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. © 2010 McGraw-Hill Companies. All Rights Reserved.
Table 11.1 Who Smokes?
Table 11.1 Who Smokes?
© 2010 McGraw-Hill Companies. All Rights Reserved.

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 sidestream smoke 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 Cigar and pipes
More than 6.6 million adults
8% of all high school students
Cigar and pipes
Highest rate among white males age 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
© 2010 McGraw-Hill Companies. All Rights Reserved.

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
© 2010 McGraw-Hill Companies. All Rights Reserved.

25. What Can Be Done? Action at many levels Individual action 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