Effets du tabac sur la santé – Wikipédia


Effets du tabac sur la santé - Wikipédia 1

Le tabagisme peut endommager de nombreuses parties du corps.

L'usage du tabac a principalement des effets négatifs sur la santé humaine et effets du tabac sur la santé a une longue histoire. La recherche s'est principalement concentrée sur le tabagisme.(1)(2)

La fumée de tabac contient plus de 70 produits chimiques cancérigènes.(3) Le tabac contient également de la nicotine, une drogue psychoactive hautement addictive. Lorsque le tabac est fumé, la nicotine entraîne une dépendance physique et psychologique. Les cigarettes vendues dans les pays sous-développés ont tendance à être plus riches en goudron et moins susceptibles d'être filtrées, augmentant potentiellement la vulnérabilité aux maladies liées au tabac dans ces régions.(4)

Le tabagisme est la principale cause de décès évitable dans le monde.(5) Près de la moitié des personnes qui consomment du tabac meurent des suites de la consommation de tabac.(3) L'Organisation mondiale de la santé (OMS) estime que le tabac cause environ 6 millions de décès chaque année (environ 10% de tous les décès), dont 600 000 surviennent chez des non-fumeurs à cause de la fumée secondaire.(3)(6) Le tabac a causé environ 100 millions de morts au XXe siècle.(3) De même, les Centers for Disease Control and Prevention des États-Unis décrivent le tabagisme comme "le risque évitable le plus important pour la santé humaine dans les pays développés et une cause majeure de décès prématuré dans le monde".(7) Actuellement, le nombre de décès prématurés dus à l'usage du tabac aux États-Unis dépasse le nombre d'employés de l'industrie du tabac de 4 à 1 par an.(8ème) Selon un examen de 2014 dans le Journal de médecine de la Nouvelle-AngleterreSi le tabagisme actuel continue, le tabac tuera environ 1 milliard de personnes au XXIe siècle, dont la moitié avant l'âge de 70 ans.(9)

Le tabagisme est la cause la plus fréquente de maladies cardiaques, hépatiques et pulmonaires. Le tabagisme est un facteur de risque majeur d'infections telles que la pneumonie, les crises cardiaques, les accidents vasculaires cérébraux, la maladie pulmonaire obstructive chronique (MPOC) (y compris l'emphysème et la bronchite chronique) et divers cancers (en particulier le cancer du poumon, le cancer du larynx et de la bouche, le cancer de la vessie et le cancer du pancréas). cancer). Il provoque également une maladie artérielle périphérique et une pression artérielle élevée. Les effets dépendent du nombre d'années pendant lesquelles une personne fume et de sa quantité de tabac. Si vous commencez à fumer plus tôt dans la vie et que vous fumez des cigarettes à plus haute teneur en goudron, le risque de ces maladies augmente. Il a également été démontré que la fumée de tabac dans l'environnement ou la fumée secondaire ont des effets néfastes sur la santé des personnes de tous âges.(dix) Le tabagisme est un contributeur majeur aux fausses couches chez les fumeuses enceintes et contribue à un certain nombre d'autres problèmes de santé affectant le fœtus, tels que la naissance prématurée, l'insuffisance pondérale à la naissance et 1,4 à 3 fois la probabilité de mort subite du nourrisson (SMSN).(11) L'incidence de la dysfonction érectile est d'environ 85% plus élevée chez les hommes fumeurs que chez les non-fumeurs.(12)(13)

Plusieurs pays ont pris des mesures pour contrôler l'usage du tabac avec des restrictions de consommation et de vente et des étiquettes d'avertissement sur les emballages. En outre, les lois interdisant de fumer, qui interdisent de fumer dans les lieux publics tels que les lieux de travail, les théâtres, les bars et les restaurants, réduisent l'exposition à la fumée secondaire et aident certains fumeurs à cesser de fumer sans aucun impact économique négatif sur les restaurants ou les bars.(3) Les taxes sur le tabac qui augmentent le prix sont également efficaces, en particulier dans les pays en développement.(3)

À la fin des années 1700 et 1800, l'idée que le tabagisme causait certaines maladies, y compris le cancer de la bouche, était initialement largement acceptée par la communauté médicale.(14) Dans les années 1880, l'automatisation a considérablement réduit le coût des cigarettes, les fabricants de tabac ont considérablement augmenté leur commercialisation et son utilisation s'est étendue.(quinze)(16) À partir des années 1890, des rapports réguliers ont été publiés sur les liens entre la consommation de tabac et le cancer et les maladies vasculaires; Une méta-analyse citant 167 autres travaux a été publiée en 1930 et a conclu que l'usage du tabac provoque le cancer.(17)(18) Dans les années 1930 et 1938, des résultats d'observation de plus en plus solides ont été publiés. la science a publié un article montrant que les consommateurs de tabac mènent une vie beaucoup plus courte. Des études cas-témoins ont été publiées en Allemagne nazie en 1939 et 1943 et aux Pays-Bas en 1948. Cependant, la première attention a attiré cinq études cas-témoins publiées en 1950 par des chercheurs des États-Unis et de Grande-Bretagne. Ces études ont été largement critiquées pour avoir montré une corrélation plutôt qu'une causalité. Des études de cohorte prospectives de suivi au début des années 1950 ont clairement montré que les fumeurs mouraient plus rapidement et mouraient plus fréquemment d'un cancer du poumon et d'une maladie cardiovasculaire.(14) Ces résultats ont d'abord été largement acceptés dans la communauté médicale et publiés au public au milieu des années 1960.(14)

l'histoire((éditer)

Pré-cigarette((éditer)

Les préoccupations concernant les effets du tabac sur la santé ont une longue histoire. La toux causée par le tabagisme, l'irritation de la gorge et l'essoufflement étaient toujours évidents.((Devis nécessaire)

Des textes sur les effets nocifs du tabagisme ont été enregistrés dans les manuscrits de Tombouctou.(19)

Le tabagisme de la pipe est progressivement devenu largement reconnu comme une cause de cancer de la bouche après le travail au 18ème siècle. Une association entre une variété de cancers et le tabagisme a été observée à plusieurs reprises de la fin du 19e siècle au début des années 1920. Une relation entre l'usage du tabac et les maladies vasculaires a été signalée à partir de la fin du 19e siècle.((Devis nécessaire)

Gideon Lincecum, naturaliste américain et praticien de la médecine botanique, a écrit à propos du tabac au début du 19e siècle: "Cette plante vénéneuse était utilisée comme médecine par la vieille faculté, et des milliers de personnes en ont été tuées. C'est un article très dangereux, et lorsque vous l'utilisez comme vous le souhaitez, cela réduit toujours les énergies vitales en proportion exacte de la quantité utilisée – cela peut être lent, mais c'est très sûr. "(20)

L'invention des machines automatisées de fabrication de cigarettes dans le sud des États-Unis dans les années 1880 a permis la production de masse de cigarettes à faible coût et le tabagisme est devenu courant. Cela a déclenché une réaction violente et un mouvement d'interdiction du tabac qui a contesté l'usage du tabac comme nocif et a créé certaines interdictions sur la vente et l'utilisation du tabac.(quinze) L'américain Dr. Isaac Adler a été le premier en 1912 à suggérer fortement que le cancer du poumon était lié au tabagisme.(21) En 1924, l'économiste Irving Fisher a écrit un article anti-tabac pour Résumé du lecteur Il dit: "… Le tabac abaisse le tonus général du corps et diminue sa vitalité et sa résilience … Le tabac agit comme un stupéfiant, comme l'opium et comme l'alcool, bien que normalement dans une moindre mesure."(22)((pas sequitur)Résumé du lecteur Pendant de nombreuses années, elle a publié fréquemment des articles anti-tabac.((Devis nécessaire)

Avant la Première Guerre mondiale, le cancer du poumon était considéré comme une maladie rare que la plupart des médecins ne verraient jamais au cours de leur carrière.(23)(24) Cependant, avec la popularité croissante du tabagisme après la guerre, une épidémie de cancer du poumon est survenue.(25)((citations supplémentaires requises)

Études observationnelles précoces((éditer)

À partir des années 1890, des rapports réguliers ont été publiés sur les liens entre la consommation de tabac et le cancer et les maladies vasculaires.(14) 1930 publié Fritz Lickint de Dresde(18)(17) une méta-analyse citant 167 autres articles liant le tabagisme au cancer du poumon.(17) Lickint a montré que les personnes atteintes d'un cancer du poumon sont probablement des fumeurs. Il a également fait valoir que l'usage du tabac était le meilleur moyen d'expliquer le fait que le cancer du poumon frappait les hommes quatre ou cinq fois plus souvent que les femmes (puisque les femmes fumaient beaucoup moins).(18) et discuté des effets causaux du tabagisme sur le cancer du foie et de la vessie.(17)

On peut supposer que la principale raison pour laquelle le problème a reçu si peu d'attention de la part de la communauté médicale est que la majorité d'entre eux, depuis la communauté générale, pratiquent le tabagisme sous une forme de l'autre et ne veulent pas s'enquérir de trop près d'une habitude défensive de qui tant peut être dit d'un point de vue hédoniste, mais si peu d'un point de vue hygiénique

Rolleston, J.D. (01/07/1932). "L'habitude de la cigarette". British Journal of Inebriety (alcoolisme et toxicomanie). 30ème (1): 1-27. doi: 10.1111 / j.1360-0443.1932.tb04849.x. ISSN 1360-0443.

D'autres résultats d'observation ont été publiés dans les années 1930 et 1938. la science a publié un article montrant que les consommateurs de tabac mènent une vie beaucoup plus courte. Une courbe de survie a été créée à partir des archives familiales conservées à la Johns Hopkins School of Hygiene and Public Health. Ce résultat a été ignoré ou mal expliqué.(14)

Un lien entre le tabac et l'infarctus du myocarde a été mentionné pour la première fois en 1930; Une vaste étude cas-témoins en 1940 a trouvé une association significative mais évitait de dire quoi que ce soit sur la cause, car une telle conclusion serait controversée et les médecins n'étaient pas prêts à le faire.(14)

L'hostilité officielle à l'usage du tabac était répandue en Allemagne nazie, où des études cas-témoins ont été publiées en 1939 et 1943. Un autre a été publié aux Pays-Bas en 1948. Une étude cas-témoins du cancer du poumon et du tabagisme réalisée par Franz Hermann Müller en 1939. présentait de graves faiblesses méthodologiques, mais les problèmes de conception des études étaient mieux traités dans les études ultérieures.(14) L'association de la recherche sur la lutte antitabac et des interventions de santé publique avec les dirigeants nazis a peut-être contribué à négliger ces études.(18) Ils ont également été publiés en allemand et en néerlandais. Ces études ont été largement ignorées.(26) En 1947, le British Medical Council a tenu une conférence pour discuter de la cause de l'augmentation des décès dus au cancer du poumon. Sans connaissance des études allemandes, ils ont planifié et fondé les leurs.(14)

Cinq études cas-témoins publiées en 1950 par des chercheurs des États-Unis et de Grande-Bretagne ont attiré une large attention.(27) Les résultats les plus solides ont été tirés du "Tabagisme et cancer du poumon. Rapport préliminaire" de Richard Doll et Austin Bradford Hill.(28)(14) et l'étude de Wynder et Graham de 1950, intitulée "Le tabagisme comme facteur étiologique possible dans le carcinome bronchiogénique: une étude de six cent quatre-vingt-quatre cas avérés". Ces deux études étaient les plus importantes et les seules à avoir soigneusement exclu les ex-fumeurs de leur groupe de non-fumeurs. Les trois autres études ont également rapporté que, pour en citer une, «le tabagisme était fortement impliqué dans le cancer du poumon».(27) Le journal Doll and Hill a rapporté que "les gros fumeurs sont cinquante fois plus susceptibles de développer un cancer du poumon que les non-fumeurs".(28)(27)

causalité((éditer)

Les études cas-témoins ont clairement montré une association étroite entre le tabagisme et le cancer du poumon, mais ont été critiquées pour ne pas montrer de causalité. De grandes études prospectives de cohorte au début des années 1950 ont clairement montré que les fumeurs mouraient plus rapidement et décédaient plus fréquemment d'un cancer du poumon, d'une maladie cardiovasculaire et d'une liste d'autres maladies qui s'étaient allongées au cours des études.(14)

La British Doctors Study, une étude longitudinale portant sur environ 40000 médecins, a débuté en 1951.(29) En 1954, il y avait des preuves de trois ans de décès chez le médecin, sur la base desquelles le gouvernement suggérait que les taux de tabagisme et de cancer du poumon étaient liés(30)(29) (La British Doctors Study a rapporté pour la dernière fois en 2001,(29) À ce stade, il y avait environ 40 maladies liées.(14) La British Doctors Study a montré qu'environ la moitié des fumeurs de cigarettes tenaces nés entre 1900 et 1909 ont finalement été tués par leur dépendance (calculée à partir des logarithmes des probabilités de survie de 35 à 70, 70 à 80 et 80 à 90) et environ les deux tiers des fumeurs de cigarettes obstinés nés dans les années 1920 finiraient par être tués par leur dépendance.((Devis nécessaire)

La sensibilisation du public((éditer)

En 1953, des scientifiques du Sloan Kettering Institute de New York ont ​​montré que le goudron de cigarette peint sur la peau des souris provoquait des cancers mortels.(26) Ce travail a reçu beaucoup d'attention médiatique; les New York Times et Vie tous deux traitaient du sujet. le Résumé du lecteur a publié un article intitulé "Cancer by the Carton".(26)::14e

Le 11 janvier 1964, le rapport du Surgeon General des États-Unis sur le tabagisme et la santé a été publié. Cela a conduit des millions de fumeurs américains à arrêter, à interdire certaines publicités et à apposer des étiquettes d'avertissement sur les produits du tabac.((Devis nécessaire)

Ces résultats ont d'abord été largement acceptés dans la communauté médicale et publiés au public au milieu des années 1960.(14) L'opposition de la communauté médicale à l'idée que le tabac provoque des maladies a été attribuée au parti pris des médecins toxicomanes, à la nouveauté des adaptations nécessaires pour appliquer les techniques épidémiologiques et heuristiques aux maladies non infectieuses et aux pressions de l'industrie du tabac.(14)

Les effets du tabagisme sur la santé ont joué un rôle important dans le développement de la science de l'épidémiologie. Le mécanisme de cancérogénicité étant radiomimétique ou radiologique, les effets sont stochastiques. Certaines déclarations ne peuvent être faites que sur la probabilité relativement accrue ou réduite d'infection par une certaine maladie. Il est impossible pour une personne en particulier d'établir définitivement un lien de causalité direct entre l'exposition à un poison radiomimétique tel que la fumée de tabac et le cancer qui en découle. De telles déclarations ne peuvent être faites qu'au niveau de la population générale. Les compagnies de tabac ont utilisé cette objection philosophique et exploité les doutes des cliniciens, qui ne considèrent que des cas individuels, sur la relation causale dans l'expression stochastique de la toxicité en tant que maladie réelle.(31)

Il y a eu plusieurs poursuites contre les fabricants de tabac pour avoir enquêté sur les effets du tabac sur la santé, mais en supprimant les résultats ou en les formatant pour impliquer un risque réduit ou nul.(31)

Après l'introduction d'une interdiction de fumer dans tous les lieux publics fermés en Écosse en mars 2006, elle a été réduite de 17%.((lorsque?) pour les hospitalisations pour syndrome coronarien aigu. 67% de la diminution est survenue chez les non-fumeurs.(32)

Effets du tabagisme sur la santé((éditer)

Effets du tabac sur la santé - Wikipédia 2

Des experts en toxicomanie dans les domaines de la psychiatrie, de la chimie, de la pharmacologie, de la médecine légale, de l'épidémiologie et des services de police et juridiques mènent des analyses Delphic sur 20 drogues récréatives populaires. Le tabac était classé 3e pour la dépendance, 14e pour les dommages physiques et 12e pour les dommages sociaux.(33)

Le tabagisme est la cause la plus fréquente de maladies cardiaques et pulmonaires et affecte souvent des zones telles que les mains ou les pieds. Les premiers signes de problèmes de santé liés au tabagisme se manifestent souvent par un engourdissement des extrémités, le tabagisme étant un facteur de risque majeur de crise cardiaque, de maladie pulmonaire obstructive chronique (MPOC), d'emphysème et de cancer, en particulier le cancer du poumon, du larynx et de la bouche. et le cancer du pancréas.(34) L'espérance de vie globale a également diminué chez les fumeurs de longue durée, avec des estimations comprises entre 10 et 10 ans(29) jusqu'à 17,9(35) Années de moins que les non-fumeurs.(36) Environ la moitié des fumeurs de longue date meurent de maladie à cause du tabagisme.(37) L'association du tabagisme avec le cancer du poumon est la plus forte à la fois dans la perception du public et sur le plan étiologique. Pour les fumeurs de sexe masculin, le risque à vie de développer un cancer du poumon est de 17,2%; Pour les femmes qui fument, le risque est de 11,6%. Ce risque est significativement plus faible pour les non-fumeurs: 1,3% pour les hommes et 1,4% pour les femmes.(38)

Le risque accru d'une personne de développer une maladie est lié à la durée pendant laquelle une personne continue de fumer, ainsi qu'à la quantité qui est fumée. Même fumer une cigarette par jour augmente le risque de maladie coronarienne d'environ 50% ou plus et d'accident vasculaire cérébral d'environ 30%. Fumer 20 cigarettes par jour comporte un risque plus élevé, mais pas proportionnellement.(39)(40)

Lorsque quelqu'un arrête de fumer, ces chances diminuent progressivement à mesure que les dommages causés à son corps sont réparés. Un an après avoir cessé de fumer, le risque de maladie cardiaque est la moitié de celui d'un fumeur prolongé.(41) Les risques pour la santé du tabagisme ne sont pas les mêmes pour tous les fumeurs. Les risques varient en fonction de la quantité de tabac fumé, ceux qui fument davantage sont plus à risque. Fumer des cigarettes dites «légères» ne réduit pas le risque.(42)

mortalité((éditer)

Le tabagisme cause environ 5 millions de décès chaque année.(43) Cela en fait la principale cause de décès prématuré évitable.(44) Une étude a révélé que les fumeurs masculins et féminins perdent en moyenne 13,2 et 14,5 ans de vie, respectivement.(45) Un autre a constaté une perte de 6,8 ans.(46) On estime que chaque cigarette fumée raccourcit sa durée de vie de 11 minutes en moyenne.(47)(48)(49) Au moins la moitié de tous les fumeurs à vie meurent plus tôt des suites du tabagisme.(29) Les fumeurs sont trois fois plus susceptibles de mourir avant 60 ou 70 ans que les non-fumeurs.(29)(50)(51)

Aux États-Unis, le tabagisme et l'exposition à la fumée de tabac représentent environ un cinquième.(52) soit au moins 443 000 décès prématurés par an.(53) Pour mettre cela en contexte, Peter Jennings d'ABC (qui mourra plus tard à l'âge de 67 ans des complications d'un cancer du poumon en raison de son habitude de fumer de longue date) a rapporté que le tabac aux États-Unis tue à lui seul l'équivalent de trois jets géants remplis de personnes. qui s'écrase tous les jours sans survivants.(54) Au niveau mondial, cela correspond à un seul jumbo jet par heure.(55)

Une étude de 2015 a révélé qu'environ 17% des décès dus au tabagisme aux États-Unis sont dus à des maladies autres que celles normalement considérées comme liées.(56)

On estime qu'entre 1 et 1,4 décès surviennent par million de cigarettes fumées. En fait, les usines de cigarettes sont les usines les plus meurtrières de l'histoire du monde.(57)(58) Le tableau ci-dessous répertorie les usines de cigarettes les plus productives et leurs décès estimés causés chaque année en raison de problèmes de santé causés par la cigarette.(57)

cancer((éditer)

Effets du tabac sur la santé - Wikipédia 5

Pourcentage de décès par cancer dus au tabac en 2016(61)
Les effets du tabagisme comprennent des lésions pulmonaires immédiates et à long terme.

De nombreux types de cancer, en particulier le cancer du poumon, figurent parmi les principaux risques associés au tabagisme.(62) Cancer du rein,(63) Cancer du larynx et de la tête et du cou,(64)(65) Cancer de la vessie,(66) Cancer de l'œsophage,(67) Cancer du pancréas(68) et le cancer de l'estomac.(69) Des études ont trouvé une association entre la fumée de tabac, y compris la fumée secondaire, et le cancer du col de l'utérus chez les femmes.(70) Il existe des preuves d'un risque légèrement accru de leucémie myéloïde.(71) Carcinome épidermoïde, cancer naso-sinusien, cancer du foie, cancer du côlon, cancer de la vésicule biliaire, de la glande surrénale, de l'intestin grêle et divers cancers infantiles.(69) Le lien possible entre le cancer du sein et le tabac est encore incertain.(72)((citation médicale requise)

Le risque de cancer du poumon est fortement influencé par le tabagisme, jusqu'à 90% des cas étant dus au tabagisme.(73) Le risque de développer un cancer du poumon augmente avec le nombre d'années pendant lesquelles vous fumez et le nombre de cigarettes fumées par jour.(74) Le tabagisme peut être lié à tous les sous-types de cancer du poumon. Le carcinome à petites cellules (SCLC) est le plus étroitement lié à près de 100% des cas qui surviennent chez les fumeurs.(75) Cette forme de cancer a été identifiée en utilisant des boucles de croissance autocrine, l'activation de proto-oncogène et l'inhibition des gènes suppresseurs de tumeur. Le SCLC peut provenir de cellules neuroendocrines situées dans la bronche appelées cellules de Feyrter.(76)

Le risque de mourir d'un cancer du poumon avant l'âge de 85 ans est de 22,1% pour un homme fumeur et de 11,9% pour une femme fumeur s'il n'y a pas de causes concurrentes de décès. Les estimations correspondantes pour les non-fumeurs à vie sont une chance de 1,1% de mourir d'un cancer du poumon avant l'âge de 85 ans pour un homme européen et une chance de 0,8% pour une femme.(77)

Poumons((éditer)

Effets du tabac sur la santé - Wikipédia 6

Comme il n'a pas été possible d'établir la cause par des essais expérimentaux en raison de contraintes éthiques, une longue étude a été menée pour déterminer le lien fort requis pour permettre une action législative contre le tabagisme.((Devis nécessaire)

On pense qu'une exposition à long terme à des composés présents dans la fumée (par exemple, le monoxyde de carbone et le cyanure) dans le tabagisme est responsable des lésions pulmonaires et de la perte d'élasticité des alvéoles, conduisant à l'emphysème et à la maladie pulmonaire obstructive chronique (MPOC). La MPOC induite par le tabagisme est une diminution permanente, incurable (souvent incurable) de la capacité pulmonaire caractérisée par un essoufflement, une respiration sifflante, une toux persistante avec expectorations et des lésions pulmonaires, y compris l'emphysème et la bronchite chronique.(78) L'acroléine cancérigène et ses dérivés contribuent également à l'inflammation chronique de la BPCO.(79)

Maladie cardiovasculaire((éditer)

Effets du tabac sur la santé - Wikipédia 7
Effets du tabac sur la santé - Wikipédia 8

Taches de tabac principalement sur les deuxième et troisième doigts d'un gros fumeur

L'inhalation de fumée de tabac provoque plusieurs réactions immédiates au niveau du cœur et des vaisseaux sanguins. La fréquence cardiaque commence à augmenter en une minute et augmente jusqu'à 30 pour cent au cours des 10 premières minutes de tabagisme. Le monoxyde de carbone contenu dans la fumée de tabac a un effet négatif en réduisant la capacité du sang à transporter l'oxygène.(80)

Le tabagisme augmente également le risque de maladie cardiaque, d'accident vasculaire cérébral, d'athérosclérose et de maladie vasculaire périphérique.(81)(82) Plusieurs ingrédients du tabac provoquent la constriction des vaisseaux sanguins, ce qui augmente la probabilité d'un blocage et donc d'une crise cardiaque ou d'un accident vasculaire cérébral. Selon une étude réalisée par une équipe internationale de chercheurs, les personnes de moins de 40 ans sont cinq fois plus susceptibles d'avoir une crise cardiaque lorsqu'elles fument.(83)(84)

L'exposition à la fumée de tabac est connue pour augmenter le stress oxydatif dans le corps grâce à un certain nombre de mécanismes, y compris la dégradation des antioxydants plasmatiques tels que la vitamine C.(85)

Des recherches récentes menées par des biologistes américains ont montré que la fumée de cigarette affecte également le processus de division cellulaire dans le muscle cardiaque et modifie la forme du cœur.(86)

L'usage du tabac a également été lié à la maladie de Buerger (Thromboangéite oblitérante), l'inflammation aiguë et la thrombose (coagulation) des artères et des veines des mains et des pieds.(87)

Bien que fumer des cigarettes augmente plus le risque de cancer que fumer des cigarettes, les fumeurs de cigares courent toujours un risque accru de nombreux problèmes de santé, y compris le cancer, par rapport aux non-fumeurs.(88)(89) En ce qui concerne la fumée secondaire, l'étude du NIH souligne la grande quantité de fumée produite par un cigare. "Les cigares peuvent apporter des quantités importantes de fumée de tabac dans l'environnement intérieur, et lorsqu'un grand nombre de fumeurs de cigares se rassemblent en fumant des cigarettes, la quantité de FTA (c.-à-d. La fumée secondaire) est suffisante pour être un problème de santé pour ceux qui régulièrement doivent travailler dans ces environnements. "(90)

Le tabagisme a tendance à augmenter le cholestérol sanguin. De plus, le rapport lipoprotéine de haute densité (HDL, également appelé «bon» cholestérol) et lipoprotéine de basse densité (LDL, également appelé «mauvais» cholestérol) a tendance à être plus faible chez les fumeurs que chez les non-fumeurs. Le tabagisme augmente également les niveaux de fibrinogène et augmente la production de plaquettes (toutes deux impliquées dans la coagulation du sang), ce qui rend le sang plus épais et le rend plus susceptible de coaguler. Le monoxyde de carbone se lie à l'hémoglobine (le composant porteur d'oxygène dans les globules rouges), ce qui donne un complexe beaucoup plus stable que l'hémoglobine, qui est liée à l'oxygène ou au dioxyde de carbone – le résultat est une perte permanente de la fonctionnalité des cellules sanguines. Les cellules sanguines sont naturellement recyclées après un certain temps, créant de nouveaux globules rouges fonctionnels. Cependant, lorsque l'exposition au monoxyde de carbone atteint un point avant qu'il ne puisse être recyclé, une hypoxie (et la mort subséquente) se produit. Tous ces facteurs augmentent le risque que les fumeurs développent diverses formes d'athérosclérose (durcissement des artères). À mesure que l'athérosclérose progresse, le sang circule moins facilement dans les vaisseaux sanguins rigides et rétrécis, ce qui rend le sang plus susceptible de former une thrombose (caillot). Eine plötzliche Verstopfung eines Blutgefäßes kann zu einem Infarkt (Schlaganfall oder Herzinfarkt) führen. Es ist jedoch auch erwähnenswert, dass die Auswirkungen des Rauchens auf das Herz subtiler sein können. Diese Zustände können sich angesichts des Rauchheilungszyklus allmählich entwickeln (der menschliche Körper heilt sich zwischen den Rauchperioden selbst), und daher kann ein Raucher weniger signifikante Störungen entwickeln, wie z. B. eine Verschlechterung oder Aufrechterhaltung unangenehmer dermatologischer Zustände, z. Ekzem aufgrund verminderter Blutversorgung. Rauchen erhöht auch den Blutdruck und schwächt die Blutgefäße.(91)

Nieren((bearbeiten)

Rauchen erhöht nicht nur das Risiko für Nierenkrebs, sondern kann auch zu zusätzlichen Nierenschäden führen. Raucher haben ein signifikant erhöhtes Risiko für chronische Nierenerkrankungen als Nichtraucher.(92) Eine Vorgeschichte des Rauchens fördert das Fortschreiten der diabetischen Nephropathie.(93)

Grippe((bearbeiten)

Eine Studie über den Ausbruch einer (H1N1) Influenza in einer israelischen Militäreinheit von 336 gesunden jungen Männern zur Bestimmung des Verhältnisses des Zigarettenrauchens zur Inzidenz klinisch offensichtlicher Influenza ergab, dass von 168 Rauchern 68,5 Prozent im Vergleich Influenza hatten mit 47,2 Prozent der Nichtraucher. Influenza war auch bei den Rauchern schwerer; 50,6 Prozent von ihnen verloren Arbeitstage oder benötigten Bettruhe oder beides, verglichen mit 30,1 Prozent der Nichtraucher.(94)

Laut einer Studie von 1.900 männlichen Kadetten nach der A2-Influenza-Epidemie in Hongkong 1968 an einer Militärakademie in South Carolina hatten starke Raucher (mehr als 20 Zigaretten pro Tag) im Vergleich zu Nichtrauchern 21% mehr Krankheiten und 20% mehr Bettruhe, leichte Raucher (20 Zigaretten oder weniger pro Tag) hatten 10% mehr Krankheiten und 7% mehr Bettruhe.(95)

Die Auswirkung des Zigarettenrauchens auf die epidemische Influenza wurde prospektiv unter 1.811 männlichen College-Studenten untersucht. Die klinische Influenza-Inzidenz bei Personen, die täglich 21 oder mehr Zigaretten rauchten, war 21% höher als bei Nichtrauchern. Die Influenza-Inzidenz bei Rauchern von 1 bis 20 Zigaretten pro Tag lag zwischen Nichtrauchern und starken Zigarettenrauchern.(95)

Die Überwachung eines Influenza-Ausbruchs 1979 auf einer Militärbasis für Frauen in Israel ergab, dass bei 60,0% der derzeitigen Raucher Influenzasymptome auftraten, bei 41,6% der Nichtraucher.(96)

Rauchen scheint in älteren Bevölkerungsgruppen ein höheres relatives Influenza-Risiko zu verursachen als in jüngeren. In einer prospektiven Studie an Menschen in Wohngemeinschaften im Alter von 60 bis 90 Jahren im Jahr 1993 hatten 23% der Raucher eine klinische Influenza im Vergleich zu 6% der Nichtraucher.(97)

Rauchen kann wesentlich zum Wachstum von Influenza-Epidemien beitragen, von denen die gesamte Bevölkerung betroffen ist.(94) Der Anteil der Influenza-Fälle an der allgemeinen Nichtraucherpopulation, der auf Raucher zurückzuführen ist, wurde jedoch noch nicht berechnet.((Zitat benötigt)

Mund((bearbeiten)

Effets du tabac sur la santé - Wikipédia 9

Zahnröntgenbild, das den Knochenverlust bei einem 32 Jahre alten starken Raucher zeigt

Die vielleicht schwerwiegendste orale Erkrankung, die auftreten kann, ist die von Mundkrebs. Rauchen erhöht jedoch auch das Risiko für verschiedene andere orale Erkrankungen, von denen einige fast ausschließlich Tabakkonsumenten vorbehalten sind. Die National Institutes of Health stellten 1998 über das National Cancer Institute fest, dass "das Rauchen von Zigarre eine Vielzahl von Krebsarten verursacht, darunter Krebserkrankungen der Mundhöhle (Lippe, Zunge, Mund, Rachen), der Speiseröhre, des Kehlkopfes und der Lunge".(90) Pfeifenrauchen birgt erhebliche Gesundheitsrisiken,(98)(99) insbesondere Mundkrebs.(100) Etwa die Hälfte der Parodontitis oder Entzündungen im Bereich der Zähne wird auf aktuelles oder früheres Rauchen zurückgeführt. Rauchloser Tabak verursacht eine Rezession des Zahnfleisches und Läsionen der weißen Schleimhaut. Bis zu 90% der Parodontitis-Patienten, denen keine gängigen Behandlungsmethoden helfen, sind Raucher. Raucher haben einen signifikant größeren Verlust an Knochenhöhe als Nichtraucher, und der Trend kann auf Pfeifenraucher ausgedehnt werden, um mehr Knochenverlust als Nichtraucher zu haben.(101)

Rauchen ist nachweislich ein wichtiger Faktor bei der Verfärbung von Zähnen.(102)(103) Mundgeruch oder Mundgeruch sind bei Tabakrauchern häufig.(104) Es wurde gezeigt, dass der Zahnverlust 2 beträgt(105) bis 3 mal(106) höher bei Rauchern als bei Nichtrauchern.(107) Zusätzlich können Komplikationen ferner Leukoplakie, die anhaftenden weißen Plaques oder Flecken auf den Schleimhäuten der Mundhöhle, einschließlich der Zunge, umfassen.(108)

Infektion((bearbeiten)

Rauchen ist auch mit der Anfälligkeit für Infektionskrankheiten verbunden, insbesondere in der Lunge (Lungenentzündung). Smoking more than 20 cigarettes a day increases the risk of tuberculosis by two to four times,(109)(110) and being a current smoker has been linked to a fourfold increase in the risk of invasive disease caused by the pathogenic bacteria Streptococcus pneumoniae.(111) 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.(112)

Smoking increases the risk of Kaposi's sarcoma in people without HIV infection.(113) One study found this only with the male population and could not draw any conclusions for the female participants in the study.(114)

Impotence((edit)

The incidence of impotence (difficulty achieving and maintaining penile erection) is approximately 85 percent higher in male smokers compared to non-smokers.(115) Smoking is a key cause of erectile dysfunction (ED).(12)(115) It causes impotence because it promotes arterial narrowing and damages cells lining the inside of the arteries, thus leading to reduce penile blood flow.(116)

Female infertility((edit)

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.(117) Some damage is irreversible, but stopping smoking can prevent further damage.(118)(119) Smokers are 60% more likely to be infertile than non-smokers.(120) Smoking reduces the chances of in vitro fertilization (IVF) producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.(120)

Psychological((edit)

American Psychologist stated, "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."(121)

Immediate effects((edit)

Users report feelings of relaxation, sharpness, calmness, and alertness.(122) Those new to smoking may experience nausea, dizziness, increased blood pressure, narrowed arteries, and rapid heart beat. Generally, 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.((citation needed)

Stress((edit)

Smokers report higher levels of everyday stress.(123) Several studies have monitored feelings of stress over time and found reduced stress after quitting.(124)(125)

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.(123)

Recent studies have shown a positive relationship between psychological distress and salivary cotinine levels in smoking and non-smoking adults, indicating that both firsthand and secondhand smoke exposure may lead to higher levels of mental stress.(126)

Social and behavioral((edit)

Medical researchers have found that smoking is a predictor of divorce.(127) Smokers have a 53% greater chance of divorce than nonsmokers.(128)

Cognitive function((edit)

The usage of tobacco can also create cognitive dysfunction. There seems to be an increased risk of Alzheimer's disease (AD), although "case–control and cohort studies produce conflicting results as to the direction of the association between smoking and AD".(129) Smoking has been found to contribute to dementia and cognitive decline,(130) reduced memory and cognitive abilities in adolescents,(131) and brain shrinkage (cerebral atrophy).(132)(133)

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.(134) A recent review of the available scientific literature concluded that the apparent decrease in Alzheimer's risk may be simply because smokers tend to die before reaching the age at which Alzheimer's 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.(129)

Some older analyses have claimed that non-smokers are up to twice as likely as smokers to develop Alzheimer's disease.(135) However, a more current analysis found that most of the studies, which showed a preventing effect, had a close affiliation to the tobacco industry. Researchers without tobacco lobby influence have concluded the complete opposite: Smokers are almost twice as likely as nonsmokers to develop Alzheimer's disease.(136)

Former and current smokers have a lower incidence of Parkinson's disease compared to people who have never smoked,(137)(138) 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.(139)

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.(140)

Most smokers, when denied access to nicotine, exhibit withdrawal symptoms such as irritability, jitteriness, dry mouth, and rapid heart beat.(141) The onset of these symptoms is very fast, nicotine's half-life being only two hours.(142) The psychological dependence may linger for months or even many years. Unlike some recreational drugs, nicotine does not measurably alter a smoker's motor skills, judgement, or language abilities while under the influence of the drug. Tobacco withdrawal has been shown to cause clinically significant distress.(143)

A very large percentage of schizophrenics smoke tobacco as a form of self-medication.(144)(145)(146)(147) 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.(148) 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.(149) Some studies suggest that a link exists between smoking and mental illness, citing the high incidence of smoking amongst those suffering from schizophrenia(150) and the possibility that smoking may alleviate some of the symptoms of mental illness,(151) but these have not been conclusive. In 2015, a meta-analysis found that smokers were at greater risk of developing psychotic illness.(152)

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.(153) 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.(154) 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.(155) Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse.(156)

Pregnancy((edit)

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. It slightly increases the risk of neural tube defects.(157)

Environmental tobacco smoke exposure and maternal smoking during pregnancy have been shown to cause lower infant birth weights.(158)

Studies have shown an association between prenatal exposure to environmental tobacco smoke and conduct disorder in children.((medical citation needed) As well, post-natal tobacco smoke exposure may cause similar behavioral problems in children.((medical citation needed)

Drug interactions((edit)

Smoking is known to increase levels of liver enzymes that break down drugs and toxins. That means that drugs cleared by these enzymes are cleared more quickly in smokers, which may result in the drugs not working. Specifically, levels of CYP1A2 and CYP2A6 are induced:(159)(160) substrates for 1A2 include caffeine and tricyclic antidepressants such as amitriptyline; substrates for 2A6 include the anticonvulsant valproic acid.

Multigenerational effects((edit)

Other harm((edit)

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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.(161) Smoking also decreases weight by overexpressing the gene AZGP1, which stimulates lipolysis.(162)

Smoking causes about 10% of the global burden of fire deaths,(163) 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.(164)

Smoking increases the risk of symptoms associated with Crohn's disease (a dose-dependent effect with use of greater than 15 cigarettes per day).(165)(166)(167)(168) There is some evidence for decreased rates of endometriosis in infertile smoking women,(169) although other studies have found that smoking increases the risk in infertile women.(170) 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,(171) but overall the evidence is unconvincing.(172)

Current research shows that tobacco smokers who are exposed to residential radon are twice as likely to develop lung cancer as non-smokers.(173) As well, the risk of developing lung cancer from asbestos exposure is twice as likely for smokers than for non-smokers.(174)

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, and is the most common form of aortic aneurysm.(175)

Smoking leads to an increased risk of bone fractures, especially hip fractures.(176) It also leads to slower wound-healing after surgery, and an increased rate of postoperative healing complication.(177)

Tobacco smokers are 30-40% more likely to develop type 2 diabetes than non-smokers, and the risk increases with the number of cigarettes smoked. Furthermore, diabetic smokers have worse outcomes than diabetic non-smokers.(178)(179)

Claimed benefits((edit)

Against the background of the overwhelmingly negative effects of smoking on health, some observational studies have suggested that smoking might have specific beneficial effects, including in the field of cardiovascular disease.(180)(181) Interest in this epidemiological phenomenon has also been aroused by COVID-19.(181) Systematic review of reports that suggested smokers respond better to treatment for ischemic stroke provided no support for such claims.(180)

Claims of surprising benefits of smoking, based on observational data, have also been made for Parkinson's disease,(181) as well as a variety of other conditions, including basal-cell carcinoma,(182) malignant melanoma,(182) acute mountain sickness,(183) pemphigus,(184) celiac disease,(185) and ulcerative colitis,(186) among others.(187)

Tobacco smoke has many bioactive substances, including nicotine, that are capable of exerting a variety of systemic effects.(181) Surprising correlations may also stem from non-biological factors such as residual confounding (that is to say, the methodological difficulties in completely adjusting for every confounding factor that can affect outcomes in observational studies).(181)

In Parkinson's disease((edit)

In the case of Parkinson's disease, a series of observational studies that consistently suggest a possibly substantial reduction in risk among smokers (and other consumers of tobacco products) has led to longstanding interest among epidemiologists.(188)(189)(190)(191) Non-biological factors that may contribute to such observations include reverse causality (whereby prodromal symptoms of Parkinson's disease may lead some smokers to quit before diagnosis), and personality considerations (people predisposed to Parkinson's disease tend to be relatively risk-averse, and may be less likely to have a history of smoking).(188) Possible existence of a biological effect is supported by a few studies that involved low levels of exposure to nicotine without any active smoking.(188) A data-driven hypothesis that long-term administration of very low doses of nicotine (for example, in an ordinary diet) might provide a degree of neurological protection against Parkinson's disease remains open as a potential preventive strategy.(188)(192)(193)(194)

History of claimed benefits((edit)

On epidemiological grounds, unexpected correlations between smoking and favorable outcomes initially emerged in the context of cardiovascular disease, where they were described as a smoker's paradox (or smoking paradox).(181)(180) Der Begriff smoker's paradox was coined in 1995 in relation to reports that smokers appeared to have unexpectedly good short-term outcomes following acute coronary syndrome or stroke.(181) One of the first reports of an apparent smoker's paradox was published in 1968 based on an observation of relatively decreased mortality in smokers one month after experiencing acute myocardial infarction.(195) In the same year, a case–control study first suggested a possible protective role in Parkinson's disease.(188)(196)

Historical claims of possible benefits in schizophrenia, whereby smoking was thought to ameliorate cognitive symptoms, are not supported by current evidence.(197)(198)

Mechanism((edit)

Chemical carcinogens((edit)

Effets du tabac sur la santé - Wikipédia 11

Benzopyrene diol epoxide, an extremely carcinogenic (cancer-causing) metabolite of benzopyrene, a polycyclic aromatic hydrocarbon produced by burning tobacco

Effets du tabac sur la santé - Wikipédia 12
Benzopyrene, a major mutagen in tobacco smoke, in an adduct to DNA(199)

Smoke, or any partially burnt organic matter, contains carcinogens (cancer-causing agents). The potential effects of smoking, such as lung cancer, can take up to 20 years to manifest themselves. Historically, women began smoking en masse later than men, so an increased death rate caused by smoking amongst women did not appear until later. The male lung cancer death rate decreased in 1975 — roughly 20 years after the initial decline in cigarette consumption in men. A fall in consumption in women also began in 1975(200) but by 1991 had not manifested in a decrease in lung cancer-related mortalities amongst women.(201)

Smoke contains several carcinogenic pyrolytic products that bind to DNA and cause genetic mutations. Particularly potent carcinogens are polycyclic aromatic hydrocarbons (PAH), which are toxicated to mutagenic epoxides. The first PAH to be identified as a carcinogen in tobacco smoke was benzopyrene, which has been shown to toxicate into an epoxide that irreversibly attaches to a cell's nuclear DNA, which may either kill the cell or cause a genetic mutation. If the mutation inhibits programmed cell death, the cell can survive to become a cancer cell. Similarly, acrolein, which is abundant in tobacco smoke, also irreversibly binds to DNA, causes mutations and thus also cancer. However, it needs no activation to become carcinogenic.(202)

There are over 19 known carcinogens in cigarette smoke.(203) The following are some of the most potent carcinogens:

  • Polycyclic aromatic hydrocarbons are tar components produced by pyrolysis in smoldering organic matter and emitted into smoke. Several of these PAH's are already toxic in their normal form, however, many of then can become more toxic to the liver. Due to the hydrophobic nature of PAH's they do not dissolve in water and are hard to expel from the body. In order to make the PAH more soluble in water, the liver creates an enzyme called Cytochrome P450 which adds an additional oxygen to the PAH, turning it into a mutagenic epoxides, which is more soluble, but also more reactive.(204) The first PAH to be identified as a carcinogen in tobacco smoke was benzopyrene, which been shown to toxicate into a diol epoxide and then permanently attach to nuclear DNA, which may either kill the cell or cause a genetic mutation. The DNA contains the information on how the cell function; in practice, it contains the recipes for protein synthesis. If the mutation inhibits programmed cell death, the cell can survive to become a cancer, a cell that does not function like a normal cell. The carcinogenicity is radiomimetic, i.e. similar to that produced by ionizing nuclear radiation. Tobacco manufacturers have experimented with combustion less vaporizer technology to allow cigarettes to be consumed without the formation of carcinogenic benzopyrenes.(205) Although such products have become increasingly popular, they still represent a very small fraction of the market, and no conclusive evidence has shown to prove or disprove the positive health claims.((citation needed)
  • Acrolein is a pyrolysis product that is abundant in cigarette smoke. It gives smoke an acrid smell and an irritating, tear causing effect and is a major contributor to its carcinogenicity. Like PAH metabolites, acrolein is also an electrophilic alkylating agent and permanently binds to the DNA base guanine, by a conjugate addition followed by cyclization into a hemiaminal. The acrolein-guanine adduct induces mutations during DNA copying and thus causes cancers in a manner similar to PAHs. However, acrolein is 1000 times more abundant than PAHs in cigarette smoke and is able to react as is, without metabolic activation. Acrolein has been shown to be a mutagen and carcinogen in human cells. The carcinogenicity of acrolein has been difficult to study by animal experimentation, because it has such a toxicity that it tends to kill the animals before they develop cancer.(202) Generally, compounds able to react by conjugate addition as electrophiles (so-called Michael acceptors after Michael reaction) are toxic and carcinogenic, because they can permanently alkylate DNA, similarly to mustard gas or aflatoxin. Acrolein is only one of them present in cigarette smoke; for example, crotonaldehyde has been found in cigarette smoke.(206) Michael acceptors also contribute to the chronic inflammation present in tobacco disease.(79)
  • Nitrosamines are a group of carcinogenic compounds found in cigarette smoke but not in uncured tobacco leaves. Nitrosamines form on flue-cured tobacco leaves during the curing process through a chemical reaction between nicotine and other compounds contained in the uncured leaf and various oxides of nitrogen found in all combustion gasses. Switching to Indirect fire curing has been shown to reduce nitrosamine levels to less than 0.1 parts per million.(207)(208)

Sidestream tobacco smoke, or exhaled mainstream smoke, is particularly harmful. Because exhaled smoke exists at lower temperatures than inhaled smoke, chemical compounds undergo changes which can cause them to become more dangerous. As well, smoke undergoes changes as it ages, which causes the transformation of the compound NO into the more toxic NO2. Further, volatilization causes smoke particles to become smaller, and thus more easily embedded deep into the lung of anyone who later breathes the air.(209)

Radioactive carcinogens((edit)

In addition to chemical, nonradioactive carcinogens, tobacco and tobacco smoke contain small amounts of lead-210 (210Pb) and polonium-210 (210Po), both of which are radioactive carcinogens. The presence of polonium-210 in mainstream cigarette smoke has been experimentally measured at levels of 0.0263–0.036 pCi (0.97–1.33 mBq),(210)(211) which is equivalent to about 0.1 pCi per milligram of smoke (4 mBq/mg); or about 0.81 pCi of lead-210 per gram of dry condensed smoke (30 Bq/kg).

Research by NCAR radiochemist Ed Martell suggested that radioactive compounds in cigarette smoke are deposited in "hot spots" where bronchial tubes branch, that tar from cigarette smoke is resistant to dissolving in lung fluid and that radioactive compounds have a great deal of time to undergo radioactive decay before being cleared by natural processes. Indoors, these radioactive compounds can linger in secondhand smoke, and greater exposure would occur when these radioactive compounds are inhaled during normal breathing, which is deeper and longer than when inhaling cigarettes. Damage to the protective epithelial tissue from smoking only increases the prolonged retention of insoluble polonium-210 compounds produced from burning tobacco. Martell estimated that a carcinogenic radiation dose of 80–100 rads is delivered to the lung tissue of most smokers who die of lung cancer.(212)(213)(214)

Smoking an average of 1.5 packs per day gives a radiation dose of 60-160 mSv/year,(215)(216) compared with living near a nuclear power station (0.0001 mSv/year)(217)(218) or the 3.0 mSv/year average dose for Americans.(218)(219) Some of the mineral apatite in Florida used to produce phosphate for U.S. tobacco crops contains uranium, radium, lead-210 and polonium-210 and radon.(220)(221) The radioactive smoke from tobacco fertilized this way is deposited in lungs and releases radiation even if a smoker quits the habit. The combination of carcinogenic tar and radiation in a sensitive organ such as lungs increases the risk of cancer.((citation needed)

In contrast, a 1999 review of tobacco smoke carcinogens published in the Journal of the National Cancer Institute states that "levels of polonium-210 in tobacco smoke are not believed to be great enough to significantly impact lung cancer in smokers."(222) In 2011 Hecht has also stated that the "levels of 210Po in cigarette smoke are probably too low to be involved in lung cancer induction".(223)

Oxidation and inflammation((edit)

Free radicals and pro-oxidants in cigarettes damage blood vessels and oxidize LDL cholesterol.(224) Only oxidized LDL cholesterol is taken-up by macrophages, which become foam cells, leading to atherosclerotic plaques.(224) Cigarette smoke increases proinflammatory cytokines in the bloodstream, causing atherosclerosis.(224) The pro-oxidative state also leads to endothelial dysfunction,(224) which is another important cause of atherosclerosis.(225)

Nicotine((edit)

Effets du tabac sur la santé - Wikipédia 13

Nicotine, which is contained in cigarettes and other smoked tobacco products, is a stimulant and is one of the main factors leading to continued tobacco smoking. Nicotine is a highly addictive psychoactive chemical. When tobacco is smoked, most of the nicotine is pyrolyzed; a dose sufficient to cause mild somatic dependency and mild to strong psychological dependency remains. The amount of nicotine absorbed by the body from smoking depends on many factors, including the type of tobacco, whether the smoke is inhaled, and whether a filter is used. There is also a formation of harmane (a MAO inhibitor) from the acetaldehyde in cigarette smoke, which seems to play an important role in nicotine addiction(226) probably by facilitating dopamine release in the nucleus accumbens in response to nicotine stimuli. According to studies by Henningfield and Benowitz, nicotine is more addictive than cannabis, caffeine, alcohol, cocaine, and heroin when considering both somatic and psychological dependence. However, due to the stronger withdrawal effects of alcohol, cocaine and heroin, nicotine may have a lower potential for somatic dependence than these substances.(227)(228) About half of Canadians who currently smoke have tried to quit.(229) McGill University health professor Jennifer O'Loughlin stated that nicotine addiction can occur as soon as five months after the start of smoking.(230)

Ingesting a compound by smoking is one of the most rapid and efficient methods of introducing it into the bloodstream, second only to injection, which allows for the rapid feedback which supports the smokers' ability to titrate their dosage. On average it takes about ten seconds for the substance to reach the brain. As a result of the efficiency of this delivery system, many smokers feel as though they are unable to cease. Of those who attempt cessation and last three months without succumbing to nicotine, most are able to remain smoke-free for the rest of their lives.(231)((failed verification) There exists a possibility of depression in some who attempt cessation, as with other psychoactive substances. Depression is also common in teenage smokers; teens who smoke are four times as likely to develop depressive symptoms as their nonsmoking peers.(232)

Although nicotine does play a role in acute episodes of some diseases (including stroke, impotence, and heart disease) by its stimulation of adrenaline release, which raises blood pressure,(91) heart and respiration rate, and free fatty acids, the most serious longer term effects are more the result of the products of the smouldering combustion process. This has led to the development of various nicotine delivery systems, such as the nicotine patch or nicotine gum, that can satisfy the addictive craving by delivering nicotine without the harmful combustion by-products. This can help the heavily dependent smoker to quit gradually, while discontinuing further damage to health.((citation needed)

Recent evidence has shown that smoking tobacco increases the release of dopamine in the brain, specifically in the mesolimbic pathway, the same neuro-reward circuit activated by drugs of abuse such as heroin and cocaine. This suggests nicotine use has a pleasurable effect that triggers positive reinforcement.(233) One study found that smokers exhibit better reaction-time and memory performance compared to non-smokers, which is consistent with increased activation of dopamine receptors.(234) Neurologically, rodent studies have found that nicotine self-administration causes lowering of reward thresholds—a finding opposite that of most other drugs of abuse (e.g. cocaine and heroin).

The carcinogenity of tobacco smoke is not explained by nicotine per se, which is not carcinogenic or mutagenic, although it is a metabolic precursor for several compounds which are.((citation needed) In addition, it inhibits apoptosis, therefore accelerating existing cancers.(235) Also, NNK, a nicotine derivative converted from nicotine, can be carcinogenic.

It is worth noting that nicotine, although frequently implicated in producing tobacco addiction, is not significantly addictive when administered alone.(236)((non-primary source needed) The addictive potential manifests itself after co-administration of an MAOI, which specifically causes sensitization of the locomotor response in rats, a measure of addictive potential.(237)

Forms of exposure((edit)

Second-hand smoke((edit)

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Second-hand 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 may cause a wide range of adverse health effects, including cancer, respiratory infections and asthma.(238) Non-smokers who are exposed to second-hand smoke at home or work are thought, due to a wide variety of statistical studies, to increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%. Second-hand smoke has been estimated to cause 38,000 deaths per year, of which 3,400 are deaths from lung cancer in non-smokers.(239)

The current US Surgeon General's Report concludes that there is no established risk-free level of exposure to second-hand smoke. Short exposures to second-hand smoke are believed to 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.((citation needed) New research indicates that private research conducted by cigarette company Philip Morris in the 1980s showed that second-hand smoke was toxic, yet the company suppressed the finding during the next two decades.(238)

Chewing tobacco((edit)

Chewing tobacco has been known to cause cancer, particularly of the mouth and throat.(240) 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."(240) Oral and spit tobacco increase the risk for leukoplakia, a precursor to oral cancer.(241)

Cigars((edit)

Like other forms of smoking, 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.(89) 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.(242) The increased risk for those smoking 1–2 cigars per day is too small to be statistically significant,(243) and the health risks of the 3/4 of cigar smokers who smoke less than daily are not known(244) 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.(88) Health risks are similar to cigarette smoking in nicotine addiction, periodontal health, tooth loss, and many types of cancer, including cancers of the mouth, throat, and esophagus. 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.(89)

Hookahs((edit)

Effets du tabac sur la santé - Wikipédia 15

A sign forbidding the use of cigarettes, e-cigarettes and hookah in Tbilisi, Georgia

A common belief among users is that the smoke of a hookah (waterpipe, narghile) is significantly less dangerous than that from cigarettes.(245) 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.(246) 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,(247)(248) and a study by the World Health Organization also confirmed these findings.(249)

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.(250)(251) In an hour-long smoking session of hookah, users consume about 100 to 200 times the smoke of a single cigarette;(250)(252) A study in the Journal of Periodontology found that water pipe smokers were marginally more likely than regular smokers to show signs of gum disease, showing rates 5-fold higher than non-smokers rather than the 3.8-fold risk that regular smokers show.(253) According to USA Today, people who smoked water pipes had five times the risk of lung cancer of non-smokers.(254)

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 as statistically significant as that 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.(255) Hookah smokers were nearly 6 times more likely to develop lung cancer as compared to healthy non-smokers in Kashmir (India).(256)

Dipping tobacco((edit)

Dipping tobacco, commonly referred to as snuff, is also put in the mouth, but it is a flavored powder. it is placed between the cheek and gum. Dipping tobacco does not need to be chewed for the nicotine to be absorbed. First-time users of these products often become nauseated and dizzy. Long-term effects include bad breath, yellowed teeth, and an increased risk of oral cancer.((citation needed)

Users of dipping tobacco are believed to face less risk of some cancers than are smokers, but are still at greater risk than people who do not use any tobacco products.(257) They also have an equal risk of other health problems directly linked to nicotine, such as increased rate of atherosclerosis.((citation needed)

Prevention((edit)

Education and counselling by physicians of children and adolescents have been found to be effective in decreasing tobacco use.(258)

Effets du tabac sur la santé - Wikipédia 20

Percentage of females smoking any tobacco product

Effets du tabac sur la santé - Wikipédia 21
Percentage of males smoking any tobacco product. Note that there is a difference between the scales used for females and for males.(5)

Though tobacco may be consumed by either smoking or other smokeless methods such as chewing, the World Health Organization (WHO) only collects data on smoked tobacco.(1) Smoking has therefore been studied more extensively than any other form of tobacco consumption.(2)

In 2000, smoking was practiced by 1.22 billion people, predicted to rise to 1.45 billion people in 2010 and 1.5 to 1.9 billion by 2025. If prevalence had decreased by 2% a year since 2000 this figure would have been 1.3 billion in 2010 and 2025.(263) Despite dropping by 0.4 percent from 2009 to 2010, the United States still reports an average of 17.9 percent usage.(52)

As of 2002, about twenty percent of young teens (13–15) smoked worldwide, with 80,000 to 100,000 children taking up the addiction every day, roughly half of whom live in Asia. Half of those who begin smoking in adolescent years are projected to go on to smoke for 15 to 20 years.(264)

Teens are more likely to use e-cigarettes than cigarettes. About 31% of teenagers who use e-cigs started smoking within six months, compared to 8% of non-smokers. Manufacturers do not have to report what is in e-cigs, and most teens either say e-cigs contain only flavoring, or that they do not know what they contain.(265)(266)

The WHO states that "Much of the disease burden and premature mortality attributable to tobacco use disproportionately affect the poor". Of the 1.22 billion smokers, 1 billion live in developing or transitional nations. Rates of smoking have leveled off or declined in the developed world.(267) In the developing world, however, tobacco consumption was rising by 3.4% per year as of 2002.(264)

The WHO in 2004 projected 58.8 million deaths to occur globally,(268)::8 from which 5.4 million are tobacco-attributed,(268)::23 and 4.9 million as of 2007.(269) As of 2002, 70% of the deaths are in developing countries.(269)

The shift in prevalence of tobacco smoking to a younger demographic, mainly in the developing world, can be attributed to several factors. The tobacco industry spends up to $12.5 billion annually on advertising, which is increasingly geared towards adolescents in the developing world because they are a vulnerable audience for the marketing campaigns. Adolescents have more difficulty understanding the long-term health risks that are associated with smoking and are also more easily influenced by "images of romance, success, sophistication, popularity, and adventure which advertising suggests they could achieve through the consumption of cigarettes". This shift in marketing towards adolescents and even children in the tobacco industry is debilitating to organizations' and countries' efforts to improve child health and mortality in the developing world. It reverses or halts the effects of the work that has been done to improve health care in these countries, and although smoking is deemed as a "voluntary" health risk, the marketing of tobacco towards very impressionable adolescents in the developing world makes it less of a voluntary action and more of an inevitable shift.(4)

Many government regulations have been passed to protect citizens from harm caused by public environmental tobacco smoke. The "Pro-Children Act of 2001" prohibits smoking within any facility that provides health care, day care, library services, or elementary and secondary education to children in the US.(270) On May 23, 2011, New York City enforced a smoking ban for all parks, beaches, and pedestrian malls in an attempt to eliminate threats posed to civilians by environmental tobacco smoke.(271)

See also((edit)

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