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© 2012 McGraw-Hill Companies. All Rights Reserved.
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Who Uses Tobacco?71 million Americans smoke, including 13.6 million college-age Americans
More likely to smoke if using other drugsAs of 2009, nearly 21% of Americans age 18 and older describe themselves as current smokers
2009 - 24% of men reported smoking regularly
2009 - 18% of women reported smoking regularly
Rates vary according to:
Gender
Age
Ethnicity
Education level
© 2012 McGraw-Hill Companies. All Rights Reserved.
Figure 11.1 Annual Mortality and Morbidity Among Smokers Attributable to Smoking
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Young People and TobaccoAs of June, 2010, federal crime to sell tobacco products to anyone under 18 years of age
Minors smoke an estimated 800 million packs of cigarettes each year
Each day 1,000 teens become regular smokers
One third of these teens will die prematurely because of tobacco
© 2012 McGraw-Hill Companies. All Rights Reserved.
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Why People Use Tobacco Nicotine Addiction
Powerful psychoactive drug Reaches brain via bloodstream in seconds Most physically addictive of the psychoactive drugs Loss of control Tolerance and withdrawal
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Social and Psychological Factors Established habits or cues to trigger smoking Secondary reinforcers Genetic factors
Specific genesCYP2A6 Influences the way nicotine is metabolized In people with slow CYP2A6 metabolism, nicotine remains
in system longer
DRD2 Associated with the brain chemical dopamine
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When Do Smokers Start? Nearly 90% of all adult smokers started smoking
before age 18 Every day 1,000 Americans under age 18 start
smoking Every day about 1,800 Americans 18 and older start
smoking Average age to start is 15
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Why Start in the First Place? Family uses tobacco Help to lose weight Peer pressure or to fit in with the crowd Emulate celebrities and athletes Does poorly in school or work
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Choosing to smoke means denying the health risks that come from smoking
Young people convince themselves they will not be vulnerable to tobacco’s dangers
Most teenagers believe they can stop smoking whenever they want, but are actually more vulnerable to nicotine
In polls, about 75% of smoking teens state they wish they had never started!
Rationalizing the Dangers
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Media portrayals of smoking are key influences on young people who start smoking
Films do not reflect actual patterns of use, but are successful forms of advertising
Some groups suggest an automatic “R” rating for any film that shows tobacco use
Emulating Smoking in the Media
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Health Hazards Tobacco adversely affects nearly every part of the
body Contains hundreds of damaging chemical substances Unfiltered cigarettes = 5 billion particles per cubic
millimeter 50,000 times more than smoggy urban air Condensed particles in the cigarette produce the tar,
a brown, sticky mass
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Carcinogens and Poisons 43 chemicals are linked to cancer (carcinogens cause cancer)
Benzo(a)pyreneUrethane
CocarcinogensCombine with other chemicals to cause cancerFormaldehyde
Poisonous substancesArsenicHydrogen cyanide
Carbon monoxide400 times greater than is considered safe in industrial workplacesDisplaces oxygen in red blood cells
AdditivesNearly 600 chemicals
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Inhaling Tobacco Smoke All smokers absorb some gases, tar, and nicotine Those who inhale keep these substances in their bodies Smoke goes directly into mouth, throat, and respiratory
tract Bypasses the nose that normally filters out 75% of
foreign matter Sidestream smoke = uninhaled smoke from a burning
cigarette (that nonsmokers may breathe)
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“Reduced Harm” Cigarettes Low-tar, low-nicotine, or filtered cigarettes No such thing as a safe cigarette Often smoke more As of June 2010, regulations prohibit labeling
cigarettes with “light,” “mild,” or “low.”
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Menthol Cigarettes 70% of African Americans smoke these
Absorb more nicotine and metabolize it slower Anesthetizing effect of menthol, inhale more
deeply and hold smoke longer in the lungs
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Immediate Effects of Smoking Acts on the brain either by exciting or
tranquilizing the nervous system Mild nicotine poisoning Stimulates the cerebral cortex Stimulates the discharge of adrenaline Physiological effects on the body
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Long-Term Effects of Smoking Cardiovascular disease
Coronary heart disease (CHD)Atherosclerosis
plaques
Angina pectorisMyocardial infarctionStrokeAortic aneurysmPulmonary heart disease
Lung cancer and other cancersBenzo(a)pyrene
Chronic Obstructive Pulmonary Disease (COPD)EmphysemaChronic bronchitis
Other respiratory damage
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Additional Health, Cosmetic, and Economic Concerns Ulcers Impotence Reproductive health problems Dental diseases Diminished physical senses Injuries Cosmetic concerns Economic costs
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Cumulative Effects Reduced life expectancy Males who start before age 15 are half as likely to live to
75 versus those who never smoked Lung cancer
Reduced quality of life Female smokers spend 17% more sick days in bed than
nonsmokers Both men and women show a greater rate of acute and
chronic diseases
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Other Forms of Tobacco Spit (smokeless) tobacco
More than 8.1 million adults
9% of all high school students Cigar and pipes
Most popular among white males aged 18-44 Clove cigarettes and Bidis
Twice the tar, nicotine, and carbon monoxide E-cigarettes
Electronic cigarette, delivers nicotine
© 2012 McGraw-Hill Companies. All Rights Reserved.
Figure 11.3 Tobacco Use Among Middle School and High School Students
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The Effects of Smoking on the Nonsmoker Environmental tobacco smoke (ETS)
“Secondhand smoke” EPA designated ETS as a Class A carcinogen DHHS National Toxicology Program - “known
human carcinogen” Surgeon General “there is no safe level of
exposure to ETS; even brief exposure can cause serious harm”
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Environmental Tobacco Smoke Mainstream smoke
Smoke exhaled by smokers Sidestream smoke
Smoke from the burning end of a cigarette, cigar, or pipe
85% of smoke in a room is sidestream smokeNot filtered, so twice the tar and nicotineThree times the benzo(a)pyreneThree times the carbon monoxide and ammonia
Smoke from a cigar can be even more dangerous30 times more carbon monoxide
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ETS Effects Develop cough, headaches, nasal discomfort, eye
irritation, breathlessness, sinus problems Those with allergies tend to suffer the most Causes 3,400 deaths due to lung cancer Contributes to about 46,000 overall deaths each year 20% increase in the progression of atherosclerosis Contributes to increased asthma attacks, and
increased risk for breast and cervical cancers
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Infants, Children, and ETS More likely to develop
Bronchitis, pneumonia, respiratory infections
More complications from asthma
Greatly increased chance of SIDS
Low birth weight
Bronchitis Chemicals from smoking show up in breast milk
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Avoiding ETS Speak up tactfully Display reminders Don’t allow smoking in your home or room Open a window Sit in the nonsmoking section Fight for a smoke-free environment Discuss quitting strategies
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Smoking and Pregnancy Almost doubles risk of miscarriage Causes hundreds of infant deaths in U.S. Premature birth, low birth weight, long-
term impairments in growth and intellectual development
Possible higher risks of getting cancer 16.4% of pregnant women smoke
© 2012 McGraw-Hill Companies. All Rights Reserved.
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Cost of Tobacco Use to Society Annual health care expenditures related to
smoking exceed $96 billion Annual cost of lost productivity nearly $97
billion Costs far exceed tax revenues that states
collect
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What Can Be Done? Action at the local level Action at the state and federal level Action at the international level
WHO
World No Tobacco Day (May 31) Action in the private sector• Smoke-free restaurants and other businesses Individual action
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How a Tobacco User Can Quit 50.2 % of all adults who have smoked have quit. Benefits of quitting
Table 11.2 Options for quitting
Smoking cessation programs1-800-QUITNOW (Quitline)
Department of Health and Human Services
Smoking cessation productsChantix (Varinicline)Zyban (Bupropion)
Nicotine replacement productsPatches, gums, lozenges, nasal sprays, inhalers