Tobacco Smoking: A Birds Eye View

Smoking causes half the male tuberculosis deaths in India. In India male smokers are about four times as likely to become ill with TB as non-smokers, and consequently four times as likely to die from the disease. Studies done by Dr Vendhan Gajalakshmi of the Epidemiological Research Center in Chennai, India showed that smoking causes half the male tuberculosis deaths in India. Almost 200,000 smokers a year in India die from tuberculosis and half the smokers killed by TB are still only in their thirties, forties or early fifties when they die.

Cardiovascular disease is another main cause of death due to smoking. Cigarette smoke that is drawn through the tobacco into an active smoker’s mouth is known as mainstream smoke. Sidestream cigarette smoke is the smoke emitted from the burning ends of a cigarette. Mainstream cigarette smoke comprises 8% of tar and 92% of gaseous components (Pryor and Stone, 1993). Environmental tobacco smoke results from the combination of sidestream smoke (85%) and a small fraction of exhaled mainstream smoke (15%) from smokers (Tylor, 1992). Sidestream cigarette smoke contains a relatively higher concentration of the toxic gaseous component than mainstream cigarette smoke (Glantz and Parmley, 1991).

Active smoker: The particle size of tobacco smoke ranges 0.2 – 0.4 micron, which is smaller than automobile smoke particle size. Those people who smoke directly from a cigarette or by a cigar, bidi etc are called active smokers and such type of smoking is called active smoking.Passive smoking: Also knows as second hand smoking, non-smoking, side stream smoking and Environmental smoke pollution. Environmental tobacco smoke consists mainly (85%) of sidestream smoke (SS) emitted from the tip of a smouldering cigarette and to a lesser extent (11%) of mainstream smoke (MS) emitted at the mouthpiece of a cigarette, compounds diffusing through the wrapping paper, and the MS that the smoker exhales (EPA, 1993 and IARC, 2004) or it is the inhalation tobacco smoke that an active smoker exhales. Passive smoking not only includes the exhalation of active smoking but also includes smoke emitted by the burning of cigarette or smoke released during puffing. Toxicity: There are 4,000 chemicals including metals released in a puff of cigarette or tobacco filled bidi. The adverse effects of a few of them are described below:

Cadmium: Cadmium (Cd) is one of the metals considered to be potentially dangerous on a global level. It is a known human carcinogen and one of the components of tobacco, which, together with water and food contamination, represent the main sources of non-occupational exposure in the general population (Elider, 1985), Willer et al., 1992), Jarup et al., 1998). The harmful health effect of metals such as Cd inhaled through smoking is most evident in pregnancy. Pregnant smokers have higher placental Cd level than non-smokers. Cd passes into fetal cord blood at practically the same concentration. In both blood and milk of lactating mothers Cd concentration increase with cigarette consumption. Ingestion of Cd causes nausea, vomiting, abnormal pain and also pulmonary odema. High concentration of Cd dose affects the gastrointestinal function while small dose of Cd causes renal dysfunction. Cd ++ get exchanged with Zn++ having enzyme alkaline phosphatase to change the metabolic activity like anemia, adrenal dysfunction, bone marrow disorder, cancer, and hypertension.

Lead: Indian cigarettes contain 2.4 mg/g Pb concentration; an Italian cigarette contains the lower value of 0.6 to 0.20 mg/g. Cigarette consumption depress’ the activity of the enzyme erythrocyte lamda – aminolevulinic acid dehydratasa (lamda – ALAD), which is most sensitive indicator of lead body burden. Passive smoking plays an important role in child exposure to Pb and parental smoking but no other environmental nor any other factors, was found to be related to blood lead level in children this was 30 mg/litre on average in children of non smoking parents, 37 mg/g if the father only smoked and 47 mg/litre, if the mother smoked or both parents smoked. Even if children lived near a lead smelter, parental smoking had a significantly stronger influence on blood lead level such level were 35 mg/ litre in children with non-smoking parents, 38 mg/ litre if only the father smoked 43mg/ litre if the mother smoked more then 15 cigarette per day, if both parents smoked 46 cigarettes per day.

Nickel: Tobacco plants tend to strongly absorb nickel from soil and accumulate it in leaves. Average Ni concentration is 0.64 mg/ litre of tobacco. During smoking, an average 73 ng of Ni pass in the main stream smoke from each cigarette. Ni forms a toxic carbonyl compound because of high carbon mono oxide level in tobacco smoke, Ni Carbaryl thus produced is considered to be a potential carcinogen.

Zinc: Zn is an essential element that is essential for normal growth and optimal health. An important, negative effect of smoking is to decrease the Zn concentration in poly morphonuclear cells.

Diseases:

It has long been known that smoking causes emphysema and chronic obstructive pulmonary disease (COPD), a common disorder in which lung damage over a long period of time impairs the flow of air in and out of the lungs. Cigarette smoking is the most important risk factor for young men and women. It produces a greater relative risk in persons under age 50 than in those over 50. Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with non-smoking women who use oral contraceptives. Smoking decreases HDL (good) cholesterol. Cigarette smoking combined with a family history of heart disease also seems to greatly increase the risk. Worldwide, there is an estimated >1 billion smokers, and 3 million deaths per year are estimated to be attributable to smoking, with this number expected to rise to 10 million per year in 30 – 40 years time (WHO, 2002). Estimates suggest that of those people alive today, half a billion will die of tobacco-associated disease (Peto et al.,1996).

Cancer: Cancer is the development of abnormal cells that grow out of control and form lumps called tumors. There are two types of tumors – benign and malignant. Malignant tumors are the most harmful and are often fatal. Benign tumors are more easily managed and controlled through surgery and other therapies. Cigarette smoke inhibits and damages the normal cleaning process by which the lungs get rid of foreign and harmful particles. Smoke destroys an important cleansing layer in the lungs, which in turn causes a build-up of mucus. The result is “smokers’ cough,” an alternative method that the lungs take in attempting to clean themselves. The harmful cancer-producing particles in cigarette smoke are able to remain lodged in the mucus and develop into cancer tumors. Cigarette smoking is the single most important preventable cause of lung cancer, accounting for 85% of all new cases of lung cancer in Canada. Lung cancer is the leading cause of cancer deaths. It is the enhancement of the new neoplacia cells that is the development of (Carcinoma and Sarcoma) which leads to Tumor formation ultimately formation of Cancer. Lung cancer may be pulmonary cancer, upper respiratory track cancer and oesophagus cancer etc. Million of people die per year in India due to disease related to cancer by smoking. 1/3 of the cancers of world are due to smoking. Lung cancer found 11 times more frequent in smoker comparision of non-smokers. Lung cancer kills more people than any other type of people. 90% death are caused by smoking. Often cancers of these organs are not discovered until it is too late to cure them. The risk of lung cancer increases directly with the number of cigarettes smoked. Doubling of the duration of smoking increases the incidence of lung cancer 16 times if daily cigarette consumption remains constant the age at the time of smoking is important. The younger people when starts smoking, the greater the risk of developing lung cancer. It is estimated that tobacco smoking and alcohol drinking accounts for about three quarters of all oral and pharyngial cancer.

Mutation: It is the interaction of heavy metals with the genetic material of an organism, which leads to the change in the number and structure of chromosomes. In India oral cancer comprises 30 – 40% of the total malignancies (Jayant and Notani, 1991), generally associated with tobacco habits (mainly chewing with/without smoking/alcohol), and usually preceded by premalignant lesions – most often a persistent leukoplakia Daftary et al., 1991). According to the recent evaluation by the International Agency for Research on Cancer, involuntary smoking causes lung cancer in never-smokers with an excess risk in the order of 20% for women and 30% for men (IARC, 2004).

Heart Attack: Tobacco smoking is the major risk factor associated with heart disease, which is the primary cause of death in developed countries (Burns, 2003). At least 80% of heart attacks in the men are thought to be due to smoking sometime heart beat rate and blood pressure increases due to smoking results more requirement of oxygen.

Emphysema: In this disease fibrous layer of lung damages due to smoking. Smoking causes other disease like asthma, bronchitis, ulcer and oedema.

Cholestasis: Each cigarette reduce life span of 5.5 minute. Chewing and smoking affect 99% population in rural areas. American research report states that 88% of non-smokers have detectable level of nicotine in their blood. The second hand smoke more effected in women, 4% of children between ages 2 months to 11 years are exposed to tobacco smoke at home. 3 million people die per year from smoking, half of them before the age of 17 and these present 20% of all death. Cigarette smokers have blood, which is stickier than non-smokers, they also have raised fibrinogen levels and platelets count, which makes the blood stickier CO, attaches itself to hemoglobin much easily than oxygen dose. This reduces the ability of blood to carry oxygen. Cigarette smoking can affect women and men’s fertility, pregnant women’s health and the health of the unborn child and young child. Cigarette smoking may also affect male fertility, from smokers has been found to be decreased in density and mobility compared with that of non-smokers. The rate spontaneous is higher in women who smoke on an average; smokers have more complications of pregnancy and labour, which can include bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membrane. Babies born to women who smoke are on an average, 200 gm lighter than non-smokers mothers.

Good Reasons for Quitting:

Benefits from quitting Smoking: Life may better and longer by quitting cigarette smoking. Quitting take away from chance of having a heart attack, stroke, lung cancer. Even pregnant women, quitting smoking will improve the health and chances of healthy newborn baby. The surrounding population especially family member will be healthier. The person can save extra money to spend on other things than the biri or cigarette.

How to quit smoking:

Some Tips

• Fix a date for quitting and do little with the surrounding environment and remove all fumitories and masticatories material from your home, driving vehicle, work place.
• Try restricting people from smoking in your house and better never permit to smoke inside house.
• Once quit smoking, never try to do use fumitories and masticatories material.
• Inform family members, neighbours, friends and colleagues you have quit the use of fumitories and masticatories material and you are interested their support in quitting this habit and ask them not to offer such material in any form.
• Keep away yourself from cigarette smokers.
• Change personal environment as use sauonf, laung, elaichi etc instead of using fumitories and masticatories material.
• Keep busy with yourself in exercise or reading.
• Use approved drugs for quitting smoking;
  1. BupropionSR – Available by prescription
  2. Nicotine gum – Available over-the-counter,
  3. Nicotine inhaler – Available by prescription,
  4. Nicotine nasal spray – Available by prescription,
  5. Nicotine patch – Available by prescription and over-the-counter.
• Avoid drinking alcohol.
• Being around smoking can make you want to smoke.
• Many smokers will gain weight when they quit, usually less than 10 pounds. Eat a healthy diet and stay active. Don’t let weight gain distract you from your main goal – quitting smoking. Some quit-smoking medications may help delay weight gain. There are a lot of ways to improve your mood other than smoking.

General Remedial Measures:

• Ads and advertisement should be banned.
• Film producers in Mumbai,India have strongly protested the Centre’s recent decision to ban smoking scenes in movies and on television.
• Creation of mass awareness of ill effect of smoking/ chewing tobacco practices.
• Support of family, friends or colleagues may help these people in their attempts in smoking.

Conclusion:

It is concluded and plead to Government that our tomorrow should not be bitterer way for today’s taxes. Furthermore, we would like to convey message to the society to stop the use of tobacco and always remember, “Where there is a will there is a way”.

References:

1. A.E. Taylor, D.C. Johnson and H. Kazemi, Environmental tobacco smokes and cardiovascular disease: A position paper from the Council on Cardiopulmonary and Critical Care, American Heart Association. Circulation 86 (1992), pp. 699-702.
2. C.J. Smith and T.H. Fischer, Particulate and vapor phase constituents of cigarette mainstream smoke and risk of myocardial infarction. Arteriosclerosis 158 (2001), pp. 257-267.
3. D.M. Burns, Epidemiology of smoking-induced cardiovascular disease, Prog. Cardiovasc. Dis. (2003), p. 46.
4. Daftary. D.K., Murti P.R., Bhonsle R.B., Gupta P.C., Mehta F.S., Pindborg J.J. Risk factors and risk markers for oral cancer in high incidence areas of the world. In: Johnson N.W., editor. Oral Cancer, Vol. 2. Cambridge University Press, Cambridge, 1991. p. 29-63.
5. Elinder, C.G., 1985. Cadmium: uses, occurrence, and intake. In: Friberg, L., Elinder, C.G., Kjellstrom, T. and Nordberg, G.F., Editors, 1985. Cadmium and Health: A Toxicological and Epidemiological Appraisal – Exposure, Dose and Metabolism, CRC Press, Cleveland, pp. 23-64.
6. International Agency for Research on Cancer (IARC), Tobacco smoke and involuntary smoking, IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, vol. 83, International Agency for Research on Cancer, WHO, Lyon, France, 2004.
7. International Agency for Research on Cancer (IARC), Tobacco smoke and involuntary smoking, IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, vol. 83, International Agency for Research on Cancer, WHO, Lyon, France, 2004.
8. J.T. Powell, Vascular damage from smoking: Disease mechanisms at the arterial wall. Vasc Med 3 (1998), pp. 21-28.
9. Jarup, L., Berglund, M., Elinder, C.G., Nordberg, G. and Vahter, M., 1998. Health effects of Cadmium exposure: a review of the literature and a risk estimate. Scand J Work Environ Health, Suppl. 1 24, pp. 1-51.
10. Jayant K., Notani P. Epidemiology of oral cancer. In: Rao R.S., Desai P.B., editors. Oral Cancer. Tata Press: India, 1991. p. 1-17.
11. R. Peto, A.D. Lopez, J. Boreham, M. Thun, C. Heath Jr. and R. Doll, Mortality from smoking worldwide, Br. Med. Bull. (1996), p. 52.
12. S.A. Glantz and W.W. Parmley, Passive smoking and heart disease: Epidemiology, physiology, and biochemistry. Circulation 83 (1991), pp. 1-12.
13. U.S. Environmental Protection Agency, Respiratory health effects of passive smoking: lung cancer and other disorders, The Report of the U.S. Environmental Protection Agency, NIH Publication No. 93-3605, 1993.
14. W.A. Pryor and K. Stone, Oxidants in cigarette smoke: Radicals, hydrogen peroxide, peroxynitrate, and peroxynitrite. Ann NY Acad Sci 686 (1993), pp. 12-28.
15. Willers, S., Attewell, R., Bensryd, I., Schutz, A., Skarping, G. and Vahter, M., 1992. Exposure to environmental tobacco smoke in the household and urinary cotinine excretion, heavy metals retention, and lung function. Arch Environ Health 47 5, pp. 357-363
16. World Health Organization, The World Health Report 2002, Reducing Risks, Promoting Healthy Life, World Health Organization, Geneva, 2002.

Furquan Ahmad Ansari and Mohd. Yunus¹
Industrial Toxicology Research Centre, Post Box – 80, M. G. Marg Lucknow-226 001
*Department of Environmental Sciences Babasaheb Bhimrao Ambedkar University, Lucknow
E-mail: [email protected]

Industrial Toxicology Research Centre, Post Box – 80, M. G. Marg Lucknow-226 001, Department of Environmental Sciences Babasaheb Bhimrao Ambedkar University, Lucknow