1. Chapter Eleven Toward a Tobacco-Free Society

2. Tobacco Use in American Society Over the past 4 decades, the proportion of cigarette smoking among adults in the United States has dropped 30%Over the past 4 decades, the proportion of cigarette smoking among adults in the United States has dropped 30% Almost every state now restricts smoking in public placesAlmost every state now restricts smoking in public places The U. S. Surgeon General has proposed that America become completely smoke-freeThe U. S. Surgeon General has proposed that America become completely smoke-free

3. Why People Use Tobacco Nicotine AddictionNicotine Addiction Modulator of everyday emotionsModulator of everyday emotions Loss of ControlLoss of Control 3 of 4 smokers find they cannot quit, which is more difficult for smokeless users3 of 4 smokers find they cannot quit, which is more difficult for smokeless users Build up of ToleranceBuild up of Tolerance Same effects build up over time, needing more cigarette to maintain the same original effects, which create dependenceSame effects build up over time, needing more cigarette to maintain the same original effects, which create dependence Social and Psychological FactorsSocial and Psychological Factors Habits are formed via ‘secondary reinforcers’ which keep the user dependent upon tobaccoHabits are formed via ‘secondary reinforcers’ which keep the user dependent upon tobacco Genetic FactorsGenetic Factors CYP2A6 enzyme can create more activity for tobacco useCYP2A6 enzyme can create more activity for tobacco use

4. Who Uses Tobacco? A parent or sibling uses tobaccoA parent or sibling uses tobacco Peers use tobaccoPeers use tobacco The child comes from a blue collar familyThe child comes from a blue collar family The family is headed by a single parentThe family is headed by a single parent The child comes from a low income home The child performs poorly in school The child drops out of school The child has positive attitudes about tobacco use Research shows that children are vulnerable to smoking based upon the following

5. Other Demographic Factors Influencing Tobacco Use GenderGender Age groupsAge groups Region of the countryRegion of the country Education levelEducation level EthnicityEthnicity

6. The Source of Physiologically Active Compounds Particulate phase (small particle compounds)Particulate phase (small particle compounds) –nicotine –water –tar (phenol, cresol, benzo pyrene, DDT) Many of these chemicals are considered carcinogens

7. Sources of Physiologically Active Compounds, cont’d Gaseous phase (gas compounds)Gaseous phase (gas compounds) –carbon monoxide (CO) –carbon dioxide, ammonia, hydrogen cyanide, isopyrene, acetone, etc. Many of these chemicals are considered carcinogens

8. Acute Effects of Smoking The effects of nicotine is dependent upon the smoker’s tolerance and previous consumption levelThe effects of nicotine is dependent upon the smoker’s tolerance and previous consumption level Once the cerebral cortex has been stimulated, arousal of nicotine allows norepinephrine, dopamine, acetylcholine, serotonin releaseOnce the cerebral cortex has been stimulated, arousal of nicotine allows norepinephrine, dopamine, acetylcholine, serotonin release CNS is depressed within the brain which stimulates areas within the heart, lungs, blood flowCNS is depressed within the brain which stimulates areas within the heart, lungs, blood flow

9. Relationship Between Cigarette Smoking and the Following Conditions Cardiovascular Disease and Carbon MonoxideCardiovascular Disease and Carbon Monoxide –Impairment of oxygen transport Cardiovascular Disease and NicotineCardiovascular Disease and Nicotine –Myocardial infarction risk –Sudden cardiac death risk –Development of Angina Pectoralis –Increase of Platelet Adhesiveness

10. Relationship Between Cigarette Smoking and the Following Conditions, cont. –Cancers LungLung MouthMouth ThroatThroat * Evidence suggests that after one year without smoking, the risk of lung cancer decreases substantially

11. What are COLD’s? Chronic Bronchitis (inflammation/infection of air passageways)Chronic Bronchitis (inflammation/infection of air passageways) Pulmonary Emphysema (destruction of the alveoli)Pulmonary Emphysema (destruction of the alveoli) Cilia destruction (hair-like projections which assist mucus movement)Cilia destruction (hair-like projections which assist mucus movement) Chronic Obstructive Lung Disorders

12. Selected Health Concerns from Cigarette Smoking Lung diseaseLung disease Cancer riskCancer risk Heart diseaseHeart disease Peripheral Vascular diseasePeripheral Vascular disease Skin changesSkin changes Orthopedic problemsOrthopedic problems Rheumatologic problemsRheumatologic problems Male Infertility Depression Neurological disorders Endocrine system problems GI tract diseases Immune system Oral Health Complications in OB/GYN

13. Other Forms of Tobacco Products Smokeless Tobacco Cigars and Pipes Clove Cigarettes and Bidis

14. Second-hand Smoke Mainstream (smoke exhaled by smoker)Mainstream (smoke exhaled by smoker) Sidestream (smoke from the burning product)Sidestream (smoke from the burning product) Environmental smoke (diluted smoke in the air)Environmental smoke (diluted smoke in the air) 85% of the smoke in a room comes from sidestream smoke

15. ETS Effects Up to 70% of nonsmokers subjected to Environmental Smoke develop some form of irritation or health ailmentUp to 70% of nonsmokers subjected to Environmental Smoke develop some form of irritation or health ailment It also causes 3000 lung cancer deaths annuallyIt also causes 3000 lung cancer deaths annually 60,000 deaths from heart disease is associated with ETS60,000 deaths from heart disease is associated with ETS Infants are 23 times more likely to die from SIDS when exposed to ETSInfants are 23 times more likely to die from SIDS when exposed to ETS Children and infants becomes vulnerable to respiratory disorders and reduced lung functionChildren and infants becomes vulnerable to respiratory disorders and reduced lung function

16. Smoking and Pregnancy InfertilityInfertility Problem pregnanciesProblem pregnancies Low birth weightLow birth weight Premature labor/deliveryPremature labor/delivery Miscarriage risk doublesMiscarriage risk doubles

17. Benefits of Quitting Taste returns back to normalTaste returns back to normal The concept of “smell” improvesThe concept of “smell” improves Breathing becomes easierBreathing becomes easier Decrease risk of heart and lung diseaseDecrease risk of heart and lung disease More energy and alertnessMore energy and alertness

18. Options for Quitting Strategies involving the benefits of behavioral and pharmacological interventions such as:Strategies involving the benefits of behavioral and pharmacological interventions such as: “Cold Turkey” method“Cold Turkey” method Non-tobacco sources of nicotine products e.g. suckers, gums, straws, sprays, drops, etc.Non-tobacco sources of nicotine products e.g. suckers, gums, straws, sprays, drops, etc. Smoking cessation programsSmoking cessation programs Support groupsSupport groups Regular exercise programRegular exercise program

19. Chapter Eleven Toward a Tobacco-Free Society