chapter 10 tobacco
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Chapter 10 Tobacco. Tobacco is an interesting social dilemma—a product that is legal for adults to use, and that a significant proportion of adults enjoy using and expect to continue using, yet a substance that is responsible for more ad-verse health consequences and death than any other. - PowerPoint PPT PresentationTRANSCRIPT
Chapter 10Tobacco
Tobacco is an interesting social dilemma—a product that is legal for adults to use, and that a significant proportion of adults enjoy using and expect to continue using, yet a substance that is responsible for more ad-verse health consequences and death than any other.
The Tobacco Dilemma
TOBACCO USE: SCOPE OF THE PROBLEM
Tobacco use is the leading preventable cause of disease and premature death in the United States.
443,000 deaths annually in United States ( hyperlink- review web page)
Tobacco is the single largest cause of preventable death and a risk factor for 6/8 of the leading causes of death.
TOBACCO USE: SCOPE OF THE PROBLEM
In 2009, 69.7 million Americans, or 27.7% of the population age 12 or older, reported current use of a tobacco product.
Approximately 33.5 percent of males and 22.2% of females age 12 or older were current users of any tobacco product.
ANNUAL DEATHS ATTRIBUTABLE TO CIGARETTE SMOKING (LINK)
CIGARETTE SMOKING: A COSTLY ADDICTION
Cigarette smoking is the leading preventable cause of death in the United States.
More deaths are caused each year by tobacco use than by HIV, illegal drug use, murders, alcohol use, suicides, and motor vehicle injuries combined.
Overall mortality rates decline the longer ex-smokers abstain from smoking.
Cultivated and used by Native Americans for centuries Presented tobacco leaves as a gift to
Columbus in 1492 The word “tobaco” was
adopted by the Spanish Possibly from the Arabic word
“tabbaq” meaning “medicinal herbs” Europeans discovered that
Amerindians sometimes put tobacco into tubes made from reeds, started a fire at one end of the reed, and “ drank” the smoke from the other end. Or, they did a similar thing with tobacco leaves rolled up like a cigar, or they “ drank” smoke from stone or clay pipes.
Early History
Commercial importation of tobacco into Europe in large quantities began around 1600.
It was the use of the of tobacco by the respected “affluent” members of society that eventually made tobacco a desired commodity for the masses
Early History
1500s: Beginning with a few trials by physicians,
recognition of the potential of tobacco grew during the middle of the 1500s.
French physician Jean Nicot: early proponent He was successful in “ curing” the migraine
headaches of Catherine de Medici, queen of Henry II of France, which made tobacco use very much “ in.”
Tobacco was called the herbe sainte, “ holy plant,” By 1565, the plant had been called nicotiane, after Nicot.
In 1753, Linnaeus, the Swedish “ father of taxonomy,” named the plant genus Nicotiana. When a pair of French chemists isolated the active ingredient in 1828, they acted like true nationalists and called it nicotine.
Early Medical Uses
16th and 17th centuries Tobacco viewed as having many positive
medical uses but as having a negative reproductive effect
1890s: The slow advance of medical science
through the 18th and 19th centuries gradually removed tobacco from the doctor’s black bag, and nicotine was dropped from The United States Pharmacopoeia in the 1890s.
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Early Medical Uses
Two major species grown today (out of more than 60) 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
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Two Major Species
SPREAD OF TOBACCO USE Tobacum was indigenous only to South America, so the
Spanish had a monopoly on its production for over a hundred years. Nicotiana rustica (see previous slide) is a small-leaf species and was the plant existing in the West Indies and eastern North America when Columbus arrived.
The Jamestown colonist tried to grow the rustica variety without luck, In 1612, John Rolfe somehow got some seeds of the Spanish tobacum species. This species grew beautifully and sold well. The colony was saved, and every available plot of land was planted with tobacum
By 1619, as much Virginia tobacco as Spanish tobacco was sold in London..
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Snuff 18th century: Snuff use became
widespread as smoking decreased The middle and lower classes only
gradually changed over, but by 1770 very few people were smoking. The reign of King George III ( 1760– 1820) was the time of the big snuff.
In U.S., perceived as a British product; American use declined after the Revolution
Chewing tobacco 19th century: Most tobacco used in the
U.S. was chewing tobacco Popularity rose from “snuff” rebellion
and fear of fire hazard from smoking Smoking did not surpass chewing
until the 1920s10-13
Types of Tobacco Products
Cigars A combination of chewing and smoking Peaked in popularity in 1920 The introduction of the cigarette-rolling
machine spurred cigarette consumption because cigarettes became cheaper than cigars.
Types of Tobacco Products
Cigarettes Thin reeds filled with tobacco had been seen by
the Spanish in Yucatan in 1518. In 1844, the French were using them, and the
Crimean War circulated the cigarette habit throughout Europe.
The first British cigarette factory was started in 1856 by a returning veteran of the Crimean War, and in the late 1850s an English tobacco merchant, Philip Morris, began producing handmade cigarettes.
In the United States, cigarettes were being produced during the same period ( 14 million in 1870), but their popularity increased rapidly in the 1880s.
Types of Tobacco Products
Cigarettes The date of the first patent on a cigarette-making
machine was 1881, and by 1885 more than a billion cigarettes a year were being sold.
At the start of the 20th century, there was a preference for cigarettes with an aromatic component— that is, Turkish tobacco.
Camels, a new cigarette in 1913, capitalized on the lure of the Near East while rejecting it in actuality. The Camel brand contained just a hint of Turkish tobacco.
The first ad showing a woman smoking appeared in 1919.
Filter cigarettes, beginning in 1954, captured an increasing share of the market and now constitute over 90 percent of all U. S. cigarette sales.
Types of Tobacco Products
Product milestones: 1913 - Camels: low-priced domestic
tobacco 1939 - Pall Mall: king-size cigarettes 1954 - Winston: filter cigarettes
History: Cigarettes
1908: New York made it illegal for a woman to use tobacco in public
“protect women from themselves”
Tobacco Under Attack
1604: King James of England published an anti-tobacco pamphlet
“harmful to the brain, dangerous to the lungs”
However, he also supported the American tobacco trade in 1610
1930s and 40s: Reports linking smoking and cancer
1952: A 1952 article in Readers’ Digest called “ Cancer by the Carton” drew public attention to the issue, and led to a temporary decline in cigarette sales.
Tobacco companies’ response: 1. Formation of the Council for Tobacco Research
Not independent and tried to undermine health risk claims
2. Mass-marketing of filter cigarettes and cigarettes with lowered tar and nicotine content
Promoted as a “safer” alternative
Tobacco Under Attack
1964: Surgeon General’s report states that smoking causes lung cancer in men Tobacco sales began a
decline that continued for 40 years (see below)
Tobacco Under Attack
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 proposed further regulation of tobacco and ads - After a year of discussion, rules were proposed that further limited advertising on billboards and other public displays, sponsorship of sporting events, promotional giveaways of caps and T- shirts, and advertising in magazines with significant youth readership.
Many additional state and local bans passed
Tobacco Under Attack
Lawsuits seeking compensation for the health consequences of smoking Unsuccessful for many years- cigarette companies
clamed that consumers were responsible for their own health behaviors
Then several victories -with the disclosure of internal tobacco company documents demonstrating both the companies’ knowledge of the adverse health consequences of smoking and their efforts to hide that knowledge from customers.
Possible reasons for legal victories Changing legal climate Revelation of tobacco companies’ actions in hiding
information on the adverse effects of smoking
Tobacco Under Attack
1998 settlement between 46 states and major tobacco companies $205 billion in payments to the states Advertising regulations Enforcement of laws prohibiting sales to
minors In exchange, the companies received a
cap on certain aspects of their legal liability, which otherwise threatened to bankrupt the industry.
Tobacco Under Attack
Lower levels of nicotine Nicotine appears to be the constituent in tobacco that keeps smokers
coming back for more— People adjust their smoking behavior to obtain a consistent amount of
nicotine By taking more puffs and inhaling more deeply
Lower levels of tar Tar is the sticky brown material seen on the filter of a smoked
cigarette Based on changes in smoking behavior, there may be no advantage to
switching to a low tar–low nicotine cigarette
Does “safer” mean safe? - Beginning in the mid-1950s with the mass marketing of filter cigarettes, the tobacco companies began to promote the idea of a “ safer” cigarette, without actually admitting that there was anything unsafe about their older products.
Quest for “Safer” Cigarettes
Does “safer” mean safe? – The problem with all this is that “ safer” doesn’t mean “
safe,” and it wasn’t at all clear how much safer these low tar and nicotine cigarettes actually are for people over a life-time of smoking.
A major blow to the “ healthier cigarette” notion was dealt in 2006 when the U. S. Government obtained a conviction against nine tobacco companies and two tobacco industry trade organizations for racketeering and fraud. The purposeful manipulation of nicotine levels to increase nicotine dependence was one charge, but another was that for years the tobacco companies promoted low tar and nicotine cigarettes as safer alternatives, when their own research and other evidence showed these claims to be misleading.
Quest for “Safer” Cigarettes
Percentage of smokers by gender
Men: 25% Women: 21%
Education is the single biggest influence on smoking rates
Percentage of smokers by education High school diploma only: 30% Non-college students: 15% Undergraduate degree: 13% Full time college students: 7%
Current Cigarette Use
This difference in cigarette smoking based on college education probably reflects the considerable influences of socioeconomic status, family background, and expectations, and apparently has little to do with any knowledge a college graduate might have obtained.
1970s: use increased as smokers looked for an alternative with a lower risk of lung cancer
Most common form Moist snuff (Skoal, Copenhagen) Nicotine absorbed through mucous membranes
Advantages over cigarettes Unlikely to cause lung cancer Less expensive More socially acceptable in some circumstances
Smokeless Tobacco
Smokeless tobacco has its hazards Smokeless tobacco packages carry warning labels
Health concerns
Smokeless Tobacco
Increased risk of dental disease and oral cancer Contains potent carcinogens such as nitrosamines
Causes leukoplakia Can lead to nicotine dependence
Hookahs: Large, ornate water
pipes imported from Arab countries
Hookahs produce milder, water-filtered tobacco smoke
Prevalence of hookah smoking is unclear
Other Tobacco Products In recent years (mid 1990’s), cigar smoking had
increased In 2008, 9% of males and 2% of females reported smoking a
cigar in the past month
Major diseases linked to smoking Lung cancer Cardiovascular disease Chronic obstructive lung diseases
including emphysema
Risk increases for those who: Start young Smoke many cigarettes Continue to smoke for a long time
Smoking is the single greatest avoidable cause of death
Smoking: Adverse Health Effects
Smoking: Adverse Health Effects Cigarette packages and advertisements are required to rotate
among different warning labels
Secondhand smoke Cigarette smoke inhaled from
the environment by nonsmokers
Components of environmental smoke Mainstream smoke: the smoke
inhaled/exhaled by the smoker Sidestream smoke: the smoke
rising from the ash of a cigarette
More carcinogens in smoke But smoke is more diluted
Secondhand Smoke
Health effects difficult to fully determine but include Lung cancer Cardiovascular disease (Increased risk of COPD like symptoms in children)
1993: Environmental Protection Agency classified secondhand smoke as a known human carcinogen
Many recent laws and regulations have been passed to protect nonsmokers
Secondhand Smoke
Five million deaths worldwide each year Perhaps as high as 8 million by 2030
Demand for American cigarettes in Asia has increased markedly Demand has also increased in Third World countries
Smoking and Heath in Other Countries
Increased risk of: Miscarriage Low birth weight Sudden infant death syndrome (SIDS)
Several studies indicate effects on physiological and cognitive development Neurological problems Problems with reading and
mathematical skills Hyperactivity
Smoking and Pregnancy
Nicotine Active ingredient in tobacco A naturally occurring liquid alkaloid that is colorless
and volatile On oxidation, it turns brown and smells like burning
tobacco
Tolerance and dependence develop quickly
Highly toxic in large enough doses Lethal dose = 60 mg
A cigar contains twice that much Typically not delivered fast enough or in a high enough dose to be lethal
Nicotine Pharmacology
Use of nicotine increases the activity of liver enzymes responsible for nicotine deactivation
Contributes to tolerance May decrease the effects of other medication –
benzodiazepines and some antidepressants and analgesics
Absorption and Metabolism Inhalation is very effective
90% of inhaled nicotine is absorbed
80–90% of nicotine is deactivated in the liver and then excreted via the kidneys
Mechanism of action: Mimics acetylcholine First stimulates and then blocks receptor sites Also causes the release of adrenaline and has an indirect
sympathomimetic effect
Symptoms of nicotine poisoning: Low-level
nausea, dizziness, and general weakness Often experienced by beginning smokers
Acute poisoning tremors, convulsions, paralysis of breathing muscles,
death Relatively rare
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
Increases the tendency to clot Increased electrical activity in the cortex
Reduced hunger Inhibition of hunger contractions Increased blood sugar Deadening of taste buds
Physiological 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
Behavioral Effects
1. Cigarettes and other forms of tobacco are addicting
2. Nicotine is the drug in tobacco that causes addiction
3. The processes that determine tobacco addiction are similar to those that determine addiction to drugs like heroin and cocaine
Tobacco industry claims that its products do not cause dependence
Conclusions made in the Surgeon General’s report (1988):
Nicotine Dependence
There are more than 40 million ex-smokers in the U.S. 90% report no formal treatment program
Yet there are many challenges to quitting Nicotine is a strongly reinforcing drug
And a pack-a-day smoker gets 50,000 reinforcing nicotine puffs per year
How to Stop Smoking
Replacement therapy Delivering nicotine without the
tar and carbon monoxide Produced in many forms: Gum, patches, nasal spray,
inhalers, lozenges
Pharmacological Therapy Example: Bupropion (Zyban)
How to Stop Smoking
Combining counseling and pharmacological treatments increases the odds of quitting
Tobacco
End of Lecture