Hart13 ppt ch10

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  • 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)
  • Hart13 ppt ch10

    1. 1. Chapter 10 Tobacco© 2011 McGraw-Hill Higher Education. All rights reserved.
    2. 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. 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© 2011 McGraw-Hill Higher Education. All rights reserved.
    4. 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. 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. 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. 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. 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. 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. 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. 11. Tobacco Regulation Efforts Anti-smoking education campaign from the 1960s© 2011 McGraw-Hill Higher Education. All rights reserved.
    12. 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. 13. Trends in cigarette sales since 1945 Source: USDA Economic Research Service© 2011 McGraw-Hill Higher Education. All rights reserved.
    14. 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. 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. 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. 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. 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.
    19. 19. Smokeless Tobacco© 2011 McGraw-Hill Higher Education. All rights reserved.
    20. 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. 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. 22. Smoking: Adverse Health Effects Cigarette packages and advertisements are required to rotate among different warning labels© 2011 McGraw-Hill Higher Education. All rights reserved.
    23. 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. 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.
    25. 25. © 2011 McGraw-Hill Higher Education. All rights reserved.
    26. 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. 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. 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. 29. Nicotine • Nicotine (1-methyl-2 [3-pyridyl] pyrrolidone)© 2011 McGraw-Hill Higher Education. All rights reserved.
    30. 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. 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. 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. 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. 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. 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. 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. 37. Chapter 10 Tobacco© 2011 McGraw-Hill Higher Education. All rights reserved.

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