Tobacco Use

Background

The use of tobacco as a stimulant goes back many thousands of years. It is estimated that the cultivation of the tobacco plant began as far back as [Page 1126]6000 BCE in the Americas. The indigenous people of the Americas were using leaf-wrapped cigarettes long before the arrival of Columbus, and from the late 1400s onward, tobacco was used in various other forms such as cigars and pipes, snuff, and chewing tobacco. However, it was not until the 1880s, when the first cigarette-making machine was invented in the United States, that natural-leaf cigarettes made from domestic tobacco began to dominate the consumer market. This development led to machine-rolled butts replacing the hand-rolled varieties, consequently making cigarettes more affordable and thereby more accessible. By World War I, cigarettes had become immensely popular, and troops in both World Wars I and II used smoking as a means of relieving the physical and psychological stress of war.

Public Health Challenge

Smoking continued to gain widespread public acceptance until 1964, when the first U.S. Surgeon General's report on smoking and health brought to the fore the many health risks associated with tobacco use. Although tobacco use has declined by more than 50% since the initial Surgeon General's report, there are still more than 40 million smokers in the United States. Tobacco use in the nation generally begins in early adolescence, and the earlier young people begin using tobacco, the more heavily they are likely to use it as adults. The addictive properties of nicotine ensure that many adolescent smokers will become regular users of tobacco as adults, leading to the eventual development of chronic health problems.

In the general population, tobacco use is associated with many diseases such as cancers of the lung, throat, pharynx, and esophagus and contributes to the development of cancers of the pancreas, cervix, kidney, and stomach. It is also associated with chronic bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). Specific to female smokers are health risks such as primary and secondary infertility and delays in becoming pregnant. With respect to pregnancy outcomes, women who smoke are at increased risk of premature rupture of membranes, low-birth-weight babies, and preterm delivery. Smoking is also a major cause of coronary heart disease among women.

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