Sunday, October 30, 2011

History and Health Effects of Smoking {Tobacco}

The health effects of tobacco are the circumstances, mechanisms, and factors of tobacco consumption on human health. Epidemiological research has been focused primarily on cigarette tobacco smoking, which has been studied more extensively than any other form of consumption.
Tobacco is the single greatest cause of preventable death globally. Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor forheart attacksstrokeschronic obstructive pulmonary disease (COPD) (including emphysemaand chronic bronchitis), and cancer (particularly lung cancercancers of the larynx and mouth, and pancreatic cancer). It also causes peripheral vascular disease and hypertension. The effects depend on the number of years that a person smokes and on how much the person smokes. Starting smoking earlier in life and smoking cigarettes higher in tar increases the risk of these diseases. Cigarettes sold in underdeveloped countries tend to have higher tar content, and are less likely to be filtered, potentially increasing vulnerability to tobacco-related disease in these regions.The World Health Organization (WHO) estimates that tobacco caused 5.4 million deaths in 2004 and 100 million deaths over the course of the 20th century.Similarly, the United States Centers for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide."
Smoke contains several carcinogenic pyrolytic products that bind to DNA and cause manygenetic mutations. There are over 19 known chemical carcinogens in cigarette smoke. Tobacco also contains nicotine, which is a highly addictive psychoactivechemical. When tobacco is smoked, nicotine causes physical and psychological dependency. Tobacco use is a significant factor in miscarriages among pregnant smokers, it contributes to a number of other threats to the health of the fetus such as premature births and low birth weight and increases by 1.4 to 3 times the chance for Sudden Infant Death Syndrome (SIDS). The result of scientific studies done in neonatal rats seems to indicate that exposure to cigarette smoke in the womb may reduce the fetal brain's ability to recognize hypoxic conditions, thus increasing the chance of accidental asphyxiation.Incidence of impotence is approximately 85 percent higher in male smokers compared to non-smokers, and is a key factor causing erectile dysfunction (ED).

Health effects

Nicotine stains on primarily the 2nd and 3rd fingers in a heavy smoker.
Tobacco use most commonly leads to diseases affecting the heart and lungs, with smoking being a major risk factor for heart attacksChronic Obstructive Pulmonary Disease (COPD),emphysema, and cancer, particularly lung cancer, cancers of the larynx and mouth, andpancreatic cancer. Overall life expectancy is also reduced in regular smokers, with estimates ranging from 10 to 17.9 years fewer than nonsmokers. About two thirds of male smokers will die of illness due to smoking. The association of smoking with lung cancer is strongest, both in the public perception and etiologically. People who have smoked tobacco at some point have about a one in ten chance of developing lung cancer during their lifetime. If one looks at men who continue to smoke tobacco, the risk increases to one in six.Historically, lung cancer was considered to be a rare disease prior to World War I and was perceived as something most physicians would never see during their career. With the postwar rise in popularity of cigarette smoking came a virtual epidemic of lung cancer.A person's increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired. A year after quitting, the risk of contracting heart disease is half that of a continuing smoker.The health risks of smoking are not uniform across all smokers. Risks vary according to amount of tobacco smoked, with those who smoke more at greater risk. Light smoking is still a health risk. Likewise, smoking "light" cigarettes does not reduce the risks.


Male and female smokers lose an average of 13.4 to 14.3 years of life, respectively.
According to the results of a 14 year study of 34,486 male British doctors, at least half of all life-long smokers die earlier as a result of smoking.
Smokers are three times as likely to die before the age of 60 or 70 as non-smokers.
In the United States alone, cigarette smoking and exposure to tobacco smoke accounts for roughly one in five,or at at least 443,000 premature deaths annually.
"In the United States alone, tobacco kills the equivalent of three jumbo jets full of people crashing every day, with no survivors, 365 days of the year." -ABC's Peter Jennings On a worldwide basis, it's 1 jumbo jet per hour, 24 hours a day, 365 days of the year. -WHO 


The primary risks of tobacco usage include many forms of cancer, particularly lung cancer,kidney cancer,cancer of the larynx andhead and neckbreast cancerbladder cancer,cancer of the esophagus, cancer of the pancreas and stomach cancer.
There is some evidence suggesting an increased risk of myeloid leukaemiasquamous cell sinonasal cancerliver cancercervical cancer,colorectal cancer, cancers of the gallbladderthe adrenal glandthe small intestine, and various childhood cancers.
The risk of dying from lung cancer before age 85 is 22.1% for a male smoker and 11.9% for a female smoker, in the absence of competing causes of death. The corresponding estimates for lifelong nonsmokers are a 1.1% probability of dying from lung cancer before age 85 for a man of European descent, and a 0.8% probability for a woman.


Secondhand smoke is a mixture of smoke from the burning end of a cigarette, pipe or cigar and the smoke exhaled from the lungs of smokers. It is involuntarily inhaled, lingers in the air hours after cigarettes have been extinguished, and can cause a wide range of adverse health effects, including cancer, respiratory infections and asthma.Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%. Secondhand smoke has been estimated to cause 38,000 deaths per year, of which 3,400 are deaths from lung cancer in non-smokers.In smoking, long term exposure to compounds found in the smoke such ascarbon monoxidecyanide, and so forth—, are believed to be responsible for pulmonary damage and for loss of elasticity in the alveoli, leading to emphysema and COPD. The carcinogen acrolein and its derivatives also contribute to the chronic inflammation present in COPD.
Chronic obstructive pulmonary disease (COPD) caused by smoking, known as tobacco disease, is a permanent, incurable reduction of pulmonary capacity characterized by shortness of breath, wheezing, persistent cough with sputum, and damage to the lungs, including emphysema and chronic bronchitis.


Inhalation of tobacco smoke causes several immediate responses within the heart and blood vessels. Within one minute the heart rate begins to rise, increasing by as much as 30 percent during the first 10 minutes of smoking. Carbon monoxide in tobacco smoke exerts its negative effectsby reducing the blood’s ability to carry oxygen.
Smoking also increases the chance of heart diseasestrokeatherosclerosis, and peripheral vascular disease. Several ingredients of tobacco lead to the narrowing of blood vessels, increasing the likelihood of a blockage, and thus a heart attack or stroke. According to a study by an international team f researchers, people under 40 are five times more likely to have a heart attack if they smoke.
Latest research of the American biologists have determined that cigarette smoke also influences the process of cell division in the cardiac muscle and changes the heart's shape.
The usage of tobacco has also been linked to Buerger's disease (thromboangiitis obliterans) the acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet.
The current Surgeon General’s Report concluded that there is no risk-free level of exposure to secondhand smoke. Even short exposures to secondhand smoke can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk of heart attack. New research indicates that private research conducted by cigarette company Philip Morris in the 1980s showed that secondhand smoke was toxic, yet the company suppressed the finding during the next two decades.
Although cigarette smoking causes a greater increase of the risk of cancer than cigar smoking, cigar smokers still have an increased risk for many health problems, including cancer, when compared to non-smokers.As for Environmental Tobacco Smoke (ETS, or "Second-hand Smoking"), the NIH study points to the large amount of smoke generated by one cigar, saying "cigars can contribute substantial amounts of tobacco smoke to the indoor environment; and, when large numbers of cigar smokers congregate together in a cigar smoking event, the amount of ETS produced is sufficient to be a health concern for those regularly required to work in those environments."
Smoking tends to increase blood cholesterol levels. Furthermore, the ratio of high-density lipoprotein (the "good" cholesterol) to low-density lipoprotein (the "bad" cholesterol) tends to be lower in smokers compared to non-smokers. Smoking also raises the levels of fibrinogen and increases platelet production (both involved in blood clotting) which makes the blood viscous. Carbon monoxide binds to haemoglobin (the oxygen-carrying component in red blood cells), resulting in a much stabler complex than haemoglobin bound with oxygen or carbon dioxide—the result is permanent loss of blood cell functionality. Blood cells are naturally recycled after a certain period of time, allowing for the creation of new, functional erythrocytes. However, if carbon monoxide exposure reaches a certain point before they can be recycled, hypoxia (and later death) occurs. All these factors make smokers more at risk of developing various forms of arteriosclerosis. As the arteriosclerosis progresses, blood flows less easily through rigid and narrowed blood vessels, making the blood more likely to form a thrombosis (clot). Sudden blockage of a blood vessel may lead to an infarction (stroke). However, it is also worth noting that the effects of smoking on the heart may be more subtle. These conditions may develop gradually given the smoking-healing cycle (the human body heals itself between periods of smoking), and therefore a smoker may develop less significant disorders such as worsening or maintenance of unpleasant dermatological conditions, e.g. eczema, due to reduced blood supply. Smoking also increases blood pressure and weakens blood vessels.


In addition to increasing the risk of kidney cancer, smoking can also contribute to additional renal damage. Smokers are at a significantly increased risk for chronic kidney disease than non-smokers.A history of smoking encourages the progression of diabetic nephropathy.


A study of an outbreak of A(H1N1) influenza in an Israeli military unit of 336 healthy young men to determine the relation of cigarette smoking to the incidence of clinically apparent influenza, revealed that, of 168 smokers, 68.5 percent had influenza, as compared with 47.2 percent of nonsmokers. Influenza was also more severe in the smokers; 50.6 percent of the smokers lost work days or required bed rest, or both, as compared with 30.1 percent of the nonsmokers.
According to a study of 1,900 male cadets after the 1968 Hong Kong A2 influenza epidemic at a South Carolina military academy, compared with nonsmokers heavy smokers (more than 20 cigarettes per day), had 21% more illnesses and 20% more bed rest, light smokers (less than 20 cigarettes per day) had 10% more illnesses and 7% more bed rest.
The effect of cigarette smoking upon epidemic influenza was studied prospectively among 1,811 male college students. Clinical influenza incidence among those who daily smoked 21 or more cigarettes was 21% higher than that of non-smokers. Influenza incidence among smokers of 1 to 20 cigarettes daily was intermediate between non-smokers and heavy cigarette smokers.
Surveillance of a 1979 influenza out-break at a military base for women in Israel revealed that, Influenza symptoms developed in 60.0% of the current smokers vs. 41.6% of the nonsmokers.
Smoking seems to cause a higher relative influenza-risk in older populations than in younger populations. In a prospective study of community-dwelling people 60–90 years of age, during 1993, of unimmunized people 23% of smokers had clinical influenza as compared with 6% of non-smokers.
Smoking may substantially contribute to the growth of influenza epidemics affecting the entire population. However the proportion of influenza cases in the general non-smoking population attributable to smokers has not yet been calculated.


Perhaps the most serious oral condition that can arise is that of oral cancer. However, smoking also increases the risk for various other oral diseases, some almost completely exclusive to tobacco users. The National Institutes of Health, through the National Cancer Institute, determined in 1998 that "cigar smoking causes a variety of cancers including cancers of the oral cavity (lip, tongue, mouth, throat),esophaguslarynx, and lung."Pipe smoking involves significant health risks, particularly oral cancer. Roughly half ofperiodontitis or inflammation around the teeth cases are attributed to current or former smoking. Smokeless tobacco causes gingival recession and white mucosal lesions. Up to 90% of periodontitis patients who are not helped by common modes of treatment are smokers. Smokers have significantly greater loss of bone height than nonsmokers, and the trend can be extended to pipe smokers to have more bone loss than nonsmokers.Smoking has been proven to be an important factor in the staining of teeth.Halitosis or bad breath is common among tobacco smokers.Tooth loss has been shown to be 2to 3 times higher in smokers than in non-smokers. In addition, complications may further include leukoplakia, the adherent white plaques or patches on the mucous membranes of the oral cavity, including the tongue, and a loss of taste sensation or salivary changes.


Tobacco is also linked to susceptibility to infectious diseases, particularly in the lungs. Smoking more than 20 cigarettes a day increases the risk of tuberculosis by two to four times, and being a current smoker has been linked to a fourfold increase in the risk of invasive pneumococcal disease.It is believed that smoking increases the risk of these and other pulmonary and respiratory tract infections both through structural damage and through effects on the immune system. The effects on the immune system include an increase in CD4+ cell production attributable to nicotine, which has tentatively been linked to increased HIV susceptibility.The usage of tobacco also increases rates of infection: common cold and bronchitischronic obstructive pulmonary diseaseemphysema and chronic bronchitis in particular.
Smoking reduces the risk of Kaposi's sarcoma in people without HIV infection.One study found this only with the male population and could not draw any conclusions for the female participants in the study.


Incidence of impotence is approximately 85 percent higher in male smokers compared to non-smokers, and it is a key cause of erectile dysfunction (ED).Smoking causes impotence because it promotes arterial narrowing.

Female infertility

Smoking is harmful to the ovaries, potentially causing female infertility, and the degree of damage is dependent upon the amount and length of time a woman smokes. Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to create estrogen, a hormone that regulates folliculogenesis and ovulation. Also, cigarette smoking interferes with folliculogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and the uterine myometrium.Some damage is irreversible, but stopping smoking can prevent further damage. Smokers are 60% more likely to be infertile than non-smokers.Smoking reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.


"Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal." 

Immediate effects

Users report feelings of relaxation, sharpness, calmness, and alertness Those new to smoking may experience nauseadizziness, andrapid heart beat. The unpleasant symptoms will eventually vanish over time, with repeated use, as the body builds a tolerance to the chemicals in the cigarettes, such as nicotine.


Smokers report higher levels of everyday stress. Several studies have monitored feelings of stress over time and found reduced stress after quitting.
The deleterious mood effects of abstinence explain why smokers suffer more daily stress than non-smokers, and become less stressed when they quit smoking. Deprivation reversal also explains much of the arousal data, with deprived smokers being less vigilant and less alert than non-deprived smokers or non-smokers.

Social and behavioral

Medical researchers have found that smoking is a predictor of divorce. Smokers have a 53% greater chance of divorce than nonsmokers.

Cognitive function

The usage of tobacco can also create cognitive dysfunction. There seems to be in increased risk of Alzheimer's disease, although "case–control and cohort studies produce conflicting results as to the direction of the association between smoking and AD". Smoking has been found to contribute to dementia and cognitive decline,reduced memory and cognitive abilities in adolescents, and brain shrinkage (cerebral atrophy).
In many respects, nicotine acts on the nervous system in a similar way to caffeine. Some writings have stated that smoking can also increase mental concentration; one study documents a significantly better performance on the normed Advanced Raven Progressive Matrices test after smoking.
Most smokers, when denied access to nicotine, exhibit symptoms such as irritability, jitteriness, dry mouth, and rapid heart beat. The onset of these symptoms is very fast, nicotine's half-life being only 2 hours. Withdrawal symptoms can appear even if the smoker's consumption is very limited or irregular, appearing after only 4–5 cigarettes in most adolescents. An ex-smoker's chemical dependence to nicotine will cease after approximately ten to twenty days, although the brain's number of nicotine receptors is permanently altered, and the psychological dependence may linger for months or even many years. Unlike some recreational drugs, nicotine does not measurably alter a smoker's motor skillsjudgement, or language abilities while under the influence of the drug. Tobacco withdrawal has been shown to cause clinically significant distress.
Most notably, some studies have found that patients with Alzheimer's disease are more likely not to have smoked than the general population, which has been interpreted to suggest that smoking offers some protection against Alzheimer's. However, the research in this area is limited and the results are conflicting; some studies show that smoking increases the risk of Alzheimer's disease. A recent review of the available scientific literature concluded that the apparent decrease in Alzheimer risk may be simply because smokers tend to die before reaching the age at which Alzheimer normally occurs. "Differential mortality is always likely to be a problem where there is a need to investigate the effects of smoking in a disorder with very low incidence rates before age 75 years, which is the case of Alzheimer's disease," it stated, noting that smokers are only half as likely as non-smokers to survive to the age of 80.
Former and current smokers have a lower incidence of Parkinson's disease compared to people who have never smoked,although the authors stated that it was more likely that the movement disorders which are part of Parkinson's disease prevented people from being able to smoke than that smoking itself was protective. Another study considered a possible role of nicotine in reducing Parkinson's risk: nicotine stimulates the dopaminergic system of the brain, which is damaged in Parkinson's disease, while other compounds in tobacco smoke inhibit MAO-B, an enzyme which produces oxidative radicals by breaking down dopamine.
A very large percentage of schizophrenics smoke tobacco as a form of self medication. The high rate of tobacco use by the mentally ill is a major factor in their decreased life expectancy, which is about 25 years shorter than the general population. Following the observation that smoking improves condition of people with schizophrenia, in particular working memory deficit, nicotine patches had been proposed as a way to treat schizophrenia.Some studies suggest that a link exists between smoking and mental illness, citing the high incidence of smoking amongst those suffering from schizophrenia and the possibility that smoking may alleviate some of the symptoms of mental illness, but these have not been conclusive.
Recent studies have linked smoking to anxiety disorders, suggesting the correlation (and possibly mechanism) may be related to the broad class of anxiety disorders, and not limited to just depression. Current and ongoing research attempt to explore the addiction-anxiety relationship.
Data from multiple studies suggest that anxiety disorders and depression play a role in cigarette smoking.A history of regular smoking was observed more frequently among individuals who had experienced a major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis.People with major depression are also much less likely to quit due to the increased risk of experiencing mild to severe states of depression, including a major depressive episode.Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse.
Evidence suggests that non-smokers are up to twice as likely as smokers to develop Parkinson's disease or Alzheimer's disease.A plausible explanation for these cases may be the effect of nicotine, a cholinergic stimulant, decreasing the levels of acetylcholine in the smoker's brain; Parkinson's disease occurs when the effect of dopamine is less than that of acetylcholine. In addition, nicotine stimulates the mesolimbic dopamine pathway (as do other drugs of abuse), causing an effective increase in dopamine levels. Opponents counter by noting that consumption of pure nicotine may be as beneficial as smoking without the risks associated with smoking, although this is unlikely due to the importance of the MAO-B inhibitor compounds of tobacco in preventing neurodegenerative diseases.

In pregnancy

A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other threats to the health of the fetus. This can especially be a problem with women who have family history of smoking and live in a smoke filled environment. Women who quit smoking and then return to it also develop an increased sensitivity to the effects of smoking on their fetus. Once a woman who was previously a smoker quits and then returns to it while pregnant, the increased sensitivty to it has a very high chance of suffocating the fetus over a period of days in a slow process eventually causing a misscarriage with a heavy flow to it. Continued smoking after this can cause a woman to become completely infertile altogether preventing them from ever being able to have children by causing permanent damage. Every cigarette smoked after the miscarriage increase the chances of infertility as well as being around second hand smoke.  Second-hand smoke appears to present an equal danger to the fetus, as one study noted that "heavypaternal smoking increased the risk of early pregnancy loss."

Other harm

Studies suggest that smoking decreases appetite, but did not conclude that overweight people should smoke or that their health would improve by smoking. This is also a cause of heart diseases. However due to some new processes of treating tobacco, especially in the case of cigarette, heavy smokers tend to become overweight as the processing involves large quantities of starch. This effect is not seen in occasional smokers.Smoking also decreases weight by overexpressing the gene AZGP1 which stimulates lipolysis.
Smoking causes about 10% of the global burden of fire deaths,and smokers are placed at an increased risk of injury-related deaths in general, partly due to also experiencing an increased risk of dying in a motor vehicle crash.
Smoking increases the risk of symptoms associated with Crohn's disease (a dose-dependent effect with use of greater than 15 cigarettes per day).There is some evidence for decreased rates of endometriosis in infertile smoking women,although other studies have found that smoking increases the risk in infertile women.There is little or no evidence of a protective effect in fertile women. Some preliminary data from 1996 suggested a reduced incidence of uterine fibroids,but overall the evidence is unconvincing.
New research has found that women who smoke are at significantly increased risk of developing an abdominal aortic aneurysm, a condition in which a weak area of the abdominal aorta expands or bulges.


The risk of symptoms associated with ulcerative colitis has been frequently shown to be reduced by smokers on a dose-dependent basis; the effect is eliminated if the individual stops smoking.
Preliminary reports suggest that smoking can decrease the incidence of acne prophylactically. This was seen by a decreased percentage ratio of patients needing acne medication versus the percentage of entire population of smokers. (A smaller percentage of patients who smoked needed medication than found in the population as a whole).
Several types of "Smoker’s Paradoxes", (cases where smoking appears to have specific beneficial effects), have been observed; often the actual mechanism remains undetermined.
Nicotine may help enhance memory ,although there have been studies proving that smoking speeds up memory loss in middle age individuals.

Particular forms of tobacco use

Chewing tobacco

Chewing tobacco has been known to cause cancer, particularly of the mouth and throat. According to the International Agency for Research on Cancer, "Some health scientists have suggested that smokeless tobacco should be used in smoking cessation programmes and have made implicit or explicit claims that its use would partly reduce the exposure of smokers to carcinogens and the risk for cancer. These claims, however, are not supported by the available evidence." Oral and spit tobacco increase the risk for leukoplakia a precursor to oral cancer.


Like other forms of tobacco use, cigar smoking poses a significant health risk depending on dosage: risks are greater for those who inhale more when they smoke, smoke more cigars, or smoke them longer. The risk of dying from any cause is significantly greater for cigar smokers, with the risk particularly higher for smokers less than 65 years old, and with risk for moderate and deep inhalers reaching levels similar to cigarette smokers.Little cigars are commonly inhaled and likely pose the same health risks as cigarettes. The increased risk for those smoking 1–2 cigars per day is too small to be statistically significant, and the health risks of the 3/4 of cigar smokers who smoke less than daily are not known and are hard to measure; although it has been claimed that people who smoke few cigars have no increased risk, a more accurate statement is that their risks are proportionate to their exposure. Health risks are similar to cigarettesmoking in nicotine addiction, periodontal health, tooth loss, and many types of cancer, including cancers of the mouth, throat, andesophagus. Cigar smoking also can cause cancers of the lung and larynx, where the increased risk is less than that of cigarettes. Many of these cancers have extremely low cure rates. Cigar smoking also increases the risk of lung and heart diseases such as chronic obstructive pulmonary disease.


A common belief among users is that the smoke is significantly less dangerous than that from cigarettes. The water moisture induced by the hookah makes the smoke less irritating and may give a false sense of security and reduce concerns about true health effects.Doctors at institutions including the Mayo Clinic have stated that use of hookah can be as detrimental to a person's health as smoking cigarettes, and a study by the World Health Organization also confirmed these findings
Each hookah session typically lasts more than 40 minutes, and consists of 50 to 200 inhalations that each range from 0.15 to 0.50 liters of smoke. In an hour-long smoking session of hookah, users consume about 100 to 200 times the smoke of a single cigarette; in a 45-minute smoking session a typical smoker would inhale 1.7 times the nicotine  of a single cigarette. A study in the Journal of Periodontology found that water pipe smokers were five times more likely than non-smokers to show signs of gum disease. People who smoked water pipes had five times the risk of lung cancer of non-smokers.
A study on hookah smoking and cancer in Pakistan was published in 2008. Its objective was "to find serum CEA levels in ever/exclusive hookah smokers, i.e. those who smoked only hookah (no cigarettes, bidis, etc.), prepared between 1 and 4 times a day with a quantity of up to 120 g of a tobacco-molasses mixture each (i.e. the tobacco weight equivalent of up to 60 cigarettes of 1 g each) and consumed in 1 to 8 sessions". Carcinoembryonic antigen (CEA) is a marker found in several forms of cancer. Levels in exclusive hookah smokers were lower compared to cigarette smokers although the difference was not statistically significant between a hookah smoker and a non-smoker. Also the study concluded that heavy hookah smoking (2–4 daily preparations; 3–8 sessions a day ; >2 hrs to ≤ 6 hours) substantially raises CEA levels.A recent study published in the Asia Pacific Journal of Cancer Prevention (Koul PA et al. Hookah Smoking and Lung Cancer in the Kashmir Valley of the Indian SubcontinentAsian Pacific J Cancer Prev, 12, 519-524; doi.) documented that hookah smokers were nearly 6-times at risk for development of lung cancer as compared to healthy non-smokers in Kashmir (India). Hookah in Kashmir has some peculiar features in having a direct contact of the live embers with the burning tobacco thus resulting in high temperatures that augments the production of carcinogenic products from tobacco burning. Additionally water in the hookah base is not changed after every session that renders the water contaminated to a greater degree and thus a possible source of dissolved carcinogens.


Users of snuff are believed to face less cancer risk than smokers, but are still at greater risk than people who do not use any tobacco products. They also have an equal risk of other health problems directly linked to nicotine such as increased rate ofatherosclerosis.


The late-19th century invention of automated cigarette-making machinery in the American South made possible mass production of cigarettes at low cost, and cigarettes became elegant and fashionable among society men as the Victorian era gave way to the Edwardian. In 1912, American Dr. Isaac Adler was the first to strongly suggest that lung cancer is related to smoking. In 1929, Fritz Lickint of Dresden,Germany, published a formal statistical evidence of a lung cancer-tobacco link, based on a study showing that lung cancer sufferers were likely to be smokers.Lickint also argued that tobacco use was the best way to explain the fact that lung cancer struck men four or five times more often than women (since women smoked much less).
Prior to World War I, lung cancer was considered to be a rare disease, which most physicians would never see during their career.With the postwar rise in popularity of cigarette smoking, however, came an epidemic of lung cancer.

Smoking heltheffects summary

In 1950, Richard Doll published research in the British Medical Journal showing a close link between smoking and lung cancer. Four years later, in 1954, the British Doctors Study, a study of some 40,000 doctors over 20 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related.The British Doctors Study lasted until 2001, with results published every ten years and final results published in 2004 by Doll and Richard Peto. Much early research was also done by Alton OchsnerReader's Digest magazine for many years published frequent anti-smoking articles. In 1964, the United States Surgeon General'sReport on Smoking and Health, led millions of American smokers to quit, the banning of certain advertising, and the requirement of warning labels on tobacco products.
The Canadian province of British Columbia has the Tobacco Damages and Health Care Costs Recovery Act.

Prime Minister Syed Yusuf Raza Gilani asks int’l community to help repatriate 3 million Afghan refugees

Prime Minister Syed Yusuf Raza Gilani Saturday urged the world community to help shift the three million Afghan refugees residing in Pakistan back to Afghanistan, to stop illegal cross border movement and prevent spread of the crippling Polio disease.
“They need to go back ... the relief centres have to be in Afghanistan,” Gilani told a press conference along with Prime Minister of United Kingdom David Cameron, Nigerian President Goodluck Jonathan, Canadian Prime Minister Stephen Harper and Australian Prime Minister Julia Gillard.

The Australian Prime Minister had invited a select group of Heads of State and Governments from the countries where Polio was still prevalent, or who were funding campaigns for the eradication of the crippling disease.

Prime Minister Gilani said the world seems to have forgotten the plight of millions of Afghans who were living in shanty make-shift homes and camps in Pakistan, years after the withdrawal of the troops of United Soviet Socialist Republic from Afghanistan as decades of continuing conflict in their country had deterred them to return.

Prime Minister Gilani said it was hard for Pakistan to check the illegal movement across the over 2000 km long border with Afghanistan and added that he was preventing his country from eradication of the disease. He said Pakistan had managed to eliminate the disease, but regretted that it resurfaced in the past seven years with 132 new cases reported. “This situation is totally unacceptable. We have launched a National Emergency Action Plan for Polio eradication and to interrupt transmission of the virus in Pakistan by the end of 2011,” he said.

Gilani attributed the resurfacing of Polio to the ongoing cross-border movement and difficulties in administrating Polio drops to the children living in camps and villages in the inhospitable terrain along the Pakistan-Afghanistan border.

Over 40,000 people cross the Pak-Afghan border daily. Polio remains endemic in four countries, three of which are members of the Commonwealth - India, Nigeria, and Pakistan, besides Afghanistan.

Gilani also pointed to the influence of the extremist elements in these areas who were preventing administration of the vaccine. He said government of Pakistan was seeking help of the religious scholars to convince the “fanatics” about the importance of vaccine. He said Pakistan was launching a three-day campaign every three months to administer anti-polio drops to 33 million children across the country.

He said the government was committed to the cause and had designated Aseefa Bhutto Zardari as the Goodwill Ambassador, as she was the first child to have received the drops from her mother late Prime Minister Benazir Bhutto, when the campaign was launched for the first time in Pakistan.

Gilani informed the other leaders that a Polio Monitoring Cell at the PM Secretariat has been set up, with similar setups at provincial, district and local levels were working to mobilize community.

He said it was being done in close coordination with the UNICEF and WHO. “We hope to see positive outcome by December this year,” he said and pointed that the task ahead was daunting. “But we remain determined to eradicate this virus and protect every child in Pakistan from the scourge of Polio.”

The Australian government announced a commitment of 50 million Australian Dollars to the Global Polio Eradication Initiative (GPEI).

The Nigerian government pledged an increase from 2011 of a planned $17 million to an annual contribution of $30 million starting in 2012. The Gates Foundation pledged an additional $40 million to GPEI for the remainder of 2011.

British Prime Minister David Cameron said his country had provided 540 million Pounds Sterling so far to fight the disease and said 8 million people today were able to walk around without any problem only because they got the vaccine on time. “With the availability of the vaccine, there is no excuse in eliminating it,” he said and warned “if we fail to get rid of polio, we run the risk of seeing it spread back to countries from which it has been eradicated.”

Cameron said Pakistan was the single largest aid recipient of the United Kingdom and the UK government was working closely with it and Afghanistan to stop the terrorists on either side of the Pak-Afghan border.

Australian Prime Minister Julia Gillard said Australia has long term commitment in Afghanistan and will stay there in some form till the end of decade as it does not want the country become a centre of terrorism.

Prime Minister Julia Gillard said the new funding of 50 million Australian Dollars, over four years to the Global Polio Eradication Initiative (GPEI) would help purchase vaccines, monitor outbreaks, and respond when and where needed.

She said Australia’s support will help take the final steps to achieve worldwide polio eradication and applauded the leadership shown by India, Nigeria, and Pakistan in their ongoing efforts to eradicate polio.

Canadian Prime Minister Stephen Harper said his country would commit further funds for polio surveillance and immunizations and said its funding in Afghanistan has helped make 85 per cent population safe from Polio.

Bill Gates joined the leaders via video to announce a new US$40 million contribution to the Global Polio Eradication Initiative (GPEI) on behalf of the Gates Foundation and in support of the Commonwealth commitments.

Significant progress has been made over the past two decades to reduce the number of polio cases by 99 per cent since the GPEI was launched in 1988. Increasing routine immunization around the world has helped reduce the number of child deaths from 12.4 million in 1990 to 7.6 million in 2010.