Must Know Details on Effects of Tobacco on Women
Author: Dr. Arunima Chakraborty
Chewable tobacco is more prevalent towards the poor, less educated and socially backward class. When exposed to tobacco the saliva alters its behavior and loses the antioxidant quality which leads to increased number of harmful bacteria, killing the good microbial flora. The epidemic of tobacco use is one of the greatest threats to global health today, and India is the fourth largest consumer and third largest producer of tobacco after China and Brazil. According to the most recent study by the WHO, in June, 2019 there were 8 million deaths globally due to this and 30% of them were women. More than 7 million of these deaths are directly linked to tobacco addiction while 1.2 million are the result of second hand smoke. There are various ways to use tobacco, it can be sniffed sucked or smoked. The leading cause of mortality and morbidity in India is because of tobacco and its byproducts and studies have shown that India had the highest number of deaths because of oral cancer.[1-9]
Smoking in women is directly linked to 80% of the COPD deaths each year, which is greater than stroke. The risk of dying of lung cancer is 20times more in female smokers than nonsmokers. Tobacco smoke contains thousands of noxious chemicals including the gaseous and solid particulate phase. The gaseous phase contains carbon monoxide, ammonia, formaldehyde, hydrogen cyanide and many other deadly irritants including 60other carcinogenic compounds. While the solid phase is also called the ‘tar’ which itself is made out of toxic chemicals like benzene. So passive smoking also known as “second hand smoke” is also as dangerous and cause of lung cancer with heart ailments for the women who have never smoked. Women using tobacco have an increased risk of periodontal and gingival diseases, dental caries and halitosis.[4, 10]
On the aesthetic point of view women who smoke age faster, which is a growing concern in the population. Smoking tobacco of any kind causes facial wrinkles and graying of hair prematurely. It has many adverse reproductive and early childhood effects including increased risk of infertility, premature delivery, still birth, low birth weight and sudden infant death syndrome (SIDS). Women users have observed to be showing early menopausal symptoms 3-4years prior to the actual age with a lot of complications. And women who smoke post-menopausal have low bone density which later leads to osteoporosis and even risk of hip fracture.
The Surgeons general report also suggested that women smokers are more likely to suffer from depression and anxiety disorders than the later. Tobacco usage also have harmful effects on clinical outcomes including surgical and non-surgical therapies among women, as it affects the healing process. On the oral cavity, Tobacco not only causes discoloration of teeth, periodontitis, dental caries, gingivitis, ANUG, but also pre-cancerous lesions like erythroplakia, leukoplakia, oral sub mucous fibrosis.
Nicotine is the main component in tobacco products that makes tobacco users addicted to it. It is a stimulant with properties similar to cocaine and other amphetamines. Nicotine is one thousand times more addictive than alcohol, 10-100 times more than barbiturates and 5-10 times more than cocaine or morphine. The addictive effect of nicotine is due to its capacity to release the happy hormone or dopamine- a chemical in the brain that is associated with feelings of pleasure. Hence with time this effect wears off and smokers and chewers need greater amounts of nicotine in any form to achieve the same level of satisfaction. Therefore, the Tobacco users self-medicate themselves by continuing the use of different products.
The Oral changes due to tobacco are 1) irritation of the oral mucosa 2) mucosal drying 3) higher intraoral pH 4) alterations of immune response. Tobacco can be used in the form of chewable and smoke, these include beedi ,cigarettes, hookah ,paan, zarda etc. All these items also contain arsenic and recently in a study, it was revealed that the concentration of arsenic in the scalp hair and blood samples of tobacco chewing patients is more prevalent than non-chewers. Arsenic is one of the most dangerous and life threatening elements to be found in a human body causing several bodily dysfunctioning.
HEALTH EFFECTS OF TOBACCO
Globally smoking accounts for 1 in 20 deaths among females.10 Smoking both actively and passively is injurious to health.10 Approximately half of these users die early before the age of 45-50 years. Below are some harmful health effects of tobacco that are important for women to be aware of:
Women smokers are likely to develop
- More painful and irregular periods
- Low estrogen levels leading to mood swings, fatigue and vaginal dryness
- Early onset of menopause
- die Issues for pregnancy
There is no cure for COPD which occurs commonly among tobacco smokers. Every year more women of COPD than men in an alarming amount.
- Tobacco users have increased risk of heart diseases than non-users.
- Women who smoke while using oral contraceptives and are above the age of 35years have a greater risk of heart diseases.
- Women users are more prone to die from an abdominal aortic aneurysm, which is weakening of the blood vessels that carry blood from the heart to the body.
- Tobacco users are facing increased risk of several kinds of cancer including cervical,lung, kidney, oral, pancreatic, breast, colorectal cancers, etc.
- As already mentioned earlier the carcinogenic property of nicotine that is present in tobacco is the main culprit behind the cause of several kinds of cancer.
- When female smokers become smoke free the mind and body begin to heal by itself and helps the patient to fight the cancer.5
PREGNANCY AND TOBACCO:
- There are several effects of tobacco over the pregnant woman and her child. It hampers the normal brain function and development before birth and during early childhood.
- The risk of developmental anomalies in these cases is higher causing syndromes like cleft lip and cleft palate.
- Above that it also affects the fertility of the individual with increased frequency of pelvic inflammatory diseases, which is also a huge factor in ectopic pregnancy.
- Smoking which is one of the most common media of tobacco is directly linked with the sensitive subject of weight gain in females.
- Women are particularly sensitive with weight gain issues at all stages of smoking.
- Compared to their non-obese peers, obese women are more likely to develop nicotine addiction. And among women who are trying to quit smoking are held back by the fear of gaining weight again.
- And hence it should be made clearer and more aware that in the process of quitting this habit of smoking a significant amount of weight is gained but this decision can avoid other life-threatening effects of smoking.
- Moreover, post cessation weight can always be reduced easily by healthy food choices and exercise.
For some unknown reason some of the effects due to the usage of tobacco vary from male to female and is seen to be more deleterious in females. Hence it is said that if we educate the women, we educate the society, for that interventions among both men and women are required. These awareness programs and discussions should not only be limited to the well to do families but also reach the population with lower socioeconomic status who require the most of these programs.
This can be achieved by two ways:
- By the government in form of camps, acts, street plays and in general motivating the population to visit the nearest hospital to the dentists and hygienists
- By the dentists, with the help of public health dentists: They can play an immense role by acting as a role model and a mentor to the affected population and show them the correct path.
Tobacco cessation centers (TCC) should be set up to counsel the patient for a healthier lifestyle and to motivate them for the greater good. This can be achieved with the help of 5 As approach that is Ask, Advice, Assess, Assist and Arrange and the 5 R approach at the chair side which is Relevance, Risk, Reward, Roadblock, Repeat. These procedures should be discussed and interacted with the patient at her every visit. Prevention is always the economical option and hence the government with the help of dentists should find out the high-risk group and divide the users into high, medium and low risk groups and act accordingly. These groups should be at first identified properly and then approached in an individual or community level.
Urban and rural health centers might also help with more visual aids like pamphlets, posters, ads etc. of the effects of tobacco in both oral and general health of the patients. All these efforts must surely motivate the females of all generations to choose a healthier lifestyle and quit tobacco for the better future
- Mubeen K, Chandrashekhar H, Kavitha M, Nagarathna S. Effects of tobacco on oral health an overview, J Evol Med Dental Sci 2013;2 (20); 3523-24.
- Tobacco and oral health. World oral health report, WHO GENEVA. 2003,
- Iida H, Kumar JV, Kopycka-Kedzierawski DT, Billings RJ. Effect of tobacco smoke on the oral health of US women of childbearing age. Journal of Public Health Dentistry. 2009;69(4):231–241.
- The health consequences of smoking – 50 years of progress: 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, 2014.
- US Department of Health and Human services, Smoking’s impact on women’s health. August 30, 2002 / 51(RR12);1-30
- Allen AM, Oncken C, Hatsukami D. Women and Smoking: The Effect of Gender on the Epidemiology, Health Effects, and Cessation of Smoking. Curr Addict Rep 2014; 1: 53.
- World health organization, World Health Organization report on global tobacco epidemic, 2019.
- Muthukrishnan A, Warnakulasuriya S. Oral health consequences of smokeless tobacco use. Indian J Med Res 2018; 148:35-40
- Peter S. Essentials of Preventive and Community Dentistry, Fourth edition, 149-57
- Carranza’s, Clinical Periodontology, Second south Asia edition, 127-32
[Author: Dr. Arunima Chakraborty, Graduated from Institute of Dental Sciences, Bhubaneswar, Odisha]