A patient spoke to me about her efforts in tobacco cessation. She had recently stopped smoking for the second time in her life, but not without much exertion. As she detailed her battle, she mentioned her second round with cigarettes was much more difficult to end than her first.
As I probed her for more information, she stated that when she quit the first time, her withdrawals were much less prominent, and the ability to stop smoking came much sooner. After starting her habit all over again sometime later after her divorce, she decided after her divorce she 1) couldn’t afford cigarettes any longer and 2) wanted to rid the habit from her life once and for all.
She succeeded in her efforts thanks to her dedication but found the battle much more grueling to conquer. After vaguely recollecting something I heard on the news about cigarettes, I decided to dig a little deeper to see if, indeed, cigarettes are more addictive than they once were.
A Brief History of Tobacco
The tobacco plant was first used and cultivated by the pre-Columbia Americans. Native Americans smoked it for medicinal and ceremonial purposes. The first successful commercial crop was cultivated by John Wolfe in Virginia in 1912.1 This cash crop fueled the demand for slave labor in North America for over two centuries.
During World War II, cigarettes were given to soldiers as a way to escape from boredom during downtime psychologically and to alleviate war stress.2 Smoking in women also increased drastically during and after World War II.3 In 1964, the Surgeon General produced a report tying cigarettes to lung cancer for the very first time, which led to warning labels on cigarettes and cautionary advertisements by the end of 1965.4
In 1970, Richard Nixon signed the Public Health Cigarette Smoking Act, which banned cigarette commercials. Public smoking bans began in the late 1990s and early 2000s and included most workplaces and all public places in an effort to decrease the amount of second-hand smoke.4
Astonishingly, as of 2021, it is estimated that 28.3 million adults in the United States smoke cigarettes.5
Cigarettes Then and Now
Are cigarettes different than they were decades ago? Are they more addictive? It’s no secret that manufacturers will develop and evolve their practices in order to compete and sustain in the ever-bloodthirsty market. It would only make complete sense for these companies to up their ante to stay ahead. While the repercussions are detrimental, it has nonetheless ceased their efforts.
One would think that since the link to lung cancer was made five decades ago, cigarettes would reform to become less harmful. However, in recent years, as a result of legislative changes, U.S. companies have been forced to publish secret documents of the studies on smoking carried out over the years and to disclose the ingredients that are added to cigarettes.6 The results were staggering.
The Results
It’s no secret the main ingredient in a cigarette is tobacco, which contains a relatively high amount of the addictive chemical nicotine. Nicotine alone is toxic and can be lethal. The most recent surgeon general’s report concluded that nicotine activates biological pathways that increase the risk for disease, adversely affects maternal and fetal health during pregnancy, and can have lasting adverse consequences for brain development in fetuses and adolescents.7 Tobacco companies have been discovered to genetically engineer their crops to contain two times the amount of nicotine.8
Sugar is also found in cigarettes. While companies argued it was to enhance the flavor, some compelling information exists as to why sugar combined with tobacco creates a much more diverse effect than flavor enhancement. Heated and burnt sugars emit a substance called acetaldehyde. When combined with nicotine, the sum is greater than their efforts alone. In controlled studies performed in rats, the combination of acetaldehyde and nicotine created a much stronger addiction than with nicotine alone.6
Licorice extract is found in cigarettes, which also helps enhance the taste. However, one of this plant’s main components is glycyrrhizin, a bronchodilator. Coincidence? I think not. Still not convinced? Licorice accounts for one to four percent of a cigarette’s weight, and the cigarette industry uses 90% of the world’s licorice.6
Di-ammonium phosphate and ammonium hydroxide are two acids that are also found on the ingredient list of cigarettes. These two chemicals release ammonia gas, which helps with nicotine uptake. Nicotine serves as a base, and bases react with acids to form a salt. When nicotine is in its salt form, absorption is much more difficult. The ammonia replaces nicotine in the salt compound, allowing it to be absorbed and act more quickly. The faster a drug affects the brain, the stronger the dependence; therefore, adding ammonia to tobacco changes the nicotine to “crack” nicotine.6
While cocoa seems innocent enough, it does contain a substance called theobromine that helps to relax the bronchi and suppress coughing. Theobromine is found to be stronger than codeine, commonly used in cough syrups.6 By suppressing the cough, smokers feel healthier and hold the smoke inhiation longer without irritation, thus increasing its absorption and, ultimately, addiction.
Cigarettes also list natural and artificial flavors as an ingredient. Because these ingredients comprise less than 0.1% of the cigarette, these individual components are classified collectively under this label. A published book based on the hundreds of documents forcibly published by U.S. tobacco companies revealed that one of the ingredients listed in this category is levulinic acid.. This chemical increases the binding of nicotine to receptors in the brain.6
But they didn’t stop there. Cigarette manufacturers also engineered new filters with ventilation holes. These holes cause smokers to inhale more frequently and vigorously.9 Cigarette companies misleadingly marketed these filters as less hazardous.
The new modern cigarette was carefully and scientifically researched for years. As a matter of fact, in 1975, a photo was released of their testing efforts on beagles. Studies prove their effectiveness by showing that 10-25% of smokers will develop symptoms of addiction just after one cigarette.6
Conclusion
While the United States has reduced smoking enormously since the 1950s, it is still the leading cause of preventable death. Since the first Surgeon General’s report in 1964, more than 20 million Americans have died because of smoking, of which 2.5 million have been among nonsmokers who have suffered second-hand smoke-related diseases.7
The estimated economic costs attributable to smoking and exposure to tobacco smoke continue to increase and now approach $300 billion annually, and productivity losses of more than $150 billion a year.7
The ultimate question is, are cigarettes more addicting and more harmful than 50 years ago? Reports found that smokers today are more likely to develop lung cancer than those who smoked 50 years ago, as 70 chemicals in cigarette smoke are known carcinogens.7 Women’s risk increased 10-fold while men’s risk doubled. I think it’s safe to say the proof is in the pudding.
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References
- A Brief History of Tobacco. (n.d.). CNN. http://edition.cnn.com/US/9705/tobacco/history/
- Tobacco Industry and the Connection to the Military. (2011, November 11). Tobacco Prevention for K-12 Educators. https://tobaccopreventionk12.wordpress.com/2011/11/11/tobacco-industry-and-the-connection-to-the-military/
- Women and Smoking: A Report of the Surgeon General. (2001). Centers for Disease Control and Prevention. https://www.ncbi.nlm.nih.gov/books/NBK44306/
- Institute of Medicine Committee on Secondhand Smoke Exposure and Acute Coronary Events. (2010). Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK219563/
- Current Cigarette Smoking Among Adults in the United States. (2023, May 4). Centers for Disease Control and Prevention. www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm
- Saig, A. (2016, November 24). Why Are Cigarettes More Addictive Nowadays? Weizmann Institute of Science. https://davidson.weizmann.ac.il/en/online/maagarmada/why-are-cigarettes-more-addictive-nowadays%e2%80%8e
- Health Consequences of Smoking, Surgeon General Fact Sheet. (2014, January 16). U.S. Department of Health and Human Services. https://www.surgeongeneral.gov/library/reports/50-years-of-progress/fact-sheet.html
- How Big Tobacco Made Cigarettes More Addictive. (2018, January 23). Truth Initiative. https://truthinitiative.org/news/how-big-tobacco-made-cigarettes-more-addictive
- Burns, D., Donny, E., Hatsukami, D., et al. (2014, June 23). Designed For Addiction – How the Tobacco Industry Has Made Cigarettes More Addictive, More Attractive, to Kids and Even More Deadly. Tobacco Free Kids. https://www.tobaccofreekids.org/assets/content/what_we_do/industry_watch/product_manipulation/2014_06_19_DesignedforAddiction_web.pdf
