1. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Nine Rejecting Tobacco Use

2. © 2011 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:  19.8% of all adults  Direct relationship between alcohol consumption and cigarette smoking

3. © 2011 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. © 2011 McGraw-Hill Higher Education. All rights reserved. Demographic Trends in Smoking  Size of the community  Large metropolitan areas have lowest smoking rate  Recent homelessness or incarceration  Higher rates  Place of birth  Native-born Americans have higher rates of smoking than foreign-born Americans

5. © 2011 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. © 2011 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. © 2011 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. © 2011 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. © 2011 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. © 2011 McGraw-Hill Higher Education. All rights reserved. Prevention and Intervention  Preventing teen smoking  Government policies  Restrictions on advertisements and promotions  Anti-tobacco advertisements  Early childhood intervention  Decision making skills  Critical thinking and refusal skills  Support for smoke-free environments

11. © 2011 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. © 2011 McGraw-Hill Higher Education. All rights reserved. Health Risks of Tobacco Use

13. © 2011 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  May cause heart attack, stroke, or embolism  Women who smoke should NOT use OCs

14. © 2011 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. © 2011 McGraw-Hill Higher Education. All rights reserved. Development of Lung Cancer

16. © 2011 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. © 2011 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. © 2011 McGraw-Hill Higher Education. All rights reserved. Risks from Specific Tobacco Products  Nonmanufactured cigarettes  Bidis  Kreteks  Mentholated cigarettes  Pipes  Cigars  Smokeless tobacco

19. © 2011 McGraw-Hill Higher Education. All rights reserved. Nonmanufactured Forms of Cigarettes  Bidis  High in tar and nicotine  High level of carbon monoxide  Kreteks (clove-flavored tobacco)  Increased tar and nicotine delivery

20. © 2011 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. © 2011 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. © 2011 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. © 2011 McGraw-Hill Higher Education. All rights reserved. New Product Development  Eclipse  Accord  Omni, Quest, and Advance  Reduced-Ignition Propensity (RIP) Cigarettes  Exotic Blend Cigarettes  Menthol Light Cigarettes  Superslim Cigarettes

24. © 2011 McGraw-Hill Higher Education. All rights reserved. Nontobacco Sources of Nicotine  Aids to smoking cessation  Supplemental forms of nicotine  Less stringent regulation  Ex: nicotine suckers, nicotine-flavored gum, nicotine straws, nicotine-enhanced water  E-cigarettes  Nicotine Bridge Products  Snus

25. © 2011 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

26. © 2011 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

27. © 2011 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

28. © 2011 McGraw-Hill Higher Education. All rights reserved. Cost of Smoking  Loss of independence, freedom, and social contacts due to addiction  Many young adults do not want smokers as life partners  Discrimination

29. © 2011 McGraw-Hill Higher Education. All rights reserved. The Health Benefits of Quitting

30. © 2011 McGraw-Hill Higher Education. All rights reserved. Smoking Cessation  Programs  Educational  Behavior modification  Aversive conditioning  Hypnosis  Acupuncture  Increased taxes on cigarettes  Involvement of family, friends, and co- workers

31. © 2011 McGraw-Hill Higher Education. All rights reserved. Medically Managed Smoking Cessation  Non-nicotine based medication  Influence the production, diffusion, or reuptake of neurotransmitters  Nicotine replacement medications  Allow a controlled and less harmful relationship with nicotine than that associated with tobacco products

32. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Nine: Rejecting Tobacco Use