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WikiDoc Resources for Tobacco


Most recent articles on Tobacco

Most cited articles on Tobacco

Review articles on Tobacco

Articles on Tobacco in N Eng J Med, Lancet, BMJ


Powerpoint slides on Tobacco

Images of Tobacco

Photos of Tobacco

Podcasts & MP3s on Tobacco

Videos on Tobacco

Evidence Based Medicine

Cochrane Collaboration on Tobacco

Bandolier on Tobacco

TRIP on Tobacco

Clinical Trials

Ongoing Trials on Tobacco at Clinical

Trial results on Tobacco

Clinical Trials on Tobacco at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Tobacco

NICE Guidance on Tobacco


FDA on Tobacco

CDC on Tobacco


Books on Tobacco


Tobacco in the news

Be alerted to news on Tobacco

News trends on Tobacco


Blogs on Tobacco


Definitions of Tobacco

Patient Resources / Community

Patient resources on Tobacco

Discussion groups on Tobacco

Patient Handouts on Tobacco

Directions to Hospitals Treating Tobacco

Risk calculators and risk factors for Tobacco

Healthcare Provider Resources

Symptoms of Tobacco

Causes & Risk Factors for Tobacco

Diagnostic studies for Tobacco

Treatment of Tobacco

Continuing Medical Education (CME)

CME Programs on Tobacco


Tobacco en Espanol

Tobacco en Francais


Tobacco in the Marketplace

Patents on Tobacco

Experimental / Informatics

List of terms related to Tobacco

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]


Tobacco is an agricultural product processed from the fresh leaves of plants in the genus Nicotiana.

Tobacco has been growing on the American Continent since about 6000 BC and began being used by native cultures at about 3000 BC. It has been smoked in one form or another since about 2000 BC. There are pictoral drawings of ancient Mayans smoking crude cigars from 1400 BC. Tobacco has a very long history of use in Native American culture and played an important part in the foundation of the United States of America, going back to colonial times and the original Jamestown settlement.

Commercially available dried, cured and natural forms, it is often smoked (see tobacco smoking) in the form of a cigar or cigarette, or in a stem pipe, water pipe, or hookah. Tobacco can also be chewed, "dipped" (placed between the cheek and gum), or sniffed into the nose as finely powdered snuff. Many countries set a minimum smoking age, regulating the purchase and use of tobacco products.

All methods of tobacco consumption results in varying quantities of nicotine being absorbed into the user's bloodstream. Over time, tolerance and dependence develop. Absorption quantity, frequency, and speed seem to have a direct relationship with how strong a dependence and tolerance, if any, might be created.

Health effects

All means of tobacco consumption result in the absorption of nicotine, in varying amounts, into the user's bloodstream. A lethal dose of nicotine is contained in as little as one half of a cigar or three cigarettes. However, only a small fraction of the nicotine contained in these products is actually released into the smoke: most clinically significant cases of nicotine poisoning result from concentrated forms of the compound used as insecticides. Some sources report, however, that even a discarded cigarette butt can contain enough nicotine to kill a small child.[1] Other active alkaloids in tobacco include harmala alkaloids.

Long-term tobacco use carries significant risks of developing various cancers as well as strokes and severe cardiovascular and respiratory diseases.[2] Significantly shorter life expectancies have been associated with tobacco smoking.[3] It has been shown that tobacco may cause lasting brain changes just like morphine or cocaine.[4]

Many jurisdictions have enacted smoking bans in an effort to minimize possible damage to public health caused by tobacco smoking. The substantially increased risk of developing cancer as a result of tobacco usage seems to be due to the plethora of nitrosamines and other carcinogenic compounds found in tobacco and its residue as a result of anaerobic heating, either due to smoking or to flue-curing or fire-curing. The use of flue-cured or fire-cured smokeless tobacco in lieu of smoked tobacco reduces the risk of respiratory cancers but still carries significant risk of oral cancer.[5] In contrast, use of steam-cured chewing tobacco (snus) avoids the carcinogenicity by not generating nitrosamines, though the negative effects of the nicotine on the cardiovascular system and pancreas are not ameliorated.[6] More than 400,000 Americans a year die from smoking: 276,000 men and 142,000 women.[7]

One study from the Aristotle University of Thessaloniki in Greece measured the amount of naturally occurring radium and polonium found in Greece's tobacco leaves. The radiation dose was discovered to be nearly a thousand times more than the amount of Caesium-137 found in the leaves of plant life adjacent to the Chernobyl disaster. Despite the actual radiation dose attained by tobacco smokers being only 10 percent of the mean dose any person receives from the environment, some scientists believe that this radioactive content is a major cause of cancer deaths in smokers, and not nicotine or tar.[8]

Tobacco Use Disorder

Epidemiology and Demographics


The 12month prevalence of tobacco use disorder according to DSM IV criteria is 13,000 per 100,000 (13%) among ages 18 years and older.[9]

Risk Factors

Diagnostic Criteria

DSM-V Diagnostic Criteria for Tobacco Use Disorder[9]

  • A.A problematic pattern of tobacco use leading to clinically significant impairment or distress,as manifested by at least two of the following, occurring within a 12-month period:
  • 1.Tobacco is often taken in larger amounts or over a longer period than was intended.
  • 2.There is a persistent desire or unsuccessful efforts to cut down or control tobacco use.
  • 3.A great deal of time is spent in activities necessary to obtain or use tobacco.
  • 4.Craving, or a strong desire or urge to use tobacco.
  • 5.Recurrent tobacco use resulting in a failure to fulfill major role obligations at work,school, or home (e.g., interference with work).
  • 6.Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco (e.g., arguments with others about tobacco use).
  • 7.important social, occupational, or recreational activities are given up or reduced because of tobacco use.
  • 8.Recurrent tobacco use in situations in which it is physically hazardous (e.g., smoking in bed).
  • 9.Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco.
  • 10.Tolerance, as defined by either of the following:
  • a.A need for markedly increased amounts of tobacco to achieve the desired effect.
  • b.A markedly diminished effect with continued use of the same amount of tobacco.
  • 11.Withdrawal, as manifested by either of the following:
  • a.The characteristic withdrawal syndrome for tobacco (refer to Criteria A and B of the criteria set for tobacco withdrawal).
  • b.Tobacco (or a closely related substance, such as nicotine) is taken to relieve or avoid withdrawal symptoms.

Specify if:

  • In early remission: After full criteria for tobacco use disorder were previously met, none of the criteria for tobacco use disorder have been met for at least 3 months but

for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use tobacco,” may be met).

  • In sustained remission: After full criteria for tobacco use disorder were previously met, none of the criteria for tobacco use disorder have been met at any time during a

period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use tobacco," may be met).

Specify if:

  • On maintenance therapy: The individual is taking a long-term maintenance medication,such as nicotine replacement medication, and no criteria for tobacco use disorder

have been met for that class of medication (except tolerance to, or withdrawal from,the nicotine replacement medication).

  • In a controlled environment: This additional specifier is used if the individual is in an environment where access to tobacco is restricted.

Tobacco Withdrawal

Differential Diagnosis

Epidemiology and Demographics


The prevalence of tobacco withdrawal is 50,000 per 100,000 (50%) of the overall population.[9]

Risk Factors

Diagnostic Criteria

DSM-V Diagnostic Criteria for Tobacco Withdrawal[9]

  • A.Daily use of tobacco for at least several weeks.


  • B.Abrupt cessation of tobacco use, or reduction in the amount of tobacco used, followed within 24 hours by four (or more) of the following signs or symptoms:


1.Irritability, frustration, or anger


3.Difficulty concentrating.

4.Increased appetite.


6.Depressed mood.



C.The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


D.The signs or symptoms are not attributed to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

See also


  2. Health harms have induced by cigarette smoking
  3. Smoking - Health Risks
  4. Smoking alters brain 'like drugs'
  5. Oral cancers in Mumbai, India: a fifteen years perspective with respect to incidence trend and cumulative risk
  6. Overview of knowledge of health effects of smokeless tobacco. Increased risk of cardiovascular diseases and mortality because of snuff
  8. New Scientist, 2 June 2007, page 6
  9. 9.0 9.1 9.2 9.3 9.4 9.5 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


  • Breen, T. H. (1985). Tobacco Culture. Princeton University Press. ISBN 0-691-00596-6. Source on tobacco culture in eighteenth-century Virginia pp. 46–55
  • W.K. Collins and S.N. Hawks. "Principles of Flue-Cured Tobacco Production" 1st Edition, 1993
  • Fuller, R. Reese (Spring 2003). Perique, the Native Crop. Louisiana Life.
  • Gately, Iain. Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization. Grove Press, 2003. ISBN 0-8021-3960-4.
  • Graves, John. "Tobacco that is not Smoked" in From a Limestone Ledge (the sections on snuff and chewing tobacco) ISBN 0-394-51238-3
  • Killebrew, J. B. and Myrick, Herbert (1909). Tobacco Leaf: Its Culture and Cure, Marketing and Manufacture. Orange Judd Company. Source for flea beetle typology (p. 243)
  • Poche, L. Aristee (2002). Perique tobacco: Mystery and history.
  • Tilley, Nannie May. The Bright Tobacco Industry 1860–1929 ISBN 0-405-04728-2. Source on flea beetle prevention (pp. 39–43), and history of flue-cured tobacco
  • Rivenson A., Hoffmann D., Propokczyk B. et al. Induction of lung and pancreas exocrine tumors in F344 rats by tobacco-specific and areca-derived N-nitrosamines. Cancer Res (48) 6912–6917, 1988. (link to abstract; free full text pdf available)
  • Schoolcraft, Henry R. Historical and Statistical Information respecting the Indian Tribes of the United States (Philadelphia, 1851-57)

External links

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