The future up in smoke: The effects of tobacco use on population health in England and the Netherlands in the 16th-19th centuries

该项目旨在评估过去烟草使用对人口健康的影响。具体来说，本博士将提出以下主要研究问题：16世纪至19世纪，在英格兰和荷兰，烟草使用对人口健康的影响是什么——更具体地说，对以先天性异常和生长迟缓变化为代表的胎儿和孕产妇健康的影响是什么？这个问题将通过1)回顾烟草使用人口统计学的历史文献，结合莱斯特大学烟草、健康和历史（THH）项目收集的个人骨骼的生物分子证据，确定“谁”、“何时”和“多少”烟草使用来解决。此外，2)人类骨骼遗骸的宏观分析将提供发育迟缓和先天性异常迹象的患病率数据。用于此目的的遗骸来自荷兰和英国的五个考古遗址。收集到的数据将以两种方式进行评估：a)比较：分析来自不同地点、不同时期和不同社会阶层的骨骼标本的生物数据趋势；b)纵向：生命历程方法的理论框架将强调生命早期发展问题对成年期健康后果的影响。通过使用考古人类骨骼遗骸中的先天性异常作为个体水平的代理，我们可以推断早期生活环境，并将其与整个人群的健康结果联系起来。在后中世纪时期，我们看到欧洲人口健康状况下降，在此期间，传染病逐渐被慢性病取代，成为主要的死亡原因。在同一时期，烟草在英国和荷兰被引进并越来越受欢迎。尽管今天烟草使用对健康的不良影响是众所周知的，但烟草商品化与慢性病的出现之间的联系从未得到彻底调查。除了直接由烟草使用引起的疾病和死亡外，孕妇在怀孕期间接触烟草可对发育中的胎儿产生深远影响。人们早就知道，在怀孕早期吸烟会对胎儿健康产生不利影响。孕妇在妊娠早期（特别是在器官发生期间）接触烟草可引起各种各样的并发症，包括先天性疾病和异常。值得注意的是，在胎儿阶段接触烟草的有害影响不会在婴儿期结束。那些在婴儿期不致命的可能会在以后的生活中引起健康问题。如果一个人的发育在胎儿期被延迟，那么至少在11岁之前不会有明显的追赶性生长。慢性病发展缓慢，生活中遇到的危险因素越多，对与富裕相关的疾病的易感性就越高。因此，早年生活中的逆境会对成年后的健康产生重大影响，进而影响人口健康。在骨学评估中，一些先天性异常已经被常规记录为“非度量特征”，形态偏离生理“标准”，记录为不同的表型表达。这些特征的病因在很大程度上是未知的，但可能是由于胎儿发育早期的环境影响（即表观遗传学）而发展起来的。非度量特征预计不会对健康产生直接影响，但可能表明早年的健康状况不佳。因此，采用烟草前后以及使用者和非使用者之间的不同流行率可以确定接触烟草是一种潜在的致病因素。这个项目的结果将为烟草对人口健康的长期影响提供有价值的见解，这将阐明目前烟草的使用情况，这是世界上可预防疾病的主要原因

This project aims to assess the impact of tobacco use on population health in the past. Specifically, the following main research question will be posed in this PhD:What has been the impact of tobacco use on population health - and more specifically, foetal and maternal health as represented by changes in congenital abnormalities and growth delay - in England and the Netherlands between the 16th and 19th centuries?AimsThis issue will be addressed by 1) reviewing historic literature on tobacco use demographics, combined with biomolecular evidence from individual skeletons gathered by the Tobacco, Health and History (THH) project at the University of Leicester, identifying the 'who', 'when' and 'how much' of tobacco use. Additionally, 2) macroscopic analysis of human skeletal remains will provide data on the prevalence of signs of developmental delay and congenital abnormalities. The remains used for this purpose derive from five archaeological sites in the Netherlands and England. The collected data will be assessed in two ways: a) Comparatively: analysis of trends in biological data for skeletal collections from different locations, different time periods, and different social strata; b) Longitudinally: the theoretical framework of the life-course approach will highlight the influence of early-life developmental issues on adult-life health consequences. By using congenital abnormalities in archaeological human skeletal remains as a proxy at the individual level, we can infer early-life circumstances and correlate them to population-wide health outcomes.BackgroundIn the post-medieval period, we see a decline in population health in Europe during which infectious disease is gradually replaced by chronic disease as the main cause of death. During the same period, tobacco is introduced and gains in popularity in England and the Netherlands. Despite the known ill health effects of tobacco use today, the link between commodification of tobacco and the emergence of chronic disease has never been thoroughly investigated.Aside from the disease and death caused by tobacco use directly, maternal exposure to tobacco during pregnancy can have a profound influence on the developing foetus. It has long been known that smoking during the early stages of pregnancy can adversely influence foetal health. Maternal tobacco exposure during early pregnancy (especially during organogenesis) can cause a wide variety of complications, including congenital disease and anomalies. Significantly, detrimental effects of tobacco exposure during the foetal stage do not end in early infancy. Those that are not fatal in infancy may cause health problems in later life. If the development of an individual is delayed during the foetal stage, no catch-up growth is evident until at least the age of 11 years. Chronic disease develops slowly, and the more risk factors are encountered in life, the higher susceptibility to disease associated with affluence becomes. Adversity in early life can thus significantly impact health in adult life, and therefore population health. Some congenital anomalies are already routinely documented during osteological assessment as 'non-metric traits', morphological deviations from the physiological 'norm', recorded as different phenotypic expressions. The aetiology of these traits is largely unknown, but may develop as a result of environmental influences during early foetal development (i.e. epigenetics). Non-metric traits are expected to not have had a direct influence on health but might be indicative of early-life ill health. Therefore, different prevalence rates before and after the introduction of tobacco - and between users and non-users - can identify exposure to tobacco as a potential causative agent. The results of this project will provide valuable insight into the long-term effects of tobacco on population health, which will shed light on current tobacco use, the world's leading cause of preventable disease