1. Toward a Tobacco-Free Society
Chapter 11

2. Psychoactive Drugs and Changes in Brain Chemistry
Psychoactive drugs produce most of their key effects by acting on brain chemistry in a characteristic fashion
Consider the route of entry for different types of drugs
Ex. Oral drugs dissolve in stomach absorbed into bloodstream liver, heart and lungs heart brain
The more quickly a drug reaches the brain, the more likely the user is to become dependent

3. Psychoactive Drugs and Changes in Brain Chemistry
Once in the brain, psychoactive drugs act on one or more neurotransmitters by increasing/decreasing their concentrations and actions
Ex. Dopamine is thought to play a role in reinforcement
Heroin, nicotine, alcohol, and amphetamines also affect dopamine levels

4. Who Uses Tobacco? ~15-18% of the U.S. population
~19% of males and ~15% of females
~480,000 deaths/year attributable to smoking
On average, smokers die about 10 years earlier than nonsmokers
The more education a person has, the less likely they are to smoke

5. Why People Use Tobacco Nicotine,
is the powerful psychoactive drug that naturally occurs in tobacco
is considered by many researchers to be the most addictive of all psychoactive drugs
reaches the brain via the bloodstream in seconds

6. 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 to start smoking
13 for smoking tobacco
10 for smokeless tobacco
Reasons why young people start smoking
Rationalizing the dangers
Danger is not immediate
Can feel invincible
Tobacco ads show smoking as exciting, glamorous or safe

7. Why Start Smoking?

8. Why People Use Tobacco Nicotine Addiction Loss of control
Nicotine addiction can start after just a few cigarettes
Most smokers who attempt to quit start again w/in a year
Loss of control
Tobacco users live according to a rigid cycle of need and gratification; on avg. smokers cannot go for no more than 40 min. between doses of nicotine
Tolerance and withdrawal
Sudden abstinence from nicotine produces predictable withdrawal symptoms: severe cravings, insomnia, confusion, tremors, difficulty concentrating, fatigue, muscle pains, headache, nausea, etc., increased heart rate and bp

9. Why People Use Tobacco Social and Psychological Factors
Secondary reinforcers are activities the smoker associates with tobacco use

10. Health Hazards of Smoking Tobacco
What’s in a Cigarette?
Cigarettes contain ~ 600 chemical substances and thousands more are formed as it is burned

11. Carcinogens and Poisons in Tobacco Smoke
43 chemicals are linked to development of cancer
Benzo(a)pyrene is a carcinogen- research has found that this causes mutations in lung cancer cells identical to those found in many lung cancer patients
Urethane- also a carcinogen (directly causes cancer)
Formaldehyde – kills microbes; causes eye irritation and coughing
Arsenic-interferes with our DNA repair mechanisms
Hydrogen cyanide-damages cilia
Carbon monoxide-Displaces oxygen in red blood cells
Other Additives
Humectants, sugars, bronchodilators, ammonia, things to make sidestream smoke less obvious
Formaldehyde:
Formaldehyde is a chemical compound that is formed by the combustion process of cigarette smoking
Tobacco smoke is one of our major sources of formaldehyde exposure
Ammonia
is a household cleaner. It is put into cigarette because it changes the properties of nicotine, and makes cigarettes more addictive. It is generally approved by the FDA to keep bacteria out of packaged meats.

12. “Light” and Low-Tar Cigarettes
Low-tar, low-nicotine, or filtered cigarettes
There is no such thing as a safe cigarette
Users often smoke more, inhale more deeply, blocking ventilation holes
Less likely to quit than smokers
of regular cigarettes
In 2010, federal law prohibited the use of terms such as “light” and “mild”

13. Menthol Cigarettes
Menthols comprise about 30% of the total cigarette market
Individuals smoking menthols 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, causing more damage.

14. Immediate Effects of Smoking
Nicotine can either Excite or Tranquilize the Nervous System Depending on Dosage and tolerance of the smoker
The beginning smoker often feels dizziness, faintness, rapid pulse, cold, clammy skin, nausea
At low dosages nicotine constricts blood vessels, elevates HR and BP; higher doses can be lethal (esp. for children) (overdoses in adults are rare)
Adrenal glands are stimulated to discharge adrenaline
Can act as a sedative, relieving symptoms of anxiety and irritability
Depresses hunger and dulls taste buds

15. The Long-Term Effects of Smoking
Cardiovascular Disease
Research indicates that the total amount of tobacco smoke inhaled is a key factor contributing to disease
Coronary heart disease (CHD) causes just as many deaths from smoking as lung cancer
Atherosclerosis leading to angina pectoris and heart attack

16. The Long-Term Effects of Smoking
Lung cancer and other cancers
Research has linked smoking to cancers of the trachea, mouth, esophagus, larynx, pancreas, bladder, kidney, breast, cervix, stomach liver, colon and skin
Chronic obstructive pulmonary disease
Emphysema and Chronic bronchitis

18. Figure 11.1 Annual Mortality Among Smokers Attributable to Smoking
Figure 11.1 Annual mortality (# of deaths per year due to smoking) and morbidity (# of people w/ chronic illnesses due to smoking) among smokers

19. Figure 11.1 Annual Morbidity Among Smokers Attributable to Smoking
Figure 11.1 Annual mortality (# of deaths per year due to smoking) and morbidity (# of people w/ chronic illnesses due to smoking) among smokers

20. Additional Health, Cosmetic, and Economic Concerns
Ulcers
Impotence
Reproductive health problems
Dental diseases
Diminished physical senses
Injuries
Cosmetic concerns (crows feet around eyes and lips)
Economic costs

21. Other Forms of Tobacco Spit (smokeless) tobacco Cigars and pipes
Contains at least 28 chemicals known to cause cancer
Cigars and pipes
Users do not need to inhale in order to ingest nicotine - its absorbed through gums and mouth
Cigars contain more tobacco than cigarettes more nicotine
E-cigarettes
Contain nicotine, other harmful substances

22. The Effects of Smoking on the Nonsmoker
Environmental Tobacco Smoke (ETS) or Secondhand
ETS consists of mainstream smoke (exhaled by smokers) and sidestream smoke (uninhaled smoke from a burning cigarette, cigar, or pipe)
Sidestream smoke has twice the tar and nicotine,~ 3X the benzo(a)pyrene, CO, and ammonia
EPA designated ETS as a class A carcinogen and Surgeon General has concluded that there is no safe level of exposure to ETS.
~ 54,000 people die/year from secondhand smoke

23. ETS Effects
Develop cough, headaches, nasal discomfort, eye irritation, breathlessness, and sinus problems
Allergies will be exacerbated
Nonsmokers can be affected by effects of ETS hours after they leave a smoky environment
Carbon monoxide lingers in bloodstream 5 hours later

24. 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

25. Smoking and Pregnancy 12-20% of pregnant women smoke
There is increased risk of miscarriage, premature birth, low birth weight, SIDS, and long term impairments in growth and intellectual development
infants of non-smoking mothers have the lowest risk of SIDS.
More than 40% of children who go to the emergency room for asthma live with smokers

26. How A Tobacco User Can Quit
The best way to avoid all of the added chemicals in cigarettes is to stop smoking right now!! This very minute!! THE BENEFITS OF QUITTING ARE IMMEDIATE!
Action at many levels
CDC-Tips From Former Smokers
Smokefree.gov
Free telephone quit-lines
1-800-QUITNOW
Individual action -Talk with your friends and family who have quit smoking and see what helped them, 'quit smoking' products

27. Benefits of Quitting Smoking
There are benefits of quitting
20 minutes after quitting, BP and heart rate drop
After 48 hrs. senses (taste, smell) may improve
Within weeks, circulation improves, less wheezing, wounds may heal faster
Within months, lung function improves, less fatigue
Benefits continue for years after quitting!

28. Toward a Tobacco-Free Society
Chapter 11