20th Century

• World War 1 (soldier’s relief)

• 1920’s beginning of heavy marketing

• World War II

• Marlboro Man

• 1964 Smoking linked to cancer

• 1971 advertisements banned from TV

• 1997 tobacco companies held liable for health problems of users.

Tobacco Use

• Results from the 1998 NHSDA:– An estimated 60 million (27.7%) Americans

were current cigarette users– Current smokers were more likely than non-

smokers to use alcohol and illicit drugs.– An estimated 3.1% of the population are

smokeless tobacco users– An estimated 6.9% were cigar smokers

Adolescents and Tobacco Use• An estimated 4.1 million youth (12-17) were current

smokers.

• 41.6% of young adults (18-25) were current smokers.

Race• Approximately 25% of African-Americans,

Caucasians, and Hispanics were current smokers.

Gender• Males had a slightly higher rate than females (29%

vs. 27%)

Regional Differences

• North Central 32%; South 28%; North East 25%; and West 24%

• Urban vs. Rural– Large Metropolitan Areas -26%

– Small Metropolitan Areas -27%

– Non-Metropolitan Areas - 30%

Louisiana Ranking

• Louisiana Ranks 19th in the Nation with regard to cigarette smoking (1992-1993).

• New cases of lung cancer annually-3000.

• Direct Medical costs related to tobacco use - 611 million (1990).

Forms of Tobacco • Forms

– Cigarettes– Cigars– Smokeless

tobacco– Pipe tobacco

• ROA:

– Oral– Smoke

Products of Smoking Tobacco

• Nicotine - psychoactive stimulant

• Tar -sticky material resulting from the smoking of tobacco

• Carbon Monoxide -toxic gas that prevents blood cells from carrying oxygen from the lungs

What is Nicotine

• Nicotine is one of 4000 chemicals found in the smoke from tobacco.

• One of the most frequently used substances and is one the most addictive.

• 1 Cigarette contains approximately 10 mg of nicotine; 1 to 2 mg are available in the smoke.

• Nicotine is absorbed through the skin, mouth, nose and/or lungs.

What is Nicotine

• Cigarette smoking delivers nicotine to the brain in approximately 10 seconds.

• Cigar and pipe smokers typically absorb nicotine through the mucus membranes of the mouth.

Effects of Nicotine

• Initial stimulation of adrenal glands resulting in the release of epinephrine. Results in an increase in heart rate, respiration, and blood pressure.

• Nicotine also causes the release of dopamine resulting in the activation of the parts of the brain responsible for pleasure.

Nicotine and Withdrawal

• Nicotine is metabolized quickly in the body.• Nicotine users develop tolerance.• Withdrawal symptoms:

– irritability, craving, cognitive deficits, sleep disturbances, increased appetite.

• Symptoms start within a few hours and peak within the first few days.

• 90% of smokers who try to quit without treatment will fail.

Cost of Tobacco Use

LifeTobacco use kills more than 430,000 people annually

- More than alcohol, cocaine, heroin, car accidents, fire, and AIDS combined.

EconomicsSmoking is responsible for over 50 million

dollars in health care costs annually

Medical Consequences (1)

• Tobacco use accounts for 1/3 of all cancers.

• Cigarette smoking is linked to 90% of all lung cancer cases.

• Cardiovascular Disease (stroke, heart attack, vascular disease, and aneurysm).

• 1/5 of all cardiovascular deaths are attributable to smoking.

Medical Consequences (2)

• Asthma, chronic bronchitis, and emphysema

Second Hand Smoke

• 3,000 annual deaths due to lung cancer in non-smokers.

• 40,000 deaths related to cardiovascular disease in non-smokers

Smoking and Pregnancy

• Interferes with the oxygen supply of the fetus

• Developmental delays after birth

• Smokers are at a greater risk of premature delivery.

• Decrease in infant birth weigh

Smokeless Tobacco and Cancer

• Cancer of the oral cavity and pharynx accounts for about 3% of all new cancer cases annually (30,500 per year).

• Only 50% of those diagnosed with oral cancer will be alive 5 years later.

• The risk of developing oral cancer is 50% higher for smokeless tobacco users.

Treatment

• Nicotine Replacement Treatments (gum, inhalers, the “patch”.

• Non-Nicotine Therapies are used for relief from withdrawal symptoms (Zyban)

• Behavioral Treatment