Tobacco Chapter 10 PDF

Tobacco Chapter 10 HPEX 352  Tobacco Tobacco is the plant that contains thousands of potent chemicals. Contains nicotine Powerful psychoactive drug Reaches the brain via the bloodstream in seconds. Both stimulant and sedative eff...

Tobacco Chapter 10 HPEX 352  Tobacco Tobacco is the plant that contains thousands of potent chemicals. Contains nicotine Powerful psychoactive drug Reaches the brain via the bloodstream in seconds. Both stimulant and sedative effects. The most physically addictive of all psychoactive drugs. 2 Categories of Drugs  The Tobacco Dilemma ▪ A legal product used by a significant proportion of adults ▪ But a substance responsible for more adverse health consequences and death than any other drug  Two Major Species ▪ Two major species grown today (out of more than 60) ▪ 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  Early History ▪ Cultivated and used by Native Americans for centuries ▪ Presented tobacco leaves as a gift to Columbus in 1492 ▪ The word “tabaco” was adopted by the Spanish ▪ Possibly from the Arabic word “tabbaq” meaning “medicinal herbs”  Early Medical Uses ▪ 1500s: ▪ Recognition of the medical potential grew ▪ French physician Jean Nicot: early proponent ▪ Nicotine (the active ingredient) and Nicotiana (the plant genus were named after 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  Types of Tobacco Products ▪ Snuff ▪ 18th century: Snuff use became widespread as smoking decreased ▪ In U.S., perceived as a British product; American use declined after the Revolution ▪ Chewing tobacco ▪ 19th century: Most tobacco used in the U.S. was chewing tobacco ▪ Smoking did not surpass chewing until the 1920s  Types of Tobacco Products ▪ Cigars ▪ A combination of chewing and smoking ▪ Peaked in popularity in 1920 ▪ Cigarettes ▪ Native Americans used thin reeds filled with tobacco ▪ Factories appeared in 19th century ▪ Habit spread widely with the advent of inexpensive machine- produced cigarettes ▪ Currently most popular form of tobacco use  Tobacco Under Attack ▪ 1604: King James of England published an anti-tobacco pamphlet ▪ “harmefull to the braine, dangerous to the lungs” ▪ Note that he also supported the American tobacco trade ▪ 1908: New York made it illegal for a woman to use tobacco in public ▪ “protect women from themselves” ▪ 1930s and 40s: Reports linking smoking and cancer ▪ 1952: Readers’ Digest article “Cancer by the Carton”  Tobacco Under Attack ▪ 1964: Surgeon General’s report states that smoking causes lung cancer in men ▪ 1965: Congress required warning labels on cigarette packages ▪ 1971: TV and radio cigarette ads banned  Tobacco Under Attack 1990: Smoking banned on interstate buses and domestic airline flights 1995: FDA proposed further regulation of tobacco and ads Many additional state and local bans passed Tobacco sales began a decline that continued for 40 years  Current Cigarette Use ▪ Cigarette smoking is down, but 34 million American adults still smoke. ▪ Percentage of smokers by gender ▪ Men: 25% ▪ Women: 20% ▪ Education is the single biggest influence on smoking rates ▪ Percentage of smokers by education ▪ High school diploma only: 28% ▪ Undergraduate degree: 11% ▪ Full time college students: 5% ▪ Non-college students: 19%  Quest for “Safer” Cigarettes ▪ Does “safer” mean safe? ▪ Lower levels of nicotine ▪ Caveat: people adjust their smoking behavior to obtain a consistent amount of nicotine ▪ By taking more puffs and inhaling more deeply ▪ Lower levels of tar ▪ Tar is the sticky brown material seen on the filter of a smoked cigarette ▪ Based on changes in smoking behavior, there may be no advantage to switching to a low tar–low nicotine cigarette  Health Hazards Tobacco adversely affects nearly every part of the body, including: Brain Mouth Stomach Reproductive organs Contains hundreds of damaging chemical substances (acetone, ammonia, hexamine, toluene) 4000 Chemicals >40 Carcinogens 500 Poisons Condensed particles in the cigarette produce a sticky, brown mass called cigarette tar. 15  Carcinogens and Poisons 43 chemicals are carcinogens Benzo(a)pyrene Nitrosamine, Urethane Cocarcinogens Combine with other chemicals to cause cancer Poisonous substances Arsenic Hydrogen cyanide Carbon monoxide Contains amounts 400 times greater than is considered safe in industrial workplaces Displaces oxygen in red blood cells Additives 16 Nearly 600 chemicals  Smokeless Tobacco ▪ Smokeless tobacco has its hazards ▪ Smokeless tobacco packages carry warning labels ▪ Benefits compared to cigarettes?? ▪ Health concerns ▪ Increased risk of dental disease and oral cancer ▪ Contains potent carcinogens such as nitrosamines ▪ Causes leukoplakia ▪ Can lead to nicotine dependence  Electronic Cigarettes The “safer” cigarette controversy took a high- tech turn in 1988 Commercial tobacco The e-cigarette is not a tobacco product but a nicotine delivery system (liquid). The e-cigarette turns the nicotine and other chemicals into a vapor that is then inhaled by the user. There is no burning of tobacco involved and the e-cigarette produces no smoke. 18 Evolution of E-Cigarettes E-cigarettes- Are they safe? - video What's wrong with E-cigarettes - video Dangers of e-cigs and juul - video  Other Forms of Tobacco ⚫ Cigar and pipes ⚫ Highest rate among white males age 18-44 with higher- than-average income and education ⚫ Contain more tobacco than cigarette ⚫ Hookahs Hookahs produce milder, water-filtered tobacco smoke Prevalence of hookah smoking is unclear ⚫ Clove cigarettes and bidis ⚫ Impair respiratory system ⚫ Twice the tar, nicotine, and carbon monoxide  Why People Use Tobacco Psychosocial Factors Social acceptance, stress/anxiety Stimulus/activities that triggers the habit Genetic Factors Specific genes associated with biological response to tobacco use CYP2A6 DRD2 24  Long-Term Effects of Smoking Smoking is the single greatest avoidable cause of death Risk increases for those who: ▪ Start young ▪ Smoke many cigarettes ▪ Continue to smoke for a long time COPD(Chronic Obstructive Pulmonary Disease) Emphysema Alveoli damaged and lose their elasticity Chronic bronchitis Inflammation of airways Lung cancer Other cancers Oral, Kidney, Stomach, Bladder 25  Long-Term Effects of Smoking Cardiovascular Disease Nicotine affects blood vessels Atherosclerosis Plaque buildup in the blood vessels Causes- Four actions of nicotine? Coronary heart disease (CHD) Myocardial infarction Stroke Peripheral Arterial Disease Aortic aneurysm Pulmonary heart disease Diabetes Insulin resistance 26 Additional Health, Cosmetic, and Economic Concerns Ulcers Impotence Reproductive health problems Dental diseases Diminished physical senses Injuries Cosmetic concerns (premature skin wrinkling, stained teeth) Economic costs How smoking affects your body – video Effects of smoking –video Effects of Smoking – video 29  The Effects of Smoking on the Nonsmoker Environmental Tobacco Smoke (ETS) Secondhand smoking or Passive smoking Cigarette smoke inhaled from the environment by nonsmokers EPA designated ETS as a class A carcinogen Surgeon General issued a report concluded that there is no safe level of exposure to ETS. 30  Smoking: Adverse Health Effects ▪ Cigarette packages and advertisements are required to rotate among different warning labels 10-31 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Environmental Tobacco Smoke ▪ Secondhand smoke ▪ Cigarette smoke inhaled from the environment by nonsmokers ▪ Components of environmental smoke ▪ Mainstream smoke: the smoke exhaled by the smoker ▪ Sidestream smoke: the smoke rising from the ash of a cigarette ▪ Twice as much the tar and nicotine & 3 times the ammonia, benzo(a)pyrene, carbon monoxide level ▪ But smoke is more diluted Thirdhand smoke ▪ Residual nicotine and other chemicals left on indoor surfaces by tobacco smoke/vapors. 32  Environmental Tobacco Smoke ETS Effects Develop cough, headaches, nasal discomfort, eye irritation, breathlessness, and sinus problems Allergies will be exacerbated Causes 3,400 deaths due to lung cancer Contributes to about 46,000 heart disease deaths Nonsmokers can be affected by effects of ETS hours after they leave a smoky environment 33  Environmental Tobacco Smoke Infants, Children, and ETS Children exposed to ETS are more likely to have SIDS, bronchitis and pneumonia Reduced lung function and asthma Middle-ear infections Lung cancer, emphysema Chronic bronchitis later in life 34  Smoking and Pregnancy ▪ Increased risk of: ▪ Miscarriage ▪ Low birth weight ▪ Sudden infant death syndrome (SIDS) ▪ Several studies indicate effects on physiological and cognitive development ▪ Neurological problems ▪ Problems with reading and mathematical skills ▪ Hyperactivity  Nicotine Pharmacology ▪ Nicotine ▪ Active ingredient in tobacco ▪ A naturally occurring liquid alkaloid that is colorless and volatile ▪ Tolerance and dependence develop quickly ▪ Highly toxic in large enough doses ▪ Lethal dose = 60 mg ▪ A cigar contains twice that much ▪ Typically not delivered fast enough or in a high enough dose to be lethal  Nicotine Pharmacology Absorption & Metabolism ▪ Inhalation is very effective ▪ Rapid onset of effect ▪ 90% of inhaled nicotine is absorbed ▪ 80–90% of nicotine 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 ▪ May decrease the effects of other medication ▪ enough dose to be lethal  Nicotine has a short half-life (24-84 minutes) Short duration of action Cotinine is an active metabolite / 3-hyrdroxycotinine is an inactive metabolite  Physiological Effects ▪ Mechanism of action: ▪ Mimics acetylcholine ▪ First stimulates and then blocks receptor sites ▪ Causes a release of dopamine ▪ Also causes the release of adrenaline and has an indirect sympathomimetic effect ▪ Symptoms of nicotine poisoning: ▪ Low-level ▪ Nausea, dizziness, and general weakness ▪ Often experienced by beginning smokers ▪ Acute poisoning ▪ Tremors, convulsions, paralysis of breathing muscles, death ▪ Relatively rare  Physiological Effects ▪ 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 ▪ Increases the tendency to clot ▪ 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 ▪ Nicotine has both stimulant and calming effects ▪ User expectation, environmental setting, and genetics play an important role in the effects  Nicotine Dependence ▪ Tobacco industry claims that its products do not cause dependence ▪ Conclusions made in the Surgeon General’s report (1988): 1.Cigarettes and other forms of tobacco are addicting 2.Nicotine is the drug in tobacco that causes addiction 3.The processes that determine tobacco addiction are similar to those that determine addiction to drugs like heroin and cocaine  How to Stop Smoking ▪ There are more than 40 million ex-smokers in the U.S. ▪ 90% report no formal treatment program ▪ Yet there are many challenges to quitting ▪ Nicotine is a strongly reinforcing drug ▪ And a pack-a-day smoker gets 50,000 reinforcing nicotine puffs per year ▪ Relapse rate from smoking cessation is extremely high (by 6 months 70-80% smoke again)  How to Stop Smoking ▪ Replacement therapy ▪ Delivering nicotine without the tar and carbon monoxide ▪ Produced in many forms: ▪ Gum, patches, nasal spray, inhalers, lozenges ▪ Pharmacological Therapy ▪ Example: Bupropion (Zyban) ▪ Combining counseling and pharmacological treatments increases the odds of quitting Quitting Smoking - video Smoking and metabolism Smoking and Heath in Other Countries ▪ Five million deaths worldwide each year ▪ Perhaps as high as 8 million by 2030 ▪ Demand for American cigarettes in Asia has increased markedly ▪ Demand has also increased in Third World countries