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Final

CPH 306 Final: 306 Final

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Department
Public Health
Course
CPH 306
Professor
Watson
Semester
Fall

Description
Chapter 10: Tobacco - A legal product used by a significant proportion of adults - But a substance responsible for more adverse health consequences and death than any other drugs - Cultivated and used by Native Americans for centuries o Presented tobacco leaves as a gift to Colombus in 1492 - The word “Tabaco” was adopted by the Spanish o Possibly from the Arabic word ‘tabbaq” meaning “medicinal hers” - 1500s: Recognition of the medical potential grew - French physician Jean Nicot: early proponent o Nicotine (the active ingredient) and Nicotiana (the plant genus were named after him) - 16 and 17 centuries: viewed as having many positive medical uses but as having a negative reproductive effect - 1890s: Nicotine dropped form the U.S. Pharmacopoeia - Two major species grown today (out of more than 60) o Nicotiana Tobacum: Large-leaf species indigenous only to South America but now cultivated widely o Nicotiana rustica: small-leaf species from the west Indies and Eastern North America - Tobacco Products: snuff, chewing tobacco, cigars, cigarettes o Snuff 18 century: snuff use became widespread as smoking decreased o Snuff: In U.S., perceived as a British product; American use declined after the Revolution o Chewing tobacco 19 century: most tobacco used in the U.S. was chewing tobacco. o Chewing tobacco: smoking did not surpass chewing until the 1920s o Cigars: A combination of chewing and smoking o Cigars: peaked in popularity in 1920 o Cigarettes: Native Americans used thin reeds filled with tobacco o Cigarettes: Factories appeared in 19 century o Cigarettes: Habit spread widely with the advent of inexpensive machine-produced cigarettes o Cigarettes: currently most popular form of tobacco use - Cigarette product milestones: o 1913- Camels: low-prices domestic tobacco o 1939- Pall Mall: king size cigarettes o 1954- Winston: filter cigarettes - Filter cigarettes have over 90% of the U.S. cigarette market - 1604: King James of England published an anti-tobacco pamphlet o “harmful to the brain, dangerous to the lungs” o Note that he also supported the American tobacco trade - 1908: New York made it illegal for a woman to use tobacco in public - 1930s and 40s: Reports linking smoking and cancer - 1952: Readers’ Digest article “Cancer by the Carton” - Tobacco companies’ response to Readers’ Digest article: o Formation of the council for tobacco research ▪ Not independent and tried to undermine health risk claims o Mass-marketing of filter cigarettes and cigarettes with lowered tar and nicotine content ▪ Promoted as a ‘safer’ alternative - 1964: Surgeon General’s report states that smoking causes lung cancer in men - Tobacco sales began a decline that continued for 40 years after Sergeon General’s report release. - 1965: Congress required warning labels on cigarette packages - 1971: TV and radio cigarette ads banned - 1990: smoking banned on interstate buses and domestic airline flights - 1995: FDA proposed further regulation of tobacco and ads - Lawsuits seeking compensation for the health consequences of smoking - 1998 settlement between 46 states and major tobacco companies o 205$ billion in payments to the states o Advertising regulations o Enforcement of laws prohibiting sales to minor - Possible reasons for legal victories o Changing legal climate o Revelation of tobacco companies actions in hiding information on the adverse effects of smoking - For ‘safer’ cigarettes lower levels of nicotine and tar. o Caveat: people adjust their smoking behavior to obtain a consistent amount of nicotine o By taking more puffs and inhaling more deeply o Tar is the sticky brown material seen on the filter of a smoked cigarette o Based on changes in smoking behavior, there may be no advantage to seitching to a low tar low nicotine cigarette - Current Cigarette Use: 25% men. 20% women - Education is the single biggest influence on smoking rates - Percentage of smokers by education: High school diploma: 28%, undergraduate degree: 11%, full time college students: 5%, non college students: 19% - 1970s: use of smokeless tobacco increased as smokers looked for an alternative with lower risk of lung cancer. - Most common form of smokeless tobacco is moist snuff or nicotine absorbed through mucous membranes - Smokeless tobacco advantages over cigarettes include: unlikely to cause lung cancer, less expensive, and more socially acceptable in some circumstances - Smokeless tobacco is still hazardous - Smokeless tobacco health concerns include: increased risk of dental disease or oral cancer - Smokeless tobacco contains potent carcinogens such as nitrosamines - Smokeless tobacco causes leukoplakia - Smokeless tobacco can lead to nicotine dependence - In recent years, cigar smoking has increased - In 2008, 9% of males and 2% of females reported smoking a cigar in the past month. - Hookahs are a large ornate water pipe imported from Arab countries - Hookahs produce milder, water filtered tobacco smoke - Prevalence of hookah smoking is unclear - Major diseases linked to smoking include: lung cancer, cardiovascular disease, chronic obstructive lung disease including emphysema. - Risks increases for those who: start young, smoke many cigarettes, and continue to smoke for a long time. - Smoking is the single greatest avoidable cause of death. - Second hand smoke is cigarette smoke inhaled from the environment by nonsmokers - Components of environmental smoke include mainstream smoke and side stream smoke. - Mainstream smoke: the smoke inhaled/exhaled by the smoker. - Sidestream smoke: the smoke rising from the ash of a cigarette, more carcinogens in smoke but smoke is more diluted. - Second hand smoke health effects difficult to fully determine but include lung cancer and cardiovascular disease. - 1933: Environmental Protection Agency classified secondhand smoke as a known human carcinogen. - Smoking causes five million deaths worldwide each year - Estimated by 2030 that smoking related deaths will rise to 8 million. - Demand for American Cigarettes in Asia and third world countries has increased markedly - Smoking while pregnant increases risks of: miscarriage, low birth weight, sudden infant death syndrome (SIDS) - Several studies indicate smoking while pregnant effects on physiological and cognitive development such as neurological problems, problems with reading and math, and hyperactivity. - Nicotine is a naturally occurring liquid alkaloid that is colorless and volatile - Tolerance and dependence for nicotine develop quickly - Nicotine is highly toxic in large enough doses. - Lethal dose of nicotine is 60mg - A cigar contains 120mg of nicotine. - 90% of inhaled nicotine is absorbed - 80-90% of nicotine is deactivated in the liver and then excreted via the kidneys - Use of nicotine increases the activity of liver enzymes responsible for nicotine deactivation. - Nicotine mimics acetylcholine - Nicotine first stimulates and then blocks receptor cites. - Nicotine causes the release of adrenaline and has an indirect sympathomimetic effect - Low level nicotine poisoning symptoms: nausea, dizziness, and weakness - Acute level poisoning symptoms: tremors, convulsions, paralysis of breathing muscles, death. - CNS and circulatory system nicotine effects: increased HR, BP, O2 needed for the heart, decreased O2 carrying ability of blood. - Nicotine reduces hunger by inhibiting hunger contractions, increasing blood sugar and deadening of taste buds - Nicotine has both stimulant and calming effects - Tobacco industry claims that its products do not cause dependence - There are more than 40 million ex smokers in the U.S. - The five A’s: Ask, Advise, Assess, Assist, and Arrange. - The average smoker takes 8-13 attempts before they are successful - Chapter 15: Marijuana - Marijuana is a preparation of leafy material from the Cannabis plant that is usually smoked - Three Marijuana species: Cannabis sativa, Cannabis Indica, and cannabis ruderalis. - Cannabis sativa: used primarily for its fibers from which hemp rope is made - Cannabis indica: grown for its psychoactive resins - Cannabis ruderalis: grows primarily in Russia - THC is the primary psychoactive agent in Cannabis and is concentrated in the resin - Potency of Cannabis preparations depends on the amount of resin present - Most resin is in the flowering tops, less in the leaves - Hashish is the most potent preparation and in its purest form it consists of pure resin that has been carefully removed from the surface of leaves and stems nd - Sinsemilla is the 2 most potent preparation. - Sinsemilla consists of died flowering tops of plants with pistillate flowers, average THC content is 11% - Earliest mention of Marijuana was 2737 BC: Chinese pharmacy book - 1000 AD: Social use of the plant had spread to the Muslim world and North Africa. - 1926: series of newspaper articles linked marijuana and crine, public interest increased - 1936: all states has laws regulating the use, sale, and/or possession of marijuana - most early regulation efforts: based on concerns about use and criminal behavior, not based on direct evidence. - Marijuana Tax Act of 1937 followed the regulation-by-taxation theme of the 1914 Harrison Act - Marijuana Tax Act of 1936 state laws made possession and use of marijuana illegal - 1969: U.S. Supreme Court declared the Marijuana Tax Act unconstitutional - After the Marijuana Tax Act cost of marijuana increased significantly. - LaGuardia Report in 1944 concluded that marijuana use had less serious effects than commonly believed. - Use of marijuana increased throughout the 1950s-1960s - After smoking THC is absorbed rapidly by the blood and travels to the brain and then to the rest of the body. - After smoking peak mood-altering and cardiovascular effects occur within 5-10 minutes. - After oral administration THC is absorbed more slowly, peak effects occur about 90minutes following ingestion - THC has
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