Nicotine is highly addictive and tobacco use has significant health risks. Smoking rates peaked in the mid-20th century and have declined since due to health campaigns and legislation, though tobacco use remains widespread globally. In addition to lung cancer and heart disease, smoking is linked to many other cancers and reduced life expectancy. While it is difficult, many techniques can help people quit smoking.

1. Albia Dugger • Miami Dade College
Chapter 7
Tobacco

2. Nicotine
• Nicotine is the addictive ingredient in tobacco – 90% of
smokers become dependent
• C. Everett Koop claimed that nicotine dependence is as
powerful as heroin and cocaine dependence
• In 1988, the American Psychiatric Association recognized
nicotine dependency as a disorder

3. History of Tobacco Use
• 600-900 AD: Mexican stone carvings depict smoking
• Early 1600s: Thousands of tobacco shops in London
• 17th century: Smoking condemned by the Pope
• 1828: Nicotine was isolated and identified as poisonous and
addictive

4. History of Tobacco Use
• Early 1600s: Jamestown settlers planted tobacco
• 1776: Tobacco production provided funds for colonial settlers
to fight the Revolutionary War against England
• Early 1800s: Tobacco was used as snuff, cigars, and pipes,
and chewing tobacco – not cigarettes
• 1883: The cigarette rolling machine was patented

5. History of Tobacco Use
• Early 1900s: Tobacco companies began marketing
campaigns to promote cigarettes
• Cigarettes were the first of the tobacco products marketed to
women
• Cigarettes were less costly and milder than cigars, which
increased their popularity with young people

6. Opposition and Escalation
• 1798: Physician Benjamin Rush condemned tobacco for its
adverse health effects
• Several states banned the sale of tobacco to children
• During World War I, the YMCA, the U.S. Army, and other
groups distributed cigarettes to soldiers
• During World War II, cigarette manufacturers donated
cigarettes to soldiers in combat

7. Costs of Smoking
• An increase in cost reduces the demand for cigarettes
• Many states tax cigarettes to pay for programs such as
smoking prevention and hospital treatment for the uninsured
• The federal government also amasses substantial tax
revenues from tobacco sales
• However, higher taxes encourage a black market for
cigarettes

8. Cigarette Excise Taxes

9. Cigarette Excise Taxes

10. Extent of Tobacco Use
• Smoking increased until 1964, when the Public Health Service
issued Smoking and Health: Report of the Advisory
Committee to the Surgeon General
• The percentage of adult Americans who smoke decreased
from 42.4% in 1965 to 20.6% in 2009

11. Tar and Nicotine Levels
• Tar is a carcinogenic component of tobacco
• Nicotine is the psychoactive component in tobacco
responsible for stimulation and tobacco dependence
• Although levels of tar and nicotine in cigarettes have been
reduced, this has increased the number of cigarettes smoked,
as smokers smoke more to get more nicotine

12. Demographics of Smoking
• More adult males smoke than adult females
• College students smoke less than young adults who are not in
college
• Parents who smoke are more likely to have children who
smoke
• Smoking rates are correlated with education and occupation

13. Smoking by Adolescents
• Smoking by
adolescents has
declined only slightly

14. Women and Smoking
• In 1965, 34% of women smoked – currently, approximately
17.9% of women smoke cigarettes
• Less-educated women are three times more likely to smoke
than women with more education
• Cigarette smoking reduces a woman’s life by 14 years
• Lung cancer is the leading fatal cancer among US women
• Women smokers have higher rates of depression,
osteoporosis, peptic ulcers, and cataracts

15. Smokeless Tobacco
• Use of smokeless tobacco (snuff and chewing tobacco) has
nearly tripled in the last twenty years
• Nicotine in smokeless tobacco is absorbed quickly through
the mucous lining of the mouth, making it highly addicting
• The nicotine in one dip of snuff equals four cigarettes
• Smokeless tobacco has a higher level of the carcinogen NNK
than regular tobacco

16. Snus
• Snus are a tobacco product packaged in small pouches that
go under one’s upper lip
• Usage is increasing in response to antismoking views,
increased taxes on cigarettes and expanding smoke-free
ordinances

17. Oral Cancer caused by Smokeless Tobacco

18. Tobacco Use in Other Countries
• According to the World Health Organization, tobacco use is
the leading cause of preventable death in the world
• In China, over half of all males aged 15 and older smoke
• Smoking rates in industrialized countries are decreasing, but
in underdeveloped countries, they are increasing
• US tobacco companies export more than $2 billion worth of
tobacco products

19. Clove Cigarettes and Bidis
• Clove cigarettes
• Made from tobacco and cloves; contain more tar, nicotine,
and carbon monoxide than commercial cigarettes
• Eugenol
• Ingredient in clove cigarettes that provides aroma and
reduces coughing reflex
• Bidis
• Flavored cigarettes from India that have considerably
higher concentrations of nicotine than regular cigarettes

20. Light Cigarettes
• Light cigarettes are advertised as having less tar and nicotine
• Account for the vast majority of cigarettes sold
• 2011: Federal judge ruled that tobacco companies must admit
that they have lied about light cigarettes
• People who smoke light cigarettes receive the same amount
of nicotine and tar as those smoking regular cigarettes

21. Cigars
• 1990: Increase in cigar bars and restaurant cigar nights
• Sales of small cigars (cigarillos) have increased
• Taxed at a lower rate than cigarettes
• Fewer restrictions placed on their promotion
• Health hazards are associated with cigar smoking:
• Nicotine levels higher than cigarettes
• 34% higher cancer rate than nonsmokers
• Higher rates of cancers of the mouth, throat, and
esophagus than cigarette smokers

22. Cigar Use

23. Characteristics of Smoking and Smokers
• Tobacco use tends to have triggers:
• Following a meal
• Talking on the phone
• Drinking coffee
• Being around other smokers
• Tobacco contains acetaldehyde, a chemical with sedating
properties similar to those of alcohol
• Nicotine improves cognitive performance slightly

24. Tobacco Use by Young People
• 60% of new smokers initiate smoking prior age 18
• One third of youths who smoked three or four cigarettes a day
developed nicotine dependence
• By 8th grade, 2.9% of students smoke on a daily basis
• One predictor of tobacco use among boys is
aggressive/disruptive behavior

25. Tobacco Use by Young People
• Young people smoke to appear mature, to display
independence, to cope with stress, or to bond with peers
• Adolescent smoking has a high correlation with psychological
distress
• Most important factors in whether a teenager smokes:
• If the teenager’s friends smoke
• If perceived benefits outweigh the risks
• If the teenager’s household includes smokers

26. Tobacco Use by Young People
• When teaching young people about the dangers of tobacco,
one challenge is that harmful effects take years to appear
• Emphasizing short-term or cosmetic effects may have a
greater impact
• Most programs that are information based have been
ineffective in reducing the onset of smoking
• Tobacco prevention programs outside of schools are more
effective with high-risk youths

27. Nicotine Dependence in Younger Smokers

28. Respected Adults Influence Decisions

29. Nicotine Tolerance and Dependence
• Smokers and chewers build-up tolerance quickly, some in a
matter of weeks
• Most people continue to use tobacco products because
nicotine is addictive – however, most people who quit are able
to do so without nicotine replacement
• Nicotine addicts develop tolerance, have a strong desire for
continued use, and undergo withdrawal

30. Nicotine Withdrawal Symptoms
• Lower heart rate
• Tremors
• Aggressiveness
• Hunger
• Heart palpitations
• Headaches
• Anxiety
• Lower blood pressure
• Shorter attention span
• Increased circulation
• Insomnia
• Fatigue
• Drowsiness
• Craving for nicotine

31. Pharmacology of Tobacco
• 4,000 chemicals are found in tobacco smoke
• Used as an insecticide
• 60 mg can cause human death
• Carcinogenic
• Nicotine
• Releases stimulant norepinephrine
• Depression follows arousal
• Constricts blood vessels
• Stays in the body for 8 to 12 hours

32. Physical Effects on the Individual
• Smoking is responsible for nearly one in five US deaths
• Most prominent behavioral cause of lung cancer, other
respiratory diseases, and cardiovascular diseases
• Responsible for $167 billion in annual health-related
economic losses in the US
• $75 billion in direct medical costs
• $92 billion in lost productivity

33. Health Effects of Smoking

34. Lost Productivity

35. Heart Disease and Strokes
• Smoking causes more cardiovascular deaths than cancer
deaths
• Smoking is implicated in 30% of all deaths from coronary
heart disease
• Risk of heart attack and stroke increases among women who
smoke cigarettes and use oral contraceptives
• Cardiovascular damage is correlated with the frequency and
length of time a person smokes

36. Heart Disease and Strokes
• Nicotine raises the heart rate and blood pressure, forcing the
heart to work harder
• Carbon monoxide impedes the oxygen-carrying capacity of
the blood, impairs circulation, increases cholesterol deposits
and arteriosclerosis
• Buerger’s disease can result in amputation of the extremities
as a result of poor circulation

37. Respiratory Diseases
• Respiratory conditions caused by smoking:
• Chronic coughing and shortness of breath
• Chronic bronchitis and emphysema (COPD)
• Bronchitis
• Smoke irritates bronchi; tar builds up on cilia; breathing
becomes more labored
• Emphysema
• Disabling, incurable disease
• Lungs lose elasticity, unable to retain air

38. Cancer
• There are dozens of carcinogenic gases in tobacco smoke,
including ammonia, benzopyrene, hydrogen cyanide,
nitrosamines, and vinyl chloride
• Most cancer-causing substances are found in the tar of
tobacco, though nicotine has been implicated as well
• Cigarette smoking is responsible for at least 30% of all
cancers deaths and 87% of lung cancer deaths

39. Cancer
• Cigarette smoking is the leading risk factor for cancers of the
larynx, mouth, esophagus, pancreas, and bladder
• Increases chances of developing cancers of the oral cavity,
pancreas, esophagus, kidney, larynx, trachea, and bladder
• Higher risk of developing non-Hodgkin’s lymphoma
• Oral and pharyngeal cancers account for almost 8,000 deaths
annually in the United States

40. Warning Signs of Oral Cancer
• Sore in the mouth that does not heal
• White or red patch on the gums, tongue, tonsil, or mouth
• Lump or thickening in the cheek
• Sore throat or a feeling that something is caught in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Numbness of the tongue or other area of the mouth
• Swelling of the jaw that causes dentures to fit poorly
• Loosening of teeth or pain around the teeth or jaw
• Voice changes
• Lump or mass in the neck
• Weight loss

41. Impact of Smoking During Pregnancy
• Smoking interferes with the fetus:
• Babies weigh less and are more likely to be premature
• Higher incidence of spontaneous abortions
• Higher rate of stillbirths
• Higher rate of sudden infant death syndrome (SIDS)
• Higher risk of cleft lip and cleft palate
• Higher rates of psychological problems
• Significantly reduces fertility in women

42. Smoking During Pregnancy
• Maternal smoking is
the most important
avoidable risk factor
for SIDS

43. Tobacco and Physical Activity
• Ability to engage in physical activity is impaired:
• Mucous membranes of the trachea and the bronchial
tubes enlarge, restricting air passage
• Alveoli in the lungs receive less oxygen
• Smoking impairs sexual activity:
• Carbon monoxide reduces testosterone production
• Erectile dysfunction due to nicotine
• Sperm count and motility is reduced
• Impairs normal sexual response in young women

44. Passive Smoke
• Passive smoke
• Tobacco smoke present in the air from someone else’s
smoking and inhaled by others
• Environmental tobacco smoke
• Smoke in the air as a result of someone smoking
• Mainstream smoke
• Smoke exhaled by a smoker
• Sidestream smoke
• Smoke from the burning end of a cigarette, pipe, or cigar

45. Passive Smoke
• Passive smoke is blamed for 3,400 lung cancer deaths each
year
• The extent of harm is related to the degree of exposure
• Sidestream smoke contains more nicotine and carbon
monoxide than mainstream smoke
• Children of smokers have five times as much cotinine in their
urine as children of nonsmokers

46. Composition of mainstream smoke

47. Effects on Nonsmokers
• Passive smoke is linked to:
• Lung cancer
• Urinary tract problems
• Cancers of the liver, pancreas, and breast cancer
• Type 2 diabetes and multiple sclerosis
• Heart attack
• The Environmental Protection Agency declared secondhand
smoke a carcinogen in 1993

48. Effects on Children of Smokers
• Children exposed to cigarette smoke:
• Higher incidence of atopic dermatitis (eczema)
• Respiratory infections (colds, bronchitis, pneumonia)
• Absent from school more often
• Higher incidence of asthma
• Childhood allergies
• Physical aggression and hyperactivity-impulsivity
• Dental cavities

49. Rights of Smokers versus Nonsmokers
• Anti-smoking legislation:
• Federal minimum age of 18 to purchase tobacco products
• Local tobacco control ordinances against smoking in
public areas and private workplaces
• Airline passengers on commercial flights within the US
were forbidden from smoking
• 2012, FDA mandates more prominent health warnings on
all cigarette packaging and advertisements
• New York City banned smoking in restaurants, and
tobacco ads within 1,000 feet of a school

50. State Cigarette Excise Tax Rates

51. Rights of Smokers versus Nonsmokers
• The Master Settlement Agreement:
• Legislation requires the tobacco industry to pay $206
billion among all 50 states in exchange for an end to
litigation against the four largest tobacco companies
• Compensate states for medical costs resulting from
cigarette smoking
• Creates a $500 million fund to educate young people
about the risks of smoking
• Tobacco companies are no longer liable for addiction or
dependence claims, class action suits, and claims of
punitive damages

52. Cessation Techniques
• Seventy percent of smokers say that they want to quit
• Withdrawal symptoms can be intense, leading to anxiety and
depressed mood
• Most people require five to seven attempts to quit before they
are successful
• Stopping smokeless tobacco is more difficult than quitting
cigarettes

53. Cessation Techniques
• Obstacles:
• Many activities trigger smoking
• Many are concerned about gaining weight once they stop
• Confidence is crucial in how long one remains abstinent
• Smoking cessation programs:
• 90% quit without a formal treatment program
• Nicotine replacement therapy helps many smokers
• Other therapies have not been proven to help

54. Cessation Techniques
• Nicotine Gum and Lozenges
• Reduce withdrawal symptoms
• Increases success by 10%
• Nicotine Patches
• Can deliver dangerously high doses to those who continue
smoking
• Nicotine Inhalers
• Can irritate nasal passages

55. Cessation Techniques
• Drug Therapy
• Zyban reduces the desire for nicotine; side effects include
convulsions and delirium
• Chantix treats nicotine addiction
• Antianxiety drugs can reduce irritability
• Three vaccines are being developed to prevent nicotine
addiction

56. Cessation Techniques
• Aversive Techniques
• Rapid smoking causes smokers to exceed their tolerance
levels and become ill
• Electric shock – benefits are short-term at best
• Behavior Modification
• The smoker learns new or alternative behaviors to use in
place of smoking
• May include support groups or a buddy system

57. Cessation Techniques
• Hypnosis
• Works best with people who want it to work
• Not found any more effective than other treatments
• Acupuncture
• Minimal evidence of effectiveness
• Claims to release endorphins and reduce physical
symptoms of withdrawal