Tobacco

1
Tobacco

• Scientists first became concerned about health
  consequences of smoking in 1930s b/c of the
  increase in lung cancer
• In 1930, fewer than 3,000 deaths were attributed
  to lung cancer
• 50 years later, lung cancer has been blamed for
  over 100,000 deaths/year
• Cigarettes have been linked to
• Cancer
• Serious pulmonary ailments
• CVD

2
Tobacco

• Cigarette smoking is the 1 preventable cause of
  disease and death in the US
• Responsible for 350,000 per year
• That is more than drugs, etoh, traffic-related
  deaths, AIDS, suicides and homicides combined
• Death toll associated w/ smoking is equivalent of
  3 fully loaded jumbo jets crashing, leaving no
  survivors every single day of the year

3
Epidemiology

• There are at least 50 million smokers in the US
• Almost ½ of smokers are women, but some say that
  female smokers outnumber male smokers
• Smoking rate of teenage girls is increasing while
  the smoking rate of teenage boys is decreasing
• Years ago, when cigarette smoking was on the
  rise, the upper class was at the forefront of the
  trend
• Ads showed physicians promoting their favorite
  brand
• Now well-educated high SES have shown declines
• Less than 20 of all MDs smoke
• 50 of blue-collar workers smoke

4
Tobacco and women

• Recent review (1991) found differences btween men
  women in tobacco use from country to country
• In Japan, China, Greece, and Indonesia, women
  smoke much less than men
• In India, 52 of men smoke but only 3 of women
• In Hong Kong, 23 of men smoke and 4 for women
• In the US, Canada, and England, smoking rates are
  very similar for men and women
• These findings suggest that culture influences
  womens smoking rates
• Even in the US, use of pipes, cigars or chewing
  tobacco is much less compared to men

5
Tobacco and Women

• Grunber et al (1991) suggest that consideration
  of different states of tobacco use may help
  explain gender differences
• The three main stages are
• Initiation
• Women are more likely to experiment with smoking
• Maintenance
• Men are more likely to somke more cigarettes per
  day and may expose themselves to higher doses of
  nicotine
• Cessation
• Has not been studied well, but men seem to
  respond better to interventions than women

6
Mortality

• 2 pack/day smoker between ages of 30-35 has a
  life expectancy 9 yrs shorter than same age
  nonsmoker
• Chances of dying are related to the overall
  lifetime exposure to smoking
• Of 350,000 American smokers who die each year
• 170,000 are from heart disease
• 130,000 are from various cancers
• 50,000 are from pulmonary problems
• Smokers who quit improve their chances of living
• It takes 10-15 years of quitting before total
  mortality rates of former smokers resemble those
  of nonsmokers

7
Morbidity

• 145 million days of disability and over 80
  million days of work lost that are the result of
  smoking related illnesses each year
• While smoking is leading cause of mortality, it
  also is the leading cause of avoidable illness
• Smokers have emphysema and bronchitis, peptic
  ulcers, chronic sinusitis and more
  hospitalizations than nonsmokers

8
CVD

• Men who smoked over a pack a day tripled their
  risk of dying from CVD
• Risk of smoking has also been documented in
  various racial and ethnic groups and among women
• While women have lower rates of heart disease
  than men, women who use oral contraceptives and
  smoke greatly increase their risk of heart
  disease
• Using oral contraceptives increase risk of MI
  twofold, but increased risk is tenfold if woman
  also smokes
• In most studies, cigar pipe smokers have lower
  risk than cigarettes

9
Cancer

• Smokers are 10 times more likely to get lung
  cancer than those who never smoked
• This translates into a 1000 higher risk for
  smokers
• Lung cancer was almost unknown at the beginning
  of the 20th centruy, but now makes up ¼ of all
  cancers
• Cancer rates are believed to be on the decline,
  but this trend is only visible when you remove
  lung cancer from the studies

10
Smoking Cessation

• Almost 90 of current smokers would like to quit
• almost all of them made at least 1 serious
  attempt
• While success of quitting on your own is only
  about 5
• most Americans who have quit smoking have done so
  without any formal program
• Those w/ smoking health problems are more
  successful at quitting
• Social pressure, , setting a good example for
  the kids

11
Maintenance or Relapse

• Smokers quickly realize that quitting is not hard
  to do, but maintaining abstinence from smoking is
  one of the most challenging tasks of their lives
• Marlatt and Gordon proposed a cognitive-behavioral
  model of relapse that has become very
  influential
• If an ex-smoker has a cigarette, it is a
  cognitive emotional reaction termed the
  abstinence violation effect
• This effect has two parts
• A) guilt from smoking, which is discrepant from
  the new self-image as a nonsmoker
• B) attribution that smoking episode was due to
  personal weakness
• The abstinence violation decreases self-esteem
  the will to keep trying
• M and G teach clients to separate a slip from a
  relapse. A slip is temporary, a relapse is long
  term

12
Maintenance or Relapse

• Interventions based on this model try to identify
  high-risk situations, develop coping strategies,
  counteract abstinence violation w/ thoughts
• There is evidence that smokers can correctly
  identify their high-risk situations that are
  related to relapse
• Study had subjects in smoking cessation program
  rate their self-efficacy in resisting smoking in
  high-risk situations
• Months later, results showed that those who
  reported low self-efficacy in certain situations
  were more likely to relapse