Slow death and Tobacco

Tobacco is obtained commercially from the plant Nicotiana tobaccum. The World Health Organization (WHO projects ~ 1.27 billion tobacco users in the world. In India, tobacco has been consumed since centuries. Approximately, 30% of the population uses tobacco in one form or the other.

Cancers, ischemic heart diseases, chronic respiratory diseases, diabetes, like non-communicable diseases (NCDs) are the leading cause of deaths worldwide that are linked with the use of tobacco.

WHO statistics in 2010 for India, accounted 53% of all deaths to NCDs. WHO data on tobacco use, found tobacco to be responsible for 6 million deaths annually. Around 5 million of such deaths are attributed to direct tobacco usage, while, more than 6 lakh deaths attributed to second-hand smoke exposure to non-smokers. A person is reported to die in every 6 second owing to tobacco and ~ half of the present users will ultimately die due to a disease resulting from tobacco usage.

Tobacco has been implicated as the leading cause of cancer that can be prevented.

Smoked tobacco usage in India

Tobacco is smoked in the following forms in India:

Beedis: Dry and crushed tobacco is rolled in Tendu leaves. Beedi making is a source of livelihood to many where from the parents to children are involved in beedi making. This exposes them to the risk of inhaling tobacco flakes, thereby increasing the risk of lung and gastrointestinal cancers and diseases.

Cigars and Cigarettes: Cigars are tobacco wrapped in tobacco leaves while cigarettes are tobacco rolled in paper. Cigarettes come in various arrays with filters, low-tar, flavours, etc., giving a wrong notion of lesser health risks. People often consider cigar smoking to be safer than cigarettes, however, the tobacco content in a cigar is almost equivalent to a pack of cigarettes.

Hookah: A device is used to heat tobacco and inhale it after passing through water. Nowadays, hooks are gaining popularity at coffee shops with their enticing flavours. It is an unsafe way of tobacco consumption and can be addictive.

Chillum: A clay pipe is used to smoke tobacco and often shared in a group. Apart from the risk of oral cancer, sharing the same chillum spreads the flu, cold, and other illnesses of the lung.

Constituents in Tobacco and Tobacco Smoke

Tobacco and its smoke contain more than 4000 chemicals. Among these, 60 cancer-causing chemicals (carcinogens) have been identified.

Cigarette smoke contains nicotine, carbon monoxide, nitrogen oxides, hydrogen cyanide, formaldehyde, benzene, few N-nitrosamines, acrolein, to name a few.

When one smokes, many of these chemicals combine to form tar which sticks to hairs lining the lung insides. These hairs are meant to sweep out the microbes and dirt. This cleaning function is not possible when the tar covers them giving rise the smoker's cough and which is a precursor to other diseases.

Nicotine

Nicotine is a highly addictive alkaloid present in tobacco. Individuals over time get emotionally and physically addicted to nicotine. Numerous health hazards are attributed to nicotine. Nicotine has been linked with increased risks of:
Breathing disorders (Respiratory disorders)
Heart problems (Cardiovascular)
Digestive system problems (Gastrointestinal disorders)

Further, nicotine has been reported to lower the immune response, impact the proliferation rates of cells, has ill effects on the reproductive health, leads to oxidative stress, mutations of DNA leading to cancer, etc.

The absorption of nicotine occurs via the oral mucosa, skin, gut or lungs. Studies have established sufficient proof to come to a conclusion that nicotine stimulates numerous biological pathways by which smoking heightens the risk for a disease.

Ill Effects on Health

The ill effects reported of cigarette smoking include cancer, atherosclerotic disease of the blood vessels and the heart, noncancerous diseases of the lung and impact the reproductive system.

Cancers

There are well-established studies that document smoking to be implicated in causing or increasing the risk of:

• Lung cancer
• Colorectal Cancer
• Liver cancer
• Breast cancer
• Oral cancer
• Oesophageal cancer

Cardiovascular diseases implicated with smoking include:
Risk of stroke

• Coronary heart disease- It is a conglomerate of diseases in which a waxy substance (plaque) gets deposited in the coronary arteries which are the main arteries supplying the heart and cause blockage of the arteries leading to heart attack.
• Cerebrovascular disease- Conditions caused due to problems of blood supply to the brain.
• Abdominal aortic aneurysm- This is a swelling (an aneurysm) of the aorta which the main blood vessel which carries blood to other parts of the body from the heart

Respiratory disorders attributed to smoking include:

• Chronic obstructive pulmonary disease
• Tuberculosis

Reproductive outcomes of smoking documented include:

• Congenital malformations
• Male sexual function
• Ectopic pregnancy

Other outcomes of smoking include:

• Age-related macular degeneration- It is a condition which affects a tiny portion of the eye behind the retina, called macula, leading to vision loss.
• Diabetes
• Impacting the immune system
• Rheumatoid arthritis

Studies conclusively document the link between smoking and diminishing overall health marked by increased health care costs, work absenteeism and poor health. There is a higher risk of all-cause mortality in people who smoke.

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