1. © Copyright 2011, Pearson Education, Inc. All rights reserved. Chapter 10 Nicotine and Tobacco Use

2. © Copyright 2011, Pearson Education, Inc. All rights reserved. Tobacco Use through History Tobacco use originated among the original inhabitants of North and South America, and its introduction to Europe and the rest of the world dates from the first voyage of Columbus. Europeans used tobacco initially in the form of pipe smoking and later in the form of snuff.

3. © Copyright 2011, Pearson Education, Inc. All rights reserved. Tobacco Use through History In the nineteenth-century United States, the most popular form was tobacco chewing and later cigar smoking. It was not until the late nineteenth century and early twentieth century that cigarette smoking became popular.

4. © Copyright 2011, Pearson Education, Inc. All rights reserved. Health Concerns and Smoking Behavior The 1964 surgeon general’s report, the first official statement on the connection between smoking and adverse health consequences, produced a general reversal in the previously climbing per capita consumption of cigarettes.

5. © Copyright 2011, Pearson Education, Inc. All rights reserved. Health Concerns and Smoking Behavior Since 1964, the surgeon general’s reports have solidified the position that nicotine is a clearly addicting component of tobacco and that tobacco use, whether in smoked or smokeless form, causes significant health risks. Since 1964, there has been increased use of filtered, low-tar, and low-nicotine cigarettes.

6. © Copyright 2011, Pearson Education, Inc. All rights reserved. Tobacco Today: An Industry on the Defensive Since the early 1990s, most U.S. states, cities, and communities have enacted laws mandating smoke-free environments in all public and private workplaces. It is now typical for restaurants, hotels, and other commercial spaces to be at least partially smoke-free.

7. © Copyright 2011, Pearson Education, Inc. All rights reserved. Tobacco Today: An Industry on the Defensive Additional pressure on the tobacco industry has come from proposals to increase the federal excise tax on tobacco products. Increased public pressure since the mid- 1990s has resulted in a greatly limited marketing approach for tobacco products, particularly with respect to sales to young people.

8. © Copyright 2011, Pearson Education, Inc. All rights reserved. Tobacco Today: An Industry on the Defensive In 1998, the major American tobacco corporations entered into a $246 billion settlement agreement with all fifty U.S. states to resolve claims that the states should be compensated for the costs of treating people with smoking-related illnesses. In 2009, the Tobacco Control Act was signed into law, authorizing the FDA to regulate tobacco products sold in the United States.

9. © Copyright 2011, Pearson Education, Inc. All rights reserved. What’s in Tobacco? The principal ingredients consumed during the smoking of tobacco are nicotine, tar, and carbon monoxide. The smoker inhales smoke in the form of mainstream smoke (through the cigarette itself) and sidestream smoke (released from the cigarette tip into the air).

10. © Copyright 2011, Pearson Education, Inc. All rights reserved. The Dependence Potential of Nicotine Nicotine ingestion produces both tolerance effects and physical withdrawal symptoms. A prominent feature of nicotine withdrawal is the strong craving to return to tobacco use. Smokers typically adjust their smoking behavior to obtain a stable dose of nicotine.

11. © Copyright 2011, Pearson Education, Inc. All rights reserved. Health Consequences of Tobacco Use Tobacco smoking produces an increased risk of cardiovascular diseases such as coronary heart disease and stroke, lung cancer and other forms of cancer, and respiratory diseases such as chronic bronchitis and emphysema.

12. © Copyright 2011, Pearson Education, Inc. All rights reserved. Figure 10.1

13. © Copyright 2011, Pearson Education, Inc. All rights reserved. Figure 10.2

14. © Copyright 2011, Pearson Education, Inc. All rights reserved. Health Consequences of Tobacco Use In addition to the hazards to the smoker through the inhalation of mainstream smoke, there are hazards to the developing fetus when the mother is smoking and hazards to nonsmokers who inhale environmental tobacco smoke.

15. © Copyright 2011, Pearson Education, Inc. All rights reserved. Patterns of Smoking Behavior and Use of Smokeless Tobacco In 2009, the past-month prevalence rate for cigarette smoking in the United States among people aged twelve years or older was approximately 23 percent. The peak years for starting to smoke are in the sixth and seventh grades of school.

16. © Copyright 2011, Pearson Education, Inc. All rights reserved. Patterns of Smoking Behavior and Use of Smokeless Tobacco A steady increase in the prevalence of smoking among secondary school students during the 1990s has been reversed. As these young people get older, the prevalence rates for cigarette smoking among college students and young adults are likely to decline.

17. © Copyright 2011, Pearson Education, Inc. All rights reserved. Table 10.1

18. © Copyright 2011, Pearson Education, Inc. All rights reserved. A global trend of unabated smoking rates in Asia, Eastern Europe, Russia, and elsewhere threatens the future health of huge populations of people worldwide. Patterns of Smoking Behavior and Use of Smokeless Tobacco

19. © Copyright 2011, Pearson Education, Inc. All rights reserved. Figure 10.3

20. © Copyright 2011, Pearson Education, Inc. All rights reserved. Quitting Smoking: The Good News and the Bad Research has clearly shown that when people quit smoking, many health risks diminish rapidly. Unfortunately, nicotine dependence is very strong, and it is difficult to quit smoking.

21. © Copyright 2011, Pearson Education, Inc. All rights reserved. Quitting Smoking: The Good News and the Bad Nonetheless, a wide range of smoking cessation treatments are available, and about 50 percent of smokers eventually succeed in quitting on a permanent basis.

22. © Copyright 2011, Pearson Education, Inc. All rights reserved. Quitting Smoking: The Good News and the Bad Present-day approaches to smoking cessation include behavioral treatment programs, hypnosis, acupuncture, and prescription drugs to reduce withdrawal symptoms and craving, as well as a variety of nicotine substitutes.

23. © Copyright 2011, Pearson Education, Inc. All rights reserved. Figure 10.4