‘How a simple cigarette made big strides towards equality and unfortunately pathology’

The history of tobacco
Nicotiana tabacum and Nicotiana rustica, known contemporarily as simply tobacco, are plants indigenous to the Americas evolved in the Andes or Equador and Peru.  The cultivation and use of tobacco is documented since 5000-3000 before Christ (BC) (Gately, 2002; MUSK & DE KLERK, 2003). The modern use of tobacco has been mostly limited to smoking. However, historically tobacco was also chewed, eaten, drunken as tea, used as ointment for bugs and parasites, and eye drops and enemas (Gately, 2002; MUSK & DE KLERK, 2003). Modern smoking began with the arrival of Columbus and his crew in Cuba in 1492. Surprisingly, smoking was considered evil and harmful by Europeans and there are reports that the first public European smoker was imprisoned for years by the inquisition.

The medical prowess of tobacco prevailed over the church and cultivation by royalty began. This marked the start of the ‘royal endorsement’ and association between tobacco and the upper class. The British took up tobacco and most notably in the English court of Elizabeth the first, which stimulated the affluent British society, and anyone who could afford tobacco partook in expensive indulgence (MUSK & DE KLERK, 2003). Tobacco became a worldwide product due to European colonization that took place in the centuries that followed. Modern cigarettes appeared in the latter part of the 1800’s. The popularity of modern cigarettes bloomed during the First World War as it served as the perfect nicotine delivery system (Gately, 2002; MUSK & DE KLERK, 2003). Since this time, the amount of people smoking has steadily increased. The first record of smoking being detrimental to health appeared in 1602 by an anonymous author that compared illnesses often seen in chimney sweeps to illnesses seen in tobacco smokers. In 1795 and 1798 accounts rose of more cancers of the lip in pipe smokers and the medical dangers of tobacco, respectively. The first medical report linking smoking and lung cancer appeared in 1920. However, the newspaper editors did not report them due to fear of the tobacco industry. In the 1950’s and 1960’s a series of medical reports confirmed that tobacco causes many diseases with high mortality rates. Smoking is now known to cause close to 6 million deaths yearly and to be a major risk factor for 6 of the 8 leading causes of death (Organization, 2008). This brings us to the following questions. How many people currently smoke, what are the differences between men and women in regards to smoking, what are the negatives, and maybe unexpected benefits?

Afbeelding met tekst, teken, buiten, rood

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Sex, Gender and The Tobacco Industry
Tobacco smoking was a men’s ‘sport’ and was exclusively for men. This was evident due to records stating that ‘ladies do not smoke’ and the idea of a woman simply experimenting with cigarettes was unacknowledged (Amos & Haglund, 2000). The earliest depictions of women who used tobacco products were of whores and ‘worldly women’ (Harley, 1998). In the 19th century tobacco smoking was still recognized as an activity almost exclusively for prostitutes or “fallen women” (Greaves, 1996). There was no condonation for a woman smoking. A woman was reportedly arrested in 1908 for smoking in public in New York in the United States (US). The idea of a woman smoking in public was so repugnant that it caused legislation to be proposed and passed by the US congress which banned women from doing so in the District of Columbia (Waldron, 1991). This was also reflected in the advertisements launched by the tobacco industry. Advertisements targeted men, women were used as props to imply that cigarettes made a man more attractive to the opposite sex. What changed this paradigm was the First World War. During this time women replaced men in not only certain occupations but also started to wear male clothing, wear shorter hair and started smoking! The First World War was the start of the female emancipation; the rise of the independent woman and the downfall of women’s health took place side by side (Amos & Haglund, 2000). The tobacco industry saw the emancipation of women as an opportunity to dive into a new market, women were referred to as a possible ‘gold mine’ (Brandt, 1996). Thus began the targeted marketing by the tobacco industry towards women. There were advertisements that focused on the weight loss effects of tobacco smoking as it was known that cigarettes were able to satiate the feeling of hunger. Public relations focused on abolishing the taboo by paying women to march in a parade and smoke cigarettes, the cigarettes symbolize freedom and the result was a national debate in the U.S.A. This debate spurred different criticisms that were swiftly dealt with by the tobacco industry. One such criticism was that women did not know what to do with cigarettes and did not know how to properly smoke a cigarette. The tobacco industry dealt with this by placing women with cigarettes in their hand on advertisements, but this does not fully embrace the scope of what the tobacco industry was doing to promote women smoking. The tobacco industry paid for a lecturer to go around the US to give women lessons on how to smoke a cigarette (Amos & Haglund, 2000; Brandt, 1996; Greaves, 1996). The tobacco industry developed a dual focus, maintaining their concentration on men while sharpening their focus on women. Smoking became the way to have an attractive waistline, a way to announce that you are a true independent woman and even a way to attract men. Similar to what smoking did for men now did for women as well (Brandt, 1996). The number of women smoking rose by exorbitant amounts. It was estimated that the rate of women smokers would pass that of men as there was a significant increase in comparison to men in Europe (Organization, 1997). All the while the tobacco industry exerted enormous pressure to silence any possible information that could lead to people believing that smoking was bad for health. To combat this, the World Health Organization (WHO) finally stepped in.

Health, gender and tobacco
The efforts of the World Health Organization’s (WHO) resulted in the Framework Convention on Tobacco Control (FCTC), an agreement between over 150 countries to implement measures to control the consumption of tobacco (FCTC & Organization, 2003). Tobacco smoking is now known as the leading cause of lung cancer in both men and women (Lindsey A. Torre et al., 2015). What is most notable is that the rates of lung cancer correlate with the rise of tobacco smoking. In countries such as the US, the United Kingdom and Denmark the incidence of lung cancer is decreasing in men and seems to have reached its peak in women, this is in line with the fact that these were the first countries to experience the peak in tobacco smoking. Subsequently it is noticeable that now in countries such as Spain and Hungary where the tobacco smoking peak occurred, there is now a decrease in lung cancer rates in men and an increase in lung cancer rates for women (Bosetti et al., 2012; Malvezzi et al., 2013; Lindsey A Torre, Siegel, Ward, & Jemal, 2014). Most impactful of all was the report by Bosetti et al., that showed that between the 1960’s and 2000’s there was a 50% increase in female lung cancer rates (Bosetti et al., 2012). When taking into account the pathogenesis of smoking-related lung cancer and the smoking behavior of women, it started to gain traction and popularity (Kumar, Abbas, Fausto, & Aster, 2014; Sekido, Fong, & Minna, 1998). It is not strange to conclude that the First World War which started the emancipation of women also innitiated the many consequences to the health of women.  

The conclusion and the other side of the cigarette bud
Tobacco smoking was initially meant and marketed towards men and afterwards women. The past had every element which propagated the idea that smoking was meant for the powerful. Tobacco was cultivated in royal gardens, used by royalty and the rich while ignorance of science and medicine could not hope to bring to light the negative effects of smoking in the long term, to add insult to injury, people were dying at such young ages that the negative effects of smoking were rarely even seen or experienced. The most notable of the many ironies related to tobacco is that it claimed to possibly cure and prevent cancer (MUSK & DE KLERK, 2003). However, there were glimmers of hope, and this may be the only account in which this author may agree with the Catholic Church’s practices, the condemning of smoking as a vile act and the imprisonment of people who smoke in public by the inquisition. The well-known account of King James the first towards the smoking of tobacco ‘a custom that is unsightly, hateful to the nose, harmful to the brain and dangerous to the lungs’ (Gately, 2002). The current research and proof that smoking causes lung cancer in both men and women, that the rise in lung cancer rates in each country and sex may be pinpointed to the time in which tobacco smoking rose in popularity are irrefutable facts. However, this author stipulates that this was a barrier that existed between men and women that was brought down, albeit for purely capitalistic reasons and the effects of which are detrimental to human health and survival. It is still a step forward in narrowing the gap of sex-specific research and sex-specific medical knowledge and health care. Currently research on lung cancer or smoking always includes both men and women. The results have only helped to show that there are fundamental differences between the sexes. This fuels the need for more research that includes women. It is not common practice of any individual to commend the tobacco industry on anything. However, one must admit that tobacco usage and the negative effects spurred research regarding both men and women. This helped narrow the gap on research. It is now unacceptable to conduct research that does not include women. To this we have the powerful women who fought for their rights during the women’s suffrage, the feminists who fought for their rights during women’s marches, women who challenged norms and entered the field of science, however simultaneously, the tobacco industry that fought for the equal right of women to smoke tobacco wherever they pleased. 

Final remarks
Research resembles searching for a black cat in a dark room, one may stumble and fumble about and finally be able to find a light switch, and when standing in a lit room notice that there is no cat but a door which leads to another dark room in search still for the ever elusive black cat (Firestein, 2012). It is clear that we have gained new insights about our previous ignorance and now delve into research equal to both men and women in regard to smoking. It is the hope of this author that this lesson and ‘dark room’ must only be experienced but once. That research in both sexes for all diseases and ailments is done equally in both quality and quantity without the need for drastic increases in mortality rates to spur interest in the opposite sex. 

References

Amos, A., & Haglund, M. (2000). From social taboo to “torch of freedom”: the marketing of cigarettes to women. Tobacco Control, 9(1), 3. Retrieved from http://tobaccocontrol.bmj.com/content/9/1/3.abstract. doi:10.1136/tc.9.1.3

Bosetti, C., Malvezzi, M., Rosso, T., Bertuccio, P., Gallus, S., Chatenoud, L., . . . La Vecchia, C. (2012). Lung cancer mortality in European women: trends and predictions. Lung Cancer, 78(3), 171-178. 

Brandt, A. M. (1996). Recruiting women smokers: the engineering of consent. 

FCTC, W., & Organization, W. H. (2003). WHO Framework Convention on Tobacco Control. Geneva: WHO Document Production Services, Geneva, Switzerland

Firestein, S. (2012). Ignorance: How it drives science: OUP USA.

Gately, I. (2002). La diva nicotina: the story of how tobacco seduced the world: Scribner.

Greaves, L. (1996). Smoke screen: women’s smoking and social control: Scarlet Pr.

Harley, D. (1998). The moral symbolism of tobacco in Dutch genre painting. Clio medica, 46, 78-86. 

Kumar, V., Abbas, A. K., Fausto, N., & Aster, J. C. (2014). Robbins and Cotran pathologic basis of disease, professional edition e-book: Elsevier health sciences.

Malvezzi, M., Bosetti, C., Rosso, T., Bertuccio, P., Chatenoud, L., Levi, F., . . . La Vecchia, C. (2013). Lung cancer mortality in European men: trends and predictions. Lung Cancer, 80(2), 138-145. 

MUSK, A. W., & DE KLERK, N. H. (2003). History of tobacco and health. Respirology, 8(3), 286-290. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1440-1843.2003.00483.x. doi:10.1046/j.1440-1843.2003.00483.x

Organization, W. H. (1997). Tobacco or health: a global status report. 

Organization, W. H. (2008). MPOWER: a policy package to reverse the tobacco epidemic. 

Sekido, Y., Fong, K. M., & Minna, J. D. (1998). Progress in understanding the molecular pathogenesis of human lung cancer. Biochimica et Biophysica Acta (BBA)-Reviews on Cancer, 1378(1), F21-F59. 

Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet-Tieulent, J., & Jemal, A. (2015). Global cancer statistics, 2012. CA: A Cancer Journal for Clinicians, 65(2), 87-108. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.3322/caac.21262. doi:10.3322/caac.21262

Torre, L. A., Siegel, R. L., Ward, E. M., & Jemal, A. (2014). International variation in lung cancer mortality rates and trends among women. Cancer Epidemiology and Prevention Biomarkers, 23(6), 1025-1036. 

Waldron, I. (1991). Patterns and causes of gender differences in smoking. Social science & medicine, 32(9), 989-1005. 

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