exposure to secondhand smoke (SHS). Even low levels of SHS can be harmful. The only way to fully protect nonsmokers from SHS is to completely eliminate smoking in indoor spaces. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot completely eliminate exposure to SHS.

Protect your family from secondhand smoke. SHS causes immediate harm to nonsmokers who breathe it. If you are a nonsmoker, you can do some important things to protect yourself and your family.

1) Do not allow anyone to smoke anywhere in or near your home. Some of the smoke stays in your house even if you only allow smoking near an open window.

2) Do not allow anyone to smoke in your car, even with the window down. No amount of smoke is safe.

3) Make sure your children’s day care centers and schools are tobacco-free. A tobacco-free campus policy prohibits any tobacco use or advertising on school property by anyone at any time. This includes off-campus school events.

4) If your state still allows smoking in public areas, look for restaurants and other places that do not allow smoking. “No-smoking sections” do not protect you and your family from secondhand smoke.

5) Teach your children to stay away from secondhand smoke. Be a good role model by not smoking.

WHO recommends that governments require that all indoor areas—all businesses, all workplaces, all schools, hospitals, and so on—should be 100% smoke free, and individuals should insist that their homes are 100% smoke free. Smoke-free environments do not result in lost business to restaurants, bars or hotels. Independent studies show that, on average, business remains at the same level or even increases after the introduction of smoking bans. Not a single independent and rigorous study has proved that smoking bans result in negative results for the economy. Ventilation systems do not protect non-smokers from SHS. In order to eliminate the toxins in SHS, so many air exchanges would be required that it would be impractical, uncomfortable and unaffordable.

Third-hand smoke:

The term “third-hand smoke” was recently coined to identify the residual tobacco smoke contamination that remains after the cigarette is extinguished and second-hand smoke has cleared from the air. Third-hand smoke is a relatively new concept, and researchers are still studying its possible dangers. Third-hand smoke is generally considered to be residual nicotine and other chemicals left on a variety of indoor surfaces by tobacco smoke. This residue is thought to react with common indoor pollutants to create a toxic mix. This toxic mix of third-hand smoke contains cancer-causing substances, posing a potential health hazard to nonsmokers who are exposed to it, especially children. Studies show that third-hand smoke clings to hair, skin, clothes, furniture, drapes, walls, bedding, carpets, dust, vehicles and other surfaces, even long after smoking has stopped. Infants, children and nonsmoking adults may be at risk of tobacco-related health problems when they inhale, ingest or touch substances containing third-hand smoke. Third-hand smoke residue builds up on surfaces over time and resists normal cleaning. Third-hand smoke can’t be eliminated by airing out rooms, opening windows, using fans or air conditioners, or confining smoking to only certain areas of a home. Third-hand smoke remains long after smoking has stopped. The only way to protect nonsmokers from third-hand smoke is to create a smoke-free environment, whether that’s your private home or vehicle, or in public places, such as hotels and restaurants. Even if you choose to smoke outside of your home or only smoke in your home when your children aren’t there, you’re still exposing them to a cocktail of lethal toxins. When you come into contact with your children, even if you’re not smoking at the time, you’re exposing them to the toxic tobacco particles that are in your hair and clothing.

Typical indoor ventilation removes about half of the particulate matter released from the tip of a cigarette but the remaining sticky tar, oil and waxy compounds are left to accumulate, toxic layer upon toxic layer. You basically build up a giant reservoir of cancer-causing compounds on every surface. According to a recent study nicotine will persist in a house previously occupied by smokers even if the rooms are given fresh layers of paint, new carpeting and standard cleaning. A number of third-hand smoke’s toxic components are released by first- and secondhand smoking, including formaldehyde, benzene and arsenic. Nicotine, the main component of cigarette smoke, can react with gases such as ozone and nitrous oxide to form lung cancer-causing compounds called tobacco-specific N-nitrosamines (TSNAs). As the smoke ages, concentrations of these compounds have been found to increase.

As reported in the January 2009 issue of the journal Pediatrics, toxins from tobacco cling to a smoker’s hair, clothing, and on other surfaces within the home, including carpets and cushions long after a cigarette is put out. Children may then ingest these particles while playing, crawling, or just snuggling up to the smoker. Researchers say tobacco smoke carries 250 poisonous gases, chemicals and several harmful metals. These compounds may remain within a home long after smoking has stopped (nursing mothers who smoke may also transfer the toxins into her baby via breast milk). And over time, children who are exposed to these low levels of tobacco particles may develop cognitive deficits and psychological problems like ADHD. According to the authors of the Pediatrics report, awareness is the first major step towards stamping out third-hand smoke. After surveying more than 1,500 households in the United States, they found that fewer than half of smokers agreed that third-hand smoke was harmful to children. Additionally, only about 25 percent had strict rules about not smoking in the house. Breathing in these toxins at an early age (babies and young children) may have devastating health problems like asthma and other breathing issues, learning disorders and cancer. It’s important that expecting moms and their children do their best to keep away from places where people smoke.

Cigarette butts and litter:

The common name for the remains of a cigarette after smoking is a “(cigarette) butt”. The butt typically comprises about 30% of the cigarette’s original length. It consists of a tissue tube which holds a filter and some remains of tobacco mixed with ash. Cigarette filters are made from cellulose acetate and are biodegradable, though depending on environmental conditions they can be resistant to degradation. Accordingly, the duration of the degradation process is cited as taking as little as 1 month to 3 years, to as long as 10–15 years. It is estimated that 4.5 trillion cigarette butts become litter every year. Cigarette butts contain the chemicals filtered from cigarettes and can leach into waterways and water supplies. The results of one study indicate that the chemicals released into freshwater environments from cigarette butts are lethal to daphnia at concentrations of 0.125 cigarette butts per liter (or one cigarette butt per 8 liter). Cellulose acetate and carbon particles breathed in from cigarette filters are suspected of causing lung damage. Smoldering cigarette butts have also been blamed for triggering fires from residential fires to major wildfires & bushfires which have caused major property damage and also death as well as disruption to services by triggering alarms and warning systems.

“Low tar”, “light” and filtered cigarettes:

There is no safe cigarette. Smokers are still exposed to dangerous chemicals if they smoke filtered or ‘low-tar’ cigarettes. The evidence indicates that changing cigarette designs over the last five decades, including filtered, low-tar, and “light” variations, have NOT reduced overall disease risk among smokers and may have hindered prevention and cessation efforts. A cigarette filter has the purpose of reducing the amount of smoke, tar, and fine particles inhaled during the combustion of a cigarettes. Filters also reduce the harshness of the smoke and keep tobacco flakes out of the smoker’s mouth. However, Filters do not block out the many toxic gases in smoke, such as hydrogen cyanide, ammonia and carbon monoxide. They also do nothing to reduce levels of sidestream smoke from the burning end of the cigarette. Some smokers block filters with fingers or saliva. One Canadian study showed that over half of discarded cigarette butts showed blocked filters. Some of the most dangerous chemicals in tobacco smoke, like hydrogen cyanide, are present as gases, and do not count as part of tar. This means that cigarettes with less tar are not necessarily any less dangerous. Besides, researchers have found that people who smoked low-tar brands smoked harder and more frequently to satisfy their nicotine cravings. For example, in one study, low-tar smokers inhaled 40% more smoke per cigarette and ended up with similar nicotine levels as smokers who use normal brands. According to another study, low-tar smokers ended up inhaling about 80% more smoke, and had similar levels of cancer-causing chemicals in their blood. They can also inhale over twice as much tar and nicotine as smokers of normal brands. Tar coats your lungs like soot in a chimney and causes cancer. A 20-a-day smoker breathes in up to a full cup (210 g) of tar in a year. Changing to low-tar cigarettes does not help because smokers usually take deeper puffs and hold the smoke in for longer, dragging the tar deeper into their lungs. The overall health of the public could be harmed if the introduction of novel tobacco products (low-tar or light cigarettes) encourages tobacco use among people who would otherwise be unlikely to use a tobacco product or delays cessation among persons who would otherwise quit using tobacco altogether.

Electronic cigarette (e-cigarette):

The Electronic cigarette is a 2 piece build device, containing a battery & a cartridge containing pure liquid nicotine which may be flavored. The battery heats the coil when switched on, which turns the liquid nicotine into vapors which is inhaled by users giving a smoking sensation without the harmful side-effects. The smoke produced by the e-cigarettes is just pure nicotine & doesn’t contain the harmful chemicals like tar & carbon monoxide which makes it safe for use & also doesn’t affect the health of those around. The e-cigarettes give the smokers a sense of taste but no second-hand smoke and no bad breath or yellow teeth. In September 2008, the World Health Organization issued a release proclaiming that it does not consider the electronic cigarette to be a legitimate smoking cessation aid, stating that to its knowledge, “No rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy.” Newer information from the FDA suggests that e-cigarettes are not safe. A 2009 analysis of 18 samples of cartridges from 2 leading e-cigarette brands found cancer-causing substances in half the samples. Unless e-cigarettes are approved by WHO & FDA, it cannot be recommended to smokers who want to quit smoking.

Eco-friendly cigarette:

When you hear a product is eco-friendly, you think it’s better for you. It is misleading to talk about being eco-friendly in a cigarette advertisement. The tobacco company says it’s not saying its cigarettes are safer but that its manufacturing is greener. It says its facilities are wind-powered, its tobacco farmers use fewer chemicals and 70% of their sales staff drives hybrid vehicles. Nonetheless, eco-friendly cigarettes are as harmful as any other cigarettes.

Tobacco and largest democracy India:

Tobacco was introduced into Europe in the late 15th century. Sometime in the late 16th or early 17th century, Portuguese traders introduced it into India. Since then, tobacco use has spread with remarkable rapidity, seeping into all sections of the society. Initially tobacco was smoked in India, but later it was used for chewing and application over the teeth and the gingiva as well (smokeless form). In the course of time, large spectrums of methods of use were developed. India is the second largest producer of tobacco in the world. Tobacco leaves are mainly used for hand-rolled bidis and chewing tobacco. The tobacco industry is a lucrative one, and numerous research centers study ways to increase productivity. However, health-related costs are also high. It had been estimated that in India, over 100 million people smoke bidis, and about 25 million smoke cigarettes, while 120 million make use of smokeless tobacco, making this nation the second largest consumer. Chewing tobacco and bidis are highly addictive and high in carcinogens. It is estimated that among the 400 million individuals aged 15 years and over in India, 47% use tobacco in one form or the other. Some 72% of tobacco users smoke bidis, 12% smoke cigarettes, and 16% use tobacco in the smokeless form. Of the 250 million kg tobacco cleared for domestic consumption in India, 86% is used for smoking, and 14% is used in the smokeless form (1% as snuff).

While WHO’s recommendation says that 65% to 80% of the retail price of a tobacco product has to be taxed, the current tax levels for bidis and cigarettes are 9% and 38%, respectively in India. A study reveals that in comparison to India, tax rate in Australia is 68%, Bangladesh 67%, Japan 63%, Malaysia 54%, Sri Lanka 77% and Thailand 70%. Some other countries, which are yet to increase taxes on tobacco products, include China (39%), Indonesia (37%), Philippines (30%) and Vietnam (45%). Research has shown that rising price of tobacco products by 10% in middle and low-income countries will result in reduction of consumption by 8%. There is overwhelming evidence to suggest that India is a failed state as far as taxes on tobacco products are concerned. No wonder, tobacco consumption in India is growing day by day as compared to other developing nations.

The tradition of chewing pan (betel leaf) is deeply rooted in India.

The popularity of chewable tobacco, particularly among the young, is a growing concern for doctors in India. They are already reporting a rise in pre-cancerous lesions in the mouth. Wrapped inside a betel leaf and placed in the side of the mouth, tobacco has been chewed for centuries in India. But it is only in the last decade that tobacco companies have started selling tobacco ready-packaged in small sachets. They are popular with street children and teenagers can go through up to 15 packets a day. It is called Gutka which is a preparation of crushed areca nut (also called betel nut), tobacco, catechu, paraffin, lime and sweet or savory flavorings. In 2008 about 5 million children under 15 were addicted to gutka in India. Excessive gutka use can eventually lead to loss of appetite, promote unusual sleep patterns, and loss of concentration along with other tobacco related problems. A gutka user can easily be identified by prominently stained teeth ranging from dirty yellowish-orange to reddish-black. The stains are difficult to remove by normal brushing and usually need the attention of a dentist. After gutka is consumed, it is generally spat onto a wall or at the ground, causing an unsightly red stain that is quite resistant to the elements. According to health officials, some children like Gutka because it’s an appetite suppressant. As health experts know that children started using Gutka six or seven years ago, they fear an epidemic of oral cancer will soon hit India. They say 11 and 12-year-old children are getting pre-cancerous growths after just two years of chewing gutka. Mumbai’s annual film festival – the Bollywood Oscars – is sponsored by one of the main producers of Gutka. Health campaigners are appalled that some big names in cinema and sport have promoted these products in TV adverts. The problem, say campaigners, is that chewing tobacco has always been seen as socially acceptable in India. Government officials say India accounts for nearly a sixth of an estimated six million tobacco-related deaths in the world (per year). In 2001, officials in Delhi, the Indian capital, banned the sale of cigarettes to people under the age of 18. India banned smoking in public places in 2008, a move the government hopes will help curb the habit in a country that has one of the world’s largest populations of smokers. However, gutka is freely available in India even to children.

A new study suggests that by 2010, India’s death toll due to tobacco consumption will be about 1 million people a year, taking the country’s smoking epidemic to catastrophic proportions. The study, which was published by the New England Journal of Medicine, is the work of researchers from India, Canada and the UK, and is the first nationally representative investigation of smoking in India as a whole. There are about 120 million smokers in India. About 5 per cent of women and more than one third of men aged between 30 and 69 smoke either conventional cigarettes or bidis. The researchers calculated that on average in India, compared with non smokers, men who smoke bidis die about six years earlier, women who smoke them die about eight years earlier, and men who smoke cigarettes die about 10 years earlier (about the same as in the West). Even low levels of smoking were not found to be safe, wrote the researchers. Smoking a few bidis a day brought substantial risks, and smoking a few cigarettes a day brought even more, to the point of doubling the risk of death in middle age, they wrote. The extreme risks from smoking that they found surprised everyone, as smokers in India start at a later age than those in Europe or America and smoke less. And smoking kills not only from diseases like cancer and lung diseases but also from tuberculosis and heart attacks. The study also found that one single factor, namely smoking, which is an entirely preventable, account for nearly one in ten of all deaths in India. In response, various activists have campaigned against tobacco products. One example is Dr. Sharad Vaidya, a cancer surgeon in India who helped to add the study of tobacco’s health effects to school curricula, to establish legislation banning public smoking, to stop sports sponsorship, and to prohibit sale to those under 18 years of age.

According to ministry of health in India, tobacco use causes nearly 40 percent of all health problems and 50 percent of all cancers. In India the tobacco contributes to 56.4% and 44.9% of cancers in men and women, respectively. India has the largest number of oral cancer cases in the world which is due to tobacco chewing. Tobacco smoking accounts for 82% of chronic obstructive lung disease in India. Prevalence of TB is about 3 times as great among the ever-smokers as among the never-smokers. Mortality from TB is 3 to 4 times as great in ever-smokers than in never-smokers. Out of 1 million Indians that are going to die from smoking every year, 50% of these are going to be illiterate people. These are people who don’t know what the warnings on the cigarette and bidi packets are saying. In china the quit rate (people who quit smoking annually) went from 2% to 10% after posting pictorial warnings and if India got pictorial warnings, it would mean that almost 100000 lives could be saved every year.

Is tobacco addictive?

Yes. Nicotine is a drug that is naturally present in the tobacco plant and is primarily responsible for a person’s addiction to tobacco products, including cigarettes. During smoking, nicotine enters the lungs and is absorbed quickly into the bloodstream and travels to the brain in a matter of seconds. Nicotine causes addiction to cigarettes and other tobacco products that is similar to the addiction produced by using drugs such as heroin and cocaine.

The above graph that shows the efficiency of smoking as a way to absorb nicotine compared to other forms of intake.

Nicotine:

Nicotine (C10H14N2) is a naturally occurring liquid alkaloid. An alkaloid is an organic compound made out of carbon, hydrogen, nitrogen and sometimes oxygen. These chemicals have potent effects on the human body. For example, many people regularly enjoy the stimulating effects of another alkaloid, caffeine, as they quaff a cup or two of coffee in the morning. Nicotine normally makes up about 5 percent of a tobacco plant, by weight.

Data from The Lancet suggests tobacco is ranked the 3rd most addictive and 14th most harmful of 20 popular recreational drugs.

Nicotine readily diffuses through:

Skin

Lungs

Mucous membranes (such as the lining of your nose or your gums)

Nicotine moves right into the small blood vessels that line the tissues listed above. From there, nicotine travels through your bloodstream to the brain, and then is delivered to the rest of your body. The most common (and the most expedient way) to get nicotine and other drugs into your bloodstream is through inhalation — by smoking it. Your lungs are lined by millions of alveoli, the tiny air sacs where gas exchange occurs. These alveoli provide an enormous surface area — 90 times greater than that of your skin — and thus provide ample access for nicotine and other compounds. Once in your bloodstream, nicotine flows almost immediately to your brain. Within 10 to 15 seconds of inhaling, most smokers are in the throes of nicotine’s effects. Nicotine doesn’t stick around your body for too long. It has a half-life of about 60 minutes, meaning that six hours after a cigarette, only about 0.031 mg of the 1 mg of nicotine you inhaled remains in your body. About 80 percent of nicotine is broken down to cotinine by enzymes in your liver. Nicotine is also metabolized in your lungs to cotinine and nicotine oxide. Cotinine and other metabolites are excreted in your urine. Cotinine has a 24-hour half-life, so you can test whether or not someone has been smoking in the past day or two by screening his or her urine for cotinine. The remaining nicotine is filtered from the blood by your kidneys and excreted in the urine. Different people metabolize nicotine at different rates. Some people even have a genetic defect in the enzymes in their liver that break down nicotine, whereby the mutant enzyme is much less effective at metabolizing nicotine than the normal variant. If a person has this gene, their blood and brain nicotine levels stay higher for longer after smoking a cigarette. Normally, people keep smoking cigarettes throughout the day to maintain a steady level of nicotine in their bodies. Smokers with this gene usually end up smoking many fewer cigarettes, because they don’t constantly need more nicotine.

In a cigarette (which contains less than 1 gram of tobacco), the nicotine content can vary between 13.7 and 23.2 milligrams per gram of dry tobacco. Cigarettes contain 8 to 20 milligrams of nicotine (depending on the brand), but only approximately 1 mg is actually absorbed by your body when you smoke a cigarette. In a cigar (which can contain as many as 20 grams of tobacco), the nicotine content can vary between 5.9 and 335.2 milligrams per gram of tobacco. The smoke from one cigarette may contain up to 6 mg of nicotine (1/7 of the lethal dose by ingestion!), but only about 1 mg is absorbed into the body. There is enough nicotine in four or five cigarettes to kill an average adult if ingested whole. Most smokers take in only one or two milligrams of nicotine per cigarette however, with the remainder being burned off. A cigarette butt contains about 25% of the nicotine of the original cigarette despite its deceptively small amount of tobacco. (Smoking seems to concentrate some of the nicotine in the tail end of the cigarette). The way a person smokes a tobacco product is more important than the nicotine content of the product in determining how much nicotine gets into the body. Nicotine is absorbed in the lungs and through the lining of the mouth. Increased levels of nicotine are absorbed by inhaling the smoke into the lungs and taking frequent and deep puffs. Various studies have shown that moist snuff had between 4.7 and 24.3 milligrams of nicotine per gram of tobacco, dry snuff had between 10.5 and 24.8 milligrams per gram of tobacco, and chewing tobacco had between 3.4 and 39.7 milligrams per gram of tobacco.

Nicotine is an alkaloid found in the nightshade family of plants (Solanaceae) that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves. It functions as an antiherbivore chemical with particular specificity to insects. In low concentrations (an average cigarette yields about 1 mg of absorbed nicotine), the substance acts as a stimulant in mammals and is the main factor responsible for the dependence-forming properties of tobacco smoking. As nicotine enters the body, it is distributed quickly through the bloodstream and crosses the blood-brain barrier reaching the brain within 10-20 seconds after inhalation. The elimination half-life of nicotine in the body is around one hour. Nicotine is found in every part of body including breast milk. The amount of nicotine absorbed by the body from smoking depends on many factors, including the types of tobacco, whether the smoke is inhaled, and whether a filter is used. For chewing tobacco, dipping tobacco, snus and snuff, which are held in the mouth between the lip and gum, or taken in the nose, the amount released into the body tends to be much greater than smoked tobacco. Nicotine acts on the nicotinic acetylcholine receptors, specifically the ganglion type nicotinic receptor and one CNS nicotinic receptor. The former is present in the adrenal medulla and elsewhere, while the latter is present in the central nervous system (CNS). By binding to nicotinic acetylcholine receptors, nicotine increases the levels of several neurotransmitters – acting as a sort of “volume control”.

The picture above shows nicotine displaces radio-labeled tracer from nicotinic acetylcholine receptors in brain and attaches itself to these receptors. This study showed that the nicotine received in just a few puffs of a cigarette can drive a person to continue smoking. Researchers found that the amount of nicotine contained in just one puff of a cigarette can occupy about 30% of the brain’s most common type of nicotine receptors, while three puffs can occupy about 70%. When nearly all of the receptors are occupied (as a result of smoking at least 2 ½ cigarettes), the smoker becomes satiated for a time. Soon, however, this level of satiation wears off, driving smokers to continue smoking throughout the day to satisfy their cigarette cravings.

Your brain is made up of billions of nerve cells. They communicate by releasing chemical messengers called neurotransmitters. Each neurotransmitter is like a key that fits into a special “lock,” called a receptor, located on the surface of nerve cells. When a neurotransmitter finds its receptor, it activates the receptor’s nerve cell. The nicotine molecule is shaped like a neurotransmitter called acetylcholine. Acetylcholine and Nicotine express chemical similarities, which allow Nicotine to trigger the receptor as well. Acetylcholine and its receptors are involved in many functions, including muscle movement, breathing, heart rate, learning, and memory. They also cause the release of other neurotransmitters and hormones that affect your mood, appetite, memory, and more. When nicotine gets into the brain, it attaches to acetylcholine receptors and mimics the actions of acetylcholine. Nicotine also activates areas of the brain that are involved in producing feelings of pleasure and reward. Scientists have discovered that nicotine raises the levels of a neurotransmitter called dopamine in the parts of the brain that produce feelings of pleasure and reward. The release of dopamine due to stimulation of alpha-4 nicotinic receptor within the ventral tegmental area (VTA) – a brain region important in motivation, emotion, and addiction – is responsible for the rewarding properties of nicotine. Dopamine, which is sometimes called the pleasure molecule, is the same neurotransmitter that is involved in addictions to other drugs such as cocaine and heroin. Researchers now believe that this change in dopamine may play a key role in all addictions. Dopamine stimulates the brain’s reward circuits. These are responsible for behavioral patterns. They cause psychological addiction, using natural habit forming processes that make positive reinforcement training efficient. But in itself this process is only slightly addictive. It is the combination of the effects of nicotine with those of harman and norharman that can potentially multiply the addictive effects. These two molecules are side-effects of tobacco combustion. These harman & nonharman bind with enzyme monoamine oxidase (MAO) which metabolizes dopamine in brain. Their effect is to inhibit the breaking down of dopamine. This results in much longer half-life, and a much longer lasting psychological imprint of dopamine in the reward circuits. This may help explain why it is so hard for people to stop smoking. Also, researchers have recently shown in animals that acetaldehyde, another chemical constituent of tobacco smoke, dramatically increases the rewarding properties of nicotine—particularly in adolescent animals—which may be one reason why teens are more vulnerable to becoming addicted to tobacco than adults. Nicotine has a higher affinity for acetylcholine receptors in the brain than those in skeletal muscles, though at toxic doses it can induce contractions and respiratory paralysis. Nicotine also activates the sympathetic nervous system, acting via splanchnic nerves to the adrenal medulla, stimulates the release of epinephrine. Acetylcholine is released by preganglionic sympathetic fibers of these nerves and nicotinic acts on these acetylcholine receptors, causing the release of epinephrine (and norepinephrine) into the bloodstream. Nicotine also has an affinity for melanin-containing tissues due to its precursor function in melanin synthesis or due to the irreversible binding of melanin and nicotine. This has been suggested to underlie the increased nicotine dependence and lower smoking cessation rates in darker pigmented individuals.

Monoamine oxidase (MAO) is a mitochondrial outer-membrane flavoenzyme involved in brain and peripheral oxidative catabolism of neurotransmitters (dopamine) and xenobiotic amines, including neurotoxic amines. Recently, positron emission tomography imaging has shown that smokers have a much lower activity of peripheral and brain MAO-A (30%) and -B (40%) isozymes compared to non-smokers. These MAO are inhibited by beta-carboline alkaloids harman and norharman present in tobacco. A study found that alkaloids harman and norharman can be isolated from cured tobacco and tobacco smoke but they are present in trace amount in uncured tobacco leaves. These alkaloids are also formed from tryptophan in cigarettes during burning. Enough tryptophan is present in tobacco to account for high quantities of these alkaloids in cigarette smoke. Therefore higher amount of harman and norharman are found in tobacco smoke as compared to smokeless tobacco resulting in greater suppression of MAO, higher dopamine level and greater addiction. Also, studies on toxicokinetics indicate that inhalative exposure leads to a rapid increase in plasma levels and high bioavailability of harman and norharman as compared to oral route. So tobacco smoke is more addicting than smokeless tobacco despite smokeless tobacco having higher nicotine than tobacco smoke. Also, high amounts of norharman and harman are found in brewed coffee, sauces (soy sauce and Tabasco), cooked meat & fish, toasted bread, and fermented alcoholic beverages. So even brewed coffee taken along with smoking cigarettes can increase addiction to tobacco.

Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate. Glucose is released into the blood while nicotine suppresses insulin output from the pancreas, which means that smokers have chronically elevated blood sugar levels. Nicotine affects the nerve-muscle junctions, causing tremors and shaking. Nicotine causes narrowing and constriction of the arteries, adding to the heart’s load. Nicotine, through its ability to stimulate, causes excitement and anxiety. But the effect wears off; often a period of depression follows, whereupon another cigarette is taken. Nicotine makes the blood more viscous and decreases the available oxygen. It also adversely affects the breathing, sweating, intestinal, and heart actions of our autonomic nervous system, probably due to hindering the blood flow to the nerve centers in the brain. Like cocaine, heroin, and marijuana; nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of negative consequences.

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When a cigarette is smoked, nicotine-rich blood passes from the lungs to the brain within ten seconds and immediately stimulates the release of many chemical messengers including acetylcholine, norepinephrine, epinephrine, vasopressin, arginine, dopamine, autocrine agents, and beta-endorphin. This release of neurotransmitters and hormones is responsible for most of nicotine’s effects. Nicotine appears to enhance concentration and memory due to the increase of acetylcholine. It also appears to enhance alertness due to the increases of acetylcholine and norepinephrine. Arousal is increased by the increase of norepinephrine. Pain is reduced by the increases of acetylcholine and beta-endorphin. Anxiety is reduced by the increase of beta-endorphin. Nicotine also extends the duration of positive effects of dopamine and increases sensitivity in brain reward systems. At low doses, nicotine potently enhances the actions of norepinephrine and dopamine in the brain, causing a drug effect typical of those of psychostimulants. At higher doses, nicotine enhances the effect of serotonin and opiate activity, producing a calming, pain-killing effect. Nicotine is unique in comparison to most drugs, as its profile changes from stimulant (increased alertness) to sedative/pain killer (relaxation) in increasing dosages and use.

Like acetylcholine, nicotine leads to a burst of receptor activity. However, unlike acetylcholine, nicotine is not regulated by your body. While neurons typically release small amounts of acetylcholine in a regulated manner, nicotine activates cholinergic neurons (which mainly use acetylcholine to communicate to other neurons) in many different regions throughout your brain simultaneously. This stimulation leads to:

1) Increased release of acetylcholine from the neurons, leading to heightened activity in cholinergic pathways throughout your brain. This cholinergic activity calls your body and brain to action, and this is the wake-up call that many smokers use to re-energize themselves throughout the day. Through these pathways, nicotine improves your reaction time and your ability to pay attention, making you feel like you can work better.

2) Stimulation of cholinergic neurons promotes the release of the neurotransmitter dopamine in the reward pathways of your brain. This neural circuitry is supposed to reinforce behaviors that are essential to your survival, like eating when you’re hungry. Stimulating neurons in these areas of the brain brings on pleasant, happy feelings that encourage you to do these things again and again. When drugs like cocaine or nicotine activate the reward pathways, it reinforces your desire to use them again because you feel so at peace and happy afterwards.

3) Release of glutamate, a neurotransmitter involved in learning and memory – Glutamate enhances the connections between sets of neurons. These stronger connections may be the physical basis of what we know as memory. When you use nicotine, glutamate may create a memory loop of the good feelings you get and further drive the desire to use nicotine.

4) Nicotine also increases the level of other neurotransmitters and chemicals that modulate how your brain works. For example, your brain makes more endorphins in response to nicotine. Endorphins are small proteins that are often called the body’s natural pain killer.

40–60 mg (0.5-1.0 mg/kg) of nicotine can be a lethal dosage for adult humans. It is unlikely that a person would overdose on nicotine through smoking alone, although overdose can occur through combined use of nicotine patches or nicotine gum and cigarettes at the same time. Nicotine poisoning causes vomiting & nausea, headaches, difficulty in breathing, stomach pains and seizures. Each of these symptoms can be traced back to excessive stimulation of cholinergic neurons. People poisoned by organophosphate insecticides experience the exact same symptoms. With organophosphates, acetylcholine builds up at synapses and over stimulates the neurons. Because nicotine is so similar to acetylcholine, and binds to cholinergic receptors, nicotine in excess produces the same overstimulation and toxicity. The more nicotine binding to the nicotinic cholinergic receptors, the more acetylcholine is subsequently released and free to activate other subsets of cholinergic receptors. The treatment for nicotine poisoning has two goals: Keep the victim breathing and keep the heart pumping until nicotine is broken down by the body and prevent any more nicotine from reaching the bloodstream.

The currently available literature indicates that nicotine, on its own, does not promote the development of cancer in healthy tissue and has no mutagenic properties. Though the teratogenic properties of nicotine may or may not yet have been adequately researched, women who use nicotine gum and patches during the early stages of pregnancy face an increased risk of having babies with birth defects, according to a study of around 77,000 pregnant women in Denmark.

Nicotine therapy and smoker’s paradox:

The primary therapeutic use of nicotine is in treating nicotine dependence in order to eliminate smoking with the damage it does to health. Controlled levels of nicotine are given to patients through gums, dermal patches, lozenges, inhalers, electronic/substitute cigarettes or nasal sprays in an effort to wean them off their dependence. However, in a few situations, smoking has been observed to apparently be of therapeutic value. These are often referred to as “Smoker’s Paradoxes”. For instance, recent studies suggest that smokers require less frequent repeated revascularization after percutaneous coronary intervention (PCI). Risk of ulcerative colitis has been frequently shown to be reduced by smokers on a dose-dependent basis; the effect is eliminated if the individual stops smoking. Smoking also appears to interfere with development of Kaposi’s sarcoma in patients with HIV. Nicotine reduces the chance of breast cancer among women carrying the very high risk BRCA gene, preeclampsia, and atopic disorders such as allergic asthma. A plausible mechanism of action in these cases may be nicotine acting as an anti-inflammatory agent, and interfering with the inflammation-related disease process, as nicotine has vasoconstrictive effects. Nicotine has been shown to delay the onset of Parkinson’s disease in studies involving monkeys and humans. Recent studies have indicated that nicotine can be used to help adults suffering from autosomal dominant nocturnal frontal lobe epilepsy. The same areas that cause seizures in that form of epilepsy are responsible for processing nicotine in the brain. Nicotine appears to improve ADHD symptoms. Some studies are focusing on benefits of nicotine therapy in adults with ADHD. Nicotine (in the form of chewing gum or a transdermal patch) is being explored as an experimental treatment for OCD. Small studies show some success, even in otherwise treatment-refractory case. It is well-known that smoking is unhealthy, yet men who smoke are less likely than nonsmokers to require total hip or knee replacement, according to a new study.

Some diseases that nicotine might improve include:

1) Alzheimer’s Disease – The first neurons lost to Alzheimers are cholinergic neurons in a specific region of the brain. Nicotine may improve the function of the neurons that are left and slow the onset of symptoms.

2) Tourette’s Syndrome – This disease produces tics (uncontrolled movements of the head, hands and other body parts) and violent urges in its sufferers. Nicotine patches that slowly deliver nicotine through the skin can reduce symptoms of people with Tourette’s.

Nicotine can both invigorate and relax a smoker, depending on how much and how often they smoke. Nicotine initially causes a rapid release of adrenaline, the “fight-or-flight” hormone. Adrenaline also tells your body to dump some of its glucose stores into your blood. Nicotine itself may also block the release of the hormone insulin. Insulin tells your cells to take up excess glucose from your blood. This means that nicotine makes people somewhat hyperglycemic, having more sugar than usual in their blood. During the early stages, smoking provides pleasurable sensations (because of its action on the dopamine system) and thus serves as a source of positive reinforcement. After an individual has smoked for many years, the avoidance of withdrawal symptoms and negative reinforcement become the key motivations. Although smoking tobacco has long been seen as a universally addictive trait, it has been proven statistically that people take a varying amount of time to become dependent on the drug nicotine. In fact, the graph showing percentage of the “population showing addictive behaviour” v/s “amount of nicotine taken” levels off before reaching 100% of the population, proving that a proportion of people never become dependent on nicotine at all. When an addicted user tries to quit, he or she experiences withdrawal symptoms including irritability, attention difficulties, sleep disturbances, increased appetite, and powerful cravings for tobacco.

Nicotine is a highly addictive drug. Addiction keeps people smoking even when they want to quit. Breaking addiction is harder for some people than others. Many people need more than one try in order to quit. Scientists now know more about why the brain craves nicotine. Like heroin or cocaine, nicotine changes the way your brain works and causes you to crave more and more nicotine. These powerful cravings make it hard for you to think about anything else. Smoking can cause both physical and psychological addiction. Cigarette makers have long known that nicotine addiction helps sell their products. Nicotine content in cigarettes has slowly increased over the years, and one study found that there was an average increase of 1.6% per year between the years of 1998 and 2005. This was found for all major market categories of cigarettes. This finding is corroborated by the Massachusetts Health department and Harvard University. As nicotine addiction leads to tolerance and a smoker need more nicotine to get the same pleasure, tobacco industry has increased the nicotine contents of cigarettes over years. Cigarettes today deliver more nicotine and deliver it quicker than ever before. The additives and chemicals that tobacco companies put in cigarettes may have helped make them more addictive. Once inhaled, nicotine races from your lungs to your heart and brain. You might have thought that “filtered,” “low-tar,” or “light” cigarettes were less dangerous than others. But research shows that these cigarettes are every bit as addictive and are no safer than other cigarettes. Misleading labels are no longer allowed.

Alcohol and smoking:

It’s no secret that “smokers drink and drinkers smoke.” In fact, the heaviest drinkers are also the heaviest smokers. According to information provided by the National Institute on Alcohol Abuse and Alcoholism, between 80 and 95 percent of alcoholics smoke cigarettes, a rate that is three times higher than among the population as a whole. Approximately 70 percent of alcoholics are heavy smokers (meaning they smoke more than one pack a day), compared with just 10 percent of the general population. Moreover, the prevalence of alcoholism in smokers is 10 times higher than among nonsmokers. Epidemiological, clinical, and laboratory evidence clearly indicate a behavioral link between cigarette smoking and alcohol use. In tests on human volunteers, Duke University Medical Center researchers have found that even small amounts of alcohol boost the pleasurable effects of nicotine, inducing people to smoke more when drinking alcoholic beverages. The findings provide a physiological explanation for the common observation that people smoke more in bars. The findings also explain statistics showing that alcoholics tend to smoke more than non-alcoholics, and that smokers are more likely to be alcoholics. The finding, published in the February/March 2004 issue of Nicotine and Tobacco Research, might help elucidate why those who have quit smoking often relapse while drinking alcohol. Such insights might lead to new smoking cessation methods that take the drugs’ interaction into account. One theory holds that nicotine offsets the sedative effects of alcohol. For example, studies have reported that nicotine counteracts the decline in the performance of certain visual tasks and the slowed reaction time induced by alcohol. Alternatively, using nicotine and alcohol in concert might serve to increase the feeling of pleasure associated with either drug alone. Both drugs have been shown to boost brain concentrations of dopamine — a nerve cell messenger implicated in the positive reinforcement underlying addiction. Tobacco, as well as alcohol, can cause mouth, oesophageal and liver cancers. Scientists have also found that together, their effects are much worse. While alcohol does not cause stomach cancer, it can worsen the risk of this disease in smokers. One study found that together, smoking and drinking increased liver cancer risk by ten times. A Spanish team found that people who smoke and drink heavily could increase their risk of oesophageal cancer by up to 50 times. This problem is made even worse because heavy drinkers and smokers often have poor diets.

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Why do we use tobacco anyway? Why do we smoke?

Of course nicotine in tobacco is a powerful addicting chemical but let me discuss other factors and especially those factors which lead to smoking first cigarette or chewing tobacco for the first time.

Tobacco and genes:

Why do some smokers become addicted, while others don’t? Studies indicate that as much as half of a smoker’s risk of becoming addicted depends on his or her genes. Recent technical advances have enabled researchers to conduct large-scale studies of the complex genetic contribution to addiction. For example, a recent study found that having a certain variant in the gene for a nicotinic receptor subunit more than doubled the risk for addiction among smokers, as well as increasing their vulnerability to lung cancer and peripheral arterial disease. Several genes have been associated with nicotine addiction. Some reduce the clearance of nicotine, and others have been associated with an increased likely hood of becoming dependent on tobacco and other drugs as well as higher incidence of depression. It is unlikely that genetic factors are the principal determinants of addiction. While genetic studies reveal exciting new directions for research, environmental risk factors are equally important. Rates of smoking addiction have dropped by almost 50 % since the mid-1950s in the U.S. suggesting that factors other than genetics are important. We need targeted research on factors correlated with tobacco use and addiction, including prenatal exposure to tobacco smoke; social environments; gender; ethnicity; age; comorbid conditions like depression and schizophrenia; and exposure to other drugs of abuse. A Chinese study found that among Chinese adolescents, experimentation with tobacco is familial, and experimentation with alcohol is heritable. It is more likely that genetic susceptibility influences the probability that experimentation with tobacco as an adolescent will lead to addiction in adult.

Smoking and IQ:

Smoking is directly correlated with a lower IQ, according to a study conducted by researchers from Tel Aviv University in Israel and published in the journal Addiction. In twin pairs where one brother smoked and the other did not, the smoker consistently tested at a lower IQ. The study could not prove whether smoking caused a lower IQ or having a lower IQ predisposed people to smoke, but the researchers did rule out the possibility that low socioeconomic status produces both smoking and a lower IQ. There is a well-established inverse association between IQ and mortality risk. Another study correlated the association between IQ at age 18 and smoking in later life in a population of 11,589 male Swedish twins. A strong inverse association between IQ and smoking status emerged in unmatched analyses over the entire range of IQ distribution. Another study found that smoking may diminish the speed and accuracy of your thinking and bring down your IQ.

Smoking and education:

A study on 21,522 members of the Danish Twin Registry, born during 1931-1982 found that education confers a culture of healthy behavior. More education was associated with less smoking, and average drinking levels were highest among the most educated. Education created a culture that discouraged smoking and heavy drinking. In India, one third of population is illiterate, how smoking will be controlled?

Children and adolescent smoking:

Aldi Rizal was just 11 months old when he smoked his first cigarette, and by the time he turned two years old, this Indonesian baby boy was smoking four packs of cigarettes a day. And there are thousands of other chain-smoking babies and children across the South Asian country just like him that are addicted to smoking, which some attribute to a lack of tobacco regulation in the country. According to reports, at least a quarter of Indonesian children over age 3 have tried cigarettes, and three percent of them are now regular chain smokers. And one reason why smoking is so common among children in Indonesia is because cigarettes are very cheap and accessible there — costing roughly $1 a pack — and there are virtually no limitations on who can purchase them. In India, besides cigarettes & bidis, children experience their first taste of tobacco in the form of Gutka (form of smokeless tobacco) and Gutka is freely available at cheap price in every Indian street. There is a reported case of oral cancer in a 17 year old boy who chewed Gutka for few years.

By the age of 15, more than one in seven children have become regular smokers. Research has shown that trying just one cigarette can make children more likely to start smoking several years later. Children who smoke often become regular adult smokers. Approximately 90 % of individuals who will become cigarette smokers initiate the behavior during adolescence. Each day, about 4,000 teens smoke a cigarette for the first time in the US and about 100,000 teens smoke a cigarette for the first time all over the world. Research shows that adolescents are especially vulnerable to nicotine addiction; the prefrontal cortex does not fully mature until the twenties, so the adolescent brain may be less able to override impulsive decisions or cravings for drugs. In addition, acetaldehyde, a compound found in tobacco smoke, may enhance nicotine’s addictive effects, especially in adolescents. Many teens who try cigarettes don’t know how easy it is to become addicted. Of those adolescents who try smoking, about one out of three will become regular smokers. According to the American Cancer Society, the earlier you start smoking, the more likely you are to develop long-term nicotine addiction. We need to direct significant resources toward monitoring teen tobacco use, understanding the biology behind it, and developing prevention programs targeted at teens. Certain social, economic, and environmental factors can be associated with the prediction of youth tobacco use. Factors that promote adolescent initiations are

1) Parental or older generation cigarette smoking. Either children & teens copy their parental tobacco habits or they may smoke to rebel against their parents.

2) Many children and teens use cigarettes, cigars, and spit tobacco because their friends or sibling do. Teens may think that smoking is a way to look more mature, independent, and self-confident to their peers.

3) Tobacco advertizing and promotional activities. Movies and TV shows can make smoking seem glamorous and attractive.

4)The easy availability of cigarettes/smokeless tobacco.

5) Social acceptability of smoking.

6) Teens, especially girls, often use smoking to try to control their weight.

7) Experimentation: All teenagers experiment – often with activities that they believe make them appear more ‘grown up’. Trying new things and making mistakes is part of the normal learning process. But the danger with trying smoking is that nicotine is very addictive.

8) Lower socioeconomic status.

9) Incompletion of higher levels of education, Poor school or academic performance.

10)Behavioral problems such as aggression.

11) Low self-esteem.

Parents and children/teen smoking:

To prevent children from smoking, parents should not smoke, and they should tell their child that they disapprove of smoking. Studies have shown that school children who believed that both their parents strongly disapproved of smoking were less than half as likely to smoke as those kids whose parents did not show as much disapproval towards smoking. Children whose parents closely monitor their television and music-listening habits are less likely to drink, use drugs, and smoke cigarettes. Neglected children, or children with absentee parents, are four times as likely to abuse drugs, drink, and smoke as children living with parents who were regularly present and who offered a structured lifestyle. Siblings and parents are role models for children. If a child’s parents smoke they are three times more likely to smoke themselves. Children of parents who smoke are more likely to smoke themselves than other children, but according to a new study published in the journal Oxford Bulletin of Economics and Statistics, the genders of those involved can make all the difference. Fathers transmit their smoking habits to a statistically significant level to their sons, and the same is true of mothers and daughters. However, if a mother smokes it does not seem to impact on the probability of her son smoking, and similarly a father that smokes does not affect his daughter.

Why adults smoke?

1) To relieve tension, especially after arguments or during stressful times, or when you feel angry, depressed, or upset. Managing unpleasant feelings such as stress, depression, loneliness, fear, and anxiety are some of the most common reasons why adults smoke.

2) To control your weight, either by keeping it down or because you’re afraid of weight gain if you quit.

3) For stimulation, to perk yourself up, improve your concentration, or boost your energy when you have low energy.

4) To be part of the group, by joining your friends in having a cigarette.

Measures to reduce tobacco epidemic:

Tobacco control:

This is an internationally accepted “no smoking” or “smoking ban” symbol.

Tobacco control refers to a range of comprehensive measures to protect people from the effects of tobacco consumption and second-hand tobacco smoke. Tobacco consumption is currently the single leading preventable cause of death, which results in the premature death of nearly six million people a year, of which more than five million are users or ex users of tobacco and more than 600 000 are nonsmokers exposed to second-hand smoke. If current patterns continue, the number of deaths will increase to eight million a year by 2030.

Key aspects of tobacco control include measures that:

1) Protect children and youths from tobacco, especially by preventing them from starting to consume tobacco;

2) Offer tobacco users help to quit;

3) Protect nonsmokers from exposure to second-hand tobacco smoke;

4) Warn people about the dangers of tobacco;

5) Regulate tobacco products;

6) Ban tobacco advertising, promotion and sponsorship.

Bhutan became the first nonsmoking nation in the world in 2004-2005. It has been illegal to smoke in public or sell tobacco. Foreigners can still smoke and import tobacco (but if caught selling it to Bhutanese they will be charged with smuggling). Bhutanese are, technically, allowed to smoke in their homes and can even import small quantities of tobacco for “personal use,” though they’ll pay as much as 200 percent in customs duties and sales taxes for the pleasure. New Zealand may become the second nation to ban sell of cigarettes in 2025 but complete banning sell of all tobacco products by all nation is a distant dream.

The above graph shows that tobacco control is grossly underfunded compared to the tax revenue from tobacco.

WHO response:

WHO is committed to fight the global tobacco epidemic. The WHO Framework Convention on Tobacco Control (FCTC) is an international treaty which was adopted in May 2003 by the 56th World Health Assembly. It is the first legal instrument designed to reduce tobacco-related deaths and disease around the world. The Convention has provisions that set international standards and guidelines for tobacco control in the following areas: tobacco price and tax increases, sales to and by minors, tobacco advertising and sponsorship, labeling, illicit trade and second-hand smoke. The FCTC entered into force in February 2005. Since then, it has become one of the most widely embraced treaties in the history of the United Nations with more than 170 Parties covering 87% of the world’s population. In 2008, WHO introduced a package of tobacco control measures to further counter the tobacco epidemic and to help countries to implement the WHO Framework Convention. Known by their acronym MPOWER, the measures are identified as “best buys” and “good buys” in tobacco control. Each measure corresponds to at least one provision of the WHO Framework Convention on Tobacco Control. The six MPOWER measures are:

1) Monitor tobacco use and prevention policies

2) Protect people from tobacco use

3) Offer help to quit tobacco use

4) Warn about the dangers of tobacco

5) Enforce bans on tobacco advertising, promotion and sponsorship

6) Raise taxes on tobacco.

On May 31 every year, the world observes World No Tobacco Day (WNTD) that is promoted by the World Health Organization (WHO). It is meant to encourage a 24-hour period of abstinence from all forms of tobacco consumption across the globe. The day is further intended to draw global attention to the widespread prevalence of tobacco use and to negative health effects, which currently lead to 6 million deaths worldwide annually.

Ad bans lower consumption:

Tobacco advertising is the advertising of tobacco products or use (typically cigarette smoking) by the tobacco industry through a variety of media including sponsorship, particularly of sporting events. It is now one of the most highly regulated forms of marketing. Some or all forms of tobacco advertising are banned in many countries. The tobacco industry spends up to $12.5 billion annually on advertising, which is increasingly geared towards adolescents in the developing world because they are a very vulnerable audience for the marketing campaigns. Adolescents have more difficulty understanding the long term health risks that are associated with smoking and are also more easily influenced by “images of romance, success, sophistication, popularity, and adventure which advertising suggests they could achieve through the consumption of cigarettes”. This shift in marketing towards adolescents and even children in the tobacco industry is debilitating to organizations’ and countries’ efforts to improve child health and mortality in the developing world. It reverses or halts the effects of the work that has been done to improve health care in these countries, and although smoking is deemed as a “voluntary” health risk, the marketing of tobacco towards very impressionable adolescents in the developing world makes it less of a voluntary action and more of an inevitable shift. Peer-reviewed studies show teenagers are heavily influenced by tobacco advertising. Adolescent smokers are the only source of replacement smokers…If the youth turn away from smoking, the tobacco industry will decline. Bans on tobacco advertising, promotion and sponsorship can reduce tobacco consumption. A comprehensive ban on all tobacco advertising, promotion and sponsorship could decrease tobacco consumption by an average of about 7%, with some countries experiencing a decline in consumption of up to 16%. Only 19 countries, representing 6% of the world’s population, have comprehensive national bans on tobacco advertising, promotion and sponsorship.

Cigarette advertising significantly increases the odds that youngsters who see the ads will start smoking, but exposure to ads for other products does not, a new study shows. The ads for other products such as cell phones and candies fail to trigger the same psychological mechanisms that make children take up the smoking habit, according to the study. The researchers say tobacco ads work because companies aim their messages at young people, who are particular susceptible to even subtle meanings, such as hints that smoking is tied to masculinity, in the case of males; and to thinness, sex appeal, and independence for girls. The other products advertised do not project such mental cues or thoughts, and thus don’t influence youngsters to start buying cell phones or candies. This study calls for Comprehensive Ban on Tobacco Ads. The authors say the study shows that cigarette advertising is a powerful lure to youths to start smoking, and that it supports calls for a comprehensive ban on tobacco advertising around the world.

Movies, smoking and children:

The picture above shows Hollywood star Marilyn Monroe smoking a cigarette in a movie.

Ever since the era of silent films, smoking has had a major part in film symbolism. In crime thrillers, cigarette smoke often frames characters and is frequently used to add an aura of mystique or even nihilism. Female smokers in film were also early on associated with a type of sensuous and seductive sexuality. With the anti-smoking movement gaining greater respect and influence, conscious attempts not to show smoking on screen are now undertaken in order to avoid encouraging smoking or giving it positive associations, particularly for family films. Smoking on screen is more common today among characters who are portrayed as anti-social or even criminal. Despite the best efforts of parents to protect their children from a variety of dangers, one danger is still present – smoking in movies. Many people view this “danger” as harmless, but I have come to realize that these movies that portray smoking translate into billions of tobacco impressions every year. Two exceptions to this concept are movies that show the real adverse effects of tobacco use and historical figures that actually smoked. This is a problem parents face for their children, especially since 90 percent of smokers start before their 19th birthday. Giving movies with smoking an “adult” rating will help parents protect their kids from the number one preventable cause of death.

Health warning on packages containing tobacco products:

Health warnings on cigarette packages prompt smokers to think about quitting, according to a 14-nation study. Effective warning labels as a component of comprehensive tobacco control can help save lives by reducing tobacco use. The study published in Morbidity and Mortality Weekly Report, finds that the vast majority of men & women that use manufactured cigarettes noticed package warning labels. Among those who noticed package warnings, data suggest there was substantial interest in quitting because of the warnings. Hard-hitting anti-tobacco advertisements and graphic pack warnings, especially those that include pictures – reduce the number of children who begin smoking and increase the number of smokers who quit. Studies carried out after the implementation of pictorial package warnings in Brazil, Canada, Singapore and Thailand consistently show that pictorial warnings significantly increase people’s awareness of the harms of tobacco use. Graphic warnings can persuade smokers to protect the health of non-smokers by smoking less inside the home and avoiding smoking near children. The warning/information label should ideally cover 50% of the front and back areas of the package. Warnings must be large enough to be easily noticed and read. Evidence suggests that the perceived credibility of warning messages, as well as the perceived risks from tobacco use, increase proportionately with increases in the size of warnings. To be effective, warnings have to contain a clear and unequivocal message about the dangers of tobacco use, in simple and stark terms. Messages should be worded simply and be in the principal language(s) of the country. They should explain the nature and extent of risk, and what to do to avoid or reduce the risks. They should speak directly to the reader using the word “you.” Packages should be free of erroneous or misleading terms, such as “light”, “low tar”, or “mild”, which give the wrong impression that tobacco is safer at lower tar and/or nicotine concentrations. These misleading terms have been banned in Brazil and the European Union, and several other countries are considering banning them.

Nearly a third of adult men and half of all adult women in low-income countries are illiterate and therefore warning messages with pictures should be made available on packages of tobacco products. Various studies found that picture warnings provide significantly more encouragement to quit and not to start smoking than messages without pictures. Pictures will help ensure that illiterate too receive important information empowering them to better protect their health. In addition to delivering new information, pictures elicit a visceral response in viewers, so their impact is both cognitive (intellectual) and affective (emotional). To improve visual effectiveness, the pictures should be colorful and the largest size possible.

The tobacco industry usually tries to delay or block more effective warnings. Countries should be prepared to face these challenges. Legal challenges are often based on constitutional rights such as free speech, or trade practices. Some constitutions guarantee the right to life, and inducements to smoke or failure to warn of the health consequences, could be argued to infringe this right. The case for tobacco control measures, including stronger health warnings is compelling, especially from a human rights and consumer rights perspective. Cigarette companies should have at least the same obligations as drug companies to inform users fully of the risks of using their products. Moreover, health-warning regulations should specify that displaying health warnings on tobacco products does not relieve tobacco companies of their liability for damages caused by the use of their tobacco products. Recently in India, top lawyers were defending tobacco companies in supreme courts and these lawyers were coincidentally belonging to two main political parties, the Congress and the BJP. Congress leader Abhishek Singhvi and BJP leader Arun Jaitley were fighting a legal battle for Indian tobacco companies. I understand that Singhvi and Jaitley are lawyers by profession and that we cannot stop them from doing what they know best. If leaders of political parties are to defend tobacco companies in courts, how can they help tobacco control?

Media and tobacco:

Mass media campaigns can also reduce tobacco consumption, by influencing people to protect non-smokers and convincing youths to stop using tobacco. Anti-tobacco mass media campaigns can be cost effective compared with other interventions despite the expense required, and can have a greater impact because they reach large populations quickly and efficiently. Exposure to effective anti-tobacco mass media campaigns has similar effects on adults and youth, with adult smokers more likely to quit and youth less likely to become established smokers. The media can change peoples’ perception of health. The bottom line is to change people’s perception because what people do and do not do is determined by their perception of reality rather than reality itself. If adolescents think that they can have a girlfriend or boyfriend by smoking, they will say bugger your health – that’s the perception. It’s the media that can change the perception that health is more important than cigarette smoking. A report indicates that more than 70% of the world’s population saw no national tobacco counter-advertising in the last two years. In nearly 150 countries, including 110 low and middle-income countries, there is a paucity of any anti-tobacco public education using mass media.

Taxes discourage tobacco use

Tobacco taxes are the most effective way to reduce tobacco use, especially among young people and poor people. A tax increase that increases tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and by up to 8% in low- and middle-income countries. However, Only 27 countries, representing less than 8% of the world’s population, have tobacco tax rates greater than 75% of the retail price as recommended by WHO. As discussed earlier, the largest democracy India has a dubious distinction of having lowest tax rate on tobacco products.

Ugly cigarette box is a design concept that turns sexy cigarette packs into disgusting, fumbly, puke-brown boxes. The idea is to discourage smoking by turning the actual act of reaching for a cigarette into a visceral reminder of smoking’s effects.

Smoking ban:

The above picture shows Smoke-free policies decrease exposure to second-hand tobacco smoke by 80-90% in high-exposure settings.

Contrary to popular social belief, it is not illegal to smoke tobacco products at any age. Parents are within the law to allow minors to smoke, and minors are within the law to smoke tobacco products freely. However, the sale of tobacco products is highly regulated with legal legislation. The minimum legal age to purchase cigarettes or tobacco products varies from country to country. Ages range from 14 to 21, but 18 tends to be the most common legal smoking age. Even though it is illegal to sell tobacco to anyone under the age of 18 in India, smokeless tobacco product Gutka is freely available to children in India.

There is no safe level of exposure to second-hand tobacco smoke. Every person should be able to breathe smoke-free air. Smoke-free laws protect the health of non-smokers, are popular, do not harm business and encourage smokers to quit. However, only nearly 11% of people are protected by comprehensive national smoke-free laws. Almost half of children regularly breathe air polluted by tobacco smoke. Over 40% of children have at least one smoking parent. Passive smoking, or secondhand smoking (SHS), which affects people in the immediate vicinity of smokers, is a major reason for the enforcement of smoking bans. This is a law enforced to stop individuals smoking in indoor public places such as bars, pubs, offices and restaurants as well as stop smoking in public transport such as aircrafts, trains and buses. The idea behind this is to discourage smoking by making it more inconvenient, and to stop harmful smoke being present in enclosed public spaces.

The countries which have ratified the WHO Framework Convention on Tobacco Control (FCTC) have a legal obligation to implement effective legislation “for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.” As a consequence of the health risks associated with passive smoking, smoking bans in indoor public places, including restaurants, cafés, and nightclubs have been introduced in a number of jurisdictions, at national or local level, as well as some outdoor open areas. Opinion polls have shown considerable support for bans. In June 2007, a survey of 15 countries found 80% approval of smoking bans. Smoking bans are public policies, including criminal laws and occupational safety and health regulations, which prohibit tobacco smoking in workplaces and/or other public spaces. The rationale for smoke-free laws is based on the fact that smoking is optional and breathing is not. Therefore, smoking bans exist to protect breathing people from the effects of second-hand smoke, which include an increased risk of heart disease, cancer, emphysema, and other diseases. Laws implementing bans on indoor smoking have been introduced by many countries in various forms over the years, with some legislators citing scientific evidence that shows tobacco smoking is harmful to the smokers themselves and to those inhaling second-hand smoke. In addition, such laws may lower health care costs, improve work productivity, and lower the overall cost of labor in a community, thus making a community more attractive for employers. Additional rationales for smoking restrictions include reduced risk of fire in areas with explosive hazards; cleanliness in places where food, pharmaceuticals, semiconductors, or precision instruments and machinery are produced; decreased legal liability; potentially reduced energy use via decreased ventilation needs; reduced quantities of litter; healthier environments; and giving smokers incentive to quit. Bans on smoking in bars and restaurants can substantially improve the air quality in such establishments. A 2007 Gallup poll found that 54% of Americans favored a complete ban inside of restaurants, 34% favored a ban in all hotel rooms, and 29% favored a ban inside of bars. Another Gallup poll, of over 26,500 Europeans, conducted in December 2008, found that “a majority of EU citizens support smoke-free public places, such as offices, restaurants and bars. Smoking bans are generally acknowledged to reduce rates of smoking; workplace bans reduce smoking rates among workers, and bans in public places reduce general smoking rates through a combination of stigmatization and reduction in the social cues for smoking. Smoking bans may make it easier for smokers to quit. In Sweden, use of snus, as an alternative to smoking, has risen steadily since the smoking ban. Restaurant smoking bans may help stop young people from becoming habitual smokers. The majority of these government and academic studies have found that there is no negative economic impact associated with bans and many findings that there may be a positive effect on local businesses.

Criticism of bans:

Smoking bans have been criticized on a number of grounds. It is considered government interference with personal lifestyle or property rights. Smoking ban is interpreted as ban on tobacco consumption instead of ban on harming other people. Businesses affected by smoking bans have filed lawsuits claiming that bans are unconstitutional or otherwise illegal. Such lawsuits have generally been unsuccessful. Bans on smoking in offices and other enclosed public places often result in smokers going outside to smoke, frequently congregating outside doorways. Many jurisdictions that have banned smoking in enclosed public places have extended the ban to cover areas within a fixed distance of entrances to buildings. Also, bans on smoking in public places may lead to more smoking at home. Critics of bans suggest ventilation is a means of reducing the harmful effects of passive smoking. However, a landmark report from the U.S. Surgeon General found that even the use of elaborate ventilation systems and smoking rooms fail to provide protection from the health hazards of secondhand smoke, since there is no safe level of second hand smoke.

A minority of epidemiologists find it hard to understand how second-hand smoke (SHS), which is far more dilute than actively inhaled smoke, could have an adverse health effect on a bystander that is as bad as similar effect on active smoker. As part of its attempt to prevent or delay tighter regulation of smoking, the tobacco industry funded a number of scientific studies where the results cast doubt on the risks associated with passive smoking, and sought wide publicity for those results. A 2003 study published in the British Medical Journal, argued that the harms of passive smoking had been overstated. A tobacco industry spokesman, a consultant and an expert on risk utility and scientific research, wrote in the libertarian Cato Institute’s journal Regulation that “…of the 75 published studies of SHS and lung cancer, some 70 percent did not report statistically significant differences of risk and are moot. Roughly 17 percent claim an increased risk and 13 percent imply a reduction of risk. Another commentator for Fox News and a former cigarette company consultant claimed that “…of the 37 studies [on passive smoking], only 7 (less than 19 percent) reported statistically significant increases in lung cancer incidence. So few epidemiologists and tobacco industry oppose smoking ban on scientific ground based on their studies but as I have discussed earlier, there is overwhelming scientific evidence to show that SHS indeed harms innocent bystander and therefore smoking ban is justified.

Smoking ban effects:

It is estimated that “comprehensive clean indoor laws” can increase smoking cessation rates by 12%–38%. In the first 18 months after the town of Pueblo, Colorado enacted a smoking ban in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighboring towns without smoking bans showed no change, and the decline in heart attacks in Pueblo was attributed to the smoking ban. In April, 2010 the Canadian Medical Association Journal published a study evaluating the effects of a 10-year, three-stage smoking ban in Toronto. The study found that during the implementation of a restaurant smoking ban, hospital admissions for cardiovascular conditions declined by 39%, and admissions for respiratory conditions declined by 33%. No significant reductions in hospital admissions occurred in other cities which did not have smoking bans. The authors concluded that the study justified further efforts to reduce public exposure to tobacco smoke. According to the American Heart Association’s journal Circulation, the rate of heart attacks alone has been shown to fall 36 percent in communities after they instituted public and workplace smoking bans.

Quit smoking:

Mark Twain said, “Quitting smoking is easy. I’ve done it a thousand times.” Maybe you’ve tried to quit too. Why is quitting and staying quit hard for so many people? The answer is nicotine. Almost all literates knows that smoking causes cancer, emphysema, and heart disease; that it can shorten your life by 10 years or more; and that the habit can cost a smoker thousands of dollars a year. So how come people are still lighting up? The answer is nicotine addiction. Once you start, it’s hard to stop. Smoking is a hard habit to break because tobacco contains nicotine, which is highly addictive. Like heroin or other addictive drugs, the body and mind quickly become so used to the nicotine in cigarettes that a person needs to have it just to feel normal. Smokers who quit go through withdrawal. The first days are the most uncomfortable. The physical symptoms of nicotine addiction end about 3 weeks after you quit smoking. But you may still have an urge to smoke when you wake up, drink coffee, or are out with friends. It takes longer to break these patterns. But you can beat addiction too. More than half of all adults who ever smoked have quit. So can you. How well a person does in the first 2 weeks of smoking cessation is critical to their success. Smokers should not be shy about seeking all the help they can during this period. Although withdrawal symptoms can be intense, treatments are available to reduce them. Attempts to quit are never a waste of time, since the amount of smoking is reduced during these periods. People who keep trying still have a 50 – 50 chance of finally quitting. Most smokers in the United States would like to quit smoking. Most people who have quit smoking made at least one unsuccessful quit attempt in the past. Try not to view past attempts to quit as failures, but rather as learning experiences. Biological, psychological, behavioral, and cultural factors all play a role in nicotine addiction, making smoking one of the hardest addictions to beat. About half of people who quit return to smoking. Even after years of not smoking, some ex-smokers still have occasional cravings for cigarettes. There are no physical reasons to start smoking. The body doesn’t need tobacco the way it needs food, water, sleep, and exercise. And many of the chemicals in cigarettes, like nicotine and cyanide, are actually poisons that can kill in high enough doses.

Tobacco users need help to quit:

According to the National Institutes of Health, about 40% of smokers who want to quit make a serious attempt to do so each year, but fewer than 5% actually succeed. Unfortunately, available smoking cessation products and therapies are greatly underused. If more smokers asked for or were offered such help, the agency says quit rates could double or triple. Studies show that few people understand the specific health risks of tobacco use. For example, a 2009 survey in China revealed that only 37% of smokers knew that smoking causes coronary heart disease and only 17% knew that it causes stroke. Among smokers who are aware of the dangers of tobacco, most want to quit. Counseling and medication can more than double the chance that a smoker who tries to quit will succeed.

Consuming tobacco in any form is both a psychological & a physical addiction. The act of smoking is ingrained as a daily ritual and at the same time, the nicotine from cigarettes provides a temporary and addictive high. Eliminating that regular fix of nicotine will cause your body to experience physical withdrawal symptoms and cravings. To successfully quit smoking, you’ll need to address both the habit and the addiction by changing your behavior and dealing with nicotine withdrawal symptoms. In a 2007 review of the effects of abstinence from tobacco, researchers concluded that anger, anxiety, depression, difficulty concentrating, impatience, insomnia, and restlessness are valid withdrawal symptoms that peak within the first week and last 2–4 weeks.

Duration of nicotine withdrawal symptoms:

Craving for tobacco –Few days, up to months; in some cases lifelong

Dizziness ————–Few days

Insomnia ————–1 week

Headaches ————1 to 2 weeks

Chest discomfort —–1 to 2 weeks

Constipation ———-1 to 2 weeks

Irritability ————-2 to 4 weeks

Fatigue —————-2 to 4 weeks

Cough or nasal drip –Few weeks

Lack of concentration –Few weeks

Hunger —————–Up to several weeks

Weight gain after quitting smoking:

People who successfully quit smoking may gain weight. In a 1991 study that found that the mean weight gain due to smoking cessation was 2.8 kg (6.2 lb) for men and 3.8 kg (8.4 lb) for women; and the researchers concluded weight gain is not likely to negate the health benefits of smoking cessation, but its cosmetic effects may interfere with attempts to quit. The causes of the weight gain are unclear, but hypotheses include: Smoking over expresses the gene AZGP1 which stimulates lipolysis, so smoking cessation may decrease lipolysis. Smoking suppresses appetite, which may be caused by nicotine’s effect on central autonomic neurons (e.g. via regulation of melanin concentrating hormone neurons in the hypothalamus). Heavy smokers are reported to burn 200 calories per day more than non-smokers eating the same diet. Nicotine replacement therapy can help protect against weight gain.

Long-Term Depression:

Depression is common during withdrawal and over the long term. In the short term, it may mimic the feelings of grief felt when a loved one is lost. A smoker should plan on a period of actual mourning in order to get through the early withdrawal depression. There is a significant association between cigarette smoking and a susceptibility to depression. People who are prone to depression face a 25% chance of becoming depressed when they quit smoking, and this increased risk persists for at least 6 months. What’s more, depressed smokers have a very low level of success. Only about 6% remain smoke-free after a year. There are strong reasons for this:

1) Smoking may mask depression, which can become severe even after the early stages of withdrawal have passed.

2) For some smokers, the future physical damage incurred by smoking is an abstraction, which fails to motivate quitting when measured up against the very real emotional pain triggered by nicotine withdrawal.

3)Not only does the smoker suffer, but the negative emotions often harm relationships with friends and family, who might even urge the ex-smoker to take up cigarettes again.

People who suffer from depression while quitting might do better using a combination of emotionally supportive therapy (as opposed to behavioral therapy), nicotine replacements, and antidepressants such as bupropion. If severe depression lasts beyond the withdrawal period, professional psychiatric help should be sought as soon as possible. It is noteworthy to highlight the fact that psychiatric patients are the highest percentages of all smokers. Statistics show that fifty percent of psychiatric outpatients are smokers, about ninety percent of all schizophrenic are smokers and about 70 % of all manic depressives are smokers.

There are some important things to remember when quitting smoking:

1. Know your triggers and avoid them early on. Try to stay away from situations that normally make you feel like smoking, especially during the first three months. This is when you are most likely to start smoking again.

2. Know that the first few days are the toughest. If you are quitting “cold turkey,” the first few days are the hardest. You will probably feel irritable, depressed, slow, and tired. Once you get past those first days, you will begin to feel normal (but still have cigarette cravings).

3. Don’t give in to your craving to smoke. Every time you don’t smoke when you have a craving, your chances of quitting successfully go up.

4. Start a new activity with friends who don’t smoke. This can increase your chances of quitting smoking.

Immediate health benefits of quitting smoking:

1) Within 20 minutes of quitting – your blood pressure and pulse rate drop to normal and the temperature of your hands & feet increases to normal.

2) Within 8 hours of quitting – your blood carbon monoxide levels drop and your blood oxygen levels increase, both to normal levels.

3) Within 24 hours of quitting – your risk of a sudden heart attack decreases.

4) Within 48 hours of quitting – nerve endings begin to regenerate and your senses of smell and taste begin to return to normal.

5) Within 2 weeks to 3 months of quitting – your circulation improves and walking becomes easier; your lung function increases by up to 30%.

6) Within 1 to 9 months of quitting – your overall energy typically increases and symptoms like coughing, nasal congestion, fatigue, and shortness of breath improve. You will have fewer illnesses, colds, and asthma attacks. You will gradually no longer be short of breath with everyday activities.

7) Within 1 year of quitting – your risk of coronary heart disease is half that of someone still using tobacco.

8) Within 5 years of quitting – your lung cancer death rate decreases by nearly 50% compared to one pack per day smokers; your risk of cancer of the mouth is half that of a tobacco user.

9)Within 10 years of quitting – your lung cancer death rate becomes similar to that of someone who never smoked; precancerous cells are replaced with normal cells; your risk of stroke is lowered, possibly to that of a nonsmoker; your risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas all go down.

What are the long-term health benefits of quitting smoking?

Quitting smoking reduces the risk of cancer and other diseases, such as heart disease and COPD, caused by smoking.

People who quit smoking, regardless of their age, are less likely than those who continue to smoke to die from smoking-related illness.

Quitting at age 30:-Studies have shown that smokers who quit at about age 30 reduce their chance of dying prematurely from smoking-related diseases by more than 90 percent.

Quitting at age 50:-People who quit at about age 50 reduce their risk of dying prematurely by 50 percent compared with those who continue to smoke.

Quitting at age 60:- Even people who quit at about age 60 or older live longer than those who continue to smoke.

Should someone already diagnosed with cancer bother to quit smoking?

Yes. There are many reasons that people diagnosed with cancer should quit smoking. For those having surgery, chemotherapy, or other treatments, quitting smoking helps improve the body’s ability to heal and respond to therapy. It also lowers the risk of pneumonia and respiratory failure. Moreover, quitting smoking may lower the risk of the cancer returning or a second cancer developing.

Other benefits of quitting smoking:

Your breath, clothes, and hair will smell better

Your sense of smell will return and food will taste better

Your fingers and fingernails will slowly appear less yellow

Your stained teeth will slowly become whiter

Your home, work, and social life will also improve immediately

Your children will be less likely to start smoking themselves

It will be easier and cheaper to find an apartment

You will miss fewer work days, or you may have an easier time getting a job

The constant search for a place to smoke when you’re out will be over

Friends will be more willing to be in your car or home

Your dating prospects will become much wider, because 80% of the population does not smoke

You will have more money available (one pack per day smokers spend around $1,800 per year on cigarettes)

The picture below shows ‘Breath CO monitor’ displaying carbon monoxide concentration of an exhaled breath sample (in ppm) with corresponding percent concentration of carboxyhemoglobin displayed below.

Breath carbon monoxide (CO) monitoring:

Because carbon monoxide is a significant component of cigarette smoke, a breath carbon monoxide monitor can be used to detect recent cigarette use. Carbon monoxide concentration in breath has been shown to be directly correlated with the CO concentration in blood, known as percent carboxyhemoglobin. With high sensitivity and specificity, it not only provides an accurate measure, but the test is also non-invasive, highly reproducible, and low in cost. Breath CO monitoring measures the concentration of CO in an exhalation in parts per million, and this can be directly correlated to the blood CO concentration (carboxyhemoglobin). The value of demonstrating blood CO concentration to a smoker through a non-invasive breath sample is that it links the smoking habit with the physiological harm associated with smoking. Within hours of quitting, CO concentrations show a noticeable decrease, and this can be encouraging for someone working to quit. Breath CO monitoring has been utilized in smoking cessation as a tool to provide patients with biomarker feedback.

Quitting is the process of discontinuing the practice of tobacco smoking and thereby getting rid of strong physical substance dependence and psychological dependence (addiction). Although stopping smoking can cause side effects such as weight gain, smoking cessation programs are cost-effective because of the positive health benefits. Smoking cessation can occur without assistance from health care professionals or the use of medications. Methods that have been found to be effective include interventions aimed at health care providers and health care systems; medications including nicotine replacement therapy (NRT) and varenicline; individual and group counseling; and Web-based and computer programs. Up to three-quarters of ex-smokers have quit without assistance (“cold turkey” or cut down then quit), and unaided cessation is by far the most common method used by most successful ex-smokers. “Cold turkey” is abrupt cessation of all nicotine use. In three studies, it was the quitting method used by 76%, 85%, or 88% of long-term successful quitters. Early “failure” is a normal part of trying to stop. Many initial efforts are not serious attempts. A serious attempt at stopping need not involve using nicotine replacement therapy (NRT) or other drugs or getting professional support. NRT, other prescribed pharmaceuticals, and professional counseling or support also help many smokers, but are certainly not necessary for quitting. The most frequent unassisted methods were “cold turkey” and “gradually decreased number” of cigarettes. A 1995 meta-analysis estimated that the quit rate from unaided methods was 7.3% after an average of 10 months of follow-up. Another estimate is that only about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help. A 2008 systematic review in the European Journal of Cancer Prevention found that group behavioral therapy was the most effective intervention strategy for smoking cessation, followed by bupropion, intensive physician advice, nicotine replacement therapy, individual counseling, telephone counseling, nursing interventions, and tailored self-help interventions; the study did not discuss varenicline.

Medications to quit smoking:

Nicotine replacement therapy (NRT) delivers nicotine in a form that does not involve the risks of smoking. Nicotine replacement therapy (NRT) is the remedial administration of nicotine to the body by means other than tobacco, usually as part of smoking cessation. The primary benefit of nicotine replacement therapy is that it prevents cravings in a smoker whilst allowing them to abstain from tobacco—and thus avoid the harmful effects of smoking. The purpose of NRT is to deliver small doses of nicotine to your body, which allow you to better manage your withdrawal symptoms and cravings as you quit smoking. When you smoke, you inhale nicotine and more than 4,000 harmful chemicals. More than 69 of those substances are known to cause cancer. Replacing smoking with a pure nicotine alternative, such as NRT eliminates all those other chemicals, and that’s definitely a benefit. Typically, people use nicotine replacement therapy for about four to six months. Although nicotine replacement therapy delivers a much lower dose of nicotine than smoking cigarettes, about three to six percent of ex-smokers become dependent on nicotine replacement and end up using it for years. The NRT medication increased the chances of stopping smoking by 50 to 70% compared to placebo or to no treatment. A study found that 93 percent of over-the-counter NRT users relapse and return to smoking within six months. As discussed before, addiction to smoking is not only due to nicotine content but also presence of high amount of MAO inhibitors in the smoke and therefore NRT fails in many patients. NRT is available as transdermal nicotine patches, gums, lozenges, inhalers and sprays. Other medications include Nicotinic receptor partial agonists Cytisine & Varenicline; Antidepressant Bupropion &Nortriptyline; and clonidine. The American Cancer Society estimates that between about 25% and 33% of smokers who use medicines can stay smoke-free for over 6 months. Nicotine patch and bupropion is the only combination that the FDA has approved for smoking cessation.

Complementary & alternative medicine (CAM) and quit smoking:

Acupuncture, aromatherapy and herbs have not been found to be useful to smokers to quit smoking. A randomized trial published in 2008 found that hypnosis and nicotine patches “compares favorably” with standard behavioral counseling and nicotine patches in 12-month quit rates.

Atropine and scopolamine combination therapy:

A few smoking cessation clinics offer a program using shots of the drugs atropine and scopolamine, sometimes along with other drugs, to help reduce nicotine withdrawal symptoms. These drugs block the action of acetylcholine, a signal transmitter in the nervous system. People who are pregnant or have heart problems, glaucoma, or uncontrolled high blood pressure are not allowed to take part in these programs. Both atropine and scopolamine are FDA-approved for other uses and have not been formally studied or approved for help in quitting smoking. Before going into such a program, you may want to ask the clinic about long-term success rates (up to a year). Some clinics claim high success rates, but the available published scientific research does not back up these claims.

The above picture shows percent increase of success for six months over unaided attempts for each type of quitting. Comparison of success rates across interventions can be difficult because of different definitions of “success” across studies.

Quitting can be harder for individuals with dark pigmented skin compared to individuals with pale skin since nicotine has an affinity for melanin-containing tissues. Studies suggest this can cause the phenomenon of increased nicotine dependence and lower smoking cessation rate in darker pigmented individuals. There is an important social component to smoking. A 2008 study analyzing a densely interconnected network of over 12,000 individuals found that smoking cessation by any given individual reduced the chances of others around them lighting up by the following amounts: a spouse by 67%, a sibling by 25%, a friend by 36%, and a coworker by 34%. Smokers with major depressive disorder are less successful at quitting smoking than non-depressed smokers. The frequency of smoking cessation among smokers varies across countries. The general trend over last few decades is that smoking is reduced in developed nations and increased in developing nations.

Behavioral methods and counseling, willpower, exercise, healthy diet, involving family & friends and changing daily habits can help quit smoking. Start your stop smoking plan with START:

S = Set a quit date.

T = Tell family, friends, and co-workers that you plan to quit.

A = Anticipate and plan for the challenges you’ll face while quitting.

R = Remove cigarettes and other tobacco products from your home, car, and work.

T = Talk to your doctor about getting help to quit.

To quit smoking, you must be ready emotionally and mentally. It may take several tries before you are successful. Some people are more ready to quit than others. Look at these five stages of change that people go through to successfully quit smoking.

Stage One: Pre-contemplation- You don’t want to quit smoking, but you may try to quit because you feel pressured to quit. Stage Two: Contemplation- You want to quit someday. You haven’t taken steps to quit, but you want to quit.

Stage Three: Preparation- You take small steps to quit such as cutting back on smoking or switching to a lighter brand.

Stage Four: Action- You commit to quitting. You make changes in your actions and environment to help cope with urges to smoke and remain smoke-free for six months.

Stage Five: Maintenance- You have not smoked for one year.

Remember: Smoking again (relapse) is common. In fact, 75% of those who quit will smoke again. Most smokers try to quit three times before being successful. So don’t give up!

Mobile phones could hold the key to people giving up smoking after a study involving sending motivational and supportive text messages to smokers doubled quit rates after six months. Telephone counseling is also effective intervention in quitting smoking.

Failure to Quit

Only about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help. Studies in medical journals have reported that between about 25% and 33% of smokers who use medicines can stay smoke-free for over 6 months. There is also early evidence that combining some medicines may work better than using them alone. Behavioral and supportive therapies may increase success rates even further, and help the person stay smoke-free.

Individual Risk Factors for Failure:

Researchers have been trying to discover individual risk factors or sets of behaviors that can help predict why specific people fail to quit. Some factors include:

Being female

Being a heavy smoker

Inhaling deeply

Being a long-term smoker

Having severe withdrawal symptoms

Cheating during the first 2 weeks of withdrawal, even with the patch, nearly guarantees that a person will smoke again in 6 months.

Women and Smoking:

Studies show that women have a harder time trying to quit smoking and have less success with abstinence programs than men. There are many proposed reasons for this:

1) Nicotine has different effects on mood in women compared to men. Women who quit may have greater anxiety and stress than men who quit.

2) Women are not as physically dependent on nicotine as men, but they are more addicted to the actual behavior of smoking, which is the more powerful deterrent to quitting. This may be the reason why nicotine replacement, which only reduces cravings, tends not to be as effective in women.

3) Women may fear weight gain after quitting more than men.

4) Certain phases in the menstrual cycle may reduce the response to drugs that are used to help women quit smoking.

5) Men may be less supportive than women in helping their partners quit.

6) Women trying to quit may miss the feeling of control associated with smoking more than men.

On the positive side, evidence suggests that when women quit, their lung function seems to improve more rapidly than in men who quit.

Will-power:

The state of mind is often referred to as will power and it is always easy to say rather than doing it. By taking an oath to stop smoking you will be taking the first step in giving up smoking. It is necessary that you have faith on yourself and travel along the right path to stop smoking. Will power and determination is necessary for you to reach the final stage of quit smoking.

Smoking and stress:

Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known. It could help those adult smokers who wish to quit and might prevent some schoolchildren from starting.

Is nicotine in nicotine replacement therapy (NRT) harmful?

Does Smoking increase heart disease risk? Yes.

The nicotine present in cigarettes causes:

1) Decreased oxygen to the heart.

2) Increased blood pressure and heart rate.

3) Increase in blood clotting.

4) Damage to cells that line coronary arteries and other blood vessels.

Now the same nicotine exists in NRT albeit in lesser amount but nonetheless it is nicotine, so won’t the same poison affect heart? How can NRT help when nicotine can harm?

The US Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guideline on Smoking Cessation in 2000 recommended NRT for all adult smokers except pregnant women and people with heart or circulatory diseases. But the 2008 Clinical Practice Guidelines for treating tobacco dependence says that NRT (in this case, the nicotine patch) can be used safely under a doctor’s careful monitoring, even in people who have heart or blood vessel disease. Studies have found the benefits of quitting smoking outweigh the risks of NRT in people with cardiovascular (heart and blood vessel) disease. When looking at NRT use, the benefits of quitting smoking must outweigh the potential health risks of NRT for each person.

Pregnant women using nicotine patches and gum to help kick their smoking habit are harming their unborn babies, scientists claim. They say the addictive substance is absorbed by the fetus and this can cause high blood pressure and heart problems later in life. American researchers suspect that nicotine causes harmful chemicals to form in the babies’ blood vessels while they are still in the womb. These chemicals, known as reactive oxygen species, permanently damage the blood vessels so they are unable to function properly, which can lead to high blood pressure and heart problems. This study provides further evidence that nicotine exposure during pregnancy not only has immediate harmful effects on the fetus, but may increase the risk of heart and circulatory disease in children as they grow up. Any form of nicotine is bad for women during pregnancy but nicotine replacement therapy, like patches or gum, is better than smoking. There is lots of help out there for a smoker wanting to quit that doesn’t involve nicotine, so there really is no excuse for expectant mums not kick the habit and avoid putting their children at unnecessary risk.

As of late 2010 there is still not enough good evidence one way or the other to know if NRT is safe in pregnant women. One 2009 US study found that NRT use during pregnancy led to a higher risk of low birth weight babies and pre-term birth. But smoking during pregnancy can cause these problems and a lot more, so many doctors think that NRT is less harmful than smoking during pregnancy. Also, while NRT exposes the fetus to nicotine, smoking exposes the fetus to nicotine and a number of other chemicals. On the other hand, nicotine may have unknown effects on the infant as the child grows up, and this has not been carefully studied over the long term. With all of this in mind, it is best to quit smoking before getting pregnant. If it’s too late for that, quitting in early pregnancy can still greatly reduce many risks to the baby. Smokers who find themselves pregnant should talk with their doctors right away to get help in choosing the best way for them to quit smoking.

Smoking cessation products such as nicotine gum, lozenges and inhalers may contribute to the development of mouth cancer, according to a study conducted by the Medical Research Council and published in the journal PLoS One. The researchers emphasized that it is far more important to quit smoking than to avoid nicotine gum, and that the point of the study is to use cessation products just long enough to quit smoking, and not longer. Smoking is of course far more dangerous than nicotine gum, and people who are using nicotine replacement to give up should continue to use it and consult their doctor if they are concerned. The important message is not to overuse it, and to follow advice on the packet.

Can you get too much nicotine from NRT?

NRT products are supposed to roughly match the amount of nicotine you get through tobacco. It can be more of a challenge to get the dose right for smokeless tobacco users, since NRT products are labeled for smokers. To avoid withdrawal symptoms, you want to aim for a nicotine dose fairly close to what you got from snuff or tobacco use. You don’t want to get more than that, because higher doses of nicotine can cause harm. An overdose can cause death. Because of their small size, overdose is more of a problem with children and pets. Nicotine absorbs through the skin, so you must store and dispose of your NRT safely. Keep new NRT and any used or empty bottles, cartridges, patches, etc., safely away from children and pets. Also, don’t uses a heat source (like a heating pad or heat lamp) on the skin under your nicotine patch – the extra blood supply could cause more nicotine to absorb.

Note that NRT has not yet been proven to help people who smoke fewer than 10 cigarettes per day. You may want to talk with your doctor about a lower dose of NRT if you smoke less than half a pack per day but feel you need nicotine replacement. NRT is recommended to be slowly withdrawn over 6 months after smoking cessation but this withdrawal of NRT itself can give rise to nicotine withdrawal symptoms, the same symptoms which a smoker gets on smoking cessation without NRT. Under such circumstances, what is the rationale of NRT?

Tobacco economics:

The Tobacco Industry and its allies use economic analysis to argue against tobacco control policies by stating that they will create havoc on jobs, tax revenues, tobacco farmers and the economy in general. These same arguments are used around the world to promote tobacco production & industry in countries that could use their resources to more humane and health promoting uses.

Why farmers grow tobacco crop?

Tobacco as a crop gives superior net economic returns compared with alternative crops. Tobacco is preferred due to its drought resistance and suitability for growing under rainfed conditions. Small-scale farmers take to tobacco cultivation as something inevitable in the absence of a suitable alternative.

Cost of smoking higher than revenue:
Let me start with India. The total health cost entailed by major tobacco-related diseases like cancer, lung disease and heart disease was estimated to be about Rs 30,833/- crore (US $ 7.2 billion) for the year 2001-02 in India, the largest democracy. This is four times the revenue generated from the tobacco industry.

Today China is the biggest world tobacco market and tobacco maker. The government collects 8% of its total tax revenue from tobacco. Annual tobacco industry profits in China stand at some US$60 Billion. China consumed 1.2 trillion cigarettes in the first 6 months of 2009. Tobacco generated 513.1 billion Yuan ($77.3 billion) in taxes and profits last year, more than 7.5 percent of the total central government revenues, and employed 520,000 workers in 183 factories, according to official statistics. The absolute production value of the industry rose from 100 billion Yuan in 1978 to 513.1 billion Yuan last year. However, citing the official report, the net contribution of tobacco to China’s economy is around minus 20 percent. Cases of lung cancer in China have soared by 465 percent since 1980, and account for nearly a quarter of cancer deaths. Diseases and fatalities caused by tobacco use have a time lag of 20 to 25 years. At the end of the day, all Chinese, including non-smokers, will be burdened with the medical costs of smokers.

Contrary to what many may think, smoking is much more expensive than it is advertised. In fact, it’s estimated that actual costs of smoking total nearly $40 a pack. This estimation includes all the factors associated with smoking, not just merely the cost of one pack of cigarettes. Researchers have broken down these factors by cost:

$33 a pack for the cost of early deaths, smoking-related disabilities and other factors (which includes $20.28 a pack due to reduced life expectancy)

$5.44 a pack for the cost of the effect of secondhand smoke on significant others

$1.44 a pack for the cost of the effect of secondhand smoke on the society as a whole

At approximately $40 for every pack, the total cost over one smoker’s lifetime equals nearly $171,000. In past studies, researchers only calculated medical and secondhand smoke costs. However, in this study researchers tried to take into account the entire range of lifetime costs. Let me put it differently. Smoking cost the United States over $193 billion in 2004, including $97 billion in lost productivity and $96 billion in direct health care expenditures, or an average of $4,260 per adult smoker. This is over 1% of the gross domestic product. So whichever way you calculate, smoking harms economy.

Tobacco kills people at the height of their productivity, depriving families of bread winners and nations of healthy workforce. Tobacco users are also less productive while they are alive due to increased sickness. There are many studies which show that in the developing countries, the lowest income groups spend as much as 10 per cent of total household expenditure on tobacco. In Indonesia, the lowest income group spends 15% of its total expenditures on tobacco. In Egypt, more than 10% of households’ expenditure in low-income homes is on tobacco. The poorest 20% of households in Mexico spend 11% of their income on tobacco. It means that the families have less money to spend on basic items such as food, education and health care.

The jobs argument:

The industry regularly uses the threat of job loss in arguing against tobacco-control measures. But should World War II have been prolonged to protect jobs in the ammunitions factories? Should drinking and driving be permitted just to protect jobs in bars? Should people be encouraged to smoke to prevent the loss of jobs? The jobs versus lives argument is without merit. The addictiveness of nicotine means that any decrease in tobacco consumption will be gradual. Decreases in employment can be dealt with principally through attrition (quitting and retirement) instead of layoffs. More important, as less money is spent on tobacco, more money will be spent on other items, thereby increasing jobs in other sectors and offsetting any job loss in the tobacco sector. There is evidence that tobacco results in a net economic loss to society such that a decrease in smoking is economically beneficial.

In a paper about the global economic burden of tobacco, a World Bank Senior Economist concludes that the world tobacco market produces an annual global net loss of US$ 200 billion. World Bank encourages developing countries to act now on tobacco control policies such as countering tobacco industry advertising & promotion activities and raising retail tobacco prices through excise taxes. A World Bank policy adopted in 1991 states, “The Bank does not lend for tobacco production, processing, imports, or marketing, whether for domestic consumption or for export.” According to World Bank, tobacco consumption provides a net economic loss, and anti-tobacco policies are a cost-effective way to save lives and benefit the economy.

Tobacco companies know they are under siege. Thus, the basic strategy is to hold off the inevitable. The industry undoubtedly realizes that in the long term, many decades from now, there will be almost no smoking in world.

The tobacco industry’s survival strategy can be summarized through the nine D’s:

1) Deny the health consequences of smoking.

2) Deceive consumers about the true nature of cigarettes through marketing and PR.

3) Damage the credibility of industry opponents.

4) Direct advertising to women and youth, in addition to men, to maximize sales volume.

5) Defeat attempts to regulate the industry or control smoking.

6) Delay legislation if it can’t be defeated.

7) Destroy legislation once it passes, either by trying to overturn the law in court, by disobeying the law, or by exploiting loopholes.

8) Defend lawsuits filed against the industry.

9) Develop new markets around the world.

Tomorrow of tobacco:

Collective advances will further drive down the incidence and prevalence of tobacco use and nicotine addiction in the U.S. and set an example for the developing world, where cigarette use is still on the upswing. The identification of susceptibility genes for tobacco addiction and associated health effects will allow for the earlier identification of individuals most at risk and will help identify novel targets for medications development. One current approach in clinical trials is a vaccine designed to bind and eliminate nicotine from the blood, preventing it from reaching the brain and exerting its effects. A nicotine vaccine is being tested in humans, with promising results. The vaccine stimulates the body to produce antibodies able to sequester nicotine in the bloodstream, preventing the drug from entering the brain and exerting its rewarding effects. The vaccine could be a powerful tool to prevent relapse in recovering individuals. Results so far show improved smoking cessation and continuous long-term abstinence (compared to placebo), and decreased use among smokers who did not achieve complete abstinence. Advances in pharmacogenomics—understanding how variations in an individual’s genome affect his or her response to a medication—will lead to personalized tobacco cessation strategies that can minimize adverse reactions and optimize quit success.

Researchers at the University of Maryland are looking for alternative uses for the tobacco crop, which could end up helping society and tobacco farmers. A team of researchers is focusing on the plant’s good side — its nutritional benefits. Believe it or not, tobacco does have a lot of very good properties. A plant has enormous potential for medicine, cosmetics, and energy. It’s got excellent quality proteins – human food proteins. They’re tasteless, odorless, the same quality as you have in soybeans or with milk. Also, tobacco produces an enormous amount of leaf matter that’s left over after you get the proteins out, and it’s from this material left over that researchers envision looking for petroleum substitutes.

Newly synthesized polymer, fitted with molecular pincers of carefully tailored structure, effectively captures nicotine molecules and its analogues. The polymer with pincers for nicotine can be used, among others, in chemosensors devised to analyze nicotine content in tobacco leaves and in biomedical studies to determine nicotine metabolites in patients’ body fluids. Another potential application is nicotine patches to help quit smoking. The new polymer could be used for prolong and smooth release of nicotine.

Tobacco myths:

Myth 1: There are safer ways to smoke cigarettes.

Fact: All cigarettes harm the human body. Any smoking is dangerous. Research has found that even smoking as few as 1 to 4 cigarettes a day can lead to serious health outcomes, including an increased risk of heart disease and a greater chance of dying at a younger age. Some people think that switching from high-tar and high-nicotine cigarettes to those with low tar and low nicotine makes smoking safer, but this is not true. Smokers have been led to believe that “light” cigarettes are a lower health risk and are a good option to quitting. This is not true. Hand-rolled cigarettes are thought by some people to be a cheaper and healthier way to smoke, but they are not safer than commercial brands. Even though herbal cigarettes do not contain tobacco, they give off tar and carbon monoxide and are dangerous to your health. The bottom line is there’s no such thing as a safe smoke.

Myth 2: Menthol cigarettes are safer than those without menthol.

Fact: Menthol cigarettes are not safer than any other brand. In fact, they may even be more dangerous. The added menthol produces a cooling sensation in the throat when the smoke is inhaled. It also lessens the cough reflex and covers the dry feeling in the throat that smokers often have. People who smoke menthol cigarettes can inhale deeper and hold the smoke in longer. Recent studies have shown that people who smoke menthol cigarettes are less likely to try to quit and are less likely to succeed when they do try. At least one researcher proposed that menthol smokers might want to switch to non-menthol cigarettes before they quit improving their chances of quitting smoking.

Myth 3: Cigarette smoking is a habit like drinking tea/coffee and not addiction.

Fact: The nicotine in cigarette smoke can cause addiction. Nicotine is an addictive drug just like heroin and cocaine. Smokers usually become dependent on nicotine and suffer physical and emotional (mental or psychological) withdrawal symptoms when they stop smoking. These symptoms include irritability, nervousness, headaches, and trouble sleeping. The true marker for addiction, though, is that people still smoke even though they know smoking is bad for them — affecting their lives, their health, and their families in unhealthy ways. Most people who smoke want to quit.

Myth 4: Nicotine causes cancer.

Fact: Many people mistakenly think that nicotine is the substance in tobacco that causes cancer. This belief may cause some people to avoid using nicotine replacement therapy when trying to quit. Nicotine is what gets (and keeps) people addicted to tobacco, but other substances in tobacco cause cancer. However, nicotine itself is a poison and can cause cardiac arrest. There is no conclusive evidence yet to show that nicotine causes cancer.

Myth 5: I know someone who smoked for ages but did not get cancer. I know someone who never smoked and got lung cancer. So smoking does not cause cancer.

Fact: Smoking causes cancer. But this doesn’t mean that all smokers will definitely get cancer or that all non-smokers won’t. It means that smoking greatly increases the risk of this disease. Smoking is the biggest single cause of cancer but it is not the only one. Even in the case of lung cancer, 1 in 10 cases happen in non-smokers and could be caused by breathing in pollutants such as second-hand smoke. Our risk of cancer depends on a combination of our genes, our lifestyle choices and our environment. Because of this, no single action will completely guarantee to protect you against cancer. Smokers are, on average, much more likely to get cancer than non-smokers. The fact is that half of all smokers eventually die from cancer, or other smoking-related illnesses.

Myth 6: With so much air pollution around us, why blame smoking for cancer.

Fact: Both smoking and air pollution are linked to lung cancer, but the effect of smoking is considerably larger. The lung cancer risk from smoking is at least 30 times greater than that from air pollution. In the UK, three out of every hundred cases of lung cancer are caused by air pollution. The rest are nearly all caused by smoking. Air pollution (auto exhausts, industry wastes, etc.) increases the lung cancer rate of the smoker, but not of the non-smoker. Apparently, the lung-cleaning cilia are alive and working for the non-smoker.

Myth 7: It is okay if I just smoke light, mild or low-tar cigarettes.

Fact: Low-tar cigarettes just as harmful as regular brands. When people smoke ‘low tar’ or “light” cigarettes, they breathe in much harder to satisfy their nicotine cravings. So even if the cigarettes taste weaker, they are still doing your body as much damage as ‘stronger’ brands. Besides, cigarettes contain many other harmful chemicals besides tar and nicotine. While different brands may vary in their ingredients, all of them are dangerous to your health.

Myth 8: It is okay if I just smoke one cigarette every day.

Fact: Studies have shown that even people who smoke 1 to 4 cigarettes a day are still almost three times more likely to die of heart disease and lung cancer than non-smokers.

Myth 9: Tobacco industry provides employment to millions.

Fact: The fact that the tobacco industry provides work, that wouldn’t exist without it, is a myth. The money now wasted on tobacco, if diverted elsewhere, would create a wealth of new job openings in industries producing goods and services more useful to the society than cigarettes.

Myth 10: Cutting back is good enough.

Fact: Every single cigarette is a source of bodily damage, so quitting completely is the only way to go.

Myth 11: Tobacco relieves mental stress.

Fact: Nicotine dependency exacerbates stress and smokers have a higher level of stress than non-smokers.

Myth 12: Smoking only affects the smoker.

Fact: Second-hand smoke can increase the risk of lung cancer and heart disease, and can further aggravate asthma and bronchitis in a non-smoker.

Myth 13: Leading an otherwise healthy life makes it okay to go on smoking.

Fact: Studies have proved that healthy eating and other healthy habits do not reduce the risks associated with smoking.

Myth 14: Tobacco is necessary self-medication for the mentally ill and quitting smoking interferes with recovery from mental illness.

Fact: Nicotine is a powerful reinforcing drug that transiently enhances concentration and attention, regardless of the smoker’s mental health status. But it has proved ineffective as an adjunctive treatment for mental disorders (e.g., depression, schizophrenia, and attention-deficit disorder), possibly because of the rapid decrease in drug response with repeated exposure. The reality is that tobacco is another problem, not a solution. Five randomized tobacco-treatment trials in patients concurrently receiving mental health treatment have found that smoking cessation did not exacerbate depression or PTSD symptoms or lead to psychiatric hospitalization or increased use of alcohol or illicit drugs.

Myth 15: Smoking has no effect on sex; in fact, there is nothing better than lighting up after sex.

Fact: Risk of impotence is increased to nearly 50% by smoking cigarettes for men in their 30s and 40s. Acute vasospasm, contraction of the penile tissue, and restricted blood flow to the penis is a result of nicotine effect on penile vasculature. The valve mechanism that traps blood in the penis is impaired as a result of nicotine in the blood stream. Some of the other male sexual dysfunctions cause by smoking cigarettes include: reduced amount of ejaculate, lower sperm count, abnormal sperm shape and impaired sperm mobility. One study of 200 women in Massachusetts revealed that smoking had more of a negative effect on women’s sexuality than did menopause. It decreases fertility in women – and it probably has to do with decreasing blood flow to the ovaries, and maybe reducing hormone levels.

Is smoking a crime?

UN statute confers jurisdiction on the international criminal court with respect to crimes such as genocide, war crimes, and “crimes against humanity”. A list of “crimes against humanity” is provided which covers events such as extermination, enforced prostitution, sterilization, and religious persecution when committed as part of a widespread or systematic attack directly against any civilian population. Significantly, the definition of a crime against humanity includes “other inhumane acts of a similar character intentionally causing great suffering, or serious injury to body or to mental or physical health”. This definition begs the question of whether the death toll from tobacco does not constitute a crime against humanity, susceptible to prosecution in the international criminal court. The World Health Organization (WHO) estimates that of some 1.35 billion smokers in the world, 50% will die prematurely from tobacco-attributable illness, half in middle age. This means that in excess of 650 million people, or about 10% of the existing population, will die from smoking. Based on current trends, WHO estimates that the death toll from smoking will rise to 10 million people per year by the year 2025. No other consumer product in the history of the world has come even close to inflicting this degree of harm on the world community. If anything else posed a threat to life of this magnitude, whether human induced or naturally occurring—be it world war, genocide or “ethnic cleansing”, natural disaster, or disease—it would demand immediate international action. The international responses to war crimes (both current and dating back to world war two), germ warfare, nuclear weapons, HIV, or even climate change are but a few examples. It may be argued that the definition of “crime against humanity” is directed rather more toward “intentional” crimes in the stronger sense: that is, not only did the perpetrators intend the acts while knowing the harm that would flow from the acts, but also they desired that very harm (either in itself, or as necessary means towards goals sought to be achieved). In this respect it could be said that the directors and executives of tobacco companies do not intend to cause their customers to suffer, nor do they need the suffering, injury, and death of their customers to achieve their goals—these consequences are merely an incidental result of their marketing activities. Even so, such conduct is comparable to manslaughter where death is an unintended consequence of a recklessly negligent act. In any event, in a case where tobacco companies are already put on notice that a consequence of their conduct is that large numbers of people may die, then it may be that the necessary intentional element is established.

So who is responsible for deaths of millions of humans every year? Is it tobacco companies? Is it their criminal offence? Of course, billions of people consume tobacco (smoke and/or smokeless) voluntarily due to nicotine addiction, no matter whether they are aware of health hazards of tobacco or not. If these people decide overnight to quit tobacco, all tobacco companies will shut down. So are people responsible for their own death? Tobacco companies manufacture cigarettes and other tobacco products obeying the laws of respective nations. It is the respective governments & parliaments of various nations that allow production, distribution and sales of tobacco products after collecting taxes from tobacco companies. So is it the governments & parliaments of various nations responsible for death of millions of their citizens? Think over it. One view is that nations have legal tobacco sales, is to prevent organized crime from controlling the tobacco market. Nations recognize that it is very difficult to eliminate tobacco use in the world, so the only rational thing to do is to legalize its sale to adults in stores we can trust. Nations want to keep criminals out of the market, not encourage tobacco use! I personally do not agree to such a view.

So where does the buck stops? Is it at tobacco companies? Is it at people? Is it at government? Is it at media?

The buck stops at nicotine. The world must get rid of nicotine from all sources including nicotine replacement therapy.

The moral of the story:

1) The world has no morals as it cultivates and distributes tobacco in many forms despite knowing that 10 % of its people will die due to tobacco use.

2) Tobacco use due to nicotine addiction is a greater problem for the world than poverty, terrorism and corruption.

3) Most tobacco users do not know that nicotine is as addictive as heroin or cocaine.

4) Tobacco use does not relieve stress but in fact increases stress.

5) Nicotine is a poison for humans no matter whether you get it through smoking tobacco or through smokeless tobacco or through nicotine replacement therapy (NRT) for quitting tobacco.

6) The best way to quit smoking is to just quit without NRT and take treatment for nicotine withdrawal symptoms. Nobody dies due to nicotine withdrawal but there is a possibility of death due to NRT.

7) All forms of tobacco use are harmful and must be strongly discouraged. Yes, smoking tobacco is more harmful than smokeless tobacco, more harmful to the smoker as well as to the society due to second hand smoke. If a smoker fails to quit smoking despite best efforts, he/she may switch to smokeless tobacco in the larger interest of society.

8) Tobacco smoking is more addictive than smokeless tobacco despite smokeless tobacco having higher nicotine than tobacco smoke because of presence of high amount of beta-carboline alkaloids harman and norharman in the smoke.

9) Education and higher IQ have inverse relationship with tobacco use. In countries where illiteracy and poverty induced lower IQ are prevalent, population is unlikely to quit tobacco voluntarily, and the only way out is to ban production & sale of all tobacco products.

10) The slogan for the 21’st century – “Quit nicotine save world”.

Dr. Rajiv Desai. MD.

August 28, 2011

Postscript:

You see even a nicotine addict can become a president.

The U.S. president has quit smoking after assuming office.

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NICOTINE ADDICTION

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