Toward a Tobacco-Free Society Chapter 11

© 2010 McGraw-Hill Companies. All Rights Reserved. 2 Use of Tobacco Why 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

© 2010 McGraw-Hill Companies. All Rights Reserved. Figure 11.1 Annual mortality and morbidity among smokers attributable to smoking 3

© 2010 McGraw-Hill Companies. All Rights Reserved. 4 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 DRD2 - Associated with brain chemical dopamine

© 2010 McGraw-Hill Companies. All Rights Reserved. Table 11.1 Who Smokes? 5

© 2010 McGraw-Hill Companies. All Rights Reserved. 6 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. 7 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 8 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 9 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 10 “Light” and Low-Tar Cigarettes  Low-tar, low-nicotine, or filtered cigarettes  No such thing as a safe cigarette  Often smoke more

© 2010 McGraw-Hill Companies. All Rights Reserved. 11 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 12 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 13 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 14

© 2010 McGraw-Hill Companies. All Rights Reserved. 15 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. 16 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 17 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  Clover cigarettes and Bidis Twice the tar, nicotine, and carbon monoxide

© 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. 19 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”.

© 2010 McGraw-Hill Companies. All Rights Reserved. 20 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 21 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 22 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.

© 2010 McGraw-Hill Companies. All Rights Reserved. 23 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 24 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 25 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.

© 2010 McGraw-Hill Companies. All Rights Reserved. 26 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

© 2010 McGraw-Hill Companies. All Rights Reserved. 27 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 QUITNOW Department of Health and Human Services Smoking cessation products Chantix (Varinicline) Zyban (Bupropion) Nicotine replacement products Patches, gums, lozenges, nasal sprays, and inhalers

Toward a Tobacco-Free Society Chapter 11