Toward a Tobacco-Free Society Chapter 11

Who Uses Tobacco? 71 million Americans smoke 24% of men and 18% of women smoke

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

Figure 11.1 Annual mortality and morbidity among smokers attributable to smoking

Why People Use Tobacco Nicotine addiction Powerful psychoactive drug The most physically addictive of all psychoactive drugs Reaches the brain via the bloodstream in seconds Loss of control Tolerance and withdrawal

Why People Use Tobacco Social and Psychological Factors Established habits or cues to trigger smoking are secondary reinforcers Genetic Factors CYP2A6 DRD2

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 13 for smoking 10 for spit tobacco Rationalizing the dangers, invincible Emulating smoking in the media

Health Hazards Tobacco adversely affects nearly every part of the body, including: Brain Stomach Mouth Reproductive organs Contains hundreds of damaging chemical substances Unfiltered cigarettes = 5 billion particles per cubic MM 50,000 times more than smoggy urban air Condensed particles in the cigarette produce a sticky, brown mass called cigarette tar

Carcinogens and Poisons 43 chemicals are linked to development of cancer (carcinogen) Benzo(a)pyrene Urethane Cocarcinogens (ex. formaldehyde) Combine with other chemicals to cause cancer Poisonous substances Arsenic Hydrogen cyanide Carbon monoxide Contains amounts 400 times greater than is considered safe in industrial workplaces Displaces oxygen in red blood cells Additives Humectants, sugars, bronchodilators, ammonia, things to make sidestream smoke less obvious

“Light” and Low-Tar Cigarettes Low-tar, low-nicotine, or filtered cigarettes No such thing as a safe cigarette Often smoke more, inhale more deeply, etc. Less likely to quit

Menthol Cigarettes 70% of African Americans smoke menthol cigarettes African Americans 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

Immediate Effects of Smoking Acts on the brain either by exciting or tranquilizing the nervous system At low doses nicotine is a stimulant (elevates bp and hr, etc.) In adults can increase alertness, concentration, information processing, etc.) opposite effect in young people Can act as a sedative, and relieve symptoms of anxiety and irritability Smokers can fine-tune nicotines effects and regulate their moods by increasing or decreasing their intake Depresses hunger

The Long-Term Effects of Smoking Cardiovascular Disease Coronary heart disease (CHD) Atherosclerosis Myocardial infarction Stroke Aortic aneurysm Pulmonary heart disease Lung cancer and other cancers Chronic obstructive pulmonary disease Emphysema Chronic bronchitis

Figure 11.4 Damage to the lungs caused by smoking

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

Cumulative Effects People who smoke before 15 yrs. old and continue to smoke are half as likely to live to 75 versus those who did not smoke Smokers spend one-third more time away from their jobs because of illness than nonsmokers Both men and women show a greater rate of acute and chronic diseases

Other Forms of Tobacco Spit (smokeless) tobacco Cigar and pipes More than 6.6 million adults 8% of all high school students Cigar and pipes Highest rate among white males age 18-44 with higher-than-average income and education Clove cigarettes and bidis Twice the tar, nicotine, and carbon monoxide

Figure 11.5 Tobacco use among middle school and high school students © 2010 McGraw-Hill Companies. All Rights Reserved.

The Effects of Smoking on the Nonsmoker Environmental Tobacco smoke (ETS) EPA designated ETS as a class A carcinogen Surgeon General issued a report in 2006 concluding that there is no safe level of exposure to ETS

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 comes from sidestream smoke Twice the tar and nicotine, and three times the benzo(a)pyrene, carbon monoxide, and ammonia

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 heart disease deaths each year 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 Estimated 4600 infant deaths in the U.S. Increased risk of miscarriage, premature birth, low birth weight, and long term impairments in growth and intellectual development

The 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 Designed to limit youth exposure and access to tobacco © 2010 McGraw-Hill Companies. All Rights Reserved.

What Can Be Done? Action at many levels Individual action Local level State level Federal level FDA, EPA International level WHO Individual action

How A Tobacco User Can Quit The benefits of quitting Options for quitting “Cold-turkey” Changes to routines Over-the-counter prescription products Support from family and friends Smoking cessation programs Free telephone quitlines 1-800-QUITNOW

Toward a Tobacco-Free Society Chapter 11