12.0 Introduction

Last updated: January 2022
Suggested citation: Winnall, WR, and Greenhalgh, EM. 12.0 Introduction. In Greenhalgh EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2022. Available from https://www.tobaccoinaustralia.org.au/chapter-12-tobacco-products/12-0-introduction   

 

For many centuries, tobacco plants have been harvested to make products for human use. But over the last 150 years, the worldwide use of tobacco has soared to pandemic levels and evolutions in tobacco product content, design, and manufacture have helped smoking become a leading cause of death and disease. The scientific study of tobacco products and their use has led to an understanding of the mechanisms by which these products cause addiction and disease, and underpinned calls for regulation of tobacco products that would reduce their enormous harms to users and the environment.

Originating in the Americas, the cultivation of tobacco plants has gradually spread to Europe, Asia and Africa since the late 1400s.1, 2 As tobacco spread around the world, its early users chewed or the dried leaves or smoked them in pipes. Early uses of tobacco by people such as Native Americans included medicine and ceremonies.3 New uses for the plant were invented as cigars and various types of smokeless tobacco products were developed. Mass production of cigars may have originated as early as 1542 in Cuba.4 Hand-rolled cigarettes were being made by the early 1800s5 but cigarettes didn’t rise in popularity until nearly 100 years later.3

Cigarettes gradually came to dominate the worldwide market for tobacco and by 2018, cigarettes accounted for 90% of this market (see Section 12.1 for a description of the tobacco in cigarettes).3 The earliest factories in which they were rolled by hand appeared in Europe and Russia in the 1840s and in the USA by the 1860s. Productivity increased greatly with the invention of rolling machines in the 1880s.6 The popularity of cigarettes rose with the use of flue-curing to dry the tobacco, the lower price due to mass production, product innovation after the break-up of the monopolising American Tobacco Company, the widespread availability of matches and lighters, and the free distribution of cigarettes to soldiers during World War I.3 Many other factors have also contributed, such as the political influence of tobacco companies and their interference in tobacco control.7 The highly addictive nature of cigarettes has also ensured that generations of people continue to smoke despite increased awareness of health risks.

Pipe and roll-your-own tobacco, smokeless tobacco products, bidis, kreteks, waterpipe tobacco, heated tobacco products and others comprise the remaining 10% of the market and have also come to be mass-produced (see Section 12.2).3

The evolution of cigarettes and other tobacco products has occurred via innovations in tobacco agriculture, manufacturing processes, chemical additives, and design features, culminating in the great range of appealing nicotine-delivering products that are available today. However, these innovations have also made tobacco products more dangerous: more addictive, more toxic and more attractive to those who use them (see Section 12.3 for a description of the chemicals in tobacco and Section 12.8 for construction and design features).

The mass cultivation of tobacco plants and production of tobacco products introduces many hundreds of chemicals into these products – from pesticides, herbicides and fertilisers to the hundreds of different chemical additives that impart flavour and increase addictive properties, palatability and attractiveness. Tobacco companies have also developed manufacturing processes that very carefully regulate the amount of nicotine delivered to the user, to balance taste with other addictive properties.3

Innovations in tobacco product content and design have led to the availability of a wide range of products that appeal to different groups. Chemical additives have been crucial in developing this range of products (see Section 12.6). An example is menthol, first added to tobacco in the 1920s, which masks the harsh taste of tobacco and promotes uptake among young people and minorities (see Section 12.7). Design features such as ’slim’ cigarettes have been used to target young women.

Physicians have suspected that tobacco is a danger to health since the 1600s.7 Smoking was confirmed to cause a range of serious diseases by major medical reports in the 1950s and 1960s.7-10 Rather than withdraw their highly profitable products from the market, the tobacco industry embarked on further innovations it claimed would reduce the dangers of smoking. Cigarettes with filters—so-called ‘light’ and ‘low-tar’ cigarettes—became the industry standard by the 1970s, along with claims of ’reduced harm’ (see Section 12.8). However, the development of filter ventilation and other innovations is now known to have deceived smokers,11 as ventilated filters have no health benefits. These plastic filters are now a major source of litter in waterways.

Once the health effects of tobacco use were widely accepted, a multi-disciplinary scientific effort was undertaken to understand which features of tobacco products were responsible. A scientific understanding of the processes of pyrolysis and combustion that convert tobacco and its chemical additives into smoke has shown that many toxic chemicals are made anew when tobacco is burned (see Section 12.4). Thousands of chemicals in tobacco emissions have been measured and characterised (see Section 12.5) and many that are responsible for the addictiveness, attractiveness and toxicity of tobacco use have been identified.

The knowledge gained from the scientific study of tobacco and its emissions has underpinned international efforts to regulate tobacco products. Early tobacco product regulation has included labelling of packets to educate users about health risks and addiction. Many countries now have mandatory requirements for cigarette design to reduce the risk of starting fires (see Attachment 12.2). The identification of chemicals that increase the attractiveness of tobacco products has led to bans on specific additives, such as menthol, and early evidence suggests that this may reduce smoking uptake (see 12.7 Menthol). Identifying the chemicals in tobacco that are contributing to diseases such as cancer and heart disease may also allow for regulation that attempts to reduce the harm from these products.

To reduce the demand for and supply of tobacco, an international treaty called the Framework Convention on Tobacco Control (FCTC) was ratified by most countries, starting from 2003. Tobacco product regulation is required by the FCTC. The World Health Organization has established a WHO Study Group on Tobacco Product Regulation (TobReg) to progress the implementation of tobacco product regulation around the world. The 2014 European Tobacco Product Directive and the 2009 Family Smoking Prevention and Tobacco Control Act in the United States have also led to important tobacco product regulation.

Australia has been a world leader in the implementation of some types of tobacco product regulation. Early use of warnings on packages, including graphic health warnings, and plain packaging have contributed to reductions in the prevalence of smoking. Smokeless tobacco is banned from the market in Australia, as well as confectionery or liqueur flavoured cigarettes. However, there are two areas of the FCTC in which Australia has made little progress: the regulation of the contents of tobacco products and the testing and disclosure of information on the contents and emissions of tobacco products.12

The implementation of comprehensive tobacco control programs, including the regulation of products and packaging, has substantially reduced smoking in many countries. However, as the tobacco industry grapples with falling sales of cigarettes, it continually finds new and innovative ways to recruit new users and circumvent tobacco control legislation. Tobacco product regulators face new challenges today, with the rising popularity, but unknown long-term effects, of products such as heated tobacco and e-cigarettes.

 

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References

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2. Swedish Health Services. History of tobacco use in America. Where does tobacco come from?  Available from: https://www.swedish.org/classes-and-resources/smoking-cessation/history-of-tobacco-use-in-america.

3. Cummings KM, Brown A, and Philipson B. History of the evolution of tobacco products, in Tobacco and cancer: the science and the story.  Hecht SS and Hatsukami DK, Editors. Singapore: World Scientific Publishing Co. Pte. Ltd.; 2022.  Available from: https://www.worldscientific.com/worldscibooks/10.1142/12348.

4. Havana House Cigar Merchants. The fascinating history behind Cuba’s cigar industry.  2019. Available from: https://www.havanahouse.co.uk/fascinating-history-behind-cubas-cigar-industry/.

5. Centers for Disease Control and Prevention. 2000 Surgeon General's Report Highlights: Tobacco Timeline.  2015. Available from: https://www.cdc.gov/tobacco/data_statistics/sgr/2000/highlights/historical/index.htm.

6. Bonsack JA. Cigarette machine, 1881: United States. Available from: https://patentimages.storage.googleapis.com/c8/ea/24/463c1e13d10bd7/US238640.pdf.

7. Cancer Council NSW. A brief history of smoking.  Available from: https://www.cancercouncil.com.au/news/a-brief-history-of-smoking/.

8. Doll R and Hill AB. The mortality of doctors in relation to their smoking habits; a preliminary report. British Medical Journal, 1954; 1(4877):1451-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/13160495

9. Wynder EL and Graham EA. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma; a study of 684 proved cases. JAMA, 1950; 143(4):329-36. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15415260

10. US Department of Health and Education and Welfare, Smoking and health: A report of the advisory committee to the Surgeon General of Public Health Service. Publication no (PHS) 1103. Washington: US Department of Health, Education and Welfare, Public Health Service, Center for Disease Control; 1964. Available from: https://profiles.nlm.nih.gov/spotlight/nn/catalog/nlm:nlmuid-101584932X202-doc.

11. US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. A report of the Surgeon General., Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53017/.

12. Morphett K and Gartner C. Future of tobacco product regulation in Australia. Insight, 2021; (6). Available from: https://insightplus.mja.com.au/2021/6/future-of-tobacco-product-regulation-in-australia/