From Cells to Society: The Multidisciplinary Nature of Tobacco Control

1. From Cells to Society: The Multidisciplinary Nature of Tobacco Control Michael Chaiton Michael.chaiton@utoronto.ca

2. Why Focus on Tobacco? Reducing tobacco use offers the greatest potential for immediate impact at the population-level.

3. Tobacco Problem in Canada Smoking, along with other forms of tobacco use, remains the leading cause of illness and death in western societies.

4. Tobacco Problem in Canada In 2002, smoking accounted for 17% of all deaths in Canada 21% for men and 12% for women.

5. Tobacco Problem in Canada Tobacco use is responsible for three times as many deaths as the combined total of alcohol, drugs, suicide, homicide, injuries sustained from car crashes, and AIDS.

6. Tobacco Problem in Canada 37,000 Deaths 515,607 Years of Life Lost 2,210,155 hospital days Cancer was the leading cause of death (17,679 deaths) followed by cardiovascular disease (10,853) and respiratory disease (8,282)

7. ENVIRONMENT VECTOR AGENT HOST Framework

8. Environment Mosquito Parasite Person Framework

9. Environment Tob Ind Cigs Person Framework

11. Host • Risk taking! • Extroversion! • Excitement! • Glamorous identity! • Higher rates of depression and other mental health issues • Genetic factors • Physiological differences: pre-natal exposure • Drug reward and satisfaction

12. The Reward Pathway

13. Agent Factors • The drug must gain access to the brain (cross the blood/brain barrier) • Blood flow, lipid solubility, molecular size, presence of active transport processes • The faster the drug reaches the brain, the more likely self-administration is to occur • Crack vs. cocaine; heroin vs. morphine; smokeless vs. cigarette

15. Environmental Factors • Gin Epidemic • Surplus grain in England • "An Act for the Encouraging of the Distillation of Brandy and Spirits from Corn” • Legislation created epidemic

16. Environmental Factors • Vietnam veterans • Epidemic of heroin use among American soldiers in Vietnam • Nearly all quit on return or with minimal intervention • Lack of availability and behavioural cues

17. WWI veterans • Prime event in diffusion to widespread use • Cigarettes packaged as rations thanks to the ‘generosity’ of tobacco companies

18. The Vector

19. https://ams-wd.utoronto.ca/sap/bc/gui/sap/its/zf_logon_mrol?sap-client=010https://ams-wd.utoronto.ca/sap/bc/gui/sap/its/zf_logon_mrol?sap-client=010

20. Agent Lectures • The cigarette (Kaiserman)

21. Host Lectures • Health effects (Ferrence) • Global impact (Jha) • Addiction (Clarke; O’Loughlin) • Genetics (Tyndale)

22. Host Lectures • Medical interventions (Selby) • Hospital Based Interventions (Pipe) • Psychology of smoking (Hammond) • Fertility (Holloway) • Physical Activity (Faulkner)

23. Environment Lectures • Smoking and the Movies (Glantz) • Mass Media (Wakefield) • Economics (Chaloupka) • Global issues (Cohen) • Policy (Fong)

24. Vector Lectures • Marketing (Dewhirst) • Contraband (Perley) • Tobacco and activism (Mahood)

25. This course is partly funded by the Canadian Cancer Society (award #702160)