Tobacco Through the Ages: From Chewing to Juuling and Marijuana
By: Chidinma Chima-Melton, MD, FCCP and Nancy Stewart, DO, MS
May 31, 2019
Tobacco use dates back centuries and remains the single biggest cause of preventable death in the United States today. With each generation, the tobacco industry introduces novel methods of delivering nicotine, the highly addictive active ingredient. In the 1800s, noncombustibles like chewing and pipe tobacco were the predominant types used. Cigarettes became readily available in the 20th century and have greater addictive potential as they can quickly deliver high levels of nicotine from the lungs to the bloodstream within seconds of inhalation.
From the 1960s through to the 1990s, teen idols from James Dean to Kurt Cobain sold teenage rebellion with a cigarette hanging off their lips. Unsurprisingly, generations of young people grew up not appreciating the increased risks of respiratory infections and lung diseases like asthma and lung cancer cigarette smoking to which they were exposed.
The global rate of smoking declined from 23.5% in 2007 to 20.7% in 2015 as knowledge of the carcinogenic and addictive potential of cigarettes permeated our collective psyche.
Along came the next iteration, vaping devices such as Juul, the USB flash drive-like e-cigarette that has spread to epidemic proportions among young people. While many teenagers believe it is safe, the reality is a lot more insidious. One pod contains as much nicotine as a pack of cigarettes and youths who use Juul and other vaping devices are four times more likely to smoke cigarettes. Withdrawal from these nicotine-containing vaping devices can cause intense cravings, increased appetite, irritability, and depressed mood. These pods come in a variety of flavors that appeal to youth although the industry continues to claim that vapes did not intentionally target children.
With rapidly changing legislation on marijuana nationwide, how does it fit in to this picture? From a public health perspective, data are scarce. When inhaled, marijuana has a mild bronchodilator effect on the lungs. Development of a pneumothorax is common amongst marijuana smokers. Due to a smaller mass of combustible material, long-term airway disease is possible in heavy users. Lung cancer may be associated with marijuana use. Smoking marijuana can increase the exposure risk to aspergillus and other fungi into the lungs. Inflammatory lung diseases have also been noted with marijuana use. Lastly, there are several studies that suggest that habitual marijuana use has a detrimental effect on the mental health of children and teens.
An unfortunate but well-known consequence of tobacco smoking is the risk of developing chronic obstructive pulmonary disease (COPD). COPD is the third-leading cause of mortality in the United States and worldwide, and the global burden continues to increase. According to the CDC, almost 15.7 million Americans reported they have been diagnosed with COPD (as of 2014). More than 50% of adults with decreased pulmonary function on testing were not aware they had COPD, so the prevalence may actually be greater. Complications of COPD include increased hospitalizations, emergency room utilization, limitations in activities, need for medical equipment, including portable oxygen tanks, increased incidence of depression, and overall poorer health status. For smokers with COPD, the most important thing they can do for their overall health is to STOP SMOKING. Physicians may often recommend that patients with COPD take medications to improve symptoms of shortness of breath or wheezing. Pulmonary rehabilitation may also be recommended to improve patient quality of life.
The influence of tobacco continues to evolve with each generation, but its impact is felt worldwide. Educating each generation on the consequences and health effects is the most important approach to affect change.