EDUCATION DEPARTMENT

Dear White Ribbon Sister,

Along with the enclosed material, once again comes my encouragement that you will take time to read it and endeavor to find some new facts on each of the topics that you can accurately share with others.

As previously stated we can only pass on to others what we ourselves know. Sometimes it’s good to test ourselves just to see how much we know on the matter we wish to present.

Are the people you share with aware that both alcohol and tobacco are drugs even though society would have us think otherwise?

As leaders, you can profit and also learn by having a gifted teacher and/or an authority on one of the drugs speak at your meetings.

May the Lord continue to bless and use you in your service for Him, your homes and communities.

Dawn Giddings

World Director The following leaflets are available at these links for educational purposes. Copies may also be ordered. What One Cigarette Does – QUIT Victoria http://www.quit.org.au/downloads/Background%20Briefs/06One.pdf What’s in Cigarettes? – QUIT Victoria

Underage Drinking Myths vs. Facts http://www.stopalcoholabuse.gov/media/pdf/MythsFactsBrochure_508compliant.pdf Tips for Teens - Tobacco http://file.lacounty.gov/lasd/cms1_145249.pdf Tips for Teens – Marijuana http://store.samhsa.gov/shin/content//PHD641/PHD641.pdf Glenda Amos prepared the material on Kava and Betel Nut. That information is also on our world website under Program Kit 2012. A PowerPoint presentation on the topic or a PDF version of the presentation is also on the website which can be downloaded for use.

What one cigarette does Diseases such as lung cancer and heart disease tend to occur in people who have smoked for a number of years. However, there are immediate and obvious effects from smoking just one cigarette.

If a person has not smoked for twelve hours and then has a cigarette, the following things happen:

1. Carbon monoxide levels in the lungs increase.1

This gas is quickly absorbed into the blood, reducing its capacity to carry oxygen.2 Carbon monoxide inhaled via secondhand smoke has a similar effect.3

The changes brought about by carbon monoxide mean that more effort must be made to achieve the same physical results as a non-smoker. In particular, the heart must work harder for the same effect, especially when doing vigorous exercise.1

Studies have shown that the levels of carbon monoxide in the blood of a 20-cigarette-a-day smoker can impair vision, perception of time and coordination.1

2. Nicotine from tobacco smoke reaches the brain and muscle tissue soon after being inhaled.4

When nicotine is present a number of changes occur:

The heart rate increases. This can be measured as an increase in pulse rate.

Nicotine also causes an increase in blood pressure and a slowing in circulation in the smaller blood vessels.4 This slowing in circulation, together with constriction of blood vessels, has the effect of lowering the skin temperature.

Nicotine can act both as a relaxant, relaxing skeletal muscles, and as a stimulant, increasing tension in other muscles. This can be illustrated by measuring hand tremors before and after a cigarette. 4,6 Nicotine also increases stomach secretions and changes brain activity.4

3. Tobacco smoke also increases resistance in the airways leading to the lungs and reduces lung capacity.5

References

1 Hill D, Larcombe I, Refshauge J. Smoking and Impairment of Performance. Med J Aust 1978;2:60–63.

2 US Department of Health and Human Services. The Health Consequences of Smoking: Cardiovascular Disease. A report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1983.

3 Glantz SA, Parmley WW. Passive smoking and heart disease epidemiology, physiology and biochemistry. Circulation 1991;83:1­–12.

4 US Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction. A report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1988.

5 US Department of Health and Human Services. The Health Consequences of Smoking: Chronic Obstructive Lung Disease. A report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1985.

6 Gilbert, R.M. and Pope, M.A., Early effects of quitting smoking. Psychopharmacology (Berl), 1982. 78(2): p. 121-7.

This material is used with permission from QUIT Victoria

What’s in cigarettes Cigarette smoke is a complex mixture of over 4000 chemicals.1 These chemicals are present as:

gases, such as carbon monoxide, hydrogen cyanide, nitrogen oxides,

liquid vapours, such as formaldehyde, methane, benzene, ammonia, acetone,

part of tiny solid particles, such as phenols, nicotine, and naphthalene.1,2

Thirty metals have been detected in tobacco smoke, as well as radioactive compounds such as polonium 210 and potassium 40.1,3

Many of the chemicals in cigarette smoke come from burning tobacco; the remainder come from burning cigarette paper, agricultural chemicals left on the tobacco leaves, and chemicals added during the cigarette making process.1,3

Once inhaled into the lungs, many of these chemicals pass through the lungs walls into the blood stream, and are pumped around the body.2

Tar, nicotine and carbon monoxide contribute to most smoking related diseases.2,4 However, there are many other chemicals in tobacco smoke which also have a role in causing disease.2

Tar

‘Tar’ describes the solid particles inhaled when a smoker draws on a lit cigarette.4 Each particle consists of a large variety of organic and inorganic chemicals, including a number of carcinogens (cancer causing substances).1,4 Tar can vary between the smoke from different types of cigarettes: it may contain different ratios of carcinogens and other substances.5,6 Tar is the sticky brown substance which can stain smokers’ fingers and teeth yellow-brown. It also stains the lung tissue.4

Nicotine

Nicotine is the drug in tobacco which causes addiction in smokers.7 It is a highly toxic chemical and its manufacture, use and sale is controlled under the State Poisons Acts, except where it occurs in tobacco.7,8,9 This exception of tobacco is for political reasons, not because nicotine is deemed ‘safe’ in cigarettes.5

Nicotine, once inhaled, affects the body very quickly. Within seconds, nicotine reaches the brain releasing dopamine, a ‘brain reward’ chemical.10 It causes changes to the structure and the working of the brain, which lead to, and maintain, nicotine addiction.2,10 Nicotine also raises heart rate, blood pressure, releases hormones affecting the central nervous system, and constricts small blood vessels under the skin.7 In the long term, nicotine may be a factor in causing coronary disease. It is believed to be involved in the development of gastrointestinal disorders and problems during pregnancy, and is linked with the development of cancers.7

Nicotine replacement products, used as quitting aids, are regulated. These safer forms of nicotine products, that is, nicotine gum, patches, lozenges, tablets, and inhalers, are sold by pharmacies.8

Carbon monoxide

Carbon monoxide is a poisonous gas which competes with oxygen in the blood.2 This is the same gas which is found in car exhaust fumes. Carbon monoxide binds to red blood cells, making it harder for the body to carry oxygen to the muscles.11 In large quantities, carbon monoxide is rapidly fatal. Smokers can have up to 10 times the amount of carbon monoxide in their bloodstream than non-smokers.1,12

Chemicals in cigarettes and disease

Cigarette smoke has many different effects on health. It causes or is associated with over thirty different diseases, including cancer, emphysema, heart disease and stroke.13 A single disease may be caused by several different chemicals in cigarette smoke.2

Cancer

More than 60 carcinogens (cancer causing substances) have been identified in tobacco smoke.6 Smoking causes cancer of the lung, throat, voice box, mouth, tongue, nose, nasal sinus, oesophagus, pancreas, bladder, stomach, liver, kidney, ureter, bowel, ovary, cervix, and bone marrow.1,14, 25 Research shows that the greater the number of cigarettes and years a person smokes, the higher the risk of developing a smoking related cancer.1,14 Carcinogens in tobacco smoke include poly aromatic hydrocarbons, N-nitrosamines, benzene, aldehydes, the metals nickel, arsenic, chromium and cadmium, and many more.2,3

Lung disease (other than cancer)

Hydrogen cyanide, acetaldehyde and acrolein directly damage cilia, the tiny hairs that have an important part in clearing the lungs of inhaled particles and substances.1,2,3 When this cleaning system is impaired, toxic agents can build up in the lungs, and increase the likelihood of developing lung diseases.15

Other chemicals damage the lung by increasing the amount of mucus in the lungs which can lead to infection (chronic bronchitis), airway thickening and narrowing, and permanently damaging air sacs (emphysema). These include hydrocarbons, ketones, organic acids, phenols, nitrous oxides, and oxidising agents.2

Heart disease, stroke and diseases of the veins

Acting together, nicotine and carbon monoxide are believed to cause these diseases in smokers, by damaging blood vessel walls and reducing the supply of oxygen to the body.2,7 Cigarette smoke also contains poly aromatic hydrocarbons which speed up the build up of fatty material on blood vessel walls, and are possibly assisted by hydrogen cyanide, nitrous oxides and some chemicals in tar.

Highly reactive chemicals in smoke (free radicals) can damage the heart muscles.2

Agricultural chemicals and additives

In Australia, tobacco is not classified as a food or a drug,9,16 and so there are no standards or controls on what may be used or left on tobacco, including agricultural chemicals and additives.17

Herbicides, insecticides, fungicides, fertilisers and other agricultural chemicals are routinely used in tobacco growing.3,17 As Australia imports much of its tobacco,18 it is unknown which agricultural chemicals may be present in cigarettes made and sold here.

Additives are chemicals added to cigarettes in the manufacturing process.2,3 They serve a number of different purposes.

To add flavour. Flavourings include sugar, honey, liquorice, cocoa, and chocolate liquor. These sweeteners lessen the harshness of the smoke.19

To lessen the irritating effects of smoke. Menthol and eugenol numb the throat.19

To change the chemistry of nicotine. Ammonium salts and acetaldehyde (in burnt sugar) increase nicotine’s addictive potential.2,19

To change smoker’s bodies. Chemicals in liquorice and cocoa act to open the airways, so that more nicotine and tar goes deeper into smokers’ lungs. Other additives change the chemistry of smokers’ brains to make them more receptive to nicotine.19

To mask the smell and visibility of smoke from the end of a burning cigarette. This might reduce other people’s annoyance, but it doesn’t reduce the health risks of passive smoking.19,20

To keep the tobacco moist, to control the burn temperature, and to treat the cigarette paper.3,17

There are a number of problems with additives:

Additives such as sugar and honey might seem harmless because we are used to eating them. But when additives in cigarettes are burnt, they can change into different chemicals, and some are toxic. For example, liquorice and sugar produce cancer causing chemicals when burnt. Also, these substances are inhaled into the lungs, which are delicate and much more vulnerable to harm than the stomach and intestines.19

The health effects of additives on smokers are not made public by the tobacco companies, and many may not be known at all.19

Some additives make tobacco smoke less harsh and taste better. It may make it easier for children to learn to smoke, and make smoking more agreeable to smokers.19

Cigarettes that claim to have no additives are not necessarily safer than those that have them. The cigarette smoke will still contain agricultural chemicals, nicotine, carbon monoxide, cancer causing tar, and more.1

Disclosure of additives

In Australia, there are no regulations to require tobacco companies to make public what they add to their cigarettes. The tobacco companies had a Voluntary Agreement with the Australian Department of Health and Ageing, where they provided a list of additives for each brand. However the terms of this agreement protected “the confidentiality of tobacco manufacturers’ trade secrets”: they could choose not to list specific additives they did not wish to make public.21

Other countries such as Canada, New Zealand and the state of Massachusetts USA, have regulations requiring companies to inform the governments of all additives they use.22, 23, 24

How much do smokers inhale?

Addiction to nicotine is a major reason for remaining a smoker.7 In general, smokers will absorb between 0.2mg to 2mg of nicotine per cigarette: the average dose is about 1mg per cigarette.2 Most cigarettes are designed by tobacco companies to deliver as much nicotine as the smoker needs to maintain their addiction, regardless of how weak or harsh the cigarette tastes.

Weaker tasting cigarettes (previously branded as variations of ‘light’ or ‘mild’ and also known as ‘low tar’ cigarettes) have holes in the filter that let in air to dilute the smoke. Smokers who switch to weaker tasting cigarettes generally end up inhaling the same amount of chemicals as they do from stronger tasting cigarettes. 2, 6 In order to maintain the level of nicotine they are used to, they tend to do the following:

1. Smokers take larger and longer puffs, and take more puffs from a cigarette. More intensive smoking also increases the ratio of tar to nicotine.6

2. Smokers can easily block the air vent holes in the filter, usually by accident with their lips and fingers, and so they receive more smoke and less air.6 In a sample of 13 Australian ‘low tar’ cigarettes tested in 1992, there was a 2 to 9 fold rise in tar and nicotine when all the air holes were blocked.26

3. Some smokers will smoke more cigarettes per day.6

Health risks of weaker tasting cigarettes

There is no evidence that smokers of weaker tasting (“low tar”) cigarettes have less risk of smoking related diseases than smokers of other cigarettes, except possibly a small decrease in risk for lung cancer.6

In 2005, the Australian Competition and Consumer Commission (ACCC) determined that 'light' and 'mild' labeling of cigarette varieties was misleading conduct, and obtained undertakings from the Australian cigarette manufacturers to remove such labeling. In 2006, tar, nicotine and carbon monoxide figures were also removed.27 In 2011, the Australian government passed legislation for

the introduction of plain packaging, which removes any labeling which may mislead consumers into thinking any cigarette is less harmful than another.

In summary, there is no safe cigarette and no safe level of consumption.4

Useful Websites:

Australian Department of Health and Ageing. Australian Cigarette Ingredient Information. Voluntary Agreement for the disclosure of the ingredients of cigarettes. http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-ingred-vol , accessed 31 August, 2011. http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-drugs-tobacco-ingredients.htm, accessed 31 August, 2011.

U.S. Department of Health and Human Services. Risks associated with smoking cigarettes with low machine-measured yields of tar and nicotine. (Smoking and Tobacco Control Monograph 13) http://cancercontrol.cancer.gov/tcrb/monographs/13/ , accessed 31 August, 2011.

Action on Smoking and Health. Bates C, Jarvis M, Connolly G. Tobacco Additives: cigarette engineering and nicotine addiction. http://www.ash.org.uk/files/documents/ASH_623.pdf, accessed 31 August, 2011.

References:

1 US Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the US Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Office on Smoking and Health, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, 1989. http://profiles.nlm.nih.gov/NN/B/B/X/S/ , accessed 22 May, 2003.

2 U.S. Department of Health and Human Services. The FTC cigarette test method for determining tar, nicotine and carbon monoxide yields of U.S. cigarettes. Report of the NCI Expert Committee. (Smoking and Tobacco Control Monograph 7) Bethesda, MA: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 1996. NIH Publication No. 96–4028.

3 International Agency for Research on Cancer. Tobacco smoking. IARC Monographs on the Evaluation of Carcinogenic Risk of Chemicals to Humans. Volume 38. World Health Organization, 1985.

4 US Department of Health and Human Services. The Health Consequences of Smoking: The Changing Cigarette. A report of the US Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1981.

5 Gray N. Reflections on the saga of tar content: why did we measure the wrong thing? Tob Control 2000;9(1):90–4.

6 U.S. Department of Health and Human Services. Risks associated with smoking cigarettes with low machine–measured yields of tar and nicotine. (Smoking and Tobacco Control Monograph 13) Bethesda, MA: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 2001. NIH Publication No. 02–5074. http://cancercontrol.cancer.gov/tcrb/monographs/13/ , accessed 22 May, 2003.

7 US Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction. A report of the US Surgeon General. Rockville, Maryland, US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking Health, 1988.

8 National Drugs and Poisons Schedule Committee. Standard for the Uniform Scheduling of Drugs and Poisons No.17 Amendment No. 1. Canberra: Commonwealth Department of Health and Ageing, 2002.

9 Commonwealth Department of Health. Tobacco is specifically exempted from the Uniform Poisons Schedule, Standard as adopted by the National Health and Medical Research Council, 94th Session. October 1982.

10 Royal College of Physicians of London. Nicotine addiction in Britain. A report of the Tobacco Advisory group of The Royal College of Physicians. London: Royal College of Physicians of London, 2000.

11 US Department of Health and Human Services. The Health Consequences of Smoking: Cardiovascular Disease. A Report of the US Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Office on Smoking and Health, Public Health Service, Department of Health Education and Welfare, 1983.

12 Rodrigo C. The effects of cigarette smoking on anesthesia. Anesth Prog. 2000 Winter;47(4):143–50. Review.

13 Ridolfo B, Stevenson C. The quantification of drug-caused mortality and morbidity in Australia, 1998. (Drug Statistics Series No. 7) Canberra: Australian Institute of Health and Welfare, 2001.

14 International Agency for Research on Cancer. Tobacco smoking and Tobacco Smoke. Summary of Data Reported and Evaluation. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. World Health Organization, 2002. Available at http://monographs.iarc.fr/htdocs/monographs/vol83/01-smoking.html , accessed 11 February, 2003.

15 US Department of Health, Education and Welfare. Smoking and Health: A report of the US Surgeon General. Rockville, Maryland, US Department of Health, Education and Welfare, Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health, 1979.

16 Standing Committee on Agriculture - Technical Committee on Agricultural Chemicals. Protocol of requirements for chemicals used on tobacco. Canberra, ACT: Department of Primary Industry, March 1985. (Document PB 479.)

17 Chapman S. Come to where the flavour is: additives and pesticide residue in cigarettes. Drug and Alcohol Review 1992; 11: 3–6.

18 Tobacco Research & Development Corporation. Annual report 2001/02. Jamison Centre, ACT: Tobacco Research and Development Corporation, 2002.

19 Bates C, Jarvis M, Connolly G. Tobacco Additives: cigarette engineering and nicotine addiction. London: Action on Smoking and Health, 1999. http://www.ash.org.uk/html/regulation/html/additives.html , accessed 27 May, 2003.

20 Connolly GN, Wayne GD, Lymperis D, Doherty MC. How cigarette additives are used to mask environmental tobacco smoke. Tob Control 2000; 9: 283–291.

21 Australian Department of Health and Ageing. Australian Cigarette Ingredient Information. Voluntary Agreement for the disclosure of the ingredients of cigarettes. http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-ingred-vol , accessed 31 August, 2011. http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-drugs-tobacco-ingredients.htm, accessed 31 August, 2011.

22 Health Canada. Tobacco Reporting Regulations. June 2000. http://www.hc-sc.gc.ca/hecs-sesc/tobacco/legislation/prop_may_36b.html , accessed 6 May, 2003.

23 Ministry of Health, New Zealand. National Drug Policy Website. Tobacco Control Legislation. (Smokefree Environments Act 1990, Sect.33,35.) http://www.ndp.govt.nz/ , accessed 6 May, 2003.

24 The General Court of the Commonwealth of Massachusetts. Massachusetts General Laws, Chapter 94, INSPECTION AND SALE OF FOOD, DRUGS AND VARIOUS ARTICLES. Section 307B. Tobacco products; annual reports of added constituent and nicotine yield ratings. http://www.state.ma.us/legis/laws/mgl/94%2D307b.htm , accessed 6 May, 2003.

25 Secretan B, Straif K, Baan R, Grosse Y, El Ghissassi F, Bouvard V, et al. A review of human carcinogens--Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol. 2009;10(11):1033-1034.

26 Evans GS. A study of smoke yield of vented filter cigarettes. South Melbourne, Vic: Australian Government Analytical Laboratories, 1993.

27 King, B., Chapter 12. The construction and labelling of Australian cigarettes, in Tobacco in Australia: Facts and Issues, M. Scollo, M. Winstanley, and eds, Editors. 2008, Cancer Council Victoria: Melbourne. http://www.tobaccoinaustralia.org.au/chapter-12-tobacco-products, accessed 31 August, 2011.

This material is used with permission from QUIT Victoria

♦ Causes sicknesses: cancer, mouth problems, teeth problems

♦ Helps to spread diseases e.g. tuberculosis, hepatitis

♦ May affect the unborn child ♦ Is addictive

♦ Bad for the economy of a family and nation.

Is chewed as a quid of: ♦ Nut ♦ Parts of the betel nut

plant (Leaf or Fruit) ♦ Slaked Lime

BETELNUT (Areca Palm Nut)

On the User: Nervous System Effects—acts like nicotine—gives nice feelings and feeling of more energy, Physical changes—sweating, breathing rate increases, more saliva, decreased appetite. May cause diarrhoea on an empty stomach Teeth— stained red, brown or black, unattractive. Greater risk of decay and abscesses, loss of teeth. Mouth—burning sensation, blisters, ulcers, dryness, loss of taste. Soft parts (gums, mouth, back of throat) get harder over time and become stiff, swallowing becomes difficult. Cancer—pre-cancer white patches. Very fast growing cell cancers—tongue, cheek, mouth floor. (PNG has the highest rate in the world, Solomon Islands is 2nd) Unborn Children—may cause genetic damage and problems for unborn babies. Poverty—money spent on something that destroys—see under Economic loss. Addictive—cannot work well or feel good without it.

EFFECTS OF BETELNUT USE On the Community: Increases the Spread of Disease—spitting, users often share the same utensils. Diseases such as tuberculosis, hepatitis, can easily be spread from one user to another user, and to others. Pollution—buildings and streets are stained with red and brown spittle, betel-nut husks litter the streets and grounds—dirty and untidy. Economic loss—affects the tourist industry - tourists go somewhere else. Users could afford more long lasting things without it—education, transport. High cost of medical resources in the

treatment of disease. Retards national development.

KAVA ♦ Used in traditional

ceremonies and for social occasions in many of the Pacific Islands.

♦ Made by mixing the dry, powdered root of the pepper plant (Piper methysticum) with water.

♦ Active chemicals are absorbed through the stomach into the bloodstream and pass quickly to the brain.

♦ Sold as a herbal preparation or medicine in many countries.

EFFECTS OF KAVA USE Short-term Health Effects In small to moderate amounts, kava causes: * mild sleepiness * relaxation of muscles * feelings of happiness * numbness of the mouth and throat * possible loss of appetite Its effects on the unborn child are not known but it is recommended that pregnant or breastfeeding women do not drink kava. Sudden death has occurred in young adult males during heavy exercise after drinking kava. Social Effects Large amounts of time and money spent on drinking kava leads to the neglect of family and community duties with an impact on the health and nutritional status of infants and children in the family.

Long Term Health Effects

Eyes: Bloodshot & red.

Respiratory System: Difficulty in breathing. Shortness of breath.

Circulatory System:

Changes in the red & white blood cells

and platelets.

Liver: Liver damage and biochemical changes.

General Body: Apathy. Increased general ill health Malnutrition. Loss of body fat. Increased chance of infection.

Central Nervous System:

Loss of muscle control.

Visual balance upset & sensitivity to light.

Makes mental illnesses such as depression and

schizophrenia worse. Nervous trembling.

Kidneys: Renal dysfunction. Increased urine output.

Skin: Dry scaly (crocodile) skin

with yellow or white discolouring.