From Cells to Society:
The Multidisciplinary Nature of
Tobacco Control
Michael Chaiton
Michael.chaiton@utoronto.ca
Why Focus on Tobacco?
Reducing tobacco use offers the greatest potential for
immediate impact at the population-level.
Tobacco Problem in Canada
Smoking, along with other forms of tobacco use, remains
the leading cause of illness and death in western
societies.
Tobacco Problem in Canada
In 2002, smoking accounted for 17% of all deaths in
Canada
21% for men and 12% for women.
Tobacco Problem in Canada
Tobacco use is responsible for three times as many
deaths as the combined total of alcohol, drugs,
suicide, homicide, injuries sustained from car crashes,
and AIDS.
Tobacco Problem in Canada
37,000 Deaths
515,607 Years of Life Lost
2,210,155 hospital days
Cancer was the leading cause of death (17,679 deaths)
followed by cardiovascular disease (10,853) and
respiratory disease (8,282)
Framework
ENVIRONMENT
VECTOR
HOST
AGENT
Framework
Environment
Mosquito
Person
Parasite
Framework
Environment
Tob Ind
Person
Cigs
Host




Risk taking!
Extroversion!
Excitement!
Glamorous identity!
Higher rates of depression and other mental
health issues
 Genetic factors
 Physiological differences: pre-natal exposure
 Drug reward and satisfaction

The Reward Pathway
12
Agent Factors


The drug must gain access to the brain (cross the
blood/brain barrier)
 Blood flow, lipid solubility, molecular size, presence
of active transport processes
The faster the drug reaches the brain, the more likely
self-administration is to occur
 Crack vs. cocaine; heroin vs. morphine; smokeless
vs. cigarette
13
Median sales (in millions of cigarettes) per group
800
700
600
500
400
300
200
100
0
0.74
0.78
0.82
0.86
0.90
0.96
Midpoint elasticity
1.00
1.04
1.08+
Environmental Factors

Gin Epidemic
 Surplus grain in England
 "An Act for the
Encouraging of the
Distillation of Brandy and
Spirits from Corn”
 Legislation created
epidemic
15
Environmental Factors

Vietnam veterans
 Epidemic of heroin use
among American
soldiers in Vietnam
 Nearly all quit on return
or with minimal
intervention
 Lack of availability and
behavioural cues
16

WWI veterans
 Prime event in diffusion to widespread use
 Cigarettes packaged as rations thanks to
the ‘generosity’ of tobacco companies
The Vector
https://amswd.utoronto.ca/sap/bc/gui/sap/its/zf_logon_
mrol?sap-client=010
Agent Lectures

The cigarette (Kaiserman)
Host Lectures

Health effects (Ferrence)

Global impact (Jha)

Addiction (Clarke; O’Loughlin)

Genetics (Tyndale)
Host Lectures

Medical interventions (Selby)

Hospital Based Interventions (Pipe)

Psychology of smoking (Hammond)

Fertility (Holloway)

Physical Activity (Faulkner)
Environment Lectures
Smoking and the Movies (Glantz)
 Mass Media (Wakefield)
 Economics (Chaloupka)
 Global issues (Cohen)
 Policy (Fong)

Vector Lectures

Marketing (Dewhirst)

Contraband (Perley)

Tobacco and activism (Mahood)

This course is partly funded by the Canadian Cancer
Society (award #702160)