Concluding Remarks ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

• ฀ The฀German฀government฀and฀its฀politicians฀have฀adopted฀this฀ambivalent฀attitude฀from฀ the฀past฀and฀have฀denied฀protection฀from฀the฀dangers฀of฀smoking฀to฀the฀majority฀of฀its฀ electorate,฀the฀non-smokers.฀They฀have฀also฀failed฀to฀protect฀the฀majority฀of฀smokers฀ from฀the฀increasingly฀apparent฀dangers฀of฀smoking. • ฀ In฀most฀countries฀in฀the฀world,฀cigarette฀smoking฀is฀the฀number฀1฀killer.฀Worldwide,฀ more฀ people฀ die฀ from฀ the฀ consequences฀ of฀ cigarette฀ smoking฀ than฀ from฀ any฀ other฀ disease.฀Despite฀these฀problems,฀the฀tobacco฀industry฀has฀been฀able฀to฀increase฀its฀ annual฀turnover฀by฀wooing฀new฀smokers฀of฀both฀sexes฀Fig.฀ 1.8 .฀Under฀these฀circum- stances,฀it฀is฀expected฀that฀in฀the฀year฀2025฀more฀than฀2฀million฀people฀in฀the฀European฀ Union฀alone฀will฀die฀from฀the฀consequences฀of฀cigarette฀smoking฀if฀this฀trend฀is฀not฀ halted฀soon. References ฀ 1.฀Akuhurst฀BC฀1981฀Tobacco.฀Longman,฀London ฀ 2.฀Japan฀Tobacco฀Plant฀Breeding฀฀Genetic฀Research฀Laboratory฀1994฀The฀genus฀Nicotiana฀ illustrated ฀ 3.฀Tabernaemontanus฀DIT฀1664฀New฀vollkommen฀Kräuter-Buch.฀Johann฀Königs,฀Basel ฀ 4.฀Wilbert฀J฀1987฀Tobacco฀and฀Shamanism฀in฀South฀America.฀Yale฀University฀Press,฀New฀Haven ฀ 5.฀Travell฀J฀1940฀The฀inluence฀of฀the฀hydrogen฀ion฀concentration฀on฀the฀absorption฀of฀alkaloids฀ from฀the฀stomach.฀J฀Pharmacol฀Exp฀Ther฀69:23–33 ฀ 6.฀Robicsek฀F฀1978฀The฀smoking฀gods.฀Tobacco฀in฀Maya฀art,฀history฀and฀religion.฀The฀University฀ of฀Oklahoma฀Press,฀Norman ฀ 7.฀Corti฀ECC฀1930฀Die฀trockene฀Trunkenheit:฀Ursprung,฀Kampf฀und฀Triumph฀des฀Rauchens.฀Insel,฀ Leipzig ฀ 8.฀Tiedemann฀F฀1854฀Geschichte฀des฀Tabaks฀und฀anderer฀ähnlicher฀Genussmittel.฀H.฀L.฀Brömmer,฀ Frankfurt ฀ 9.฀Monardes฀N฀1970฀Joyful฀Newes฀Out฀to฀the฀Newe฀Founde฀Worlde.฀London.฀1577฀reprint.฀ Da฀Capo฀Press,฀Amsterdam 10.฀Laufer฀ B฀ 1924฀ Introduction฀ of฀ tobacco฀ into฀ Europe.฀ Field฀ Museum฀ of฀ Natural฀ History,฀ Chicago 11.฀Brooks฀JE฀1952฀The฀mighty฀leaf.฀In:฀Little฀B฀ed฀Tobacco฀through฀the฀centuries.฀Little฀Brown,฀ Boston 12.฀Sandgruber฀R฀1994฀Genussmittel.฀Ihre฀reale฀und฀symbolische฀Bedeutung฀im฀neuzeitlichen฀ Europa.฀In:฀Jahrbuch฀für฀Wirtschaftsgeschichte.฀Akademie,฀Berlin,฀pp฀73–88 13.฀Jacob.฀1603฀MBR.฀Misocapnus฀seu฀de฀abusu฀tabaci฀lusus฀regius.฀London 14.฀Precht฀K,฀Baumgartner฀HJ฀1993฀Tabak.฀Gewohnheiten,฀Konsequenzen.฀Edition฀diá,฀St.฀Gallen 15.฀Bunbury฀H฀1794฀A฀Smoking฀Club.฀S.W.฀Fores฀No.฀3,฀Piccadilly 16.฀Tilley฀ NM฀ 1948฀ The฀ bright-tobacco฀ industry,฀ 1860–1929.฀ University฀ of฀ North฀ Carolina฀ Press,฀Chapel฀Hill 17.฀Slade฀J฀1993฀Nicotine฀delivery฀devices.฀In:฀Orleans฀CT,฀Slade฀J฀eds฀Nicotine฀addiction:฀ principles฀and฀management.฀Oxford฀University฀Press,฀New฀York,฀pp฀3–23 18.฀Tilley฀NM฀1985฀The฀R.J.฀Reynolds฀Tobacco฀Company.฀University฀of฀North฀Carolina฀Press,฀ Chapel฀Hill 19.฀Kluger฀R฀1996฀Ashes฀to฀ashes.฀America’s฀Hundred-Year฀Cigarette฀War,฀the฀Public฀Health,฀ and฀the฀Unabashed฀Triumph฀of฀Philip฀Morris.฀Alfred฀A.฀Knopf,฀New฀York 20.฀Lorillard฀P฀Jr฀1895฀American฀tobacco฀factories.฀In:฀Depew฀CM฀ed฀One฀hundred฀years฀of฀ American฀commerce.฀Haynes,฀New฀York 21.฀Goodman฀J฀1993฀Tobacco฀in฀history.฀The฀cultures฀of฀dependence.฀Routledge,฀London 22.฀Lickint฀F฀1939฀Tabak฀und฀Orgnaismus.฀In:฀Handbuch฀der฀gesamten฀Tabakkunde.฀Hippokrates,฀ Stuttgart,฀pp฀1232 23.฀1938–1939฀Pennsylvania฀Med฀J฀42:471 24.฀Posselt฀WH,฀Reimann฀KL฀1821฀Bemerkungen฀Nicotinanin฀und฀seine฀Eigenschaften.฀Schweigger฀ u฀Meinicke฀Neues฀Journal฀für฀Chemie฀und฀Physik,฀pp฀1–442 25.฀Posselt฀WH,฀Reimann฀KL฀1828฀Chemische฀Untersuchung฀des฀Tabaks฀und฀Darstellung฀des฀ eigenthümlichen฀ wirksamen฀ Prinzips฀ dieser฀ Planze.฀ Geigers฀ Magazin฀ f฀ Pharmacie฀ 623:฀ 138–161 26.฀Trommsdorff฀ JB฀ 1829฀ Beiträge฀ zur฀ chemischen฀ Kenntnis฀ des฀ Tabaks.฀ Neues฀ Journal฀ der฀ Pharmacie฀Leipzig฀19:129–155 27.฀Hartwich฀C฀1911฀Die฀menschlichen฀Genußmittel.฀Ihre฀Herkunft,฀Verbreitung,฀Geschichte,฀ Bestandteile,฀Anwendung฀und฀Wirkung.฀Tauchnitz,฀Leipzig 28.฀Bentley฀HR฀1997฀Report฀on฀visit฀to฀USA฀and฀Canada,฀17฀April–12฀May฀1958.฀Tob฀Prod฀ Litigation฀Rep฀12:383–389 29.฀Goodman฀J฀1993฀Tobacco฀in฀history.Routledge,฀London 30.฀Kellogg฀JH฀1946฀Tobaccoism.฀Battle฀CreekMich.฀The฀Good฀Health฀Publishing,฀Michigan 31.฀Hamilton฀AE฀1927฀The฀smoking฀world.฀Century,฀New฀York 32.฀Blum฀D฀1997฀Auf฀leichten฀Flügeln฀ins฀Land฀der฀Phantasie.฀Tabak฀und฀Kultur฀–฀Columbus฀bis฀ Davidoff.฀Transit,฀Berlin 33.฀Hurt฀RD,฀Robertson฀CR฀1998฀Prying฀open฀the฀door฀to฀the฀tobacco฀industry’s฀secrets฀about฀ nicotine:฀the฀Minnesota฀Tobacco฀Trial.฀JAMA฀280:1173–1181 34.฀Müller฀ J฀ 1842฀ Der฀ Tabak฀ in฀ geschichtlicher,฀ botanischer,฀ chemischer,฀ medicinischer฀ und฀ diätetischer฀Hinsicht.฀von฀Gebrüder฀Daams,฀Emmerich 35.฀Redmond฀DE฀Jr฀1970฀Tobacco฀and฀cancer:฀the฀irst฀clinical฀report,฀1761.฀N฀Engl฀J฀Med฀282:฀ 18–23 36.฀Glinski฀ von฀ 1939฀ Untersuchungen฀ über฀ die฀ Zunahme฀ des฀ primären฀ Lungenkrebses฀ unter฀ Berücksichtigung฀der฀Pathogenese.฀Dtsch฀Arch฀klin฀Med฀185:75–88 37.฀Müller฀FH฀1939฀Tabakmissbrauch฀und฀Lungencarcinom.฀Zschr฀Krebsforsch฀491:57–85 38.฀Haustein฀KO฀2004฀Fritz฀Lickint฀1898–1960฀–฀Ein฀Leben฀als฀Aufklärer฀über฀die฀Gefahren฀ des฀Tabaks.฀Suchtmed฀63:249–255 39.฀Schöninger฀E฀1944฀Lungenkrebs฀und฀Tabakrauch.฀Inaugural-Dissertation,฀Universität฀Jena,฀ pp฀1–25 40.฀Schairer฀E,฀Schöninger฀E฀1943฀Lungenkrebs฀und฀Tabakverbrauch.฀Zschr฀Krebsforsch฀54:฀ 261–269 41.฀Schairer฀E,฀Schoniger฀E฀2001฀Lung฀cancer฀and฀tobacco฀consumption.฀Int฀J฀Epidemiol฀301:฀ 24–27 42.฀Ernst฀E฀2001฀Commentary:฀The฀Third฀Reich฀–฀German฀physicians฀between฀resistance฀and฀ participation.฀Int฀J฀Epidemiol฀30:37–42 43.฀Proctor฀RN฀2001฀Commentary:฀Schairer฀and฀Schoniger’s฀forgotten฀tobacco฀epidemiology฀ and฀the฀Nazi฀quest฀for฀racial฀purity.฀Int฀J฀Epidemiol฀301:31–34 44.฀Wachter฀T฀2001฀Beleckte฀Kampagne฀gegen฀das฀Rauchen.฀Der฀Bund฀Zürich฀2:16 17 K.-O.฀Haustein,฀D.฀Groneberg,฀Tobacco฀or฀Health?฀฀ DOI:฀10.1007978-3-540-87577-2_2,฀©฀Springer฀Verlag฀Berlin฀Heidelberg฀2010 Epidemiology of Tobacco Dependence 2 The฀twentieth฀century฀has฀witnessed฀the฀birth฀and฀development฀of฀a฀new฀epidemic฀-฀tobacco฀ dependence฀ [1–3] .฀In฀the฀last฀40฀years,฀due฀to฀the฀rise฀in฀tobacco฀consumption฀Fig.฀ 2.1 ;฀ Table฀ 2.1 ,฀tobacco฀use฀has฀become฀a฀particular฀health฀hazard,฀as฀documented฀in฀numerous฀ reports฀ [2,฀3,฀7–13] .฀It฀has฀become฀clear฀that฀the฀nicotine฀dependence฀nicotine฀being฀pro- duced฀through฀the฀tobacco฀plant,฀a฀fact฀now฀conirmed฀by฀the฀World฀Health฀Organization฀ WHO,฀is฀responsible฀for฀the฀adverse฀effects฀on฀health฀ [14] .฀Nicotine฀itself฀is฀known฀to฀be฀ a฀powerful฀poison฀–฀similar฀to฀prussic฀acid฀ [15] .฀Nevertheless,฀most฀health-related฀conse- quences฀are฀attributable฀to฀the฀2,500฀toxins฀in฀the฀tobacco฀plant฀and฀to฀some฀4,000฀sub- stances฀present฀in฀tobacco฀smoke฀ [16–18] .฀In฀the฀USA฀and฀many฀European฀Union฀EU฀ countries,฀tobacco฀causes฀more฀deaths฀than฀any฀other฀dependence-producing฀substance฀ Table฀ 2.2 ฀ [4,฀19] .฀The฀developing฀countries฀will฀be฀suffering฀this฀if฀they฀continue฀to฀ increase฀their฀tobacco฀consumption฀ [20] . In฀Europe,฀more฀than฀30฀of฀the฀population฀smoke฀cigarettes;฀cigar฀and฀pipe฀smoking฀ and฀the฀use฀of฀chewing฀or฀snuff฀tobacco฀are฀of฀secondary฀importance.฀In฀Germany,฀where฀ more฀than฀17฀million฀people฀currently฀smoke,฀309฀people฀die฀each฀day฀from฀the฀direct฀ consequences฀of฀smoking,฀whereas฀road฀trafic฀accidents฀claim฀a฀“mere”฀21฀deathsday.฀If฀ an฀airliner฀with฀309฀passengers฀on฀board฀crashes฀every฀day฀in฀Germany,฀there฀would฀be฀a฀ 1925 1,000 2,000 Great Depression Postwar demobilization Korean War Increased marketing of filter cigarettes begins Broadcast ads end Federal excise tax doubled Rotating package warnings Nonsmokers begin to demand rights Fairness Doctrine First surgeon general’s report Early reports linking smoking and cancer World War II 3,000 4,000 Cigarettes per Year 5,000 1930 1935 1940 1945 1955 1950 1960 1965 1970 1975 1980 1985 1990 Fig. 2.1 ฀฀฀Annual฀per฀capita฀cigarette฀consumption฀in฀the฀USA฀during฀the฀period฀from฀1925฀to฀1990฀ from฀ [4] national฀outcry฀and฀the฀government฀would฀be฀compelled฀to฀take฀action.฀During฀the฀period฀ from฀1925฀to฀the฀1960s,฀tobacco฀consumption฀in฀the฀USA฀showed฀a฀4.2-fold฀increase,฀ before฀falling฀again฀to฀2.5฀times฀the฀1925฀level฀by฀the฀start฀of฀the฀1990s฀Fig.฀ 2.1 . In฀ the฀ USA,฀ cigarette฀ smoking฀ is฀ responsible฀ for฀ one฀ in฀ every฀ ive฀ deaths฀ 400,000฀ deaths฀per฀annum,฀see฀Table฀ 2.2 ,฀chiely฀as฀a฀result฀of฀coronary฀heart฀disease,฀lung฀cancer฀ and฀other฀respiratory฀tract฀diseases฀which฀would฀be฀avoidable฀in฀principle฀by฀smoking฀ces- sation฀ [21] .฀As฀an฀exotic฀commodity,฀therefore,฀the฀cigarette฀has฀advanced฀to฀become฀the฀ commonest฀cause฀of฀death.฀The฀problem฀has฀reached฀similar฀dimensions฀in฀Europe฀ [4] .

2.1 Tobacco Consumption in the Twentieth Century

The฀irst฀two฀decades฀of฀the฀twentieth฀century฀laid฀the฀foundation฀for฀huge฀growth฀in฀the฀ cigarette฀industry,฀with฀cigarettes฀in฀the฀1920s฀not฀so฀much฀producing฀dependence,฀but฀rather฀ being฀highly฀toxic฀for฀the฀respiratory฀tract.฀In฀the฀1920s฀and฀1930s,฀cigarette฀consumption฀ was฀boosted฀particularly฀when฀women฀were฀included฀as฀targets฀of฀the฀increasingly฀success- ful฀advertising฀efforts฀of฀the฀tobacco฀industry,฀with฀Camel฀cigarettes฀gaining฀widespread฀ popularity฀ [5,฀22] .฀Following฀the฀recognition฀even฀during฀these฀years฀of฀the฀adverse฀effects฀ of฀cigarettes฀on฀health฀ [7,฀9,฀13,฀23] ,฀the฀cigarette฀industry฀developed฀the฀ilter฀cigarette฀as฀a฀ kind฀of฀safety฀“guarantee”฀in฀the฀1950s฀and฀the฀“low-tar”฀cigarette฀in฀the฀1960s฀ [2,฀5] .฀The฀ percentage฀share฀of฀ilter฀cigarettes฀increased฀from฀0.3฀in฀1949฀to฀97฀in฀1992฀ [24] . In฀men฀born฀between฀1911฀and฀1930,฀the฀prevalence฀of฀cigarette฀smoking฀in฀the฀USA฀ reached฀peak฀levels฀of฀67฀in฀the฀1940s฀and฀1950s฀ [25] ,฀with฀a฀maximum฀prevalence฀of฀ Tobacco฀type 1900 1952 1991 Tobacco฀in฀general฀kgperson ฀ 3.4 ฀ 5.9 ฀ 2.3 Cigarettes฀ ฀ 2 81 87 Snuff,฀chewing฀tobacco฀ ฀ 4 ฀ 3 ฀ 5 Cigars฀ 27 10 ฀ 4 Pipe฀or฀hand-rolled฀ 19 ฀ 1 ฀ 1 Table 2.1 ฀฀฀Methods฀of฀ tobacco฀consumption฀ in฀the฀USA฀from฀ 1900฀to฀1991฀ [5,฀6] Death฀due฀to Deaths Percentage Tobacco 400,000 19 Poor฀diet,฀sedentary฀lifestyle 300,000 14 Alcohol 100,000 ฀ 5 Bacterial฀infections ฀ 90,000 ฀ 4 Poisoning ฀ 60,000 ฀ 3 Firearms ฀ 35,000 ฀ 2 Sexual฀deviancy ฀ 30,000 ฀ 1 Road฀trafic฀accidents ฀ 25,000 ฀ 1 Illicit฀drugs ฀ 20,000 1 Table 2.2 ฀฀฀Avoidable฀ deaths฀in฀the฀USA฀in฀ 1990฀ [4] 44฀recorded฀for฀women฀in฀the฀1960s.฀The฀number฀of฀smokers฀fell฀only฀in฀response฀to฀the฀ massive฀ anti-smoking฀ campaigns฀ of฀ the฀ 1970s,฀ with฀ a฀ greater฀ decline฀ among฀ men฀ than฀ among฀women฀ [26] .฀Smoking฀prevalence฀in฀Germany฀was฀conirmed฀in฀the฀latest฀Microcen- sus฀Study฀Fig.฀ 2.2 .฀The฀national฀Youth฀Risk฀Behavior฀Survey฀YRBS฀2003฀of฀the฀United฀ States฀indicates฀that฀the฀prevalence฀of฀current฀cigarette฀use฀has฀declined฀substantially฀since฀ the฀late฀1990s฀and฀is฀at฀the฀lowest฀level฀since฀YRBS฀was฀initiated฀in฀1991฀ [28] .

2.2 Cigarette Smoking in the USA Since 1965

Over฀the฀period฀from฀1965฀to฀1993,฀smokers฀in฀the฀USA฀and฀their฀tobacco-use฀behaviour฀ were฀monitored฀in฀a฀survey฀of฀all฀smokers฀above฀the฀age฀of฀18฀years฀with฀a฀minimum฀annual฀ consumption฀of฀100฀cigarettes฀ [6] .฀With฀effect฀from฀1991฀and฀1992,฀the฀survey฀included฀all฀ those฀who฀smoked฀daily฀ [29,฀30] .฀Deined฀in฀these฀terms,฀the฀annual฀prevalence฀of฀cigarette฀ smoking฀in฀the฀USA฀was฀42฀in฀1965฀and฀25฀in฀1993฀ [6,฀30] .฀Smoking฀cessation฀was฀ achieved฀by฀24฀in฀1965฀compared฀with฀50฀in฀1993฀ [30] .฀In฀the฀30–39-year-old฀category,฀ 89฀irst฀tried฀smoking฀before฀the฀age฀of฀18฀and฀71฀became฀regular฀smokers฀ [21] .฀The฀ average฀age฀at฀which฀smoking฀was฀irst฀tried฀was฀14.6฀years฀and฀the฀age฀at฀which฀survey฀ respondents฀became฀regular฀smokers฀was฀17.7฀years฀ [21] .฀In฀contrast,฀after฀1980,฀the฀survey฀ revealed฀that฀the฀transition฀to฀regular฀smoking฀did฀not฀occur฀until฀after฀the฀age฀of฀20฀ [31] . Smoking฀was฀initially฀a฀male฀preserve;฀however,฀from฀1965฀to฀1993,฀smoking฀prevalence฀ among฀men฀declined฀from฀52฀to฀28.฀Smoking฀prevalence฀among฀women฀was฀34฀in฀1965,฀ falling฀to฀22฀in฀1993.฀Overall,฀the฀prevalence฀of฀cessation฀among฀ex-smokers฀in฀1993฀was฀ 52฀for฀men฀and฀47฀for฀women฀ [30] .฀Nevertheless,฀the฀prevalence฀of฀male฀pipe฀and฀cigar฀ smoking,฀chewing฀tobacco฀and฀using฀snuff฀rose฀continuously฀ [3,฀32] .฀Among฀adolescent฀ smokers,฀there฀was฀gender฀equality.฀From฀1967฀onwards฀in฀particular,฀there฀was฀an฀increase฀ in฀the฀number฀of฀female฀smokers฀following฀the฀introduction฀of฀“female฀cigarettes”฀ [31] ,฀ whereas฀smoking฀prevalence฀among฀young฀women฀with฀a฀college฀education฀declined฀over฀ the฀period฀from฀1983฀to฀1991฀ [6] . 50 Male Smokers Female Smokers Frequency [] 45 40 35 30 25 20 15 10 5 15 16- 20 21- 25 26- 30 31- 35 36- 40 41- 45 46- 50 51- 55 56- 60 61- 65 66- 70 71- 75 75 Fig. 2.2 ฀฀฀Smoking฀prevalence฀ among฀men฀and฀women฀as฀a฀ function฀of฀age.฀Data฀from฀ the฀Microcensus฀Study฀1999฀ [27] ,฀by฀kind฀permission฀of฀ the฀German฀Federal฀ Statistics฀Ofice