Tobacco Primer by Brian Primack


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Dr. Brian Primack's presentation at the 3rd Annual Media Literacy Conference, sponsored by Drug Free Pennsylvania. Dr. Primack is a Professor at the University of Pittsburgh Medical School.

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  • Unfortunately, this is when they start. In their secret documents, Brown and Williamson tobacco company said this:
  • And these ads work. Whereas 86% of young people smoke the top advertised brands, only 32% of adults do.
  • Tobacco Primer by Brian Primack

    1. 1. Tobacco Primer: Four Questions about Smoking Brian A. Primack, MD, EdM, MS March 2010 Drug Free Pennsylvania
    2. 2. 1. What’s the big deal?
    3. 4. Worldwide deaths, 2010
    4. 5. Costs <ul><li>Direct and indirect medical costs from one year of smoking in the US </li></ul><ul><ul><li>$157 billion (75 direct, 82 indirect) </li></ul></ul><ul><li>Immunize the entire 3 rd world </li></ul><ul><ul><li>$2 billion </li></ul></ul>
    5. 8. “ The Big Lie” <ul><li>In the advertisement: </li></ul><ul><li>Peace </li></ul><ul><li>Freshness </li></ul><ul><li>Good smells </li></ul><ul><li>Independence </li></ul><ul><li>In real life: </li></ul><ul><li>Coughing </li></ul><ul><li>Stale taste, smoke </li></ul><ul><li>Bad smells </li></ul><ul><li>Dependence (addiction) </li></ul>
    6. 10. Worldwide toll of smoking <ul><li>Kills five million people annually worldwide </li></ul><ul><li>Will be over 10 million annually by 2050 (Some countries with 10 million or fewer people: Hungary, Sweden, Belgium, Switzerland, Senegal, Portugal, Greece, Bolivia) </li></ul><ul><li>Half of deaths in middle age (workforce needed for economic development) </li></ul><ul><li>Half of deaths in rich nations, half in developing nations </li></ul><ul><li>Apparent causes of death different (India TB, China COPD) </li></ul>
    7. 11. 2. How can it be that bad?
    8. 12. Ingredients <ul><li>Dried tobacco leaves </li></ul><ul><li>Additives </li></ul><ul><li>Fire </li></ul>
    9. 14. Cigarette Additives that start with A or B <ul><li>Acetanisole, Acetic Acid, Acetoin, Acetophenone, 6-Acetoxydihydrotheaspirane, 2-Acetyl-3- Ethylpyrazine, 2-Acetyl-5-Methylfuran, Acetylpyrazine, 2-Acetylpyridine, 3-Acetylpyridine, 2-Acetylthiazole, Aconitic Acid, dl-Alanine, Alfalfa Extract, Allspice Extract, Oleoresin, And Oil, Allyl Hexanoate, Allyl Ionone, Almond Bitter Oil, Ambergris Tincture, Ammonia, Ammonium Bicarbonate, Ammonium Hydroxide, Ammonium Phosphate Dibasic, Ammonium Sulfide, Amyl Alcohol, Amyl Butyrate, Amyl Formate, Amyl Octanoate, alpha-Amylcinnamaldehyde, Amyris Oil, trans-Anethole, Angelica Root Extract, Oil and Seed Oil, Anise, Anise Star, Extract and Oils, Anisyl Acetate, Anisyl Alcohol, Anisyl Formate, Anisyl Phenylacetate, Apple Juice Concentrate, Extract, and Skins, Apricot Extract and Juice Concentrate, 1-Arginine, Asafetida Fluid Extract And Oil, Ascorbic Acid, 1-Asparagine Monohydrate, 1-Aspartic Acid, Balsam Peru and Oil, Basil Oil, Bay Leaf, Oil and Sweet Oil, Beeswax White, Beet Juice Concentrate, Benzaldehyde, Benzaldehyde Glyceryl Acetal, Benzoic Acid, Benzoin, Benzoin Resin, Benzophenone, Benzyl Alcohol, Benzyl Benzoate, Benzyl Butyrate, Benzyl Cinnamate, Benzyl Propionate, Benzyl Salicylate, Bergamot Oil, Bisabolene, Black Currant Buds Absolute, Borneol, Bornyl Acetate, Buchu Leaf Oil, 1,3-Butanediol, 2,3-Butanedione, 1-Butanol, 2-Butanone, 4(2-Butenylidene)-3,5,5-Trimethyl-2-Cyclohexen-1-One, Butter, Butter Esters, and Butter Oil, Butyl Acetate, Butyl Butyrate, Butyl Butyryl Lactate, Butyl Isovalerate, Butyl Phenylacetate, Butyl Undecylenate, 3-Butylidenephthalide, Butyric Acid </li></ul>
    10. 15. Why Add? <ul><li>Enhance flavor </li></ul><ul><li>Change burn rates </li></ul><ul><li>Change tar/nicotine ratings </li></ul><ul><li>Increase delivery of nicotine </li></ul>
    11. 16. What happens when you burn? <ul><li>Over 4000 chemicals, including … </li></ul>
    12. 17. Selected Chemicals Released When Cigarettes Are Burned <ul><li>Benzene </li></ul><ul><li>Formaldehyde </li></ul><ul><li>Urea </li></ul><ul><li>Arsenic </li></ul><ul><li>Cyanide </li></ul><ul><li>Acetone </li></ul><ul><li>Pyridine </li></ul><ul><li>Ammonia </li></ul><ul><li>Tar </li></ul><ul><li>Carbon Monoxide </li></ul><ul><li>DDT </li></ul><ul><li>Butane </li></ul><ul><li>Cadmium </li></ul>
    13. 18. A is for Addiction <ul><li>Nicotine is a carcinogen itself </li></ul><ul><li>Binds to adenosine receptors in the brain, releasing dopamine (rush); has effect within 10 seconds </li></ul><ul><li>Potent withdrawal begins within minutes </li></ul><ul><li>Leads to the next cigarette </li></ul>
    14. 19. B is for blood vessels <ul><li>Multiple chemicals in cigarettes cause endothelial damage </li></ul><ul><li>Increases predisposition to clotting, plaque buildup, and heart attack </li></ul>
    15. 20. Atherosclerosis
    16. 21. Myocardial Infarction
    17. 22. Stroke = CVA (cerebro-vascular accident)
    18. 23. Peripheral Vascular Disease
    19. 24. 59 year old female smoker
    20. 25. C is for Cancer
    21. 26. Some carcinogens in cigarettes <ul><li>PAHs: </li></ul><ul><li>Benzo[ a ]anthracene, Benzo[ b ]fluoranthene, Benzo[ f ]fluoranthene, Benzo[ k ]fluoranthene, Benzo[ a ]pyrene, Chrysene, Dibenz[ a , h ]anthracene, Dibenzo[ a , i ]pyrene, Dibenzo[ a ],[1]pyrene, Indenol[1,2,3][ c , d ]pyrene, 5-Methytlchrysene </li></ul><ul><li>Aza-arenes: </li></ul><ul><li>Dibenz[ a , h ]acridine, Dibenz[ a , j ]acridine, 7H-Dibenzo[ c , g ]carbazole, Quinoline </li></ul><ul><li>N -Nitrosamines: </li></ul><ul><li>4-(methylnitrosamine)-1-(3-pyridyl)-1-butanone, N -Nitrosethylmethylamine, N -Nitrosoanabasine, N -Nitrosodiethanolamine, N -Nitrosodiethylamine, N -Nitrosodimethylamine, N -Nitrosonornicotine, N -Nitrosopyrrolidine </li></ul><ul><li>Aromatic Amines: </li></ul><ul><li>Acetaldehyde, Aldehydes, 4-Aminobiphenyl, Crotonaldehyde, Formaldehyde, 2-Naphthylamine, 2-Toluidine </li></ul><ul><li>Miscellaneous Organic Compounds: </li></ul><ul><li>Acrylonitrile, Benzene, Ethylcarbamate, 2-Nitropropane, Vinyl chloride </li></ul><ul><li>Inorganic Compounds: </li></ul><ul><li>Arsenic, Cadmium, Chromium, Hydrazine, Nickel, Polonium-210 </li></ul><ul><li>* From Reducing the Health Consequences of Smoking: 25 Years of Progress. Washington, DC, U.S. Department of Health and Human Services, 1989. </li></ul>
    22. 27. D is for Destruction of Lungs (COPD)
    23. 29. E is for Environmental Smoke (Second-Hand Smoke)
    24. 30. Second Hand Smoke <ul><li>38,000 deaths each year (more than homicide and AIDS combined) </li></ul><ul><li>Most pronounced in waiters, bartenders, spouses </li></ul><ul><li>Infants </li></ul>
    25. 31. “Safer” cigarettes … <ul><li>No additives </li></ul><ul><li>Low tar </li></ul><ul><li>Low nicotine </li></ul><ul><li>“ Smokeless” </li></ul>
    26. 35. 3. Who smokes, and why?
    27. 36. Gender
    28. 37. Race
    29. 39. Wilkinsburg
    30. 41. “Menthol X”
    31. 42. Ever Smokers Who Have Quit
    32. 43. African Americans <ul><li>Bear the greatest burden of mortality from smoking </li></ul><ul><li>Don’t really smoke more </li></ul><ul><li>Is it the menthol? </li></ul>
    33. 44. Poverty Level
    34. 45. Age
    35. 47. “ As this 14-24 age group matures, they will account for a key share of the total cigarette volume for at least the next 25 years.” --RJ Reynolds
    36. 48. “ Our studies report on youngsters' motivation for starting, their brand preferences, as well as the starting behavior of children as young as 5 years old.” -- Brown and Williamson Tobacco Company
    37. 52. US Tobacco, quoted 1994 <ul><li>“ Cherry Skoal is for somebody who likes the taste of candy, if you know what I’m saying.” </li></ul>
    38. 54. Smoke Top Advertised Brands CDC, 2004
    39. 63. $20 Sampler
    40. 64. <ul><li>Regular $7.00 </li></ul><ul><li>Large $10.00 </li></ul><ul><li>Arabic Coffee, Apple, Apple Alex, Double Apple, Apricot, Banana, Candy, Cappuccino, Cherry, Carmel, Coconut, Cola, Grape, Jasmine, Lemon, Mint, Mango, Mandarin, Mixed Fruit, Orange, Pistachio, Peach Rose, Salloum, Strawberry, Vanilla, Zaghoul Light, Zaghoul, Licorice </li></ul>
    41. 66. Smoke Volume <ul><li>“ A typical 1-hour long hookah smoking session involves inhaling 100-200 times the volume of smoke inhaled with a single cigarette.” </li></ul><ul><ul><li>WHO, 2005 </li></ul></ul><ul><ul><li>Shihadeh, 2004 </li></ul></ul>
    42. 67. Smoke Contents 1 Shihadeh and Saleh, 2005 2 Djordjevic, 2000 Compound (mg) Hookah 1 Cigarette 2 Ratio Tar 802 22.3 36 Nicotine 2.96 1.74 1.7 CO 145 17.3 8
    43. 69. 1 Sepetdjian, 2008; 2 Gmeiner, 1977 Carcinogen (ng) Hookah 1 Cigarette 2 Ratio Benz[a]anthracene 677 35 19 Benzo[a]pyrene 370 10.1 37 Benzo[g,h,i]perlyene 307 7.9 56 Di-benzo[a,h]anthracene 140 2.5 245 Indeno[1,2,3-cd]pyrene 183 3.5 52
    44. 73. Tobacco Types * Includes little cigars, cigarillos
    45. 74. Hookah Smoking by Grade Level Primack et al., Pediatrics 2009
    46. 75. 4. What do we do about it?
    47. 77. Legislation <ul><li>Ban on TV advertising 1971 </li></ul><ul><li>MSA of 1998 (no billboards) </li></ul><ul><li>Clean air laws </li></ul>
    48. 82. Public Service Announcements <ul><li>Do have an effect </li></ul><ul><li>About 50 “just say yes” for each “just say no” </li></ul><ul><li>US PSA budget is about 1/30 of England, Canada </li></ul>
    49. 83. School Programs <ul><li>“Tar Wars” – 4 th and 5 th grade </li></ul><ul><li>“Social influences” programs </li></ul><ul><ul><li>Grade school: effect on body </li></ul></ul><ul><ul><li>Middle school: peer pressure, friends, family </li></ul></ul><ul><ul><li>High school: self esteem, aspirations </li></ul></ul>
    50. 84. HSPP <ul><li>Peterson, AV, JNCI 2000 </li></ul><ul><li>Curriculum for youth, 3 rd -10 th grades </li></ul><ul><li>47.25 hours total </li></ul><ul><li>“Social Influences” approach </li></ul><ul><li>How to say no, effects on body, resisting peer influence, self esteem, etc. </li></ul><ul><li>20 school districts got the program, 20 did not </li></ul><ul><li>94% follow up, high implementation fidelity </li></ul>
    51. 85. Results of HSPP <ul><li>No difference in smoking at 12 th grade </li></ul><ul><li>No difference in smoking 2 years after high school </li></ul><ul><li>No difference among boys or girls </li></ul><ul><li>No difference among people of other subgroups (such as family risk for smoking) </li></ul>
    52. 86. Is Media Literacy Different?
    53. 87. Major Reasons for Media Literacy <ul><li>Fun, creative </li></ul><ul><li>Someone to rebel against </li></ul><ul><li>Developmentally appropriate </li></ul><ul><li>Most effective for the ones most at risk </li></ul><ul><li>Empowering, not protectionist </li></ul>
    54. 88. Thank You [email_address]