Chapter 12 Tobacco

Tobacco Use: Scope of the Problem  Cigarette smoking is the major, most pre- ventable cause of disease and premature death in the U.S.  1192 deaths a day and 435,000 annually related to cigarette smoking  One in four regular smokers will eventually die from tobacco use  Nicotine dependency is the most common form of drug addiction

Current tobacco use  In 1995, 61 million Americans smoked cigarettes  This represents 29 % among the U.S. population age 12 and older  An additional 6.9 million Americans use smokeless tobacco  This represents 3.3% of the population

Current tobacco use  From 1965 to 1993, smoking among adults decreased from 42% to 25%  The average age of people who began daily cigarette use was 19.1 years in 1993  The average age of people who began daily cigarette use was 16.8 years in 1995  Since 1956, the amount of leaf tobacco in a cigarette has declined by approximately 25%

Modern government regulation  the Advisory Committee to the U.S. Surgeon General reported that cigarette smoking is related to lung cancer  Congress passed legislation setting up the National Clearinghouse of Smoking and Health  Since all cigarette packages and cartons have had to carry a warning label

Pharmacology of nicotine  Nicotine is the substance in tobacco that causes dependence  It is a colorless, highly volatile liquid alkaloid  It initially stimulates and then depresses the nervous system

Pharmacology of nicotine  Amount of tobacco absorbed depends on:  Exact composition of tobacco  How densely the tobacco is packed  Length of the cigarette smoked  Whether a filter is used and characteristic of filter  The volume of smoke inhaled  The number of cigarettes smoked

Physiological effects  In large doses, nicotine is highly toxic  Symptoms of nicotine poisoning  Sweating, vomiting, mental confusion, diminished pulse rate, and breathing difficulty  Respiratory failure  Stimulus effect - release of norepinephrine  Depression - caused by blocked nerve activity  Stimulates CVS - by releasing of epinephrine

A costly addiction Q. How many packages of cigarettes are purchased annually in the U.S.? Q. How many packages of cigarettes are purchased annually in the U.S.? A. 24 billion Q. Approximately how many deaths are attributed to cigarette smoking each year? A. 400,000 Q. In 1993, smoking-attributable costs for medical care reached ? billion. A. $50 billion

Mortality Rates  About 10 million people in the U.S. have died from causes attributed to smoking since the Surgeon General’s report on smoking and health in  The risk of premature death is significantly higher (70%) for cigarette smokers than for nonsmokers.  A 35-year-old male who smokes two packs a day has a life expectancy that is 8.1 years shorter than his nonsmoking counterpart.

Deaths attributable to cigarette smoking:1990

Comparative causes of annual deaths in the U.S.: 1990

 Men and women who smoke have more chronic illnesses, including: - emphysema & bronchitis - cardiovascular disease - cancer - bronchopulmonary disease  Sudden infant death syndrome (SIDS) Chronic illnesses and smoking

Tobacco use without smoking  How safe are smokeless tobacco products compared with cigarettes?  One pinch of snuff has effects equivalent to those derived from smoking 3 to 4 cigarettes Snuff dipping Tobacco chewing

Secondhand and sidestream smoke  Mainstream smoke - smoke drawn through the mouthpiece of the cigarette  Sidestream smoke - smoke released into the air directly from the lighted tip of a cigarette  Passive smoking - nonsmokers’ inhalation of tobacco smoke  Environmental tobacco smoke - sidestream smoke and exhaled mainstream smoke that is inhaled by the passive smoker

Who smokes?  In 1994, estimated 60 million Americans  This is 29% of population age 12 and older  Approximately 4.5 million youths aged  This is about 20% of this population  year-old age group has the highest rate of smokers (35%)  Whites have the highest past-month smoking rate (29.7%), blacks have the 2nd highest (28.1%)

Quitting smoking  The primary methods for quitting smoking are:  Step-by-step manuals  Acupuncture  “Cold turkey” techniques  Hypnosis  Nicotine gum  Nicotine patches  Self-help with behavioral modification

Social Issues  Economic interests  Mickey Mouse vs. Joe Camel  Tobacco as a gateway drug  Smoking prohibition vs. smokers’ rights  Smoke-free indoor air  Youth access to tobacco  Licensing  Advertising  Taxing cigarettes