1. Tobacco Chapter 11

2. Tobacco Use: Scope of the Problem Tobacco use is the leading preventable cause of disease and premature death in the United States. -443,000 deaths annually in United States Tobacco is the single largest cause of preventable death and a risk factor for 6/8 of the leading causes of death.

3. Current Tobacco Use in the U.S. In 2011, 68.2 million Americans, or 26.5% of the population age 12 or older, reported current use of a tobacco product. Approximately 32.3 percent of males and 21.1% of females age 12 or older were current users of any tobacco product.

4. Tobacco Use: A Costly Addiction More deaths are caused each year by tobacco use than by HIV, illegal drug use, murders, alcohol use, suicides, and motor vehicle injuries combined.

5. History of Tobacco Use Mayans: tobacco smoke as “divine incense” Turkey: poets vs. priests France: Louis XIII vs. Louis XIV Nicholas Monardes: infallible cure Pope Urban VII: excommunication for tobacco users

6. History of Tobacco Use in America Cigars became popular in the United States in the early 1800s. The introduction of the cigarette-rolling machine spurred cigarette consumption because cigarettes became cheaper than cigars.

7. Tobacco Production Nicotiana tabacum is the primary species of tobacco. Flue-cured tobacco is cured with heat transmitted through a flue without exposure to smoke or fumes.

8. Government Regulation 1964: The Advisory Committee to the U.S. Surgeon General reported that cigarette smoking is related to lung cancer. 1970: Warnings on cigarette labels.

9. Limitations on advertising Ban on cartoon characters in advertising Ban on “branded” merchandise Limitations on sponsoring of sporting events Disbanding of tobacco trade organizations Funds designated to support anti-smoking measures and research to reduce youth smoking Master Settlement Agreement

10. Gave FDA authority to regulate the manufacture, distribution, and marketing of tobacco products Restricts cigarette sales to youth and requires proof of age Family Smoking Prevention and Control Act

11. Pharmacology of Nicotine It is a colorless, highly volatile liquid alkaloid. When smoked, nicotine enters the lungs and is then absorbed into the bloodstream. When chewed or dipped, nicotine is absorbed through the mucous lining of the mouth.

12. Pharmacology of Nicotine Amount of tobacco absorbed depends on -Exact composition of tobacco -How densely the tobacco is packed in the cigarette -Whether a filter is used and characteristics of filter -The volume of smoke inhaled -The number of cigarettes smoked

13. Physiological Effects Stimulates central dopamine release Stimulates cardiovascular system

14. Cigarette Smoking Cigarette smokers not only tend to die at an earlier age than nonsmokers, but also have a higher probability of developing certain diseases, including cardiovascular disease, cancer, bronchopulmonary disease, and other illnesses

15. Cardiovascular Disease Smoking causes coronary heart disease, the leading cause of death in the United States. Compared with non-smokers, smoking increases the risk of coronary heart disease two to four times. Smoking puts smokers at greater risk for developing peripheral artery disease.

16. Cancer Cigarette smoking is a major cause of cancers of the lung, bladder, pancreas, cervix, esophagus, stomach, oral cavity and kidney. The risk of lung cancer in men who smoke two or more packs per day is 23 times greater than the risk for nonsmokers, while the risk for women is approximately 13 times greater.

17. Bronchopulmonary Disease Cigarette damages the airways and alveoli, and causes emphysema, chronic airway obstruction, and emphysema

18. Effects on Pregnancy One in six pregnant women smoked cigarettes in the past month Increased risk for stillbirth, pre-term delivery, infertility, low birth weight and sudden infant death syndrome

19. Light Cigarettes There is no conclusive evidence of reduced health risks associated with low-tar cigarettes. Filtered cigarettes reduce levels of tar, nicotine, and carbon monoxide at the mouth end of the filter and should be of some limited benefit. Many smokers lose this benefit because they often smoke more cigarettes per day, increase puff number and volume, or block the filter holes with their fingers or lips.

20. Electronic Cigarettes Electronic cigarettes (e-cigarettes) are devices designed to deliver nicotine or other substances to a user as a vapor. The FDA has not evaluated e-cigarettes for effectiveness or safety.

21. Tobacco Use Without Smoking Chewing tobacco and snuff. Use can lead to nicotine addiction and dependence. Contains 28 cancer-causing agents. Smokeless tobacco is strongly associated with leukoplakia. Smokeless tobacco increases the risk of developing cancer of the oral cavity and pancreas. Smokeless tobacco use during pregnancy increases the risks for preeclampsia, premature birth, and low birth weight.

22. Secondhand Smoke Secondhand smoke includes a mixture of smoke that comes directly from the lighted tip of a cigarette, cigar, or pipe tip and exhaled smoke Passive smoking refers to nonsmokers’ inhalation of tobacco smoke. Secondhand smoke exposure causes an estimated 46,000 heart disease deaths annually in the United States.

23. Benefits of Cessation 1.A return to normalcy of heart rate and blood pressure (which are abnormally high while smoking). 2.A decline of carbon monoxide in the blood within hours. 3.Improved circulation, production of less phlegm, and decreased rate of coughing and sneezing within weeks. 4.Substantial improvements in lung function within several months.

24. Benefits of Cessation (continued) 5. Decreased risk for lung and other types of cancer. 6. Decreased risk for coronary heart disease, stroke, and peripheral vascular disease. 7. Decreased respiratory symptoms such as coughing, wheezing, and shortness of breath.

25. Benefits of Cessation (continued) 8. Decreased risk of developing chronic obstructive pulmonary disease. 9. Decreased risk for infertility in women. 10. Decreased risk of having a low birth weight baby.

26. Methods for Quitting Nicotine gum Nicotine patches Nicotine spray Nicotine lozenges Bupropion Varenicline