Nicotine and Tobacco

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• Chapter 11
• Nicotine and Tobacco

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HIGHLIGHTS FROM THE HISTORY OF TOBACCO

• 1492 --- Christopher Columbus discovers tobacco
• 1700s --- Snuffing is predominant form of tobacco
  use in Europe
• 1800s --- Tobacco chewing is predominant form of
  tobacco use in U.S.
• 1920s --- Cigarettes become predominant form of
  tobacco use in U.S.
• 1964 --- First surgeon generals report on smoking

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THE MOST IMPORTANT TOXIC COMPOUNDS IN TOBACCO
SMOKE

• Carbon Monoxide
• Tar
• Nicotine

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FACTS ABOUT CARBON MONOXIDE

• An odorless, colorless, tasteless toxic gas
• Attaches itself to hemoglobin, preventing oxygen
  from being carried from the lungs to the rest of
  the body
• Carbon monoxide in tobacco smoke produces a
  subtle but effective asphyxiation of the body.

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FACTS ABOUT TAR

• A sticky substance, adhering to cells in the
  lungs and airways leading to them
• Alters the composition of cilia that normally
  sweep unwanted particles
• Permits carcinogenic compounds to settle on
  pulmonary tissue

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FACTS ABOUT NICOTINE

• A toxic, dependence-producing psychoactive drug.
• Is it found exclusively in tobacco?

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FACTS ABOUT NICOTINE

• Nicotine is an alkaloid found in the nightshade
  family of plants (Solanaceae), predominantly in
  tobacco, and in lower quantities in tomato,
  potato, eggplant (aubergine), and green pepper.
• Stimulates CNS receptors sensitive to
  acetylcholine
• Releases epinephrine
• Inhibits gastrointestional activity

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FACTS ABOUT NICOTINE

• Stimulates CNS receptors sensitive to
  acetylcholine
• Releases epinephrine
• Inhibits gastrointestional activity

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HEALTH CONSEQUENCES OF TOBACCO USE

• Cardiovascular disease
• Arteriosclerosis
• Atherosclerosis
• Coronary heart disease and stroke
• Respiratory diseases (COPD)
• Chronic bronchitis
• Emphysema
• Cancer

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DISTRIBUTION OF APPROXIMATELY 430,000 U.S.
TOBACCO-RELATED DEATHS EACH YEAR
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TOBACCO USE AND CANCER

• Tobacco use increases risk of
• Lung cancer
• Larynx cancer
• Mouth cancer
• Lip cancer
• Bladder cancer
• Pancreatic cancer
• Kidney or uterine cancer

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TRENDS IN CANCER-RELATED DEATH RATES IN THE U.S.
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SPECIAL HEALTH CONCERNS FOR WOMEN

• For women, tobacco use increases the risk of
• Dying from stroke due to brain hemorrhage
• Dying from a heart attack
• Increase in risk is greater when women are also
  using birth-control pills.

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HAZARDS OF ENVIRONMENTAL SMOKE

• In an average room, three-fourths of the nicotine
  originating from cigarettes being smoked ends up
  in the atmosphere.
• Nonsmoking wives of husbands who smoke have a 30
  increased risk of lung cancer compared to women
  whose husbands do not smoke.

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YOUNG SMOKERS

• 28 percent of eighth graders have tried
  cigarettes in their lifetime.
• Peak years for starting to smoke is in the sixth
  or seventh grade.
• 80 to 90 percent of regular smokers began to
  smoke by the age of eighteen.

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REALLY YOUNG SMOKERS

• "Everyone knows that children of smokers have
  more respiratory problems--more puffing,
  wheezing, cases of pneumonia"
• - Bert Arets, M.D., Ph.D., University Medical
  Center, Utrecht.

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REALLY YOUNG SMOKERS

• Researchers found that children of smoking
  parents had significantly reduced lung function
  similar to that seen in smokers.
• Smoking after birth appeared to be more harmful
  than smoking during pregnancy alone.

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HAZARDS OF CIGAR SMOKING

• Nicotine content in cigar smoke is absorbed
  directly through tissues lining the mouth.
• 5 times higher risk of lung cancer
• 2 times higher risk of cancer of the mouth,
  throat, and esophagus
• 45 percent higher risk of COPD
• 27 percent higher risk of CHD

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FORMS OF SMOKELESS TOBACCO

• Chewing tobacco
• Loose-leaf
• Fine-cut
• Plug
• Twist
• Snuff

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FORMS OF SMOKELESS TOBACCO
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SIGNS OF TROUBLE FROM SMOKELESS TOBACCO

• Lumps in jaw or neck
• Color changes inside lips
• White patches in mouth (leukoplakia) on neck or
  lips
• Red spots or sores (erythroplakia) on lips or
  gums
• Repeated bleeding in the mouth
• Difficulty in speaking or swallowing

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• THE GLOBAL PICTURE OF TOBACCO USE

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FIVE AS THE ROLE OF THE PHYSICIAN IN SMOKING
CESSATION

• Ask about tobacco use
• Advise to quit
• Assess willingness to make a cessation attempt
• Assist in cessation attempt
• Arrange follow-up