Drinking Smoke: The Tobacco Syndemic in Oceania

11. Tobaccosis: The Tobacco Syndemic

191 Chapter 11 Tobaccosis The Tobacco Syndemic Perspectives that recognize syndemic relationships are necessary in studying the health of Pacific peoples given the extent of clustering of disease and other social conditions. They offer a way of assessing and developing inter-sectoral approaches to health and disease prevention and to understanding the way risks are concentrated and buffered over time in particular people and communities. —Judith Littleton and Julie Park, Tuberculosis and Syndemics As we launch into a full description and analysis of the tobacco syndemic in this final chapter, a few reminders about syndemics are in order. Please keep in mind that a syndemic is a complex, interrelated, multivariate phenomenon made up of both biological and sociocultural parts. The syndemic lies in the intertwining of these various parts and the ways their combinations affect diseases and health problems. Our concern is specifically with tobaccosis, that is, with how tobacco use connects to and is associated with various biological diseases on the one hand, and with their assorted environmental and sociocultural contexts on the other.1 The diseases, the environments, and the sociocultural contexts are all equally important parts of a syndemic. The argument is not that tobacco use by itself causes all the components that make up the tobacco syndemic, but rather that tobacco use is the key constituent that binds all of these parts together, thereby producing most of the morbidity, mortality, and health inequities that afflict Pacific Islanders today. From tobacco’s earliest introduction into the Pacific Islands it was 192 Chapter 11 either smoked in pipes or as cigars or chewed, sometimes along with betel nut. The dark-colored tobacco that was grown in the islands (principally in New Guinea, as we have seen) was air-cured. The same was true of the Cavendish , “Negro Head,” and twist tobacco that figured so importantly in trade between Islanders and Europeans beginning in the late eighteenth century. The nicotine in all these forms of tobacco—both homegrown and trade— has an alkaline pH that is readily absorbed through the oral mucosa. As a result, inhalation was not necessary for the smoker to obtain nicotine’s drug effect. Because alkaline nicotine irritates the pharynx, “most people find it aversive to inhale pipe or cigar smoke” (Slade 1992, 101), so we can assume that deep inhalation of tobacco smoke was relatively rare back then. While the methods of consuming tobacco that prevailed in Oceania until at least World War II entailed some health risk, they were relatively benign when compared with the risks of smoking industrially manufactured cigarettes. In the mid-nineteenth century, farmers in the eastern United States learned to flue-cure tobacco by forcing heat “from wood fires through curing barns without smoking the tobacco leaves” at temperatures above 150 degrees Fahrenheit (ibid.). The resultant flue-cured tobacco was light-colored—“blonde” or “bright”—and its abundance of sugars made its acidic smoke easier to inhale than that of the more traditional dark-colored tobacco. The acidic smoke is far less irritating and nicotine is transported to the brain more rapidly via the pulmonary alveoli in the lungs than it is through the oral mucosa. Not long after flue-cured tobacco was created, a second blonde variety—Burley tobacco—was discovered and “became especially popular with the plug tobacco manufacturers” (ibid., 102). Burley is air-cured, “but its leaves ferment to a light color” (ibid.), and while it was developed mainly to be chewed, sugared Burley tobacco produces an acidic smoke in many ways comparable to flue-cured tobacco. Flue-cured and Burley tobaccos became the mainstays of industrially manufactured cigarettes, and they are also widely sold for roll-your-own cigarettes such as those smoked in Aotearoa/New Zealand and in French Polynesia.2 Cigarettes pose a special problem for human health. Flue-cured and Burley tobacco burn hotter and release greater concentrations of carcinogens than the homegrown and trade tobaccos of an earlier era. Cigarette smokers inhale much more smoke and inhale more deeply than either pipe or cigar smokers, and “the main danger from manufactured cigarettes is the amount of smoke inhaled into the lungs” (Marshall 1991b, 1331). Tobacco smoke contains some six thousand different chemical compounds,3 and it is these rather than nicotine per se that cause tobaccosis. By “drinking” tobacco smoke deeply into their lungs, smokers set themselves up for the intertwined Tobaccosis 193 congeries of ailments that comprise the...