1. © 2009 McGraw-Hill Higher Education. All rights reserved. Chapter Nine Rejecting Tobacco Use

2. © 2009 McGraw-Hill Higher Education. All rights reserved. Cigarette Smoking among College Students  College smoking trending upwards  Smoking among college students decreased from 1964 to 1995 (from 21% to 14%)  Current rates of smoking among college students:  30.6% of full-time students  42.7% of part-time students  Current rates of smoking among general population:  Men: 23.9%  Women: 18.1%  Direct relationship between alcohol consumption and cigarette smoking

3. © 2009 McGraw-Hill Higher Education. All rights reserved. Demographic Trends in Smoking  Gender  Men have higher rates of smoking than women  Race/ethnicity  Highest smoking rates among American Indians and Alaska Natives  Lowest smoking rates among Asian Americans  Level of education  Higher levels of education are associated with lower rates of smoking  Age  Smoking rates go down as age goes up  Geographic residence  Highest smoking rates in Midwest  Lowest smoking rates in West

4. © 2009 McGraw-Hill Higher Education. All rights reserved. Demographic Trends in Smoking  Size of the community  Large metropolitan areas have lowest smoking rate  Employment status  Highest rate of smoking among unemployed  Recent homelessness or incarceration  Higher rates  Place of birth  Native-born Americans have higher rates of smoking than foreign-born Americans

5. © 2009 McGraw-Hill Higher Education. All rights reserved. Marketing of Tobacco Products  Controversy about advertising due to industry’s knowledge of the health risks  Restrictions on marketing of all tobacco products, BUT  Magazine advertising has increased  Especially in magazines with 15% or more youth readership  Free distribution of cigarettes in bars and restaurants  Luring teens through anti-smoking ads

6. © 2009 McGraw-Hill Higher Education. All rights reserved. Development of Dependence  Dependence: Physical and/or psychological need to continue the use of nicotine  Physical dependence  Tolerance  Withdrawal  Titration  Particular level of a drug within the body  Adjusting the level of nicotine by adjusting the rate of smoking

7. © 2009 McGraw-Hill Higher Education. All rights reserved. Theories of Nicotine Addiction  Genetic influences  60% of initiation and maintenance of initial smoking is driven by genetic influences  Bolus theory  Based on body’s response to the bolus (ball) of nicotine delivered to the brain  Adrenocorticotropic hormone (ACTH) theory  Release of beta endorphins delivers euphoric effect  Self-medication theory  Nicotine, through effects on dopamine, “lifts spirits”

8. © 2009 McGraw-Hill Higher Education. All rights reserved. Acute Effects of Nicotine on Nervous System Function  Nicotine induces increased brain activity  Increased release of neurotransmitters  Norepinephrine  Dopamine  Acetylcholine  Serotonin  Very heavy use of nicotine depresses the central nervous system

9. © 2009 McGraw-Hill Higher Education. All rights reserved. Psychosocial Factors Related to Dependence  Modeling behavior  Manipulation  Susceptibility to advertising  Use of tobacco products associated with a better life  Once smoking is initiated, dependence becomes a key factor in use

10. © 2009 McGraw-Hill Higher Education. All rights reserved. Prevention and Intervention  Preventing teen smoking  Targeted audience  Governments policies  Restrictions on advertising and promotions  Funding for smoking education  Early childhood intervention  Decision making skills  Critical thinking and refusal skills  Support for smoke-free environments

11. © 2009 McGraw-Hill Higher Education. All rights reserved. Tobacco Smoke  Particulate phase (small suspended particles)  Nicotine  Water  Tar  Phenol, benzo[a]pyrene, DDT, and many other chemicals  Gaseous phase  Carbon monoxide  Carcinogens

12. © 2009 McGraw-Hill Higher Education. All rights reserved. Health Risks of Tobacco Use

13. © 2009 McGraw-Hill Higher Education. All rights reserved. Illness, Premature Death, and Tobacco Use  Cardiovascular disease and nicotine  Myocardial infarction  Sudden cardiac death  Angina pectoris  Increased platelet adhesiveness  Unhealthy cholesterol changes  Cardiovascular disease and carbon monoxide  Impairment of oxygen transport  Smoking and oral contraceptive (OC) use  Linked to clots and heart attacks  Women who smoke should NOT use OCs

14. © 2009 McGraw-Hill Higher Education. All rights reserved. Illness, Premature Death, and Tobacco Use  Cancer  Respiratory tract cancers (lung, mouth, larynx  Damage to the respiratory lining (mucus, cilia) brings carcinogens into direct contact with tissues  Other tobacco-enhanced cancers  Kidney  Gastrointestinal system

15. © 2009 McGraw-Hill Higher Education. All rights reserved. Development of Lung Cancer

16. © 2009 McGraw-Hill Higher Education. All rights reserved. Chronic Obstructive Lung Disease  Chronic bronchitis  Persistent inflammation or infection of the smaller airways within the lungs  Pulmonary emphysema  Irreversible disease process in which the alveoli are destroyed  Significant impact on quality of life

17. © 2009 McGraw-Hill Higher Education. All rights reserved. Additional Health Concerns  Poor nutritional state  Reduced insulin sensitivity  Decline in short-term memory  Loss of senses of smell and hearing  Premature wrinkling of the skin  Stroke  Loss of bone mass  Impaired recovery from surgery  Gum disease  Impaired resistance to infection  Asthma  Infertility  Impotence  Earlier menopause  Poor circulation  Burns

18. © 2009 McGraw-Hill Higher Education. All rights reserved. Risks from Specific Tobacco Products  Nonmanufactured cigarettes  Roll-your-own  Bidis  Kreteks  Mentholated cigarettes  Pipes  Cigars  Smokeless tobacco

19. © 2009 McGraw-Hill Higher Education. All rights reserved. Nonmanufactured Forms of Cigarettes  Roll-your-own  More affordable  Equal risk  Bidis  High in tar and nicotine  High level of carbon monoxide  Kreteks (clove-flavored tobacco)  Increased tar and nicotine delivery

20. © 2009 McGraw-Hill Higher Education. All rights reserved. Mentholated Cigarettes  Menthol  Unique taste and “cooling” sensation  Heavily marketed to African American smokers  Special health risks still under investigation

21. © 2009 McGraw-Hill Higher Education. All rights reserved. Pipe and Cigar Smoking  Pipe/cigar smokers have the same rates of cancer as cigarette smokers:  Mouth  Larynx  Throat  Esophagus  Cigar manufacturers are now required to disclose tobacco content and additives  Warning labels required

22. © 2009 McGraw-Hill Higher Education. All rights reserved. Smokeless Tobacco Use  Types  Chewing tobacco  Snuff  Risks associated with use  Leukoplakia  Erythroplakia  Periodontal disease  Oral cancer  Nicotine addiction  Other health risks

23. © 2009 McGraw-Hill Higher Education. All rights reserved. New Product Development  Eclipse  Cigarette that heats rather than burns tobacco  Accord  Cigarette that reduces sidestream smoke  Advance, Omni, and Quest  Cigarettes with “trionic” filters that are supposedly able to reduce carcinogen exposure  Flavored cigarettes  Camel Exotic Blends  Non-tobacco sources of nicotine  Suckers, gums, straws, sprays, drops, etc.

24. © 2009 McGraw-Hill Higher Education. All rights reserved. Smoking and Reproduction  Infertility  Increased risk of ectopic pregnancy  Problem pregnancies  Breast-feeding  Exposes infants to harmful effects and chemicals  Neonatal health problems  Low birth weight  Respiratory problems  Higher risk of SIDS

25. © 2009 McGraw-Hill Higher Education. All rights reserved. Involuntary (Passive) Smoking  Mainstream smoke  Smoke inhaled and then exhaled by smoker  Sidestream smoke  Smoke from the burning end of the cigarette, pipe, or cigar  Contains 85% of harmful substances associated with secondhand smoke  Environmental tobacco smoke  Diluted smoke that stays within a common source of air

26. © 2009 McGraw-Hill Higher Education. All rights reserved. Health Risks of Passive Smoking  Heart disease  Cancer  Eye irritation  Nasal symptoms  Headaches  Cough  In children:  Bronchitis or pneumonia  Respiratory symptoms  Middle ear infections

27. © 2009 McGraw-Hill Higher Education. All rights reserved. Cost of Smoking  440,000 deaths/year  $150 billion/year in health- related expenditures  Reduced life expectancy  Loss of independence, freedom, and social contacts due to addiction

28. © 2009 McGraw-Hill Higher Education. All rights reserved. The Health Benefits of Quitting

29. © 2009 McGraw-Hill Higher Education. All rights reserved. Smoking Cessation  Programs  Education  Behavior modification  Aversive conditioning  Hypnosis  Acupuncture

30. © 2009 McGraw-Hill Higher Education. All rights reserved. Smoking Cessation  Nicotine substitution products  Chewing gum  Patch  Inhaler  Spray  Neurotransmitter-based prescription medications  Bupropion (Zyban)  Varenicline (Chantix)

31. © 2009 McGraw-Hill Higher Education. All rights reserved. Chapter Nine: Rejecting Tobacco Use

32. © 2009 McGraw-Hill Higher Education. All rights reserved. Discussion questions What is the safe level of use for drugs such as cocaine heroin marijuana? Does the drinking age of 21 make sense? Why not just outlaw tobacco? Should anti-drug, tobacco and alcohol programs be increased in schools? For people who are susceptible to addictive behavior, should drug abuse be decriminalized in these cases?