1. 20th Century World War 1 (soldier’s relief) 1920’s beginning of heavy marketing World War II Marlboro Man 1964 Smoking linked to cancer 1971 advertisements banned from TV 1997 tobacco companies held liable for health problems of users.

2. Tobacco Use Results from the 1998 NHSDA: –An estimated 60 million (27.7%) Americans were current cigarette users –Current smokers were more likely than non- smokers to use alcohol and illicit drugs. –An estimated 3.1% of the population are smokeless tobacco users –An estimated 6.9% were cigar smokers

3. Adolescents and Tobacco Use An estimated 4.1 million youth (12-17) were current smokers. 41.6% of young adults (18-25) were current smokers. Race Approximately 25% of African-Americans, Caucasians, and Hispanics were current smokers. Gender Males had a slightly higher rate than females (29% vs. 27%)

4. Regional Differences North Central 32%; South 28%; North East 25%; and West 24% Urban vs. Rural –Large Metropolitan Areas -26% –Small Metropolitan Areas -27% –Non-Metropolitan Areas - 30%

5. Louisiana Ranking Louisiana Ranks 19th in the Nation with regard to cigarette smoking (1992-1993). New cases of lung cancer annually- 3000. Direct Medical costs related to tobacco use - 611 million (1990).

6. Forms of Tobacco Forms –Cigarettes –Cigars –Smokeless tobacco –Pipe tobacco ROA : –Oral –Smoke

7. Products of Smoking Tobacco Nicotine - psychoactive stimulant Tar -sticky material resulting from the smoking of tobacco Carbon Monoxide -toxic gas that prevents blood cells from carrying oxygen from the lungs

8. What is Nicotine Nicotine is one of 4000 chemicals found in the smoke from tobacco. One of the most frequently used substances and is one the most addictive. 1 Cigarette contains approximately 10 mg of nicotine; 1 to 2 mg are available in the smoke. Nicotine is absorbed through the skin, mouth, nose and/or lungs.

9. What is Nicotine Cigarette smoking delivers nicotine to the brain in approximately 10 seconds. Cigar and pipe smokers typically absorb nicotine through the mucus membranes of the mouth.

10. Effects of Nicotine Initial stimulation of adrenal glands resulting in the release of epinephrine. Results in an increase in heart rate, respiration, and blood pressure. Nicotine also causes the release of dopamine resulting in the activation of the parts of the brain responsible for pleasure.

11. Nicotine and Withdrawal Nicotine is metabolized quickly in the body. Nicotine users develop tolerance. Withdrawal symptoms: –irritability, craving, cognitive deficits, sleep disturbances, increased appetite. Symptoms start within a few hours and peak within the first few days. 90% of smokers who try to quit without treatment will fail.

12. Cost of Tobacco Use Life Tobacco use kills more than 430,000 people annually - More than alcohol, cocaine, heroin, car accidents, fire, and AIDS combined. Economics Smoking is responsible for over 50 million dollars in health care costs annually

13. Medical Consequences (1) Tobacco use accounts for 1/3 of all cancers. Cigarette smoking is linked to 90% of all lung cancer cases. Cardiovascular Disease (stroke, heart attack, vascular disease, and aneurysm). 1/5 of all cardiovascular deaths are attributable to smoking.

14. Medical Consequences (2) Asthma, chronic bronchitis, and emphysema Second Hand Smoke 3,000 annual deaths due to lung cancer in non-smokers. 40,000 deaths related to cardiovascular disease in non-smokers

15. Smoking and Pregnancy Interferes with the oxygen supply of the fetus Developmental delays after birth Smokers are at a greater risk of premature delivery. Decrease in infant birth weigh

16. Smokeless Tobacco and Cancer Cancer of the oral cavity and pharynx accounts for about 3% of all new cancer cases annually (30,500 per year). Only 50% of those diagnosed with oral cancer will be alive 5 years later. The risk of developing oral cancer is 50% higher for smokeless tobacco users.

17. Treatment Nicotine Replacement Treatments (gum, inhalers, the “patch”. Non-Nicotine Therapies are used for relief from withdrawal symptoms (Zyban) Behavioral Treatment