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Tobacco

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Smoking cigarettes and using other tobacco products is the largest cause of preventable death in the United States. Smoking leads to the development of lung cancer, asthma, chronic obstructive pulmonary disease and infertility, among many other serious health conditions. It is also known to aggravate conditions such as asbestos lung cancer.

Tobacco has been a major American industry, economic driver and influencer of pop culture since the invention of the cigarette-making machine in the late 1880s. However, it has also caused millions to experience disease and premature deaths because of the high number of toxins involved in the drug. Upwards of 20 million Americans have died because of smoking and its effects since 1964, according to the U.S. Department of Health and Human Services. Since the 1960s, when scientists first linked tobacco to lung cancer and other health conditions, millions of Americans have sued “Big Tobacco” companies and won vast settlements for their pain and suffering — including the largest settlement in U.S. history in 1998.

Tobacco is a leafy crop indigenous to North and South America that is dried and cured for the purpose of smoking or chewing. Most people smoke tobacco in the form of a cigarette, but it can also be rolled into cigars, smoked using a pipe, snorted and chewed. Nicotine, one of the main substances in tobacco, is highly addictive.

About 600 ingredients in one cigarette create more than 7,000 chemicals when burned, according to the American Lung Association. Roughly, 70 of these chemicals are poisonous and known to cause cancer and other health problems.

Some of these chemicals, toxins and poisons include:

  • Acetone
  • Ammonia
  • Arsenic
  • Carbon Monoxide
  • Lead
  • Methanol
  • Nicotine
  • Tar

Researchers first linked smoking to lung cancer in 1964. Since then, studies also connected smoking to other health conditions, including birth defects, infertility, throat cancer and chronic obstructive pulmonary disease, also known as COPD. Because cigarette smoke is so harmful, it can also aggravate lung cancer that began from other causes, such as exposure to asbestos. When particles of asbestos are inhaled, they can cause damage to the lungs.

How Is Tobacco Consumed?

There are two types of tobacco products — smoked, and smokeless. Of both kinds, smoked — specifically cigarettes — is the most common. Studies show an estimated 19 percent of the adult population in the U.S. smokes cigarettes, compared to 3.5 percent that use smokeless tobacco.

Smoked tobacco products include cigarettes, cigars, pipes and hookahs. Smoked tobaccos consist of dried and fermented tobacco leaves, which are:

  • Wrapped in paper to make cigarettes
  • Wrapped in large tobacco leaves to make cigars
  • Kept loose and packed into smoking devices like pipes and hookahs

Cigarettes are by far the most popular type of tobacco product. Some major cigarette brands are:

  • Marlboro
  • Camel
  • Newport
  • Pall Mall
  • Dunhill
  • Lucky Strike
  • Kool

Smokeless tobacco includes chewing tobacco, dip (a type of chewing tobacco) and snuff (dry tobacco that people snort). Chewing tobacco and dip is sweetened, loose tobacco cut in varying sizes that consumers “chew.” To “chew,” consumers put a pinch of the substance between their gum and lower lip. These products can last for several hours and require the consumer to spit out tobacco juices during use. Snuff is ground or shredded tobacco that consumers snort nasally.

In recent years, electronic cigarettes or e-cigarettes have also risen in popularity. These battery-operated devices vaporize liquid nicotine, which the consumer then inhales.

Tobacco Users

Studies from 2014 show that about 16.8 percent of American adults aged 18 or older smoke cigarettes. That breaks down to about 17 out of 100 people. As a result, cigarette smoking is the leading cause of preventable death and disease in the U.S. More than 480,000 Americans die each year from complications due to cigarette smoking, equating to one in every five deaths.

Based on Centers for Disease Control and Prevention studies from 2014, cigarette smoking is the most prevalent in men, American Indians/Alaska natives and people aged 25 – 44.

Current Smoking Among Adults
Men 18.8%
Women 14.8%
18 – 24 years old 16.7%
25 – 44 years old 20%
45 – 64 years old 18%
65 years and older 8.5%
American Indians/Alaska natives 29.2%
Asians 9.5%
Blacks 17.5%
Hispanics 11.2%
Whites 18.2%
Multiple race 27.9%

Many adult smokers start as adolescents. Studies from the U.S. Department of Health and Human Services show nine out of 10 smokers take up the habit before they are 18 years old, and 98 percent started by the time they are 26 years old. Statistics estimate 18 percent of high school students smoke cigarettes, with 3,200 adolescents under the age of 18 trying cigarettes each day.

Although the numbers may seem high, they are comparatively much lower than 50 years ago. In 1964, 42 percent of Americans smoked cigarettes, compared to the 18 percent of Americans who smoked in 2014.

The Rise of Big Tobacco

Tobacco has played a large role in American history, culture and industry since before the founding of the U.S., but “Big Tobacco,” as it is known, did not begin until the turn of the 20th century.

When the settlers arrived in the New World, they discovered native populations smoking tobacco for religious ceremonies and medical purposes. The colonists of Jamestown, Virginia, grew tobacco in the early 1600s, and they used the crop in part to fund the American Revolution. Tobacco gained some popularity in the early 1800s when people began to chew it. The first commercial cigarette company, founded by Washington Duke in 1865, hand-rolled cigarettes.

The rise of “Big Tobacco” began in 1881 when James Bonsack invented a cigarette-making machine that could make 120,000 cigarettes each day. He partnered with Duke and his son, James “Buck” Duke, to build American Tobacco Company. The company’s first factory made 10 million cigarettes in its first year.

From that point forward, the tobacco and cigarette industry boomed. In 1923, American tobacco companies sold 73 billion cigarettes. By 1939, 53 percent of American adult males smoked. The upward trend began to falter in the mid-1950s, however, around the time American Tobacco Company was named the top tobacco company in the U.S.

1964 Surgeon General’s Report

In 1957, the first U.S. Surgeon General, Leroy E. Burney, issued a report on smoking and health that linked “excessive” cigarette smoking to lung cancer. After facing pressure from the presidents of the American Cancer Society, American Heart Association, National Tuberculosis Association and American Public Health Association, President John F. Kennedy established a commission on the subject in 1961. They reported their findings three years later as the historic 1964 Surgeon General’s report, which officially linked smoking to the development of lung cancer.

The industry began to decline after the announcement. By 1968, 78 percent of Americans believed smoking caused cancer, compared to 44 percent in 1958. In 1988, the Surgeon General report named nicotine a “powerfully addicting drug.” In 1998, all U.S. carrier flights banned smoking. A significant cigarette tax hike in 2009 caused sales to drop 10 percent that year. The same year, Congress passed a comprehensive law giving the U.S. Food and Drug Administration broad control over restricting the tobacco industry’s sales and marketing as it sees fit. The industry’s advertising was first restricted off TV and radio in 1970 and the new law makes it the most regulated form of advertising in the country.

Some of the changes the FDA implemented include:

  • Banning tobacco companies from sponsoring sports and entertainment events
  • Banning free cigarette samples and giveaways
  • Limit color and imagery in print advertising
  • Restrict tobacco vending machines to adult-only facilities

The modern rate of smoking is roughly 17 percent, according to data from 2014. Although the rate has declined by more than half since 1964, tobacco giants like Philip Morris USA and R.J. Reynolds Tobacco Company still spend $30 million daily marketing cigarettes and smokeless tobacco to Americans.

E-Cigarette Use Increases

While conventional cigarette smoking saw a decline, the early 2010s saw the rise in popularity of electronic or e-cigarettes. In 2013, e-cigarette sales reached $1 billion. E-cigarette companies advertise their products as a clean alternative to smoking and a smoking cessation aid.  The FDA first began regulating e-cigarettes in 2016, banning minors from using the product, requiring warning labels about nicotine and restricting the distribution of free samples, among other rules.

While critics say these products contain no tobacco products and should not be regulated as such, the FDA disagrees. “Because e-cigarettes contain nicotine derived from tobacco, they are now subject to government regulation as tobacco products,” according to the National Institute on Drug Abuse.

E-cigs are also controversial because critics say manufacturers market to teenagers. According to a study by the University of Cambridge, flavored e-cigarette ads may entice young people to vape. Fruit and candy-flavored vaping liquids increased interest among children in buying and trying them, the research showed. The Centers for Disease Control and Prevention found that millions of teens started vaping because of e-cigarette ads.

“The same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entice a new generation of young people to use e-cigarettes,” CDC director Dr. Tom Frieden told NBC News.

In addition, the FDA, CDC and the National Institute on Drug Abuse say there are not enough studies on the health risks of these products.

Lung Cancer

Health authorities first linked smoking cigarettes to lung cancer in the 1960s. Lung cancer is the development of abnormal cells in the lungs that join to form a tumor. As the cancerous cells multiply and the tumor grows, it destroys healthy lung tissue and eventually impedes the organ from functioning properly.

There are many reasons the cells in a person’s lungs could mutate and lead to lung cancer, including continued exposure to toxic gaseous substances such as cigarette smoke. For this reason, non-smokers who regularly breathe in cigarette smoke from others, called “secondhand smoke,” can develop lung cancer.

According to the American Lung Association, more people die of lung cancer than any other type of cancer. Smoking causes 87 percent of all lung cancer deaths.

Types of Lung Cancer

There are two categories of lung cancer — small cell and non-small cell. Between these, there are five different types.

Small cell lung cancers are:

  • Small cell carcinoma (oat cell cancer)
  • Combined small cell carcinoma

Non-small cell lung cancers are:

  • Adenocarcinoma
  • Squamous cell carcinoma
  • Large cell carcinoma

Research shows most smokers used to develop squamous cell carcinomas, but this type of cancer has declined as the development of adenocarcinomas in smokers has inclined. National Cancer Institute authorities believe this change may have to do with cigarette companies’ changes in their formulas.

Lung Cancer Symptoms

Lung cancer can be difficult to detect when it is in early stages. Symptoms vary from person to person, and include:

  • Constant chest pain
  • “Smoker’s cough”
  • Chronic cough that worsens over time
  • Hoarseness
  • Shortness of breath or wheezing
  • Recurring lung infections, like bronchitis or pneumonia
  • Coughing up blood
  • Headaches
  • Blood clots
  • Bone pain or fractures
  • Loss of appetite
  • Weight loss

Lung Cancer Staging

Doctors can determine the stage of lung cancer by examining the tumor’s size and location, lymph node involvement and metastasis status, or whether or not the cancer has spread to other organs. Small cell lung cancer has two stages — limited and extensive — while non-small cell lung cancer is classified as Stage I through Stage IV.

Asbestos Lung Cancer

In addition to causing conditions like lung cancer, smoking can also aggravate and amplify the effects of other health conditions. For example, research shows people who have been exposed to asbestos and who smoke have a 90 percent risk of contracting asbestos-related diseases.

Asbestos is a highly toxic mineral found in many products made in the early 20th century, including fabrics and building materials. Those exposed to asbestos often develop several types of cancer, including lung cancer. They may also develop asbestosis — a pulmonary disease that causes scarring in the lungs. Many people were exposed to asbestos on the job. Certain occupations are most at-risk for asbestos exposure, including:

  • Miners
  • Construction workers
  • Firefighters
  • Industrial workers or trade laborers
  • Power plant workers
  • Shipyard workers

Research published in the American Journal of Respiratory and Critical Care Medicine proved there is a direct correlation between smoking and the development of asbestos lung cancer. The study found smokers exposed to asbestos were 50 – 90 times more likely to contract lung cancer than people with the same asbestos exposure who were nonsmokers.

Other Health Issues Caused by Tobacco

Smoking damages every organ in the body and is the leading preventable cause of death in the United States — roughly 480,000 die from smoking complications each year. Because tobacco causes so many health problems, including a variety of cancers, studies show smokers and other tobacco users die 14 years earlier than nonsmokers do.

Other Cancers

Smoking has been linked to a dozen different types of cancer, the most pervasive of which being lung cancer. However, data from the American Cancer Society shows smoking causes 30 percent of all cancer deaths in America.

Smoking can also cause cancer of the:

  • Mouth
  • Throat (pharynx)
  • Voice box (larynx)
  • Esophagus
  • Kidney
  • Cervix
  • Liver
  • Bladder
  • Pancreas
  • Stomach
  • Colon

In addition, research found smoking reduces the survival rate of prostate cancer patients.

COPD

Chronic obstructive pulmonary disease, also known as COPD, is a lung disease that makes it hard to breathe. The disease causes long-term disability and early death, and it has no cure. The condition worsens over time, eventually stopping a person from participating in any physical activities that require rapid or heavy breathing, such as playing sports, climbing stairs and holding long conversations. People who have COPD very often become confined to their home and/or bed as a result, which can cause many other health conditions. COPD patients also often require the use of an oxygen mask and tank.

In the United States, cigarette smoking causes 80 percent of COPD cases. Research shows women are more susceptible to COPD than men, and female smokers are almost 22 times more likely to die from COPD than women who have never smoked. The condition is the third-leading cause of death in America.

Other Health Issues

Smoking and tobacco use affects every organ in the body, therefore causing myriad health problems to users and those exposed to secondhand smoke. According to the U.S. Department of Health and Human Services, more than 16 million Americans have at least one disease from smoking.

Some of these diseases and conditions, excluding cancer and lung disease, are:

Litigation History

Since the U.S. Surgeon General’s report first linked smoking to lung cancer in 1964, millions of Americans and their families have pursued legal action against tobacco companies. The “big three” Big Tobacco companies have taken the brunt of this litigation — Philip Morris USA, R.J. Reynolds Tobacco Company and Lorillard.

One of the most famous tobacco lawsuits made history in 1998 when four of the largest tobacco companies in the U.S. agreed to a $206 billion master settlement with 46 states over Medicaid costs for tobacco-related healthcare expenses. The settlement is the largest in American history.

A U.S. District Court judge also ruled on a landmark tobacco case in 2006, holding tobacco companies liable for violating the Racketeer Influenced and Corrupt Organizations Act and fraudulently covering up the health risks of smoking. Although appealed, the court upheld the decision in 2009.