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Polycystic ovary syndrome


 Polycystic ovary syndrome


Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder in women of reproductive age. The syndrome is named after the characteristic cysts which may form on the ovaries, though it is important to note that this is a sign and not the underlying cause of the disorder.


Women with PCOS may experience irregular menstrual periods, heavy periods, excess hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin. The primary characteristics of this syndrome include: hyperandrogenism, anovulation, insulin resistance, and neuroendocrine disruption.


A review of the international evidence found that the prevalence of PCOS could be as high as 26% among some populations, though ranges between 4% and 18% are reported for general populations. Despite its high prevalence, the exact cause of PCOS remains uncertain and there is no known cure.




Two definitions are commonly used:


NIH

In 1990 a consensus workshop sponsored by the NIH/NICHD suggested that a person has PCOS if they have all of the following:

oligoovulation

signs of androgen excess (clinical or biochemical)

exclusion of other disorders that can result in menstrual irregularity and hyperandrogenism

Rotterdam

In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met, in the absence of other entities that might cause these findings:


oligoovulation and/or anovulation

excess androgen activity

polycystic ovaries (by gynecologic ultrasound)

The Rotterdam definition is wider, including many more women, the most notable ones being women without androgen excess. Critics say that findings obtained from the study of women with androgen excess cannot necessarily be extrapolated to women without androgen excess.


Androgen Excess PCOS Society

In 2006, the Androgen Excess PCOS Society suggested a tightening of the diagnostic criteria to all of the following:

excess androgen activity

oligoovulation/anovulation and/or polycystic ovaries

exclusion of other entities that would cause excess androgen activity

Signs and symptoms

Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin. This metabolic, endocrine and reproductive disorder is not universally defined, but the most common symptoms are irregular or irregular absent periods, ovarian cysts, enlarged ovaries, excess androgen, weight gain and hirsutism. Associated conditions include type 2 diabetes, obesity, obstructive sleep apnea, heart disease, mood disorders, and endometrial cancer. This disease is related to the number of follicles per ovary each month growing from the average range of 6 to 8 to double, triple or more. it is important to distinguish between PCOS (the syndrome) and a woman with PCO (polycystic ovaries): to have PCOS, a woman must have at least two of these three symptoms (PCO, anovulation/oligoovulation and hyperandrogenism). This means that a woman can have PCOS (displaying anovulation and hyperandrogenism) without having PCO. At the same time, having polycystic ovaries does not relate necessary with the presence of PCOS.


Further information: Infertility in polycystic ovary syndrome

Common signs and symptoms of PCOS include the following:


Menstrual disorders: PCOS mostly produces oligomenorrhea (fewer than nine menstrual periods in a year) or amenorrhea (no menstrual periods for three or more consecutive months), but other types of menstrual disorders may also occur.

Infertility: This generally results directly from chronic anovulation (lack of ovulation).

High levels of masculinizing hormones: Known as hyperandrogenism, the most common signs are acne and hirsutism (male pattern of hair growth, such as on the chin or chest), but it may produce hypermenorrhea (heavy and prolonged menstrual periods), androgenic alopecia (increased hair thinning or diffuse hair loss), or other symptoms. Approximately three-quarters of women with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of hyperandrogenemia.

Metabolic syndrome: This appears as a tendency towards central obesity and other symptoms associated with insulin resistance, including low energy levels and food cravings. Serum insulin, insulin resistance, and homocysteine levels are higher in women with PCOS.

Polycystic Ovaries: Ovaries might get enlarged and comprise follicles surrounding the eggs. As result, ovaries might fail to function regularly.

Women with PCOS tend to have central obesity, but studies are conflicting as to whether visceral and subcutaneous abdominal fat is increased, unchanged, or decreased in women with PCOS relative to reproductively normal women with the same body mass index. In any case, androgens, such as testosterone, androstanolone (dihydrotestosterone), and nandrolone decanoate have been found to increase visceral fat deposition in both female animals and women.


Although 80% of PCOS presents in women with obesity, 20% of women diagnosed with the disease are non-obese or "lean" women.[33] However, obese women that have PCOS have a higher risk of adverse outcomes such as, hypertension, insulin resistance, metabolic syndrome, and endometrial hyperplasia.


Even though most women with PCOS are overweight or obese, it is important to acknowledge that non-overweight women can also be diagnosed with PCOS. Up to 30% of women diagnosed with PCOS maintain a normal weight before and after diagnosis. "Lean" women still face the various symptoms of PCOS with the added challenges of getting their symptoms properly addressed and recognized. Lean women often go undiagnosed for years, and usually are diagnosed after struggles to conceive. Lean women are likely to have incidences of missed diagnosis of diabetes and cardiovascular diseases. These women also have an increased risk of developing insulin resistance despite not being overweight. Lean women are often taken less seriously with their diagnosis of PCOS, and also face challenges finding appropriate treatment options. This is because most treatment options are limited to approaches of losing weight and healthy dieting.


Associated conditions

Many individuals aren't under the impression that the first warning sign is usually a change in appearance. But there are also manifestations of mental health problems, such as anxiety, depression, and eating disorders.


A diagnosis of PCOS suggests an increased risk of the following:


Endometrial hyperplasia and endometrial cancer (cancer of the uterine lining) are possible, due to overaccumulation of uterine lining, and also lack of progesterone resulting in prolonged stimulation of uterine cells by estrogen. It is not clear whether this risk is directly due to the syndrome or from the associated obesity, hyperinsulinemia, and hyperandrogenism.

Insulin resistance/Type II diabetes. A review published in 2010 concluded that women with PCOS have an elevated prevalence of insulin resistance and type II diabetes, even when controlling for body mass index (BMI). PCOS also makes a woman at higher risk for diabetes.

High blood pressure, in particular if obese or during pregnancy

Depression and anxiety

Dyslipidemia – disorders of lipid metabolism — cholesterol and triglycerides. Women with PCOS show a decreased removal of atherosclerosis-inducing remnants, seemingly independent of insulin resistance/Type II diabetes.

Cardiovascular disease, with a meta-analysis estimating a 2-fold risk of arterial disease for women with PCOS relative to women without PCOS, independent of BMI.

Strokes

Weight gain

Miscarriage

Sleep apnea, particularly if obesity is present

Non-alcoholic fatty liver disease, particularly if obesity is present

Acanthosis nigricans (patches of darkened skin under the arms, in the groin area, on the back of the neck)[20]

Autoimmune thyroiditis

Some studies report a higher incidence of PCOS among transgender men (prior to taking testosterone),[49][50][51] though not all have not found the same association. People with PCOS in general are also reportedly more likely to see themselves as "sexually undifferentiated" or "androgynous" and "less likely to identify with a female gender scheme."

The risk of ovarian cancer and breast cancer is not significantly increased overall.


Cause

PCOS is caused by a combination of genetic and environmental factors. Risk factors include obesity, a lack of physical exercise, and a family history of someone with the condition. Transgender men may also experience a higher than expected rate of PCOS.Diagnosis is based on two of the following three findings: anovulation, high androgen levels, and ovarian cysts. Cysts may be detectable by ultrasound. Other conditions that produce similar symptoms include adrenal hyperplasia, hypothyroidism, and high blood levels of prolactin.


PCOS is a heterogeneous disorder of uncertain cause. There is some evidence that it is a genetic disease. Such evidence includes the familial clustering of cases, greater concordance in monozygotic compared with dizygotic twins and heritability of endocrine and metabolic features of PCOS. There is some evidence that exposure to higher than typical levels of androgens and the anti-Müllerian hormone (AMH) in utero increases the risk of developing PCOS in later life.


Genetics

The genetic component appears to be inherited in an autosomal dominant fashion with high genetic penetrance but variable expressivity in females; this means that each child has a 50% chance of inheriting the predisposing genetic variant(s) from a parent, and, if a daughter receives the variant(s), the daughter will have the disease to some extent. The genetic variant(s) can be inherited from either the father or the mother, and can be passed along to both sons (who may be asymptomatic carriers or may have symptoms such as early baldness and/or excessive hair) and daughters, who will show signs of PCOS. The phenotype appears to manifest itself at least partially via heightened androgen levels secreted by ovarian follicle theca cells from women with the allele. The exact gene affected has not yet been identified. In rare instances, single-gene mutations can give rise to the phenotype of the syndrome. Current understanding of the pathogenesis of the syndrome suggests, however, that it is a complex multigenic disorder.


Due to the scarcity of large-scale screening studies, the prevalence of endometrial abnormalities in PCOS remains unknown, though women with the condition may be at increased risk for endometrial hyperplasia and carcinoma as well as menstrual dysfunction and infertility.


The severity of PCOS symptoms appears to be largely determined by factors such as obesity. PCOS has some aspects of a metabolic disorder, since its symptoms are partly reversible. Even though considered as a gynecological problem, PCOS consists of 28 clinical symptoms.[citation needed]


Even though the name suggests that the ovaries are central to disease pathology, cysts are a symptom instead of the cause of the disease. Some symptoms of PCOS will persist even if both ovaries are removed; the disease can appear even if cysts are absent. Since its first description by Stein and Leventhal in 1935, the criteria of diagnosis, symptoms, and causative factors are subject to debate. Gynecologists often see it as a gynecological problem, with the ovaries being the primary organ affected. However, recent insights show a multisystem disorder, with the primary problem lying in hormonal regulation in the hypothalamus, with the involvement of many organs. The term PCOS is used due to the fact that there is a wide spectrum of symptoms possible. It is common to have polycystic ovaries without having PCOS; approximately 20% of European women have polcystic ovaries, but most of those women do not have PCOS.


Environment

PCOS may be related to or worsened by exposures during the prenatal period, epigenetic factors, environmental impacts (especially industrial endocrine disruptors, such as bisphenol A and certain drugs) and the increasing rates of obesity. Along with PCOS appearing to be inherited as a complex genetic trait that is characterized by both androgen excess and ovulatory dysfunction.


Endocrine disruptors are defined as chemicals that can interfere with the Endocrine system by mimicking hormones such as estrogen; "they are of particular interest to reproductive health, including PCOS and its related symptoms". However, additional research is needed to assess the role that endocrine disruptors may play in disrupting reproductive health among women and possibly triggering or exacerbating PCOS and its related symptoms.

Natural skin care

 


Natural skin care


Natural skin care uses topical creams and lotions made of ingredients available in nature. Much of the recent literature reviews plant-derived ingredients, which may include herbs, roots, flowers and essential oils, but natural substances in skin care products include animal-derived products such as beeswax, and minerals. These substances may be combined with various carrier agents, preservatives, surfactants, humectants and emulsifiers. 


There are no legal definitions in the U.S. for advertising terms "natural" or "organic" when applied to personal care products. Consumers often express a preference for skin products with organic and natural ingredients. The personal skin care market based on natural products has shown strong growth. Clinical and laboratory studies have identified activities in many natural ingredients that have potential beneficial activities for personal skin care, but there is a shortage of convincing evidence for natural product efficacy in medical problems.


Some natural products and therapies may be harmful, either to the skin or systemically. People prone to allergies should pay careful attention to what they use on their skin. Dermatologists may feel that there is enough scientific evidence to assist in the selection or avoidance of particular natural ingredients.

Background

Main article: Skin care

Jojoba oil is easily refined to be odorless, colorless and oxidatively stable, and is often used in cosmetics as a moisturizer and as a carrier oil for specialty fragrances

Many countries require that the ingredient composition of skin care products is listed on the product, using the International Nomenclature of Cosmetic Ingredients (INCI) conventions. Ingredients are listed in the order of their percentage within the product; natural ingredients are listed in Latin and synthetic ingredients are listed by technical name.  "The U.S. government has documented more than 10,500 ingredients in cosmetic products, but only a small percentage of those chemicals have been tested for safety. Of those that have been tested, some have been identified as carcinogens (causes cancer), teratogens (causes birth defects), and reproductive toxicants (damages the ability to reproduce)."


The FDA surveyed 1,687 consumers ages 14 and older in 1994 about their use of cosmetics. Nearly half of these consumers felt that a product claiming to be "natural" should contain all natural ingredients. However, although the United States Department of Agriculture (USDA) has designated within its certain requirements within its specific area of regulation for organic products, the U.S. Food and Drug Administration (FDA) does not recognize a definition for natural products. Accordingly, there are no legal definitions in the U.S. for the advertising terms "natural" or "organic" in personal care products. The FDA prohibits certain ingredients in cosmetics.


Some organic products which are designated organic may be intensely modified, sometimes considerably more so than conventional products.


History

Main article: History of cosmetics

Plant extracts and herbs have been used by many cultures as cosmetics and perfumes since ancient times.


Research is scientifically assessing natural products, selected based on experience in the ancient era. Validated use of these materials and products awaits further assessment.



Cosmetics

Consumer preference

Consumers often express a preference for skin products with organic and natural ingredients. The skin care market based on natural products has shown strong growth. Clinical and laboratory studies have identified activities in many natural ingredients that have potential beneficial activities for the skin. Dermatologists may feel that there is enough scientific evidence to assist in the selection of particular natural ingredients.


Consumers expected products to perform as advertised.


Industry response

Voluntary discontinuation of precursor substances that release small quantities of formaldehyde, which is a carcinogen, as well as reducing levels of the potentially carcinogenic impurity 1,4-dioxane. Polycyclic musk fragrance ingredients, which have raised concerns as persistent and bioaccumulative endocrine disruptors, are being discontinued.


Alternative medicine

Main article: Alternative medicine

There are significant reservations about complementary and alternative medicine (CAM) including a "shortage of evidence supporting the efficacy and safety of CAM" for skin problems. However, patients express a desire to utilize natural ingredients as treatment. A literature search found a growing prevalence of CAM use for skin conditions. A number of textbooks address CAM perspectives of skin care. The purpose of this section is to review botanical compounds in skin care; a broader review the history and theory behind other CAM modalities such as psychocutaneous therapies, acupuncture and homeopathy can be found in recent reviews.


Western

The plant monographs with dermatological relevance of the former German Commission E have recently been reviewed.


According to Baumann, "Botanical compounds for which dermatologic and cosmetic applications have emerged include: olive oil, chamomile, colloidal oatmeal, oat kernel extract, feverfew, acai berry, coffee berry, curcumin, green tea, pomegranate, licorice, paper mulberry, arbutin, and soy. "Many of these botanical sources offer biologically active components that require further in vitro and in vivo investigation".


A review of 35 plant families found that a "variety of phytomolecules, derived in particular from polyphenols, triterpenes and sterols classes, demonstrated a promising activity."


Colloidal oatmeal may be beneficial in psoriasis. Aloe vera may help in atopic dermatitis. In both these conditions, the benefit may arise from anti-inflammatory properties. "For combating acne and rosacea, green tea, niacinamide and feverfew are considered efficacious. For hyperpigmentation and antioxidative capabilities, licorice, green tea, arbutin, soy, acai berry, turmeric and pomegranate are among those plants and compounds found to be most beneficial. Additional research is needed to determine to confirm and elucidate the benefits of these ingredients in the prevention and management of skin disease."


An assessment of clinical trials on green tea preparations and their uses in dermatology found some evidence for potential benefits.


Ayurveda

Main article: Ayurveda

Ayurvedic skincare is derived from medicinal practices that began over 5,000-years ago in India. Ayurvedic medicine and healing practices are based on Indian philosophical, psychological, conventional, and medicinal understandings. Most of the ayurvedic skincare products contain the following herbs—aloe vera, almond, avocado, carrot, castor, clay, cocoa, coconut oil, cornmeal, cucumber, cutch tree, emu oil, ginkgo biloba, ginseng, grape seed oil, ground almond and walnut shell, horse chestnut, witch hazel, and honey.


Ayurvedic approaches have been used in molluscum contagiosum, lymphatic filariasis, vitiligo and lichen planus.


Phyllanthus emblica (amla, Indian gooseberry) has been used in ayurvedic medicine.[26] Standardized extracts of Phyllanthus emblica have a long-lasting and broad-spectrum antioxidant activity. This may be suitable for use in Anti-aging cream, sunscreen and general purpose skin care products.


Traditional Chinese medicine

Substances

Natural skin care ingredients include jojoba, safflower oil, rose hip seed oil, shea butter, beeswax, witch hazel, aloe vera, tea tree oil, coconut oil, and chamomile.


Egg oil can be used as an excipient/carrier in a variety of cosmetic preparations such as creams, ointments, sun-screen products, or lotions. In Indian, Japanese, Unani (Roghan Baiza Murgh) and Chinese traditional medicine, egg oil was traditionally used as a treatment for hair care.

Jojoba is used for skin care because it is a natural moisturizer for the skin. Jojoba is actually a liquid wax that becomes solid below room temperature, but is known as an oil.

Shea butter is derived from the kernel of the shea tree (Vitellaria paradoxa). Shea butter is known for its cosmetic properties as a moisturizer and emollient.

Research

Dermatological research suggests that the bioactive ingredients used in cosmeceuticals have benefits beyond the traditional moisturizer (e.g., Chen et al., 2005; Zettersten, Ghadially, Feingold, Crumrine, & Elias, 1997). However, despite reports of benefits from some cosmeceutical products, there are no formal requirements to prove that these products live up to their claims.


Biocompatible and environmentally friendly natural compounds have the potential to provide materials with photoresistant and thermoresistant properties.


Dehydroabietic acid (DAA), a naturally occurring diterpene resin acid, "has lifespan extension effects in Caenorhabditis elegans, prevents lipofuscin accumulation, and prevents collagen secretion in human dermal fibroblasts. We found that these anti-aging effects are primarily mediated by SIRT1 activation." DAA may activate SIRT1 enzymatic activity, which may have a preventive effect against the aging process.


Validated use of these materials and products awaits further assessment.

Gastrointestinal disease


 Gastrointestinal disease



Gastrointestinal diseases (abbrev. GI diseases or GI illnesses) refer to diseases involving the gastrointestinal tract, namely the oesophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.



Oral disease

Main article: Oral and maxillofacial pathology

See also: Tongue disease and Salivary gland disease

The oral cavity is part of the gastrointestinal system and as such the presence of alterations in this district can be the first sign of both systemic and gastrointestinal diseases. By far the most common oral conditions are plaque-induced diseases e.g., gingivitis, periodontitis, dental caries. Oral symptoms can be similar to lesions occurring elsewhere in the digestive tract, with a pattern of swelling, inflammation, ulcers, and fissures. If these signs are present, then patients are more likely to also have anal and esophageal lesions and experience other extra-intestinal disease manifestations. Some diseases which involve other parts of the GI tract can manifest in the mouth, alone or in combination, including:


Gastroesophageal reflux disease can cause acid erosion of the teeth and halitosis.

Gardner's syndrome can be associated with failure of tooth eruption, supernumerary teeth, and dentigerous cysts.

Peutz–Jeghers syndrome can cause dark spots on the oral mucosa or on the lips or the skin around the mouth.

Several GI diseases, especially those associated with malabsorption, can cause recurrent mouth ulcers, atrophic glossitis, and angular cheilitis e.g., Crohn's disease is sometimes termed orofacial granulomatosis when it involves the mouth alone.

Sideropenic dysphagia can cause glossitis, angular cheilitis.

Oesophageal disease

Main article: Oesophageal disease

Oesophageal diseases include a spectrum of disorders affecting the oesophagus. The most common condition of the oesophagus in Western countries is gastroesophageal reflux disease, which in chronic forms is thought to result in changes to the epithelium of the oesophagus, known as Barrett's oesophagus.


Acute disease might include infections such as oesophagitis, trauma caused by the ingestion of corrosive substances, or rupture of veins such as oesophageal varices, Boerhaave syndrome or Mallory-Weiss tears. Chronic diseases might include congenital diseases such as Zenker's diverticulum and esophageal webbing, and oesophageal motility disorders including the nutcracker oesophagus, achalasia, diffuse oesophageal spasm, and oesophageal stricture.


Oesophageal disease may result in a sore throat, throwing up blood, difficulty swallowing or vomiting. Chronic or congenital diseases might be investigated using barium swallows, endoscopy and biopsy, whereas acute diseases such as reflux may be investigated and diagnosed based on symptoms and a medical history alone.


Gastric disease

Main article: Stomach disease

Gastric diseases refer to diseases affecting the stomach. Inflammation of the stomach by infection from any cause is called gastritis, and when including other parts of the gastrointestinal tract called gastroenteritis. When gastritis persists in a chronic state, it is associated with several diseases, including atrophic gastritis, pyloric stenosis, and gastric cancer. Another common condition is gastric ulceration, peptic ulcers. Ulceration erodes the gastric mucosa, which protects the tissue of the stomach from the stomach acids. Peptic ulcers are most commonly caused by a bacterial Helicobacter pylori infection. Epstein–Barr virus infection is another factor to induce gastric cancer.


As well as peptic ulcers, vomiting blood may result from abnormal arteries or veins that have ruptured, including Dieulafoy's lesion and Gastric antral vascular ectasia. Congenital disorders of the stomach include pernicious anaemia, in which a targeted immune response against parietal cells results in an inability to absorb vitamin B12. Other common symptoms that stomach disease might cause include indigestion or dyspepsia, vomiting, and in chronic disease, digestive problems leading to forms of malnutrition.  In addition to routine tests, an endoscopy might be used to examine or take a biopsy from the stomach.


Intestinal disease

The small and large intestines may be affected by infectious, autoimmune, and physiological states. Inflammation of the intestines is called enterocolitis, which may lead to diarrhea.


Acute conditions affecting the bowels include infectious diarrhea and mesenteric ischaemia. Causes of constipation may include faecal impaction and bowel obstruction, which may in turn be caused by ileus, intussusception, volvulus. Inflammatory bowel disease is a condition of unknown aetiology, classified as either Crohn's disease or ulcerative colitis, that can affect the intestines and other parts of the gastrointestinal tract. Other causes of illness include intestinal pseudoobstruction, and necrotizing enterocolitis.


Diseases of the intestine may cause vomiting, diarrhoea or constipation, and altered stool, such as with blood in stool. Colonoscopy may be used to examine the large intestine, and a person's stool may be sent for culture and microscopy. Infectious disease may be treated with targeted antibiotics, and inflammatory bowel disease with immunosuppression. Surgery may also be used to treat some causes of bowel obstruction.


The normal thickness of the small intestinal wall is 3–5 mm, and 1–5 mm in the large intestine. Focal, irregular and asymmetrical gastrointestinal wall thickening on CT scan suggests a malignancy. Segmental or diffuse gastrointestinal wall thickening is most often due to ischemic, inflammatory or infectious disease. Though less common, medications such as ACE inhibitors can cause angioedema and small bowel thickening.


Small intestine

The small intestine consists of the duodenum, jejunum and ileum. Inflammation of the small intestine is called enteritis, which if localised to just part is called duodenitis, jejunitis and ileitis, respectively. Peptic ulcers are also common in the duodenum.


Chronic diseases of malabsorption may affect the small intestine, including the autoimmune coeliac disease, infective tropical sprue, and congenital or surgical short bowel syndrome. Other rarer diseases affecting the small intestine include Curling's ulcer, blind loop syndrome, Milroy disease and Whipple's disease. Tumours of the small intestine include gastrointestinal stromal tumours, lipomas, hamartomas and carcinoid syndromes.


Diseases of the small intestine may present with symptoms such as diarrhoea, malnutrition, fatigue and weight loss. Investigations pursued may include blood tests to monitor nutrition, such as iron levels, folate and calcium, endoscopy and biopsy of the duodenum, and barium swallow. Treatments may include renutrition, and antibiotics for infections.


Large intestine


Abdominal X-rays may be used to visualise the large intestine.

Diseases that affect the large intestine may affect it in whole or in part. Appendicitis is one such disease, caused by inflammation of the appendix. Generalised inflammation of the large intestine is referred to as colitis, which when caused by the bacteria Clostridium difficile is referred to as pseudomembranous colitis. Diverticulitis is a common cause of abdominal pain resulting from outpouchings that particularly affects the colon. Functional colonic diseases refer to disorders without a known cause, including irritable bowel syndrome and intestinal pseudoobstruction. Constipation may result from lifestyle factors, impaction of a rigid stool in the rectum, or in neonates, Hirschprung's disease.


Diseases affecting the large intestine may cause blood to be passed with stool, may cause constipation, or may result in abdominal pain or a fever. Tests that specifically examine the function of the large intestine include barium swallows, abdominal x-rays, and colonoscopy.


Rectum and anus

Diseases affecting the rectum and anus are extremely common, especially in older adults. Hemorrhoids, vascular outpouchings of skin, are very common, as is pruritus ani, referring to anal itchiness. Other conditions, such as anal cancer may be associated with ulcerative colitis or with sexually transmitted infections such as HIV. Inflammation of the rectum is known as proctitis, one cause of which is radiation damage associated with radiotherapy to other sites such as the prostate. Faecal incontinence can result from mechanical and neurological problems, and when associated with a lack of voluntary voiding ability is described as encopresis. Pain on passing stool may result from anal abscesses, small inflamed nodules, anal fissures, and anal fistulas.


Rectal and anal disease may be asymptomatic, or may present with pain when passing stools, fresh blood in stool, a feeling of incomplete emptying, or pencil-thin stools. In addition to regular tests, medical tests used to investigate the anus and rectum include the digital rectal exam and proctoscopy.


Accessory digestive gland disease

Hepatic

Main article: Liver disease

Hepatic diseases refers to those affecting the liver. Hepatitis refers to inflammation of liver tissue, and may be acute or chronic. Infectious viral hepatitis, such as hepatitis A, B and C, affect in excess of (X) million people worldwide. Liver disease may also be a result of lifestyle factors, such as fatty liver and NASH. Alcoholic liver disease may also develop as a result of chronic alcohol use, which may also cause alcoholic hepatitis. Cirrhosis may develop as a result of chronic hepatic fibrosis in a chronically inflamed liver, such as one affected by alcohol or viral hepatitis.


Liver abscesses are often acute conditions, with common causes being pyogenic and amoebic. Chronic liver disease, such as cirrhosis, may be a cause of liver failure, a state where the liver is unable to compensate for chronic damage, and unable to meet the metabolic demands of the body. In the acute setting, this may be a cause of hepatic encephalopathy and hepatorenal syndrome. Other causes of chronic liver disease are genetic or autoimmune disease, such as hemochromatosis, Wilson's disease, autoimmune hepatitis, and primary biliary cirrhosis.


Acute liver disease rarely results in pain, but may result in jaundice. Infectious liver disease may cause a fever. Chronic liver disease may result in a buildup of fluid in the abdomen, yellowing of the skin or eyes, easy bruising, immunosuppression, and feminization. Portal hypertension is often present, and this may lead to the development of prominent veins in many parts of the body, such as oesophageal varices, and haemorrhoids.


In order to investigate liver disease, a medical history, including regarding a person's family history, travel to risk-prone areas, alcohol use and food consumption, may be taken. A medical examination may be conducted to investigate for symptoms of liver disease. Blood tests may be used, particularly liver function tests, and other blood tests may be used to investigate the presence of the Hepatitis viruses in the blood, and ultrasound used. If ascites is present, abdominal fluid may be tested for protein levels.


Pancreatic

Main article: Pancreatic disease

Pancreatic diseases that affect digestion refers to disorders affecting the exocrine pancreas, which is a part of the pancreas involved in digestion.


One of the most common conditions of the exocrine pancreas is acute pancreatitis, which in the majority of cases relates to gallstones that have impacted in the pancreatic part of the biliary tree, or due to acute or chronic hazardous alcohol use or as a side-effect of ERCP. Other forms of pancreatitis include chronic and hereditary forms. Chronic pancreatitis may predispose to pancreatic cancer and is strongly linked to alcohol use. Other rarer diseases affecting the pancreas may include pancreatic pseudocysts, exocrine pancreatic insufficiency, and pancreatic fistulas.


Pancreatic disease may present with or without symptoms. When symptoms occur, such as in acute pancreatitis, a person may experience acute-onset, severe mid-abdominal pain, nausea and vomiting. In severe cases, pancreatitis may lead to rapid blood loss and systemic inflammatory response syndrome. When the pancreas is unable to secrete digestive enzymes, such as with a pancreatic cancer occluding the pancreatic duct, result in jaundice. Pancreatic disease might be investigated using abdominal x-rays, MRCP or ERCP, CT scans, and through blood tests such as measurement of the amylase and lipase enzymes. 


Gallbladder and biliary tract

Diseases of the hepatobiliary system affect the biliary tract also known as the biliary tree, which secretes bile in order to aid digestion of fats. Diseases of the gallbladder and bile ducts are commonly diet-related, and may include the formation of gallstones that impact in the gallbladder (cholecystolithiasis) or in the common bile duct (choledocholithiasis).


Gallstones are a common cause of inflammation of the gallbladder, called cholecystitis. Inflammation of the biliary duct is called cholangitis, which may be associated with autoimmune disease, such as primary sclerosing cholangitis, or a result of bacterial infection, such as ascending cholangitis.


Disease of the biliary tree may cause pain in the upper right abdomen, particularly when pressed. Disease might be investigated using ultrasound or ERCP, and might be treated with drugs such as antibiotics or UDCA, or by the surgical removal of the gallbladder.

Laziness

 


Laziness


Laziness (also known as indolence) is disinclination to activity or exertion despite having the ability to act or to exert oneself. It is often used as a pejorative; terms for a person seen to be lazy include "couch potato", "slacker", and "bludger". Related concepts include sloth, a Christian sin, and lethargy, a state of lacking energy.


Despite famed neurologist Sigmund Freud's discussion of the "pleasure principle", Leonard Carmichael noted in 1954 that "laziness is not a word that appears in the table of contents of most technical books on psychology". A 1931 survey found high-school students more likely to attribute their failing performance to laziness, while teachers ranked "lack of ability" as the major cause, with laziness coming in second. Laziness is not to be confused with avolition, a negative symptom of certain mental-health issues such as depression, ADHD, ASD, sleep disorders, substance use disorders and schizophrenia.

Psychology

Laziness may reflect a lack of self-esteem, a lack of positive recognition by others, a lack of discipline stemming from low self-confidence, or a lack of interest in the activity or belief in its efficacy. Laziness may manifest as procrastination or vacillation. Studies of motivation suggest that laziness may be caused by a decreased level of motivation, which in turn can be caused by over-stimulation or excessive impulses or distractions. These increase the release of dopamine, a neurotransmitter responsible for reward and pleasure. The more dopamine that is released, the greater intolerance one has for valuing and accepting productive and rewarding action. This desensitization leads to dulling of the neural patterns and affects negatively the anterior insula of the brain responsible for risk perception.

ADHD specialists say engaging in multiple activities can cause behavioral problems such as attention/focus failure or perfectionism and subsequently pessimism. In these circumstances laziness can manifest as a negative coping mechanism (aversion), the desire to avoid certain situations in the hopes of countering certain experiences and preconceived ill results. Lacanian thought says laziness is the "acting out" of archetypes from societal programming and negative child rearing practices. Boredom is sometimes conflated with laziness; one study shows that the average Briton is bored 6 hours a week. Thomas Goetz, University of Konstanz, Germany, and John Eastwood, York University, Canada, concur that aversive states such as laziness can be equally adaptive for making change and toxic if allowed to fester. An outlook found to be helpful in their studies is "being mindful and not looking for ways out of it, simultaneously to be also open to creative and active options if they should arise." They point out that a relentless engaging in activities without breaks can cause oscillations of failure, which may result in mental health issues.


It has also been shown that laziness can render one apathetic to reactant mental health issues such as anger, anxiety, indifference, substance abuse, and depression.


Related concepts

Acedia, a state of listlessness.

Avolition, decrease in the motivation to initiate and perform self-directed purposeful activities.

Athymhormia, disorder of motivation.

Aboulia, neurological, with anatomical damage.

Amotivational syndrome, normally in the context of heavy cannabis use.

Procrastination, the delaying of fulfilling tasks.

Counter-productive work behavior

Senioritis, the decreased motivation to study which is said to affect those nearing the end of their studies.

Economics


Economists have differing views of laziness. Frédéric Bastiat argues that idleness is the result of people focusing on the pleasant immediate effects of their actions rather than potentially negative long-term consequences. Others note that humans seem to have a tendency to seek after leisure. Hal Cranmer writes, "For all these arguments against laziness, it is amazing we work so hard to achieve it. Even those hard-working Puritans were willing to break their backs every day in exchange for an eternity of lying around on a cloud and playing the harp. Every industry is trying to do its part to give its customers more leisure time."[13] Ludwig von Mises writes, "The expenditure of labor is deemed painful. Not to work is considered a state of affairs more satisfactory than working. Leisure is, other things being equal, preferred to travail (work). People work only when they value the return of labor higher than the decrease in satisfaction brought about by the curtailment of leisure. To work involves disutility."


Literary

Laziness in American literature is figured as a fundamental problem with social and spiritual consequences. In 1612 John Smith in his A Map of Virginia is seen using a jeremiad to address idleness. In the 1750s this sort of advocating reached its apex in literature. David Bertelson in The Lazy South (1767) expressed this as a substitution of "spiritual industry" over "patriotic industry". Writers like William Byrd went to a great extent and censured North Carolina as land of lubbers. Thomas Jefferson in his Notes on the State of Virginia (1785) acknowledges a small portion of the people have only seen labor and identifies the cause of this indolence to the rise of "slave-holding" society. Jefferson raised his concerns what this deleterious system will bring to the economic system. Later by the 1800s the rise of Romanticism changed attitudes of the society, values of work were re-written; stigmatization of idleness was overthrown with glamorous notions. John Pendleton Kennedy was a prominent writer in romanticizing sloth and slavery: in Swallow Barn (1832) he equated idleness and its flow as living in oneness with nature. Mark Twain in The Adventures of Huckleberry Finn (1885) contrasts realist and romantic perspective of "laziness" and calls attention to the essential convention of aimlessness and transcendence that connects the character. In 20th century the poor whites were portrayed in the grotesque caricatures of early southern laziness. In Flannery O'Connor's Wise Blood (1952) and Good Country People (1955) she depicts spiritual backwardness as the cause for disinclination to work. The lack of any social function which could be valued equally with a luxurious lifestyle was closely portrayed through lives of displaced aristocrats and their indolence. Jason Compson, Robert Penn Warren and William Styron were some of the writers who explored this perspective. The lack of meaningful work was defined as a void which aristocrats needed to fill with pompous culture; Walker Percy is a writer who has thoroughly mined the subject. Percy's characters are often exposed to the emptiness (spiritual sloth) of contemporary life, and come to rectify it with renewed spiritual resources.


Religion

Christianity

Main article: Sloth (deadly sin)

One of the Catholic seven deadly sins is sloth, which is often defined as spiritual and/or physical apathy or laziness. Sloth is discouraged in (Hebrews 6:12), 2 Thessalonians, and associated with wickedness in one of the parables of Jesus in the Gospel of Matthew (Matthew 25:26). In the Wisdom books of Proverbs and Ecclesiastes, it is stated that laziness can lead to poverty (Proverbs 10:4, Ecclesiastes 10:18). According to Peter Binsfeld's Binsfeld's Classification of Demons, Belphegor is thought to be its chief demon.

Islam

The Arabic term used in the Quran for laziness, inactivity and sluggishness is كَسَل (kasal).[19] The opposite of laziness is Jihad al-Nafs, i.e. the struggle against the self, against one’s own ego. Among the five pillars of Islam, praying five times a day and fasting during Ramaḍān are part of actions against laziness.


Buddhism

Main article: Kausīdya

In Buddhism, the term kausīdya is commonly translated as "laziness" or "spiritual sloth". Kausīdya is defined as clinging to unwholesome activities such as lying down and stretching out, procrastinating, and not being enthusiastic about or engaging in virtuous activity.


In selected societies

Southern United States

From 1909 to 1915, the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease sought to eradicate hookworm infestation from 11 southern U.S. states. Hookworms were popularly known as "the germ of laziness" because they produced listlessness and weakness in the people they infested. Hookworms infested 40 percent of southerners and were identified in the North as the cause of the South's alleged backwardness.


Indonesia

It was alleged[21] that indolence was the reason for backward conditions in Indonesia, such as the failure to implement Green Revolution agricultural methods. But a counter-argument is that the Indonesians, living very precariously, sought to play it safe by not risking a failed crop, given that not all experiments introduced by outsiders had been successful.


Animals

It is common for animals (even those like hummingbirds that have high energy needs) to forage for food until satiated, and then spend most of their time doing nothing, or at least nothing in particular. They seek to "satisfice" their needs rather than obtaining an optimal diet or habitat. Even diurnal animals, which have a limited amount of daylight in which to accomplish their tasks, follow this pattern. Social activity comes in a distant third to eating and resting for foraging animals. When more time must be spent foraging, animals are more likely to sacrifice time spent on aggressive behavior than time spent resting. Extremely efficient predators have more free time and thus often appear more lazy than relatively inept predators that have little free time. Beetles likewise seem to forage lazily due to a lack of foraging competitors.[24] On the other hand, some animals, such as pigeons and rats, seem to prefer to respond for food rather than eat equally available "free food" in some conditions.

Alcohol (drug)


 Alcohol (drug)


Alcohol, sometimes referred to by the chemical name ethanol, is a psychoactive drug that is the active ingredient in drinks such as beer, wine, and distilled spirits (hard liquor). It is one of the oldest and most common recreational substances, causing the characteristic effects of alcohol intoxication ("drunkenness"). Among other effects, alcohol produces happiness and euphoria, decreased anxiety, increased sociability, sedation, impairment of cognitive, memory, motor, and sensory function, and generalized depression of central nervous system function. Ethanol is only one of several types of alcohol, but it is the only type of alcohol that is found in alcoholic beverages or commonly used for recreational purposes; other alcohols such as methanol and isopropyl alcohol are significantly more toxic. A mild, brief exposure to isopropanol, being only moderately more toxic than ethanol, is unlikely to cause any serious harm. Methanol, being profoundly more toxic than ethanol, is lethal in quantities as small as 10–15 milliliters (2–3 tsp).


Alcohol has a variety of short-term and long-term adverse effects. Short-term adverse effects include generalized impairment of neurocognitive function, dizziness, nausea, vomiting, and hangover-like symptoms. Alcohol is addictive to humans, and can result in alcohol use disorder, dependence and withdrawal. It can have a variety of long-term adverse effects on health, for instance liver damage, brain damage, and its consumption is the fifth leading cause of cancer. The adverse effects of alcohol on health are most important when it is used in excessive quantities or with heavy frequency. However, some of them, such as increased risk of certain cancers, may occur even with light or moderate alcohol consumption. In high amounts, alcohol may cause loss of consciousness or, in severe cases, death.


Alcohol works in the brain primarily by increasing the effects of a neurotransmitter called γ-aminobutyric acid, or GABA. This is the major inhibitory neurotransmitter in the brain, and by facilitating its actions, alcohol suppresses the activity of the central nervous system. The substance also directly affects a number of other neurotransmitter systems including those of glutamate, glycine, acetylcholine, and serotonin. The pleasurable effects of alcohol ingestion are the result of increased levels of dopamine and endogenous opioids in the reward pathways of the brain. Alcohol also has toxic and unpleasant actions in the body, many of which are mediated by its byproduct acetaldehyde.


Alcohol has been produced and consumed by humans for its psychoactive effects for almost 10,000 years. Drinking alcohol is generally socially acceptable and is legal in most countries, unlike with many other recreational substances. However, there are often restrictions on alcohol sale and use, for instance a minimum age for drinking and laws against public drinking and drinking and driving. Alcohol has considerable societal and cultural significance and has important social roles in much of the world. Drinking establishments, such as bars and nightclubs, revolve primarily around the sale and consumption of alcoholic beverages, and parties, festivals, and social gatherings commonly involve alcohol consumption. Alcohol is unique in that it is the only drug that damages others more than the user. It is related to various societal problems, including drunk driving, accidental injuries, sexual assaults, domestic abuse, and violent crime. Alcohol remains illegal for sale and consumption in a number of countries, mainly in the Middle East. While some religions, including Islam, prohibit alcohol consumption, other religions, such as Christianity and Shinto, utilize alcohol in sacrament and libation.



Use and effects

Main articles: Alcohols (medicine), Short-term effects of alcohol consumption, Alcohol intoxication, and Long-term effects of alcohol

See also: Alcohol and health § Short-term effects

Ethanol is typically consumed as a recreational substance by mouth in the form of alcoholic beverages such as beer, wine, and spirits. It is commonly used in social settings due to its capacity to enhance sociability.


The amount of ethanol in the body is typically quantified by blood alcohol content (BAC); weight of ethanol per unit volume of blood. Small doses of ethanol, in general, are stimulant-like and produce euphoria and relaxation; people experiencing these symptoms tend to become talkative and less inhibited, and may exhibit poor judgement. At higher dosages (BAC > 1 g/L), ethanol acts as a central nervous system depressant, producing at progressively higher dosages, impaired sensory and motor function, slowed cognition, stupefaction, unconsciousness, and possible death. Ethanol is commonly consumed as a recreational substance, especially while socializing, due to its psychoactive effects.


Toxicity

See also: Alcohol and health and Health effects of wine

Alcohol has a variety of short-term and long-term adverse effects. It also has reinforcement-related adverse effects, including addiction, dependence, and withdrawal.


Social harm


Alcohol causes a plethora of detrimental effects in society. It is highly associated with drinking in public, impaired social distancing, passive drinking, drunk dialing, drunk driving, sexual risk-taking or drug facilitated sexual assault (especially with caffeinated alcoholic drinks), and both violent and non-violent crime. About one-third of arrests in the United States involve alcohol misuse. Many emergency room visits also involve alcohol use. As many as 15% of employees show problematic alcohol-related behaviors in the workplace, such as drinking before going to work or even drinking on the job. Heavy drinking is associated with vulnerability to injury, marital discord, and domestic violence. Alcohol use is directly related to considerable morbidity and mortality, for instance due to overdose and alcohol-related health problems.


Alcohol-related crimes

Main articles: Alcohol-related crime and Drug-related crime

Automobile accidents

Main articles: Drunk driving and Driving under influence

A 2002 study found 41% of people fatally injured in traffic accidents were in alcohol-related crashes. Misuse of alcohol is associated with more than 40% of deaths that occur in automobile accidents every year. The risk of a fatal car accident increases exponentially with the level of alcohol in the driver's blood. Most drunk driving laws in the United States governing the acceptable levels in the blood while driving or operating heavy machinery set typical upper limits of legal blood alcohol content (BAC) at 0.08%.



Sexual assault

See also: Drug-facilitated sexual assault and Date rape drug

Alcohol is often used to facilitate sexual assault or rape. Over 50% of reported rapes involve alcohol. It is the most commonly used date rape drug.


Violent crime

Main article: Alcohol-related crime

Over 40% of all assaults and 40 to 50% of all murders involve alcohol. More than 43% of violent encounters with police involve alcohol. Alcohol is implicated in more than two-thirds of cases of intimate partner violence. In 2002, it was estimated that 1 million violent crimes in the United States were related to alcohol use. Alcohol is more commonly associated with both violent and non-violent crime than are drugs like marijuana.

Health consequences

Main articles: Alcohol and health and Alcoholism § Moderate drinking

Alcohol use disorder is a major problem and many health problems as well as death can result from excessive alcohol use. Alcohol dependence is linked to a lifespan that is reduced by about 12 years relative to the average person. In 2004, it was estimated that 4% of deaths worldwide were attributable to alcohol use. Deaths from alcohol are split about evenly between acute causes (e.g., overdose, accidents) and chronic conditions. The leading chronic alcohol-related condition associated with death is alcoholic liver disease. Alcohol dependence is also associated with cognitive impairment and organic brain damage. Some researchers have found that even one alcoholic drink a day increases an individual's risk of health problems by 0.4%.


Adverse effects

Short-term effects

Main articles: Short-term effects of alcohol consumption and Alcohol intoxication


Central nervous system impairment

Alcohol causes generalized central nervous system depression, is a positive allosteric GABAA modulator and is associated and related with cognitive, memory or memory loss, motor, and sensory impairment. It slows and impairs cognition and reaction time and the cognitive skills, impairs judgement, interferes with motor function resulting in motor incoordination, loss of balance, confusion, sedation, numbness and slurred speech, impairs memory formation, and causes sensory impairment. At high concentrations, it can induce amnesia, analgesia, spins, stupor, and unconsciousness as result of high levels of ethanol in blood.


At very high concentrations, alcohol can cause anterograde amnesia, markedly decreased heart rate, pulmonary aspiration, positional alcohol nystagmus (PAN), respiratory depression, shock, coma and death can result due to profound suppression of central nervous system function alcohol overdose and can finish in consequent dysautonomia.


Gastrointestinal effects


Alcohol can cause nausea and vomiting in sufficiently high amounts (varies by person).


Alcohol stimulates gastric juice production, even when food is not present, and as a result, its consumption stimulates acidic secretions normally intended to digest protein molecules. Consequently, the excess acidity may harm the inner lining of the stomach. The stomach lining is normally protected by a mucosal layer that prevents the stomach from, essentially, digesting itself. However, in patients who have a peptic ulcer disease (PUD), this mucosal layer is broken down. PUD is commonly associated with the bacteria H. pylori. H. pylori secrete a toxin that weakens the mucosal wall, which as a result lead to acid and protein enzymes penetrating the weakened barrier. Because alcohol stimulates a person's stomach to secrete acid, a person with PUD should avoid drinking alcohol on an empty stomach. Drinking alcohol causes more acid release, which further damages the already-weakened stomach wall. Complications of this disease could include a burning pain in the abdomen, bloating and in severe cases, the presence of dark black stools indicate internal bleeding. A person who drinks alcohol regularly is strongly advised to reduce their intake to prevent PUD aggravation.


Ingestion of alcohol can initiate systemic pro-inflammatory changes through two intestinal routes: (1) altering intestinal microbiota composition (dysbiosis), which increases lipopolysaccharide (LPS) release, and (2) degrading intestinal mucosal barrier integrity – thus allowing this (LPS) to enter the circulatory system. The major portion of the blood supply to the liver is provided by the portal vein. Therefore, while the liver is continuously fed nutrients from the intestine, it is also exposed to any bacteria and/or bacterial derivatives that breach the intestinal mucosal barrier. Consequently, LPS levels increase in the portal vein, liver and systemic circulation after alcohol intake. Immune cells in the liver respond to LPS with the production of reactive oxygen species (ROS), leukotrienes, chemokines and cytokines. These factors promote tissue inflammation and contribute to organ pathology.


Allergic-like reactions

Main articles: Alcohol-induced respiratory reactions and Alcohol flush reaction

Ethanol-containing beverages can cause alcohol flush reactions, exacerbations of rhinitis and, more seriously and commonly, bronchoconstriction in patients with a history of asthma, and in some cases, urticarial skin eruptions, and systemic dermatitis. Such reactions can occur within 1–60 minutes of ethanol ingestion, and may be caused by:


genetic abnormalities in the metabolism of ethanol, which can cause the ethanol metabolite, acetaldehyde, to accumulate in tissues and trigger the release of histamine, or

true allergy reactions to allergens occurring naturally in, or contaminating, alcoholic beverages (particularly wine and beer), and

other unknown causes.

Tobacco


 Tobacco

Tobacco is the common name of several plants in the genus Nicotiana of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the chief commercial crop is N. tabacum. The more potent variant N. rustica is also used in some countries.


Dried tobacco leaves are mainly used for smoking in cigarettes and cigars, as well as pipes and shishas. They can also be consumed as snuff, chewing tobacco, dipping tobacco and snus.


Tobacco contains the highly addictive stimulant alkaloid nicotine as well as harmala alkaloids. Tobacco use is a cause or risk factor for many deadly diseases, especially those affecting the heart, liver, and lungs, as well as many cancers. In 2008, the World Health Organization named tobacco use as the world's single greatest preventable cause of death.

History

Main article: History of tobacco

See also: History of commercial tobacco in the United States


William Michael Harnett (American, 1848–1892), Still Life with Three Castles Tobacco, 1880, Brooklyn Museum.

Traditional use


The earliest depiction of a European man smoking, from Tobacco by Anthony Chute, 1595.


An Indian man smoking tobacco on hookah, Rajasthan, India.

Tobacco has long been used in the Americas, with some cultivation sites in Mexico dating back to 1400–1000 BC. Many Native American tribes traditionally grow and use tobacco. Historically, people from the Northeast Woodlands cultures have carried tobacco in pouches as a readily accepted trade item. It was smoked both socially and ceremonially, such as to seal a peace treaty or trade agreement. In some Native cultures, tobacco is seen as a gift from the Creator, with the ceremonial tobacco smoke carrying one's thoughts and prayers to the Creator.


Popularization


An illustration from Frederick William Fairholt's Tobacco, its History and Association, 1859


Tobacco plant and tobacco leaf from the Deli plantations in Sumatra, 1905

Following the arrival of the Europeans to the Americas, tobacco became increasingly popular as a trade item. Hernández de Boncalo, Spanish chronicler of the Indies, was the first European to bring tobacco seeds to the Old World in 1559 following orders of King Philip II of Spain. These seeds were planted in the outskirts of Toledo, more specifically in an area known as "Los Cigarrales" named after the continuous plagues of cicadas (cigarras in Spanish). Before the development of the lighter Virginia and white burley strains of tobacco, the smoke was too harsh to be inhaled. Small quantities were smoked at a time, using a pipe like the midwakh or kiseru, or newly invented waterpipes such as the bong or the hookah (see thuốc lào for a modern continuance of this practice). Tobacco became so popular that the English colony of Jamestown used it as currency and began exporting it as a cash crop; tobacco is often credited as being the export that saved Virginia from ruin.

The alleged benefits of tobacco also contributed to its success. The astronomer Thomas Harriot, who accompanied Sir Richard Grenville on his 1585 expedition to Roanoke Island, thought that the plant "openeth all the pores and passages of the body" so that the bodies of the natives "are notably preserved in health, and know not many grievous diseases, wherewithal we in England are often times afflicted."


Production of tobacco for smoking, chewing, and snuffing became a major industry in Europe and its colonies by 1700.


Tobacco has been a major cash crop in Cuba and in other parts of the Caribbean since the 18th century. Cuban cigars are world-famous.


In the late 19th century, cigarettes became popular. James Bonsack invented a machine to automate cigarette production. This increase in production allowed tremendous growth in the tobacco industry until the health revelations of the late 20th century.


Contemporary

See also: Tobacco control and Tobacco in the United States

Following the scientific revelations of the mid-20th century, tobacco was condemned as a health hazard, and eventually became recognized as a cause of cancer, as well as other respiratory and circulatory diseases. In the United States, this led to the Tobacco Master Settlement Agreement, which settled the many lawsuits by the U.S. states in exchange for a combination of yearly payments to the states and voluntary restrictions on advertising and marketing of tobacco products.


In the 1970s, Brown & Williamson cross-bred a strain of tobacco to produce Y1, a strain containing an unusually high nicotine content, nearly doubling from 3.2 to 3.5%, to 6.5%. In the 1990s, this prompted the Food and Drug Administration to allege that tobacco companies were intentionally manipulating the nicotine content of cigarettes.


The desire of many addicted smokers to quit has led to the development of tobacco cessation products.


In 2003, in response to growth of tobacco use in developing countries, the World Health Organization successfully rallied 168 countries to sign the Framework Convention on Tobacco Control. The convention is designed to push for effective legislation and enforcement in all countries to reduce the harmful effects of tobacco. Between 2019 and 2021, concerns about increased COVID-19 health risks due to tobacco consumption facilitated smoking reduction and cessation.


Biology

Nicotiana

Main article: Nicotiana

See also: List of tobacco diseases


Nicotine is the compound responsible for the addictive nature of tobacco use.


Tobacco (Nicotiana rustica) flower, leaves, and buds

Many species of tobacco are in the genus of herbs Nicotiana. It is part of the nightshade family (Solanaceae) indigenous to North and South America, Australia, south west Africa, and the South Pacific.

Most nightshades contain varying amounts of nicotine, a powerful neurotoxin to insects. However, tobaccos tend to contain a much higher concentration of nicotine than the others. Unlike many other Solanaceae species, they do not contain tropane alkaloids, which are often poisonous to humans and other animals.


Despite containing enough nicotine and other compounds such as germacrene and anabasine and other piperidine alkaloids (varying between species) to deter most herbivores, a number of such animals have evolved the ability to feed on Nicotiana species without being harmed. Nonetheless, tobacco is unpalatable to many species due to its other attributes. For example, although the cabbage looper is a generalist pest, tobacco's gummosis and trichomes can harm early larvae survival. As a result, some tobacco plants (chiefly N. glauca) have become established as invasive weeds in some places.


Types

Main article: Types of tobacco

The types of tobacco include:


Aromatic fire-cured is cured by smoke from open fires. In the United States, it is grown in northern middle Tennessee, central Kentucky, and Virginia. Fire-cured tobacco grown in Kentucky and Tennessee is used in some chewing tobaccos, moist snuff, some cigarettes, and as a condiment in pipe tobacco blends. Another fire-cured tobacco is Latakia, which is produced from oriental varieties of N. tabacum. The leaves are cured and smoked over smoldering fires of local hardwoods and aromatic shrubs in Cyprus and Syria.

Brightleaf tobacco is commonly known as "Virginia tobacco", often regardless of the state where it is planted. Prior to the American Civil War, most tobacco grown in the US was fire-cured dark-leaf. Sometime after the War of 1812, demand for a milder, lighter, more aromatic tobacco arose. Ohio, Pennsylvania and Maryland all innovated with milder varieties of the tobacco plant. Farmers discovered that bright leaf tobacco needs thin, starved soil, and those who could not grow other crops found that they could grow tobacco. Confederate soldiers traded it with each other and Union soldiers, and developed quite a taste for it. At the end of the war, the soldiers went home and a national market had developed for the local crop.

Broadleaf, a dark tobacco varietal family popular for producing enormous, resilient, and thick wrapper leaves.

Burley tobacco is an air-cured tobacco used primarily for cigarette production. In the U.S., burley tobacco plants are started from pelletized seeds placed in polystyrene trays floated on a bed of fertilized water in March or April.

Cavendish is more a process of curing and a method of cutting tobacco than a type. The processing and the cut are used to bring out the natural sweet taste in the tobacco. Cavendish can be produced from any tobacco type, but is usually one of, or a blend of Kentucky, Virginia, and burley, and is most commonly used for pipe tobacco and cigars.

Criollo tobacco is primarily used in the making of cigars. It was, by most accounts, one of the original Cuban tobaccos that emerged around the time of Columbus.

Dokha is a tobacco originally grown in Iran, mixed with leaves, bark, and herbs for smoking in a midwakh.

Turkish tobacco is a sun-cured, highly aromatic, small-leafed variety (Nicotiana tabacum) grown in Turkey, Greece, Bulgaria, and North Macedonia. Originally grown in regions historically part of the Ottoman Empire, it is also known as "oriental". Many of the early brands of cigarettes were made mostly or entirely of Turkish tobacco; today, its main use is in blends of pipe and especially cigarette tobacco (a typical American cigarette is a blend of bright Virginia, burley, and Turkish).

Perique was developed in 1824 through the technique of pressure-fermentation of local tobacco by a farmer, Pierre Chenet. Considered the truffle of pipe tobaccos, it is used as a component in many blended pipe tobaccos, but is too strong to be smoked pure. At one time, the freshly moist Perique was also chewed, but none is now sold for this purpose. It is typically blended with pure Virginia to lend spice, strength, and coolness to the blend.

Shade tobacco is cultivated in Connecticut and Massachusetts. Early Connecticut colonists acquired from the Native Americans the habit of smoking tobacco in pipes, and began cultivating the plant commercially, though the Puritans referred to it as the "evil weed". The Connecticut shade industry has weathered some major catastrophes, including a devastating hailstorm in 1929, and an epidemic of brown spot fungus in 2000, but is now in danger of disappearing altogether, given the increase in the value of land.

White burley air-cured leaf was found to be more mild than other types of tobacco. In 1865, George Webb of Brown County, Ohio planted red burley seeds he had purchased, and found a few of the seedlings had a whitish, sickly look, which became white burley.

Wild tobacco is native to the southwestern United States, Mexico, and parts of South America. Its botanical name is Nicotiana rustica.

Parasites

Main article: List of tobacco diseases


Illustration with photographs of tobacco leaves infested by Lasioderma serricorne (tobacco beetles), from Runner, G. A., The tobacco beetle (1919), Bulletin of the U.S. Department of Agriculture, Biodiversity Heritage Library

Tobacco, alongside its related products, can be infested by parasites such as the Lasioderma serricorne (tobacco beetle) and the Ephestia elutella (tobacco moth), which are the most widespread and damaging parasites to the tobacco industry.[28] Infestation can range from the tobacco cultivated in the fields to the leaves used for manufacturing cigars, cigarillos, cigarettes, etc. Both the larvae of Lasioderma serricorne and caterpillars of Ephestia elutella are considered a pest.


Production


Cultivation

Main article: Cultivation of tobacco


Tobacco plants growing in a field in Intercourse, Pennsylvania.

Tobacco is cultivated similarly to other agricultural products. Seeds were at first quickly scattered onto the soil. However, young plants came under increasing attack from flea beetles (Epitrix cucumeris or E. pubescens), which caused destruction of half the tobacco crops in United States in 1876. By 1890, successful experiments were conducted that placed the plant in a frame covered by thin cotton fabric. Today, tobacco seeds are sown in cold frames or hotbeds, as their germination is activated by light. In the United States, tobacco is often fertilized with the mineral apatite, which partially starves the plant of nitrogen, to produce a more desired flavor.


After the plants are about 8 inches (20 cm) tall, they are transplanted into the fields. Farmers used to have to wait for rainy weather to plant. A hole is created in the tilled earth with a tobacco peg, either a curved wooden tool or deer antler. After making two holes to the right and left, the planter would move forward two feet, select plants from his/her bag, and repeat. Various mechanical tobacco planters like Bemis, New Idea Setter, and New Holland Transplanter were invented in the late 19th and 20th centuries to automate the process: making the hole, watering it, guiding the plant in — all in one motion.


Tobacco is cultivated annually, and can be harvested in several ways. In the oldest method, still used today, the entire plant is harvested at once by cutting off the stalk at the ground with a tobacco knife; it is then speared onto sticks, four to six plants a stick, and hung in a curing barn. In the 19th century, bright tobacco began to be harvested by pulling individual leaves off the stalk as they ripened. The leaves ripen from the ground upwards, so a field of tobacco harvested in this manner entails the serial harvest of a number of "primings", beginning with the volado leaves near the ground, working to the seco leaves in the middle of the plant, and finishing with the potent ligero leaves at the top. Before harvesting, the crop must be topped when the pink flowers develop. Topping always refers to the removal of the tobacco flower before the leaves are systematically harvested. As the industrial revolution took hold, the harvesting wagons which were used to transport leaves were equipped with man-powered stringers, an apparatus that used twine to attach leaves to a pole. In modern times, large fields are harvested mechanically, although topping the flower and in some cases the plucking of immature leaves is still done by hand.


In the U.S., North Carolina and Kentucky are the leaders in tobacco production, followed by Tennessee, Virginia, Georgia, South Carolina and Pennsylvania.


Curing

Main article: Curing of tobacco


Tobacco barn in Simsbury, Connecticut used for air curing of shade tobacco


Sun-cured tobacco, Bastam, Iran

Curing and subsequent aging allow for the slow oxidation and degradation of carotenoids in tobacco leaf. This produces certain compounds in the tobacco leaves and gives a sweet hay, tea, rose oil, or fruity aromatic flavor that contributes to the "smoothness" of the smoke. Starch is converted to sugar, which glycates protein, and is oxidized into advanced glycation endproducts (AGEs), a caramelization process that also adds flavor. Inhalation of these AGEs in tobacco smoke contributes to atherosclerosis and cancer.[32] Levels of AGEs are dependent on the curing method used.


Tobacco can be cured through several methods, including:


Air-cured tobacco is hung in well-ventilated barns and allowed to dry over a period of four to eight weeks. Air-cured tobacco is low in sugar, which gives the tobacco smoke a light, mild flavor, and high in nicotine. Cigar and burley tobaccos are 'dark' air-cured.[33]

Fire-cured tobacco is hung in large barns where fires of hardwoods are kept on continuous or intermittent low smoulder, and takes between three days and ten weeks, depending on the process and the tobacco. Fire curing produces a tobacco low in sugar and high in nicotine. Pipe tobacco, chewing tobacco, and snuff are fire-cured.

Flue-cured tobacco was originally strung onto tobacco sticks, which were hung from tier poles in curing barns (Aus: kilns, also traditionally called 'oasts'). These barns have flues run from externally fed fire boxes, heat-curing the tobacco without exposing it to smoke, slowly raising the temperature over the course of the curing. The process generally takes about a week. This method produces cigarette tobacco that is high in sugar and has medium to high levels of nicotine. Most cigarettes incorporate flue-cured tobacco, which produces a milder, more inhalable smoke. It is estimated that 1 tree is cut to flue-cure every 300 cigarettes, resulting in serious environmental consequences.

Sun-cured tobacco dries uncovered in the sun. This method is used in Turkey, Greece, and other Mediterranean countries to produce oriental tobacco. Sun-cured tobacco is low in sugar and nicotine and is used in cigarettes.

Some tobaccos go through a second stage of curing, known as fermenting or sweating. Cavendish undergoes fermentation pressed in a casing solution containing sugar and/or flavoring.


Global production


Tobacco production, 2018

Trends


Tobacco production in Portuguese Timor in the 1930s

Production of tobacco leaf increased by 40% between 1971, when 4.2 million tons of leaf were produced, and 1997, when 5.9 million tons of leaf were produced.[38] According to the Food and Agriculture organization of the UN, tobacco leaf production was expected to hit 7.1 million tons by 2010. This number is a bit lower than the record-high production of 1992, when 7.5 million tons of leaf were produced.[39] The production growth was almost entirely due to increased productivity by developing nations, where production increased by 128%.[40] During that same time, production in developed countries actually decreased.[39] China's increase in tobacco production was the single biggest factor in the increase in world production. China's share of the world market increased from 17% in 1971 to 47% in 1997.[38] This growth can be partially explained by the existence of a low import tariff on foreign tobacco entering China. While this tariff has been reduced from 66% in 1999 to 10% in 2004,[41] it still has led to local, Chinese cigarettes being preferred over foreign cigarettes because of their lower cost.


Major producers


Every year, about 6.7 million tons of tobacco are produced throughout the world. The top producers of tobacco are China (39.6%), India (8.3%), Brazil (7.0%) and the United States (4.6%).


China

Around the peak of global tobacco production, 20 million rural Chinese households were producing tobacco on 2.1 million hectares of land. While it is the major crop for millions of Chinese farmers, growing tobacco is not as profitable as cotton or sugarcane, because the Chinese government sets the market price. While this price is guaranteed, it is lower than the natural market price, because of the lack of market risk. To further control tobacco in their borders, China founded a State Tobacco Monopoly Administration (STMA) in 1982. The STMA controls tobacco production, marketing, imports, and exports, and contributes 12% to the nation's national income. As noted above, despite the income generated for the state by profits from state-owned tobacco companies and the taxes paid by companies and retailers, China's government has acted to reduce tobacco use.

India

India's Tobacco Board is headquartered in Guntur in the state of Andhra Pradesh. India has 96,865 registered tobacco farmers and many more who are not registered. In 2010, 3,120 tobacco product manufacturing facilities were operating in all of India. Around 0.25% of India's cultivated land is used for tobacco production.


Since 1947, the Indian government has supported growth in the tobacco industry. India has seven tobacco research centers, located in Tamil Nadu, Andhra Pradesh, Punjab, Bihar, Mysore, and West Bengal houses the core research institute.


Brazil

In Brazil, around 135,000 family farmers cite tobacco production as their main economic activity. Tobacco has never exceeded 0.7% of the country's total cultivated area. In the southern regions of Brazil, Virginia, and Amarelinho, flue-cured tobacco, as well as burley and Galpão Comum air-cured tobacco, are produced. These types of tobacco are used for cigarettes. In the northeast, darker, air- and sun-cured tobacco is grown. These types of tobacco are used for cigars, twists, and dark cigarettes.[51] Brazil's government has made attempts to reduce the production of tobacco but has not had a successful systematic antitobacco farming initiative. Brazil's government, however, provides small loans for family farms, including those that grow tobacco, through the Programa Nacional de Fortalecimento da Agricultura Familiar.


Problems in production

Child labor

Main article: Child labor

The International Labour Office reported that the most child-laborers work in agriculture, which is one of the most hazardous types of work. The tobacco industry houses some of these working children. Use of children is widespread on farms in Brazil, China, India, Indonesia, Malawi, and Zimbabwe. While some of these children work with their families on small, family-owned farms, others work on large plantations. In late 2009, reports were released by the London-based human-rights group Plan International, claiming that child labor was common on Malawi (producer of 1.8% of the world's tobacco) tobacco farms. The organization interviewed 44 teens, who worked full-time on farms during the 2007-8 growing season. The child-laborers complained of low pay and long hours, as well as physical and sexual abuse by their supervisors. They also reported suffering from green tobacco sickness, a form of nicotine poisoning. When wet leaves are handled, nicotine from the leaves gets absorbed in the skin and causes nausea, vomiting, and dizziness. Children were exposed to levels of nicotine equivalent to smoking 50 cigarettes, just through direct contact with tobacco leaves. This level of nicotine in children can permanently alter brain structure and function.


Economy


Major tobacco companies have encouraged global tobacco production. Philip Morris, British American Tobacco, and Japan Tobacco each own or lease tobacco-manufacturing facilities in at least 50 countries and buy crude tobacco leaf from at least 12 more countries. This encouragement, along with government subsidies, has led to a glut in the tobacco market. This surplus has resulted in lower prices, which are devastating to small-scale tobacco farmers. According to the World Bank, between 1985 and 2000, the inflation-adjusted price of tobacco dropped 37%. Tobacco is the most widely smuggled legal product.


Environment

Tobacco production requires the use of large amounts of pesticides. Tobacco companies recommend up to 16 separate applications of pesticides just in the period between planting the seeds in greenhouses and transplanting the young plants to the field. Pesticide use has been worsened by the desire to produce larger crops in less time because of the decreasing market value of tobacco. Pesticides often harm tobacco farmers because they are unaware of the health effects and the proper safety protocol for working with pesticides. These pesticides, as well as fertilizers, end up in the soil, waterways, and the food chain. Coupled with child labor, pesticides pose an even greater threat. Early exposure to pesticides may increase a child's lifelong cancer risk, as well as harm his or her nervous and immune systems.


As with all crops, tobacco crops extract nutrients (such as phosphorus, nitrogen, and potassium) from soil, decreasing its fertility.


Furthermore, the wood used to cure tobacco in some places leads to deforestation. While some big tobacco producers such as China and the United States have access to petroleum, coal, and natural gas, which can be used as alternatives to wood, most developing countries still rely on wood in the curing process. Brazil alone uses the wood of 60 million trees per year for curing, packaging, and rolling cigarettes.


In 2017 WHO released a study on the environmental effects of tobacco.[63]


Research

Several tobacco plants have been used as model organisms in genetics. Tobacco BY-2 cells, derived from N. tabacum cultivar 'Bright Yellow-2', are among the most important research tools in plant cytology. Tobacco has played a pioneering role in callus culture research and the elucidation of the mechanism by which kinetin works, laying the groundwork for modern agricultural biotechnology. The first genetically modified plant was produced in 1982, using Agrobacterium tumefaciens to create an antibiotic-resistant tobacco plant. This research laid the groundwork for all genetically modified crops.


Genetic modification

Because of its importance as a research tool, transgenic tobacco was the first genetically modified (GM) crop to be tested in field trials, in the United States and France in 1986; China became the first country in the world to approve commercial planting of a GM crop in 1993, which was tobacco.


Field trials

Many varieties of transgenic tobacco have been intensively tested in field trials. Agronomic traits such as resistance to pathogens (viruses, particularly to the tobacco mosaic virus (TMV); fungi; bacteria and nematodes); weed management via herbicide tolerance; resistance against insect pests; resistance to drought and cold; and production of useful products such as pharmaceuticals; and use of GM plants for bioremediation, have all been tested in over 400 field trials using tobacco.


Production

Currently, only the US is producing GM tobacco. The Chinese virus-resistant tobacco was withdrawn from the market in China in 1997  From 2002 to 2010, cigarettes made with GM tobacco with reduced nicotine content were available in the US under the market name Quest.


Consumption

Further information: Tobacco products


Tobacco is consumed in many forms and through a number of different methods. Some examples are:


Beedi (also known as bidis or biris) are thin, often flavoured cigarettes from India made of tobacco wrapped in a tendu leaf, and secured with coloured thread at one end.

Chewing tobacco is the oldest way of consuming tobacco leaves. It is consumed orally, in two forms: through sweetened strands ("chew" or "chaw"), or in a shredded form ("dip"). When consuming the long, sweetened strands, the tobacco is lightly chewed and compacted into a ball. When consuming the shredded tobacco, small amounts are placed at the bottom lip, between the gum and the teeth, where it is gently compacted, thus it can often be called dipping tobacco. Both methods stimulate the salivary glands, which led to the development of the spittoon.

Cigars are tightly rolled bundles of dried and fermented tobacco, which are ignited so their smoke may be drawn into the smokers' mouths.

Cigarettes are a product consumed through inhalation of smoke and manufactured from cured and finely cut tobacco leaves and reconstituted tobacco, often combined with other additives, then rolled into a paper cylinder.

Creamy snuff is tobacco paste, consisting of tobacco, clove oil, glycerin, spearmint, menthol, and camphor, and sold in a toothpaste tube. It is marketed mainly to women in India, and is known by the brand names Ipco (made by Asha Industries), Denobac, Tona, and Ganesh. It is locally known as mishri in some parts of Maharashtra.

Dipping tobaccos are a form of smokeless tobacco. Dip is occasionally referred to as "chew", and because of this, it is commonly confused with chewing tobacco, which encompasses a wider range of products. A small clump of dip is 'pinched' out of the tin and placed between the lower or upper lip and gums. Some brands, as with snus, are portioned in small, porous pouches for less mess.

Gutka is a preparation of crushed betel nut, tobacco, and sweet or savory flavorings. It is manufactured in India and exported to a few other countries. A mild stimulant, it is sold across India in small, individual-sized packets.

Heat-not-burn products heat rather than burn tobacco to generate an aerosol that contains nicotine.

Dokha is a middle eastern tobacco with high nicotine levels grown in parts of Oman and Hatta, which is smoked through a thin pipe called a medwakh. It is a form of tobacco which is dried up and ground and contains little to no additives excluding spices, fruits, or flowers to enhance smell and flavor.

Hookah is a single- or multistemmed (often glass-based) water pipe for smoking. Hookahs were first used in India and Persia; the hookah has gained immense popularity, especially in the Middle East. A hookah operates by water filtration and indirect heat. It can be used for smoking herbal fruits or moassel, a mixture of tobacco, flavouring, and honey or glycerin.

Kreteks are cigarettes made with a complex blend of tobacco, cloves, and a flavoring "sauce". They were first introduced in the 1880s in Kudus, Java, to deliver the medicinal eugenol of cloves to the lungs.

Roll-your-own, often called 'rollies' or 'roll-ups', are relatively popular in some European countries. These are prepared from loose tobacco, cigarette papers, and filters all bought separately. They are usually cheaper to make.

Snuff is a ground smokeless tobacco product, inhaled or "snuffed" through the nose. If referring specifically to the orally consumed moist snuff, see dipping tobacco.

Snus is a steam-pasteurized moist powdered tobacco product that is not fermented, and induces minimal salivation. It is consumed by placing it (loose or in little pouches) against the upper gums for an extended period of time. It is somewhat similar to dipping tobacco but does not require spitting and is significantly lower in TSNAs.

Tobacco edibles, often in the form of an infusion or a spice, have gained popularity in recent years.

Tobacco pipes typically consist of a small chamber (the bowl) for the combustion of the tobacco to be smoked and a thin stem (shank) that ends in a mouthpiece (the bit). Shredded pieces of tobacco are placed in the chamber and ignited.

Tobacco smoke enemas were employed by the indigenous peoples of North America to stimulate respiration, injecting the smoke with a rectal tube. Later, in the 18th century, Europeans emulated the Americans. Tobacco resuscitation kits consisting of a pair of bellows and a tube were provided by the Royal Humane Society of London and placed at various points along the Thames.

Tobacco water is a traditional organic insecticide used in domestic gardening. Tobacco dust can be used similarly. It is produced by boiling strong tobacco in water, or by steeping the tobacco in water for a longer period. When cooled, the mixture can be applied as a spray, or 'painted' on to the leaves of garden plants, where it kills insects. Tobacco is, however, banned from use as pesticide in certified organic production by the USDA's National Organic Program.

Topical tobacco paste is sometimes used as a treatment for wasp, hornet, fire ant, scorpion, and bee stings. An amount equivalent to the contents of a cigarette is mashed in a cup with about a half a teaspoon of water to make a paste that is then applied to the affected area.

Impact

Social

Smoking in public was, for a long time, reserved for men, and when done by women was sometimes associated with promiscuity; in Japan, during the Edo period, prostitutes and their clients often approached one another under the guise of offering a smoke. The same was true in 19th-century Europe.


Following the American Civil War, the use of tobacco, primarily in cigars, became associated with masculinity and power. Today, tobacco use is often stigmatized; this has spawned quitting associations and antismoking campaigns. Bhutan is the only country in the world where tobacco sales are illegal. Due to its propensity for causing detumescence and erectile dysfunction, some studies have described tobacco as an anaphrodisiacal substance.


Religion

Christianity

In Christian denominations of the conservative holiness movement, such as the Allegheny Wesleyan Methodist Connection and Evangelical Wesleyan Church, the use of tobacco and other drugs is prohibited; : 37  ¶42 of the 2014 Book of Discipline of the Allegheny Wesleyan Methodist Connection states:


In the judgment of The Allegheny Wesleyan Methodist Connection (Original Allegheny Conference), the use of tobacco is a great evil, unbecoming a Christian, a waste of the Lord’s money, and a defilement of the body, which should be the temple of the Holy Ghost. We do, therefore, most earnestly require our members to refrain from its cultivation, manufacture, and sale, and to abstain from its use in all forms, for Jesus’ sake. We will not receive as members into our churches nor will we ordain or license to preach or to exhort, persons who use, cultivate, manufacture, or sell tobacco. Using tobacco by a member of a church or of the Conference after being received from this date (June 28, 1927) is a violation of the law of the church, and the offending party should be dealt with according to the judiciary rules.


Members of The Church of Jesus Christ of Latter-day Saints (popularly known as Mormons) adhere to the Word of Wisdom, a religious health code that is interpreted as prohibiting the consumption of tobacco as well as alcohol, coffee, and tea.

Islam

Main article: Tobacco fatwa

Sikhism

Further information: Prohibitions in Sikhism

Sikhism, a monotheistic religion from India, considers tobacco consumption as a taboo and very bad for health and spirituality. Initiated Sikhs are never to consume tobacco in any form.


Demographic

Main article: Prevalence of tobacco consumption

Research on tobacco use is limited mainly to smoking, which has been studied more extensively than any other form of consumption. An estimated 1.1 billion people, and up to one-third of the adult population, use tobacco in some form. Smoking is more prevalent among men (however, the gender gap declines with age), the poor, and in transitional or developing countries. A study published in Morbidity and Mortality Weekly Report found that in 2019 approximately one in four youths (23.0%) in the U.S. had used a tobacco product during the past 30 days. This represented approximately three in 10 high school students (31.2%) and approximately one in eight middle school students (12.5%).


Rates of smoking continue to rise in developing countries, but have leveled off or declined in developed countries. Smoking rates in the United States have dropped by half from 1965 to 2006, falling from 42% to 20.8% in adults. In the developing world, tobacco consumption is rising by 3.4% per year.


Health effects

Main article: Health effects of tobacco

Main article: List of cigarette smoke carcinogens

Main article: Tobacco packaging warning messages

Main article: List of additives in cigarettes

Chemicals

Tobacco smoking harms health because of the toxic chemicals in tobacco smoke, including carbon monoxide, cyanide, and carcinogens, which have been proven to cause heart and lung diseases and cancer. Thousands of different substances in cigarette smoke, including polycyclic aromatic hydrocarbons (such as benzopyrene), formaldehyde, cadmium, nickel, arsenic, tobacco-specific nitrosamines, and phenols contribute to the harmful effects of smoking.


According to the World Health Organization, tobacco is the single greatest cause of preventable death globally.[99] 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 describe tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide." Due to these health consequences, it is estimated that a 10 hectare (approximately 24.7 acre) field of tobacco used for cigarettes causes 30 deaths per year – 10 from lung cancer and 20 from cigarette-induced diseases like cardiac arrest, gangrene, bladder cancer, mouth cancer, etc.


The harms caused by inhaling tobacco smoke include diseases of the heart and lungs, with smoking being a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (emphysema), and cancer (particularly cancers of the lungs, larynx, mouth, and pancreas). Cancer is caused by inhaling carcinogenic substances in tobacco smoke.


Inhaling secondhand tobacco smoke (which has been exhaled by a smoker) can cause lung cancer in nonsmoking adults. In the United States, about 3,000 adults die each year due to lung cancer from secondhand smoke exposure. Heart disease caused by secondhand smoke kills around 46,000 nonsmokers every year.


In children, exposure to secondhand tobacco smoke is associated with a higher incidence and severity of respiratory illnesses, middle ear disease, and asthma attacks. Each year in the United States, secondhand smoke exposure causes 24,500 infants to be born with low birthweight, 71,900 preterm births, 202,300 episodes of asthma, and 790,00 health care visits for ear infections.


The addictive alkaloid nicotine is a stimulant, and popularly known as the most characteristic constituent of tobacco. In drug effect preference questionnaires, a rough indicator of addictive potential, nicotine scores almost as highly as opioids. Users typically develop tolerance and dependence. Nicotine is known to produce conditioned place preference, a sign of psychological enforcement value. In one medical study, tobacco's overall harm to user and self was determined at 3 percent below cocaine, and 13 percent above amphetamines, ranking 6th most harmful of the 20 drugs assessed.

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