Toward a Tobacco-Free Society

Chapter 11

Use of Tobacco
Why People use Tobacco
71 Million Americans, including 13.7 million collegeaged Americans. 2008, nearly 21% of Americans age 18 describe themselves as current smokers.

Nicotine Addiction

Powerful psychoactive drug Reaches Brain via bloodstream in seconds Most physically addictive of the psychoactive drugs. Loss of control Tolerance and Withdrawal
2

2010 McGraw-Hill Companies. All Rights Reserved.

Figure 11.1 Annual mortality and morbidity among smokers attributable to smoking

2010 McGraw-Hill Companies. All Rights Reserved.

Social and Psychological Factors

Established habits or cues to trigger smoking Secondary reinforcers. Genetic Factors:

Specific Genes
CYP2A6

influences the way in which nicotine is metabolized People with slow CYP2A6, nicotine remains in the system longer Associated with brain chemical dopamine

DRD2
4

2010 McGraw-Hill Companies. All Rights Reserved.

Table 11.1 Who Smokes?

2010 McGraw-Hill Companies. All Rights Reserved.

Why Start in the First Place?

Children and teenagers make-up 90% of all new smokers in this country. Thousands of children and adolescents (12-17) start smoking everyday. Average age
13 for smoking 10 for spit tobacco

2010 McGraw-Hill Companies. All Rights Reserved.

Characteristics which could increase the potential for use.

A parent or sibling uses tobacco Peers use tobacco Child comes from blue-collar family Child comes from low-income home Single parent. Performs poorly in school Child drops out of school Has positive attitudes towards tobacco
7

2010 McGraw-Hill Companies. All Rights Reserved.

Health Hazards

Tobacco adversely affects nearly every part of the body. Contains hundreds of damaging chemical substances. Unfiltered cigarettes = 5 billion particles per cubic MM 50,000 times more than polluted urban air Condensed particles in the cigarette produce the tar
8

2010 McGraw-Hill Companies. All Rights Reserved.

Carcinogens and Poisons

43 chemicals are linked to cancer (Carcinogen)

Benzo(a)pyrene Urethane

Cocarcinogens
Combine with other chemicals to cause cancer

Poisonous substances
Arsenic Hydorgen cyanide

Carbon monoxide
400 times greater than is considered safe in industrial workplaces Displaces oxygen in red blood cells

Additives
Nearly 600 chemicals
9

2010 McGraw-Hill Companies. All Rights Reserved.

Light and Low-Tar Cigarettes

Low-tar, low-nicotine, or filtered cigarettes No such thing as a safe cigarette Often smoke more

10

2010 McGraw-Hill Companies. All Rights Reserved.

Menthol Cigarette

70% of African Americans smoke these

Absorb more nicotine and metabolize it slower

Anesthetizing effect of menthol, inhale more deeply and hold smoke longer in the lungs

11

2010 McGraw-Hill Companies. All Rights Reserved.

Immediate Effects

Acts on the brain either by exciting or tranquilizing the nervous system

Mild nicotine poisoning Stimulates the cerebral cortex Stimulates the discharge of adrenaline Physiological effects on the body

12

2010 McGraw-Hill Companies. All Rights Reserved.

The Long-Term Effects

Cardiovascular Disease
Coronary Heart Disease (CHD) Atherosclerosis
plaques

Angina pectoris Myocardial infarction Stroke Aortic aneurysm Pulmonary heart disease

Lung and other cancers

Benzo (a) pyrene

Chronic Obstructive Lung Disease

Emphysema Chronic Bronchitis

Other Respiratory Damage

13

2010 McGraw-Hill Companies. All Rights Reserved.

14

2010 McGraw-Hill Companies. All Rights Reserved.

Additional Health, Cosmetic, and Economic Concerns

Ulcers Impotence Reproductive health problems Dental diseases Diminished physical senses Injuries Cosmetic concerns Economic costs
2010 McGraw-Hill Companies. All Rights Reserved.

15

Cumulative Effects

Males before 15 yrs. old are half as likely to live to 75 versus those who did not smoke Females with similar habits reduce life expectancy by more than 10 years Female smokers spend 17% more sick days in bed than nonsmokers Both men and women show a greater rate of acute and chronic diseases
16

2010 McGraw-Hill Companies. All Rights Reserved.

Other Forms of Tobacco

Spit (Smokeless) Tobacco

More than 6.6 million adults 8% of all high school students

Cigar and Pipes

Cigar smoking has increased by 148% from 1993-2006.

Clover cigarettes and Bidis

Twice the tar, nicotine, and carbon monoxide
17

2010 McGraw-Hill Companies. All Rights Reserved.

Figure 11.5 Tobacco use among middle school and high school students

18

2010 McGraw-Hill Companies. All Rights Reserved.

The Effects of Smoking on the Nonsmoker

Environmental Tobacco smoke (ETS)

EPA designated ETS as a class A carcinogen Department of Health and Human Services National Toxicology Program - known human carcinogen Surgeon General 2006 there is no safe level of exposure to ETS; even brief exposure can cause serious harm.
19

2010 McGraw-Hill Companies. All Rights Reserved.

Environmental Tobacco Smoke

Mainstream smoke
Smoke exhaled by smokers

Sidestream smoke
Smoke from the burning end of a cigarette, cigar, or pipe.

85% of smoke in a room is second hand

Twice the tar and nicotine Three times the benzo(a)pyrene Three times the ammonia

Smoke from a cigar can be even more dangerous

30 times more carbon monoxide
20

2010 McGraw-Hill Companies. All Rights Reserved.

ETS Effects

Develop cough, headaches, nasal discomfort, eye irritation, breathlessness and sinus problems Allergies will be exacerbated Causes 3,000 deaths due to lung cancer Contributes to about 35,000 overall deaths each year. 20% increase in the progression of atherosclerosis. Contributes to increased Asthma attacks

21

2010 McGraw-Hill Companies. All Rights Reserved.

Infants, Children, and ETS

More likely to develop

Bronchitis, pneumonia,& respiratory infections More complications from asthma Increased chance of SIDS Low-birth weight Bronchitis

Chemicals from smoking show up in breast milk Children inhale three times more pollutants per unit of body weight than adults.
22

2010 McGraw-Hill Companies. All Rights Reserved.

Avoiding ETS

Speak up tactfully Display reminders Dont allow smoking in your home or room Open a window Sit in the nonsmoking section Fight for a smoke-free environment Discuss quitting strategies
23

2010 McGraw-Hill Companies. All Rights Reserved.

Smoking and Pregnancy

Estimated 4600 infant deaths in the U.S. Miscarriage, premature birth, low birth weight, long term impairments in growth and intellectual development Possible higher risks of getting cancer 16% of pregnant women smoke

24

2010 McGraw-Hill Companies. All Rights Reserved.

Cost of Tobacco Use to Society

Lost productivity from sickness, disability, and premature death makes it close to $167 billion per year. 1998 Master Settlement Agreement (MSA)
Tobacco companies have to pay $206 billion over 25 years. Limits or bans certain types of advertising, promotions, and lobbying.
25

2010 McGraw-Hill Companies. All Rights Reserved.

What Can Be Done?

Action at the Local level Action at the State and Federal level FDA EPA OSHA International Action WHO Action in the private sector Individual Action
26

2010 McGraw-Hill Companies. All Rights Reserved.

How A Tobacco User Can Quit

50.2 % of all adults who have smoked have quit. The Benefits of Quitting
Table 11.2

Options for quitting

Smoking cessation programs 1-800-QUITNOW
Department of Health and Human Services

Smoking cessation products

Chantix (Varinicline) Zyban (Bupropion)

Nicotine replacement products

Patches, gums, lozenges, nasal sprays, and inhalers
27

2010 McGraw-Hill Companies. All Rights Reserved.

Toward a Tobacco-Free Society

Chapter 11