Chapter Eight:
Rejecting Tobacco Use
© 2013 McGraw-Hill Higher Education. All rights reserved.
Cigarette Smoking among College
Students
 College smoking trending upwards
 Smoking among college students decreased from 1964
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to 1995 (from 21% to 14%)
Current rates of smoking among college students:
 30.6% of full-time students
 42.7% of part-time students
Current rates of smoking among general population:
 20.6% of all adults
Direct relationship between alcohol consumption and
cigarette smoking
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Demographic Trends in Smoking
 Gender
 Men have higher rates of smoking than women
 Race/ethnicity
 Highest smoking rates among American Indians and Alaska
Natives
 Lowest smoking rates among Asian Americans
 Level of education
 Higher levels of education are associated with lower rates of
smoking
 Age
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 Smoking rates go down as age goes up
Geographic residence
 Highest smoking rates in Midwest
 Lowest smoking rates in West
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Demographic Trends in Smoking
 Size of the community
 Large metropolitan areas have lowest
smoking rate
 Recent homelessness or incarceration
 Higher rates
 Place of birth
 Native-born Americans have higher rates of
smoking than foreign-born Americans
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Marketing of Tobacco Products
 Controversy about advertising due to
industry’s knowledge of the health risks
 Restrictions on marketing of all tobacco
products, BUT
 Magazine advertising has increased
 Especially in magazines with 15% or more youth
readership
 Free distribution of cigarettes in bars and
restaurants
 Luring teens through anti-smoking ads
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Development of Dependence
 Dependence: Physical and/or psychological
need to continue the use of nicotine
 Physical dependence
 Tolerance
 Withdrawal
 Titration
 Particular level of a drug within the body
 Adjusting the level of nicotine by adjusting the rate of
smoking
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Theories of Nicotine Addiction
 Genetic influences
 60% of initiation and maintenance of initial smoking
is driven by genetic influences
 Bolus theory
 Based on body’s response to the bolus (ball) of
nicotine delivered to the brain
 Adrenocorticotropic hormone (ACTH) theory
 Release of beta endorphins delivers euphoric effect
 Self-medication theory
 Nicotine, through effects on dopamine, “lifts spirits”
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Acute Effects of Nicotine on
Nervous System Function
 Nicotine induces increased brain activity
 Increased release of neurotransmitters
 Norepinephrine
 Dopamine
 Acetylcholine
 Serotonin
 Very heavy use of nicotine depresses the
central nervous system
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Psychosocial Factors Related to
Dependence
 Modeling behavior
 Manipulation
 Susceptibility to advertising
 Use of tobacco products associated with a
better life
 Once smoking is initiated, dependence
becomes a key factor in use
© 2013 McGraw-Hill Higher Education. All rights reserved.
Prevention and Intervention
 Preventing teen smoking
 Government policies
 Restrictions on advertisements and promotions
 Anti-tobacco advertisements
 Early childhood intervention
 Decision making skills
 Critical thinking and refusal skills
 Support for smoke-free environments
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Tobacco Smoke
 Particulate phase (small
suspended particles)
 Nicotine
 Water
 Tar
 Phenol, benzo[a]pyrene, DDT, and
many other chemicals
 Gaseous phase
 Carbon monoxide
 Carcinogens
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Toxic and Carcinogenic
Compounds in Tobacco Smoke
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Health Risks of Tobacco Use
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Illness, Premature Death, and
Tobacco Use
 Cardiovascular disease and nicotine
 Myocardial infarction
 Sudden cardiac death
 Angina pectoris
 Increased platelet adhesiveness
 Unhealthy cholesterol changes
 Cardiovascular disease and carbon monoxide
 Impairment of oxygen transport
 Smoking and oral contraceptive (OC) use
 May cause heart attack, stroke, or embolism
 Women who smoke should NOT use OCs
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Illness, Premature Death, and
Tobacco Use
 Cancer
 Respiratory tract cancers (lung, mouth,
larynx
 Damage to the respiratory lining (mucus, cilia)
brings carcinogens into direct contact with tissues
 Other tobacco-enhanced cancers
 Kidney
 Gastrointestinal system
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Development of Lung Cancer
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Chronic Obstructive Lung
Disease
 Chronic bronchitis
 Persistent inflammation or infection of the
smaller airways within the lungs
 Pulmonary emphysema
 Irreversible disease process in which the
alveoli are destroyed
 Significant impact on quality of life
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Additional Health Concerns
 Poor nutritional state
 Reduced insulin
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sensitivity
Decline in short-term
memory
Loss of senses of smell
and hearing
Premature wrinkling of
the skin
Stroke
Loss of bone mass
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 Impaired recovery from
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surgery
Gum disease
Impaired resistance to
infection
Asthma
Infertility
Impotence
Earlier menopause
Poor circulation
 Burns
Risks from Specific Tobacco
Products
 Nonmanufactured cigarettes
 Bidis
 Kreteks
 Mentholated cigarettes
 Pipes
 Cigars
 Smokeless tobacco
© 2013 McGraw-Hill Higher Education. All rights reserved.
Nonmanufactured Forms of
Cigarettes
 Bidis
 High in tar and nicotine
 High level of carbon monoxide
 Kreteks (clove-flavored tobacco)
 Increased tar and nicotine delivery
© 2013 McGraw-Hill Higher Education. All rights reserved.
Mentholated Cigarettes
 Menthol
 Unique taste and “cooling” sensation
 Heavily marketed to African American
smokers
 Special health risks still under investigation
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Pipe and Cigar Smoking
 Pipe/cigar smokers have the same rates
of cancer as cigarette smokers:
 Mouth
 Larynx
 Throat
 Esophagus
 Cigar manufacturers are now required to
disclose tobacco content and additives
 Warning labels required
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Smokeless Tobacco Use
 Types
 Chewing tobacco
 Snuff
 Risks associated with use
 Leukoplakia
 Erythroplakia
 Periodontal disease
 Oral cancer
 Nicotine addiction
 Other health risks
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New Product Development
 Eclipse
 Accord
 Omni, Quest, and Advance
 Reduced-Ignition Propensity (RIP)
Cigarettes
 Exotic Blend Cigarettes
 Menthol Light Cigarettes
 Superslim Cigarettes
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Nontobacco Sources of Nicotine
 Aids to smoking cessation
 Supplemental forms of nicotine
 Less stringent regulation
 Ex: nicotine suckers, nicotine-flavored gum,
nicotine straws, nicotine-enhanced water
 E-cigarettes
 Nicotine Bridge Products
 Snus
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Smoking and Reproduction
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Infertility
Increased risk of ectopic pregnancy
Problem pregnancies
Breast-feeding
 Exposes infants to harmful effects and chemicals
Neonatal health problems
 Low birth weight
 Respiratory problems
 Higher risk of SIDS
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Involuntary (Passive) Smoking
 Mainstream smoke
 Smoke inhaled and then exhaled by smoker
 Sidestream smoke
 Smoke from the burning end of the
cigarette, pipe, or cigar
 Contains 85% of harmful substances
associated with secondhand smoke
 Environmental tobacco smoke
 Diluted smoke that stays within a common
source of air
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Health Risks of Passive Smoking
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Heart disease
Cancer
Eye irritation
Nasal symptoms
Headaches
Cough
In children:
 Bronchitis or pneumonia
 Respiratory symptoms
 Middle ear infections
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Cost of Smoking
 Loss of independence,
freedom, and social
contacts due to addiction
 Many young adults do not
want smokers as life
partners
 Discrimination
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The Health Benefits of Quitting
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Smoking Cessation
 Programs
 Educational
 Behavior modification
 Aversive conditioning
 Hypnosis
 Acupuncture
 Increased taxes on cigarettes
 Involvement of family, friends, and coworkers
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Medically Managed Smoking
Cessation
 Non-nicotine based medication
 Influence the production, diffusion, or
reuptake of neurotransmitters
 Nicotine replacement medications
 Allow a controlled and less harmful
relationship with nicotine than that
associated with tobacco products
© 2013 McGraw-Hill Higher Education. All rights reserved.
Chapter Eight:
Rejecting Tobacco Use
© 2013 McGraw-Hill Higher Education. All rights reserved.