Personal HealthPersonal Health

Chapter 9Chapter 9

Rejecting Tobacco UseRejecting Tobacco Use

Advertisement & PrevelanceAdvertisement & Prevelance

Do tobacco ads target kids?Do tobacco ads target kids?

Master Settlement AgreementMaster Settlement Agreement

Table 9.1Table 9.1

Table 9.2Table 9.2

Smoking Among College StudentsSmoking Among College Students

21% in 196421% in 1964 14% in 199514% in 1995 Recent study showed 31.4%Recent study showed 31.4% Some studies show a link between heavy Some studies show a link between heavy

smoking and not completing either high school smoking and not completing either high school or college.or college.

Is there a link between heavy smoking and Is there a link between heavy smoking and dropping out of high school?dropping out of high school?

Other Demographic FactorsOther Demographic Factors Gender, race, ethnicity and education levelGender, race, ethnicity and education level Also: Also:

Age – as the age groups go up in age smoking goes Age – as the age groups go up in age smoking goes downdown

Region of the country – northcentral 26%, west 20%, Region of the country – northcentral 26%, west 20%, south 25.4%, northeast 23.9%south 25.4%, northeast 23.9%

Size of the community – outside metro 30.5%, small Size of the community – outside metro 30.5%, small metro 27.2, large metro 26.5metro 27.2, large metro 26.5

Employment status – part-time 31.2%, full-time Employment status – part-time 31.2%, full-time 25.5%, unemployed 48.2%25.5%, unemployed 48.2%

Marketing of Tobacco ProductsMarketing of Tobacco Products

Smoking is a learned habit.Smoking is a learned habit. Do advertisements act as a source of behavior Do advertisements act as a source of behavior

to be modeled?to be modeled? They must because they work.They must because they work. Advertisements entice new smokers in Advertisements entice new smokers in

sufficient numbers to replace the 3000 sufficient numbers to replace the 3000 smokers who die each day.smokers who die each day.

What has changed in the advertising of What has changed in the advertising of tobacco products over the last 10 years?tobacco products over the last 10 years?

Pipe and Cigar SmokingPipe and Cigar Smoking

Many people believe that pipe and cigar Many people believe that pipe and cigar smoking is a safe alternative to cigarette smoking is a safe alternative to cigarette smoking.smoking.

See Star Box 283See Star Box 283 Still fewer people smoke pipes and cigars.Still fewer people smoke pipes and cigars. Starting to see an increase in the number of Starting to see an increase in the number of

women who smoke cigars.women who smoke cigars. Any big media advertisements for cigars?Any big media advertisements for cigars?

Tobacco Use and the Development of Tobacco Use and the Development of DependenceDependence

Dependence – a physical and/or psychological Dependence – a physical and/or psychological need to continue the use of a drugneed to continue the use of a drug

Titration – the particular level of a drug within the Titration – the particular level of a drug within the body; adjusting the level of nicotine by adjusting body; adjusting the level of nicotine by adjusting the rate of smokingthe rate of smoking

Dependency to tobacco is easily established.Dependency to tobacco is easily established. Of the people who experimented, 85% develop Of the people who experimented, 85% develop

various aspects of a dependence relationshipvarious aspects of a dependence relationship Some people fear the consequences of stopping.Some people fear the consequences of stopping.

Tobacco Use and the Development of Tobacco Use and the Development of DependenceDependence

Full-time smokersFull-time smokers Social smokers or chippersSocial smokers or chippers Part-time smokers – 20% of the smoking Part-time smokers – 20% of the smoking

populationpopulation

Theories of Nicotine AddictionTheories of Nicotine Addiction

Genetic influences – they do existGenetic influences – they do exist Initial smoking is 60% driven by genetic influencesInitial smoking is 60% driven by genetic influences Not so much the genetic predisposition to try smoking, Not so much the genetic predisposition to try smoking,

but more of a genetic predisposition to but more of a genetic predisposition to neurohormonally “appreciate” the stimulating effects neurohormonally “appreciate” the stimulating effects of nicotine.of nicotine.

Bolus Theory – each inhalation of smoke releases Bolus Theory – each inhalation of smoke releases into the blood a concentrated quantity of nicotine into the blood a concentrated quantity of nicotine that reaches the brain & results in a period of that reaches the brain & results in a period of neurohormonal excitementneurohormonal excitement

Theories of Nicotine AddictionTheories of Nicotine Addiction

Adrenocorticotrpoic Hormone )ACTH) Theory – Adrenocorticotrpoic Hormone )ACTH) Theory – suggests that nicotine stimulates the release of suggests that nicotine stimulates the release of ACTH from the anterior pituitary gland causing a ACTH from the anterior pituitary gland causing a release of beta endorphinsrelease of beta endorphins

Self-Medication Theory – through the effects of Self-Medication Theory – through the effects of mood-enhancing dopamine smokers can treat mood-enhancing dopamine smokers can treat feelings of tiredness, lack of motivation or even feelings of tiredness, lack of motivation or even depressiondepression

Acute Effects of Nicotine on Nervous Acute Effects of Nicotine on Nervous System FunctionSystem Function

Nicotine starts out producing a stat of general Nicotine starts out producing a stat of general arousal by causing the release of arousal by causing the release of norepinephrine, dopamine, scetylcholine and norepinephrine, dopamine, scetylcholine and serotonin.serotonin.

Heavy use eventually produces a blocking Heavy use eventually produces a blocking effect as more and more receptor sites for effect as more and more receptor sites for these neurotransmitters are filled.these neurotransmitters are filled.

The result is a generalized depression of the The result is a generalized depression of the CNS.CNS.

Non-Nervous System Acute EffectsNon-Nervous System Acute Effects

Nicotine affects the transmission of nerve Nicotine affects the transmission of nerve signals at the neuromuscluar junction by signals at the neuromuscluar junction by mimicking the action of the neurotransmitter mimicking the action of the neurotransmitter acetylcholine.acetylcholine.

Nicotine prevents the transmission of nerve Nicotine prevents the transmission of nerve impulses from nerve cell to muscle cell.impulses from nerve cell to muscle cell.

The release of epinephrine results in an The release of epinephrine results in an increase in respiration rate, heart rate, blood increase in respiration rate, heart rate, blood pressure & coronary blood flow.pressure & coronary blood flow.

Non-Nervous System Acute EffectsNon-Nervous System Acute Effects

Also, constriction of the blood vessels beneath Also, constriction of the blood vessels beneath the skin, reduction in the motility in the the skin, reduction in the motility in the bowels, loss of appetite and changes in the bowels, loss of appetite and changes in the sleep patterns.sleep patterns.

Psychosocial Factors Related to Psychosocial Factors Related to DependenceDependence

Many of these influences support the dependence Many of these influences support the dependence process before the onset of the physical addiction.process before the onset of the physical addiction.

Modeling – susceptible people smoke to emulate Modeling – susceptible people smoke to emulate smokers whom they admire or with whom they smokers whom they admire or with whom they share other types of bondsshare other types of bonds Advertisements for tobacco must use models who are Advertisements for tobacco must use models who are

21 years old21 years old Yet they use models who look much youngerYet they use models who look much younger

Psychosocial Factors Related to Psychosocial Factors Related to DependenceDependence

Manipulation – cigarette use may meet the beginning Manipulation – cigarette use may meet the beginning smokers need to manipulate something & at the same smokers need to manipulate something & at the same time provide the manipulative tool necessary to offset time provide the manipulative tool necessary to offset boredomboredom

Susceptibility to Advertising – the media has paired Susceptibility to Advertising – the media has paired suggestions of a better life with the use of its productssuggestions of a better life with the use of its products

To the users & potential users, the self-reward of power, To the users & potential users, the self-reward of power, liberation, affluence, sophistication, or adult status is liberation, affluence, sophistication, or adult status is achieved by using the products that they are told are achieved by using the products that they are told are associated with these desired states.associated with these desired states.

Preventing Teen SmokingPreventing Teen Smoking

The tobacco industry used to intentionally The tobacco industry used to intentionally target youths with its advertising and target youths with its advertising and marketing campaigns.marketing campaigns.

5 policies aimed at reducing the percentage of 5 policies aimed at reducing the percentage of adolescent smoking to no more than 16% by adolescent smoking to no more than 16% by 2010, pg 289.2010, pg 289.

Which of these do you think will have the Which of these do you think will have the greatest effect?greatest effect?

Early Childhood InterventionEarly Childhood Intervention

Some people believe that you should start Some people believe that you should start educating your children as preschoolers.educating your children as preschoolers.

Suggested activities as opposed to facts for Suggested activities as opposed to facts for preschoolers, K-3, and preteen years pgs 289-preschoolers, K-3, and preteen years pgs 289-290.290.

Tobacco: The Source of Tobacco: The Source of Physiologically Active CompoundsPhysiologically Active Compounds

With each puff of smoke, the body is exposed With each puff of smoke, the body is exposed to approx. 4,700 chemical compounds.to approx. 4,700 chemical compounds.

An annula 70,000 puffs taken in by the on-An annula 70,000 puffs taken in by the on-pack-a-day cigarette smoker results in an pack-a-day cigarette smoker results in an environment that makes the most polluted environment that makes the most polluted urban environment seem clean by comparison.urban environment seem clean by comparison.

Table 9.3Table 9.3

Tobacco: The Source of Tobacco: The Source of Physiologically Active CompoundsPhysiologically Active Compounds

Particulate Phase – portion of the tobacco Particulate Phase – portion of the tobacco smoke composed of small suspended particlessmoke composed of small suspended particles

Includes – nicotine, water, and a variety of Includes – nicotine, water, and a variety of powerful chemicals collectively known as tarpowerful chemicals collectively known as tar

Gaseous Phase – portion of the tobacco smoke Gaseous Phase – portion of the tobacco smoke containing carbon monoxide and many other containing carbon monoxide and many other physiologically active gaseous compoundsphysiologically active gaseous compounds

Tobacco: The Source of Tobacco: The Source of Physiologically Active CompoundsPhysiologically Active Compounds

60 of these compounds have been determined to 60 of these compounds have been determined to be carcinogens or co-carcinogenic promotersbe carcinogens or co-carcinogenic promoters

Carbon monoxide is the most damaging Carbon monoxide is the most damaging compound found in this component of tobacco compound found in this component of tobacco smokesmoke

Carbon monoxide can inactivate red blood cellsCarbon monoxide can inactivate red blood cells Can cause brain function to eventually be Can cause brain function to eventually be

reduced, reactions and judgment are dulled and reduced, reactions and judgment are dulled and cardiovascular function is impairedcardiovascular function is impaired

Illness, Premature Death & Illness, Premature Death & Tobacco UseTobacco Use

Two-pack-a-day smokers can expect to die 7-8 Two-pack-a-day smokers can expect to die 7-8 years earlier.years earlier.

Smoking is responsible for nearly 440,000 Smoking is responsible for nearly 440,000 premature deaths each yearpremature deaths each year

Table 9.4Table 9.4

Illness, Premature Death & Illness, Premature Death & Tobacco UseTobacco Use

Cardiovascular DiseaseCardiovascular Disease Tobacco use is clearly one of the major contributing Tobacco use is clearly one of the major contributing

factorsfactors Smoking more than doubles the risk of a myocardial Smoking more than doubles the risk of a myocardial

infarctioninfarction 2-4 times more likely to have a sudden cardiac death2-4 times more likely to have a sudden cardiac death

Nicotine increases the heart rate, which increases Nicotine increases the heart rate, which increases cardiac output, which increases blood pressure.cardiac output, which increases blood pressure.

Nicotine also increases blood platelet Nicotine also increases blood platelet Adhesiveness.Adhesiveness.

Illness, Premature Death & Illness, Premature Death & Tobacco UseTobacco Use

Cancer – tobacco use is a significant factor in Cancer – tobacco use is a significant factor in the development of virtually all forms of the development of virtually all forms of cancer and the most significant factor in cancer and the most significant factor in cancers involving the respiratory systemcancers involving the respiratory system

During 2004 an est. 1,372, 910 Americans During 2004 an est. 1,372, 910 Americans developed cancer, equally divided between developed cancer, equally divided between men and women, leading to 570,280 deathsmen and women, leading to 570,280 deaths

30% of all cancer cases are heavily influenced 30% of all cancer cases are heavily influenced by tobacco use.by tobacco use.

Additional Health ConcernsAdditional Health Concerns Poor state of nutritionPoor state of nutrition Decline in insulin sensitivityDecline in insulin sensitivity Decline in short-term memoryDecline in short-term memory Gradual loss of the sense of smellGradual loss of the sense of smell Premature wrinkling of the skinPremature wrinkling of the skin More likely to experience strokesMore likely to experience strokes Lose bone mass leading to osteoporosisLose bone mass leading to osteoporosis

Additional Health ConcernsAdditional Health Concerns

Experience more back pain and muscle injuryExperience more back pain and muscle injury Find that fracture heal more slowlyFind that fracture heal more slowly Spend more time in the recovery room after Spend more time in the recovery room after

surgerysurgery Greater risk of developing serious gum diseaseGreater risk of developing serious gum disease May need supplementation for vitamins C and May need supplementation for vitamins C and

BB

Smoking and ReproductionSmoking and Reproduction Infertility – smoking reduces the level of fertility Infertility – smoking reduces the level of fertility

in both men and womenin both men and women Men – sperm degradation and erectile dysfunctionMen – sperm degradation and erectile dysfunction Women – abnormal ovum formation, negatively Women – abnormal ovum formation, negatively

influences estrogen levelsinfluences estrogen levels Problem Pregnancy – problems during the Problem Pregnancy – problems during the

pregnancy are a result of the carbon monoxide pregnancy are a result of the carbon monoxide and nicotine exposure; hypoxia and nicotine exposure; hypoxia Miscarriage, stillborn, premature birthMiscarriage, stillborn, premature birth Low birth weightLow birth weight

Smoking and ReproductionSmoking and Reproduction

Breast feeding – nicotine will appear in breast Breast feeding – nicotine will appear in breast milk; will then have the same effectsmilk; will then have the same effects

Neonatal health problems – babies born to Neonatal health problems – babies born to mothers who smoked during pregnancy are:mothers who smoked during pregnancy are: Shorter and have a lower birth weightShorter and have a lower birth weight Elevated rate of SIDSElevated rate of SIDS More likely to develop chronic respiratory problemsMore likely to develop chronic respiratory problems More frequent colicMore frequent colic Be hospitalized and have poorer overall health earlyBe hospitalized and have poorer overall health early Behavioral issuesBehavioral issues

Oral Contraceptives and SmokingOral Contraceptives and Smoking

Women who smoke and use oral contraceptives, Women who smoke and use oral contraceptives, particularly after age 35 are placing themselves particularly after age 35 are placing themselves at a much greater risk of experiencing a fatal at a much greater risk of experiencing a fatal cardiovascular accident.cardiovascular accident.

This risk increase further for women over 40.This risk increase further for women over 40. Women who smoke and use oral contraceptives Women who smoke and use oral contraceptives

are 4 times more likely to die from a heart are 4 times more likely to die from a heart attack.attack.

Combining Tobacco and Alcohol UseCombining Tobacco and Alcohol Use

Young people are more likely to use other drugs.Young people are more likely to use other drugs. Instead of dealing with the negative Instead of dealing with the negative

consequences of one issue you now have to deal consequences of one issue you now have to deal with both.with both.

Smokeless Tobacco UseSmokeless Tobacco Use

Nicotine is absorbed through the mucous Nicotine is absorbed through the mucous membranes in the mouth.membranes in the mouth.

ChewChew SnuffSnuff Major cause of periodontal disease and cancer.Major cause of periodontal disease and cancer. Not just in the mouth but also the throat, Not just in the mouth but also the throat,

stomach and digestive tract.stomach and digestive tract.

The Risks of Involuntary SmokingThe Risks of Involuntary Smoking Mainstream smoke – is inhaled and then exhaled Mainstream smoke – is inhaled and then exhaled

by a smokerby a smoker Sidestream smoke – comes from the burning endSidestream smoke – comes from the burning end Sidestream smoke is responsible for 85% of the Sidestream smoke is responsible for 85% of the

harmful substances associated with second hand harmful substances associated with second hand smoke exposure. smoke exposure.

Involuntary smoke exposure may be responsible Involuntary smoke exposure may be responsible for 35,000 – 40,000 premature deaths per year for 35,000 – 40,000 premature deaths per year from heart disease among non-smokers.from heart disease among non-smokers.

Because of this there are new laws.Because of this there are new laws.

New Product DevelopmentNew Product Development Eclipse – a cigarette that heats rather than burns Eclipse – a cigarette that heats rather than burns

most of its tobaccomost of its tobacco Accord – intended to reduce the production of Accord – intended to reduce the production of

sidestream smokesidestream smoke Advance – cigarettes with Trionic filters Advance – cigarettes with Trionic filters

supposedly capable of extracting more toxinssupposedly capable of extracting more toxins Omni – advertised to significantly reduce selected Omni – advertised to significantly reduce selected

carcinogenscarcinogens

New Product DevelopmentNew Product Development

Quest – intended to lead smokers to nicotine free Quest – intended to lead smokers to nicotine free smokingsmoking

Reduced-ignition-propensity – self-extinguishing Reduced-ignition-propensity – self-extinguishing cigarettescigarettes

Flavored cigarettes?Flavored cigarettes?

Nontobacco Sources of NicotineNontobacco Sources of Nicotine

Multiple flavors of nicotine suckersMultiple flavors of nicotine suckers Nicotine flavored gumNicotine flavored gum Nicotine strawsNicotine straws Nicotine enhanced waterNicotine enhanced water Inhalers, sprays, drops, lozenges and Inhalers, sprays, drops, lozenges and

transdermal patchestransdermal patches Are these products intended to aid smokers in Are these products intended to aid smokers in

quitting smoking or something else?quitting smoking or something else?

Stopping What You StartedStopping What You Started

KnowledgeKnowledge RecognitionRecognition FamiliarityFamiliarity BeliefBelief CertaintyCertainty Figure 9-2 and Changing for the Better pg 303Figure 9-2 and Changing for the Better pg 303 Gum, patches, hypnotism, counseling, Gum, patches, hypnotism, counseling,

exercise, prescription medsexercise, prescription meds

Tobacco Use: A Question of RightTobacco Use: A Question of Right

Is it your right as a free American, adult, to Is it your right as a free American, adult, to choose whether you smoke?choose whether you smoke?

Tobacco Use: A Question of RightTobacco Use: A Question of Right

Is it our right as Americans to have laws to are Is it our right as Americans to have laws to are aimed at protecting minors?aimed at protecting minors?

Tobacco Use: A Question of RightTobacco Use: A Question of Right

Is it our right as Americans to limit where a Is it our right as Americans to limit where a smoker can smoke?smoker can smoke?

Tobacco Use: A Question of RightTobacco Use: A Question of Right

Do we do the same thing with Alcohol?Do we do the same thing with Alcohol?