1. Factors that Influence Use

2. 45.3 million adults in the United States smoke cigarettes, although this single behavior results in disability or premature death for half of all regular users. Source: CDC, Office on Smoking and Health Factors that Influence Use Nicotine Addiction

3. Smokers give several general reasons for smoking. 1. Stimulation 2. Handling the cigarette 3. Relaxation 4. Help for tension 5. Craving 6. Habit * (Addiction) * The preferred term in Tobacco Control is addiction, not habit. Factors that Influence Use Nicotine Addiction

4. Addiction : Habitual psychological and physiological dependence on a substance beyond one's voluntary control Addiction Psychological Need Physical Need Tolerance Factors that Influence Use Nicotine Addiction

5. Withdrawal Symptoms  Irritability  Anxiety  Difficulty concentrating  Increased appetite. Factors that Influence Use Nicotine Addiction

6.  Adrenaline—rush of energy  Acetylcholine—awake and stimulated  Dopamine—relaxed and feeling good  Endorphins—natural painkillers  Glutamate--learning and memory Source: How Stuff Works, Inc. Factors that Influence Use Nicotine Addiction

7. Factors that Influence Use Physiological Effects

8. Withdrawal symptoms are REAL and can range in severity. Q: Do you know the signs of withdrawal from nicotine?

9. Factors that Influence Use Physiological Effects  People who stop smoking greatly reduce their risk of dying prematurely.  The younger a smoker quits, the greater the health benefits.  But, stopping at any age is beneficial to health. CDC, Office on Smoking and Health

10. Factors that Influence Use Physiological Effects

11. Factors that Influence Use Tobacco Products

12. Factors that Influence Use Tobacco Products

13. Additives are also in cigars, pipe tobacco, and spit tobacco for taste and addictive properties. Factors that Influence Use Tobacco Products

15. Clove Cigarettes or Kreteks  70% tobacco and 30% cloves  Clove numbs throat  Densely rolled = higher exposure to carcinogens Factors that Influence Use Tobacco Products

16. Bidis  Non-filtered, sweet-flavored cigarette  Higher levels of carbon monoxide, nicotine, and tar than cigarettes  Popular with young people Factors that Influence Use Tobacco Products

17. Cigars and Cigarillos  Tobacco wrapped in a tobacco leaf  Can contain as much tobacco as a pack of cigarettes  Growing popularity among young people

18. Hookah  Traditional Middle Eastern and Asian device for smoking shisha tobacco  Perceived as less risky  Growing popularity in U.S. among young people Factors that Influence Use Tobacco Products

19. E-Cigarettes Nicotine delivery systems that use water, a heating element, and electricity to mimic the sensation of smoking a cigarette Factors that Influence Use Tobacco Products

21. Snus  Taboka was the tobacco industry’s first attempt at Snus.  A smokeless form of tobacco that comes in pouches.  Originated in Sweden, new to the U.S.

22. Factors that Influence Use Tobacco Products

23. Factors that Influence Use Social Factors

24. CommunityCulture Customs Values Attitudes Beliefs Factors that Influence Use Social Factors

25.  Behavioral norm: the most common actions or behaviors exhibited in a social group.  Attitudinal norm: the most widely shared beliefs or expectations in a social group about how people or members of the group ought to behave. National Social Norms Resource Center, 2009 Factors that Influence Use Social Norms

27. Factors that Influence Use Movies “In contrast to the health groups, who saw smoking as a medical issue, the tobacco industry has always seen smoking as a cultural issue. And there is not a better way to control pop culture worldwide than through movies…” Professor Stanton Glantz

28.  Smoking in the most popular, youth-oriented, PG-13 movies has increased.  Teenagers are more readily influenced than other age groups.  Tobacco companies benefit financially from individuals who start to use tobacco at an early age.  Tobacco companies have violated the tobacco settlement and have a long history of marketing their products to young people. Ng & Dakake. 2002. MASSPIRG. Factors that Influence Use Movies

29.  Tobacco use has increased 50% since the MSA.  Tobacco use remains prevalent in PG-13, youth-oriented movies.  Most films portray smokers and smoking in a positive or neutral light.  Fewer films feature negative statements about tobacco use.  Several films show identifiable, brand name cigarette packs.  Big name stars smoked in both pre- and post-settlement films. Ng & Dakake. 2002. MASSPIRG. Factors that Influence Use Movies

30.  Efforts are being made to get smoking out of the movies.  Programs such as Screen Out! and California Youth and Advocacy Network’s (CYAN’s) “Tobacco and Hollywood Campaign” are raising awareness of this problem and endorsing change. Factors that Influence Use Movies

31. Factors that Influence Use The Power of Advertising Campaign for Tobacco Free Kids Ad Gallery, 2009

32. Campaign for Tobacco Free Kids Ad Gallery Factors that Influence Use The Power of Advertising

33. Campaign for Tobacco Free Kids Ad Gallery

34.  African Americans  Hispanics and Latinos  Native Americans and Alaskan Natives  Asian Americans and Pacific Islanders  Lesbians, Gays, Bisexuals and Transgenders (LGBT)  Low SES Factors that Influence Use Targeting Specific Populations

35. “ RJR's business among Blacks is underdeveloped.... Further, given their strong preference for menthol flavor, we probably need to devote more attention to Blacks... In fact, I even feel that a project designed to develop a cigarette for Blacks may be a viable business proposition.” Targeting Cigarettes at African Americans RJR, 1977 Campaign for Tobacco Free Kids Ad Gallery

36. Factors that Influence Use Targeting Specific Populations

37. 1990s 2008 Factors that Influence Use Targeting Specific Populations

38. Campaign for Tobacco Free Kids Ad Gallery Factors that Influence Use Targeting Specific Populations

39. Campaign for Tobacco Free Kids Ad Gallery Factors that Influence Use Targeting Specific Populations

40. Factors that Influence Use

41. National Cancer Institute, Visuals Online How could they possibly enhance that image? Factors that Influence Use Tobacco Product Enhancement

48. Factors that Influence Use Tobacco Industry Enhancement

49. Why the name change?  Official reason: Represents diversity of products  Real Reason: disassociates company from its strong tobacco identity.

50. In 2001, the manufacturer of Skoal chewing tobacco changed its name from “United States Tobacco Company” to disassociate from smoking and auxiliary issues like smoke-free air. In 2001, the manufacturer of Skoal chewing tobacco changed its name from “United States Tobacco Company” to disassociate from smoking and auxiliary issues like smoke-free air. Factors that Influence Use Tobacco Industry Enhancement

51. Review Evolution of Tobacco Control  Described the history and evolution of the tobacco control movement.  Learned the impact that events had on tobacco use throughout U.S. history Prevalence of Tobacco Use  Learned where to obtain data on the prevalence and impact of tobacco use.  Learned the importance of using local data.

52.  Discussed the impact of addiction.  Analyzed how the tobacco industry influences tobacco use.  Discussed the health effects and health risks associated with tobacco use.  Discussed the health effects of secondhand smoke  Discussed the health effects of secondhand smoke. Review Impact of Tobacco Use Factors that Influence Use

53. Tobacco Technical Assistance Consortium Rollins School of Public Health Emory University Atlanta, Georgia To contact: ttac@sph.emory.edu Phone: 404-712-8474