1. Concepts of Fitness & Wellness 8e The Use and Abuse of Tobacco
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The Use and Abuse of Tobacco
The Use and Abuse of Tobacco
Developed by: E. Hope Shupp, MA, M.Ed
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2. Concepts of Fitness & Wellness 8e
McGraw Hill -
Objectives
We will learn about:
Tobacco and Nicotine
Health and Economic Costs
Facts about Tobacco Usage
Techniques for Quitting
Smoking is the #1 cause of preventable mortality in the US. It is linked to most of the leading causes of death and it leads to various other chronic conditions. Rates of smoking in the US have decreased in recent decades due to better awareness and a changed social norm concerning smoking and tobacco use. Despite the progress, smoking is still a major public health problem.
This presentation will cover the health risks of tobacco and discuss the behavioral strategies commonly used to try to quit.
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3. Chemistry of Cigarette Smoke
Concepts of Fitness & Wellness 8e
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Chemistry of Cigarette Smoke
Gaseous Phase (CO)
- Carbon monoxide released
- Shortness of breath
- Neonatal problems
Particulate Phase
Tobacco and its smoke contain over 400 noxious chemicals, including 200 known poisons and 50 carcinogens. Tobacco smoke contains both gases and particulates.
Cigarette smoke can be divided into 2 phases (gaseous phase and a particulate phase).
The gaseous phase contains carbon monoxide and other dangerous gases. CO combines with hemoglobin more strongly than oxygen and therefore limits the oxygen carrying capacity of the blood. (This explains why smokers are always out of breath.) Neonatal problems from smoking during pregnancy are also related to poor oxygen delivery to the fetus.
The particulate phase includes nicotine and tar. Nicotine is the addictive component in cigarettes but it also increases the risk of CHD (decrease HDL, increases platelet aggregation). Tar contains the carcinogenic compounds that lead to cancer. The compounds get stuck in the mouth, throat, esophagus, and lungs and increase risk for cancers.
- Nicotine (psychoactive drug increases CHD risks)
Photo: Creative Commons Flickr
- Tar (increases cancer risks)
Tobacco and its smoke contain over 400 noxious chemicals, including 200 known poisons and 50 carcinogens.
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4. Concepts of Fitness & Wellness 8e
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Nicotine
Addictive component of tobacco
More addictive than heroin and alcohol
When inhaled, reaches brain in 7 seconds
Withdrawal effect
Physical dependence
Nicotine is the addictive component of tobacco. When smoke is inhaled, the nicotine reaches the brain in 7 seconds, where it acts on highly sensitive receptors and provides a sensation that brings about a wide variety of responses throughout the body.
At first, heart and breathing rates increase. Blood vessels constrict, peripheral circulation slows down, and BP increases. New users may experience dizziness, nausea, and headache. Then feelings of tension and tiredness are relieved. After a few minutes, the feeling wears off and a rebound, or withdrawal, effect occurs. The smoker may feel depressed and irritable and have the urge to smoke again. Physical dependence occurs with continued use. Nicotine is one of the most addictive drugs known, even more addictive than heroin and alcohol.
Photo: Creative Commons Flickr
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5. Smokeless Chewing Tobacco
Concepts of Fitness & Wellness 8e
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Smokeless Chewing Tobacco
Variety of forms
Loose leaf
Twist
Plug
Dip, chew, or chaw stays in the mouth for several hours
Contains 7x more nicotine than cigarettes
Smokeless chewing tobacco is as addictive (and maybe more so) as smoking and produces the same kind of withdrawal symptoms on quitting.
When it stays in the mouth for several hours, it mixes well with saliva and is absorbed in the bloodstream.
Smokeless tobacco contains about 7 times more nicotine than cigarettes, and more of it is absorbed because of the length of time the tobacco is in the mouth. It also contains a higher level of carcinogens than cigarettes.
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6. Health Effects of Smoking
Concepts of Fitness & Wellness 8e
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Health Effects of Smoking
Most preventable cause of death in our society
Tobacco use is the most preventable cause of death in our society. This means premature death CAN be prevented by quitting!
Photo: Creative Commons Flickr
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7. Surgeon General’s Report on Smoking
Concepts of Fitness & Wellness 8e
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Surgeon General’s Report on Smoking
Tobacco use affects all organs of the body, reducing the health of smokers
Quitting smoking has immediate and long-term benefits
Smoking cigarettes low in tar and nicotine provides no clear benefit to health
# of diseases resulting from tobacco is much more extensive than previously thought
Four decades after the landmark surgeon general’s report on smoking, a new surgeon general’s report draws these four major conclusions.
Tobacco use affects all organs of the body, reducing the health of smokers
Quitting smoking has immediate and long-term benefits
Smoking cigarettes low in tar and nicotine provides no clear benefit to health
# of diseases resulting from tobacco is much more extensive than previously thought
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8. Health Effects of Smoking
Concepts of Fitness & Wellness 8e
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Health Effects of Smoking
Increased risk of:
Cancer
Coronary heart disease
Atherosclerosis
Blood pressure
Stroke
Ulcers
Emphysema
Bronchitis
Deaths from smoking are preventable and are linked to 7 of the 10 leading causes of death. It is estimated that between 80% and 90% of all deaths related to lung cancer and obstructive lung disease are caused by smoking, and the risk for coronary disease and stroke is increased two to four-fold among smokers.
The earlier people quit, the more years of life they save with roughly 9 years saved for those who quit at age 40, 6 years for those who quit at age 50, and 3 years for those who quit at age 60.
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9. Concepts of Fitness & Wellness 8e
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Adds 9 years for those who quit at age 40
+ 6 years (age 50)
+ 3 years (age 60)
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10. Health Risks from Tobacco
Concepts of Fitness & Wellness 8e
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Health Risks from Tobacco
The more you use the product (more doses), the greater the health risk
Several factors determine the dosage
# of cigarettes smoked
Length of time one has been smoking
Strength (amount of tar, nicotine, etc.)
Depth of inhalation
Amount of exposure to other lung-damaging substances (e.g., asbestos)
The health risks from tobacco are directly related to overall exposure. In past years, tobacco companies denied there was conclusive proof of the harmful effects of tobacco products. Now, in the face of overwhelming medical evidence, tobacco officials have finally conceded that tobacco is harmful to health. It is now clear that the more you use the product (the more doses), the greater the health risk.
Several factors determine the dosage:
the number of cigarettes smoked;
the length of time one has been smoking;
the strength (amount of tar, nicotine, etc.) of the cigarette;
the depth of the inhalation; and
the amount of exposure to other lung-damaging substances (e.g., asbestos).
The greater the exposure to smoke, the greater the risk.
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11. Do you know what a “chipper” is?
Concepts of Fitness & Wellness 8e
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Do you know what a “chipper” is?
social smoker
While risks clearly increase with the amount of exposure, recent studies suggest that even low levels of smoking have negative consequences. Many college students who smoke identify themselves as “social smokers” or “chippers.” (Overall rates of non-daily smoking have increased). Some may view that this level of smoking as safe, but even low levels of regular smoking can have significant health consequences.
Social smoking may also set the stage for the development of nicotine dependence and increased use later in life. Short-term physical consequences of smoking include increased rates of respiratory infections and asthma, impairment of athletic performance, and reduced benefits and enjoyment associated with recreational exercise. Smoking also causes shortness of breath and increases in phlegm production leading to a subjectively negative state.
Photo: Creative Commons Flickr
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12. Concepts of Fitness & Wellness 8e
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Cigar & Pipe Smokers
Lower death rates, but still great risk
Contains same harmful ingredients as cigarette smoke, sometimes in higher amounts
Nicotine dependence
Higher risks for cancer of the mouth, throat, and larynx
Cigar and pipe smokers have lower death rates than cigarette smokers but still are at great risk. Cigar and pipe smokers usually inhale less and, therefore, have less risk for heart and lung disease, but cigarette smokers who switch to cigars and pipes tend to continue inhaling in some way.
Cigar and pipe smoke contains most of the same harmful ingredients as cigarette smoke, sometimes in higher amounts. It may also have high nicotine content, leading to no appreciable difference between cigarette and pipe/cigar smoking with respect to the development of nicotine dependence.
Also, higher risks for cancer of the mouth, throat, and larynx relative to cigarette smokers. Pipe smokers are especially at risk for lip cancer.
Photo: Creative Commons Flickr
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13. Concepts of Fitness & Wellness 8e
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Second-Hand Smoke
Mainstream smoke
Smoke that is inhaled and exhaled
Sidestream smoke
Unfiltered smoke from burning tip of cigarette
Contains nicotine and x carcinogens as mainstream smoke
Recently, it has become clear that passive smoke also poses significant health risks.
There are 2 types of passive smoke: mainstream, and sidestream (explain the difference between them).
Mainstream smoke is the smoke that is inhaled and then exhaled.
Sidestream smoke is the smoke that comes off of the burning tip of the cigarette. Sidestream smoke is by far the most damaging since this smoke has not been filtered or inhaled. In a confined space a non-smoker will passively "smoke" the equivalent of 5 cigarettes for each pack smoked by a smoker.
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14. Dangers of Second-Hand Smoke
Concepts of Fitness & Wellness 8e
Dangers of Second-Hand Smoke
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Increased risk of:
Early death
Heart disease
Lung cancer
Emphysema
Depression
Women/children are especially susceptible to negative effects
“Thirdhand” smoke
Second hand smoke has been shown to create significant health problems. Glantz and Parmley (1995) estimated the Relative Risk (RR) of heart disease from passive smoke to be between 1.3 and 1.7. This suggests that individuals who are exposed to second-hand smoke have a 30-70% greater chance of developing heart disease than people who are not exposed to second-hand smoke. This type of evidence strongly supports the need for bans on smoking in all public places since other people can be harmed from someone else’s smoking.
Glantz S.A., and Parmley, W.W. (1995). Passive smoking and Heart Disease. JAMA, 273(13):
Woman and children are especially susceptible to the negative effects of secondhand smoke. Evidence suggests that adolescents exposed to secondhand smoke are at 5x the risk of developing metabolic syndrome, which increases risk for heart disease, stroke, and diabetes, and they are also at increased risk of becoming smokers themselves.
Babies of parents who only smoked outdoors had levels of cotinine (a nicotine byproduct) 7x higher than babies of nonsmokers. Presumably, children are exposed to “thirdhand” smoke that clings to clothing and hair.
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15. Trends in Adult Smoking Rates
Concepts of Fitness & Wellness 8e
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Trends in Adult Smoking Rates
There have been drastic reductions in smoking since the 1950s but a sizable percent still smoke.
In 1955, 45% of the population smoked. In 1965, 40% of the population smoked. The Surgeon General’s report that smoking was dangerous for health prompted many people to quit. By 1987, 29% of the population was smoking. The strong social stigmas against smokers have caused these figures to keep dropping. In the late 1990s, rates of smoking dropped from 25% to 20% in Unfortunately, rates have begun to climb over the past two years with a prevalence of 20.8% in 2009.
However, adolescent smoking rates have declined in recent years.
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16. Global Public Health Threat
Concepts of Fitness & Wellness 8e
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Global Public Health Threat
The prevalence of smoking is higher in Europe and is especially high in China. Smoking remains a global public health threat. While progress in curbing smoking is evident in the United States and other developed countries, these trends are not as apparent elsewhere. The popularity of smoking across the world presents a considerable challenge to the public health community because each country has its own norms and values, as well as unique policies regulating access and advertising.
Higher smoking prevalence in Europe and China
Photo: Creative Commons Flickr
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17. Why Young People Start Using Tobacco
Concepts of Fitness & Wellness 8e
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Why Young People Start Using Tobacco
Peer influence
Social acceptance
Desire to be “mature”
Desire to be “independent”
Desire to be like their role models
Appealing advertisements (media)
Most tobacco users begin “using” during adolescence and find it hard to quit.
This list covers some of the factors that predispose people to begin smoking. The factors tend to be most significant for teenage smokers since most smokers begin their habit at this time. Coincidentally, this is also the age group that the cigarette manufacturers target the most in their advertising.
Why Young People Start Using Tobacco
Peer influence
• Social acceptance
• Desire to be “mature”
• Desire to be “independent”
• Desire to be like their role models
• Appealing advertisements
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18. Factors Contributing to the Declines in Smoking
Concepts of Fitness & Wellness 8e
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Factors Contributing to the Declines in Smoking
Public policy
Media campaigns
Changing social norms
Legal claims against the tobacco industry have aided in antismoking campaigns. But tobacco companies are finding new ways to recruit smokers. They have provided discounts to offset increased taxes and introducing new products and packaging to entice young smokers. New alternative products include tobacco pills and electronic or e-cigarettes.
These lawsuits have also had an impact on public opinions of tobacco companies. Documents uncovered from the files of tobacco companies, during litigation against the companies, have contained incriminating evidence that has undermined the reputation of tobacco companies and contributed to an unfavorable public attitude toward the industry.
Recent efforts to limit exposure to second-hand smoke seem to be paying off. Public smoking bans decrease rates of heart attacks.
Many employers refuse to hire smokers, and many companies include smoking cessation in employee assistance programs to encourage smokers to quit.
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19. Facts about Quitting Smoking
Concepts of Fitness & Wellness 8e
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Facts about Quitting Smoking
30% of smokers try to quit each year
10% of the people who try to quit smoking are successful
Increasing the price of cigarettes is the most successful method of reducing smoking in youth
Some women begin smoking to control their weight – unable to quit due to fear of weight gain
Addictive nature of nicotine makes it difficult to quit using tobacco
Various factors influence a person’s decision to begin or quit smoking.
30% of the people who smoke each year attempt to quit. Of this group of people only 10% are successful. Most people who quit require a few attempts before they succeed. These facts reveal the highly addictive nature of nicotine. Once people start, they usually find it difficult to stop. The statistics are from a review article by Fiore et al. (1990).
Fiore, M.C. et al. (1990) Methods used to quit smoking in the United States: Do cessation programs help? JAMA 263(20),
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20. Concepts of Fitness & Wellness 8e
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Smoking is associated with increased risk for the use of both alcohol and illicit drugs.
Alcohol has often been considered a gateway to other drug use and marijuana is often thought of as a gateway to the use of other drugs, such as cocaine and heroine. Although tobacco use has been studied less extensively as a gateway drug, there is strong evidence that smoking is associated with increased risk for the use of both alcohol and illicit drugs. The combination of smoking and drinking is particularly common in college students. In a nationally representative study of college students, 97 percent of smokers drink, compared with national averages of about 80 percent. In addition, those who drink report high levels of smoking, even for college students with rates ranging from 44 to 59 percent (compared with a national average rate of under 30 percent). The combination of alcohol use and smoking poses an even greater risk to physical health.
Photo: Creative Commons Flickr
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21. Techniques to Quit Smoking
Concepts of Fitness & Wellness 8e
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Techniques to Quit Smoking
Stopping "cold turkey"
Gradually decreasing number
Using low nicotine cigarettes/nicotine gum
Counseling / hypnosis
Develop effective stress-management techniques
Remove reminders and temptations
Use substitutes and distractions
This slide outlines some techniques that could be used to quit smoking. Most people attempt to quit on their own and are usually more successful than people who try to utilize some outside assistance (ex. counseling). Nicotine gum despite its logical appeal has not been found to be very effective unless it is used in the prescribed doses.
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22. Concepts of Fitness & Wellness 8e
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Conclusion
Tobacco is the #1 cause of preventable mortality
Nicotine is the addictive component
Second-hand smoke poses a significant health risk
Public policy to reduce smoking
Various techniques to quit smoking
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23. Concepts of Fitness & Wellness 8e
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References
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