kalo mau liat foto memekku dan no HPku, klik tulisan warna hitam di sebelah kanan ato kiri. nomer kontakku ada disitu, silahkan telpon
YOGYAKARTA (pronounced "Jogjakarta" and often just shortened to "Jogja") is the smallest province of Indonesia (excluding Yogyakarta) and ranks as one of the best preserved and most attractive cities in Java, and is a major centre for the classical Javanese arts of batik, ballet, drama, music, poetry and puppet shows. At its heart is Yogya's first family, the Hamengkubuwonos, whose elegant palace lies at the centre of Yogya's quaint old city, the Kraton, itself concealed behind high castellated walls. It is located on the island of Java. It is the only province in Indonesia that is still formally governed by a precolonial Sultanate: the Sultanate of Ngayogyakarta Hadiningrat.
Yogyakarta (pronounced 'Jogjakata' or often simply 'Jogja') is often referred to as the main gateway of Central Java and is a popular destination among visitors to Indonesia. The city is renowned as being the centre of Javanese fine arts and culture such as the Wayang Kulit or shadow puppets, as well as for music, ballet, drama, poetry, and batik. It is also one of the most important centres of learning in Indonesia.
Home to many fascinating attractions and two UNESCO Heritage Sites, Yogyakarta is more than just a cultural and religious site. Its city centre, the Kraton or Sri Sultan’s Palace, is relatively lively while the Malioboro, the centre of economic activity, is a paradise for shoppers and travelers.
Home to many fascinating attractions and two UNESCO Heritage Sites, Yogyakarta is more than just a cultural and religious site. Its city centre, the Kraton or Sri Sultan’s Palace, is relatively lively while the Malioboro, the centre of economic activity, is a paradise for shoppers and travelers.
Tips on How to Stop Using Smokeless Tobacco
Why is it hard to quit?
Like cigarettes, smokeless tobacco such as snuff or chewing tobacco
contains nicotine. Nicotine is very addictive and can change the way you
think and act. If you are addicted to nicotine, you crave the “buzz” you get
from using tobacco. You have to use more and more to get the effect you
want.
Smokeless tobacco puts more nicotine into your bloodstream than
cigarettes do. People who chew or dip tobacco regularly may think that
quitting smokeless tobacco is even harder that quitting cigarette smoking.
Using smokeless tobacco may be a habit for you when you do certain
things or when you are with certain people. For example, maybe you
always chew tobacco when you go to a sporting event or when you watch
TV. It can be hard to break this habit.
Many smokeless tobacco users have quit successfully. You can, too. Your
doctor or others on your health care team can help you quit.
What can I use to replace smokeless tobacco?
• Talk to your doctor about whether nicotine gum or other nicotine
replacement therapy is right for you. In many cases, tobacco users who
benefit most from nicotine replacement include people who:
• Use 3 or more tins or pouches a week
Use smokeless tobacco within 30 minutes after they wake up
Often swallow tobacco juice when they chew or dip• Find a substitute that you enjoy. Try sugarless gum, hard candy, beef
jerky or sunflower seeds.
• Do not substitute cigarette smoking for smokeless tobacco. Stop using
all tobacco products because there is no such thing as a safe tobacco
product.
• Find activities to do when you want to chew or dip. Many people chew
or dip when they are bored. Try a walk or quick jog, lift weights, take a
hot shower to relax, or do something you enjoy to keep your mind off
smokeless tobacco.
What can I do to get ready to quit?
• Set a date to quit and stick to it. Choose a date 2 to 4 weeks from today.
• Develop a plan because quitting can be hard.
• Identify times when you want to use smokeless tobacco the most. Plan
to avoid those situations or have tobacco substitutes with you, like
sunflower seeds or sugarless gum.
• Get rid of your chewing tobacco or snuff before your quit date.
• Start to cut down on the amount you chew or dip.
• Get support from your family and friends and talk to your doctor. If you
have a family member or friend who uses smokeless tobacco, have that
person quit with you. Studies have shown that people who have the
support of family and friends are more successful at quitting.
Like cigarettes, smokeless tobacco such as snuff or chewing tobacco
contains nicotine. Nicotine is very addictive and can change the way you
think and act. If you are addicted to nicotine, you crave the “buzz” you get
from using tobacco. You have to use more and more to get the effect you
want.
Smokeless tobacco puts more nicotine into your bloodstream than
cigarettes do. People who chew or dip tobacco regularly may think that
quitting smokeless tobacco is even harder that quitting cigarette smoking.
Using smokeless tobacco may be a habit for you when you do certain
things or when you are with certain people. For example, maybe you
always chew tobacco when you go to a sporting event or when you watch
TV. It can be hard to break this habit.
Many smokeless tobacco users have quit successfully. You can, too. Your
doctor or others on your health care team can help you quit.
What can I use to replace smokeless tobacco?
• Talk to your doctor about whether nicotine gum or other nicotine
replacement therapy is right for you. In many cases, tobacco users who
benefit most from nicotine replacement include people who:
• Use 3 or more tins or pouches a week
Use smokeless tobacco within 30 minutes after they wake up
Often swallow tobacco juice when they chew or dip• Find a substitute that you enjoy. Try sugarless gum, hard candy, beef
jerky or sunflower seeds.
• Do not substitute cigarette smoking for smokeless tobacco. Stop using
all tobacco products because there is no such thing as a safe tobacco
product.
• Find activities to do when you want to chew or dip. Many people chew
or dip when they are bored. Try a walk or quick jog, lift weights, take a
hot shower to relax, or do something you enjoy to keep your mind off
smokeless tobacco.
What can I do to get ready to quit?
• Set a date to quit and stick to it. Choose a date 2 to 4 weeks from today.
• Develop a plan because quitting can be hard.
• Identify times when you want to use smokeless tobacco the most. Plan
to avoid those situations or have tobacco substitutes with you, like
sunflower seeds or sugarless gum.
• Get rid of your chewing tobacco or snuff before your quit date.
• Start to cut down on the amount you chew or dip.
• Get support from your family and friends and talk to your doctor. If you
have a family member or friend who uses smokeless tobacco, have that
person quit with you. Studies have shown that people who have the
support of family and friends are more successful at quitting.
Health Consequences of Tobacco Use
Tobacco causes a wide spectrum of fatal and nonfatal
diseases. Although tobacco is smoked and used in a wide variety of ways all over the world, especially in India,
the epidemiologic evidence of specific harmful effects of
tobacco is based largely on studies of people who smoke
cigarettes, the most popular form in the West. However,
studies on some of the effects of cigars, pipes, bidi and
smokeless tobacco show that all forms of tobacco use
are harmful. We discuss here several potentially fatal
diseases implicating tobacco, as found in studies of ciga-
rette smokers and people exposed to second-hand smoke.
A few health risks to tobacco workers are mentioned. A
discussion of tobacco-related disease in cigar and bidi
smokers and smokeless tobacco consumers is given below.
Tobacco and cancer
The role of tobacco in increasing the risk of lung cancer is
widely known. Richard Doll’s 1950 paper, demonstrating
the association between smoking and lung cancer, has
become a public health classic
4
. Many people may not
realize that tobacco use increases the risk of cancer at
many sites in the body: the head and neck (covering
cancers of the oesophagus, larynx, tongue, salivary glands,
lip, mouth, and pharynx), urinary bladder and kidneys,
breast, uterine cervix, pancreas, colon and other sites
5
.
Lung cancer
How much risk of lung cancer does cigarette smoking
pose? On an average, smokers increase their risk of lung
cancer between 5 and 10-fold, and in developed coun-
tries, smoking is responsible for more than 80% of all
lung cancers. Using American data, 24% of men who
smoke can expect to develop cancer during their lifetime.
Recently, the spread of tobacco use to developing coun-
tries has led to similar disease patterns there. In a report
from India, roughly two-thirds of all patients with lung
cancer were smokers of either cigarettes and/or bidis
(hand-rolled tobacco in tendu leaves). Among 54 female
patients, only 5% were smokers, reflecting both the low
prevalence of tobacco use among women and the cancer-
causing effects of environmental tobacco smoke
6
. In a
study of 1,000,000 deaths in China, lung cancer risk was
found to be two to four times higher among men who
smoked compared to nonsmokers and this association was
generally consistent over both rural and urban areas
7
.
Lung cancer remains a disease of dismal prognosis.
Although one-year all-stage survival is reported to have
increased from 32% in 1973 to 41% in 1994, five-year
survival has remained unchanged at 14%. Early detection
has been promoted as a potentially valuable intervention
but its cost-effectiveness puts it beyond the reach of all
but the best funded health care systems, and even
then, early detection pales in comparison to the cost-
effectiveness of comprehensive programmes and policies
to reduce tobacco consumption.
Head and neck cancer
Tobacco use has long been linked to head and neck
cancers, particularly in tissues through which inhaled
smoke passes. For oral cancers, men who smoke have a
27-times higher rate of oral cancer than men who do not
smoke. For laryngeal cancer, rates are 12 times higher
among smokers.
Urinary bladder and kidney cancer
In the Western countries, tobacco use is the single most
important cause of bladder cancer, accounting for an
estimated 40–70% of all cases. Smokers’ risk of bladder
cancer is 2–3 times higher than of nonsmokers. Poly-
aromatic hydrocarbons contained in cigarette smoke are
known carcinogens and may be absorbed into the blood
and transported to the bladder where the cells are unable
to withstand their carcinogenic effects.
Breast cancer
For women in developed countries, cases of breast cancer
have been rising over the last few decades, in consonance
with the rapid increase in female smoking that has occurred
from the middle of the 20th century. Data on links between
breast cancer and smoking have, however, been mixed,
and this has led to conflicting health messages. In Danish
women interviewed at the time of mammography, smoking
for more than 30 years was associated with a 60% higher
risk of breast cancer and an age of onset at an average of
eight years earlier, when compared with nonsmokers.
Given that breast cancer incidence is soon to be
eclipsed by lung cancer incidence among women, further
data clarifying the role of smoking in causing breast
cancer should be of value in strengthening efforts to
inform and assist women to quit smoking.
Uterine cervix cancer
The effect of tabacco on cervical cancer has only been
recently recognized, in part because women who smoke
may also have other risk factors for cervical cancer,
particularly exposure to human papilloma virus. Never-
theless, there is now general consensus that cigarette
smoking increases risks of cervical cancer, particularly
among women smoking as many as 40 cigarettes daily,
and is responsible for approximately 30% of cervical
cancer deaths in the US.
Pancreatic cancer
Smoking is estimated to be responsible for 30% of
pancreatic cancer. Like for bladder cancer, carcinogens
inhaled by the smoker are thought to enter the blood
stream and reach the pancreas via the blood and the bile, secreted by the liver to aid digestion. Pancreatic cancer
prognosis remains very poor, with 5-year survival less
than 5% in most reports.
Colon cancer
Colon cancer risk is also greater among smokers, pre-
sumably due to the transport of carcinogens to the colon
from inhaled or swallowed tobacco smoke. Data support-
ing this association come from several longitudinal
studies in which groups of people are followed over many
years to record the occurrence of various illnesses.
Based on data from both male and female health pro-
fessionals in the US, smoking appears to double the risk
of colon cancers. Most colon cancers begin as polyps.
Risk of cancer increases with polyp size and there is
a dose–response relationship with increasing years of
tobacco use associated with larger polyps and, after 35
years of smoking, colon cancer.
Tobacco and atherosclerotic diseases
In atherosclerosis, blood vessels are narrowed as plaques
of lipid material build up in them, typically when ravaged
by harmful substances (e.g. free radicals – molecules with
unpaired electrons, that grab electrons from other sub-
stances around them, damaging them) contained in high
concentrations in tobacco ‘tar’. Atherosclerosis reduces
blood flow through the coronary arteries supplying the
heart muscle, the carotid arteries feeding the brain and
the small vessels in the legs. Smoking can increase the
size of plaques in the carotid arteries by over three-fold,
as demonstrated by studies of identical twin pairs, in
which one smokes and the other does not, thus cancelling
out the effects of genetic predispositions to atherosclero-
sis
8
. The implication of smoking in heart disease, stroke
and peripheral vascular disease is discussed below.
Heart disease
A heart attack (myocardial infarction) occurs when a dis-
eased coronary artery is blocked by a blood clot or a
breakup of the plaque material. The link between smoking
and heart (cardiovascular) disease has been well described
in populations all over the world. Twenty-five years of
follow-up in the Seven Countries Study (16 cohorts of
men, aged 40 to 59 at enrolment in the USA, Finland, the
Netherlands, Italy, Croatia, Serbia, Greece and Japan)
reported a dose-dependent increase in the risk of death.
After 25 years, 57.7% of persons smoking 30 cigarettes
per day had died, compared to only 36.3% of non-
smokers
9
. Additional long-term data come from a 40-year
follow up of British physicians noted that excess mortality
from cardiovascular disease was twice that among smo-
kers compared to non-smokers but this ratio was even
more extreme during middle age
10
.
The data for men and women differ slightly, but recent
work underlines the importance of smoking as a cause of
heart attack in both. In a Norwegian study, rates of myo-
cardial infarction among women who smoked were six
times higher than in female non-smokers and rates among
men, three times higher than among male nonsmokers
11
.
Danish investigators concluded that women might be
more sensitive to tobacco, as risks of heart attack due to
current smoking and total tobacco exposure were consis-
tently higher in women than in men.
In an increasing number of health systems, patients are
offered expensive therapies, like coronary bypass surgery
or angioplasty, to open or bypass vessels that have
become too narrow to supply enough oxygen to the heart.
American data show that after an average of four and a
half years of follow-up of 3437 patients, people who con-
tinued to smoke after angioplasty had a 76% increased
risk of death, compared to nonsmokers, and a 44% higher
risk of death compared to those who quit smoking12
.
Stroke
A stroke occurs when blood flow to the brain is reduced,
often by a blood clot, or less commonly, when a blood
vessel in the brain bursts. Non-fatal strokes often leave
their victims substantially disabled. Research has shown
that tobacco use increases the risk of stroke. Stroke risk is
also increased among people with uncontrolled blood
pressure. Smoking cessation and treatment of hyperten-
sion combined can reduce the risk of stroke and also that
of cardiovascular and peripheral vascular disease.
How high is the risk of stroke from tobacco use?
Research results vary, but data from US physicians show
a 2.71 higher risk of non-fatal stroke among persons
smoking more than 20 cigarettes a day and data from the
UK report a 3.7 times higher risk of stroke among current
smokers. The risk among current smokers may be as high
as seven times greater than that among non-smokers
for subarachnoid haemorrhage (blood between the two
innermost of the three membranes protecting the brain),
which if survived is likely to cause more devastating
disability13
.
The risk of stroke among smokers increases with
the amount smoked so that heavy smokers can make the
greatest improvements to their health by quitting. The
good news is that several studies, with both male and
female subjects, report that five years after quitting, the
former smoker has no higher risk of stroke than the non-
smoker
13
.
Peripheral vascular disease
Peripheral vascular disease refers to a cluster of condi-
tions in which atherosclerosis occurs in the peripheral
circulation, particularly in the legs. Peripheral vascular
disease, unlike myocardial infarction, has a relatively low risk of death but causes substantial disability as affected
limbs are at higher risk of amputation and infection.
The link between peripheral vascular disease and
tobacco use was described in the early 1900s by Buerger
after whom one form of vascular disease, rare in non-
smokers, is named.
Tobacco and diabetes
Diabetes mellitus is a chronic disease affecting multiple
systems in the body and often leading to substantial dis-
ability due to blindness, vascular disease necessitating leg
amputation, kidney failure and premature death. Tobacco
use increases the risk of diabetes, which itself speeds up
atherosclerosis, with its attendant diseases.
There are two forms of diabetes mellitus, insulin-
dependent (IDDM) and non-insulin-dependent (NIDDM).
NIDDM usually is diagnosed in midlife and may be
treated with diet modification, drugs and lifestyle modifi-
cation to encourage regular exercise. Studying the effect
of smoking on NIDDM is complicated by the fact that
people who smoke are more likely to be sedentary and
overweight, therefore already at risk for NIDDM. This
problem has been solved by following a group of non-
diabetic people over time and identifying diabetics when
they are initially diagnosed with NIDDM, so that their
smoking habits at the time of diagnosis and in the years
leading up to diagnosis are recorded.
Male health care professionals in the US who smoke 25
or more cigarettes daily appear to have a double risk of
NIDDM14
. This is important because once diagnosed, NIDDM
is often more severe in those who continue to smoke.
Tobacco and chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) encom-
passes chronic bronchitis and emphysema. Chronic bron-
chitis refers to a productive cough for at least three
months in each of two successive years for which other
causes have been ruled out. Emphysema involves destruc-
tion of the lung architecture with enlargement of the
airspaces and loss of alveolar surface area.
COPD prevalence increases with age, but there is a
dramatic synergy with smoking. Unlike heart disease,
quitting smoking does not produce substantial reversal of
tobacco’s harmful effects once COPD is established. As a
result, in many developed countries, COPD is increasing
as a cause of death as cardiovascular death rates fall
5
. As
with other tobacco-associated adverse health effects,
smoking either cigarettes or cigars increases risks of
COPD. Thus, cigar smokers are reported to have a 45%
higher risk of COPD when compared to nonsmokers
15
.
Tobacco and osteoporosis
As populations age the world over, osteoporosis, or loss
of bone mineral density, will generate an increasing bur-
den of disease. Far more common among women than
men, osteoporosis itself is less a disease than a risk factor
because people with osteoporosis have much higher risk
of fractures, particularly of the hip and vertebrae.
Hip fractures often cause substantial disability and may
prevent someone from returning home even after surgery
and rehabilitation, if their home is unsuitable for their
impaired mobility. In even the most resource-rich health
care systems, the resources that will be consumed by
treatment and care of persons with such fractures is
expected to grow exponentially.
The strongest evidence of the effects of smoking in
decreasing bone mineral density comes from a meta-
analysis which considered 29 studies and concluded that
roughly one in eight hip fractures is attributable to ciga-
rette smoking. Hip fracture risk among smokers is greater
at all ages but rises from 17% greater at age 60 to 71% at
age 80 and 108% at age 90 (ref. 16). Risks are lower in
former smokers, suggesting a benefit of quitting smoking
in slowing the rate of bone loss.
Tobacco and the thyroid
The thyroid gland sits in the neck and is responsible for
metabolic control. It produces thyroid hormone, which is
involved in many of the body’s metabolic processes.
Among women with hypothyroidism (insufficient thyroid
hormone), smoking is reported to be responsible for both
decreasing secretion of thyroid hormone and blocking its
action, thus exacerbating the symptoms of hypothyroidism
and reducing basal metabolism17
. Symptoms include obe-
sity, poor appetite, fatigue, poor memory, slow heart beat,
low body temperature, cold intolerance, reduced sweating,
dry, rough skin, constipation, joint pain and muscle
cramps. Case-control studies have reported that smoking
is over seven times more frequent among hypothyroid
patients with Graves’ opthalmopathy, a severe form of
hypothyroidism involving the eyes.
Tobacco and women’s health
The adverse health effects of tabacco are universal in that
they increase risks of cancer and heart disease among all
smokers and quitting smoking reduces these risks. How-
ever, for women, smoking carries special risks. In addi-
tion to cancer risks unique to women and a greater risk for
osteoporosis, smoking by pregnant women and mothers
may affect their offspring. Pregnancy outcomes, including
lower birth weight and intrauterine growth retardation, are
more frequent among women who smoke than among
those who do not smoke. Smoking during pregnancy is also
a major cause of sudden infant death syndrome (SIDS) and
decreased lung function, which are well-documented
effects
. In India a high proportion of women use smokeless
tobacco even during their pregnancy. This has been shown
to cause a range of adverse reproductive outcomes
diseases. Although tobacco is smoked and used in a wide variety of ways all over the world, especially in India,
the epidemiologic evidence of specific harmful effects of
tobacco is based largely on studies of people who smoke
cigarettes, the most popular form in the West. However,
studies on some of the effects of cigars, pipes, bidi and
smokeless tobacco show that all forms of tobacco use
are harmful. We discuss here several potentially fatal
diseases implicating tobacco, as found in studies of ciga-
rette smokers and people exposed to second-hand smoke.
A few health risks to tobacco workers are mentioned. A
discussion of tobacco-related disease in cigar and bidi
smokers and smokeless tobacco consumers is given below.
Tobacco and cancer
The role of tobacco in increasing the risk of lung cancer is
widely known. Richard Doll’s 1950 paper, demonstrating
the association between smoking and lung cancer, has
become a public health classic
4
. Many people may not
realize that tobacco use increases the risk of cancer at
many sites in the body: the head and neck (covering
cancers of the oesophagus, larynx, tongue, salivary glands,
lip, mouth, and pharynx), urinary bladder and kidneys,
breast, uterine cervix, pancreas, colon and other sites
5
.
Lung cancer
How much risk of lung cancer does cigarette smoking
pose? On an average, smokers increase their risk of lung
cancer between 5 and 10-fold, and in developed coun-
tries, smoking is responsible for more than 80% of all
lung cancers. Using American data, 24% of men who
smoke can expect to develop cancer during their lifetime.
Recently, the spread of tobacco use to developing coun-
tries has led to similar disease patterns there. In a report
from India, roughly two-thirds of all patients with lung
cancer were smokers of either cigarettes and/or bidis
(hand-rolled tobacco in tendu leaves). Among 54 female
patients, only 5% were smokers, reflecting both the low
prevalence of tobacco use among women and the cancer-
causing effects of environmental tobacco smoke
6
. In a
study of 1,000,000 deaths in China, lung cancer risk was
found to be two to four times higher among men who
smoked compared to nonsmokers and this association was
generally consistent over both rural and urban areas
7
.
Lung cancer remains a disease of dismal prognosis.
Although one-year all-stage survival is reported to have
increased from 32% in 1973 to 41% in 1994, five-year
survival has remained unchanged at 14%. Early detection
has been promoted as a potentially valuable intervention
but its cost-effectiveness puts it beyond the reach of all
but the best funded health care systems, and even
then, early detection pales in comparison to the cost-
effectiveness of comprehensive programmes and policies
to reduce tobacco consumption.
Head and neck cancer
Tobacco use has long been linked to head and neck
cancers, particularly in tissues through which inhaled
smoke passes. For oral cancers, men who smoke have a
27-times higher rate of oral cancer than men who do not
smoke. For laryngeal cancer, rates are 12 times higher
among smokers.
Urinary bladder and kidney cancer
In the Western countries, tobacco use is the single most
important cause of bladder cancer, accounting for an
estimated 40–70% of all cases. Smokers’ risk of bladder
cancer is 2–3 times higher than of nonsmokers. Poly-
aromatic hydrocarbons contained in cigarette smoke are
known carcinogens and may be absorbed into the blood
and transported to the bladder where the cells are unable
to withstand their carcinogenic effects.
Breast cancer
For women in developed countries, cases of breast cancer
have been rising over the last few decades, in consonance
with the rapid increase in female smoking that has occurred
from the middle of the 20th century. Data on links between
breast cancer and smoking have, however, been mixed,
and this has led to conflicting health messages. In Danish
women interviewed at the time of mammography, smoking
for more than 30 years was associated with a 60% higher
risk of breast cancer and an age of onset at an average of
eight years earlier, when compared with nonsmokers.
Given that breast cancer incidence is soon to be
eclipsed by lung cancer incidence among women, further
data clarifying the role of smoking in causing breast
cancer should be of value in strengthening efforts to
inform and assist women to quit smoking.
Uterine cervix cancer
The effect of tabacco on cervical cancer has only been
recently recognized, in part because women who smoke
may also have other risk factors for cervical cancer,
particularly exposure to human papilloma virus. Never-
theless, there is now general consensus that cigarette
smoking increases risks of cervical cancer, particularly
among women smoking as many as 40 cigarettes daily,
and is responsible for approximately 30% of cervical
cancer deaths in the US.
Pancreatic cancer
Smoking is estimated to be responsible for 30% of
pancreatic cancer. Like for bladder cancer, carcinogens
inhaled by the smoker are thought to enter the blood
stream and reach the pancreas via the blood and the bile, secreted by the liver to aid digestion. Pancreatic cancer
prognosis remains very poor, with 5-year survival less
than 5% in most reports.
Colon cancer
Colon cancer risk is also greater among smokers, pre-
sumably due to the transport of carcinogens to the colon
from inhaled or swallowed tobacco smoke. Data support-
ing this association come from several longitudinal
studies in which groups of people are followed over many
years to record the occurrence of various illnesses.
Based on data from both male and female health pro-
fessionals in the US, smoking appears to double the risk
of colon cancers. Most colon cancers begin as polyps.
Risk of cancer increases with polyp size and there is
a dose–response relationship with increasing years of
tobacco use associated with larger polyps and, after 35
years of smoking, colon cancer.
Tobacco and atherosclerotic diseases
In atherosclerosis, blood vessels are narrowed as plaques
of lipid material build up in them, typically when ravaged
by harmful substances (e.g. free radicals – molecules with
unpaired electrons, that grab electrons from other sub-
stances around them, damaging them) contained in high
concentrations in tobacco ‘tar’. Atherosclerosis reduces
blood flow through the coronary arteries supplying the
heart muscle, the carotid arteries feeding the brain and
the small vessels in the legs. Smoking can increase the
size of plaques in the carotid arteries by over three-fold,
as demonstrated by studies of identical twin pairs, in
which one smokes and the other does not, thus cancelling
out the effects of genetic predispositions to atherosclero-
sis
8
. The implication of smoking in heart disease, stroke
and peripheral vascular disease is discussed below.
Heart disease
A heart attack (myocardial infarction) occurs when a dis-
eased coronary artery is blocked by a blood clot or a
breakup of the plaque material. The link between smoking
and heart (cardiovascular) disease has been well described
in populations all over the world. Twenty-five years of
follow-up in the Seven Countries Study (16 cohorts of
men, aged 40 to 59 at enrolment in the USA, Finland, the
Netherlands, Italy, Croatia, Serbia, Greece and Japan)
reported a dose-dependent increase in the risk of death.
After 25 years, 57.7% of persons smoking 30 cigarettes
per day had died, compared to only 36.3% of non-
smokers
9
. Additional long-term data come from a 40-year
follow up of British physicians noted that excess mortality
from cardiovascular disease was twice that among smo-
kers compared to non-smokers but this ratio was even
more extreme during middle age
10
.
The data for men and women differ slightly, but recent
work underlines the importance of smoking as a cause of
heart attack in both. In a Norwegian study, rates of myo-
cardial infarction among women who smoked were six
times higher than in female non-smokers and rates among
men, three times higher than among male nonsmokers
11
.
Danish investigators concluded that women might be
more sensitive to tobacco, as risks of heart attack due to
current smoking and total tobacco exposure were consis-
tently higher in women than in men.
In an increasing number of health systems, patients are
offered expensive therapies, like coronary bypass surgery
or angioplasty, to open or bypass vessels that have
become too narrow to supply enough oxygen to the heart.
American data show that after an average of four and a
half years of follow-up of 3437 patients, people who con-
tinued to smoke after angioplasty had a 76% increased
risk of death, compared to nonsmokers, and a 44% higher
risk of death compared to those who quit smoking12
.
Stroke
A stroke occurs when blood flow to the brain is reduced,
often by a blood clot, or less commonly, when a blood
vessel in the brain bursts. Non-fatal strokes often leave
their victims substantially disabled. Research has shown
that tobacco use increases the risk of stroke. Stroke risk is
also increased among people with uncontrolled blood
pressure. Smoking cessation and treatment of hyperten-
sion combined can reduce the risk of stroke and also that
of cardiovascular and peripheral vascular disease.
How high is the risk of stroke from tobacco use?
Research results vary, but data from US physicians show
a 2.71 higher risk of non-fatal stroke among persons
smoking more than 20 cigarettes a day and data from the
UK report a 3.7 times higher risk of stroke among current
smokers. The risk among current smokers may be as high
as seven times greater than that among non-smokers
for subarachnoid haemorrhage (blood between the two
innermost of the three membranes protecting the brain),
which if survived is likely to cause more devastating
disability13
.
The risk of stroke among smokers increases with
the amount smoked so that heavy smokers can make the
greatest improvements to their health by quitting. The
good news is that several studies, with both male and
female subjects, report that five years after quitting, the
former smoker has no higher risk of stroke than the non-
smoker
13
.
Peripheral vascular disease
Peripheral vascular disease refers to a cluster of condi-
tions in which atherosclerosis occurs in the peripheral
circulation, particularly in the legs. Peripheral vascular
disease, unlike myocardial infarction, has a relatively low risk of death but causes substantial disability as affected
limbs are at higher risk of amputation and infection.
The link between peripheral vascular disease and
tobacco use was described in the early 1900s by Buerger
after whom one form of vascular disease, rare in non-
smokers, is named.
Tobacco and diabetes
Diabetes mellitus is a chronic disease affecting multiple
systems in the body and often leading to substantial dis-
ability due to blindness, vascular disease necessitating leg
amputation, kidney failure and premature death. Tobacco
use increases the risk of diabetes, which itself speeds up
atherosclerosis, with its attendant diseases.
There are two forms of diabetes mellitus, insulin-
dependent (IDDM) and non-insulin-dependent (NIDDM).
NIDDM usually is diagnosed in midlife and may be
treated with diet modification, drugs and lifestyle modifi-
cation to encourage regular exercise. Studying the effect
of smoking on NIDDM is complicated by the fact that
people who smoke are more likely to be sedentary and
overweight, therefore already at risk for NIDDM. This
problem has been solved by following a group of non-
diabetic people over time and identifying diabetics when
they are initially diagnosed with NIDDM, so that their
smoking habits at the time of diagnosis and in the years
leading up to diagnosis are recorded.
Male health care professionals in the US who smoke 25
or more cigarettes daily appear to have a double risk of
NIDDM14
. This is important because once diagnosed, NIDDM
is often more severe in those who continue to smoke.
Tobacco and chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) encom-
passes chronic bronchitis and emphysema. Chronic bron-
chitis refers to a productive cough for at least three
months in each of two successive years for which other
causes have been ruled out. Emphysema involves destruc-
tion of the lung architecture with enlargement of the
airspaces and loss of alveolar surface area.
COPD prevalence increases with age, but there is a
dramatic synergy with smoking. Unlike heart disease,
quitting smoking does not produce substantial reversal of
tobacco’s harmful effects once COPD is established. As a
result, in many developed countries, COPD is increasing
as a cause of death as cardiovascular death rates fall
5
. As
with other tobacco-associated adverse health effects,
smoking either cigarettes or cigars increases risks of
COPD. Thus, cigar smokers are reported to have a 45%
higher risk of COPD when compared to nonsmokers
15
.
Tobacco and osteoporosis
As populations age the world over, osteoporosis, or loss
of bone mineral density, will generate an increasing bur-
den of disease. Far more common among women than
men, osteoporosis itself is less a disease than a risk factor
because people with osteoporosis have much higher risk
of fractures, particularly of the hip and vertebrae.
Hip fractures often cause substantial disability and may
prevent someone from returning home even after surgery
and rehabilitation, if their home is unsuitable for their
impaired mobility. In even the most resource-rich health
care systems, the resources that will be consumed by
treatment and care of persons with such fractures is
expected to grow exponentially.
The strongest evidence of the effects of smoking in
decreasing bone mineral density comes from a meta-
analysis which considered 29 studies and concluded that
roughly one in eight hip fractures is attributable to ciga-
rette smoking. Hip fracture risk among smokers is greater
at all ages but rises from 17% greater at age 60 to 71% at
age 80 and 108% at age 90 (ref. 16). Risks are lower in
former smokers, suggesting a benefit of quitting smoking
in slowing the rate of bone loss.
Tobacco and the thyroid
The thyroid gland sits in the neck and is responsible for
metabolic control. It produces thyroid hormone, which is
involved in many of the body’s metabolic processes.
Among women with hypothyroidism (insufficient thyroid
hormone), smoking is reported to be responsible for both
decreasing secretion of thyroid hormone and blocking its
action, thus exacerbating the symptoms of hypothyroidism
and reducing basal metabolism17
. Symptoms include obe-
sity, poor appetite, fatigue, poor memory, slow heart beat,
low body temperature, cold intolerance, reduced sweating,
dry, rough skin, constipation, joint pain and muscle
cramps. Case-control studies have reported that smoking
is over seven times more frequent among hypothyroid
patients with Graves’ opthalmopathy, a severe form of
hypothyroidism involving the eyes.
Tobacco and women’s health
The adverse health effects of tabacco are universal in that
they increase risks of cancer and heart disease among all
smokers and quitting smoking reduces these risks. How-
ever, for women, smoking carries special risks. In addi-
tion to cancer risks unique to women and a greater risk for
osteoporosis, smoking by pregnant women and mothers
may affect their offspring. Pregnancy outcomes, including
lower birth weight and intrauterine growth retardation, are
more frequent among women who smoke than among
those who do not smoke. Smoking during pregnancy is also
a major cause of sudden infant death syndrome (SIDS) and
decreased lung function, which are well-documented
effects
. In India a high proportion of women use smokeless
tobacco even during their pregnancy. This has been shown
to cause a range of adverse reproductive outcomes
Types of Tobacco
There is no safe form of tobacco use. All forms contain nicotine and can cause
addiction and health problems.
Bidis
Bidis (pronounced "bee-dees") are small, thin hand-rolled cigarettes
imported to the United States primarily from India and other
Southeast Asian countries. They consist of tobacco wrapped in a
tendu or temburni leaf (plants native to Asia), and may be secured
with a colorful string at one or both ends. Bidis can be flavored
(e.g., chocolate, cherry, mango) or unflavored.
Bidi smoking is associated with an increased risk for oral, lung, stomach,
and esophageal
cancer and an increased risk for coronary heart disease and heart attacks, and risk for
chronic bronchitis.
Bidis are carcinogenic. There is no evidence to indicate that bidis are safer than
conventional cigarettes. They have higher concentrations of nicotine, tar, and carbon
monoxide than conventional cigarettes sold in the United States, so are even more addictive
than cigarettes.
Cigarettes
A cigarette is a combination of cured and finely cut tobacco,
reconstituted tobacco and other additives rolled or stuffed into a paper-
wrapped cylinder. Many cigarettes have a filter on one end.
More than 4,000 different chemicals have been found in tobacco and
tobacco smoke. Among these are more than 60 chemicals that are
known to cause cancer.
Studies have proven that smoking cigarettes causes cancers of the bladder, oral cavity,
pharynx, larynx (voice box), esophagus, cervix, kidney, lung, pancreas, and stomach, and
causes acute myeloid leukemia. It also causes heart disease and stroke.
Cigars, Cigarillos and Little Cigars
Most cigars are made up of a single type of air-cured or dried
tobacco. Cigar tobacco leaves are first aged for about a year and
then fermented in a multi-step process that can take from 3 to 5
months. Fermentation causes chemical and bacterial reactions that
change the tobacco. This is what gives cigars a different taste and
smell from cigarettes.
Regular cigars are larger than cigarettes and do not have a filter.
Little cigars or cigarillos are very similar in size and shape of
cigarettes, have filters and are filled with pipe tobacco. Little cigars
are often flavored (e.g., chocolate, cherry, apple, mango). They are
sold in packs of 20 just like cigarettes or singly.
Cigars contain higher level of nicotine than cigarettes. For those
cigar smokers who inhale, the nicotine is absorbed through the
lungs as quickly as it is with cigarettes. For those who do not inhale, the nicotine is
absorbed more slowly through the lining of the mouth.
Studies have shown that cigar smoking is linked to cancers of the mouth, lips, tongue,
throat, larynx, lung, pancreas and bladder cancer. Cigar smoking, like cigarette smoking, is
also linked to gum disease, where the gums shrink away from the teeth. It also raises your
risk that teeth will actually fall out.
A study completed in 2000 found cigar smoking, like cigarette smoking, is linked to sexual
impotence in men (an inability to get an erection, known as erectile dysfunction).
Dissolvable Tobacco
This type of tobacco is finely processed to dissolve on the tongue or in the
mouth. Varieties include strips, sticks,orbs and compressed tobacco
lozenges. They are smoke and spit free, are held together by food-grade
binders and look similar to a breath mint or candy.
Since this product is very new to the market, research has not been
conducted on the health effects. This product does contain nicotine.
Smokeless tobacco products are known to cause significant health
risks and are not a safe substitute for smoking tobacco.
Electronic cigarette or E- cigarette (nicotine delivery system)
The e-cigarette is a battery-powered device that contains a
cartridge filled with nicotine, flavor and other chemicals. The e-
cigarrette is not a tobacco product but a nicotine delivery system.
The e-cigarette turns the nicotine and other chmicals into a vapor
that is then inhaled by the user. The user will puff on it, similar to
a cigarette, and receive a vaporized solution of propylene
glycol/nicotine. There is no tobacco or burning of tobacco involved and the e-cigarette
produces no smoke. It does produce a fine, heated mist.
The e-cigarette often looks like a real cigarette and some have a glowing tip. Other models
look similar to a ball point pen. Most electronic cigarettes are reusable.
Re-fillable and replaceable cartridges are available with different nicotine levels and flavors
such as menthol, cherry, chocolate, mint, and orange. There are also cartridges available
that state they contain no nicotine, although the US Food and Drug Administration (FDA)
conducted studies showing that these cartridges do contain nicotine.
This product is often marketed as an alternative to smoking or an aid in quitting but the
World Health Organization claims there are no studies showing that the electronic cigarette
is a safe and effective nicotine replacement therapy and no scientific evidence to confirm
the product's safety. Recent studies by the FDA show that the e-cigarette contains known
carcinogens and toxic chemicals that are harmful to the user.
Hookah
Hookah is a pipe used to smoke Shisha, a combination of tobacco and fruit
or vegetable that is heated and the smoke is filtrated through water. The
Hookah consists of a head, body water bowl and hose. The tobacco or
Shisha is heated in the hookah usually using charcoal.
According to a World Health Organization advisory, a typical one-hour
session of hookah smoking exposes the user to 100 to 200 times the
volume of smoke inhaled from a single cigarette. Even after passing
through water, tobacco smoke still contains high levels of toxic compounds,
including carbon monoxide, heavy metals and cancer-causing chemicals (carcinogens).
Hookah smoking also delivers significant levels of nicotine — the addictive substance in
tobacco.
Hookah smoking has been associated with lung, mouth and other cancers, heart disease
and respiratory infections.
The substances used to heat the tobacco also produce carbon monoxide, heavy metals and
cancer causing chemicals, creating it own health hazards.
Sharing the mouthpiece of the Hookah has been associated with mouth and other infections
including herpes, tuberculosis and hepatitis.
Hookah smoking is no safer than other forms of tobacco use.
Kreteks
Kreteks (pronounced "cree-techs") are sometimes referred to as clove
cigarettes. Kreteks are imported from Indonesia, and typically contain a
mixture consisting of tobacco, cloves, and other additives. As with bidis,
standardized machine-smoking analyses indicate that kreteks deliver more
nicotine, carbon monoxide, and tar than conventional cigarettes.
Kretek smoking is associated with an increased risk for acute lung injury, especially among
susceptible individuals with asthma or respiratory infections. Research shows that regular
kretek smokers have 13−20 times the risk for abnormal lung function compared with
nonsmokers.
There is no evidence to indicate that kreteks are safe alternatives to conventional
cigarettes.
Pipe
Pipes are often reusable and consist of a chamber or bowl, stem and
mouthpiece. Tobacco is placed into the bowl and lit. The smoke is
than drawn through the stem and mouthpiece and inhaled.
Pipe smoking has been shown to cause gum disease and tooth loss,
cancer of the mouth, lip, tongue, throat, larynx, lung, pancreas,
kidney, bladder, colon, and cervix as well as leukemia and
diseases such as chronic obstructive lung disease, stroke, and
coronary heart disease. Pipe smoking can also cause "hairy
tongue," furry-looking bumps on the tongue that can become stained by tobacco, making
the tongue look discolored or black.
Smokeless Tobacco
The two main types of smokeless tobacco in the United States are
chewing tobacco and snuff.
Chewing tobacco comes in the form of
loose leaf, plug, or twist. Snuff is finely ground tobacco that can be
dry, moist, or in sachets (tea bag-like pouches).
Although some forms of snuff can be used by sniffing or inhaling into
the nose, most smokeless tobacco users place the product in their
cheek or between their gum and cheek. Users then suck on the
tobacco and spit out the tobacco juices, which is why smokeless
tobacco is often referred to as spit or spitting tobacco. The nicotine in
this tobacco is absorbed primarily through the skin in the mouth.
Smokeless tobacco is a significant health risk and is not a safe substitute for smoking
cigarettes.
Smokeless tobacco contains 28 cancer-causing agents (carcinogens). It increases the risk of
developing cancer of the oral cavity, is strongly associated with leukoplakia (a lesion of the
soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off)
and recession of the gums.
Using smokeless tobacco can lead to nicotine addiction and dependence and is not a safe
alternative to smoking.
Tobacco History Timeline
IN THE BEGINNING . . .
Huron Indian myth has it that in ancient times, when the land was barren and the people were starving, the Great Spirit sent forth a woman to save humanity. As she traveled over the world, everywhere her right hand touched the soil, there grew potatoes. And everywhere her left hand touched the soil, there grew corn. And when the world was rich and fertile, she sat down and rested. When she arose, there grew tobacco . . .
Prehistory: In 2010, tobacco was found that dates to the Pleistocene Era 2.5 million years ago. Paleontologists from the Meyer-Honninger Paleontology Museum discovered the small block of fossilised tobacco in the Maranon river basin in northeastern Peru.
Prehistory: As far as human use of tobacco, although small amounts of nicotine may be found in some Old World plants, including belladonna and Nicotiana africana, and nicotine metabolites have been found in human remains and pipes in the Near East and Africa, there is no indication of habitual tobacco use in the Ancient world, on any continent save the Americas.
The sacred origin of tobacco and the first pipe (Schoolcraft)
c. 6000 BCE: Experts believe the tobacco plant, as we know it today, begins growing in the Americas.
c.1 BCE: Experts believe American inhabitants have begun finding ways to use tobacco, including smoking (in a number of variations), chewing and in probably hallucinogenic enemas (by the Peruvian Aguaruna aboriginals).
c. 1 CE: Tobacco was "nearly everywhere" in the Americas. (American Heritage Book of Indians, p.41).
470-630 CE: Between 470 and 630 A.D. the Mayas began to scatter, some moving as far as the Mississippi Valley. The Toltecs, who created the mighty Aztec Empire, borrowed the smoking custom from the Mayas who remained behind. Two castes of smokers emerged among them. Those in the Court of Montezuma, who mingled tobacco with the resin of other leaves and smoked pipes with great ceremony after their evening meal; and the lesser Indians, who rolled tobacco leaves together to form a crude cigar. The Mayas who settled in the Mississippi Valley spread their custom to the neighboring tribes. The latter adapted tobacco smoking to their own religion, believing that their god, the almighty Manitou, revealed himself in the rising smoke. And, as in Central America, a complex system of religious and political rites was developed around tobacco. (Imperial Tobacco Canada, Tobacco History)
600-1000 CE: UAXACTUN, GUATEMALA. First pictorial record of smoking: A pottery vessel found here dates from before the 11th century. On it a Maya is depicted smoking a roll of tobacco leaves tied with a string. The Mayan term for smoking was sik'ar
Introduction:
The Chiapas Gift, or The Indians' Revenge?
Columbus' sailors find Arawak and Taino Indians smoking tobacco. Some take up the habit and begin to spread it worldwide.
1492-10-12: Columbus Discovers Tobacco; "Certain Dried Leaves" Are Received as Gifts, and Thrown Away.
On this bright morning Columbus and his men set foot on the New World for the first time, landing on the beach of San Salvador Island or Samana Cay in the Bahamas, or Gran Turk Island. The indigenous Arawaks, possibly thinking the strange visitors divine, offer gifts. Columbus wrote in his journal,
the natives brought fruit, wooden spears, and certain dried leaves which gave off a distinct fragrance. As each item seemed much-prized by the natives; Columbus accepted the gifts and ordered them brought back to the ship. The fruit was eaten; the pungent "dried leaves" were thrown away.
1492-10-15: Columbus Mentions Tobacco. "We found a man in a canoe going from Santa Maria to Fernandia. He had with him some dried leaves which are in high value among them, for a quantity of it was brought to me at San Salvador" -- Christopher Columbus' Journal
1492-11: Jerez and Torres Discover Smoking; Jerez Becomes First European Smoker
Rodrigo de Jerez and Luis de Torres, in Cuba searching for the Khan of Cathay (China), are credited with first observing smoking. They reported that the natives wrapped dried tobacco leaves in palm or maize "in the manner of a musket formed of paper." After lighting one end, they commenced "drinking" the smoke through the other. Jerez became a confirmed smoker, and is thought to be the first outside of the Americas. He brought the habit back to his hometown, but the smoke billowing from his mouth and nose so frightened his neighbors he was imprisoned by the holy inquisitors for 7 years. By the time he was released, smoking was a Spanish craze.
1493: Ramon Pane, a monk who accompanied Columbus on his second voyage, gave lengthy descriptions about the custom of taking snuff. He also described how the Indians inhaled smoke through a Y-shaped tube. Pane is usually credited with being the first man to introduce tobacco to Europe.
1497: Robert Pane, who accompanied Christopher Columbus on his second voyage in 1493, writes the first report of native tobacco use to appear in Europe, "De Insularium Ribitus."
1498: Columbus visits Trinidad and Tobago, naming the latter after the native tobacco pipe.
1499: Amerigo Vespucci noticed that the American Indians had a curious habit of chewing green leaves mixed with a white powder. They carried two gourds around their necks -- one filled with leaves, the other with powder. First, they put leaves in their mouths. Then, after dampening a small stick with saliva, they dipped it in the powder and mixed the adhering powder with the leaves in their mouths, making a kind of chewing tobacco.
Huron Indian myth has it that in ancient times, when the land was barren and the people were starving, the Great Spirit sent forth a woman to save humanity. As she traveled over the world, everywhere her right hand touched the soil, there grew potatoes. And everywhere her left hand touched the soil, there grew corn. And when the world was rich and fertile, she sat down and rested. When she arose, there grew tobacco . . .
Prehistory: In 2010, tobacco was found that dates to the Pleistocene Era 2.5 million years ago. Paleontologists from the Meyer-Honninger Paleontology Museum discovered the small block of fossilised tobacco in the Maranon river basin in northeastern Peru.
Prehistory: As far as human use of tobacco, although small amounts of nicotine may be found in some Old World plants, including belladonna and Nicotiana africana, and nicotine metabolites have been found in human remains and pipes in the Near East and Africa, there is no indication of habitual tobacco use in the Ancient world, on any continent save the Americas.
The sacred origin of tobacco and the first pipe (Schoolcraft)
c. 6000 BCE: Experts believe the tobacco plant, as we know it today, begins growing in the Americas.
c.1 BCE: Experts believe American inhabitants have begun finding ways to use tobacco, including smoking (in a number of variations), chewing and in probably hallucinogenic enemas (by the Peruvian Aguaruna aboriginals).
c. 1 CE: Tobacco was "nearly everywhere" in the Americas. (American Heritage Book of Indians, p.41).
470-630 CE: Between 470 and 630 A.D. the Mayas began to scatter, some moving as far as the Mississippi Valley. The Toltecs, who created the mighty Aztec Empire, borrowed the smoking custom from the Mayas who remained behind. Two castes of smokers emerged among them. Those in the Court of Montezuma, who mingled tobacco with the resin of other leaves and smoked pipes with great ceremony after their evening meal; and the lesser Indians, who rolled tobacco leaves together to form a crude cigar. The Mayas who settled in the Mississippi Valley spread their custom to the neighboring tribes. The latter adapted tobacco smoking to their own religion, believing that their god, the almighty Manitou, revealed himself in the rising smoke. And, as in Central America, a complex system of religious and political rites was developed around tobacco. (Imperial Tobacco Canada, Tobacco History)
600-1000 CE: UAXACTUN, GUATEMALA. First pictorial record of smoking: A pottery vessel found here dates from before the 11th century. On it a Maya is depicted smoking a roll of tobacco leaves tied with a string. The Mayan term for smoking was sik'ar
Introduction:
The Chiapas Gift, or The Indians' Revenge?
Columbus' sailors find Arawak and Taino Indians smoking tobacco. Some take up the habit and begin to spread it worldwide.
1492-10-12: Columbus Discovers Tobacco; "Certain Dried Leaves" Are Received as Gifts, and Thrown Away.
On this bright morning Columbus and his men set foot on the New World for the first time, landing on the beach of San Salvador Island or Samana Cay in the Bahamas, or Gran Turk Island. The indigenous Arawaks, possibly thinking the strange visitors divine, offer gifts. Columbus wrote in his journal,
the natives brought fruit, wooden spears, and certain dried leaves which gave off a distinct fragrance. As each item seemed much-prized by the natives; Columbus accepted the gifts and ordered them brought back to the ship. The fruit was eaten; the pungent "dried leaves" were thrown away.
1492-10-15: Columbus Mentions Tobacco. "We found a man in a canoe going from Santa Maria to Fernandia. He had with him some dried leaves which are in high value among them, for a quantity of it was brought to me at San Salvador" -- Christopher Columbus' Journal
1492-11: Jerez and Torres Discover Smoking; Jerez Becomes First European Smoker
Rodrigo de Jerez and Luis de Torres, in Cuba searching for the Khan of Cathay (China), are credited with first observing smoking. They reported that the natives wrapped dried tobacco leaves in palm or maize "in the manner of a musket formed of paper." After lighting one end, they commenced "drinking" the smoke through the other. Jerez became a confirmed smoker, and is thought to be the first outside of the Americas. He brought the habit back to his hometown, but the smoke billowing from his mouth and nose so frightened his neighbors he was imprisoned by the holy inquisitors for 7 years. By the time he was released, smoking was a Spanish craze.
1493: Ramon Pane, a monk who accompanied Columbus on his second voyage, gave lengthy descriptions about the custom of taking snuff. He also described how the Indians inhaled smoke through a Y-shaped tube. Pane is usually credited with being the first man to introduce tobacco to Europe.
1497: Robert Pane, who accompanied Christopher Columbus on his second voyage in 1493, writes the first report of native tobacco use to appear in Europe, "De Insularium Ribitus."
1498: Columbus visits Trinidad and Tobago, naming the latter after the native tobacco pipe.
1499: Amerigo Vespucci noticed that the American Indians had a curious habit of chewing green leaves mixed with a white powder. They carried two gourds around their necks -- one filled with leaves, the other with powder. First, they put leaves in their mouths. Then, after dampening a small stick with saliva, they dipped it in the powder and mixed the adhering powder with the leaves in their mouths, making a kind of chewing tobacco.
Memphis lemon law lawyer
Representation by a skilled Memphis lemon law lawyer is of the utmost importance if you are a consumer and you believe that you have a lemon on your hands. A dealership or manufacturer may have an attorney or even a team of attorneys whose sole purpose is to protect the interests of the company in lemon law claims and lawsuits. At the National Lemon Law Center, it is our primary goal to protect consumers in these situations by helping them find the right attorney for their case. You deserve a skilled Memphis lemon law attorney to fight for you and hold the dealership, seller or manufacturer responsible.
At the National Lemon Law Center, we help consumers throughout Memphis and the following areas find attorneys for their lemon law claims and lawsuits. Some of the types of claims we handle include:
- Cars
- Trucks
- SUVs
- Motorcycles
- Mini-vans
- All other types of motor vehicles
- Computers
Why a Memphis Lemon Law Attorney
Why should you work with a Memphis lemon law attorney? We believe that consumers deserve maximum protection as provided under state and federal law. Having a car, truck or SUV that’s a lemon is not only stressful and a hassle – it can also be dangerous. The right attorney can advise you from the very beginning to help you take the right actions as far as repairing the vehicle and filing a claim against the manufacturer or dealership.
With the help of a Memphis lemon law lawyer consumers just like you have the opportunity at a fair cash settlement from the responsible party. Your lawyer may also be able to negotiate for a replacement vehicle or computer or may be able to have the manufacturer, retail seller or dealer purchase the item back from you.
About Tennessee's Automobile Lemon Law for Used Cars
Tennessee lemon laws do not apply to the sale and purchase of used vehicles. The law specifies that only purchasers or new vehicles are protected.
-
What is the Lemon Law
- Tennessee lemon law states that the seller is responsible for giving a refund or an equal replacement vehicle to any purchaser of a new vehicle that is defective and that can't be repaired in three attempts or 30 days by the manufacturer, agent of the manufacturer or the dealer themselves. Refusal to provide a refund or replacement would be a crime.
Where to Find the Lemon Law
- Tennessee's lemon laws are in Title 55, Chapter 24 of the Tennessee Code. They were reprinted in the 2007 edition of the Tennessee Consumer Protection Act and Related Laws under the heading "Facts About the Lemon Law".
Defective Used Cars
- According to the rules of the Tennessee Motor Vehicle Commission, the purchaser of a defective vehicle from a licensed or unlicensed seller has no legal recourse. The dealer must honor any warranty they may have provided, but has no further obligation to the purchaser.
-
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