Tobacco

Ceremonial Tobacco use in Oklahoma

- 1% of SHS males - .4% of SHS females

Adolescents & smoking

- 50% of young people who continue to smoke will die from smoking - Every day, upto 100, 000 young people globally become addicted to tobacco

Other Adverse Outcomes

- A 10-fold increase in the risk of dying from chronic obstructive lung disease. - 90% of all deaths from chronic obstructive lung diseases are attributable to cigarette smoking. - Cigarette smoking has many adverse reproductive and early childhood effects, including an increased risk for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS). - Postmenopausal women who smoke have lower bone density than non smoking women. - Women who smoke have an increased risk for hip fracture over never smokers.

Secondhand smoke (con'td)

- Breathing secondhand smoke has immediate harmful effects on cardiovascular system that can increase risk of heart attack. - Exposure causes respiratory symptoms in children & slows their lung growth - Associated w/ SIDS, acute respiratory infections, ear problems and more frequent and severe asthma attacks in children

Tobacco's Devastation

- Caused about 400,000 U.S. deaths/year (1990's) - 181,000 cardiovascular diseases - 155,000 cancers - 91,000 respiratory diseases - 3,000 ETS induced lung cancer - 1,600 diseases among infants - 1,100 cigarette caused fires

1988 Surgeon General Report

- Cigarettes and other forms of tobacco are addicting. - Nicotine is the drug in tobacco that causes addiction. - The pharmacologic and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs, such as, heroin and cocaine.

Smokeless tobacco

- Contains 28 carcinogens. - Increases the risk of developing cancer of the oral cavity. - Oral health problems strongly associated with smokeless tobacco are leukoplakia (a lesion of the soft tissue that consists of a white patch or plaque that cannot be scraped off) and recession of the gums. - Use can lead to nicotine addiction and dependence.

Smoking contributes to many chronic diseases

- Coronary heart disease - Cerebrovascular disease - Atherosclerotic peripheral artery disease - Lung, larynx, mouth, esophagus and bladder cancers - Chronic obstructive pulmonary disease - Intrauterine growth retardation - Low birth weight babies

Secondhand smoke (cont'd)

- Exposure is associated with heart disease and lung cancer in nonsmoking adults. - Nonsmokers exposed to secondhand smoke at home or work increase their heart disease risk by 25-30% & their lung cancer risk by 20-30%. - People who already have heart disease are at especially high risk.

Hope for the Future

- Implementing policies that establish smoke-free environments is the most effective approach to prevent exposure and harm from secondhand smoke. - Presently in the US, more than 2,650 municipalities have passed smoke-free legislation and 28 states, the District of Columbia and Puerto Rico have implemented or enacted statewide smoking bans.

Cigar Risk factors

- Many of the same carcinogens found in cigarettes are also found in cigars. Cancers caused by cigar smoking include: - Lung - Oral cavity - Larynx - Esophagus - Pancreas (possibly)

Prevalence of Tobacco smoking

- More than 47 million Americans smoke. - In 1995, the highest prevalence was seen in American Indians and Alaskan Natives. - Prevalence is highest among persons with 9 - 11 years of education. - The highest prevalence is among those of lower SES. - High risk group are children, adolescents and ethnic groups.

Smoking risks

- Nearly 87% of all lung cancers are caused by smoking. - Smokers are 15 times more likely to die of lung cancer than people who have never smoked.

Reasons for using tobacco (USA)

- Nicotine addiction, Social norms (psychosocial support), Self image, Weight control, Parental smoking, Peer/friends smoke, Low academic involvement, Advertising and promotion of tobacco products, Lack of services to support smoking cessation, Legislation and policies that allow smoking in public places, Ease of access, Lack of health education & Cost

Cardiovascular pathophysiology

- Nicotine and carbon monoxide disturb blood vessel walls. - Smoking decreases oxygen-carrying capacity of blood. - Smoking reduces threshold for ventricular fibrillation. - Smoking contributes to atherosclerotic buildup over time. It is a major independent CHD risk factor.

Increasing the Price of Tobacco

- One of the simplest and most effective methods for rapidly and significantly reducing tobacco use - Benefits most striking for young people and persons in developing countries - On average, a 10% increase in price of cigarettes reduces demand by 4% (in high-income countries)

Snuff Risk factors

- Oral cancer occurs several times more frequently among users than non-users. - Long-term snuff users may have nearly a 50- fold greater risk of cheek and gum cancers.

Prevention and Control

- Provide school based health education - Broadcast mass media anti-smoking messages - Enforce state legislation on selling to minors - Educate merchants - Prohibit free distribution of tobacco products - Restrict advertising - Stop glamorizing smoking in movies Increase tobacco taxes

The Bottom Line

- Stopping tobacco use, or not starting, is the single most important action that can be taken to reduce cancer in the United States. - If all adults stopped tobacco use and children did not start: - Nearly one-third of all cancer deaths would be prevented. - Billions of dollars would be saved. - Millions of family members and friends would avoid the sickness and premature death of a loved one.

Effective Govt. Policy

- Stronger public health warnings

Nicotine

- The cigarette is a very efficient and highly engineered drug delivery system. - Average smoker takes in 1 to 2 mg nicotine per cigarette - Potent stimulator of the midbrain dopamine reward pathway - Nicotine reaches the brain within 10 seconds after smoke is inhaled. It has been found in every part of the body and in breast milk.

Youth and Tobacco Use

- The prevention of tobacco use among children and youth is equally important, since over 90% of smokers begin to smoke before age 18. - If children and youth can be prevented from starting, a substantial portion of tobacco-related health problems can be solved.

Smoking and cancer

- The risk of dying from lung cancer is more than 22 times higher among men who smoke cigarettes and about 12 times higher among women who smoke cigarettes compared with never smokers. - Rates of cancers related to cigarette smoking vary widely among members of racial/ethnic groups but are highest among African-American men.

Price and Youth Tobacco Use

- Youth are more sensitive to changes in cigarette prices because they have less disposable income and are less addicted. - In Canada, when cigarette prices were raised dramatically in 1980's and 90's, youth consumption fell by 60%, while overall consumption dropped 38%.

Cancer Pathophysiology

- mainstream cigarette smoke 5,000 chemicals - contains 43 known human or animal carcinogen - Carcinogens include polycyclic aromatic hydrocarbons, nitrosamines, & aldehydes - studies confirm carcingoenic potential of these agens

MPOWER Reduce smoking in NYC

- monitor adult smoking prevalence - protect people from tobacco smoke - raise taxes on tobacco (city & state) - monitor youth smoking - warn about the dangers of smoking - 350, 000 fewer adult smokers - >100,000 fewer smoking-related deaths in future years

Motivational tension

- offering treatment can influence the choice

The benefits of quitting w/n months

1 month - Appearance improves - skin loses greyish pallor, less wrinkled; Regeneration of respiratory cilia starts; Withdrawal symptoms have stopped 3-9 months - Coughing and wheezing decline

Nicotine withdrawal: Duration

2 days- Lightheadedness 1 week - Sleep disturbance 2 weeks - Poor concentration, Craving for nicotine 4 weeks - Irritability or aggression, Depression Restlessness 10 weeks - Increased appetite

The benefits of quitting w/n years

5 years -The excess risk of a heart attack reduces by half 10 years - The risk of lung cancer halved

The benefits of quitting w/n hours

8 hours - Nicotine and carbon monoxide levels halved, Blood oxygen levels return to normal 24 hours - Carbon monoxide eliminated from the body 48 hours - Nicotine eliminated from the body, Taste buds start to recover

Secondhand smoke

Each year, secondhand smoke causes: - About 3,000 lung cancer deaths - 35,000 heart disease deaths - Respiratory illness and asthma attacks

Sales to youth

In 1992, Congress enacted the Synar amendment, requiring every state to have a law prohibiting tobacco sales to minors under age 18 years, to enforce the law, to conduct annual statewide inspections of tobacco outlets to assess the rate of illegal tobacco sales to minors and to develop a strategy and time frame to reduce the statewide illegal sales rate to 20% or less.

NRT: Nicotine levels in smokers

NRT increases the odds of quitting about 1.5 to 2 fold

Strength of Evidence

Strong evidence over the years has found a clear cause-and-effect relationship between the use of tobacco and several types of cancer.

Risk Ratio of Tobacco smoking

The relative risk of premature death among male smokers compared with men who have never smoked is 2.34.

Cancers Affected

Tobacco use is primary risk factor for lung cancer - also associated w/ cancer of other body parts: Cervix, mouth, pharynx, larynx, esophagus, pancreas, kidney, & bladder

Tobacco control policies

o Tobacco Settlement (Endowment Trusts) o Clean indoor air for buildings o Clean indoor air for most public places/workplaces o New tribal tobacco compacts (Oklahoma) o Restrictions on youth access to tobacco o Increase in excise tax on tobacco products o Smokefree restaurants and bars o "24/7" tobacco-free properties o Recent Federal Policies: o Increased federal excise tax o FDA regulation

Smoking Epidemic

• 75% of smokers live in low or middle income countries • 1 billion smokers • 5 million people die every year (This figure will have doubled by 2030) - 75% of smokers want to quit - <2% of smokers quit each year

Effective Govt. Policy

• Bans on tobacco advertising and sponsorship • Regular price rises • Stronger public health warning labels • Smoking bans in all public places SMOKING GOES DOWN AS PRICES GO UP

Respiratory Pathophysiology

• Cigarette smoking causes ~ 90% of COPD. • Other lung diseases are exacerbated by smoking. • Smoking paralyzes respiratory ciliary action, increases mucus production and small airway plugging, and causes an inflammatory response in respiratory syncitial cells. This facilitates the breakdown of alveolar membranes thus causing emphysema. • Poor exchange of oxygen and carbon dioxide can cause hypoxemia (oxygen starvation). • Bronchial hyper-responsiveness, exacerbated by ETS, may contribute to asthma.

Increasing risk of Adolescent smoking

• Parental / other family members smoking • Less 'connectedness' to family, school & society • Ready availability of cigarettes • Peer pressure • Advertising, influence of media • Concern over weight

Decreasing risk of Adolescent smoking

• School-based policies around smoking education • Good social support • Higher levels of physical activity

Smoking during Pregnancy

• Smoking has adverse effects on unborn child • 20-30% of smoking women quit in pregnancy • Smoking cessation programmes are effective • Post-partum follow up reduces the 70% relapse rate - Pregnancy is often a trigger for quitting

Some History about Smoking

• Thomas Venner of London was one of the first to warn about tobacco dangers in his Via Recta, published in London in 1620. • John Hill in 1761 wrote a book entitled Cautions Against the Immoderate Use of Snuff. • In the 1950's and early 1960's published epidemiologic reports showed that smoking was linked to lung cancer.

Tobacco Prevention

• Tobacco is the leading preventable cause of death • After 40 years of progress, the decrease in adult smoking rates has stalled in the past 6 yrs • But most people who have ever smoked have already quit, and most of today's smokers want to quit • Progress stalled starting in 2004

Tobacco Use & Cancer

• Tobacco use, the most preventable cause of death in our society, accounts for at least 30% of all cancer deaths. • An estimated 45 million adults are current smokers in the United States. • About half of those who continue to smoke will die prematurely from smoking. • The best way to avoid getting cancer is to not start using tobacco or to quit using it.