© 2009 mcgraw-hill higher education. all rights reserved. chapter nine rejecting tobacco use

© 2009 McGraw-Hill Higher Education. All rights reserved.

Chapter Nine Rejecting Tobacco Use

© 2009 McGraw-Hill Higher Education. All rights reserved.

Cigarette Smoking among College Students

College smoking trending upwards Smoking among college students decreased from 1964

to 1995 (from 21% to 14%) Current rates of smoking among college students:

30.6% of full-time students 42.7% of part-time students

Current rates of smoking among general population: Men: 23.9% Women: 18.1%

Direct relationship between alcohol consumption and cigarette smoking

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Demographic Trends in Smoking

Gender Men have higher rates of smoking than women

Race/ethnicity Highest smoking rates among American Indians and Alaska

Natives Lowest smoking rates among Asian Americans

Level of education Higher levels of education are associated with lower rates of

smoking Age

Smoking rates go down as age goes up Geographic residence

Highest smoking rates in Midwest Lowest smoking rates in West

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Demographic Trends in Smoking

Size of the community Large metropolitan areas have lowest smoking rate

Employment status Highest rate of smoking among unemployed

Recent homelessness or incarceration Higher rates

Place of birth Native-born Americans have higher rates of

smoking than foreign-born Americans

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Marketing of Tobacco Products

Controversy about advertising due to industry’s knowledge of the health risks

Restrictions on marketing of all tobacco products, BUT Magazine advertising has increased

Especially in magazines with 15% or more youth readership

Free distribution of cigarettes in bars and restaurants

Luring teens through anti-smoking ads

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Development of Dependence

Dependence: Physical and/or psychological need to continue the use of nicotine

Physical dependence Tolerance Withdrawal Titration

Particular level of a drug within the body Adjusting the level of nicotine by adjusting the rate of

smoking

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Theories of Nicotine Addiction

Genetic influences 60% of initiation and maintenance of initial smoking

is driven by genetic influences

Bolus theory Based on body’s response to the bolus (ball) of

nicotine delivered to the brain

Adrenocorticotropic hormone (ACTH) theory Release of beta endorphins delivers euphoric effect

Self-medication theory Nicotine, through effects on dopamine, “lifts spirits”

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Acute Effects of Nicotine on Nervous System Function

Nicotine induces increased brain activity Increased release of neurotransmitters

Norepinephrine Dopamine Acetylcholine Serotonin

Very heavy use of nicotine depresses the central nervous system

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Psychosocial Factors Related to Dependence

Modeling behavior Manipulation

Susceptibility to advertising Use of tobacco products associated with a

better life

Once smoking is initiated, dependence becomes a key factor in use

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Prevention and Intervention

Preventing teen smoking Targeted audience Governments policies

Restrictions on advertising and promotions Funding for smoking education

Early childhood intervention Decision making skills Critical thinking and refusal skills Support for smoke-free environments

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Tobacco Smoke

Particulate phase (small suspended particles) Nicotine Water Tar

Phenol, benzo[a]pyrene, DDT, and many other chemicals

Gaseous phase Carbon monoxide Carcinogens

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Health Risks of Tobacco Use

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Illness, Premature Death, and Tobacco Use

Cardiovascular disease and nicotine Myocardial infarction Sudden cardiac death Angina pectoris Increased platelet adhesiveness Unhealthy cholesterol changes

Cardiovascular disease and carbon monoxide Impairment of oxygen transport

Smoking and oral contraceptive (OC) use Linked to clots and heart attacks Women who smoke should NOT use OCs

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Illness, Premature Death, and Tobacco Use

Cancer Respiratory tract cancers (lung, mouth,

larynx Damage to the respiratory lining (mucus, cilia)

brings carcinogens into direct contact with tissues

Other tobacco-enhanced cancers Kidney Gastrointestinal system

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Development of Lung Cancer

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Chronic Obstructive Lung Disease

Chronic bronchitis Persistent inflammation or infection of the

smaller airways within the lungs

Pulmonary emphysema Irreversible disease process in which the

alveoli are destroyed

Significant impact on quality of life

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Additional Health Concerns

Poor nutritional state Reduced insulin

sensitivity Decline in short-term

memory Loss of senses of smell

and hearing Premature wrinkling of

the skin Stroke Loss of bone mass

Impaired recovery from surgery

Gum disease Impaired resistance to

infection Asthma Infertility Impotence Earlier menopause Poor circulation Burns

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Risks from Specific Tobacco Products

Nonmanufactured cigarettes Roll-your-own Bidis Kreteks

Mentholated cigarettes Pipes Cigars Smokeless tobacco

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Nonmanufactured Forms of Cigarettes

Roll-your-own More affordable Equal risk

Bidis High in tar and nicotine High level of carbon monoxide

Kreteks (clove-flavored tobacco) Increased tar and nicotine delivery

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Mentholated Cigarettes

Menthol Unique taste and “cooling” sensation

Heavily marketed to African American smokers

Special health risks still under investigation

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Pipe and Cigar Smoking

Pipe/cigar smokers have the same rates of cancer as cigarette smokers: Mouth Larynx Throat Esophagus

Cigar manufacturers are now required to disclose tobacco content and additives

Warning labels required

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Smokeless Tobacco Use

Types Chewing tobacco Snuff

Risks associated with use Leukoplakia Erythroplakia Periodontal disease Oral cancer Nicotine addiction Other health risks

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New Product Development

Eclipse Cigarette that heats rather than burns tobacco

Accord Cigarette that reduces sidestream smoke

Advance, Omni, and Quest Cigarettes with “trionic” filters that are supposedly

able to reduce carcinogen exposure

Flavored cigarettes Camel Exotic Blends

Non-tobacco sources of nicotine Suckers, gums, straws, sprays, drops, etc.

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Smoking and Reproduction

Infertility Increased risk of ectopic pregnancy Problem pregnancies Breast-feeding

Exposes infants to harmful effects and chemicals

Neonatal health problems Low birth weight Respiratory problems Higher risk of SIDS

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Involuntary (Passive) Smoking

Mainstream smoke Smoke inhaled and then exhaled by smoker

Sidestream smoke Smoke from the burning end of the

cigarette, pipe, or cigar Contains 85% of harmful substances

associated with secondhand smoke

Environmental tobacco smoke Diluted smoke that stays within a common

source of air

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Health Risks of Passive Smoking

Heart disease Cancer Eye irritation Nasal symptoms Headaches Cough In children:

Bronchitis or pneumonia Respiratory symptoms Middle ear infections

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Cost of Smoking

440,000 deaths/year $150 billion/year in health-

related expenditures Reduced life expectancy Loss of independence,

freedom, and social contacts due to addiction

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The Health Benefits of Quitting

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Smoking Cessation

Programs Education Behavior modification Aversive conditioning Hypnosis Acupuncture

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Smoking Cessation

Nicotine substitution products Chewing gum Patch Inhaler Spray

Neurotransmitter-based prescription medications Bupropion (Zyban) Varenicline (Chantix)

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Chapter Nine: Rejecting Tobacco Use

© 2009 McGraw-Hill Higher Education. All rights reserved.

Discussion questions

What is the safe level of use for drugs such as cocaine heroin marijuana?

Does the drinking age of 21 make sense?

Why not just outlaw tobacco?

Should anti-drug, tobacco and alcohol programs be increased in schools?

For people who are susceptible to addictive behavior, should drug abuse be decriminalized in these cases?