Transcript Tobacco Use

Tobacco
Chapter 11
Tobacco Use: Scope of the Problem
• Tobacco use is the leading preventable
cause of disease and premature death in the
United States.
- 443,000 deaths annually in United States
• Tobacco is the single largest cause of
preventable death and a risk factor for 6/8 of
the leading causes of death.
Current Tobacco Use in the U.S.
• In 2011, 68.2 million Americans, or 26.5%
of the population age 12 or older, reported
current use of a tobacco product.
• Approximately 32.3 percent of males and
21.1% of females age 12 or older were
current users of any tobacco product.
Tobacco Use:
A Costly Addiction
• More deaths are caused each year by
tobacco use than by HIV, illegal drug use,
murders, alcohol use, suicides, and motor
vehicle injuries combined.
History of Tobacco Use
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Mayans: tobacco smoke as “divine incense”
Turkey: poets vs. priests
France: Louis XIII vs. Louis XIV
Nicholas Monardes: infallible cure
Pope Urban VII: excommunication for
tobacco users
History of Tobacco Use
in America
• Cigars became popular in the United States in
the early 1800s.
• The introduction of the cigarette-rolling
machine spurred cigarette consumption
because cigarettes became cheaper than
cigars.
Tobacco Production
• Nicotiana tabacum is the primary species of
tobacco.
• Flue-cured tobacco is cured with heat
transmitted through a flue without exposure
to smoke or fumes.
Government Regulation
• 1964: The Advisory Committee to the U.S.
Surgeon General reported that cigarette
smoking is related to lung cancer.
• 1970: Warnings on cigarette labels.
Master Settlement Agreement
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Limitations on advertising
Ban on cartoon characters in advertising
Ban on “branded” merchandise
Limitations on sponsoring of sporting events
Disbanding of tobacco trade organizations
Funds designated to support anti-smoking
measures and research to reduce youth
smoking
Family Smoking Prevention
and Control Act
• Gave FDA authority to regulate the
manufacture, distribution, and
marketing of tobacco products
• Restricts cigarette sales to youth
and requires proof of age
Pharmacology of Nicotine
• It is a colorless, highly volatile liquid
alkaloid.
• When smoked, nicotine enters the lungs and
is then absorbed into the bloodstream.
• When chewed or dipped, nicotine is absorbed
through the mucous lining of the mouth.
Pharmacology of Nicotine
• Amount of tobacco absorbed depends on
- Exact composition of tobacco
- How densely the tobacco is packed in the
cigarette
- Whether a filter is used and characteristics of
filter
- The volume of smoke inhaled
- The number of cigarettes smoked
Physiological Effects
• Stimulates central dopamine release
• Stimulates cardiovascular system
Cigarette Smoking
• Cigarette smokers not only tend to die at
an earlier age than nonsmokers, but also
have a higher probability of developing
certain diseases, including cardiovascular
disease, cancer, bronchopulmonary
disease, and other illnesses
Cardiovascular Disease
• Smoking causes coronary heart disease, the
leading cause of death in the United States.
• Compared with non-smokers, smoking increases
the risk of coronary heart disease two to four
times.
• Smoking puts smokers at greater risk for
developing peripheral artery disease.
Cancer
• Cigarette smoking is a major cause of cancers
of the lung, bladder, pancreas, cervix,
esophagus, stomach, oral cavity and kidney.
• The risk of lung cancer in men who smoke two
or more packs per day is 23 times greater than
the risk for nonsmokers, while the risk for
women is approximately 13 times greater.
Bronchopulmonary Disease
• Cigarette damages
the airways and
alveoli, and causes
emphysema,
chronic airway
obstruction, and
emphysema
Effects on Pregnancy
• One in six pregnant women smoked
cigarettes in the past month
• Increased risk for stillbirth, pre-term
delivery, infertility, low birth weight and
sudden infant death syndrome
Light Cigarettes
• There is no conclusive evidence of reduced
health risks associated with low-tar cigarettes.
• Filtered cigarettes reduce levels of tar, nicotine,
and carbon monoxide at the mouth end of the
filter and should be of some limited benefit.
• Many smokers lose this benefit because they
often smoke more cigarettes per day, increase
puff number and volume, or block the filter
holes with their fingers or lips.
Electronic Cigarettes
• Electronic cigarettes (e-cigarettes) are devices
designed to deliver nicotine or other substances
to a user as a vapor.
• The FDA has not evaluated e-cigarettes for
effectiveness or safety.
Tobacco Use Without Smoking
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Chewing tobacco and snuff.
Use can lead to nicotine addiction and dependence.
Contains 28 cancer-causing agents.
Smokeless tobacco is strongly associated with
leukoplakia.
• Smokeless tobacco increases the risk of developing
cancer of the oral cavity and pancreas.
• Smokeless tobacco use during pregnancy increases the
risks for preeclampsia, premature birth, and low birth
weight.
Secondhand Smoke
• Secondhand smoke includes a mixture of
smoke that comes directly from the lighted tip of
a cigarette, cigar, or pipe tip and exhaled smoke
• Passive smoking refers to nonsmokers’
inhalation of tobacco smoke.
• Secondhand smoke exposure causes an
estimated 46,000 heart disease deaths annually
in the United States.
Benefits of Cessation
1. A return to normalcy of heart rate and
blood pressure (which are abnormally high
while smoking).
2. A decline of carbon monoxide in the blood
within hours.
3. Improved circulation, production of less
phlegm, and decreased rate of coughing
and sneezing within weeks.
4. Substantial improvements in lung function
within several months.
Benefits of Cessation
(continued)
5. Decreased risk for lung and other types of
cancer.
6. Decreased risk for coronary heart disease,
stroke, and peripheral vascular disease.
7. Decreased respiratory symptoms such as
coughing, wheezing, and shortness of
breath.
Benefits of Cessation (continued)
8. Decreased risk of developing chronic
obstructive pulmonary disease.
9. Decreased risk for infertility in women.
10. Decreased risk of having a low birth
weight baby.
Methods for Quitting
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Nicotine gum
Nicotine patches
Nicotine spray
Nicotine lozenges
Bupropion
Varenicline