SAC360

1. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
CHAPTER 15
Public Health
Enemy Number
One: Tobacco

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Diseases Caused by Smoking
 Cardiovascular disease
 Lung cancer
 Respiratory diseases
– Pneumonia, influenza, bronchitis, emphysema, chronic airway obstruction
 Other cancers
– Laryngeal, oral, esophageal, pancreatic, urinary
 Diseases among infants
 Burns

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Biomedical Basis of Smoking’s Harmful Effects
 Nicotine is an addictive drug.
– Raises blood pressure and heart rate.
– May cause spasms in blood vessels of the heart.
 Tars are the residue from burning tobacco that condenses in lungs.
– Damage cilia and irritate the respiratory tract.
– Are a major source of carcinogenicity.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Biomedical Basis of Smoking’s Harmful Effects
(cont.)
 Carbon monoxide
– Interferes with oxygen carrying capacity of blood.
 Other ingredients
– Are also carcinogenic (e.g., arsenic and benzene)
– Alter clotting properties of blood
– Raise blood cholesterol and reduce HDL

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Historical Tobacco Trends
 Intensive use began in early 20th century
 It was distributed free to soldiers in world wars.
 Women began smoking during and after World War II.
 Smoking peaked in the mid-1960s with over 42% of adults.
 Lung cancer trends followed smoking trends about 20 years later.
 The Surgeon General’s first report was 1964.
– Smoking rates began to decline.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Prevalence of Smoking and Cancer
 Fallacy of women’s immunity: Women started smoking later than men, women’s
lung cancer rates began rising later, and lung cancer among women surpassed
breast cancer in the 1980s.
 African American men had a higher rate, but it has declined.
 American Indians and Alaskan Natives have high rates.
 There is a strong association with lack of education.
 Now in the U.S., about 14% of adults smoke.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Regulatory Restrictions
 Federal Trade Commission
– Warning labels
 Federal Communications Commission
– Fairness Doctrine for counter-advertising
 1971—The industry submitted a total ban on advertising on radio and
television.
 1990s—Nonsmokers’ rights movement.
 1992—EPA declared environmental tobacco smoke to be a carcinogen.
 2019—27 states and the District of Columbia had banned or severely restricted
smoking in all public places including work sites, restaurants, and most bars.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Emphasis on Youth
 Tobacco companies must recruit 1 million smokers per year to replace those
who die or quit.
 Most smokers begin smoking in their teens.
 Ads focus on young people.
– Joe Camel
 Ads focus on young women.
– They are attracted by suggestions that smoking will help them lose weight.
 Laws prohibit sale of tobacco to minors but are ineffective.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Taxes
 Teenagers are especially sensitive to price.
 California raised cigarette taxes to fund tobacco control programs.
 Many states have raised cigarette taxes to close budget shortfalls.
– Number one strategy to damage the tobacco industry
– Tax increase is effective at reducing the number of smokers.

10. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
California’s Tobacco Control Program
 Program was funded by 1989 tax increase of 25 cents per pack.
 Cigarette consumption immediately declined.
 Antismoking campaign in 1990 and 1991 simultaneously reduced smoking.
– In 1994, smoking was banned in all workplaces except bars, taverns, and casinos.
 Cigarette consumption declined to 11% in 2017.
 Studies of antismoking messages show which messages are more effective.

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2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
1990s Broad Attack on Tobacco
 Class-action lawsuits by state attorneys general were filed.
 FDA commissioner Kessler proposed to regulate tobacco.
 “Mr. Butts” leaked tobacco company documents.
 Tobacco industry was put on the defensive.
 Tobacco companies challenged the FDA’s authority to regulate tobacco.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Master Settlement Agreement
 In 1997–1998, attorneys general and the tobacco industry agreed on a
settlement.
 Industry agreed to:
– Pay $206 billion to 46 states over 25 years
– Pay $1.7 billion to American Legacy Foundation
• “Truth campaign” used lessons from California’s campaign.
– Restrict advertising
 Disappointingly, states used very little settlement money for tobacco control.

13. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Family Smoking Prevention and Tobacco Control Act
• Was passed by Congress in 2009
• Authorizes the FDA to regulate tobacco products and to restrict advertising and
promotion
• Requires larger and more graphic warning labels on cigarette packages
• Forbids tobacco companies from sponsoring sporting events
• Requires disclosure of ingredients of cigarettes

14. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Electronic Cigarettes
 According to CDC, between 2010 and 2013, e-cigarette awareness grew to
80% and use more than doubled among U.S. adults.
 They are heavily marketed on television.
 FDA does not have the authority to regulate.
 There is concern for small children due to fruit and candy flavors.

15. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 1
 Use the ecological model (see Chapter 14) to design a community program to
discourage smoking among teenagers.

16. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 2
 Do you believe statements by tobacco companies that their advertising is not
aimed at getting kids to smoke?
 Explain your response.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 3
 Visit the American Legacy Foundation’s truth campaign website,
www.thetruth.com.
 Try playing a game.
 Check out the T-shirts in the apparel store.
 Do you think these messages are effective at discouraging teenagers from
smoking?

18. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 4
 Visit the CDC’s Smoking and Tobacco Use webpage, www.cdc.gov/tobacco.
 What is the CDC doing to reduce the prevalence of smoking in the U.S.?