Chapter 11Chapter 11 Alcohol, Tobacco and CaffeineUnacknowledged Addictions

Tobacco

TOBACCOJanuary 11, 1964:

U.S. Surgeon General ReportCigarette smoking is linked to

increased morbidity and mortality

Canadian Smokers

proportion of smokers decreased in past 25 years - still approximately 30% smoke

Smoking…… in CanadaSmoking…… in Canada• 7 millions Canadians smoke7 millions Canadians smoke• heavy smokers on the rise heavy smokers on the rise • 45,000 Canadians die from 45,000 Canadians die from

tobacco abuse each yeartobacco abuse each year• Adolescent females (14-20 yr.)Adolescent females (14-20 yr.)• 1990-1994 # of adolescents 1990-1994 # of adolescents

smoking increased by 24 %smoking increased by 24 %• Health care cost more than $9.6 Health care cost more than $9.6

billion annuallybillion annually

Forms of Tobacco Consumption:

Snuff:Snuff:• powdered tobaccopowdered tobacco• absorbed through absorbed through

mucous mucous membrane of nosemembrane of nose

• some increase in some increase in popularitypopularity

Chewing TobaccoChewing Tobacco

• tobacco leaves mixed with a tobacco leaves mixed with a variety of flavoring agents (ex. variety of flavoring agents (ex. molasses)molasses)

• tobacco constituents (nicotine) tobacco constituents (nicotine) absorbed through mucous absorbed through mucous membrane in mouthmembrane in mouth

• Snuff and chewing tobacco Snuff and chewing tobacco smokeless tobaccosmokeless tobacco

• smokeless tobacco = 11 X the risk smokeless tobacco = 11 X the risk of developing cancers mouth and of developing cancers mouth and gum as nonusersgum as nonusers

Pipes-Cigars-Cigarettes:Pipes-Cigars-Cigarettes:Composition of Tobacco Smoke:

• inhaling hot smoke absorbed via the inhaling hot smoke absorbed via the lungslungs

• 65 species of tobacco65 species of tobacco

• over 4000 known compounds in tobaccoover 4000 known compounds in tobacco

• smoke in our atmosphere smoke in our atmosphere

• 1. Mainstream smoke - drawn through 1. Mainstream smoke - drawn through cigarette & filtercigarette & filter

• 2. Side-stream smoke - burning tobacco 2. Side-stream smoke - burning tobacco not inhaled = second-hand smokenot inhaled = second-hand smoke

Composition of Cigarette SmokeComposition of Cigarette Smoke

• Condensed particles: Condensed particles: Tar (8 % of total Tar (8 % of total volume)volume)

• Gases and Vapors (92 % Gases and Vapors (92 % of total volume)of total volume)

Harmful constituents of cigarette smokeHarmful constituents of cigarette smoke

TarTar• Carcinogenic agents (cancer-Carcinogenic agents (cancer-

producing chemicals)producing chemicals)• Co-carcinogenic agents (substances Co-carcinogenic agents (substances

combine with others that cause combine with others that cause cancer)cancer)

• NicotineNicotine• Tar + CO + Nicotine are obtained Tar + CO + Nicotine are obtained

from burning tobacco in cigarettes, from burning tobacco in cigarettes, pipes and cigarspipes and cigars

• Tar - related to mortality & Tar - related to mortality & morbiditymorbidity

Carcinogens and Co-carcinogens

• Carcinogens or Carcinogens or tumor initiators, tumor initiators, lung, pancreas, lung, pancreas, kidney, and bladder;kidney, and bladder;

• Co-carcinogens or Co-carcinogens or tumor promoters: tumor promoters: help maintain help maintain process of tumor process of tumor formationformation

Nicotine:Nicotine:

• 50-2500 mg/cigarette50-2500 mg/cigarette

• powerful pharmacological agentpowerful pharmacological agent

• stimulates cerebral cortex stimulates cerebral cortex immediate effects:immediate effects:

• HRHR

• MAP (vasoconstriction)MAP (vasoconstriction)

• MVOMVO22

• ventilationventilation

• hunger (dulls taste buds)hunger (dulls taste buds)

• 1/2 life of nicotine 30 min - highly 1/2 life of nicotine 30 min - highly addictiveaddictive

NicotineNicotine

• regular smokers need regular smokers need to replenish body's to replenish body's nicotine level every nicotine level every 30-min.30-min.

• major addictive major addictive agentagent

• nicotine dependence nicotine dependence is a physical and is a physical and psychologicalpsychological

• several “breaks/day”several “breaks/day”

Carbon Monoxide (CO):

• CO causes noticeable CO causes noticeable physiological effectsphysiological effects

• 1-5 % of smoke1-5 % of smoke• CO interferes with CO interferes with

ability of Hb to bind ability of Hb to bind with Owith O22

• CO levels in smoke CO levels in smoke have been positively have been positively correlated with correlated with risk risk of CAD/strokeof CAD/stroke

Benzopyrene:

• responsible for lung responsible for lung cancer kills the cancer kills the cancer-protecting cancer-protecting cells in the bodycells in the body

During Puffing:

• temperature in burning cone temperature in burning cone is between 900 and 1050 °Cis between 900 and 1050 °C

• these temperatures produce these temperatures produce mainstream smokemainstream smoke

• the side-stream smoke is the side-stream smoke is generated during smoldering generated during smoldering of tobacco at 800 °Cof tobacco at 800 °C

• estimated that 55-70 % of estimated that 55-70 % of tobacco of cigarettes is tobacco of cigarettes is burned between puffs burned between puffs source of side-stream smokesource of side-stream smoke

Giving Up Smoking!

Smoking - powerful immediateSmoking - powerful immediate

satisfaction for individual:satisfaction for individual:• pharmacological• psychological• emotional• social

Approximately:Approximately:• 50 % quit smoking "COLD 50 % quit smoking "COLD

TURKEY"TURKEY"• 50 % gradual reduction50 % gradual reduction

2 types of withdrawal:

Physiological Withdrawal:Physiological Withdrawal:• physical dependence on nicotine / physical dependence on nicotine /

easiest to deal witheasiest to deal with

Symptoms:Symptoms:• headachesheadaches• irritabilityirritability• sleeplessnesssleeplessness• intense cravings intense cravings • muscle achesmuscle aches• symptoms highest at three days - symptoms highest at three days -

diminish with timediminish with time

Psychological WithdrawalPsychological Withdrawal

• breaking patterns / breaking patterns / changing behavior changing behavior

• first few months are first few months are critical…… critical……

• relapses are commonrelapses are common• Individual changes Individual changes

in behaviorin behavior• moodmood• craving for tobaccocraving for tobacco

Smoking a Learned BehaviourSmoking a Learned Behaviour

Tobacco industry portraysTobacco industry portrays

smoking as positivesmoking as positive• a gradual processa gradual process• peer pressurepeer pressure

Promotion of SmokingPromotion of Smoking• helps to shape & reinforce + imagehelps to shape & reinforce + image• influences amount smokedinfluences amount smoked• negative influence to quit bynegative influence to quit by acting

as reassuring cue

Don’t Start Smoking…..Don’t Start Smoking….. Best Results from PreventionBest Results from Prevention

• Stay HealthyStay Healthy• pursue healthy activitiespursue healthy activities• choose friends who also choose friends who also

respect healthyrespect healthy• lifestyleslifestyles• protect your personal protect your personal

environment……public environment……public places, home, car and places, home, car and other places where other places where smoking occurs!smoking occurs!