Tobacco Use and Statistics 2021

Clinician-Assisted Tobacco Cessation

• The presentation is about clinician-assisted tobacco cessation.
• The presenter is Kelly Orr, PharmD, AE-C, a Clinical Professor at The University of Rhode Island College of Pharmacy.

Training Overview

• The overview covers Epidemiology of Tobacco use, Nicotine Pharmacology & Principles of Addiction, Drug Interactions with Smoking, Forms of Tobacco, Medications for Cessation (part 2), and Assisting Patients with Quitting.
• The content is relevant to a course called PHC 415, Fall 2022.

Epidemiology of Tobacco Use

• Cigarette smoking is the leading cause of preventable death.
• The presentation shows historical trends in cigarette consumption in the US from 1900 to 2002.
• Data on current adult smoking rates in the US (by sex) are presented since 1955.
• A graph shows current adult use of any form of tobacco or e-cigarettes in the U.S., in 2021.
• Current e-cigarette use is discussed among middle and high school students in 2024.
• State-by-state data on smoking prevalence among adults in 2014-2015, and prevalence by race/ethnicity and education in 2021 are provided.
• Trends in teen smoking by ethnicity (1977-2021) are presented.

Marketing Strategy: "Light" Cigarettes

• A notable marketing strategy was the introduction of "light" cigarettes.
• The differences in cigarette design, particularly ventilation holes were presented, and connected to the marketing of light cigarettes.

FDA Regulation of Tobacco Products

• The FDA Center for Tobacco Control Products regulates cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and e-cigarettes.

Compounds in Tobacco Smoke

• There is an estimated 8,700 compounds in tobacco smoke.
• 72 components are proven to be carcinogens.
• The different gas-phase components (carbon monoxide, hydrogen cyanide, Ammonia, Benzene, Formaldehyde) and particle-phase components (nicotine, nitrosamines, lead, cadmium, polonium-210) are listed for the smoking components
• Nicotine is highlighted as the addictive component but not the driver of the health effects

Annual U.S. Deaths Attributable to Smoking, 2005-2009

• Smoking-related deaths are attributed to cardiovascular/metabolic disorders, lung cancer, pulmonary diseases, second-hand smoke, and cancers other than lung cancers.

Annual Smoking-Attributable Economic Costs

• The economic costs associated with smoking are discussed.
• A presentation on health care expenditures, lost productivity costs, and total economic burden totals are shown.

2014 Report of the Surgeon General: Health Consequences of Smoking

• The 2014 report states that cigarette smoking is linked to various health issues.
• It also addresses second-hand smoke and its detrimental effects on infants and children.
• The report indicates increased risks of diseases across the sexes, particularly for women over the past 50 years.

Health Consequences of Smoking

• The presentation covers diverse health issues related to smoking.
• Several types of cancers are listed as well as cardiovascular diseases, reproductive effects, and pulmonary diseases.

Health Consequences of Smokeless Tobacco Use

• The presentation highlights periodontal issues such as gingival recession, bone attachment loss and dental caries.
• Various cancers are associated with smokeless tobacco use, such as cancers of the oral cavity and pharynx.

2006 Report of the Surgeon General: Involuntary Exposure to Tobacco Smoke

• This report highlights risks to nonsmokers (children and adults) from second-hand smoke.
• There's no safe level of second-hand smoke.
• This report identifies increased risks for children such as issues related to SIDS, respiratory infections etc. Increased risks for adults are also highlighted

Quitting: Health Benefits

• Benefits of quitting smoking are detailed in various timeframes (2 weeks to 15 years).
• Improvements highlighted included improved circulation, easier walking, increased lung function, reduced risk of heart disease and stroke, also reduced risk of several cancers and improved lung health

Beneficial Effects of Quitting: Pulmonary Effects

• The presentation discusses the ongoing and consistent benefits of quitting smoking at any age
• Pulmonary recovery is highlighted in relation to quitting smoking at different ages.

Reduction in Cumulative Risk of Death from Lung Cancer in Men

• The presentation displays a graph showing the cumulative risk of death from lung cancer over time for different groups

Smoking Cessation: Reduced Risk of Death

• The presentation explains that smokers typically die 10 years earlier than nonsmokers
• At least half of those who continue smoking will die from a tobacco-related disease

Financial Impact of Smoking

• The economic burden of smoking is highlighted with figures given to the national cost associated with buying cigarettes for 50 years.

Epidemiology of Tobacco Use: Summary

• Fewer than one in five adults smoke, and rates vary across socio-demographic factors.
• Annually, almost half a million US deaths are linked to smoking.
• The annual financial burden in the US due to smoking is an estimated $288.9 billion (plus healthcare costs).

Nicotine Addiction: U.S. Surgeon General's Report

• Tobacco, including cigarettes, is addictive.
• Nicotine is the addictive agent in tobacco.
• The mechanisms of nicotine addiction are similar to other addictive substances (like heroin and cocaine).

Chemistry of Nicotine

• Nicotine is a natural compound that acts as a volatile base.
• There is a chemical structure provided in the presentation.

Pharmacology

• Pharmacokinetics and pharmacodynamics are explained in relation to the effects of the body on drugs.
• Absorption, distribution, metabolism, and excretion are highlighted.

Nicotine Absorption

• The absorption of nicotine depends on the pH of the medium
• Nicotine is readily absorbed in the small intestine and across intact skin.

Absorption Nicotine (Buccal (Oral) Mucosa)

• The presentation addresses nicotine absorption in the mouth based on pH levels (7.0)

Nicotine Absorption: Skin and Gastrointestinal Tract

• Nicotine absorbs readily through intact skin.
• Nicotine is effectively absorbed into the small intestine.
• Nicotine has a low bioavailability.

Nicotine Absorption (Lung)

• Nicotine absorption takes place in the lungs when the tobacco is burned.
• Nicotine is absorbed across the respiratory epithelium in vapor form or through tar droplets in the respiratory system.
• Large surface area of alveoli favors absorption.

Nicotine Distribution

• Nicotine quickly reaches the brain within ~10-20 seconds.
• Arterial peak levels reach significantly high levels.

Nicotine Metabolism

• Nicotine is metabolized mostly to cotinine.
• A small proportion is excreted without being metabolized.

Nicotine Excretion

• Nicotine and its metabolites are excreted through the kidneys.
• The process is pH-dependent
• Nicotine is also excreted through breast milk

Nicotine Pharmacodynamics

• Nicotine interacts with receptors throughout the body.
• The primary effects are stimulatory. Details on effects on the central nervous system, cardiovascular system, gastrointestinal system, and other organs are given.

Nicotine Pharmacodynamics (cont'd)

• Nicotine's effects on the Central Nervous System, the Cardiovascular system are addressed. Other effects like Appetite suppression and Increased metabolic rate are also covered.

Neurochemical Effects of Nicotine

• Neurochemical mechanisms related to nicotine's effects (Dopamine, Norepinephrine, Acetylcholine, Glutamate, Serotonin, Beta-Endorphin, GABA) are covered.

What is Addiction?

• Addiction is defined as compulsive drug use, without medical purpose, in the face of negative consequences.

Dopamine Reward Pathway

• The presentation describes the dopamine reward pathway in the brain and its stimulation by nicotine

Chronic Administration of Nicotine: Effects on the Brain

• Nicotine receptors in the prefrontal cortex increase in response to chronic nicotine exposure.

Nicotine Withdrawal Symptoms Time Course

• Withdrawal symptoms, including mood swings, difficulty concentrating, anxiety, weight gain, or cravings peak and generally subside by 2-4 weeks after the quit date.

Nicotine Addiction Cycle

• A graph demonstrating the fluctuating plasma nicotine concentration levels throughout the day.
• The highs and lows demonstrate the pleasure/arousal and neutral/abstinence/withdrawal phases of the cycle.

Nicotine Addiction

• Tobacco users need to keep nicotine levels within a certain range to avoid withdrawal symptoms and sustain continued use.
• Users can adjust their smoking, vaping, dipping etc., to regulate the nicotine level.

Assessing Nicotine Dependence (FTND)

• The Fagerström Test for Nicotine Dependence (FTND) is a widely used method to measure nicotine dependence.
• Information on its development, practical use, and scoring are covered.

Nicotine Pharmacology Summary

• Focuses on nicotine's effects on various systems within the body.
• Addresses the idea that tobacco products act as effective delivery systems for nicotine.

Drug Interactions with Tobacco Smoke

• The focus falls on pharmacokinetic, and pharmacodynamic interactions.
• Various examples of medications are presented alongside their possible responses resulting from the interaction with tobacco smoke.

Drug Interaction: Tobacco Smoke and Caffeine

• Caffeine metabolism is affected by smoking, and concentrations may increase after quitting.
• This effect may be connected to nicotine withdrawal symptoms.
• Clinicians might advise a decrease in caffeine consumption to address any side effects or withdrawal symptoms.

Pharmacodynamic Drug Interactions with Tobacco Smoke

• People who use contraceptives have and maintain a heightened risk of cardiovascular issues when combined with cigarette smoking.

Drug Interactions with Tobacco Smoke: Summary

• Smoking status significantly influences medications' actions.
• Clinicians should consider patients' smoking status when prescribing medications.
• The combustion products in tobacco smoke interact with a majority of pharmaceuticals, influencing their metabolic pathways and effectiveness

Factors Contributing to Tobacco Use

• Individual factors (sociodemographics, genes' susceptibility, co-existing medical conditions) influenced
• Environmental factors (tobacco advertising, conditioned stimuli, social interactions) are described
• The roles and impact of tobacco use on the body are examined in the context of an associated pharmacological response as well as associated environmental triggers.

Tobacco Dependence: A 2-Part Problem

• Addressing tobacco dependence requires a comprehensive approach to deal with both physiological and behavioral aspects of dependance.
• Treatment involves addressing the nicotine addiction (physiological) and also behavior relating to the use of tobacco. This necessitates a plan that acknowledges the multi-faceted needs of the user.

Forms of Tobacco

• The presentation details different tobacco products available including cigarettes, smokeless tobacco (chewing tobacco, snuff, snus), cigars, pipes, and hookah (waterpipes) and E-cigarettes/ENDS.

Cigars

• The presentation provides context relating to cigar products, providing details and figures relating to prevalence and nicotine content in cigars.

Electronic Nicotine Delivery Systems (ENDS): Considerations

• The variability in e-cigarette aerosol production and nicotine delivery due to device design and puff patterns is presented.
• The presentation highlights that reported nicotine levels on e-liquids do not always accurately reflect the real levels of nicotine they contain.
• Comparable levels of plasma nicotine are achieved with cigarette use and the use of some e-cigarettes.

Electronic Cigarettes (e-cigarettes): Potential Health Risks

• Propylene glycol, glycerin may contribute to respiratory irritation and possible asthma symptoms.
• Nicotine remains highly addictive even in electronic cigarette forms and is harmful.
• Refill cartridges in e-cigarettes pose a poisoning risk, especially in children.
• Use of e-cigarettes are indicated to emit other substances like propylene-glycol and particles

Plasma Nicotine Concentrations: Cigarettes and Juul

• The presentation provides a graph comparing nicotine concentration in the blood after cigarette and e-cigarette use.
• The speed and intensity of nicotine uptake are visualized and compared

Tobacco Harm Reduction

• Minimizing harm while addressing dependence is described as a major goal.
• Alternative methods to tobacco use are presented
• Continual risk levels are identified to guide efforts

Forms of Tobacco: Summary

• Cigarette remains a prevalent form of tobacco in the U.S
• Other less common forms like E-cigarettes/ENDS and cigars are gaining popularity.
• All tobacco forms are harmful, and their safety/efficacy is not well established.

Test your knowledge on tobacco use in 2021 with this quiz. Explore statistics about adult usage, common products, and economic implications. Challenge yourself to match tobacco products with their usage percentages and learn about public health efforts regarding smoking.