Toward a Tobacco-Free Society Chapter 11

Psychoactive Drugs and Changes in Brain Chemistry Psychoactive drugs produce most of their key effects by acting on brain chemistry in a characteristic fashion Consider the route of entry for different types of drugs Ex. Oral drugs dissolve in stomach absorbed into bloodstream liver, heart and lungs heart brain The more quickly a drug reaches the brain, the more likely the user is to become dependent

Psychoactive Drugs and Changes in Brain Chemistry Once in the brain, psychoactive drugs act on one or more neurotransmitters by increasing/decreasing their concentrations and actions Ex. Dopamine is thought to play a role in reinforcement Heroin, nicotine, alcohol, and amphetamines also affect dopamine levels

Who Uses Tobacco? ~15-18% of the U.S. population ~19% of males and ~15% of females ~480,000 deaths/year attributable to smoking On average, smokers die about 10 years earlier than nonsmokers The more education a person has, the less likely they are to smoke

Why People Use Tobacco Nicotine, is the powerful psychoactive drug that naturally occurs in tobacco is considered by many researchers to be the most addictive of all psychoactive drugs reaches the brain via the bloodstream in seconds

Why Start in the First Place? 90% of all new smokers in this country are children and teenagers 1,300 children and adolescents start smoking every day Average age to start smoking 13 for smoking tobacco 10 for smokeless tobacco Reasons why young people start smoking Rationalizing the dangers Danger is not immediate Can feel invincible Tobacco ads show smoking as exciting, glamorous or safe

Why Start Smoking?

Why People Use Tobacco Nicotine Addiction Loss of control Nicotine addiction can start after just a few cigarettes Most smokers who attempt to quit start again w/in a year Loss of control Tobacco users live according to a rigid cycle of need and gratification; on avg. smokers cannot go for no more than 40 min. between doses of nicotine Tolerance and withdrawal Sudden abstinence from nicotine produces predictable withdrawal symptoms: severe cravings, insomnia, confusion, tremors, difficulty concentrating, fatigue, muscle pains, headache, nausea, etc., increased heart rate and bp

Why People Use Tobacco Social and Psychological Factors Secondary reinforcers are activities the smoker associates with tobacco use

Health Hazards of Smoking Tobacco What’s in a Cigarette? Cigarettes contain ~ 600 chemical substances and thousands more are formed as it is burned

Carcinogens and Poisons in Tobacco Smoke 43 chemicals are linked to development of cancer Benzo(a)pyrene is a carcinogen- research has found that this causes mutations in lung cancer cells identical to those found in many lung cancer patients Urethane- also a carcinogen (directly causes cancer) Formaldehyde – kills microbes; causes eye irritation and coughing Arsenic-interferes with our DNA repair mechanisms Hydrogen cyanide-damages cilia Carbon monoxide-Displaces oxygen in red blood cells Other Additives Humectants, sugars, bronchodilators, ammonia, things to make sidestream smoke less obvious Formaldehyde: Formaldehyde is a chemical compound that is formed by the combustion process of cigarette smoking Tobacco smoke is one of our major sources of formaldehyde exposure Ammonia is a household cleaner. It is put into cigarette because it changes the properties of nicotine, and makes cigarettes more addictive. It is generally approved by the FDA to keep bacteria out of packaged meats.

“Light” and Low-Tar Cigarettes Low-tar, low-nicotine, or filtered cigarettes There is no such thing as a safe cigarette Users often smoke more, inhale more deeply, blocking ventilation holes Less likely to quit than smokers of regular cigarettes In 2010, federal law prohibited the use of terms such as “light” and “mild”

Menthol Cigarettes Menthols comprise about 30% of the total cigarette market Individuals smoking menthols absorb more nicotine and metabolize it slower than other groups Anesthetizing effect of menthol, means smokers inhale more deeply and hold smoke longer in the lungs, causing more damage.

Immediate Effects of Smoking Nicotine can either Excite or Tranquilize the Nervous System Depending on Dosage and tolerance of the smoker The beginning smoker often feels dizziness, faintness, rapid pulse, cold, clammy skin, nausea At low dosages nicotine constricts blood vessels, elevates HR and BP; higher doses can be lethal (esp. for children) (overdoses in adults are rare) Adrenal glands are stimulated to discharge adrenaline Can act as a sedative, relieving symptoms of anxiety and irritability Depresses hunger and dulls taste buds

The Long-Term Effects of Smoking Cardiovascular Disease Research indicates that the total amount of tobacco smoke inhaled is a key factor contributing to disease Coronary heart disease (CHD) causes just as many deaths from smoking as lung cancer Atherosclerosis leading to angina pectoris and heart attack

The Long-Term Effects of Smoking Lung cancer and other cancers Research has linked smoking to cancers of the trachea, mouth, esophagus, larynx, pancreas, bladder, kidney, breast, cervix, stomach liver, colon and skin Chronic obstructive pulmonary disease Emphysema and Chronic bronchitis

Figure 11.1 Annual Mortality Among Smokers Attributable to Smoking Figure 11.1 Annual mortality (# of deaths per year due to smoking) and morbidity (# of people w/ chronic illnesses due to smoking) among smokers

Figure 11.1 Annual Morbidity Among Smokers Attributable to Smoking Figure 11.1 Annual mortality (# of deaths per year due to smoking) and morbidity (# of people w/ chronic illnesses due to smoking) among smokers

Additional Health, Cosmetic, and Economic Concerns Ulcers Impotence Reproductive health problems Dental diseases Diminished physical senses Injuries Cosmetic concerns (crows feet around eyes and lips) Economic costs

Other Forms of Tobacco Spit (smokeless) tobacco Cigars and pipes Contains at least 28 chemicals known to cause cancer Cigars and pipes Users do not need to inhale in order to ingest nicotine - its absorbed through gums and mouth Cigars contain more tobacco than cigarettes more nicotine E-cigarettes Contain nicotine, other harmful substances

The Effects of Smoking on the Nonsmoker Environmental Tobacco Smoke (ETS) or Secondhand ETS consists of mainstream smoke (exhaled by smokers) and sidestream smoke (uninhaled smoke from a burning cigarette, cigar, or pipe) Sidestream smoke has twice the tar and nicotine,~ 3X the benzo(a)pyrene, CO, and ammonia EPA designated ETS as a class A carcinogen and Surgeon General has concluded that there is no safe level of exposure to ETS. ~ 54,000 people die/year from secondhand smoke

ETS Effects Develop cough, headaches, nasal discomfort, eye irritation, breathlessness, and sinus problems Allergies will be exacerbated Nonsmokers can be affected by effects of ETS hours after they leave a smoky environment Carbon monoxide lingers in bloodstream 5 hours later

Infants, Children, and ETS Children exposed to ETS are more likely to have SIDs and low-birth weight Bronchitis, pneumonia, and asthma Reduced lung function Middle-ear infections Lung cancer, emphysema, and chronic bronchitis later in life

Smoking and Pregnancy 12-20% of pregnant women smoke There is increased risk of miscarriage, premature birth, low birth weight, SIDS, and long term impairments in growth and intellectual development infants of non-smoking mothers have the lowest risk of SIDS. More than 40% of children who go to the emergency room for asthma live with smokers

How A Tobacco User Can Quit The best way to avoid all of the added chemicals in cigarettes is to stop smoking right now!! This very minute!! THE BENEFITS OF QUITTING ARE IMMEDIATE! Action at many levels CDC-Tips From Former Smokers Smokefree.gov Free telephone quit-lines 1-800-QUITNOW Individual action -Talk with your friends and family who have quit smoking and see what helped them, 'quit smoking' products http://www.cdc.gov/tobacco/campaign/tips/ http://smokefree.gov/

Benefits of Quitting Smoking There are benefits of quitting 20 minutes after quitting, BP and heart rate drop After 48 hrs. senses (taste, smell) may improve Within weeks, circulation improves, less wheezing, wounds may heal faster Within months, lung function improves, less fatigue Benefits continue for years after quitting!

Toward a Tobacco-Free Society Chapter 11