More Related Content Similar to Hart13 ppt ch10 (20) Hart13 ppt ch101. Chapter 10
Tobacco
© 2011 McGraw-Hill Higher Education. All rights reserved.
2. The Tobacco Dilemma
A legal product used by a significant proportion
of adults
The leading cause of preventable death among
Americans
© 2011 McGraw-Hill Higher Education. All rights reserved.
3. History
Used by Native Americans, who presented
tobacco leaves as a gift to Columbus in
1492
Tobaco was adopted by the Spanish, either
from an Arawak term they encountered in
the Carribean or from the Arabic word
tabbaq which was used for medicinal herbs
Methods of use: users “took” (used snuff)
or “drank” (smoked) tobacco
Indian tobacco
pouches
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4. History: Early Medical Uses
Beginning with a few trials by physicians, recognition of
the potential of tobacco grew during the middle 1500s
French physician Jean Nicot made glowing reports
Plant genus (Nicotiana) and active ingredient named for him
16th and 17th centuries: viewed as having many positive
medical uses but as having a negative reproductive effect
1890s: Nicotine dropped from the U.S. Pharmacopoeia
© 2011 McGraw-Hill Higher Education. All rights reserved.
5. History: Spread of Tobacco
Cultivation
Two main species grown today, out of more
than 60 species of Nicotiana
Nicotiana tobacum: large-leaf species indigenous
only to South America but now cultivated widely
Nicotiana rustica:
small-leaf species
from the West Indies
and eastern North
America
© 2011 McGraw-Hill Higher Education. All rights reserved.
6. History: Changes in Product
Popularity Over Time
Snuff: During the 18th century,
smoking diminished but snuff use
became widespread
Snuff was perceived as a British
product, and American use declined
after the Revolution
Chewing tobacco: During the
19th century, nearly all tobacco
produced and used in the United
States was chewing tobacco
Smoking did not surpass chewing until
the 1920s
© 2011 McGraw-Hill Higher Education. All rights reserved.
7. History: Changes in Product
Popularity Over Time
Cigars: A combination of chewing and smoking
Peaked in popularity in 1920
Cigarettes: Most popular form
of tobacco use
Native Americans used thin reeds
filled with tobacco
Factories appeared in 19th century
Habit spread widely with the
advent of inexpensive machine-
produced cigarettes
© 2011 McGraw-Hill Higher Education. All rights reserved.
8. History: Cigarettes
At the start of the 20th century,
users preferred cigarettes with
Turkish tobacco
Other styles were introduced later
1913: Camels, which had a hint of
Turkish tobacco
1939: King-size cigarettes (Pall Mall)
1954: Filter cigarettes (Winston)
As a class, filter cigarettes have
over 90 percent of the
U.S. cigarette market
© 2011 McGraw-Hill Higher Education. All rights reserved.
9. Tobacco Regulation Efforts
1604: King James of
England published an
anti-tobacco pamphlet
stating that tobacco was
harmful to health and
morality
1908: New York made it
illegal for a woman to use
tobacco in public over
concern for women’s
health and morals
© 2011 McGraw-Hill Higher Education. All rights reserved.
10. Tobacco Regulation Efforts
1930s and 40s: Reports indicated a possible
link between smoking and cancer
1952: Reader’s Digest article, “Cancer by the
Carton,” drew attention to the issue
In response to early reports of health risks:
Mass-marketing of filter cigarettes and cigarettes
with lowered tar and nicotine content
Promoted as a safer alternative but marketed in
ways to avoid any implication that original cigarettes
were unsafe
© 2011 McGraw-Hill Higher Education. All rights reserved.
11. Tobacco Regulation Efforts
Anti-smoking education campaign from the 1960s
© 2011 McGraw-Hill Higher Education. All rights reserved.
12. Tobacco Regulation Efforts
1964: Surgeon General’s report states that
smoking causes lung cancer in men
Tobacco sales began a decline that continued
for 40 years
1965: Congress required warning labels on
cigarette packages
1971: TV and radio cigarette ads banned
1990: Smoking banned on interstate buses
and domestic airline flights
1995: FDA proposes to further regulate
tobacco and ads
Many additional state and local bans passed
© 2011 McGraw-Hill Higher Education. All rights reserved.
13. Trends in cigarette
sales since 1945
Source: USDA Economic Research Service
© 2011 McGraw-Hill Higher Education. All rights reserved.
14. Tobacco Regulation Efforts
Lawsuits seeking compensation for the health
consequences of smoking
Unsuccessful for many years
Then . . . victories
Changing legal climate
Revelation of tobacco companies’ actions in hiding
information on the adverse effects of smoking
1998 settlement agreement between 46 states and
the major tobacco companies
$205 billion in payments to the states
Advertising regulations
Programs to enforce laws prohibiting sales to minors
Where does the FDA come in?
© 2011 McGraw-Hill Higher Education. All rights reserved.
15. Safer Cigarettes?
Lower nicotine cigarettes
People adjust their smoking behavior to
obtain a consistent amount of nicotine (e.g.,
taking more puffs and inhaling more deeply)
Lower tar cigarettes
Tar is the sticky brown material seen on the
filter of a smoked cigarette
Safer, but not safe?
© 2011 McGraw-Hill Higher Education. All rights reserved.
16. Current Cigarette Use
Percentage of smokers Percentage of smokers
(by gender) (by years of education)
Men 26 High school diploma only 30%
Undergraduate degree 14%
Women 22
Full time students attending college
18%
Non-college students 32%
8th Graders who plan to attend a 4 year
college 5.5%
Source: Centers for Disease Control and Prevention
8th graders who don’t plan to attend a 4
year college 21.1%
© 2011 McGraw-Hill Higher Education. All rights reserved.
17. Smokeless Tobacco
Use increased in the 1970s as smokers looked
for a method of tobacco use with a lower risk of
lung cancer
Forms
Moist snuff
“Benefits” compared with cigarettes
Less expensive
Easier to use outdoors
More socially acceptable in some circumstances
Less likely to cause lung cancer
© 2011 McGraw-Hill Higher Education. All rights reserved.
18. Smokeless Tobacco
Health and cosmetic concerns
Bad breath, spitting, disposal of quid
Significantly increased risk of dental
disease and oral cancer
Contains nitrosamines and other
potent carcinogens
Causes leukoplakia
Nicotine dependence
Nicotine absorbed through mucous
membranes
Smokeless tobacco packages
carry warning labels
© 2011 McGraw-Hill Higher Education. All rights reserved.
20. Tobacco Products
Are cigars back?
In 2008, 9% of males and
less than 2% of females
reported smoking a cigar in
the past month.
Hookahs: large,
ornate water pipes
imported from Arab
countries
Hookahs produce milder,
water-filtered tobacco smoke
© 2011 McGraw-Hill Higher Education. All rights reserved.
21. Smoking: Adverse
Health Effects
Lung cancer (see top right)
Cardiovascular disease
Chronic obstructive lung
diseases, including emphysema
(see bottom right)
Risk increases for those who start
young, smoke many cigarettes,
and continue to smoke for a long
time
Smoking is the single greatest
avoidable cause of death
© 2011 McGraw-Hill Higher Education. All rights reserved.
22. Smoking: Adverse Health Effects
Cigarette
packages and
advertisements
are required to
rotate among
different warning
labels
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23. Secondhand Smoke
Secondhand smoke=
nonsmokers inhaling cigarette
smoke from the environment
Components of environmental
tobacco smoke
Sidestream smoke: the smoke
rising from the ash of a cigarette
Mainstream smoke: the smoke
inhaled/exhaled by the smoker
© 2011 McGraw-Hill Higher Education. All rights reserved.
24. Secondhand Smoke
Health effects difficult to define but include
Lung cancer
Cardiovascular disease
Other adverse health effects
Environmental Protection Agency classified
secondhand smoke as a known human
carcinogen in 1993
Many laws and regulations have been passed
to protect nonsmokers
© 2011 McGraw-Hill Higher Education. All rights reserved.
26. Smoking and Health
in Other Countries
Five million deaths worldwide each year
Perhaps as high as 8 million by 2030
Third World demand for American
cigarettes has increased markedly
Asian countries also experiencing
increased demand for American
cigarettes
© 2011 McGraw-Hill Higher Education. All rights reserved.
27. Smoking and Pregnancy
Increased risk of miscarriage, low birth
weight, and SIDS
Later effects on physical and intellectual
development
Neurological problems, problems with
certain reading and mathematical skills, and
hyperactivity
Effects are of the same type and
magnitude as those reported for “crack
babies,” and many more pregnant
women smoke than use cocaine
© 2011 McGraw-Hill Higher Education. All rights reserved.
28. Nicotine
Nicotine = a naturally occurring liquid
alkaloid that is colorless and volatile
Tolerance and dependence develop
quickly
Highly toxic
Typically not delivered fast enough or in a
high enough dose to be lethal
Lethal dose = 60 mg
A cigar contains twice that much
© 2011 McGraw-Hill Higher Education. All rights reserved.
29. Nicotine
• Nicotine (1-methyl-2 [3-pyridyl] pyrrolidone)
© 2011 McGraw-Hill Higher Education. All rights reserved.
30. Nicotine:
Absorption and Metabolism
Inhalation is very effective
90 percent of inhaled nicotine is
absorbed
Most nicotine (80 to 90 percent)
is deactivated in the liver and
then excreted via the kidneys
Use of nicotine increases the
activity of liver enzymes
responsible for nicotine
deactivation
Contributes to tolerance
© 2011 McGraw-Hill Higher Education. All rights reserved.
31. Nicotine:
Physiological Effects
Mimics acetylcholine
First stimulates and then blocks certain
receptor sites
Causes the release of adrenaline and has an
indirect sympathomimetic effect
Symptoms of nicotine poisoning
Low-level (often experienced by beginning smokers):
nausea, dizziness, and general weakness
Higher-level: tremors, convulsions, paralysis of
breathing muscles, death
© 2011 McGraw-Hill Higher Education. All rights reserved.
32. Nicotine:
Physiological Effects
CNS and circulatory system effects
Increased heart rate and blood pressure
Increased oxygen need of the heart
Decreased oxygen-carrying ability of blood
Causes shortness of breath
Increased platelet adhesiveness
Increased electrical activity in the cortex
Reduced hunger
Inhibition of hunger contractions
Increased blood sugar
Deadening of taste buds
© 2011 McGraw-Hill Higher Education. All rights reserved.
33. Nicotine:
Behavioral Effects
Nicotine is the primary
reinforcing substance in
tobacco
Smokers report that
nicotine has both
stimulant and calming
effects
User expectation probably
plays an important role in
the effects
© 2011 McGraw-Hill Higher Education. All rights reserved.
34. Nicotine Dependence
Debate continues despite conclusions made
in the Surgeon General’s report:
Cigarettes and other forms of
tobacco are addicting
Nicotine is the drug in tobacco that
causes addiction
The processes that determine
tobacco addiction are similar to
those that determine addiction to
drugs like heroin and cocaine
© 2011 McGraw-Hill Higher Education. All rights reserved.
35. How to Stop Smoking
There are more than 40 million
ex-smokers in the United States!
Challenges to quitting
Nicotine is a strongly reinforcing drug
Pack-a-day smoker puffs at least
50,000 times a year
Six-month relapse rate from smoking
cessation is extremely high (70 to 80
percent)
© 2011 McGraw-Hill Higher Education. All rights reserved.
36. How to Stop Smoking
Nicotine replacements—nicotine
without the tar and carbon monoxide
Nicotine gum
Nicotine patches
Nicotine nasal spray
Nicotine inhalers
Nicotine lozenge
Bupropion (Zyban)
Combining counseling and
pharmacological treatments
increases the odds of quitting
Keep trying!
© 2011 McGraw-Hill Higher Education. All rights reserved.
37. Chapter 10
Tobacco
© 2011 McGraw-Hill Higher Education. All rights reserved.
Editor's Notes Image source: The McGraw-Hill Companies, Inc./Christopher Kerrigan, photographer (Image Ch10_13BusAntiSmoking) Image source: Brand X Pictures (Image Ch10_01CigaretteBurning) Image source: The McGraw-Hill Companies, Inc./Gary He, photographer (Image Ch10_27CollegeSmoker) Image source (lighter): TRBfoto/Getty Images (Image Ch10_04CigaretteLighter) Image source (pack): C. Sherburne/PhotoLink/Getty Images (Image Ch10_3CigarettePack) Image source (no smoking sign): Photodisc Collection/Getty Images (Image Ch10_36NoSmokingSign) Image source (cigarette butt): Photodisc Collection/Getty Images (Image Ch10_02CigaretteButt) Image source: Library of Congress Prints and Photographs Division (Image Ch10_33IndianTobaccoPouch) Image source: Flora Torrance/Life File/Getty Images (Image Ch10_05TobaccoPlants) Images source: Library of Congress Prints and Photographs Division (Images Ch10_08ChewLabel3; Ch10_07ChewLabel2) Image source: © Royalty-Free/CORBIS (Image Ch10_09CigaretteProduction) Images source: Library of Congress Prints and Photographs Division (Image Ch10_10TurkishCigaretteAd) Image source: Library of Congress Prints and Photographs Division (Image Ch10_11NoSmokingforWomen1897) Image source: Dynamic Graphics/JupiterImages (Image Ch10_12AntiSmokingPosters1960) Image source: D. Falconer/PhotoLink/Getty Images (Image Ch10_14SmokeFreeSign) Figure 10.1 from text Image source: The McGraw-Hill Companies/Christopher Kerrigan, photographer (Image Ch10_15TeenSmoker) Image source: Stockbyte/PictureQuest (Image Ch10_16SmokelessTobaccoPouch) Image source: National Cancer Institute (Image Ch10_17SpitTobaccoDamage) Image source: National Institute for Drug Abuse (Image Ch10_38SnuffWarning) Image source: Centers for Disease Control and Prevention (Image Ch10_37CDCChewTobaccoPoster) Image source: Jonnie Miles/Getty Images (Image Ch10_18CigarSmokingWoman) Image source: The McGraw-Hill Companies, Inc./Lars A. Niki, photographer (Image Ch10_20Hookah) Image source (lung cancer): National Cancer Institute (Image Ch10_21LungCancer) Image source (emphysema): Centers for Disease Control and Prevention/Dr. Edwin P. Ewing, Jr. (Image Ch10_22Emphysema) Figure 10.3 from text Image source: © Creatas/PunchStock (Image Ch10_23BlowingSmoke) Image source: Insel/Roth, Core Concepts in Health, 10 th ed. New York: McGraw-Hill (Image Ch10_24NonsmokersBill) Image source: Getty Images (Image Ch10_26PregnantSmoker) Figure 10.4 from text Image source: McGraw-Hill Companies, Inc./Gary He, photographer (Image Ch10_27CollegeSmoker) Image source: McGraw-Hill Companies, Inc./Gary He, photographer (Image Ch10_29ManLightingUp) Image source: The McGraw-Hill Companies, Inc./Christopher Kerrigan, photographer (Image Ch10_31TeenSmoker2) Image source: Stockdisc/Punchstock (Image Ch10_32NicotinePatch) Image source: The McGraw-Hill Companies, Inc./Christopher Kerrigan, photographer (Image Ch10_13BusAntiSmoking) Image source: The McGraw-Hill Companies, Inc./Gary He, photographer (Image Ch10_27CollegeSmoker)