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HSCI180 CH 10-11 Tobacco & Caffeine.docx

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Simon Fraser University
Health Sciences
HSCI 180
Julian Somers

CHAPTER 10– Tobacco History  1492 Used by Native Americans, who presented tobacco leaves as a gift to Columbus  1497 first printed report of tobacco smoking  ―took‖ = used snuff // ―drank‖ = smoked tobacco  Tobacco was adopted by the Spanish, either from an Arawak term they encountered in the Caribbean or from the Arabic word tabbaq which was used for medicinal herbs Early Medical Uses  1529 – In Europe, first prescribed for treating headaches, cold, sores on head  1535 – Jacques Cartier met Montreal natives using tobacco.  1565 – French physician Jean Nicot - cure migraines for Queen with tobacco o Plant genus (Nicotiana) and active ingredient named for him  16th and 17th C: negative effects on pregnant women  1890s: Nicotine dropped from the U.S. Pharmacopoeia Spread of Tobacco Cultivation  Two main species grown today, out of + 60 species of Nicotiana o Nicotiana tobacum: large-leaf species, indigenous to South America, widely cultivated o Nicotiana rustica: small-leaf species from the West Indies and eastern North America, less desirable  1610–1612 tobacco colony in Virginia by John Rolfe  1619 – King James declared tobacco trade a royal monopoly  1800 – Commercially grown in Canada o 3 major tobacco companies th  Imperial Tobacco Canada Ltd. (founded in the 19 century in Montreal)  Rothmans, Benson & Hedges Inc.  JTI-Macdonald Corporation o 90% grown in south western Ontario near the towns of Tillonsburg and Delhi o Many brands of Canadian cigarettes are made from 100% pure Virginia tobacco History: Changes in Product Popularity Over Time  Snuff: 18th C, smoking diminished but snuff use became widespread o Snuff was perceived as a British product, and American use declined after the Revolution  Chewing tobacco: 19th C, nearly all tobacco produced/used in US was chewing tobacco o Smoking did not surpass chewing until the 1920s  Cigars: A combination of chewing and smoking (peak 1920) o In 2008, 9% of males and less than 2% of females reported smoking a cigar in the past month.  Hookahs: large, ornate water pipes imported from Arab countries o Hookahs produce milder, water-filtered tobacco smoke  Cigarettes: Most popular form of tobacco use o Native Americans used thin reeds filled with tobacco o Popularity increase rapidly 19 C, factories appear - Habit spread widely with the advent of inexpensive machine-produced cigarettes o At the start of the 20th century, users preferred cigarettes with Turkish tobacco  1913: Camels, which had a hint of Turkish tobacco  1919: first ad showing a women smoking  1939: King-size cigarettes (Pall Mall)  1954: Filter cigarettes (Winston) – 90% of US cigarette sales  Smokeless Tobacco = chewing = moist snuff o Use increased in the 1970-8s as smokers looked alternative with a lower risk of lung cancer o Smokeless tobacco packages carry warning labels o Prevalence very low now – less than 1% for recent use, 8% ever use o Benefits = Cheaper, Easier to use outdoors (wind, ashes), More socially acceptable in, Less lung cancer o Concerns  Bad breath, spitting, disposal of quid (leftover of chewing tobacco)  Risk of dental disease / oral cancer  Contains nitrosamines and other potent carcinogens  Causes leukoplakia (whitening, thickening, hardening of tissue in mouth – precancerous lesion – tissue change that can develop into cancer) o Nicotine dependence = Nicotine absorbed through mucous membranes Tobacco Regulation Efforts  1604: King James of England published an anti-tobacco pamphlet stating that tobacco was harmful to brain/lungs Canada  1908: Tobacco Restraint Act – ban cigarette sales to those under 16 years (never enforced)  1912: The Imperial Tobacco Company incorporated to produce and market tobacco products  1920-1950 : Three golden decades for cigarette consumption in Canada  1950s: Link between smoking and lung cancer established  1974: The Canadian Council on Smoking and Health formed  Charter members include: Canadian Cancer Society, Canadian Heart Foundation, Heart & Stroke Foundation of Canada and Canadian Lung Association  Also formed Non-smokers’ Rights Association  1988-9: Federal Laws - prohibit tobacco advertising to ensure smoke free workplaces  1989: Cigarette manufacturers required to list additives for each brand  1989: Tobacco Products Control Act ( TPCA) (smoking and smokeless)  prohibited tobacco advertising  required health warnings on tobacco packaging  restricted promotional activities  1993: Federal law - raised legal age for buying tobacco to 18 years  1994: Canadian scientists find evidence of cigarette smoke in fetal hair  first biochemical proof that offspring of non-smoking mothers affected by passive smoke  1995: SCC squashed federal ban on tobacco advertising  Tobacco company launched aggressive advertising campaign   1997: The Tobacco Act imposed general restrictions on manufacturers/distributors  Restricting promotion/packaging of products.  The Canadian Council for Tobacco Control is the national organization that specializes on tobacco and health. USA  1908: New York made it illegal for a woman to use tobacco in public over  1930s-40s: Reports indicated a possible link between smoking and cancer  1952: Reader’s Digest article, “Cancer by the Carton,‖ drew attention to the issue  1964: Surgeon General‘s report states that smoking causes lung cancer in men  Tobacco sales began a decline that continued for 20 years  1965: cigarette packages required warning labels  1971: TV and radio cigarette ads banned  1989: Smoking banned on interstate buses and domestic airline flights  1995: FDA proposes to further regulate tobacco and ads  Many additional state and local bans passed Safer Cigarettes?  Mass-marketing of filter cigarettes and cigarettes with lowered tar and nicotine content  Promoted as a safer alternative but marketed in ways to avoid any implication that original cigarettes were unsafe  Lower nicotine + tar o Tar = sticky brown material seen on the filter after a cigarette is smoked o 1954 – filter cigarette, sales increase, by 1980 low nicotine/tar dominate market  Safer, but not safe = People adjust their smoking behaviour to obtain a consistent amount of nicotine (e.g., taking more puffs and inhaling more deeply)  Modern cigarette is half as strong in tar and nicotine content as a cigarette of 50 years ago. Tobacco in Movies  Based on WHO reports, about 130,000/300,000 youth smokers began smoking as a result of exposure to on screen tobacco use  Canadian youth exposed to 60% more images of tobacco than American youth  Teens with favourite stars who smoke on TV are 16x more likely to have positive attitudes about smoking Tobacco Use Canada  National estimate = 12.7% (age 12+) o Above average among those attending University in Quebec (18.3%) + Atlantic provinces (16.9%) o Lowest among those from BC (9.6%) and Prairies (8.9%)  Not related to gender or extracurricular orientation  Since 1985 smoking prevalence has decreased in all age groups o 20% of young people still become regular smokers o In 2009 the smoking rate among young teenagers was down 13% from 15% in 2008.  First nations 2005 study, current smokers = 70% age 18-45 and 82% adolescents (15-19) o Prevalence of current smoking among ages 10-19 in the Oji-Cree community of Sandy Lake, Ontario. o Rates of smoking are highest among First Nations and Inuit youth. o 3x likely to smoke o Less likely to use a smoking cessation aid such as a nicotine patch o Government is cutting back on the tax free cigarettes they can buy.  According to a drug use survey in Nova Scotia (2007), o average age for first time smoking of a whole cigarette = 12.9 years old o 28% of students in grades 7-12 reported they had smoked at least one cigarette in their lifetime. USA  Men 26% / Women 22% (Source: Centers for Disease Control and Prevention)  Percentage of smokers (by years of education) o Undergraduate degree 14% o Full time students attending college 18% o Non-college students 32% o Hthh school diploma only 30% o 8 Graders who plan to attend a 4 year college 5.5% o 8 graders who don‘t plan to attend a 4 year college 21.1% Other Countries  3 million deaths worldwide each year  Perhaps as high as 10 million by 2020  Third World demand for American cigarettes has increased markedly  Asian countries also experiencing increased demand for American cigarettes Pharmacology of Nicotine Nicotine  Nicotine = a naturally occurring liquid alkaloid that is colorless and volatile  CNS stimulant  Tolerance and dependence develop quickly  Two forms – positive charge and electrically neutral o Neutral more easily absorbed o Tobacco industry manipulates pH of product to be more non-charged, easily absorbed state  Highly toxic = Lethal dose (60 mg) - A cigar contains twice that much o Typically not delivered fast enough or in a high enough dose to be lethal  Nicotine affects dopamine like cocaine and heroin – in mesolimbic system (reinforcing effects) o After nicotine binds to the nicotinic acetylcholine receptor in the VTA ( ventral tegmental area) it results in a release of dopamine Absorption and Metabolism  Inhalation is very effective = 90 percent of inhaled nicotine is absorbed  Primary deactivated in the liver (80-90%)  Excreted through kidneys  Tolerance = Nicotine/tar increases the activity of liver enzymes responsible for nicotine deactivation o Decrease benzo/anti-depressants/analgesic drugs Physiological Effects  Mimics acetylcholine o First stimulates and then blocks certain receptor sites o Causes the release of adrenaline and has an indirect sympathomimetic effect  Symptoms of nicotine poisoning o Low-level (beginning smokers): nausea, dizziness, and general weakness o (acute) Higher-level: tremors, convulsions, paralysis of breathing muscles, death  CNS and circulatory system effects o Increased heart rate and blood pressure o Increased tendency to clot o Increased platelet adhesiveness o Increased electrical activity in the cortex o Increased oxygen need of the heart o Decreased oxygen-carrying ability of blood = Causes shortness of breath  Blood supply to skeletal muscles does not change with smoking, but regular smokers have higher amount of carboxyhemglobin (carbon monoxide and hemoglobin) – no longer carry oxygen  Reduced hunger o Inhibition of hunger contractions + Deadening of taste buds o Increased blood sugar Behavioral Effects  Nicotine is the primary reinforcing substance in tobacco  Smokers report that nicotine has both stimulant and calming effects  User expectation probably plays an important role in the effects  Some smokers sustain more attention after smoking – perhaps because they suffer from some withdrawal if not allowed to smoke Nicotine Dependence  Cigarettes and other forms of tobacco are addicting – cause by Nicotine  The processes that determine tobacco addiction are similar to those that determine addiction to drugs like heroin and cocaine Smoking cessation study  91% on assisted cessation program  8.6% unassisted (by themselves)  However * 80% of those who QUIT did so without intervention o But they not long term smoker Causes for Concern  Smoking is the leading cause of preventable death among Americans and Canadians  Every 11 minutes, a Canadian dies from tobacco use ~ 47,000 people/year  Risk increases for those who start young, smoke many cigarettes, and continue to smoke for a long time  Smoking does not do any part of the body any good, at any time, under any conditions.  Lung cancer o 85% of all lung cancers occurs in smokers o Cancer causing agent = not nicotine - but aromatics such as benzo[a]pyrene, that arise from burning tobacco - They damage DNA causing cancerous mutations. o Chronic obstructive pulmonary disease – airway swell and partly blocked by mucus, include:  Emphysema – chronic lung disease – difficulty breathing and shortness of breath  Bronchitis – inflammation of the main air passages to the lungs  Cardiovascular disease o 11,000 of these deaths are related to heart disease or stroke Second-hand Smoke  About 6300 non-smokers die in Canada each year from exposure to second hand smoke  Passive smoking = non-smokers inhaling cigarette smoke from the environment o Death of Heather Crowe= a non-smoking server whose lung cancer was attributed to occupational nd exposure to cigarette smoke – pass Smoke Free Ontario Act (protect workers from 2 hand smoke)  Sidestream smoke: the smoke rising from the ash of a cigarette - higher in carcinogens o Mainstream smoke: the smoke inhaled/exhaled by the smoker  Health effects difficult to define but include = Lung cancer, Cardiovascular disease, Other adverse health effects  US Environmental Protection Agency classified second-hand smoke as a known human carcinogen in 1993  Many laws and regulations have been passed to protect non-smokers Smoking and Pregnancy  Low birth weight = Smoker babies are 250g lighter than non-smoker babies o Dose-response relationship = more smoking = greater reduction in baby weight  Increased risk of miscarriage and SIDS (sudden infant death) o 10,000 deaths related  Later effects on physical and intellectual development o Increase risk for nicotine dependence in adolescents whose mothers smoked during pregnancy o Neurological problems, problems with certain reading and mathematical skills, and hyperactivity  Effects are of the same type and magnitude as those reported for ―crack babies,‖ and many more pregnant women smoke than use cocaine Targeting Prevention in Canada  In Canada, selling tobacco products to minors can result in fines up to $4000 for a store owner and $10,000 for a corporation for a first offence.  Cigarette packages and advertisements are required to rotate among different warning labels How to Stop Smoking  There are more than 40 million ex-smokers in the United States!  Challenges to quitting o Nicotine is a strongly reinforcing drug
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