Toward a Tobacco-Free Society

1. Toward a Tobacco-Free Society Chapter 11

2. Who Uses Tobacco? • 71 million Americans smoke • 24% of men and 18% of women smoke

3. Table 11.1 Who Smokes?

4. Figure 11.1 Annual mortality and morbidity among smokers attributable to smoking

5. Why People Use Tobacco • Nicotine addiction • Powerful psychoactive drug • The most physically addictive of all psychoactive drugs • Reaches the brain via the bloodstream in seconds • Loss of control • Tolerance and withdrawal

6. Why People Use Tobacco • Social and Psychological Factors • Established habits or cues to trigger smoking are secondary reinforcers • Genetic Factors • CYP2A6 • DRD2

7. Why Start in the First Place? • 90% of all new smokers in this country are Children and teenagers • 1,300 children and adolescents start smoking every day • Average age • 13 for smoking • 10 for spit tobacco • Rationalizing the dangers, invincible • Emulating smoking in the media

8. Health Hazards • Tobacco adversely affects nearly every part of the body, including: • Brain • Stomach • Mouth • Reproductive organs • Contains hundreds of damaging chemical substances • Unfiltered cigarettes = 5 billion particles per cubic MM • 50,000 times more than smoggy urban air • Condensed particles in the cigarette produce a sticky, brown mass called cigarette tar

9. Carcinogens and Poisons • 43 chemicals are linked to development of cancer (carcinogen) • Benzo(a)pyrene • Urethane • Cocarcinogens (ex. formaldehyde) • Combine with other chemicals to cause cancer • Poisonous substances • Arsenic • Hydrogen cyanide • Carbon monoxide • Contains amounts 400 times greater than is considered safe in industrial workplaces • Displaces oxygen in red blood cells • Additives • Humectants, sugars, bronchodilators, ammonia, things to make sidestreamsmoke less obvious

10. “Light” and Low-Tar Cigarettes • Low-tar, low-nicotine, or filtered cigarettes • No such thing as a safe cigarette • Often smoke more, inhale more deeply, etc. • Less likely to quit

11. Menthol Cigarettes • 70% of African Americans smoke menthol cigarettes • African Americans absorb more nicotine and metabolize it slower than other groups • Anesthetizing effect of menthol, means smokers inhale more deeply and hold smoke longer in the lungs

12. Immediate Effects of Smoking • Acts on the brain either by exciting or tranquilizing the nervous system • At low doses nicotine is a stimulant (elevates bp and hr, etc.) • In adults can increase alertness, concentration, information processing, etc.) opposite effect in young people • Can act as a sedative, and relieve symptoms of anxiety and irritability • Smokers can fine-tune nicotines effects and regulate their moods by increasing or decreasing their intake • Depresses hunger

13. The Long-Term Effects of Smoking • Cardiovascular Disease • Coronary heart disease (CHD) • Atherosclerosis • Myocardial infarction • Stroke • Aortic aneurysm • Pulmonary heart disease • Lung cancer and other cancers • Chronic obstructive pulmonary disease • Emphysema • Chronic bronchitis

14. Figure 11.4 Damage to the lungs caused by smoking

15. Additional Health, Cosmetic, and Economic Concerns • Ulcers • Impotence • Reproductive health problems • Dental diseases • Diminished physical senses • Injuries • Cosmetic concerns • Economic costs

16. Cumulative Effects • People who smoke before 15 yrs. old and continue to smoke are half as likely to live to 75 versus those who did not smoke • Smokers spend one-third more time away from their jobs because of illness than nonsmokers • Both men and women show a greater rate of acute and chronic diseases

17. Other Forms of Tobacco • Spit (smokeless) tobacco • More than 6.6 million adults • 8% of all high school students • Cigar and pipes • Highest rate among white males age 18-44 with higher-than-average income and education • Clove cigarettes and bidis • Twice the tar, nicotine, and carbon monoxide

18. Figure 11.5 Tobacco use among middle school and high school students

19. The Effects of Smoking on the Nonsmoker • Environmental Tobacco smoke (ETS) • EPA designated ETS as a class A carcinogen • Surgeon General issued a report in 2006 concluding that there is no safe level of exposure to ETS

20. Environmental Tobacco Smoke • Mainstream smoke • Smoke exhaled by smokers • Sidestream smoke • Smoke from the burning end of a cigarette, cigar, or pipe • 85% of smoke in a room comes from sidestream smoke • Twice the tar and nicotine, and three times the benzo(a)pyrene, carbon monoxide, and ammonia

21. ETS Effects • Develop cough, headaches, nasal discomfort, eye irritation, breathlessness, and sinus problems • Allergies will be exacerbated • Causes 3,000 deaths due to lung cancer • Contributes to about 35,000 heart disease deaths each year • Nonsmokers can be affected by effects of ETS hours after they leave a smoky environment • Carbon monoxide lingers in bloodstream 5 hours later

22. Infants, Children, and ETS • Children exposed to ETS are more likely to have • SIDs and low-birth weight • Bronchitis, pneumonia, and asthma • Reduced lung function • Middle-ear infections • Lung cancer, emphysema, and chronic bronchitis later in life

23. Smoking and Pregnancy • Estimated 4600 infant deaths in the U.S. • Increased risk of miscarriage, premature birth, low birth weight, and long term impairments in growth and intellectual development

24. The Cost of Tobacco Use to Society • Lost productivity from sickness, disability, and premature death makes it close to $167 billion per year • 1998 Master Settlement Agreement (MSA) • Tobacco companies have to pay $206 billion over 25 years • Limits or bans certain types of advertising, promotions, and lobbying • Designed to limit youth exposure and access to tobacco

25. What Can Be Done? • Action at many levels • Local level • State level • Federal level • FDA, EPA • International level • WHO • Individual action

26. How A Tobacco User Can Quit • The benefits of quitting • Options for quitting • “Cold-turkey” • Changes to routines • Over-the-counter prescription products • Support from family and friends • Smoking cessation programs • Free telephone quitlines • 1-800-QUITNOW

27. Toward a Tobacco-Free Society Chapter 11