SOC 204 Goldberg Ch 7 Week 4
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Nicotine is the addictive substance in tobacco. 90% of smokers become dependent on nicotine, which is as addictive as heroin or cocaine. In 1988, nicotine dependence was recognized as a disorder by the American Psychiatric Association. The majority of adults who are dependent on nicotine started smoking before age 18. Less than half as many adults smoke today compared to 40 years ago, and trends in cigarette sales have declined. Nicotine affects absorption, metabolism, physiological and behavioral effects, and leads to dependence.
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SOC 204 Goldberg Ch 7 Week 4
- 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. THE MAJORITY OF ADULTS DEPENDENT ON NICOTINE STARTED SMOKING BEFORE AGE 18. A.True B.False True False 9% 91%
- 4. TRENDS IN CIGARETTE SALES
- 5. LESS THAN HALF AS MANY ADULTS SMOKE TODAY COMPARED WITH 40 YEARS AGO. A.True B.False True False 10% 90%
- 6. PHARMACOLOGY OF NICOTINE • Absorption & Metabolism • Physiological Effects • Behavioral Effects • Nicotine Dependence
- 7. THE NUMBER OF PEOPLE DYING FROM TOBACCO-RELATED ILLNESSES IS ABOUT THE SAME AS PEOPLE DYING FROM ALCOHOL- RELATED ILLNESSES. A.True B.False True False 82% 18%
- 8. SMOKERS ARE MORE LIKELY TO DIE FROM HEART DISEASE THAN FROM LUNG CANCER. A.True B.False True False 33% 67%
- 9. PEOPLE WHO STOP SMOKING BY AGE 35 AVOID 90% OF THE HEALTH RISKS ATTRIBUTED TO TOBACCO. A.True B.False True False 60% 40%
- 11. TOBACCO UNDER ATTACK Adverse health effects Secondhand smoke Smoking and pregnancy Advertising Public Education http://ezproxy.wwcc.edu:2048/login?url=htt p://digital.films.com/PortalPlaylists.aspx?ai d=7539&xtid=34864
Editor's Notes
- 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 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 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 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 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 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
- 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 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
- 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 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 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 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 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 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 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 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 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 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? 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? SMOKELESS 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 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 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 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 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 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 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 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
- 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 Percentage of smokers (by gender) Men 26 Women 22 Percentage of smokers (by years of education) High school diploma only 30% Undergraduate degree 14% Full time students attending college 18% Non-college students 32% 8th Graders who plan to attend a 4 year college 5.5% 8th graders who don’t plan to attend a 4 year college 21.1% 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 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 Smoking by adolescents has declined only slightly 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 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 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 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 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 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
- 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 Nicotine = a naturally occurring liquid alkaloid that is colorless and volatile Tolerance and dependence develop quickly Smokers and chewers build-up tolerance quickly, some in a matter of weeks Withdrawal symptoms 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 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 Lower heart rate Tremors Aggressiveness Hunger Heart palpitations Headaches Anxiety Lower blood pressure Shorter attention span Increased circulation Insomnia Fatigue Drowsiness Craving for nicotine 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 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 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 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 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 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 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 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) Nicotine replacements—nicotine without the tar and carbon monoxide Nicotine gum Nicotine patches Nicotine nasal spray Nicotine inhalers Nicotine lozenge Bupropion (Zyban) – nicotine antagonist Chantix – nicotine agonist Combining counseling and pharmacological treatments increases the odds of quitting Keep trying! 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 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 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 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 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 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 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 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
- 400,000 tobacco 100,000 alcohol
- 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
- 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 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 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 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 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 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 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 Maternal smoking is the most important avoidable risk factor for SIDS 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
- 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 Cigarette packages and advertisements are required to rotate among different warning labels 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 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 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 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 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 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 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 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 1798: Physician Benjamin Rush condemned tobacco for its adverse health effects Several states banned the sale of tobacco to children 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 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 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 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