HARMFUL HEALTH EFFECTS OF TOBACCO CONSUMPTION

Dr.P.Naina MohamedPharmacologist

INTRODUCTION Tobacco use is the largest single

preventable cause of illness and premature deaths .

Tobacco use currently causes about 5 million deaths (9% of all deaths) annually.

Approximately 1.6 million deaths are CVD-related.

If current smoking patterns continue, by 2030 about 10 million deaths would be caused by tobacco use annually.

Tobacco use has been the leading cause of cancer death in men since 1955 and in women since 1986.

FORMS OF TOBACCO CONSUMPTION Tobacco is consumed in many forms and through a number of different methods. They may include… Smokeless Tobacco

Chewing Tobacco Snuff Creamy Snuffs Dipping Tobaccos Gutka Snus

Burned Tobacco Cigarette Smoking Cigar Smoking Beedi (Bidi) smoking Kreteks Hookah

SMOKELESS TOBACCO Recent research shows the dangers of smokeless tobacco may

go beyond the mouth. Smokeless tobacco contains more nicotine than cigarettes.

Nicotine is a highly addictive drug. Harmful health effects of smokeless tobacco 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 Possible increase in 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 and discolored teeth Bad breath

LEUKOPLAKIA

Leukoplakia is a white patch in the mouth that can become cancer.

They are usually painless. Many studies have shown high rates of

leukoplakia at the place in the mouth where users place their chew or dip.

One study found that nearly 3 of 4 of daily users of moist snuff and chewing tobacco had non-cancerous or pre-cancerous lesions (sores) in the mouth.

The longer a person uses oral tobacco, the more likely they are to have leukoplakia.

GUM DISEASESTobacco

Irritate or destroy gum tissue

Receding gums, gum disease, tooth decay (from the high sugar content in the tobacco),

and bone loss around the teeth

Loosen teeth

Tooth Loss

HEART DISEASES Smokeless tobacco may also play a role in

heart disease and high blood pressure. A large American Cancer Society study

showed that men who switched from cigarettes to snuff or chewing tobacco had higher death rates from heart disease stroke, cancer of the mouth and lung, and all causes of death combined than former smokers.

Studies in Sweden found that snuff (snus) users were more likely to die from their heart attacks than non-users.

CANCERSSnuff and chewing tobacco

Very high levels of tobacco-specific nitrosamines, benzo[a]pyrene and other polycyclic aromatic

hydrocarbons

Cancer-causing agents (carcinogens)

CancersAbout 70 percent of deaths in smokeless tobacco users, are from oral cancer. Other cancers caused by tobacco include cancer of the pancreas, nasal cavity, urinary tract, oesophagus, pharynx, larynx, intestines and the stomach.

CHEWING TOBACCO

Chewing tobacco is used by putting a wad of tobacco inside the cheek. Chewing tobacco and snuff contain 28 cancer-causing agents. Chewing tobacco is more addictive because it contains higher levels of

addictive nicotine than cigarettes and can be harder to quit than cigarettes.

The most common sign of possible cancer in smokeless tobacco users is leukoplakia, a white scaly patch or lesion inside the mouth or lips, common among many chewing tobacco users.

Red sores are also a warning sign of cancer. Studies have found that 60 to 78 percent of chewing tobacco users have

oral lesions. Those who mix snuff and chewing tobacco, are more likely to develop

precancerous lesions than those who use only one type of chewing tobacco.

Long-term snuff users have a 50 percent greater risk of developing oral cancer than non-users, and chewing tobacco users are more likely to become cigarette smokers.

Chewing tobacco has been known to cause cancer, particularly of the mouth and throat.

Smokeless tobacco is a major cause of oral cancer, pancreatic cancer, and esophageal cancer.

SNUFF Snuff is a smokeless tobacco made from

ground or pulverised tobacco leaves which is either sniffed through the nose or placed between the cheek and gum.

The nicotine in snuff is absorbed through the mucus membrane.

Scientists have known for more than a century that using snuff increases the risk of nasal and oral cancers.

CREAMY SNUFFS

Creamy snuff is marketed mainly to women in India, and is known by the brand names IPCO (made by Asha Industries).

Creamy snuff is a paste consisting of tobacco, clove oil, glycerin, spearmint, menthol, and camphor.

It is sold in a toothpaste tube. According to the U.S NIH-sponsored Smokeless

Tobacco Fact Sheet, it is marketed as a dentifrice. The same factsheet also mentions that it is "often

used to clean teeth. The manufacturer recommends letting the paste

linger in your mouth before rinsing. The product is addictive. A similar product, known as gul or gadakhu, is made

with tobacco powder and molasses, and used mainly by women in Central and South Asia as a dentifrice.

DIPPING TOBACCOS

Dipping tobacco, traditionally referred to as moist snuff, is a type of finely ground or shredded, moistened smokeless tobacco product.

It is used by placing a lump or "dip" of tobacco between the lip and the gum.

Nicotine is the main ingredient of concern in smokeless tobacco. It is estimated that a normal, 30-minute dip of smokeless

tobacco delivers the same amount of nicotine as 3-4 cigarettes. Nicotine affects the brain and central nervous system and

changes neurotransmitters levels regulating mood, learning, alertness, and ability to concentrate.

Nicotine causes the release of endorphins, which provide a tranquilizing effect.

Nicotine is considered more addictive . According to the American Cancer Society, chewing tobacco

users are 50 times more likely than non-users to get cancers of the cheek, gums, and inner surface of the lips.

Dipping tobacco can cause fatal oral cancers and tooth loss.

GUTKA

Gutka or Gutkha is manufactured in India and exported to a few other countries.

It is a preparation of crushed areca nut (also called betel nut), tobacco, catechu, paraffin, slaked lime and sweet or savory flavorings.

It is consumed by placing a pinch of the mixture in the mouth between the gum and cheek and gently sucking and chewing.

A gutkha 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.

Excessive gutkha use can eventually lead to loss of appetite, promote unusual sleep patterns, and loss of concentration along with other tobacco-related problems.

It is considered responsible for oral cancer and other severe negative health effects.

SNUS

Snus is originated in Sweden and Norway. Snus is packaged in small bags, similar to tea bags. Snus is typically placed under the upper lip. Each bag lasts around 30 to 45 minutes. Snus, is made of tobacco, salt, and sodium

carbonate. The ground tobacco is mixed with water, salt, and

an alkylizing agent (sodium carbonate) and aroma and is prepared through heating.

Snus is linked to mouth sores, dental cavities, heart attack, stroke, and diabetes risk.

Snus use causes 40% increased risk of death from cardiovascular disease and strokes.

Snus users are twice likely to develop pancreatic cancer when compared to non-tobacco users.

BURNED (SMOKING) TOBACCO All forms of burned tobacco generate toxic and

carcinogenic smoke. There are about 1.3 billion tobacco smokers worldwide and this number is still increasing. About 1 in 5 adults smoke. More men (nearly 24%) than women (about 18%) smoke. Smoking rates are higher among people with a lower education level. Tobacco smoke contains chemicals that are

harmful to both smokers and nonsmokers. Breathing even a little tobacco smoke can be

harmful. Tobacco smoke contains about 4800

compounds.

HEALTH RISKS OF TOBACCO SMOKING Atherosclerotic diseases of the heart and blood

vessels: Cardiovascular disease (including myocardial

infarction and sudden death) Cerebrovascular disease (Stroke) Peripheral vascular disease (Claudication, etc)

Noncancerous lung diseases: Chronic obstructive pulmonary disease Asthma

Cancers at many sites, including the lung, larynx, oral cavity, esophagus, bladder, kidney, pancreas, and uterine cervix.

Toxicity to the human reproductive system Reduced Fertility

CIGARETTE SMOKING

Cigarettes are uniform in size and contain less than 1 gram of tobacco each.

Cigarette (Tobacco) smoke contains irritating, suffocating, dissolving, inflammable, toxic, poisonous, carcinogenic gases and substances and even radioactive compounds (nickel, polonium, plutonium, etc.).

Some of these include benzopyrene, dibenzopyrene, benzene, isoprene, toluene (hydorcarbons); naphthylamines; nickel, polonium, plutonium, arsenic, cadmium (metallic constituents); carbon dioxide, methane, ammonia, nitric oxide, nitrogen dioxide, hydrogen sulphide (gases); methyl alcohol, éthanol, glycerol or glycerine, glycol (alcohols and esters); acetaldehyde, acrolein, acetone (aldehydes and ketones); cyanhydric or prussic acid, carboxyl derivatives (acids); chrysene, pyrrolidine, nicoteine, nicotinine, nicoteline, nornicotine, nitrosamines (alkaloids or bases); cresol (phenols), etc.

CIGAR SMOKING

Cigar is a roll of tobacco wrapped in leaf tobacco or in any substance containing tobacco. Most cigars are made of a single type of air-cured or dried tobacco. Like other forms of tobacco use, cigar smoking also poses a significant health risk depending on dosage. Health risks are similar to cigarette smoking in nicotine addiction, periodontal health, tooth loss, and many types of cancer, including cancers of the mouth, throat, and esophagus. Cigar smoking also can cause cancers of the lung and larynx. Cigar smoking also increases the risk of lung and heart diseases such as chronic obstructive pulmonary disease and myocardial infarction respectively.

BEEDI (BIDI) SMOKING

Bidis are small, thin hand-rolled cigarettes imported primarily from India and other Southeast Asian countries.

Bidis are a combustible tobacco product. Despite their small size, their toxin levels are higher

than cigarettes because of the need to puff harder to keep bidis lit.

Smoke from a bidi contains three to five times the amount of nicotine as a regular cigarette and places users at risk for nicotine addiction.

Bidi smokers also have three times the risk for developing coronary heart disease and having a heart attack and four times the risk for chronic bronchitis, according to the Indian research.

Bidi smoking increases the risk for oral cancer, lung cancer, stomach cancer, and esophageal cancer.

Bidi smoking is associated with emphysema and a nearly fourfold increased risk for chronic bronchitis.

KRETEKS SMOKING

kreteks are the most widely smoked form of cigarettes in Indonesia, where about 90% of smokers usually smoke kreteks.

Kreteks are cigarettes made with a blend of tobacco, cloves and other flavors.

The eugenol in clove smoke causes a numbing of the throat which can diminish the gag reflex in users.

Kretek smoking is associated with an increased risk for acute lung injury (i.e., lung damage that can include a range of characteristics, such as decreased oxygen, fluid in the lungs, leakage from capillaries, and inflammation), especially among susceptible individuals with asthma or respiratory infections.

Regular kretek smokers have 13 to 20 times the risk for abnormal lung function (e.g., airflow obstruction or reduced oxygen absorption) compared with nonsmokers.

Kretek smoking is associated with an increased risk of acute lung injury, especially among individuals with asthma or other breathing problems.

The venous plasma nicotine and carbon monoxide levels from 10 smokers were tested after smoking kreteks and were found to be similar to non-clove brands of cigarettes.

HOOKAH SMOKING

Hookahs are single- or multi-stemmed instruments for vaporizing and smoking flavored tobacco called shisha in which the vapor or smoke is passed through a water basin (often glass-based) before inhalation.

Each hookah session typically lasts more than 40 minutes, and consists of 50 to 200 inhalations that each range from 0.15 to 0.50 liters of smoke.

In an hour-long smoking session of hookah, users consume about 100 to 200 times the smoke of a single cigarette and in a 45-minute smoking session a typical smoker would inhale 1.7 times the nicotine of a single cigarette.

The water moisture induced by the hookah makes the smoke less irritating and may give a false sense of security and reduce concerns about true health effects.

Use of hookah can be as detrimental to a person's health as smoking cigarettes, and a study by the World Health Organization also confirmed these findings.

A study in the Journal of Periodontology found that water pipe smokers were five times more likely than non-smokers to show signs of gum disease.

A study on hookah smoking and cancer in Pakistan, concluded that heavy hookah smoking (2–4 daily preparations; 3–8 sessions a day ; >2 hrs to ≤ 6 hours) substantially raises Carcinoembryonic antigen (CEA) levels.

Hookah smokers were nearly 6-times at risk for development of lung cancer as compared to healthy non-smokers in Kashmir (India).

REFERENCES CURRENT Diagnosis & Treatment in Family

Medicine, 3e Jeannette E. South-Paul, Samuel C. Matheny, Evelyn L. Lewis Harrison's Online Featuring the complete contents of Harrison's

Principles ofInternal Medicine, 18e Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, J. Larry Jameson, Joseph Loscalzo, Eds.

Behavioral Medicine: A Guide for Clinical Practice, 3e Mitchell D. Feldman, John F. Christensen

CURRENT Practice Guidelines in Primary Care, 2013Joseph S. Esherick, Daniel S. Clark, Evan D. Slater

REFERENCES Goodman & Gilman's The Pharmacological

Basis of Therapeutics, 12eLaurence L. Brunton, Bruce A. Chabner, Björn C. Knollmann

Hurst's The Heart, 13e Valentin Fuster, Richard A. Walsh, Robert A. Harrington

Hazzard's Geriatric Medicine and Gerontology, 6eJeffrey B. Halter, Joseph G. Ouslander, Mary E. Tinetti, Stephanie Studenski, Kevin P. High, Sanjay Asthana

CURRENT Diagnosis & Treatment: Psychiatry, 2eMichael H. Ebert, Peter T. Loosen, Barry Nurcombe, James F. Leckman

REFERENCES http://www.nlm.nih.gov/medlineplus/smokele

sstobacco.html http://www.cancer.org/cancer/cancercauses/t

obaccocancer/smokeless-tobacco http://www.cancer.gov/cancertopics/tobacco/

smokeless-tobacco http://www.cdc.gov/tobacco/data_statistics/fa

ct_sheets/smokeless/betel_quid/ http://www.webmd.com/smoking-cessation/fe

atures/snus-tobacco-health-risks