Tobacco use: an addiction

Minority Nurse Newsletter, Fall, 2003 by Geraldine Brown

Tobacco use in an addiction is usually nicotine dependence. There are noticeable effects. Unpleasant systems may occur as to attempting to withdraw such as craving for nicotine, irritability, anxiety, poor concentration, restlessness, headaches, drowsiness and stomach upset. Most smokers, who stop smoking, usually do for health or economic reasons. Behavior modification is a regimen with the assistance of a professional. Behavior modification is changing habit patterns that are cures to smoking during the person's normal activities of daily living. These cures may include phone conversations, taking walk breaks instead of coffee breaks, or substituting oral activity such as sucking on a toothpick, candy or chewing gum.

According to the Centers for Disease Control (CDC, 2003), a goal for Healthy People 2010 is to reduce illness, disability, and death related to tobacco use and exposure to secondhand smoke.

Scientific knowledge about the health effects of tobacco use has increased greatly since the first Surgeon General's report on tobacco was released in 1964. Cigarette smoking causes heart disease, several kinds of cancer (lung, larynx, esophagus, pharynx, mouth, and bladder), and chronic lung disease. Cigarette smoking also contributes to cancer of the pancreas, kidney, and cervix. Smoking during pregnancy causes spontaneous abortions, low birth weight, and sudden infant death syndrome.

There are other forms of tobacco that are not safe alternatives to smoking cigarettes. The use of spit tobacco causes a number of serious oral health problems, including cancer of the mouth and gum, periodontitis, and tooth loss. Cigar use causes cancer of the larynx, mouth, esophagus, and lung. In recent years, reports have shown an increase in the popularity of bidis (small brown cigarettes, often flavored, consisting of tobacco hand rolled in tendu or temburni leaf and secured with a string at one end). Research has shown that bidis are a significant health hazard to users, increasing the risk of coronary heart disease and cancer of the mouth, pharynx and larynx, lung, esophagus, stomach and liver (CDC, 2003).

Tobacco use is responsible for more than 430,000 deaths per year among adults in the United States, representing more than 5 million years of potential life lost. If current tobacco use patterns persist in the United States, an estimated 5 million persons under age 18 will die prematurely from a smoking related disease. Direct medical costs related to smoking total at least $50 billion per year, and direct medical costs related to smoking during pregnancy are approximately $1.4 billion per year. www.healthypeople.gov/document/html/volume2/27tobacco.htm

Evidence is accumulating that shows maternal tobacco use is associated with mental retardation and birth defects such as oral clefts. Exposure to secondhand smoke also has serious health effects. Researchers have identified more than 4,000 chemicals in tobacco smoke; of these, at least 43 cause cancer in humans and animals. Each year, because of exposure to secondhand smoke, an estimated 3,000 nonsmokers die of lung cancer, and 150,000 to 300,000 infants and children under age 18 months experience lower respiratory tract infections.

Tobacco use and addiction usually begin in adolescence. Tobacco use may increase the probability that an adolescent will use other drugs. Among adults in the United States who have ever smoked daily, 82 percent tried their first cigarette before the age of 18 years, and 53 percent became daily smokers before age 18 years. Preventing tobacco use among youth has emerged as a major focus of tobacco control efforts.

Youth are put at increased risk of initiating tobacco use by socio-demographic, environmental, and personal factors. Socio-demographic risk factors include coming from a family with low socioeconomic status. Environmental risk factors include accessibility and availability of tobacco products, cigarette advertising and promotion practices, the price of tobacco products, perceptions that tobacco use is normal, peers" and siblings' use and approval, and lack of parental involvement. Personal risk factors include low self-image and low self-esteem; the belief that tobacco use provides a benefit, and the lack of ability to refuse offers to use tobacco.

Research indicates that men are more likely to smoke than women (26 percent compared to 22 percent). Disparities in tobacco use exist among certain racial and ethnic populations. American Indians or Alaska Natives (35 percent) are more likely to smoke than other racial and ethnic groups, with considerable variations in percentages by Tribe. Hispanics (18 percent) and Asians or Pacific Islanders (13 percent) are less likely to smoke than other groups. Studies have found higher levels of cigarette use among gay men and lesbians than among heterosexuals. Persons with 9 to 11 years of education (38 percent) have significantly higher levels of smoking than individuals with 8 years or less of education. Data reveal high levels of tobacco use among college students. Spit tobacco use among adolescents differs significantly by students' gender, race, and ethnicity. Current spit tobacco use is 12.2 percent for non-Hispanic whites, 2.2 percent for non-Hispanic African Americans, and 5.1 percent for Hispanics (CDC, 2003).