Chapter 12Chapter 12TobaccoTobacco

Tobacco Use: Tobacco Use: Scope of the ProblemScope of the Problem

Cigarette smoking is the major, most pre-Cigarette smoking is the major, most pre-ventable cause of disease and premature ventable cause of disease and premature death in the U.S.death in the U.S.

1192 deaths a day and 435,000 annually 1192 deaths a day and 435,000 annually related to cigarette smokingrelated to cigarette smoking

One in four regular smokers will eventually One in four regular smokers will eventually die from tobacco usedie from tobacco use

Nicotine dependency is the most common Nicotine dependency is the most common form of drug addictionform of drug addiction

Current tobacco useCurrent tobacco use

In 1995, 61 million Americans smoked In 1995, 61 million Americans smoked cigarettescigarettes

This represents 29 % among the U.S. population This represents 29 % among the U.S. population age 12 and olderage 12 and older

An additional 6.9 million Americans use An additional 6.9 million Americans use smokeless tobaccosmokeless tobacco

This represents 3.3% of the populationThis represents 3.3% of the population

Current tobacco useCurrent tobacco use

From 1965 to 1993, smoking among adults From 1965 to 1993, smoking among adults decreased from 42% to 25%decreased from 42% to 25%

The average age of people who began daily The average age of people who began daily cigarette use was 19.1 years in 1993cigarette use was 19.1 years in 1993

The average age of people who began daily The average age of people who began daily cigarette use was 16.8 years in 1995cigarette use was 16.8 years in 1995

Since 1956, the amount of leaf tobacco in a Since 1956, the amount of leaf tobacco in a cigarette has declined by approximately cigarette has declined by approximately 25%25%

Modern government regulationModern government regulation

1964 - the Advisory Committee to the U.S. 1964 - the Advisory Committee to the U.S. Surgeon General reported that cigarette Surgeon General reported that cigarette smoking is related to lung cancersmoking is related to lung cancer

1965 - Congress passed legislation setting up 1965 - Congress passed legislation setting up the National Clearinghouse of Smoking the National Clearinghouse of Smoking and Healthand Health

Since 1970 - all cigarette packages and Since 1970 - all cigarette packages and cartons have had to carry a warning cartons have had to carry a warning

labellabel

Pharmacology of nicotinePharmacology of nicotine

NicotineNicotine is the substance in tobacco that is the substance in tobacco that causes dependencecauses dependence

It is a colorless, highly volatile liquid It is a colorless, highly volatile liquid alkaloidalkaloid

It initially stimulates and then depresses the It initially stimulates and then depresses the nervous systemnervous system

Pharmacology of nicotinePharmacology of nicotine

Amount of tobacco absorbed depends on:Amount of tobacco absorbed depends on: Exact composition of tobaccoExact composition of tobacco How densely the tobacco is packedHow densely the tobacco is packed Length of the cigarette smokedLength of the cigarette smoked Whether a filter is used and characteristic of Whether a filter is used and characteristic of

filterfilter The volume of smoke inhaledThe volume of smoke inhaled The number of cigarettes smokedThe number of cigarettes smoked

Physiological effectsPhysiological effects

In large doses, nicotine is highly toxicIn large doses, nicotine is highly toxic Symptoms of nicotine poisoningSymptoms of nicotine poisoning

Sweating, vomiting, mental confusion, Sweating, vomiting, mental confusion, diminished pulse rate, and breathing difficultydiminished pulse rate, and breathing difficulty

Respiratory failureRespiratory failure Stimulus effect - release of norepinephrineStimulus effect - release of norepinephrine Depression - caused by blocked nerve Depression - caused by blocked nerve

activityactivity Stimulates CVS - by releasing of epinephrineStimulates CVS - by releasing of epinephrine

A costly addictionA costly addiction

Q. How many packages of cigarettes are Q. How many packages of cigarettes are purchased annually in the U.S.?purchased annually in the U.S.?

A. 24 billionA. 24 billion

Q. Approximately how many deaths are Q. Approximately how many deaths are attributed to cigarette smoking each year?attributed to cigarette smoking each year?

A. 400,000A. 400,000

Q. In 1993, smoking-attributable costs for Q. In 1993, smoking-attributable costs for medical care reached medical care reached ? ? billion. billion.

A. $50 billionA. $50 billion

Mortality RatesMortality Rates About 10 million people in the U.S. have About 10 million people in the U.S. have

died from causes attributed to smoking died from causes attributed to smoking since the Surgeon General’s report on since the Surgeon General’s report on smoking and health in 1964.smoking and health in 1964.

The risk of premature death is significantly The risk of premature death is significantly higher (70%) for cigarette smokers than higher (70%) for cigarette smokers than for for nonsmokers.nonsmokers.

A 35-year-old male who smokes two packs a A 35-year-old male who smokes two packs a day has a life expectancy that is 8.1 years day has a life expectancy that is 8.1 years shorter than his nonsmoking counterpart.shorter than his nonsmoking counterpart.

Deaths attributable to cigarette smoking:1990Deaths attributable to cigarette smoking:1990

120,000

99,000

65,000

80,00023,000

31,000 Lung Cancer

Is chemic HeartDis eas eChronic LungDis eas eOther Diagnos es

Stroke

Other Cance rs

Comparative causes of annual deathsComparative causes of annual deathsin the U.S.: 1990in the U.S.: 1990

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Men and women who smoke have more Men and women who smoke have more chronic illnesses, including:chronic illnesses, including:

- emphysema & bronchitis- emphysema & bronchitis

- cardiovascular disease- cardiovascular disease

- cancer- cancer

- bronchopulmonary disease- bronchopulmonary disease Sudden infant death syndrome (SIDS)Sudden infant death syndrome (SIDS)

Chronic illnesses and smokingChronic illnesses and smoking

Tobacco use without smokingTobacco use without smoking

How safe are smokeless tobacco products How safe are smokeless tobacco products compared with cigarettes?compared with cigarettes? One pinch of snuff has effects equivalent to those One pinch of snuff has effects equivalent to those

derived from smoking 3 to 4 cigarettesderived from smoking 3 to 4 cigarettes

Snuffdipping

Tobaccochewing

Secondhand and sidestream smokeSecondhand and sidestream smoke Mainstream smokeMainstream smoke - smoke drawn through - smoke drawn through

the mouthpiece of the cigarettethe mouthpiece of the cigarette Sidestream smokeSidestream smoke - smoke released into the - smoke released into the

air directly from the lighted tip of a air directly from the lighted tip of a cigarettecigarette

Passive smokingPassive smoking - nonsmokers’ inhalation of - nonsmokers’ inhalation of tobacco smoketobacco smoke

Environmental tobacco smokeEnvironmental tobacco smoke - sidestream - sidestream smoke and exhaled mainstream smoke smoke and exhaled mainstream smoke

that is inhaled by the passive smokerthat is inhaled by the passive smoker

Who smokes?Who smokes? In 1994, estimated 60 million AmericansIn 1994, estimated 60 million Americans

This is 29% of population age 12 and olderThis is 29% of population age 12 and older Approximately 4.5 million youths aged 12-Approximately 4.5 million youths aged 12-

1717 This is about 20% of this populationThis is about 20% of this population

18-25-year-old age group has the highest rate 18-25-year-old age group has the highest rate of smokers (35%)of smokers (35%)

Whites have the highest past-month smoking Whites have the highest past-month smoking rate (29.7%), blacks have the 2nd rate (29.7%), blacks have the 2nd

highest highest (28.1%)(28.1%)

Quitting smokingQuitting smoking The primary methods for quitting smoking The primary methods for quitting smoking

are:are: Step-by-step manualsStep-by-step manuals AcupunctureAcupuncture “ “Cold turkey” techniquesCold turkey” techniques HypnosisHypnosis Nicotine gumNicotine gum Nicotine patchesNicotine patches Self-help with behavioral modificationSelf-help with behavioral modification

Social IssuesSocial Issues Economic interestsEconomic interests

Mickey Mouse vs. Joe CamelMickey Mouse vs. Joe Camel Tobacco as a gateway drugTobacco as a gateway drug Smoking prohibition vs. smokers’ rightsSmoking prohibition vs. smokers’ rights Smoke-free indoor airSmoke-free indoor air Youth access to tobaccoYouth access to tobacco LicensingLicensing AdvertisingAdvertising Taxing cigarettesTaxing cigarettes