Chapter 9 Alcohol and Tobacco 1

Who Drinks? Patterns of Alcohol Use About ___% of American adults drink at least occasionally ____% of the adult U.S. population are abstainers Of the two-thirds who do consume alcohol, 28% are at-risk drinkers Low-risk drinkers are men who drink no more than 14 drinks per week or women who drink no more than 7 drinks per week “One drink” is defined by the NIAAA as 0.5 ounce (or 15 grams) of alcohol 2

One Drink 3

Who Drinks? Patterns of Alcohol Use True or False Alcohol consumption is highest between 18 and 25 for Whites and between 26 and 30 for Hispanics and African Americans People are less likely to drink as adolescents and during early adulthood Older adults drink more than younger adults do Women drink more than men and start drinking later in life 4

Who Drinks? Patterns of Alcohol Use Alcohol use is generally lower among African Americans than among other groups Among Native Americans, alcoholism is recognized as the number one health concern Alcohol consumption is high among Hispanic/Latino men, but it is very low among Hispanic/Latina women Asian Americans have lower consumption rates than White Americans, possibly due to genetic biological reactions toward alcohol 5

Why Do Some People Have Problems with Alcohol? Psychosocial factors Family history of alcoholism Family dysfunction in general Sociocultural/environmental factors Cultural attitudes Economic factors Laws Stresses Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 6

Drinking on the College Campus What is considered binge drinking? Some health experts believe the current definition of binge drinking is too broad and classifies a large number of people as binge drinkers who may not have a problem Other terms, such as heavy drinking or high-risk drinking, may be preferable to describe the drinking currently labeled binge drinking Binge drinking could be reserved for a prolonged period of intoxication (two days or more) Extreme drinking used to describe alcohol consumption beyond binge drinking—10 to 15 drinks a day for men and 8 to 12 for women 7

The Path of Alcohol 8

Alcohol Metabolism A small amount of alcohol is metabolized in the stomach; however, 90% is metabolized by the liver Between 2% and 10% is not metabolized at all but is excreted unchanged through the skin, urine, or breath The liver allows conversion of alcohol to acetaldehyde by an enzyme, alcohol dehydrogenase (ADH) 9

Effects of Alcohol on the Body 10

Liver Damage from Alcohol 11

Fatty Liver 12

Alcohol Metabolism Blood alcohol concentration (BAC): the amount of alcohol in grams in 100 milliliters of blood, expressed as a percentage 100 mgs of alcohol in 100 milliliters of blood is equivalent to a BAC of.10% Breath analyzers are valid based upon alcohol concentrations in the breath that correspond well to levels of alcohol in the brain The amount of body water and body fat a person has influences the BAC levels in the body 13

Blood Alcohol Concentration Over Time 14

15

Effects of Alcohol on the Body Effects of mixing alcohol and energy drinks Up to 28 percent of college students reportedly mix alcohol and energy drinks, despite evidence that doing so is dangerous College students who mix alcohol and energy drinks are three times more likely to leave a bar drunk and four times more likely to drive drunk Other dangerous trends in alcohol consumption include vaporized alcohol and alcohol enemas 16

Social Problems Associated with Alcohol Use Reduction of inhibitions, which may lead to high-risk sexual activity and a lowered likelihood of practicing safe sex Violence, including robbery, assault, rape, domestic violence, and homicide Risk of injury Drunk driving Alcoholism Suicide risk 17

Another View: Health Benefits The Dietary Guidelines for Americans notes that moderate alcohol consumption can be beneficial Anticlotting effect on the blood Enhances body’s sensitivity to insulin Stress reduction Diuretic effect of high water content in beer Increase in HDL In younger adults, alcohol appears to have fewer if any health benefits and is associated with more deaths, injuries, and accidents 18

Treatment Options Brief interventions Alcohol Skills Training Program; Brief Alcohol Screening and Intervention for College Students (BASICS); AlcoholEdu Inpatient and outpatient treatment Residential facilities Detoxification and withdrawal Medications Counseling Self-help programs Support groups (AA, Al-Anon, Alateen, Adult Children of Alcoholics, others) 19

Developing a Behavior Change Plan Following a behavior change plan can assist you with reducing alcohol consumption Record behavior patterns Analyze your drinking diary Establish goals Implement your plan Evaluate your results Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 20

Tobacco 21

Data sources: Campaign for Tobacco Free Kids, 2012 Centers for Disease Control, 2012 U.S.California Adult smoking %19.3%12.1% (3,383,000) High school smoking %18.1%13.8% (304,000) Tobacco-related deaths each year443,00036,600 Annual heath care costs$96.7 Billion$9.1 Billion Tobacco industry marketing$8.5 Billion (30 million/day) $535.7 Million Where: Kern County 21%

Teen Smokers are 6x More: Likely to use alcohol & other drugs Get in fights & carry a weapon Engage in unprotected sex Attempt more at risk behaviors Why?

How? Benowitz, 1999 Heroin Cocaine Dopamine Pleasure, appetite suppression Arousal, appetite suppression Arousal, cognitive enhancement Memory improvement Mood modulation, appetite suppression Reduction of anxiety and tension Norepinephrine Acetylcholine Vasopressin Serotonin Beta-endorphin Nicotine Epinephrine Adrenaline

Key Features of N-O-T 10 Week Session Health Credit Comprehensive Facilitator Training Technical Assistance is Available ALAC Staff Can Co-facilitate & Facilitate Evaluation Component for Tracking

Effects of Environmental Tobacco Smoke Environmental tobacco smoke (ETS): smoke from other people’s tobacco products, also known as secondhand smoke or passive smoke Significant evidence indicates that inhaling ETS has serious health consequences In 2006, the U.S. surgeon general stated that there is no safe level of ETS exposure Infants and children are especially vulnerable to the effects of ETS 27

Treatment Programs and Medications to Quit Smoking Treatment programs Of smokers who enter good treatment programs, 20–40% are able to quit for at least a year Medications Nicotine replacement therapy (NRT) Transdermal patch, nicotine inhaler, nicotine patch, hand gel (Nicogel) Prescription drug (Zyban, Wellbutrin, Chantix) Experimental vaccine (NicVax) 28

29

E-Cigarette Liquid

E-Cigarette Liquid: The “Juice” E-Cigarette Liquid contains: Nicotine, extracted from tobacco leaves Large variation in content between and within brands (Cheah et al 2012; Trtchounian et al 2011; Goniewicz et al 2013) Lethal if ingested; 60 mg Adult; 6 mg Children Detrimental to fetuses (Martz, 2009) Tobacco specific nitrosamines (TSNAs) (Laugesen, 2008; Westenberger, 2009; Goniewicz et al 2013)

E-Cigarette Liquid: The “Juice” E-Cigarette Liquid contains: Propylene Glycol - the vapor; the fog FDA approved food additive (humectant, solvent for colors and flavors), cosmetics, and medicines. Short term exposure causes eye, throat, and airway irritation (Wieslander et al 2001; Vardavas et al 2012,) Long term exposure can result in children developing asthma. (Choi et al 2010) Chemical composition changes when heated (Henderson et al, 1981)

E-Cigarette Liquid: The “Juice” E-Cigarette Liquid contains: Glycerin: A humectant used instead of or in combination with propylene glycol in EC fluids for aerosol production. FDA Approved for ingestion. Slightly hazardous in case of skin and eye contact, ingestion, and inhalation; prolonged exposure may cause organ damage. Metals Tin Particles found in E-liquid (Williams et al., 2013)

E-Cigarette Liquid: The “Juice” E-Cigarette Liquid contains: Flavorants. Key one Menthol; Candy flavoring Anesthetic effects, mimics bronchial dilatation, increases salivary flow; transbuccal absorption; greater cell permeability Allows the poison to go down easier! 100s of candy flavors; appeals to kids (bubblegum, strawberry, gummy bears, etc.) Exotic for adults (Sex on the Beach, Aces and 8’s) Mix your Own (ala roll your own)

Combustion; Heating; Aerosolizing Cigarettes burn tobacco at ~ 900˚ Celsius Heated Tobacco Products E-Cigarettes aerosolize nicotine laced propylene glycol at 40 – 65˚ Celsius

Propylene glycol glycerin Flavorings (many) NicotineNicotine NNNNNN NNKNNK NAB NAT EthylbenzeneEthylbenzene BenzeneBenzene P,m, xylene TolueneToluene AcetaldehydeAcetaldehyde FormaldehydeFormaldehyde NaphthaleneNaphthalene StyreneStyrene Benzo(b)fluorantheneBenzo(b)fluoranthene Benzo(ghi)perylene AcetoneAcetone AcroleinAcrolein Silver NickelNickel Tin Sodium Strontium Barium Aluminum ChromiumChromium Boron Copper SeleniumSelenium ArsenicArsenic Aerosol composition CadmiumCadmium Silicon Lithium LeadLead Magnesium Manganese Potassium Titanium Zinc Zirconium Calcium Iron Sulfur Vanadium CobaltCobalt Rhubidium yellow Compounds in yellow are from FDA 2012, Harmful and Potentially Harmful Substances – Established List Chlorobenzene CrotonaldehydeCrotonaldehyde PropionaldehydePropionaldehyde Benzaldehyde Valeric acid Hexanal Fluorine Anthracene Pyrene Acenaphthylene Acenapthene Fluoranthene Benz(a)anthraceneBenz(a)anthracene ChryseneChrysene Retene Benzo(a)pyreneBenzo(a)pyrene Indeno(1,2,3- cd)pyreneIndeno(1,2,3- cd)pyrene

The Aerosol: Its not just Water Vapor E-Cigarette Vapor Concentrations of pollutants less than in cigarettes Carcinogens, less than in cigarettes Great variation across products; no product standards Intermediate and long term health effects unknown Maybe safer, but this doesn’t mean safe

Secondhand Exposure to Vapors From Electronic Cigarettes (Czogala et al, 2013) The average concentration of nicotine resulting from smoking tobacco cigarettes was 10 times higher than from e-cigarettes (31.60±6.91 vs. 3.32±2.49 µg/m 7xs more Particulate matter Still, in a room of 5 to or more e-cigarette users, nicotine and particulate matter levels are above healthy levels

Short Term Pulmonary Effects A team of scientists found that only after 5 minutes of use, e- cigarettes had immediate adverse physiologic effects, similar to some of the effects seen with tobacco smoking, including decreased FeNO. FeNo, or Fractional exhaled Nitric Oxide, shows the retardation of lung function; this measure is often used in assessing persons with asthma (Vardavas, et. al., 2012)

Litter Only 10% of cigarette butts are properly deposited in ash receptacles. A survey of more than 1,000 smokers found that 35% of smokers toss five or more cigarette butts per pack on the ground, overlooking the consequences of their cigarette butt litter because of its small size. 2 Cigarette butts may be small but doesn’t mean that cigarette litter is a small problem. 40

Tobacco-Free College Campuses Should college campuses be tobacco free? 1,182 of 6,000 are smoke- or tobacco-free Must have real enforcement 41