Tobacco use is the leading cause of preventable death in the US and worldwide. In the US, tobacco use results in over 400,000 premature deaths annually. Worldwide, tobacco use causes over 3 million deaths per year. The tobacco industry targets youth to replace the 3000 smokers who die or quit each day. Nicotine is highly addictive due to its effects on the brain's reward pathways and dopamine release. While the health risks of smoking are well established, the tobacco industry suppressed this information and targeted youth in marketing for many years.

1. Tobacco Use is Leading Cause of
Preventable Death

2. Toll of Smoking
USA: 400,000 premature deaths annually
• one every 45 sec
• annual health care costs $50 billion (1993)
Worldwide: 3,000,000 deaths annually
• one every 10 sec
• 1 billion people smoke about 6 trillion
cigarettes a year
Revenues of US tobacco companies: $32 billion (1991)
Marketing & promotional budget: $6 billion (1993))

3. President Clinton
August 23, 1996
"Cigarette smoking is the most significant
public health problem facing our people.
More Americans die every year from
smoking-related diseases than from
AIDS, car accidents, murders, suicides and
fires — combined."
… during speech declaring nicotine an addictive drug

4. Do tobacco companies target kids?
Tobacco industry “needs” to replace 3,000
smokers who die or quit each day
Very small percentage of smokers begin
after teens
Go figure …

5. “Today, nearly 3,000 young people across our country will begin smoking
regularly. Of these 3,000 young people, 1,000 will lose that gamble to the
diseases caused by smoking. The net effect of this is that among children
living in America today, 5 million will die an early, preventable death
because of a decision made as a child.”
Donna E. Shalala, PhD (Syracuse)
(Former) Secretary, U.S. Department of Health and Human Services

6. Are teens influenced by advertising?
0
10
20
30
40
50
60
Percent
Marlboro
Camel
Newport
advertising
teens
adults
Period of study
1973-1993

13. Former snuff user
… died of cancer at age 27 — subsequent to amputation of jaw

17. Nicotine — is it addictive?
C10H14N2

18. Nicotine dependence
Addiction/dependence
• can’t stop when you want to
• continue use, despite clear evidence of harm
• clear withdrawal symptoms
• nicotine: depressed mood, insomnia, irritability,
difficulty concentrating
but no intoxication
• unlike cocaine, heroin, alcohol
Approx. 44% of the cigarettes smoked in the United States are smoked by
the mentally ill. — Harvard Medical School study (11/2000)

19. Brain regions & pathways
reward
judgment

20. Nicotine action
Accelerates release of
neurotransmitter
dopamine in the
brain’s NA*
& increases
metabolism in NA
dopamine ~ pleasure,
emotions, addiction
… “reward system”
*NA = nucleus accumbens
nucleus
accumbens
amygdala

21. Dopamine as a
neurotransmitter

22. What else besides lung cancer?
cancer of the mouth, throat, pancreas,
kidney, bladder, and other organs
heart disease and strokes
emphysema
sudden infant death syndrome (SIDS)?
impotence
and much much more …

23. From ASH,
Australia

25. Tobacco smoke
~4,000 chemicals
43 known carcinogens
smoking gun (1996 finding)
• benzo[α]pyrene product (BP → BPDE)
• BPDE damages p53 tumor suppressor gene!
http://heat.usc.edu/chemical/bap.html
http://www.tobacco.neu.edu/tot/Nov96/smoking_gun.htm
benzo[α]pyrene

26. Tobacco Documents
Tobacco industry
• knew about nicotine addiction
• adjusted nicotine levels
• targeted youngsters in ads
Liggett Group caves in first (3/97)
• Leads to $246 billion deal (thru 2025) between
(attorneys general of) 46 states and the major tobacco
companies
• Also underwrite campaign to cut under-age smoking
and substance abuse, and educate smokers about
diseases related to tobacco

27. 1996 Book on
Tobacco
Documents
by Stanton
Glantz (UCSF)
et al.
http://www.library.ucsf.edu/tobacco/cigpapers/book/

28. True story of
tobacco
executive-
turned-
whistleblower,
Jeffrey
Wigand

29. Supreme Court on FDA
Supreme Court* decided, in March 2000,
that F.D.A. needs specific authority from
Congress before it can regulate tobacco
(again; as a drug)
• 1998 tobacco bill before the Senate provided
for F.D.A. regulation, but was blocked by
Senate leadership.
*tobacco “poses perhaps the single most significant
threat to public health in the United States.”

30. Florida Class-Action Lawsuit
$145-billion punitive award against the five
major tobacco companies (7/14/2000)
The class: 300,000–700,000 sick smokers
Appeals process will take (many) years

31. Whiteley Case
Leslie Whiteley (Ojai, CA)
• Mother of four; had started smoking at age 13
• Marlboros and Camels
• This was after warning labels appeared (1965).
• Diagnosed w. lung cancer in 1998
• Then spread to liver and brain
• San Francisco jury ordered Philip Morris and
R. J. Reynolds to pay $1.7M in compensatory & $20M
in punitive damages (3/27/2000)
• Her lawyer, Madelyn Chaber, asserted fraud by PM &
RJR to overcome ’92 Supreme Court decision about
labeling
• Died 7/3/2000 at age 40

32. Female smoking deaths double
By Rita Rubin
USA TODAY 3/28/2001
WASHINGTON -- Four out of every 10 Americans who
die from smoking are women, a proportion that has
more than doubled since 1965, according to a report
Tuesday by Surgeon General David Satcher.
''Women who smoke like men die like men,'' Satcher
says.
Since the surgeon general's last report on women and
smoking in 1980, 3 million women have died
prematurely from smoking-related ailments.
Although breast cancer generates more anxiety, lung
cancer surpassed it in 1987 as the deadliest
malignancy in women. Satcher says 68,000 women

33. Women also are susceptible to smoking-related
reproductive problems, such as cervical cancer and
early menopause. And he says smoking during
pregnancy remains a public health problem,
increasing the risk of stillbirth and sudden infant
death syndrome.
In 1964, 52% of men smoked, compared with 34%
of women. Today, about 26% of men and 22% of
women smoke.
Satcher blames aggressive marketing for the
continuing appeal of cigarettes. The Federal Trade
Commission says the five leading cigarette
companies spent $8.24 billion on marketing in 1999,
up 22% from '98.
…

34. If you smoke, please quit!