Tobacco
People who smoke “light” or low-tar
cigarettes reduce their risk of smokingrelated diseases compared to people who
smoke other cigarettes. True or False?
 False. Smokers who choose “light” or low-tar cigarettes do not
reduce tar intake or smoking-related disease risks, nor is there
any evidence that switching to “light” cigarettes helps smokers
quit.
2
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Chapter eleven
Which of the following substances is found in
tobacco smoke?
A. Acetone (nail polish remover)
B. Ammonia (cleaner)
C. Hexamine (lighter fluid)
D. Toluene (industrial solvent)
 All four. Tobacco contains thousands of chemical substances,
including many that are poisonous or linked to the development
of cancer.
3
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Chapter eleven
Every day in the United States, about
1000 children and adolescents between
the ages of 12 and 17 start smoking.
True or False?
 False. The number is closer to 4000 children and adolescents.
The average age of a first-time smoker is 13.
4
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Chapter eleven
Cigarette smoking increases the risk for which
of the following conditions?
A. Facial wrinkling
B. Miscarriage
C. Impotence
D. Automobile crashes
All four. Cigarette smoking reduces the quality of life and is the
greatest preventable cause of death in the United States.
5
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Chapter eleven
A person who quits smoking now will
reduce his or her risk of lung cancer
within 10 years. True or False?
 True. The lung cancer rate of a former smoker is 50% of that of
a continuing smoker within 10 years of quitting.
6
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Chapter eleven
Every cigarette a person smokes reduces
life expectancy by about 1 minute. True
or False?
 False. Every cigarette reduces the life expectancy by about 11
minutes; one carton represents a day and a half of lost life.
7
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Chapter eleven
History of Tobacco Use
 Over the past 4 decades, the proportion of
cigarette smoking among adults in the U.S. has
dropped 30%.
 Almost every state now restricts smoking in
public places, and several have introduced
statewide smoking bans for indoor
workplaces.
8
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Chapter eleven
Despite progress…
 Tobacco use is still widespread.
 In 2005, 29.4% of Americans age 12 and older reported
having used tobacco in some form during the past 30 days.
 Although the rate of tobacco use declined slightly from 2002
to 2005, it remained unchanged from 2004 to 2005.
 Smoking is the leading cause of preventable illness and
premature death in the United States.
 Cigarette smoking is the major single cause of cancer deaths
in the U.S. and is responsible for more deaths than all other
drugs combined.
9
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Chapter eleven
Who does it affect?
 Smoking has health effects on people at all
stages of life from unborn babies to seniors.
 Each year 440,000 Americans die prematurely
from tobacco-related causes. This accounts for
nearly 1 in every 5 adult deaths each year.
 Male smokers lose an average of 13.2 years of
life and Female smokers lose an average of
14.5 years of life.
10
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Chapter eleven
Others?
 Non-smokers, particularly children also suffer.
 Exposure to environmental tobacco smoke (ETS)
causes more than 35,000 deaths annually among nonsmokers.
 Smoking by pregnant women is responsible for about
1000 infant deaths each year in the U.S.
 Children exposed to ETS suffer higher rates of
asthma, bronchitis, and pneumonia.
 Smokeless tobacco use has tripled since 1972, and
cigar use has increased 50% since 1993.
11
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Chapter eleven
Use of Tobacco
People who use Tobacco
 70 Million Americans, nearly 4 million adolescents
 Each day more than 2000 teenagers become regular
smokers. At least one-third of them will die
prematurely.
 2004, nearly 30% of Americans age 12 and older had
used tobacco during the past 30 days
12
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Chapter eleven
Tobacco Substances
 There are hundreds of chemical substances
in cigarette smoke.
 Three of the most damaging are:
 Tars
 Nicotine
 Carbon Monoxide
13
Tar
 Brown, sticky substance
 Tars damage delicate lung tissue
and are considered the main
carcinogen in cigarette smoke.
 Carcinogen – cancer causing
substance
 1 pack-a-day smokers get almost
a liter of tar in their lungs in one
year of smoking
14
Nicotine
 Nicotine is found in tobacco leaves.
 It can be extracted as a colorless, oily





15
transparent liquid
 It is used in solutions such as
insecticides
Nicotine can be smoked, inhaled,
absorbed or chewed.
It is in cigarettes, cigars, pipe tobacco
and chewing tobacco.
One drop of pure nicotine can be fatal
to humans.
Nicotine is a psychoactive drug.
It acts on the brain in much the same
way as cocaine and heroin.
How Nicotine Affects the Body
 Nicotine is a powerful stimulant to the brain and the central
nervous system.
 It hits the brain within 4 seconds of being used.
 Nicotine constricts the blood vessels, cutting down the flow of
blood and oxygen throughout the body.
 This causes the heart to pump harder
 It raises the blood pressure
 It narrows the bronchioles (air passageways) in the lungs, depriving
the body of oxygen
 Because of its effects on the heart and the lungs nicotine increases
the risk of heart disease and stroke.
16
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Chapter eleven
More About Nicotine
 After Nicotine initially stimulates the brain it has a depressant
effect.
 Nicotine is addictive and tolerance (needs more and more to get
the desired effect) develops.
 Teens are more vulnerable to nicotine than older adults
 Nicotine addiction can start within a few days of smoking and after
just a few cigarettes
 A person can develop a dependency (needs it to feel
comfortable). Users need to have a constant flow of nicotine to
the brain.
 Users build their daily schedule around use.
 Over half of those who smoke daily progress to dependence
17
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Chapter eleven
Nicotine Withdrawal
 A person suffers from withdrawal symptoms
(physical and psychological discomfort) when they try
to stop using.
 Cravings, insomnia, confusion, tremors, difficulty
concentrating, fatigue, muscle pains, headache,
nausea, irritability, anger, depression
 Most symptoms pass in 2 or 3 days, the craving
persists
18
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Chapter eleven
Nicotine and Tobacco Research
 The tobacco industry has long maintained that nicotine has
not been proven to be addictive.
 Scientific evidence overwhelmingly shows to the contrary.
 Many researchers consider nicotine to be the most physically
addictive of all psychoactive drugs
 According to a 2006 study, the amount of nicotine in
cigarettes increased by 10% between 1998 and 2004.
19
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Chapter eleven
Carbon Monoxide
 Carbon Monoxide replaces needed
oxygen in a person’s red blood cells
 Even after a person stops smoking,
carbon monoxide stays in the
bloodstream for hours, depriving the
cells of oxygen.
 Carbon Monoxide is a waste product
of cigarette smoking, car exhaust and
unvented kerosene heaters.
20
21
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Chapter eleven
Other Components
 43 chemicals in tobacco smoke are linked to cancer (Carcinogen)
 Benzo(a)pyrene
 Urethane
 Cocarcinogens - Combine with other chemicals to cause cancer
 Formaldehyde (embalming fluid)
 Poisonous substances
 Arsenic (ant poison)
 Hydrogen cyanide (used as method of execution in the U.S.)
 Carbon monoxide (exhaust fumes)
 400 times greater than is considered safe in industrial workplaces
 Displaces oxygen in red blood cells
 Additives
 Nearly 600 chemicals
22
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Chapter eleven
Additives
 Some additives are regarded as safe when ingested
but when heated or burned can form carcinogens.
 Sugars and flavoring agents as flavor enhancers and
addictive components
 Licorice, cocoa, honey
 When sugars burn they produce acetaldehyde, a
chemical that enhances the addictive effect of
nicotine.
 Acetaldehyde is a carcinogen
23
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Chapter eleven
Other Additives
 Ammonia (cleaning agent)
 Boosts the amount of addictive nicotine
 Reduces acidity in smoke, allowing nicotine to be
more readily absorbed in the blood
 Potassium Citrate
 Aluminum
 Clay
 All work to make cigarette smoke less obvious and
objectionable to the non-smoker.
24
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Chapter eleven
“Smokers’ Face: Another Reason to
Quit the Habit”
 H:\Smokers Face Chart.notebook
 Read the article and fill in the chart.
 What are the smoking-related problems
that affect women, affect men, and affect
women and men?
25
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Chapter eleven
Health Hazards
 Tobacco adversely affects nearly every part of
the body, including the
 Brain
 Stomach
 Mouth
 Reproductive organs
26
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Chapter eleven
The Long-Term Effects of Smoking
 Cardiovascular Diseases
Coronary Heart Disease
Smokers have a death rate 70% higher than non-smokers
Atherosclerosis (blockage in the arteries)
Smoking and exposure to ETS permanently accelerates the
rate of plaque accumulation in the coronary arteries
Chest Pain
Heart Attack
Stroke
Aneurysm (blood vessel bursts)
27
Chapter eleven
Other Long-Term Effects
 Lung Cancer
 Those who smoke 2 or more packs-a-day have a lung cancer death
rate 12-25 times greater than those of nonsmokers.
 Evidence suggests after 1year without smoking the risk of lung
cancer decreases substantially; after 10 years the risk is reduced
by half.
 Smoking is also linked to cancers of the:














28
Trachea
Mouth
Pharynx
Esophagus
Larynx
Pancreas
Bladder
Kidney
Breast
Cervix
Stomach
Liver
Colon
Skin
More Effects
 Chronic Obstructive Lung Disease (COPD)
 From constant exposure to dangerous chemicals and
irritants, must work harder to function adequately
 4th leading cause of death in the U.S.
 Most common forms:
Emphysema – where walls of the air sacs of the lungs lose
elasticity and are gradually destroyed
Chronic Bronchitis – cell lining of the bronchial tubes are
inflammed, producing excess mucus.
Cigarette smokers are up to 18 times more likely than nonsmokers
to die from emphysema and chronic bronchitis
Pipe and cigar smokers are more likely to die than nonsmokers but
risk is smaller
29
30
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Chapter eleven
Additional Health, Cosmetic, and
Economic Concerns
 Ulcers
 Impotence
 Reproductive health problems
 Dental diseases
 Diminished physical senses
 Injuries
 Cosmetic concerns
 Economic costs
31
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Chapter eleven
Cumulative Effects
 Males before 15 yrs. old are half as likely to live to 75
versus those who did not smoke
 Females with similar habits reduce life expectancy by
more than 10 years
 Female smokers spend 17% more sick days in bed
than nonsmokers
 Both men and women show a greater rate of acute
and chronic diseases
32
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Chapter eleven
Environmental Tobacco Smoke
 Environmental Tobacco Smoke (ETS)
Environmental Protection Agency, the Department of
Health and Human Services and the U.S. Surgeon General
have all concluded that ETS is a known carcinogen.
There is no safe level of exposure to ETS
Every year ETS causes thousands of deaths from lung
cancer and heart disease and is responsible for hundreds of
thousands of respiratory infections in young children.
33
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Chapter eleven
Primary Sources of ETS
 Primary Sources of ETS
 Home
 Workplace
 Cars
 Restaurants and public places
 Policies to eliminate smoking in the workplace
and public places are increasing.
34
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Chapter eleven
Second-hand Smoke
 Second hand smoke
 Mainstream smoke
 Smoke exhaled by the smoker
 Sidestream smoke
Smoke from the burning end of the cigarette
Twice the tar and nicotine
Three times the benzo(a)pyrene, carbon monoxide and
ammonia
85% of smoke in a room is sidestream smoke
In a typical home with the windows closed, it takes about 6 hours for
35
95% of the airborne cigarette smoke particles to clear
Smoke from a cigar can be even more dangerous
30 times more carbon monoxide and 3 times as many carcionogenic
particles
ETS Effects
 Develop cough, headaches, nasal discomfort,
eye irritation, throat irritation, breathlessness and sinus
problems
 Allergies will be exacerbated, increased asthma attacks
 24-50% increase in lung cancer risk
 Causes 3,000 deaths due to lung cancer
 Contributes to about 35,000 overall deaths
 After just 30 minutes of exposure to ETS, the endothelial
36
function in the coronary arteries of a healthy nonsmoker is
reduced to the same level as that of smokers. Carbon
monoxide lingers in the bloodstream 5 hours later.
Infants, Children, and ETS
 Infants and Children are more likely to develop
Bronchitis, pneumonia,& respiratory infections
More complications from asthma
Increased chance of SIDS
Low-birth weight
Bronchitis
 Chemicals from smoking show up in breast milk
 Children inhale three times more pollutants per unit of body
weight than adults.
37
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Chapter eleven
Tobacco Mathematics
$6.72 per pack “Regular”









38
Marlboro
Camel
Virginia Slims
Newport
Winston
Kool
Capri
Misty
Salem
©2008 McGraw-Hill Companies. All Rights
Reserved.
$6.14 per pack “Generic”
 Tahoe
 Bailey
 Maverick
Chapter eleven
Tobacco Mathematics
Regular
2.
3.
4.
5.
6.
7.
8.
9.
39
$6.72 a pack
$47.04 each week
$188.16 every month
$2,446.08 every year
$9,784.32 every 4 years
$24,460.80 every 10 years
7,300 cigarettes a year
73,000 over a decade
©2008 McGraw-Hill Companies. All Rights
Reserved.
Generic
2.
3.
4.
5.
6.
7.
8.
9.
$6.14 a pack
$42.98 each week
$171.92 every month
$2,234.96 every year
$8,939.84 every 4 years
$22,349.60 every 10 years
7,300 cigarettes a year
73,000 over a decade
Chapter eleven
Smokeless Tobacco
 Smokeless tobacco includes both
chewing tobacco and snuff
 Commonly called chew or dip
 Made from tobacco leaves that are
formed into loose-leaf, plugs, or
twists.
 Can be dry or moist
 Held in place between the gum and
the lip or cheek
40
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Chapter eleven
Smokeless Tobacco
 More than 6.5 million adults use smokeless
tobacco
 Nicotine is absorbed through the gums and
lining of the mouth
 1 dip for 30 minutes = 2-3 cigarettes worth of
nicotine
41
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Chapter eleven
Effects of Smokeless Tobacco
 Changes in the mouth can occur even
after only 2 weeks of use
 Gums and lips become dried and
irritated and may bleed
 Leukoplakia (white or red patches)
may appear
 can lead to oral cancer
 About 25% of regular spit tobacco
users have Gingivitis (gum disease)
 Cancers of the lip, tongue, cheek,
throat, gums, roof and floor of the
mouth, and larynx
42
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Chapter eleven
“The Sean Marsee Story”
43
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Chapter eleven
Other forms of tobacco
Cigars
 Cigarette smoking among Maryland high school
44
students has decreased since 2000 however cigar use
has increased by more than 11% in the same time
 Cigarette packs sold in Maryland have declined since
2000 however cigar sales have increased by more
than 176%
 Cigars contain more tobacco than cigarettes
therefore contain more nicotine and produce more
tar.
 Cigars have a high concentration of nitrogen
compounds, some of the most potent carcinogens
known.
Chapter eleven
More about Cigars
 Flavored cigars are driving youth
cigar use
 In 2010 nearly 80% of underage
high school cigar smokers
reported smoking flavored cigars
 In contrast only 4% of adults
smoke cigars and less than 2% of
adults reported flavored cigar use
 The most popular types of
flavored cigars are small cigars
called cigarillos.
45
Cigarillos
 How are cigarillos sold?
 Brightly colored,
attractive packaging
 Enticing fruit, candy and
alcohol flavorings
 Small packages or singles
in front of stores at cash
registers
 Cheap, inexpensive prices
46
Pack of 20 cigarettes $6.00
Single cigar 69 ¢
If you were a teen, which would you buy with your
pocket change?
Other forms of tobacco
 Clover cigarettes and Bidis
 Imported from primarily
from Pakistan, India and
Indonesia
 Clover cigarettes contain
twice the tar, nicotine,
and carbon monoxide
 Bidis contain up to 4
times more nicotine and
twice as much tar
47
What are Electronic Cigarettes?
 also known as “E-Cigs”
 cigarette-shaped device
 contains a nicotine-based liquid that
is vaporized and inhaled
 used to simulate the experience of
smoking tobacco
 some are rechargeable
 manufactured by tobacco companies as
a “safe” product you can use anywhere
 Do you think this product
is safe for the user or others
nearby? Why or why not?
Ingredients of E-cigarettes:
The nicotine-based chamber normally
contain a mixture of:
 propylene glycol, a liquid alcohol
 glycerin, a colorless liquid
 nicotine, a colorless oily liquid found
in tobacco
 flavorings
Other types may use similar ingredients,
but without nicotine.
Components of E-Cigarettes:
Legal Status & FDA Regulation
Age:
 In most states, the age for purchasing e- cigarettes is a
minimum of 18.
 The “Vape it” stores in Salisbury and Delaware require
customers to be 18 or older to purchase from their websites
or stores.
 There are issues with underage e- cigarette users, but at
least 41 states prohibit sales of e-cigarettes to minors as of
October 6, 2014.
http://www.ncsl.org/research/health/alternative-nicotine-products-e-cigarettes.aspx
Legal Status & FDA Regulation
Are ingredients regulated?
In April 2011, the FDA issued a statement that they intend to
regulate e-cigarettes as “tobacco products.” (To date, the FDA has
not taken authority, and has left the e-cigarette unregulated.)
E-cigarette bans:
 Several state governments are processing/adding e-cigarettes
to their list of smoking bans.
 Several countries have banned the sale of e-cigarettes.
 41 states prohibit the sale of e-cigarettes to minors
Other Problems associated
 CDC study finds dramatic
increase in e-cigarette related
calls to Poison Centers (all 50
states and DC)
 More than 50% of the calls
involved young children under
age 5; mainly due to ingestion.
 Not needed to be childproof,
have colors and flavors like candy
that are appealing to children
 Can also be poisoned by
inhalation and absorption through
skin and eyes.
http://www.cdc.gov/media/releases/2014/p0403-e-cigarette-poison.html
http://www.wboc.com/story/26779698/liquid-nicotine-exposures-up-sharply-among-kids#.VD2mhhs--qk.mailto
Local specialty stores and online sites
Locations:
 North Salisbury
 South Salisbury
 Millsboro
advertised at the register at Ace Hardware
Why Start in the First Place?
 Between 2001-2005 high school use has declined.
 28.5% to 23%
 Children and teenagers make-up 90% of all new
smokers in this country.
 Estimated 4000 children and adolescents (12-17) start
smoking.
 Average age
 13 for smoking
 10 for spit tobacco
55
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Chapter eleven
Listening to Advertising
 In 2003 the Tobacco Industry spent nearly $15 billion for
advertising
 Most heavily advertised brands
 Marlboro
 Camel
 Newport
 90% of teens prefer the top three most advertised
brands.
 Joe Camel is more familiar than Mickey Mouse.
 More than 90% of 6-year-olds recognized the character
56
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Chapter eleven
Who do advertisers reach?
 Certain brands are designed
to appeal primarily to men,
women or particular ethnic
groups.
 Virginia Slims
 Winston
 Community-based
advertising
 Audience-based advertising
57
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Chapter eleven
Advertisements & Price
 Even famous people do advertisements!
Local specialty stores and online
sites
Isn’t this a pharmacy?
Government regulation
 The U.S. government began regulating tobacco advertising in
1967
 FCC required broadcasters to air anti-smoking messages
along with industry-sponsored advertisements on television
and radio
 Between 1967 and 1971, per capita cigarette consumption
declined by 7%
 Cigarette advertising on television and radio was banned
altogether in 1971
60
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Chapter eleven
Regulations…
 In 1996, the FDA issued strict advertising
regulations designed to reduce minors’ exposure and
access to tobacco advertising and products; however
the Supreme Court ruled the FDA does not have this
authority.
 In November 1998, controls on advertising were
enacted as part of a $206 billion deal to settle
lawsuits brought against “Big Tobacco” by attorney
generals of 39 states
61
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Chapter eleven
Big Tobacco settlement
 This settlement limits or bans billboard and transit advertising




62
Cartoon characters in advertisements and packaging
Tobacco logos on t-shirts, hats and promotional items
Brand name sponsorship of sporting events
Payments for product placement in movies, television, and
concerts
©2008 McGraw-Hill Companies. All Rights
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Chapter eleven
Emulating Smoking Onscreen
 Tobacco companies agreed to end paid product
placement in movies as part of the settlement
 Actually smoking in movies has increased particularly in
PG-13
 The portrayal of smoking does not reflect U.S. patterns
of use
 Films typically show the smoker as white, male, well-educated,
successful and attractive
 In reality, smokers tend to be poor and have less education
63
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Chapter eleven
Who Uses Tobacco?
 Characteristics which could increase the potential for use.
 A parent or sibling uses tobacco
 Peers use tobacco
 Child comes from blue-collar family
 Child comes from low-income home
 Single parent.
 Performs poorly in school
 Child drops out of school
 Has positive attitudes towards tobacco
64
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Chapter eleven
Users
 Between 1996 and 2001 the percentage of
smokers who said they smoked only
“occasionally” rose in 38 states and Washington
D.C., and the trend is continuing
 Most “occasional smokers” are adults age 18-25
who say they smoke only with friends who smoke
 Less likely to try to quit
 Still vulnerable to dependence and addiction
65
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Chapter eleven
Young Users
 All states ban the sale of tobacco to anyone under the age
of 18 but
 At least 500 million packs of cigarettes and 26 million containers
of chewing tobacco are consumed by minors each year
 In 2004, about 5% of 13-year old Americans said they
had used tobacco products in the last month
 Among high school students, about
 23% smoke at least occasionally
 14% smoke cigars
 8% use spit tobacco (male college and professional baseball
players have even higher rates)
66
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Chapter eleven
Habitual Users
 Men and women with other drug-abuse problems frequently
use tobacco
 Studies show that roughly 80% of alcoholics and 90% of heroin
addicts are heavy smokers
 Smoking is also more prevalent among people with mental
disorders
 40% of people with major depression, social phobias,
generalized anxiety disorders and 80% of people with
schizophrenia are smokers
67
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Chapter eleven
Tobacco Use Among Middle and High School Students
68
Effects of Smoking Behavior
 Smokers who inhale bring the substances into their bodies
and keep them there.
 In 1 year a typical pack-a-day smoker takes 50,000 – 70,000
puffs.
 Inhaling deeply, smoking to down to the short butts, puffing
more frequently will all increase effects of smoking.
69
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Chapter eleven
Smoking and Pregnancy
 Estimated 4600 infant deaths in the U.S.
 Miscarriage, premature birth, low birth weight, long term
impairments in growth and intellectual development
 Possible higher risks of getting cancer
 11% of pregnant women smoke
 14% of female smokers quit while pregnant
70
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Chapter eleven
Cost of Tobacco Use to Society
 Health care costs exceed $75 billion per year.
 Lost productivity from sickness, disability, and premature
death makes it closer to $157 Billion per year.
 1998 Master Settlement Agreement (MSA)
 Tobacco companies have to pay $206 billion over 25 years
 Many of the provisions designed to limit youth exposure and
access
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Chapter eleven
What Can Be Done?
 Local laws
 State and Federal laws
 FDA
 EPA
 International Action
 Marketing efforts and restrictions
 Private sector
 Individual Action
 Controlling the tobacco companies
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Chapter eleven
What about quitting?
 More than 80% of adult smokers believe tobacco will
shorten their life and would like to quit.
 Each year roughly 40% of smokers quit for at least a day, but
9 out of 10 of them are smoking again within a year.
 Although 60-80% of people who attend stop-smoking
clinics are able to quit, three-quarters of them start smoking
again within 1 year.
 Quitting for smokeless users is even harder, in one study 1
out of 4 spit tobacco users who participated in a tobaccocessation clinic was able to stop for more than 4 hours.
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Chapter eleven
Quitting
 Since 1964 - 50% of all adults who have smoked have quit.
 Benefits of quitting
 Giving up smoking provides
immediate health benefits to
men and women of all ages.
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Chapter eleven
Benefits of Quitting
 Within 20 minutes
 Blood pressure and pulse drops to




75
normal
 Temperature of hands and feet increases
to normal
8 hours
 Carbon monoxide level in blood drops
to normal
 Oxygen level in blood increases to
normal
24 hours
 Chance of heart attack decreases
48 hours
 Nerve endings start to regrow
 Ability to smell and taste is enhanced
2-3 months
 Circulation improves
 Walking becomes easier
 Lung function increases up to 30%
 1-9 months
 Coughing, sinus congestion, fatigue, and




shortness of breath all decrease
1 year
 Heart disease death rate is half that of a
smoker
5 years
 Stroke risk drops nearly to the risk of
nonsmokers
10 years
 Lung cancer death rate drops to 50% of
that of continuing smokers
 Incidence of other cancers decreases
 Risk of ulcers decrease
15 years
 Risk of lung cancer is about 25% of that
of continuing smokers
 Risks of heart disease and death are
close to those for nonsmokers
Anti-Smoking Advertisement Reflection
 How do these advertisements make you feel?
 Anthem Ad
 Terrie's Ad
 updated Terrie’s Ad
 Jessica's Asthma Ad
 Buerger's Disease Ad
 Would these videos help make you quit smoking or prevent you from
ever experimenting with tobacco?
 Would you show these videos to family/friends who smoke?
 What is your opinion towards tobacco after watching these videos?
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Chapter eleven
MTV “True Life”
 “I Can’t Breathe” – Pam Laffin has emphysema
 Pam is 28 years old during the filming of this video
 She died at the age of 31 of emphysema
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Chapter eleven