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Toward a Tobacco-Free Society

Chapter 11

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Use of TobaccoWhy People use Tobacco

71 Million Americans, including 13.7 million college-aged 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

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Figure 11.1 Annual mortality and morbidity among smokers attributable to smoking

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Social and Psychological Factors

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

Specific GenesCYP2A6 – influences the way in which nicotine is metabolized People with slow CYP2A6, nicotine remains in the system

longer

DRD2 - Associated with brain chemical dopamine

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Table 11.1 Who Smokes?

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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

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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

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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

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Carcinogens and Poisons 43 chemicals are linked to cancer (Carcinogen)

Benzo(a)pyreneUrethane

CocarcinogensCombine with other chemicals to cause cancer

Poisonous substancesArsenicHydorgen cyanide

Carbon monoxide400 times greater than is considered safe in industrial workplacesDisplaces oxygen in red blood cells

AdditivesNearly 600 chemicals

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“Light” and Low-Tar Cigarettes Low-tar, low-nicotine, or filtered cigarettes No such thing as a safe cigarette Often smoke more

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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

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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

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The Long-Term Effects Cardiovascular Disease

Coronary Heart Disease (CHD)Atherosclerosis

plaques

Angina pectorisMyocardial infarctionStrokeAortic aneurysmPulmonary heart disease

Lung and other cancersBenzo (a) pyrene

Chronic Obstructive Lung DiseaseEmphysemaChronic Bronchitis

Other Respiratory Damage

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Additional Health, Cosmetic, and Economic Concerns Ulcers Impotence Reproductive health problems Dental diseases Diminished physical senses Injuries Cosmetic concerns Economic costs

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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

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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 BidisTwice the tar, nicotine, and carbon monoxide

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Figure 11.5 Tobacco use among middle school and high school students

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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”.

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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 handTwice the tar and nicotineThree times the benzo(a)pyreneThree times the ammonia

Smoke from a cigar can be even more dangerous30 times more carbon monoxide

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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

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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.

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Avoiding ETS Speak up tactfully Display reminders Don’t allow smoking in your home or room Open a window Sit in the nonsmoking section Fight for a smoke-free environment Discuss quitting strategies

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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

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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.

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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

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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 programs1-800-QUITNOW

Department of Health and Human Services

Smoking cessation productsChantix (Varinicline)Zyban (Bupropion)

Nicotine replacement productsPatches, gums, lozenges, nasal sprays, and inhalers

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Toward a Tobacco-Free Society

Chapter 11