Recently, I had a patient who spoke to me about her efforts in tobacco cessation. She had recently stopped smoking for the 2nd time in her life, but not without much exertion. As she detailed her battle, she mentioned her second round with cigarettes was much more difficult to end than her first. As I probed her for more information, she stated that when she quit the first time her withdrawals were much less prominent, and the ability to stop smoking came much sooner. After starting her habit all over again sometime later, she decided after her divorce she 1) couldn’t afford cigarettes any longer and 2) wanted to rid the habit from her life once and for all. Thanks to her dedication she succeeded in her efforts but found the battle much more grueling to conquer. After vaguely recollecting something I heard on the news about cigarettes, I decided to dig a little deeper to see if indeed cigarettes are more addictive than they once were.
A Brief History on Tobacco
The tobacco plant was first used and cultivated by the pre-Columbia Americans. Native Americans smoked it for medicinal and ceremonial purposes. The first successful commercial crop was cultivated by John Wolfe in Virginia during 1912.[1] This cash crop fueled the demand for slave labor in North America for over two centuries.
During WWII cigarettes were given to soldiers as a way to psychologically escape from boredom during downtime, and to alleviate war stress.[2] Smoking in woman also increased drastically during and after WWII.[3] In 1964, the Surgeon General produced a report tying cigarettes to lung cancer for the very first time which led to warning labels on cigarettes and cautionary advertisements by the end of 1965.
In 1970, Richard Nixon signed the Public Health Cigarette Smoking Act which banned cigarette commercials. Public smoking bans begin in the late 1990s and early 2000s that included most workplaces and all public places in an effort to decrease the amount of second-hand smoke.[4] Astonishing, as of 2017, 34.3 million adults in the United States smoke cigarettes.[5]
Cigarettes Then and Now
Are cigarettes different than they were decades ago? Are they more addictive? It’s no secret that manufacturers will develop and evolve their practices in order to compete and sustain in the ever-bloodthirsty market. It would only make complete utter sense for these companies to up their ante in order to stay ahead. While the repercussions are detrimental, it has nonetheless ceased their efforts.
One would think that since the link to lung cancer was made five decades ago, cigarettes would reform to become less harmful. However, in recent years, as a result of legislative changes, U.S. companies have been forced to publish secret documents of the studies on smoking carried out over the years and to disclose the ingredients which are added to cigarettes.[6] The results were staggering.
The Results
It’s no secret the main ingredient in a cigarette is tobacco, which contains a relatively high amount of the addictive chemical nicotine. Nicotine alone is toxic and can be lethal. The most recent surgeon general’s report concluded that nicotine activates biological pathways which increase the risk for disease, adversely affects maternal and fetal health during pregnancy and can have lasting adverse consequences for brain development in fetuses and adolescents.[7] Tobacco companies have been discovered to genetically engineer their crops to contain two times the amount of nicotine.[8]
Sugar was also found in cigarettes. While companies argued it was to enhance the flavor, there exists some compelling information as to why sugar combined with tobacco creates a much more diverse effect than flavor enhancement. Heated and burnt sugars emit a substance called acetaldehyde. When combined with nicotine, the sum is greater than their efforts alone. In controlled studies performed in rats, the combination of acetaldehyde and nicotine created a much stronger addiction than with nicotine alone.[6]
Licorice extract is also found in cigarettes which also helps to enhance the taste. However, one of this plant’s main components is Glycyrrhizin, a bronchodilator. Coincidence? I think not. Still not convinced? Licorice accounts for 1-4% of a cigarette’s weight and 90% of the world’s licorice is used by the cigarette industry.[6]
Di-ammonium phosphate and ammonium hydroxide are two acids that are also found on the ingredient list of cigarettes. These two chemicals release ammonia gas which helps with nicotine uptake. Nicotine serves a base, and bases react with acids to form a salt. When nicotine is in its salt form, its absorption is much more difficult. The ammonia replaces nicotine in the salt compound and allows it to be absorbed and allows it to act more quickly. The faster a drug affects the brain, the stronger the dependence; therefore, by adding ammonia to tobacco, it changes the nicotine to “crack” nicotine.[6]
While cocoa seems innocent enough, it does contain a substance called Theobromine that helps to relax the bronchi and suppress coughing. In fact, a 2004 study found that it was stronger than codeine, commonly used in cough syrups.[6] By suppressing the cough smokers feel healthier and hold the smoke inhiation longer without irritation thus increasing its absorption and ultimately addiction.
Cigarettes also list natural and artificial flavors as an ingredient. Because these ingredients comprise less than 0.1% of the cigarette, these individual components are classified collectively under this label. A recently published book which is based on the hundreds of documents forcibly published by U.S. tobacco companies revealed that one of these ingredients listed in this category is levulinic acid. This chemical increases the binding of nicotine to receptors in the brain.[6]
But they didn’t’ stop there. Cigarette manufacturers also engineered new filters with ventilation holes. These holes cause smokers to inhale more frequent and vigorously.[9] Cigarette companies misleadingly marketed these filters as less hazardous.
The new modern cigarette was carefully and scientifically researched for years. As a matter of fact, in 1975 a photo was released of their testing efforts on beagles. Studies prove their effectiveness by showing that 10-25% of smokers will develop symptoms of addiction just after one cigarette.[6]
Conclusion
While the United States has reduced smoking enormously since the 1950s, it is still the leading cause of preventable death. Since the first Surgeon General’s report in 1964, more than 20 million Americans have died because of smoking; of which 2.5 million have been among nonsmokers who have suffered secondhand smoke-related diseases.[10] The estimated economic costs attributable to smoking and exposure to tobacco smoke continue to increase and now approach $300 billion annually, and productivity losses of more than $150 billion a year.[10]
The ultimate question is, are cigarettes more addicting and more harmful than 50 years ago? Reports found that smokers today are more likely to develop lung cancer than those who smoked 50 years ago, as 70 chemicals in cigarette smoke are known carcinogens.[10] In fact, women’s risk increased 10-fold while men’s risk doubled. I think it’s safe to say the “proof is in the pudding.”
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References
- “A Brief History of Tobacco.” CNN. Retrieved from http://edition.cnn.com/US/9705/tobacco/history/
- “Tobacco Industry and The Connection to the Military.” tobaccopreventionk12, 11 Nov. 2011. Retrieved from https://tobaccopreventionk12.wordpress.com/2011/11/11/tobacco-industry-and-the-connection-to-the-military/
- Office on Smoking and Health (US). Women and Smoking: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2001 Mar. Preface. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK44306/
- Institute of Medicine (US) Committee on Secondhand Smoke Exposure and Acute Coronary Events. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Washington (DC): National Academies Press (US); 2010. 5, The Background of Smoking Bans. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK219563/
- “Current Cigarette Smoking Among Adults in the United States | CDC.” Centers for Disease Control and Prevention. Retrieved from www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm
- Saig, A. “Why Are Cigarettes More Addictive Nowadays.” Davidson Institute of Science Education. 24 Nov. 2016. Retrieved from https://davidson.weizmann.ac.il/en/online/maagarmada/why-are-cigarettes-more-addictive-nowadays%e2%80%8e
- U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014. Retrieved from https://www.surgeongeneral.gov/library/reports/50-years-of-progress/fact-sheet.html
- “How Big Tobacco Made Cigarettes More Addictive.” Truth Initiative. 23 Jan. 2018. Retrieved from https://truthinitiative.org/news/how-big-tobacco-made-cigarettes-more-addictive
- Burns, D. Donny, E. Hatsukami, D. Hecht, S. Henningfield, J. Designed For Addiction – How the Tobacco Industry Has Made Cigarettes More Addictive, More Attractive, to Kids and Even More Deadly. 23 June 2014. Retrieved from https://www.tobaccofreekids.org/assets/content/what_we_do/industry_watch/product_manipulation/2014_06_19_DesignedforAddiction_web.pdf
- The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. SurgeonGeneral.gov, U.S. Department of Health and Human Services. Retrieved from www.surgeongeneral.gov/library/reports/50-years-of-progress/fact-sheet.html
