1. Toward a Tobacco-Free Society Chapter 11

2. © 2010 McGraw-Hill Companies. All Rights Reserved. 2 Use of Tobacco Why People use Tobacco 71 Million Americans, including 13.7 million college- aged Americans. 2008, nearly 21% of Americans age 18 describe themselves as current smokers.  Nicotine Addiction  Powerful psychoactive drug  Reaches Brain via bloodstream in seconds  Most physically addictive of the psychoactive drugs.  Loss of control  Tolerance and Withdrawal

3. © 2010 McGraw-Hill Companies. All Rights Reserved. Figure 11.1 Annual mortality and morbidity among smokers attributable to smoking 3

4. © 2010 McGraw-Hill Companies. All Rights Reserved. 4 Social and Psychological Factors  Established habits or cues to trigger smoking  Secondary reinforcers.  Genetic Factors: Specific Genes CYP2A6 – influences the way in which nicotine is metabolized People with slow CYP2A6, nicotine remains in the system longer DRD2 - Associated with brain chemical dopamine

5. © 2010 McGraw-Hill Companies. All Rights Reserved. Table 11.1 Who Smokes? 5

6. © 2010 McGraw-Hill Companies. All Rights Reserved. 6 Why Start in the First Place?  Children and teenagers make-up 90% of all new smokers in this country.  Thousands of children and adolescents (12-17) start smoking everyday.  Average age 13 for smoking 10 for spit tobacco

7. © 2010 McGraw-Hill Companies. All Rights Reserved. 7 Characteristics which could increase the potential for use.  A parent or sibling uses tobacco  Peers use tobacco  Child comes from blue-collar family  Child comes from low-income home  Single parent.  Performs poorly in school  Child drops out of school  Has positive attitudes towards tobacco

8. © 2010 McGraw-Hill Companies. All Rights Reserved. 8 Health Hazards  Tobacco adversely affects nearly every part of the body.  Contains hundreds of damaging chemical substances.  Unfiltered cigarettes = 5 billion particles per cubic MM  50,000 times more than polluted urban air  Condensed particles in the cigarette produce the tar

9. © 2010 McGraw-Hill Companies. All Rights Reserved. 9 Carcinogens and Poisons  43 chemicals are linked to cancer (Carcinogen) Benzo(a)pyrene Urethane  Cocarcinogens Combine with other chemicals to cause cancer  Poisonous substances Arsenic Hydorgen cyanide  Carbon monoxide 400 times greater than is considered safe in industrial workplaces Displaces oxygen in red blood cells  Additives Nearly 600 chemicals

10. © 2010 McGraw-Hill Companies. All Rights Reserved. 10 “Light” and Low-Tar Cigarettes  Low-tar, low-nicotine, or filtered cigarettes  No such thing as a safe cigarette  Often smoke more

11. © 2010 McGraw-Hill Companies. All Rights Reserved. 11 Menthol Cigarette  70% of African Americans smoke these Absorb more nicotine and metabolize it slower  Anesthetizing effect of menthol, inhale more deeply and hold smoke longer in the lungs

12. © 2010 McGraw-Hill Companies. All Rights Reserved. 12 Immediate Effects  Acts on the brain either by exciting or tranquilizing the nervous system  Mild nicotine poisoning  Stimulates the cerebral cortex  Stimulates the discharge of adrenaline  Physiological effects on the body

13. © 2010 McGraw-Hill Companies. All Rights Reserved. 13 The Long-Term Effects  Cardiovascular Disease Coronary Heart Disease (CHD) Atherosclerosis plaques Angina pectoris Myocardial infarction Stroke Aortic aneurysm Pulmonary heart disease  Lung and other cancers Benzo (a) pyrene  Chronic Obstructive Lung Disease Emphysema Chronic Bronchitis  Other Respiratory Damage

14. © 2010 McGraw-Hill Companies. All Rights Reserved. 14

15. © 2010 McGraw-Hill Companies. All Rights Reserved. 15 Additional Health, Cosmetic, and Economic Concerns  Ulcers  Impotence  Reproductive health problems  Dental diseases  Diminished physical senses  Injuries  Cosmetic concerns  Economic costs

16. © 2010 McGraw-Hill Companies. All Rights Reserved. 16 Cumulative Effects  Males before 15 yrs. old are half as likely to live to 75 versus those who did not smoke  Females with similar habits reduce life expectancy by more than 10 years  Female smokers spend 17% more sick days in bed than nonsmokers  Both men and women show a greater rate of acute and chronic diseases

17. © 2010 McGraw-Hill Companies. All Rights Reserved. 17 Other Forms of Tobacco  Spit (Smokeless) Tobacco More than 6.6 million adults 8% of all high school students  Cigar and Pipes Cigar smoking has increased by 148% from 1993-2006.  Clover cigarettes and Bidis Twice the tar, nicotine, and carbon monoxide

18. © 2010 McGraw-Hill Companies. All Rights Reserved. Figure 11.5 Tobacco use among middle school and high school students 18

19. © 2010 McGraw-Hill Companies. All Rights Reserved. 19 The Effects of Smoking on the Nonsmoker  Environmental Tobacco smoke (ETS)  EPA designated ETS as a class A carcinogen  Department of Health and Human Services’ National Toxicology Program - “known human carcinogen”  Surgeon General – 2006 – “there is no safe level of exposure to ETS; even brief exposure can cause serious harm”.

20. © 2010 McGraw-Hill Companies. All Rights Reserved. 20 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 is second hand Twice the tar and nicotine Three times the benzo(a)pyrene Three times the ammonia  Smoke from a cigar can be even more dangerous 30 times more carbon monoxide

21. © 2010 McGraw-Hill Companies. All Rights Reserved. 21 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 overall deaths each year.  20% increase in the progression of atherosclerosis.  Contributes to increased Asthma attacks

22. © 2010 McGraw-Hill Companies. All Rights Reserved. 22 Infants, Children, and ETS  More likely to develop Bronchitis, pneumonia,& respiratory infections More complications from asthma Increased chance of SIDS Low-birth weight Bronchitis  Chemicals from smoking show up in breast milk  Children inhale three times more pollutants per unit of body weight than adults.

23. © 2010 McGraw-Hill Companies. All Rights Reserved. 23 Avoiding ETS  Speak up tactfully  Display reminders  Don’t allow smoking in your home or room  Open a window  Sit in the nonsmoking section  Fight for a smoke-free environment  Discuss quitting strategies

24. © 2010 McGraw-Hill Companies. All Rights Reserved. 24 Smoking and Pregnancy  Estimated 4600 infant deaths in the U.S.  Miscarriage, premature birth, low birth weight, long term impairments in growth and intellectual development  Possible higher risks of getting cancer  16% of pregnant women smoke

25. © 2010 McGraw-Hill Companies. All Rights Reserved. 25 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.

26. © 2010 McGraw-Hill Companies. All Rights Reserved. 26 What Can Be Done?  Action at the Local level  Action at the State and Federal level FDA EPA OSHA  International Action WHO  Action in the private sector  Individual Action

27. © 2010 McGraw-Hill Companies. All Rights Reserved. 27 How A Tobacco User Can Quit  50.2 % of all adults who have smoked have quit.  The Benefits of Quitting Table 11.2  Options for quitting Smoking cessation programs 1-800-QUITNOW Department of Health and Human Services Smoking cessation products Chantix (Varinicline) Zyban (Bupropion) Nicotine replacement products Patches, gums, lozenges, nasal sprays, and inhalers

28. Toward a Tobacco-Free Society Chapter 11