Chapter 11 Chapter 11 Alcohol, Tobacco and Caffeine Unacknowledged Addictions Tobacco

TOBACCO January 11, 1964: U.S. Surgeon General Report Cigarette smoking is linked to increased morbidity and  mortality Canadian Smokers proportion of smokers decreased in past 25 years - still approximately 30% smoke

Smoking…… in Canada 7 millions Canadians smoke7 millions Canadians smoke heavy smokers on the riseheavy smokers on the rise 45,000 Canadians die from tobacco abuse each year45,000 Canadians die from tobacco abuse each year Adolescent females (14-20 yr.)Adolescent females (14-20 yr.) # of adolescents smoking increased by 24 % # of adolescents smoking increased by 24 % Health care cost more than $9.6 billion annuallyHealth care cost more than $9.6 billion annually

Forms of Tobacco Consumption: Snuff: powdered tobaccopowdered tobacco absorbed through mucous membrane of noseabsorbed through mucous membrane of nose some increase in popularitysome increase in popularity

Chewing Tobacco tobacco leaves mixed with a variety of flavoring agents (ex. molasses)tobacco leaves mixed with a variety of flavoring agents (ex. molasses) tobacco constituents (nicotine) absorbed through mucous membrane in mouthtobacco constituents (nicotine) absorbed through mucous membrane in mouth Snuff and chewing tobacco smokeless tobaccoSnuff and chewing tobacco smokeless tobacco smokeless tobacco = 11 X the risk of developing cancers mouth and gum as nonuserssmokeless tobacco = 11 X the risk of developing cancers mouth and gum as nonusers

Pipes-Cigars-Cigarettes: Pipes-Cigars-Cigarettes: Composition of Tobacco Smoke: inhaling hot smoke absorbed via the lungsinhaling hot smoke absorbed via the lungs 65 species of tobacco65 species of tobacco over 4000 known compounds in tobaccoover 4000 known compounds in tobacco smoke in our atmospheresmoke in our atmosphere 1. Mainstream smoke - drawn through cigarette & filter1. Mainstream smoke - drawn through cigarette & filter 2. Side-stream smoke - burning tobacco not inhaled = second-hand smoke2. Side-stream smoke - burning tobacco not inhaled = second-hand smoke

Composition of Cigarette Smoke Condensed particles: Tar (8 % of total volume)Condensed particles: Tar (8 % of total volume) Gases and Vapors (92 % of total volume)Gases and Vapors (92 % of total volume)

Harmful constituents of cigarette smoke Tar Carcinogenic agents (cancer- producing chemicals)Carcinogenic agents (cancer- producing chemicals) Co-carcinogenic agents (substances combine with others that cause cancer)Co-carcinogenic agents (substances combine with others that cause cancer) NicotineNicotine Tar + CO + Nicotine are obtained from burning tobacco in cigarettes, pipes and cigarsTar + CO + Nicotine are obtained from burning tobacco in cigarettes, pipes and cigars Tar - related to  mortality &  morbidityTar - related to  mortality &  morbidity

Carcinogens and Co-carcinogens Carcinogens or tumor initiators, lung, pancreas, kidney, and bladder;Carcinogens or tumor initiators, lung, pancreas, kidney, and bladder; Co-carcinogens or tumor promoters: help maintain process of tumor formationCo-carcinogens or tumor promoters: help maintain process of tumor formation

Nicotine: mg/cigarette mg/cigarette powerful pharmacological agentpowerful pharmacological agent stimulates cerebral cortex immediate effects:stimulates cerebral cortex immediate effects:  HR  HR  MAP (vasoconstriction)  MAP (vasoconstriction)  MVO 2  MVO 2  ventilation  ventilation  hunger (dulls taste buds)  hunger (dulls taste buds) 1/2 life of nicotine 30 min - highly addictive1/2 life of nicotine 30 min - highly addictive

Nicotine regular smokers need to replenish body's nicotine level every 30-min.regular smokers need to replenish body's nicotine level every 30-min. major addictive agentmajor addictive agent nicotine dependence is a physical and psychologicalnicotine dependence is a physical and psychological several “breaks/day”several “breaks/day”

Carbon Monoxide (CO): CO causes noticeable physiological effectsCO causes noticeable physiological effects 1-5 % of smoke1-5 % of smoke CO interferes with ability of Hb to bind with O 2CO interferes with ability of Hb to bind with O 2 CO levels in smoke have been positively correlated with  risk of CAD/strokeCO levels in smoke have been positively correlated with  risk of CAD/stroke

Benzopyrene: responsible for lung cancer kills the cancer-protecting cells in the bodyresponsible for lung cancer kills the cancer-protecting cells in the body

During Puffing: temperature in burning cone is between 900 and 1050 °Ctemperature in burning cone is between 900 and 1050 °C these temperatures produce mainstream smokethese temperatures produce mainstream smoke the side-stream smoke is generated during smoldering of tobacco at 800 °Cthe side-stream smoke is generated during smoldering of tobacco at 800 °C estimated that % of tobacco of cigarettes is burned between puffs  source of side-stream smokeestimated that % of tobacco of cigarettes is burned between puffs  source of side-stream smoke

Giving Up Smoking! Smoking - powerful immediate satisfaction for individual: pharmacological psychological emotional socialApproximately: 50 % quit smoking "COLD TURKEY"50 % quit smoking "COLD TURKEY" 50 % gradual reduction50 % gradual reduction

2 types of withdrawal: Physiological Withdrawal: physical dependence on nicotine / easiest to deal withphysical dependence on nicotine / easiest to deal withSymptoms: headachesheadaches irritabilityirritability sleeplessnesssleeplessness intense cravingsintense cravings muscle achesmuscle aches symptoms highest at three days - diminish with timesymptoms highest at three days - diminish with time

Psychological Withdrawal breaking patterns / changing behaviorbreaking patterns / changing behavior first few months are critical……first few months are critical…… relapses are commonrelapses are common Individual changes in behaviorIndividual changes in behavior mood mood craving for tobaccocraving for tobacco

Smoking a Learned Behaviour Tobacco industry portrays smoking as positive a gradual processa gradual process peer pressurepeer pressure Promotion of Smoking helps to shape & reinforce + imagehelps to shape & reinforce + image influences amount smokedinfluences amount smoked negative influence to quit bynegative influence to quit by acting as reassuring cue

Don’t Start Smoking….. Best Results from Prevention Stay HealthyStay Healthy pursue healthy activitiespursue healthy activities choose friends who also respect healthychoose friends who also respect healthy lifestyleslifestyles protect your personal environment……public places, home, car and other places where smoking occurs!protect your personal environment……public places, home, car and other places where smoking occurs!