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From Cells to Society: From Cells to Society: The Multidisciplinary The Multidisciplinary
Nature of Tobacco ControlNature of Tobacco Control
Michael [email protected]
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Why Focus on Tobacco?
Reducing tobacco use offers the greatest potential for immediate impact at the population-level.
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Tobacco Problem in Canada
Smoking, along with other forms of tobacco use, remains the leading cause of illness and death in western societies.
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Tobacco Problem in Canada
In 2002, smoking accounted for 17% of all deaths in Canada
21% for men and 12% for women.
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Tobacco Problem in Canada
Tobacco use is responsible for three times as many deaths as the combined total of alcohol, drugs, suicide, homicide, injuries sustained from car crashes, and AIDS.
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Tobacco Problem in Canada
37,000 Deaths515,607 Years of Life Lost2,210,155 hospital daysCancer was the leading cause of death
(17,679 deaths) followed by cardiovascular disease (10,853) and respiratory disease (8,282)
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Framework
VECTOR
HOST
ENVIRONMENT
AGENT
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Framework
Mosquito
Person
Environment
Parasite
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Framework
Tob Ind
Person
Environment
Cigs
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Host
Risk taking! Extroversion! Excitement! Glamorous identity!
Higher rates of depression and other mental health issues
Genetic factors Physiological differences: pre-natal exposure Drug reward and satisfaction
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The Reward Pathway
12
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Agent Factors
13
The drug must gain access to the brain (cross the blood/brain barrier) Blood flow, lipid solubility, molecular size,
presence of active transport processes The faster the drug reaches the brain, the
more likely self-administration is to occur Crack vs. cocaine; heroin vs. morphine;
smokeless vs. cigarette
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0
100
200
300
400
500
600
700
800
0.74 0.78 0.82 0.86 0.90 0.96 1.00 1.04 1.08+
Midpoint elasticity
Med
ian
sale
s (in
mill
ions
of c
igar
ette
s) p
er g
roup
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Environmental Factors
15
Gin Epidemic Surplus grain in
England "An Act for the
Encouraging of the Distillation of Brandy and Spirits from Corn”
Legislation created epidemic
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Environmental Factors
16
Vietnam veterans Epidemic of heroin
use among American soldiers in Vietnam
Nearly all quit on return or with minimal intervention
Lack of availability and behavioural cues
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WWI veterans Prime event in diffusion to
widespread use Cigarettes packaged as rations
thanks to the ‘generosity’ of tobacco companies
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The Vector
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https://ams-wd.utoronto.ca/sap/bc/gui/sap/its/zf_logon_mrol?sap-client=010
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Agent Lectures The cigarette (Kaiserman)
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Host Lectures Health effects (Ferrence)
Global impact (Jha)
Addiction (Clarke; O’Loughlin)
Genetics (Tyndale)
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Host Lectures Medical interventions (Selby)
Hospital Based Interventions (Pipe)
Psychology of smoking (Hammond)
Fertility (Holloway)
Physical Activity (Faulkner)
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Environment Lectures Smoking and the Movies
(Glantz) Mass Media (Wakefield) Economics (Chaloupka) Global issues (Cohen) Policy (Fong)
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Vector Lectures
Marketing (Dewhirst)
Contraband (Perley)
Tobacco and activism (Mahood)
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This course is partly funded by the Canadian Cancer Society (award #702160)