1. Tobacco

2. What are the effects of nicotine? How does nicotine affect neurotransmission (generalities here are OK – you don’t need to know all the details) What are the health problems with smoking cigarettes? What are alternate forms of tobacco? How do they affect health? Understand e-cigarettes. There may be some pros and some cons regarding e-cigarettes compared to smoking. Why is quitting difficult? What are some mechanisms to help? Learning objectives

3. ~20% of adults smoke (more men than women) Numbers are falling for adults ~20% of high school students and 6% of middle school student smoke; numbers are rising >90% of smokers start before age 23 Smoking in the US

4. May 2016 Also bans e-cigarettes in all places smoking is banned

5. Chemicals in Cigarettes Naturally in tobacco: nicotine, tar, carbon monoxide 599 chemicals approved for use in manufacture of cigarettes which can transform into >5,000 when burned

6. Acetanisole Acetic Acid Acetoin Acetophenone 6-Acetoxydihydrotheaspirane 2-Acetyl-3- Ethylpyrazine 2-Acetyl-5-Methylfuran Acetylpyrazine 2-Acetylpyridine 3-Acetylpyridine 2-Acetylthiazole Aconitic Acid dl-Alanine Alfalfa Extract Allspice Extract,Oleoresin, and Oil Allyl Hexanoate Allyl Ionone Almond Bitter Oil Ambergris Tincture Ammonia Ammonium Bicarbonate Ammonium Hydroxide Ammonium Phosphate Dibasic Ammonium Sulfide Amyl Alcohol Amyl Butyrate Amyl Formate Amyl Octanoate alpha-Amylcinnamaldehyde Amyris Oil trans-Anethole Angelica Root Extract, Oil and Seed Oil Anise Anise Star, Extract and Oils Anisyl Acetate Anisyl Alcohol Anisyl Formate Anisyl Phenylacetate Apple Juice Concentrate, Extract, and Skins Apricot Extract and Juice Concentrate 1-Arginine Asafetida Fluid Extract And Oil Ascorbic Acid 1-Asparagine Monohydrate 1-Aspartic Acid Balsam Peru and Oil Basil Oil Bay Leaf, Oil and Sweet Oil Beeswax White Beet Juice Concentrate Benzaldehyde Benzaldehyde Glyceryl Acetal Benzoic Acid, Benzoin Benzoin Resin Benzophenone Benzyl Alcohol Benzyl Benzoate Benzyl Butyrate Benzyl Cinnamate Benzyl Propionate Benzyl Salicylate Bergamot Oil Bisabolene Black Currant Buds Absolute Borneol Bornyl Acetate Buchu Leaf Oil 1,3-Butanediol 2,3-Butanedione 1-Butanol 2-Butanone 4(2-Butenylidene)-3,5,5-Trimethyl-2- Cyclohexen-1-One Butter, Butter Esters, and Butter Oil Butyl Acetate Butyl Butyrate Butyl Butyryl Lactate Butyl Isovalerate Butyl Phenylacetate Butyl Undecylenate 3-Butylidenephthalide Butyric Acid] Cadinene Caffeine Calcium Carbonate Camphene Cananga Oil Capsicum Oleoresin Caramel Color Caraway Oil Carbon Dioxide Cardamom Oleoresin, Extract, Seed Oil, and Powder Carob Bean and Extract beta-Carotene Carrot Oil Carvacrol 4-Carvomenthenol 1-Carvone beta-Caryophyllene beta-Caryophyllene Oxide Cascarilla Oil and Bark Extract Cassia Bark Oil Cassie Absolute and Oil Castoreum Extract, Tincture and Absolute Cedar Leaf Oil Cedarwood Oil Terpenes and Virginiana Cedrol Celery Seed Extract, Solid, Oil, And Oleoresin Cellulose Fiber Chamomile Flower Oil And Extract Chicory Extract Chocolate Cinnamaldehyde Cinnamic Acid Cinnamon Leaf Oil, Bark Oil, and Extract Cinnamyl Acetate Cinnamyl Alcohol Cinnamyl Cinnamate Cinnamyl Isovalerate Cinnamyl Propionate Citral Citric Acid Citronella Oil dl-Citronellol Citronellyl Butyrate itronellyl Isobutyrate Civet Absolute Clary Oil Clover Tops, Red Solid Extract Cocoa Cocoa Shells, Extract, Distillate And Powder Coconut Oil Coffee Cognac White and Green Oil Copaiba Oil Coriander Extract and Oil Corn Oil Corn Silk Costus Root Oil Cubeb Oil Cuminaldehyde para-Cymene 1-Cysteine Dandelion Root Solid Extract Davana Oil 2-trans, 4-trans-Decadienal delta-Decalactone gamma-Decalactone Decanal Decanoic Acid 1-Decanol 2-Decenal Dehydromenthofurolactone Diethyl Malonate Diethyl Sebacate 2,3-Diethylpyrazine Dihydro Anethole 5,7-Dihydro-2-Methylthieno(3,4- D) Pyrimidine Dill Seed Oil and Extract meta-Dimethoxybenzene para-Dimethoxybenzene 2,6-Dimethoxypheno lDimethyl Succinate 3,4-Dimethyl- 1,2 Cyclopentanedione 3,5- Dimethyl- 1,2-Cyclopentanedione 3,7-Dimethyl-1,3,6-Octatriene 4,5-Dimethyl-3-Hydroxy- 2,5-Dihydrofuran-2-One6, 10-Dimethyl-5,9-Undecadien-2- One 3,7-Dimethyl-6-Octenoic Acid 2,4 Dimethylacetophenonealpha para-Dimethylbenzyl Alcoholalpha, alpha-Dimethylphenethyl Acetate

7. Immediate Effects of Nicotine Triggers release of neurotransmitters (eg. dopamine) and hormones (eg. adrenaline)

8. Nicotine is stimulant and depressant! Affects on Central nervous system: Stimulates reward system Causes release of excessive dopamine Affects on sympathetic nervous system Activates sympathetic nervous system Many ‘fight or flight’ reactions through release of epinephrine (noradrenaline) Increased heart rate Increased blood pressure Increased respiration Higher glucose levels Increasing dosage Nicotine profile changes from stimulant to sedative Smokers use quick puffs to produce low level of blood nicotine Stimulant effects

9. Nicotine’seffectsonthebrain Normal amount of acetylcholineand acetylcholine receptors

10. Toomanychemicalsin synapse Nicotine Increases release of dopamine from pre- synaptic neuron. You get a ‘high’ when acetylcholine receptors are activated in the post-synaptic neuron.

11. Lessacetylcholineand fewerreceptors Body compensates by reducing acetylcholineand receptors

12. Notenoughacetylcholine andreceptors When you quit smoking,your body isn’t stimulatedenough because you have reduced acetylcholine and their receptors. Body craves more nicotine to make up the difference

13. Tobacco produces tar as it burns Made up of hundreds of chemicals – some poisonous, some carcinogenic Settles in lungs, damages cilia and mucus

14. Tobacco smoke also contains carbon monoxide Interferes with hemoglobin’s ability to carry oxygen and impacts nervous system

15. Smoking greatly increases riskof heartdisease and stroke Heart attack is leading cause of death for smokers Smoking increases BP, increases LDL, decreases HDL, increases plaque Increased risk with oral contraceptives

16. Smoking is linked to many kinds of cancer 30% of all deaths from cancer > 80% of cases of lung cancer Genetics and smoke work together

17. Other smoking-related issues Gum disease, tooth loss, ulcers, erectile dysfunction, fires, high- frequency hearing loss

18. Smoking while pregnant Affects on fetal development Hypoxia in fetus Undernourishment (vasoconstriction of placenta and umbilical cord may play a role) Abnormal brain development Impaired orientation Later in life, increased risk of: Type 2 diabetes Obesity Hypertension Neurobehavioral defects Respiratory dysfunction Nicotine crosses placenta and is found in breast milk (even from 2 nd -hand smoke)

19. How much does smoking cost per year? $3,000 cigarettes (1pack / day) $3,000 health care cost / smoker $4,000 income lost per smoker $250 other costs (2 nd hand smoke)

20. Otherformsoftobacco:Cigars Basically, large, unfiltered cigarettes Much more tobacco per cigar but are not usually inhaled = less risky Mouth, throat, esophageal cancer risk same as cigarettes

21. Otherforms:Smokeless tobacco Includes snuff, chewing tobacco Same effects, addictions, carcinogen as cigarettes Mouth cancers are common!

22. Other forms of tobacco: Vaping Nicotine is a drug, but does not cause many of the negative health problems associated with cigarettes. Not carcinogen Minimal effect on heart disease No platelet aggregation No adverse effects on lipid profile No chemicals from combustion Can cause headaches, changes in appetite, respiratory tract irritation

23. E-cigarettes: the downside Nicotine may prime brain for addiction to other drugs Other toxic chemicals present including formaldehyde (carcinogenic) Acetaldehyde Acetone butanol heavy metals (from device) FDA regulations of e-juice announced in May 2016: do you really know what a company is putting in its product? “flavors” have been assessed as ‘generally safe’ for ingestion, but may be toxic when inhaled to lungs. “It’s better than cigarettes” is a very low bar!

25. Do they help people quit smoking? Reduce and manage nicotine intake But may perpetuate nicotine addiction May interfere with quitting Kids Flavors appeal to younger kids Those who vape by 9 th grade more likely to start smoking within the next year E-cigarettes

26. Second-Hand Smoke Smoke from smoldering cigarette doesn’t pass through filter Smoke from a smoldering cigarette contains 2x as much nicotine and tar, 5x as much CO, 50x as much ammonia!

27. Quitting is toughbutworthit! 70% want to quit, 4-7% succeed each year Decreased risk of heart disease within a year; after 20 years – normal risk of cancers Any time you quit, it’s good

28. Howto quit… RCC offers classes and individual stop-smoking counseling contact Health Services (951-222-8151)

29. Nicotine Replacement Therapy

30. RCC is a non-smoking campus! Since Fall 2009, no smoking is allowed on campus