1. WHY CHEWING TOBACCO IS DANGEROUS TO HEALTH ?

Smokeless tobacco causes other health problems

Mouth and tooth problems
Many studies have shown high rates of leukoplakia in the mouth where users place
their chew or dip. Leukoplakia is a gray-white patch in the mouth that can become
cancer. These patches cant be scraped off. Theyre sometimes called sores but are
usually painless. The longer a person uses oral tobacco, the more likely they are to
have leukoplakia. Stopping tobacco usually clears the spot, but treatment may be
needed if there are signs of early cancer.
Tobacco stains teeth and causes bad breath. It can also irritate or destroy gum
tissue. Many regular smokeless tobacco users have receding gums, gum disease,
cavities and tooth decay (from the high sugar content in the tobacco), scratching
and wearing down (abrasion) of teeth, and bone loss around the teeth. The surface
of the tooth root may be exposed where gums have shrunken. All this can cause
teeth to loosen and fall out.
Other health problems
Other harmful health effects of smokeless tobacco include:
Heart disease and high blood pressure
Increased risk of heart attack and stroke
Increased risk of early delivery and stillbirth when used during pregnancy
Smokeless tobacco can lead to nicotine poisoning and even death in children who
mistake it for candy.
Smokeless tobacco causes nicotine addiction. This can lead to smoking and using
other forms of tobacco. In fact, using both smokeless tobacco and cigarettes is
becoming more common, especially in young people. This can lead to even greater
future health risks than they would have from using either product alone.
Dissolvable tobacco is of special concern because at this time little is known about
the health effects of these products. Still, its clear that they are another way for
people, especially youth, to experiment with tobacco products and become addicted
to nicotine. Because they are so tempting, they can easily poison children and pets.
2. WHY SMOKING IS DANGEROUS TO HEALTH ?
smoke is enormously harmful to your health. Theres no safe way to smoke.
Replacing your cigarette with a cigar, pipe, or hookah wont help you avoid the
health risks associated with tobacco products.
Cigarettes contain about 600 ingredients. When they burn, they generate more
than 7,000 chemicals, according to the American Lung Association. Many of those
chemicals are poisonous and at least 69 of them can cause cancer. Many of the
same ingredients are found in cigars and in tobacco used in pipes and hookahs.
According to the National Cancer Institute, cigars have a higher level of
carcinogens, toxins, and tar than cigarettes.
When using a hookah pipe, youre likely to inhale more smoke than you would from
a cigarette. Hookah smoke has many toxic compounds and exposes you to more
carbon monoxide than cigarettes do. Hookahs also produce more secondhand
smoke.
In the United States, the mortality rate for smokers is three times that of people
who never smoked, according to the Centers for Disease Control and Prevention.
Its one of the leading causes of preventable death.

Smokers are at great risk of developing oral problems. Tobacco use can cause gum
inflammation (gingivitis) or infection (periodontitis). These problems can lead to tooth
decay, tooth loss, and bad breath.

3. WHAT ARE THE ILL EFFECTS OF CHEWING TOBACCO ON HEALTH ?

Cancer risk and chewing tobacco

Users of snuff and chewing tobacco are at an increased risk for certain types of
cancer, most notably cancer of the oral cavity including cancers of the:

cheek,

gums,

lips,

tongue, and

floor and roof of the mouth.

Some studies have suggested a link between the use of chewing tobacco and the
development of:

Other health risks of chewing tobacco

Those who use chewing tobacco have an increased risk of:

developing gum diseases and gum recession (pulling away of the gum tissue
from the teeth);

leukoplakia (whitish patches inside the mouth that can become cancerous)
4. WHAT ARE THE ILL EFFECTS OF SMOKING ON HEALTH ?

The immune system is the bodys way of protecting itself from infection and disease. Smoking
compromises the immune system, making smokers more likely to have respiratory infections.
Smoking also causes several autoimmune diseases, including Crohns disease and rheumatoid
arthritis. It may also play a role in periodic flare-ups of signs and symptoms of autoimmune
diseases. Smoking doubles your risk of developing rheumatoid arthritis. Smoking has recently
been linked to type 2 diabetes, also known as adult-onset diabetes. Smokers are 30% to 40%
more likely to develop type 2 diabetes than nonsmokers. Additionally, the more cigarettes an
individual smokes, the higher the risk for diabetes. Recent studies show a direct relationship between
tobacco use and decreased bone density. Smoking is one of many factorsincluding weight, alcohol
consumption, and activity levelthat increase your risk for osteoporosis, a condition in which bones weaken
and become more likely to fracture. Significant bone loss has been found in older women and men who smoke.
Quitting smoking appears to reduce the risk for low bone mass and fractures. However, it may take several
years to lower a former smokers risk.In addition, smoking from an early age puts women at even higher risk for

osteoporosis. Smoking lowers the level of the hormone estrogen in your body, which can cause you to go
through menopause earlier, boosting your risk for osteoporosis.
5. WHAT ARE THE DIFFERENT ADVERTISING CAMPAIGN OF GOVT ?

As soon as you stop smoking your body begins to repair itself...

Within 6 hours

Your heart rate slows and your blood pressure decreases.

Within a day

Almost all of the nicotine is out of your bloodstream.

The level of carbon monoxide in your blood has dropped and oxygen can more easily reach your heart and
muscles.

Your fingertips become warmer and your hands steadier.

Within a week

Your sense of taste and smell may improve.

Your lungs natural cleaning system is starting to recover, becoming better at removing mucus, tar and dust
from your lungs (exercise helps to clear out your lungs).

You have higher blood levels of protective antioxidants such as vitamin C.

6. How Many People In India Are Addicted To Chewing Tobacco And Smoking?

Tobacco inflicts huge damage on the health of India's people and could be clocking up a
death toll of 1.5 million a year by 2020 if more users are not persuaded to kick the habit,
an international report said on Thursday.
Despite having signed up to a global treaty on tobacco control and having numerous
anti-tobacco and smoke-free laws, India is failing to implement them effectively, leaving

its people vulnerable to addiction and ill health, according to the report by the
International Tobacco Control Project (ITCP).
As a result, India, with a population of 1.2 billion, currently has around 275 million
tobacco users, the report said.

7. What are positive effects of tobacco advertising on peoples mind?

The advertising response function explains the relationship between consumption and
advertising. A brand-level advertising response function shows that the consumption of a
specific brand increases at a decreasing rate as advertising of that brand increases. That is,
the response function illustrates a diminishing marginal product of advertising. (2)Ultimately,
consumption is completely unresponsive to additional advertising. The assumptions of the
brand-level advertising response function also can be applied to industry-level advertising.
The industry level includes all brands and products in an industry; for example, the industry
level for alcohol would include all brands and variations of beer, wine, and spirits. The
industry-level advertising response function is assumed to be subject to diminishing
marginal product, as in the case of the brand-level function. The industry-level response
function is different from the brand-level response function, though, in that advertisinginduced sales must come at the expense of sales of products from other industries.
Increases in consumption come from new consumers, often youths, or from increases by
existing consumers.
The industry-level response function can be defined by measuring advertising with a timeseries of national data. This function also can be defined by measuring advertising with
cross-sectional data from local markets. The industry-level advertising response functions
provide two simple predictions: first, if advertising is measured at a high enough level, there
will be little or no consumption response; second, the greater the variance in the advertising
data, the greater the probability of measuring the effect of advertising in the upward sloping
section of the response function.
8. What are positive effects of tobacco advertising on peoples mind?

Pinpointing Youth Behaviors

Tobacco companies intimately study youth behavior and use their findings to create
images and themes attractive to youth.

They spend enormous resources tracking the behaviors and preferences of

youth under 21.

They knowingly place advertisements in magazines popular with youth.

They send direct mail pieces to youth without verifying their age.

They use youth-targeted flavors in their tobacco and smokeless tobacco, such as
Cherry Skoal, and candy-flavored cigarettes.

They promote cigarette-sized cigars and push youth-targeted promotional items

to promote their brands.

9. How people are responding to these advertising ?

10. How people are responding to these advertising ?

Percentage of high school students who smoked cigarettes on 1 or more of the 30 days preceding
the survey. Data first collected in 1991. (Youth Risk Behavior Survey, 19912011).
**Percentage of adults who are current cigarette smokers (National Health Interview Survey, 1965
2011).

11. Give Warning Levels of Chewing Tobacco ?

Currently, warning labels on all smokeless tobacco products, using wording required by
law, say that the products can cause mouth cancer, gum disease and tooth loss and are
not a safe alternative to cigarettes. Swedish Match, the seller, wants to eliminate these
specific disease warnings, and modify the label to say that No tobacco product is safe,
but this product presents substantially lower risks to health than cigarettes.
The company says greater use of snus in Sweden since the 1970s has contributed
significantly to reduced smoking rates and lower rates of tobacco-related diseases such
as lung and oral cancer.
12. have people give up the habits of chewing tobacco and smoking ?

Quitting smokeless is a little different

In many ways, quitting smokeless tobacco is a lot like quitting smoking. Both involve tobacco products
that contain nicotine, and both involve the physical, mental, and emotional parts of addiction. Many of the
ways to handle the mental hurdles of quitting are the same. But there are 2 parts of quitting that are
unique to oral tobacco users:

There is often a stronger need to have something in the mouth (an oral substitute) to take the
place of the chew, snuff, or pouch.
Mouth sores often start to go away and gum problems caused by the smokeless tobacco often
stop getting worse.

Making the decision to quit using smokeless tobacco is hard, but it has to be your
decision. Many people can encourage you to quit, but you have to want to quit. Quitting
smokeless tobacco is a lot like quitting smoking, however, there are a few parts of
quitting that are unique for smokeless tobacco users.

There is often a stronger need for having something in the mouth to take the
place of the chew, snuff, or pouch.

Mouth sores often slowly go away and gum problems will get better.

Aims
Participating in the course will:

Improve understanding of the patterns, determinants, and health effects of tobacco use,
as well as the biology and epidemiology of tobacco use
Increase appreciation of the differences and similarities among smoking cessation
interventions, including population and individual approaches
Increase knowledge of common programs and policies for protection and prevention
Increase recognition of tobacco industry opposition strategies
Increase familiarity with current policy debates in the field of tobacco control

Module-Specific Objectives
Upon completion of the Cessation module, participants will be able to identify the
complexities of quitting smoking, describe the roles that nicotine addiction and
motivation play in the quitting process, and define best practices for smoking cessation.
They will also be able to identify and describe pharmacological and nonpharmacological cessation strategies.

Upon completion of the Prevention module, participants will be able to identify patterns
of smoking initiation and summarize the factors that influence smoking uptake. They will
also be able to describe prevention interventions including legislation, programs and
advocacy campaigns.
Upon completion of the Protection module, participants will be able to describe what is
currently known about secondhand smoke, assess its effects on health, and list smokefree initiatives in Canada. They will also be able to identify and recommend initiatives to
counter tobacco industry opposition to smoke-free legislation.
Upon completion of the Evaluation module, participants will be able to describe the
importance of evaluating tobacco control initiatives and identify some of the frameworks
for evaluating tobacco control programs and policies. They will also be able to plan for
program and policy evaluation and learn how to report the results of an evaluation. They
will also be able to identify the ethics and politics of evaluation.

Major Conclusions
1. Cigarette smoking by youth and young adults has immediate adverse health
consequences, including addiction, and accelerates the development of
chronic diseases across the full life course.
2. Prevention efforts must focus on both adolescents and young adults because
among adults who become daily smokers, nearly all first use of cigarettes
occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
3. Advertising and promotional activities by tobacco companies have been
shown to cause the onset and continuation of smoking among adolescents
and young adults.
4. After years of steady progress, declines in the use of tobacco by youth and
young adults have slowed for cigarette smoking and stalled for smokeless
tobacco use.
5. Coordinated, multicomponent interventions that combine mass media
campaigns, price increases including those that result from tax increases,
school-based policies and programs, and statewide or community-wide
changes in smoke-free policies and norms are effective in reducing the
initiation, prevalence, and intensity of smoking among youth and young
adults.

Relevance
totally avoidable risk factor of CVD
Smoking is estimated to cause nearly 10 per cent of cardiovascular disease (CVD) and is the second leading cause of CVD,
after high blood pressure.1 The impact of tobacco smoke is not confined solely to smokers. Nearly 6 million people die from
tobacco use or exposure to secondhand smoke, accounting for 6 per cent of female and 12 per cent of male deaths
worldwide, every year. By 2030 tobacco-related deaths are projected to increase to more than 8 million deaths a
year.1 Smoking is, however, avoidable and advancing a tobacco-free world is a key strategic priority for the World Heart
Federation.
How tobacco causes cardiovascular disease
Tobacco acts in a number of ways to cause CVD. Its use, whether by smoking or chewing, damages blood vessels,
temporarily raises blood pressure and lowers exercise tolerance. Moreover, tobacco decreases the amount of oxygen that
the blood can carry and increases the tendency for blood to clot. Blood clots can form in arteries causing a range of heart
diseases that ultimately result in a stroke or sudden death.
Facts and figures

Smoking causes one-tenth of CVD worldwide.1

Globally, tobacco causes some 6 million deaths a year.1
The risk for coronary heart disease is 25 per cent higher in female smokers than in male smokers. 2
The risk of a non-fatal heart attack increases by 5.6 per cent for every cigarette smoked and persists even at only
one to two cigarettes per day.3
Chewing tobacco more than doubles the risk of heart attack.4
Awareness of links between smoking and cardiovascular disease remains low in many parts of the world: in China,
where the risk of stroke is very high, more than 70 per cent of all smokers do not know that smoking increases their
risk of having a stroke.5
Smoking bans have been found to decrease the rates of heart attacks;6 the evidence indicates that smokefree
laws are one of the most cost-effective ways to prevent heart attacks. 7

Secondhand smoke exposure and its link to cardiovascular disease

There is no risk-free level of exposure to secondhand smoke.8

Non-smokers who breathe secondhand smoke have between a 2530 per cent increase in the risk of developing a
CVD.9
Each year, exposure to secondhand smoke kills 600,000 people: 28 per cent of them are children.8 Of all adult
deaths caused by secondhand smoke, more than 80 per cent are from CVD. 10
In China and Bangladesh, more than half of all adults working indoors are exposed to secondhand smoke and in
Russia, India and Ukraine it is more than one quarter.11
In most countries surveyed around the world, the majority of smokers want to quit. 11
In 2002, exposure to secondhand smoke was found to kill as many women in China as active smoking. 12
Frequent exposure to tobacco smoke, whether in the workplace or home, has been found to nearly double the risk
of having a heart attack.10
Exposure to secondhand smoke worldwide causes an estimated 603,000 deaths each year among non-smokers,
including 379,000 deaths from ischaemic heart disease.10

Impact of quitting

Within 20 minutes of quitting smoking, blood pressure and pulse return to normal, and circulation improves. 13
Within eight hours, blood oxygen levels increase and the chances of a heart attack start to fall. 13
Within 24 hours, carbon monoxide is eliminated from the body and the lungs start to clear out mucus and debris. 13
Within 72 hours, the lungs can hold more air and breathing becomes easier.13
Within five years, the risk of a heart attack falls to about half that of a smoker.13
Within 10 years, the risk of lung cancer falls to around half that of a smoker.14
Within 15 years, the risk of CVD becomes nearly the same as someone who has never smoked. 15
Quitting when older is still worthwhile: among smokers who quit at age 66 years, men gained up to two years of
life, and women gained up to 3.7 years.16

Tobacco Research Methodology

Over the past half century, tobacco control arguably has been America's greatest public health success story.
Antismoking campaigninduced decisions to quit smoking or not to start in the first place have translated into
the avoidance of more than 5 million premature smoking-related deaths. On average, each of the affected
individuals has gained 15 to 20 years of life expectancy as a consequence ( 1). This is a truly remarkable public
health achievement.
The glass-half-empty side of the story is that tobacco consumption, primarily in the form of cigarette smoking,
remains by far the nation's leading behavior-related cause of death, illness, and disability. Four hundred and
thirty thousand Americans lose their lives annually to smoking, active or passive, constituting a sixth of all
deaths; another 9 million are ill or disabled as a result of smoking (2), and many observers worry that the
steady decline in the prevalence of smoking over the past four decades might be slowing significantly, with a
fifth of all adults remaining smokers (3). Evidence points to a more addicted population of continuing smokers.
Compared with previous generations of smokers, they are less educated and more likely to work in blue collar
occupations than in the past. Importantly, a substantial proportion of smokers suffer from a mental illness or
substance abuse comorbidity (4). And yet, as in the past, a sizable majority reports that they would like to quit
smoking cigarettes if they could.1
Although researchers in and outside of pharmaceutical companies seek more effective methods of helping
smokers to quit, the tobacco industry, including both mainstream companies and a new cottage industry of
innovators, has adopted a different approach: they are developing novel tobacco and nicotine-based products
that, they hope, health-concerned smokers might adopt instead of smoking conventional cigarettes. The
products range from cigarettes modified to reduce yields of specific toxins to low-nitrosamine forms of
smokeless tobacco, from dissolvable tobacco lozenges to new electronic cigarettes (5,6). Unlike the
pharmaceuticals, these products have been brought to the market at the whim of their producers, subject to
absolutely no regulation regarding their safety or efficacy as substitutes for conventional cigarettes.
Until now, that is. In 2009, Congress passed and President Obama signed legislation giving the U.S. Food and
Drug Administration (FDA) the responsibility for regulating aspects of the sale and marketing of cigarettes,
smokeless tobacco, and related products. 2The agency's regulatory authority with regard to this product
category differs dramatically from its responsibilities in its more traditional domains of pharmaceuticals, medical
technologies, cosmetics, and food products, in which agency attention focuses narrowly on product efficacy
and/or safety. Tobacco products are inherently unsafe, so the herculean task confronting the FDA will be to
address issues of relative harm and population consequences of the introduction of novel products. Still, the
critical fact is that companies wishing to bring novel tobacco and nicotine-related products to market will no
longer be able to do so without regulatory approval. The FDA now also has the ability to impose performance
standards for all tobacco products, including conventional ones. These performance standards would also be
implemented in the context of relative harm.

Just as the tobacco control story itself represents only half a victory, the multi-year battle to secure FDA
regulation must be considered only a partial win for public health. We the people now have at least partial
authority to regulate the marketing of what has historically been the world's most toxic category of legal
products. However, we don't have complete authority, nor do we yet possess the wherewithal to do the job
assigned to the FDA. At the core of effective regulation in all of FDA's domains lies a base of scientific
knowledge, both the methods to assess the safety, efficacy, and toxicities of products and the results of years of
research to develop a foundation of data upon which subsequent studies, and regulatory decisions, can rely.
For the task of assessing the relative toxicity of myriad novel tobacco and nicotine-related products, the
essential need to achieve sound regulation, the cupboard is nearly bare.
Although the paucity of existent research represents a problem, it also constitutes a challenge and an
opportunity. More precisely, it constitutes a challenge that is an opportunity, an opportunity to bring objective
evaluation to a class of products that heretofore has wreaked havoc with the public's health, and thereby to
reduce the morbidity and mortality associated with the core product, the cigarette. Although the interest in
tackling this challenge in the United States is driven by the new FDA legislation, the opportunity it affords
extends to all the world, for the toll of tobacco knows no geographic boundaries.