Tobacco or Health? (eBook)

Preface 6
Contents 7
History of Tobacco 14
1.1 Tobacco Plants and Their Origin 14
1.2 Use of Tobacco for Religious Purposes 14
1.3 The Appropriation of Tobacco by Europeans 15
1.4 Worldwide Spread of Tobacco 16
1.4.1 Development of the Cigar 18
1.4.2 Development of the Cigarette 18
1.5 Objections to Smoking on Health Grounds 20
1.6 Women Won Over by the Cigarette 21
1.7 The Medical Use of Tobacco in the Nineteenth Century 25
1.8 Tobacco Research in the Twentieth Century 25
1.9 Concluding Remarks 27
Epidemiology of Tobacco Dependence 30
2.1 Tobacco Consumption in the Twentieth Century 31
2.2 Cigarette Smoking in the USA Since 1965 32
2.3 Smoking Habits in Germany 33
2.4 Cigarette-Related Mortality in Different Countries 35
2.5 Other Forms of Tobacco Use 38
2.6 Smokers and Other Risk Factors 40
2.7 Smoking Behaviour and Educational Level in the EU 41
2.8 Concluding Remarks 43
Tobacco Constituents and Additives 47
3.1 Non-Disclosure of Findings by the Tobacco Industry 47
3.2 Constituents of..Tobacco 48
3.3 Nicotine and Dependence 52
3.3.1 The Cigarette as a Vehicle for Nicotine Release 53
3.3.2 Modifications of Nicotine Release 53
3.3.3 Maintaining Nicotine Dependence 54
3.3.4 Marketing of Cigarettes with a “Reduced” Health Risk 55
3.3.5 Compensatory Behaviour by Smokers 55
3.3.6 Optimising Nicotine Release 56
3.3.7 Importance of Absorption Rate 57
3.3.8 Ammonium and pH Manipulation 57
3.4 Tobacco Additives 58
3.5 Cigarettes with Reduced Tar Yield 60
3.6 Snuff Tobacco 62
Box 3.1 63
Box 3.2 63
Box 3.3 Non-volatile nitrosamines in tobacco: NSAR N-nitrosarcosine NMPA 3-(N-nitroso-N-methylamino)-propionic acid
3.7 Concluding Remarks 67
Pharmacology and Pharmacokinetics of Nicotine 73
Box 4.1...Compounds with nAChR-agonistic efficacy: cytisine, epibatidine, anatoxin A, lobeline 73
4.1 The Nicotine Receptor 73
4.2 Agonists and Antagonists of the nAChR and its Subtypes 77
Box 4.2...Compounds with nAChR-antagonistic efficacy: mecamylamine, d-tubocurarine 78
4.3 Pharmacology 78
4.3.1 Effects of Nicotine on Receptors in Different Organs 78
4.3.2 Organ Effects and Toxicity 79
4.3.3 Metabolic and Hormonal Effects of Nicotine 80
4.3.4 Central Nervous System Effects of Nicotine 80
4.4 Pharmacokinetics of Nicotine 81
4.5 Nicotine Dependence 85
4.5.1 Types of Dependence 85
4.5.2 Molecular Biological Aspects of Dependence 87
4.5.3 Genetic Aspects 89
4.5.4 Withdrawal Symptoms 91
4.6 Concluding Remarks 92
Smoking and Lung Disease 99
5.1 Immunological Reactions Caused by Cigarette Smoking 99
5.2 Cigarette Smoking and Lung Cancer 100
5.2.1 Association Between Smoking and Lung Cancer 102
5.2.2 Types of Lung Cancer 103
5.2.3 Genetic Factors That Increase the Risk for Bronchial Carcinoma 105
5.2.3.1 Tobacco-Specific Carcinogens 105
5.2.3.2 The Cytochrome P450 and GST System and Carcinogenesis 106
5.2.3.3 Peptide Receptors, a1-Antitrypsin and Carcinogenesis 109
5.2.3.4 Exogenous Factors and Lung Cancer 110
5.3 Cigarette Smoking and COPD 111
5.3.1 Pathophysiology of COPD 112
5.3.2 Important Risk Factors for COPD 114
5.3.2.1 Genetic Factors 114
5.3.2.2 Occupational and Environmental Factors 114
5.4 Cigarette Smoking and Bronchial Asthma 115
5.4.1 Caveats Concerning the Informative Value of Studies 115
5.4.2 Cigarette Smoking and Bronchial Asthma in Adults 115
5.4.3 Bronchial Asthma in Children 116
5.5 Bronchitis and Pneumonia 118
5.6 Other Lung Diseases Influenced by Cigarette Smoking 119
5.7 Concluding Remarks 119
Cardiovascular Disease, Disturbances of Blood Coagulation and Fibrinolysis 131
6.1 Coronary Artery Disease and Myocardial Infarction 131
6.2 Systemic Vascular Changes 135
6.2.1 Regulation of Vascular Tone 137
6.2.2 Changes in Endothelial Function and Microcirculation 141
6.2.3 Microcirculation and O2 Supply 142
6.2.4 Arteriosclerotic and Inflammatory Vascular Reactions 146
6.3 Blood Coagulation and Fibrinolysis 147
6.3.1 Genetic Factors 148
6.3.2 Nicotine and Ischaemic Heart Disease 148
6.4 Concluding Remarks 149
Other Organ Systems 161
7.1 Central Nervous System 161
7.1.1 Cognitive Impairment 162
7.1.2 Influence on Cognitive Performance 163
7.1.3 Intellectual Impairment in Childhood 164
7.1.4 Smoker Personality Profiles and Genetic Inheritance of Smoking 166
7.1.5 Depression 167
7.1.5.1 Smoking Prevalence 167
7.1.5.2 Peculiarities of the Smoker’s Personality 168
7.1.5.3 Reasons for Increased Cigarette Consumption 168
7.1.5.4 Comorbidity Between Depression and Smoking 169
7.1.6 Schizophrenia 169
7.1.6.1 Prevalence 169
7.1.6.2 Reasons for Increased Cigarette Consumption 170
7.1.6.3 Extent of Cigarette Consumption 170
7.1.7 Effects of Smoking in Forms of Dementia 171
7.1.8 Smoking and Parkinson’s Disease 172
7.2 Ocular Diseases 173
7.2.1 Diabetic Retinopathy 173
7.2.2 Cataract and Lens Opacity 174
7.2.3 Graves’ Ophthalmopathy 175
7.2.4 Macular Degeneration 175
7.2.5 Glaucoma 176
7.2.6 Strabismus 176
7.2.7 Ocular Tumours 176
7.2.8 Retinal Detachment 177
7.3 Ears, Oral Cavity and Larynx 177
7.3.1 Harmful Effects on the Ears 177
7.3.2 Changes in the Oral Cavity 177
7.3.3 Oral and Laryngeal Cancer 178
7.4 Disorders of Lipid and Glucose Metabolism 179
7.4.1 Lipid and Cholesterol Metabolism 179
7.4.2 Diabetes and Smoking 181
7.4.2.1 Insulin Resistance 182
7.4.2.2 Diabetic Nephropathy 182
7.5 Gastrointestinal Tract 185
7.5.1 Oesophageal Cancer 185
7.5.2 Gastrointestinal Ulcers 186
7.5.3 Cancers of the Gastrointestinal Tract 187
7.5.4 Pancreatic Cancer 187
7.6 Urinary Tract Diseases 188
7.6.1 Toxic Substances and Inducers 189
7.6.2 Kidney Cancer 190
7.6.3 Bladder Cancer 191
7.6.4 Cancer of the Cervix 191
7.6.5 Prostatic Hyperplasia and Prostatic Cancer 192
7.6.6 Fertility Disorders 193
7.7 Disorders of Mineral Metabolism and Bone 194
7.7.1 Vitamin D and Oestrogen Metabolism 194
7.7.2 Osteoporosis 195
7.7.3 Hip Fractures 197
7.8 Skin and Mucosa 197
7.8.1 Skin Changes 198
7.8.2 Psoriasis 199
7.8.3 Skin Tumours 200
7.8.4 Breast Cancer 200
7.9 Haematopoietic System 201
7.10 Concluding Remarks 203
Smoking and Pregnancy 233
8.1 Effects of Smoking on the Placenta 234
8.2 Complications of Pregnancy 236
8.3 Malformations Possibly Caused by Smoking 239
8.4 Smoking and Sudden Infant Death Syndrome (SIDS) 242
8.5 Foetotoxic Effects of CO 244
8.6 Effects of Nicotine on the Foetus 245
8.7 Smoking and Breast-feeding 246
8.8 Medical Care Costs Attributable to Smoking During Pregnancy 248
8.9 Concluding Remarks 248
Passive Smoking 259
9.1 ETS in the Workplace and at Home 262
9.2 Changes at the Molecular and Cellular Level 264
9.2.1 Fibrinogen 265
9.2.2 Cholesterol 265
9.2.3 Endothelium and Platelets 265
9.2.4 Markers of Inflammation 266
9.2.5 ETS and Drug Metabolism 268
9.3 Passive Smoking During and After Pregnancy 268
9.4 Cardiovascular Disease 270
9.4.1 Coronary Heart Disease 270
9.4.2 Arteriosclerosis 272
9.4.3 Stroke and Subarachnoid Haemorrhage 274
9.5 Respiratory Tract 275
9.5.1 Respiratory Tract in Children and Teenagers 275
9.5.2 Bronchial Carcinoma 279
9.6 Complications of Anaesthesia 282
9.7 Otitis Media 283
9.8 Meningococcal Infections 285
9.9 Breast Cancer 285
9.10 Psychosocial Changes 286
9.11 Concluding Remarks 287
Non-Drug Treatments to Promote Smoking Cessation 301
10.1 Indications and Diagnostic Considerations 303
10.2 Objective of Treatment 304
10.3 Self-Help Interventions by the Smoker 305
10.4 Physician Advice for Smoking Cessation 307
10.5 Nursing Involvement 309
10.6 Group Behaviour Therapy Programmes 309
10.7 Aversion Therapy 310
10.8 Mass Media Communication Strategies 311
10.9 Hypnosis 314
10.10 Acupuncture 314
10.11 Reduced Smoking 315
10.12 Pregnancy 315
10.13 E-Learning, Email and Internet for Smoking Cessation 316
10.14 Concluding Remarks 316
Pharmacotherapy of Nicotine Dependence 322
11.1 Nicotine 322
11.1.1 Evaluation of Nicotine Products 325
11.1.2 Nicotine Chewing Gum 326
11.1.3 Nicotine Patch 327
11.1.4 Nicotine Sublingual Tablet 328
11.1.5 Nicotine Nasal Spray 328
11.1.6 Nicotine Inhaler 329
11.1.7 Nicotine Lozenge 329
11.1.8 Treatment and Dosage 330
11.1.9 Adverse Events Associated with NRT 332
11.1.9.1 Nicotine Chewing Gum 332
11.1.9.2 Nicotine Patch 333
11.1.9.3 Nicotine Nasal Spray 334
11.1.9.4 Nicotine Inhaler 334
11.1.9.5 Nicotine Sublingual Tablet 335
11.1.9.6 Nicotine Lozenge 335
11.1.10 Withdrawal Symptoms 335
11.1.11 Drug Interactions During Smoking Cessation 335
11.1.12 Contraindications for the Use of Nicotine Products 336
11.1.13 Nicotine Formulations as OTC Products 336
11.2 Bupropion 339
11.2.1 Pharmacodynamics 339
11.2.2 Pharmacokinetic Properties 340
11.2.3 Therapeutic Efficacy 341
11.2.4 Dosage 342
11.2.5 Adverse Effects 343
11.2.6 Contraindications and Drug Interactions 344
11.2.7 Summary 344
11.3 Other Pharmacotherapies 345
11.3.1 Varenicline 345
11.3.2 Nortriptyline 346
11.3.3 Clonidine 346
11.3.4 Mecamylamine 347
11.3.5 Tranquillisers and b-Receptor Blockers 347
11.3.6 Buspirone 347
11.3.7 Rimonabant 348
11.3.8 Various Antidepressants 348
11.3.9 Opioid Antagonists 349
11.3.10 Lobeline 349
11.3.11 Silver Acetate 350
11.3.12 Nicotine-Vaccination 350
11.4 Therapeutic Monitoring in Smoking Cessation 350
11.5 Special Therapeutic Situations 351
11.5.1 Ischaemic Heart Disease 351
11.5.2 Pregnancy 352
11.5.3 Weight Gain 353
11.5.4 Alcohol Consumption 353
11.5.5 Organic Depression and Schizophrenia 353
11.5.5.1 Organic Depression 354
11.5.5.2 Schizophrenic Patients 355
11.5.5.3 Interactions Between Cigarette Smoking and Administration of Psychopharmaceuticals 355
11.5.6 Pre-operative Smoking Cessation 356
11.6 Concluding Remarks 357
Primary Prevention 370
12.1 Smoking Initiation 371
12.2 Reasons for Smoking 373
12.3 Primary Prevention Programmes 374
12.3.1 Prevention Programmes for Schools 375
12.3.1.1Social Influence Inoculation Strategy 378
12.3.1.2 Life Skills Strategy 378
12.4 “Be Smart: Don’t Start” 378
12.5 Class 2000 Health Promotion Programme 381
12.6 Trier University Health Programme 382
12.7 Long-Term Studies 382
12.8 Role of Teachers in Primary Prevention 384
12.9 Prevention by Restricting Sales of Tobacco Products to Minors 385
12.10 Role of the Mass Media in Sales of Tobacco Products to Adolescents 387
12.11 Role of Government and Community in Primary Prevention 389
12.12 Concluding Remarks 390
Tobacco Industry, Advertising and Advertising Bans 397
13.1 Tobacco Advertising Strategies 398
13.2 Advertising Messages 402
13.3 Effect of Tobacco Industry Advertising Messages 403
13.4 Tobacco Advertising and Adolescent Smoking Initiation 406
13.5 Advertising with “Light” Cigarettes 408
13.6 Tobacco Smuggling 409
13.7 Effect of Advertising Bans 411
13.8 Smoking Bans in Public Buildings and Public Spaces 413
13.9 Concluding Remarks 414
Society, Politics and the Tobacco Industry 420
14.1 Tobacco Industry, Governmental and Non-governmental Organisations 421
14.2 Politicians and Their Attitude to Smoking 423
14.3 Scientists and the Tobacco Industry 424
14.4 “Subsidised” Tobacco Growing 425
14.5 Governmental Control of Toxic Tobacco Constituents 427
14.6 Tobacco Taxes 428
14.7 Regulations on Smoking 429
14.8 Bans on Advertising in Various Countries 431
14.9 Tobacco Industry: Playing Down the Risks of Smoking and Passive Smoking 432
14.10 Smoking and Non-smoking: Weighing the Benefits 433
14.11 Concluding Remarks 435
Appendix: Experiences from a Smoker Counselling Centre 441
15.1 Treatment Strategy 441
15.2 The Counselling Process 442
15.3 Experiences with Outpatient Smoker Counselling 443
15.4 Success in Smoking Cessation 444
15.5 Concluding Remarks 444
Index 453