Nicotine and Nicotine and Tobacco Tobacco

HIGHLIGHTS FROM HIGHLIGHTS FROM THE HISTORY OF TOBACCOTHE HISTORY OF TOBACCO

• 1492 - Christopher Columbus’s crew discover 1492 - Christopher Columbus’s crew discover tobaccotobacco

• 1700s - Snuffing is predominant form of tobacco 1700s - Snuffing is predominant form of tobacco use in Europeuse in Europe

• 1800s - Tobacco chewing is predominant form of 1800s - Tobacco chewing is predominant form of tobacco use in U.S.tobacco use in U.S.

• 1920s - Cigarettes become predominant form of 1920s - Cigarettes become predominant form of tobacco use in U.S.tobacco use in U.S.

• 1964 - First surgeon general’s report on smoking1964 - First surgeon general’s report on smoking

• 1998 - Compensation Agreement with Tobacco 1998 - Compensation Agreement with Tobacco IndustryIndustry

THE MOST IMPORTANT TOXIC THE MOST IMPORTANT TOXIC COMPOUNDS IN TOBACCO SMOKECOMPOUNDS IN TOBACCO SMOKE

•Two Main Components•Particulate Phase

•Nicotine•Tar

•Gaseous Phase•Carbon Monoxide•Acetone•Carbon Dioxide

FACTS ABOUT CARBON FACTS ABOUT CARBON MONOXIDEMONOXIDE

• An odorless, colorless, tasteless toxic gasAn odorless, colorless, tasteless toxic gas

• Attaches itself to hemoglobin, preventing oxygen Attaches itself to hemoglobin, preventing oxygen from being carried from the lungs to the rest of from being carried from the lungs to the rest of the bodythe body

• Carbon monoxide in tobacco smoke produces a Carbon monoxide in tobacco smoke produces a subtle but effective asphyxiation of the body.subtle but effective asphyxiation of the body.

FACTS ABOUT TARFACTS ABOUT TAR

• A sticky substance, adhering to cells in the A sticky substance, adhering to cells in the lungs and airways leading to themlungs and airways leading to them

• Alters the composition of cilia that normally Alters the composition of cilia that normally sweep unwanted particlessweep unwanted particles

• Permits carcinogenic compounds to settle on Permits carcinogenic compounds to settle on pulmonary tissuepulmonary tissue

• 12-15mg tar in each cigarette12-15mg tar in each cigarette

FACTS ABOUT NICOTINEFACTS ABOUT NICOTINE

• A toxic, dependence-producing psychoactive drug, A toxic, dependence-producing psychoactive drug, found exclusively in tobaccofound exclusively in tobacco

• 0.5 - 2.0mg/per cigarette; 2-8mg/day @ pack/day0.5 - 2.0mg/per cigarette; 2-8mg/day @ pack/day

• Stimulates CNS receptors sensitive to acetylcholineStimulates CNS receptors sensitive to acetylcholine

• Releases adrenalinReleases adrenalin

• Inhibits activity in the gastrointestinal tractInhibits activity in the gastrointestinal tract

• Increase STM and concentrationIncrease STM and concentration

Factors Influencing Factors Influencing Dependency on NicotineDependency on Nicotine• Speed of the Hit Speed of the Hit

• Frequency of HitsFrequency of Hits

• Psychological FactorsPsychological Factors

• Titration HypothesisTitration Hypothesis

• Tolerance & WithdrawalTolerance & Withdrawal

HEALTH CONSEQUENCES HEALTH CONSEQUENCES OF TOBACCO USEOF TOBACCO USE

• Cardiovascular diseaseCardiovascular disease

ArteriosclerosisArteriosclerosis

AtherosclerosisAtherosclerosis

Coronary heart disease and strokeCoronary heart disease and stroke

• Respiratory diseases (COPD)Respiratory diseases (COPD)

Chronic bronchitisChronic bronchitis

EmphysemaEmphysema

• CancerCancer

DISTRIBUTION OF APPROXIMATELY DISTRIBUTION OF APPROXIMATELY 438,000 U.S. TOBACCO-RELATED 438,000 U.S. TOBACCO-RELATED DEATHS EACH YEARDEATHS EACH YEAR

Visualizing 400,000 to Visualizing 400,000 to 450,000450,000annual tobacco-related annual tobacco-related deathsdeaths Population estimates, U.S. Census, 2007:Population estimates, U.S. Census, 2007:

– Kansas City, Missouri: 450,375Kansas City, Missouri: 450,375

– Cleveland, Ohio: 438,042Cleveland, Ohio: 438,042

– Virginia Beach, Virginia: 434,743Virginia Beach, Virginia: 434,743

– Omaha, Nebraska: 424,482Omaha, Nebraska: 424,482

– Miami, Florida: 409,719Miami, Florida: 409,719

– Oakland, California: 401,489Oakland, California: 401,489

HEALTH CONSEQUENCES HEALTH CONSEQUENCES OF TOBACCO USEOF TOBACCO USE

• Cardiovascular diseaseCardiovascular disease

ArteriosclerosisArteriosclerosis

AtherosclerosisAtherosclerosis

Coronary heart disease and strokeCoronary heart disease and stroke

• Respiratory diseases (COPD)Respiratory diseases (COPD)

Chronic bronchitisChronic bronchitis

EmphysemaEmphysema

• CancerCancer

TOBACCO USE AND CANCERTOBACCO USE AND CANCER

Tobacco use increases risk ofTobacco use increases risk of•Lung cancerLung cancer

•Larynx cancerLarynx cancer

•Mouth cancerMouth cancer

•Lip cancerLip cancer

•Bladder cancerBladder cancer

•Pancreatic cancerPancreatic cancer

•Kidney or uterine cancerKidney or uterine cancer

TRENDS IN CANCER-RELATED TRENDS IN CANCER-RELATED DEATH RATES IN THE U.S.DEATH RATES IN THE U.S.

SPECIAL HEALTH CONCERNS FOR SPECIAL HEALTH CONCERNS FOR WOMENWOMEN

For women, tobacco use increases the For women, tobacco use increases the risk ofrisk of

• Dying from stroke due to brain Dying from stroke due to brain hemorrhagehemorrhage

• Dying from a heart attackDying from a heart attack

Increase in risk is greater when women Increase in risk is greater when women are also using birth-control pills.are also using birth-control pills.

HAZARDS OF ENVIRONMENTAL HAZARDS OF ENVIRONMENTAL SMOKESMOKE

• In an average room, three-fourths of the nicotine In an average room, three-fourths of the nicotine originating from cigarettes being smoked ends up in originating from cigarettes being smoked ends up in the atmosphere.the atmosphere.

• Nonsmoking wives of husbands who smoke have a Nonsmoking wives of husbands who smoke have a 30 percent increased risk of lung cancer compared 30 percent increased risk of lung cancer compared to women whose husbands do not smoke.to women whose husbands do not smoke.

• SIDS - higher rates among children whose mothers SIDS - higher rates among children whose mothers smoked during pregnancy and have environmental smoked during pregnancy and have environmental exposure in infancyexposure in infancy

• Childhood Illness - increased risk of bronchitis and Childhood Illness - increased risk of bronchitis and asthmaasthma

YOUNG SMOKERSYOUNG SMOKERS

• 2007 Rates (smoked within past month):2007 Rates (smoked within past month):

• 20% - College Students20% - College Students

• 22% - 12th Graders22% - 12th Graders

• 14% - 10th Graders14% - 10th Graders

• 7% - 8th Graders 7% - 8th Graders

• Peak years for starting to smoke is in the Peak years for starting to smoke is in the sixth or seventh grade.sixth or seventh grade.

• 80 to 90 percent of regular smokers began 80 to 90 percent of regular smokers began to smoke by the age of eighteen.to smoke by the age of eighteen.

HAZARDS OF CIGAR SMOKINGHAZARDS OF CIGAR SMOKING

• Nicotine content in cigar smoke is Nicotine content in cigar smoke is absorbed directly through tissues lining the absorbed directly through tissues lining the mouth.mouth.

• 5 times higher risk of lung cancer5 times higher risk of lung cancer

• 2 times higher risk of cancer of the mouth, 2 times higher risk of cancer of the mouth, throat, and esophagusthroat, and esophagus

• 45 percent higher risk of COPD45 percent higher risk of COPD

• 27 percent higher risk of coronary heart 27 percent higher risk of coronary heart diseasedisease

FORMS OF SMOKELESS TOBACCOFORMS OF SMOKELESS TOBACCO

•Chewing tobaccoChewing tobacco

Loose-leafLoose-leaf

Fine-cutFine-cut

PlugPlug

TwistTwist

•SnuffSnuff

SIGNS OF TROUBLE SIGNS OF TROUBLE FROM SMOKELESS TOBACCOFROM SMOKELESS TOBACCO

• Lumps in jaw or neckLumps in jaw or neck

• Color changes inside lipsColor changes inside lips

• White patches in mouth (leukoplakia) on White patches in mouth (leukoplakia) on neck or lipsneck or lips

• Red spots or sores (erythroplakia) on lips or Red spots or sores (erythroplakia) on lips or gumsgums

• Repeated bleeding in the mouthRepeated bleeding in the mouth

• Difficulty in speaking or swallowingDifficulty in speaking or swallowing

THE GLOBAL THE GLOBAL PICTURE OF PICTURE OF TOBACCO USETOBACCO USE

Benefits of QuittingBenefits of Quitting• 8 Hours: Drop in CO levels in blood8 Hours: Drop in CO levels in blood

• 24 Hours: Decreased risk of heart attack24 Hours: Decreased risk of heart attack

• 8 Weeks: up to 30% increase in lung functioning8 Weeks: up to 30% increase in lung functioning

• 6 Months: Reduced risk of infection due to 6 Months: Reduced risk of infection due to impaired lung function; decrease in SOBimpaired lung function; decrease in SOB

• 1 Year: 50% decrease in risk of Coronary Heart 1 Year: 50% decrease in risk of Coronary Heart DiseaseDisease

• 10 Years: Significant reduction in lung cancer 10 Years: Significant reduction in lung cancer death ratedeath rate

FIVE A’S: THE ROLE OF THE FIVE A’S: THE ROLE OF THE PHYSICIAN IN SMOKING CESSATIONPHYSICIAN IN SMOKING CESSATION

• AAsk about tobacco usesk about tobacco use

• AAdvise to quitdvise to quit

• AAssess willingness to make a cessation ssess willingness to make a cessation attemptattempt

• AAssist in cessation attemptssist in cessation attempt

• AArrange follow-uprrange follow-up