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Health Effects of Tobacco Use What else do we need to know ?

Everyone knows that smoking kills, as epidemiological studies have long identified the adverse health effects of tobacco use. Nevertheless, a significant proportion of adults still smoke, and youth smoking rates are increasing. These facts ensure that tobacco use will continue to have a major impact on personal tragedy and health care costs for decades to come. Although smoking is the leading preventable cause of death, some question the need to continue researching the health effects of smoking. What is the role of experimentally-based biomedical research in the current tobacco control effort? Tobacco use presents a complex challenge for attributing specific health effects to a certain means of exposure and thus establishing a cause-effect relationship. Unfortunately, in the health sciences, researchers operate with risk factors and probabilities, since getting definitive evidence of causality is easier said than done. As revealed in litigation documents, the tobacco industry has masterfully hindered tobacco control efforts by categorically challenging studies of tobacco’s health effects (and by concealing self-incriminating data from its own research). Recent advances in molecular epidemiology have successfully been used to establish links between specific components of tobacco smoke and associated diseases. However, these studies are less informative in characterizing the effects of relatively low level xposures or in understanding the combined (and possibly additive) effects among the individual components in tobacco smoke (1). In addition, not all smokers are equally likely to suffer from tobacco-related morbidity or mortality. Such variability in individual susceptibility to tobacco-related disease and the difficulty in estimating disease risks and probabilities compromises the public perception of risk. The intent of this article is to illustrate how, by the identification of pecific dose-response relationships and the identification of individual factors that American Indian and Alaska Natives (AIAN) have used tobacco products for thousands of years. They introduced their special ceremonial leaf to their European conquerors, who subsequently introduced it to the rest of the world. Before 1492, only native peoples of the Americas smoked tobacco, but by the 1650s, tobacco had spread throughout Europe, Asia and the coasts of Africa (1). Tobacco was once used mainly in spiritual rites, now AIAN use this substance principally as an addictive habit shared by the rest of the world. Today, AIAN have the highest smoking prevalence in the United States (2). This elevated use is due to a very complex, paradoxical and culturally driven relationship that this population has with tobacco.