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Health Chapter Nine.docx

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Lawrence Murphy

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Chapter 9: Tobacco and Smoking - Tobacco smoking originated as a part of religious ceremonies for aboriginal people on Turtle Island  Peace pipes contained tobacco  Smoke from tobacco seen as taking words to the Creator  Tobacco given as gift or to honour or show respect to another person  Huron Indian story tells of woman from the Creator  Connects the physical and spiritual worlds  No records or stories of addiction - 193 farmer licenses in Ontario were responsible for 436 million pounds of tobacco in 2011 - Tax revenue from tobacco products in Canada reached $7.5 billion in 2010/11. Prevalence and Distribution - Development of cigarettes toward the end of the 19 century was followed by a rapid increase in tobacco consumption - Prevalence in developing countries is rising dramatically where there is extensive promotion of smoking by the tobacco industry - Few women than men smoke but there have been dramatic increasing in that among women and the gap is narrowing in most places - 16.7% of Canadians (approximately 4.7 million) were current smokers. - The majority of smokers reported smoking daily (13.1% daily/3.7% non‐ daily prevalence). - Although prevalence is at an all‐time low, the decline in smoking prevalence observed over the past 10 years appears to have slowed. - Prevalence was higher among males (19.7%) than females (13.8%). - Smoking prevalence was highest among young adults (age 20‐24), at 22.1%. - Substantial differences in smoking prevalence by education level persisted over the last decade, despite declining prevalence\ - A British survey illustrated that smoking is more prevalent among people on low incomes, the unemployed and those who are divorced or separated Effects on Active Smokers: - Cigarette smoking accounts for nearly 1 of every 5 deaths each year - The risk of dying from lung cancer is at least 22 times higher among men who smoke, and about 12 times higher among women who smoke compared with those who have never smoked - Carcinogens initiate a series of genetic alterations which stimulate cells to proliferate uncontrollably - A delay of several decades occurs between exposure to carcinogens in tobacco smoke and the onset of cancer (won’t get cancer for 20-30 years) - The 2004 US Surgeon General’s report on smoking and health revealed that smoking causes diseases in nearly every organ of the body - Cigarette smoking is conclusively linked to leukemia, cataracts, pneumonia and cancer of the cervix, kidney, pancreas and stomach - On average, men who smoke cut their lives short by 13.2 years, and female smokers lose 14.5 years Health Effects of Smoking on Passive Smokers - Those consistently breathing secondhand smoke (SHS) also have a higher risk of cancer, heart disease and respiratory disease, as well as sensory irritation - The Surgeon General estimated that exposure to SHS killed more than 3000 adult non-smokers from lung cancer each year, approximately 46,000 from coronary heart disease, and an estimated 430 newborns from sudden infant death syndrome - A review by the The Scientific Committee on Tobacco and Health (SCOTH, 1998) concluded that parental smoking caused acute and chronic middle ear disease in children and is associated with sudden infant death syndrome. - Also concluded that sudden infant death syndrome is associated with exposure to environmental tobacco smoke (cause and effect) Tobacco Industry Campaign of Disinformation - The tobacco industry has carried out a campaign of disinformation over decades - This campaign has deliberately sought to create doubt in the minds of legislators and the public about the effects of smoking - With the release of thousands of tobacco industry documents through litigation and the action of whistleblowers, the details of the disinformation campaign have been revealed - Analysis of tobacco industry documents on smoking and health  Nicotine and addiction: deny but knew it was addictive since 1960  Marketing to children  Advertising: say it is only used to fight for brand share, not to increase consumption  Cigarette design: promoted ‘low-tar’ when they knew it lacked health benefits  Passive smoking: refused to accept evidence of harm by SHS  Emerging markets: moved into developing countries - Concluded that tobacco industry executives deployed the concept of information to shift full moral responsibility for the harms caused by tobacco products to consumers Tobacco Promotion and the Social and Economic Context of Smoking - The US Surgeon General (1989) stated that tobacco advertising increases consumption by: • Encouraging children or young adults to experiment with tobacco and thereby slip into regular use; • Encouraging smokers to increase consumption; • Reducing smokers’ motivation to quit and encouraging former smokers to resume; • Discouraging discussion of the hazards of smoking as a result of media dependence on advertising revenues; • Muting opposition to controls on tobacco as a result of the dependence of organizations receiving sponsorship from tobacco companies; • Creating, through the ubiquity of advertising and sponsorship, an environment in which tobacco use is seen as familiar and acceptable and the warnings about its health are undermined. - Econometric studies showed that increased expenditure on tobacco advertising increases demand for cigarettes, while banning advertisements leads to reduction - Abolition of advertisements: 1) Lack of evidence to suggest that advertising significantly increases smoking 2) Tangled when politics are included (European Union supports and finances the tobacco industries but funds the ‘Europe Against Cancer’ campaign by recognizing health effects of smoking Theories of Smoking 1. Biological Theories - Nicotine, the main active ingredient in tobacco smoke, can be toxic. - In small amounts, psychophysiological effects include tranquillization, weight loss, decreased irritability, increased alertness and improved cognitive functioning. - Over time the smoker develops a physical dependence on nicotine. - Nicotine is absorbed through the skin and lining of the mouth and nose or by inhalation in the lungs - In cigarettes it reaches peak levels in the bloodstream and brain within 7-10 seconds of inhalation - Nicotine is addictive because it activates the release of dopamine in the brain - Acute effects disappear in a few minutes, causing the smoker to repeat the dose of nicotine to maintain the drug’s pleasurable effects and prevent withdrawal symptoms - Monoamineoxidase (MAO)is responsible for breaking down dopamine however these enzymes are decreased during smoking - Genetic factors could play a role in several aspects of nicotine addiction, from the tendency to begin smoking, to the chances of quitting. 2. Psychological Theory - Probably the most frequently used model of smoking is that based on learning theory, arguing that although smoking is initially physically unpleasant, this is overruled because of the social reinforcement from peers - Smoker learns to discriminate between situations when smoking is rewarded and when it is punished - Smoking can be conceptualized as an escape/avoidance response to certain aversive states (i.e., lighting a cigarette to escape uncomfortable situations) - The ‘affect management model’ identified six smoking motivation factors: • Reduction of negative affect • Habit • Addiction • Pleasure
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