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Recent research available online related to Tobacco Use Rates and/or colleges: Harvard School of Public Health National Social Norms Research Center CDC State Level Data on tobacco use Monitoring the Future Facts about Tobacco Use and Addiction Tobacco, nicotine and addiction: More than we knew before Although we know a lot about nicotine and tobacco, there is still much that we don't know. In 1989 the U.S. Surgeon General issued a report that concluded cigarettes and other forms of tobacco are addictive and that nicotine is the drug that causes the addiction. Nicotine is only one of more than 4,000 chemicals and dozens of carcinogens released during the use of tobacco products such as cigarettes, cigars, pipes, smokeless tobacco, bidis and cloves. What's in cigarette smoke? More than 4,000 chemicals including: |
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Cancer causing agents Nitrosamines Crysenes Cadmium Benzo(a)pyrene Polonium 210 Nickel P.A.H.s Diberiz Acidine B-Napthylamine Urethane N. Nitrosonornicotine Toluidine Metals Aluminum Zinc Magnesium Mercury Gold Silicon Silver Titanium Lead Copper |
And more Acetone (Nail Polish Remover) Acetic Acid (Vinegar) Ammonia (Floor/Toilet Cleaner) Arsenic (Poison) Butane (Cigarette Lighter Fluid) Cadmium (Rechargeable Batteries) Carbon Monoxide (Car Exhaust Fumes) DDT/Dieldrin (Insecticides) Ethanol (Alcohol) Formaldehyde (Preserver of Body Tissue and Fabric) |
Hexamine (Barbecue Lighter) Hydrogen Cyanide (Gas Chamber Poison) Methane (Swamp Gas) Methanol (Rocket Fuel) Napthalene (Mothballs) Nicotine (Insecticide/Addictive Drug) Nitrobenzene (Gasoline Additive) Nitrous Oxide Phenols (Disinfectant) Stearic Acid (Candle Wax) Toluene (Industrial Solvent) Vinyl Chloride (Makes PVC) |
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Recent research seems to indicate that more than nicotine is addictive in tobacco use. Independent of nicotine, smoke seems to change people's anti-depressive enzymes in the brain. This may be one reason women, who typically suffer more than men from depression, seem to have a harder time quitting with just the nicotine replacement patch. We are only beginning to learn about how the many chemicals in tobacco affect human behavior. Many things to many people While nicotine is classified as a stimulant, it seems to have a number of complex and sometimes unpredictable effects on the brain and the body. Although nicotine stimulates or raises the heart rate and blood pressure of users, chemical changes in the brain may or may not be perceived as stimulating. John Rosecrans Ph.D., nicotine researcher at VCU's Medical College of Virginia, calls nicotine a "normo-stat." Rosecrans says, "Nicotine causes some people to feel more alert and others to feel drowsy and relaxed. Nicotine can take you up when you are down or down when you are up." This variable effect has to do with where and how nicotine acts in the brain. While nicotine can regulate people's moods one way or the other, each exposure to nicotine causes the brain to change nerve endings and to build more molecular receptor sites for nicotine (or to "up-regulate" in scientific jargon). Up-regulation changes where "normal" is for that person. The cycle is repeated puff after puff. In a fairly short period of time, the person has to use nicotine to feel "normal." If smokers switch to a brand with less nicotine, they subconsciously try to reach their usual nicotine level by inhaling more deeply and holding the smoke longer. Regular smokers often do not experience the "buzz" of smoking. Most addicted smokers continue to smoke simply because they feel so bad if they don't. Curing withdrawal motivates most tobacco use. Seventy percent of current smokers would quit right now if they could. Unfortunately, nicotine withdrawal causes irritability, headaches, hostility, frustration, loss of concentration, decreased heart rate and increased appetite. Studies show that it is not just nicotine that causes people who stop to restart. Tobacco use causes millions of behavioral associations in the brain. Nicotine delivery: "Trapped like a rat in a cage" Smoking is an amazing drug delivery system. It gets the drug to the brain in just a few seconds, much faster even than injecting drugs. The use of nicotine is immediately "paired" with whatever is going on in the environment at the time. In essence, smokers become like Pavlov's dogs or experimental rats in a cage. A pack-a-day smoker experiences 70,000 hits or pairings per year. Pairing causes environmental cues to trigger a craving for nicotine. Simple paired activities like drinking a cup of coffee, sitting in the car, finishing a meal or having a beer cause brain changes that induce craving. The smoker's nicotine receptors cry out, "Feed me, feed me!" Pavlovian pairings with "hits" of nicotine over time Based on an average of 10 drags (or hits) per cigarette |
| Pairings per day | Pairings per month | Pairings per year | |
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1/4 pack (5 cigs) 1/2 pack (10 cigs) 1 pack (20 cigs) |
50 100 200 |
1,500 3,000 6,000 |
18,250 36,5000 73,000 |
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"I only smoke when I party" College students who "only smoke occasionally" are amazed how hard it is to quit smoking. Even if they only smoke when they drink or socialize, the brain is changed. For example, an occasional smoker using a half pack when out drinking, experiences 100 "hits" and chemical pairings of alcohol and tobacco in one evening and within a month, 800 chemical pairings. The brain gets used to that pairing and up-regulated nicotine receptors cry out in displeasure when the association is missing. It is easy to see how stopping even occasional use can be very tough. There is also new research that seems to indicate there is a synergistic effect with tobacco and other mood altering substances. For whatever reason, biologic or sociocultural, smokers are more likely to use other substances. Students who use tobacco are more likely to be using other substances as well. Nicotine as addictive as heroin. Huh? At first, it doesn't seem possible. Heroin causes a powerful change in brain chemistry while the nicotine buzz is minimal in comparison. So how can people say that nicotine is as addictive as heroin? Addiction occurs because of a variety of brain change factors. While heroin causes a powerful reinforcing high that is repeated relatively infrequently, nicotine is a mild buzz that is repeated hundreds of times per day. The mechanisms are different but the end results are the same. Ninety percent of regular users of heroin and nicotine become addicted and relapse rates are the same for heroin and nicotine. Both drugs are very hard to quit, but for different chemical and behavioral reasons. Did you notice that the paragraph above stated that 90% of regular users of heroin and nicotine become addicted? What happened to the other 10%? One of 10 people can use heroin or tobacco occasionally and not become addicted. These people have been called "chippers." Genetics and nicotine addiction: What's in your family tree? "Chippers" The term "chippers" was used originally to describe the one in 10 who used heroin and didn't become addicted. More recently the term has been used to describe people who use tobacco at low levels for many years. A chipper is the occasional social smoker, or the light daily smoker who uses for years. Unlike nine out of 10 smokers, chippers don't seem to progress to addicted use. Chippers can take or leave cigarettes. They don't seem to suffer from withdrawal when not using. While scientists don't understand fully why chippers can do this, they do know that being a chipper runs in families. Being an addicted smoker also runs in families. Remember that old saying, "The apple doesn't fall far from the tree?" Smokers who come from families of addicted smokers may look like occasional users when they start, but if they persist in using tobacco, in a matter of a few weeks, months or years, they are likely to follow others on their genetic tree who have become addicted. Unfortunately, it is only the genetically rare chipper who escapes this fate. "The nicotine gene" and your genetic roll of the dice Smoking is a very complicated behavior and none of us are entitled to be judgmental of others. We live in a culture that has advertised and glamorized the use of tobacco products and where the majority of tobacco users begin using before they can do so legally. We also live in a society where 60-80% of people have "tried" or taken at least a puff on a cigarette. About half of students who try cigarettes walk away from them early in their experimentation. The other half go on to become regular or addicted users. Why do some people walk away and others get hooked? The answer is complicated. It may be explained partially by group norms, personal values, cost or policies. Recently scientists have found that part of the answer lies in a person's genes. Smoking just "clicks" better genetically and biologically for some people than for others. When we are born, each of us gets a genetic roll of the dice. New research indicates that some individuals have greater resistance to nicotine addiction if they have a defective gene that decreases the function of the enzyme CYP2A6. The decrease in CYP2A6 slows the breakdown of nicotine. Nicotine at certain levels is a lethal poison. Nicotine at even low levels can cause people at first use to feel nauseated and sick. People with two defective genes have inadequate enzymes to rapidly break down nicotine and they feel much sicker than the average person. The 20% of the population has defective genes for the enzyme CYP2A6 finds nicotine exposure very unpleasant, and they do not go on to get addicted. These people aren't morally or intellectually superior to their friends who are addicted. They were just born with a body that made them dislike nicotine. They were, in essence, given a lucky roll of the genetic dice. Early enjoyment or dislike of tobacco can give a person an indication as to how addictive it might be for them. If nicotine clicks with your body's chemistry, you may be looking at smoking for a lot longer than you ever planned. Most students think they will smoke for only a short time but then find out quitting isn't so easy. One researcher using data from England wrote a paper titled, "The nicotine addiction trap: A forty year sentence for four cigarettes." His data shows that a person who smokes 4 full cigarettes, has a 90% probability of smoking for the next 40 years. In this country, researchers have found that 50% of those who smoke as adolescents will smoke for at least 16 to 20 years. Colleges and the smoking uptake continuum: Who are the "smokers"? How did they get there? And why does it matter? Smoking and tobacco-use uptake are very complex behaviors. As can be seen from the chart below, becoming a "smoker" is not something that happens at one point in time. Becoming a "smoker" is a process that occurs on a continuum. The continuum begins at the psychological and attitudinal level of non-use, transitions through psychological preparation to try and trying, increases into experimentation, escalates into regular use and then ultimately reaches addicted use. College professionals need to appreciate this complexity if they are to develop effective strategies to deal with tobacco use reduction. Although complex, the research and research terms are useful to college professionals in designing and understanding surveys and assessment tools. When developing policies and when creating prevention and cessation interventions, terminology is important. Measuring smoking behavior in youth is fraught with complexity because it is a variable process. At any point, youth may exit or reenter the process. Many young people try a cigarette (up to 70.2% of high school seniors had tried cigarette smoking according to the 1997 Youth Risk Behavior Survey collected by the CDC18). However, many youth never get past the first few cigarettes. CDC estimated that 33-50% of those who tried smoking cigarettes escalated to regular patterns of use. As can be seen in this chart, there are several "risk factors" associated with progression through the continuum. College professionals need to be aware of how the living and learning environments they create either inhibit or promote the process through this continuum. Norms and lax policies can contribute to increased experimentation with tobacco and more regular use. Caution in defining a smoker At what point on the continuum does a person become a "smoker"? The answer probably will never be completely resolved, but in general the CDC considers people to be smokers if they answer "yes" to the following two questions: "Have you smoked at least 100 cigarettes in your life?" and "Do you currently smoke cigarettes?" By the time a person has smoked 100 cigarettes there is a very high likelihood that he/she will continue to smoke for years to come. College students, however, will label themselves "non-smokers" long after they have passed the 100-cigarette mark. Caution needs to be used in how survey questions are asked and interpreted. Research distinguishes many categories of smoking behavior. When reading research articles, it is best to focus on how that author or agency defines what is measured. Typically, a discussion of "how many college students smoke," a prevalence measure is the reference. In other words, a current smoker would be any student who responded that he/she had smoked at least one cigarette in the last 30 days. Note that this is different than the CDC's definition of a smoker and would include someone who only tried one cigarette that particular month and never plans to smoke again. Not to make a mountain out of a mole hill, but understanding the uptake of smoking and the terms used to study it is crucial in understanding your population and any changes in behavior. For example, one university administrator conducted a study and found that "less than 10% of our students are smokers." In reality, the smoking rate on their campus was probably closer to the mid-20% range, similar to other universities. The misunderstanding occurred because the survey simply asked students if they were: smokers, occasional smokers, non-smokers or ex-smokers. Only 10% checked "smokers," but another 15% checked "occasional smokers." The extra 15% probably would have easily met the CDC definition for a smoker. Yet the administrator believed that only 10% of his students were "smokers," because that's how they labeled themselves. Different types of tobacco Cigars: What's in a name? Hint: It's the wrapping. The U.S. Department of Treasury20 defines cigars and cigarettes as follows:
The many types of cigars vary greatly in size and tobacco content. There are little cigars with filter tips, small cigars with plastic mouth pieces, regular cigars and premium cigars. In recent years, more and more of the large premium cigars are being sold. Most popular brands of cigarettes are 85 mm long and contain less than one gram of tobacco. Large cigars vary, but the most common ones are 110-150 mm long and contain between five and 17 grams of tobacco. It takes cigarette smokers only five to 10 minutes to finish a cigarette while cigar smoking can last for hours. Tobacco used in cigars is prepared differently from the tobacco used in cigarettes. The type of tobacco used, how it is cured (either air-cured or flue-cured) and how it is fermented and treated with chemicals all make cigars different from cigarettes. Cigar tobacco has a higher pH, which allows nicotine to be absorbed readily in the mucous membranes of the mouth. Cigarette smoke is more acidic so the nicotine is not readily absorbed in the mouth. Cigarette smokers must inhale in order to get nicotine. Although most students don't use cigars or at least don't use them regularly, cigar use in the United States has increased dramatically since 1993. Data on sales of cigars have gone up 50% since 1992 when the magazine "Cigar Aficionado" began publication. Before the early 1990s, cigar use was primarily by older males. Rates have been increasing in younger males and among females. While most college health surveys have not addressed the issue of cigar use, national data from a Robert Wood Johnson Survey on cigar use in the past year among adolescents in 1996 found a percent pre-valence of 37.0 + 2.4 in males and 16.0 + 1.3 in females. In contrast to cigarettes, which are more likely to be used by those with lower educational levels, "much of the increased use of cigars by adults appears to be occurring among those with higher incomes and greater educational attainment." Cigars have been marketed with an associated image of power and prestige. Image and reality often are two different things. As one Newsweek reporter noted, cigars may be, "the most expensive, least healthful way yet devised to ruin a perfectly good set of drapes." How bad are cigars? When all else fails, use common sense. This is a complicated issue. Cigar smokers have some lower health risks than cigarette smokers and some higher risks. The amount of risk incurred is related to the product used, the amount and frequency of use, how much and how long the person inhales, how often and how long the mucous membranes are exposed and the biology/genetics of the individual. Simply put, lighting organic matter and sucking on it and/or inhaling it into the lungs produces irritation and harm to the human body. Cigar smoke can cause oral, esophageal, laryngeal and lung cancer. Obviously if those who use cigars don't inhale they will be at a lower risk for lung cancer and lung disease than smokers who do inhale. However, just holding tobacco in the mouth increases risk for cancer of the mouth, tongue and larynx. These risks are amplified if you drink alcohol while you use tobacco. The abrasive particles in the cigars outer wrapping also erode teeth and gums. A large cigar can contain more tobacco than a whole pack of cigarettes and is richer in noxious combustion products. If you want all the facts, check out the Monograph 9 "Cigars: Health Effects and Trends" published by NIH, NCI. Double whammy: The risk of "mixed smokers" While cigarette smokers inhale, most cigar smokers do not. Of special concern are those individuals who are "mixed smokers." Mixed smokers are either current smokers of both cigar and cigarettes or those who switch to smoking cigars from smoking cigarettes. These individuals are much more likely to have health problems such as lung cancer and heart disease related to cigar use because they continue to inhale smoke when they smoke cigars. In essence, they expose their bodies to a double whammy - both the mouth and the lungs become sites for tobacco concentration. This puts them at much higher risk for all the major smoking-related diseases than are cigar smokers who have never smoked cigarettes. ETS and cigars All tobacco smoke contains 4,000 compounds and dozens of carcinogens. However, because of their greater size and mass, cigars generate much higher levels of indoor pollutants. Because of their chemical composition, they make more pungent and ammonia-laden odors. A medium-size cigar emits as many respirable particles as five cigarettes and as much carbon dioxide as 25 cigarettes. Smoke from a single cigar burned in a home can require five hours to dissipate. Smokeless tobacco: The spitting image Who uses it? Survey data show that smokeless tobacco use has increased dramatically in teenagers since the 1980s. While college athletes are much less likely to smoke cigarettes, they are much more likely to use smokeless tobacco products. Typically, college baseball team members or those athletes who have played baseball sometime in their athletic careers are at increased risk. Certain areas of the country, such as the South, also may have increased prevalence. The 1995 CDC College Health Risk Behavior Survey found that 11.7% of males and 0.3% of females had used smokeless tobacco in the past 30 days. White students were more likely to use than African-American or Hispanic students. Types of smokeless tobacco Typically, tobacco companies manufacture "starter" products that contain more sugar, flavorings and less nicotine. These starter products allow people to build a tolerance to nicotine and provide a "sweeter," easier-to-accept taste. Users then "graduate" to other stronger products as tolerance builds. The stronger products have high amounts of nicotine. Most users park a "dip" or a "chew" in their mouths, usually in the cheek or alongside the gums. Saliva mixes with tobacco to release nicotine and other chemicals. Users "spit" out the saliva mix. Nicotine is absorbed directly through the mucous membranes of the mouth - the spit is not meant to be swallowed. However, obviously some spit is swallowed and the amount varies by user. Types of smokeless tobacco
Smokeless tobacco or cigarettes- which is more dangerous? There is no simple answer to this question. Tobacco use is a matter of relative risk. As with any substance, the amount of damage caused to an individual is related to quantity and frequency of use combined with the individual's genetic and biological makeup. The myth exists that smokeless tobacco is a "safe" alternative. While it may be "safer" in some ways, it is more dangerous in others. It essentially becomes a matter of "picking your poison." Relative risk has to do with how the tobacco is used and taken into the body. Tobacco smoke is more likely to cause lung problems and problems related to the combustion of organic matter. Smoking causes exposure to carbon monoxide and other chemicals and is associated with a wide variety of systemic problems such as heart attacks, strokes, stomach ulcers, impotence and wrinkles. While smokeless tobacco users do experience less premature death than smokers, there are still several significant health consequences related to its use. Smokeless tobacco problems are more directly related to how the tobacco and toxic additives irritates the mucous membranes of the mouth, gums, teeth, throat and the stomach. Highest risks for smokeless tobacco use include oral cancers, cancer of the larynx, and tooth loss. Leukoplakia (pronounced loo-ko-play-kia) Leukoplakia are white patches or sores in the mouth that form where tobacco irritates the mucous membranes. Leukoplakia can develop into cancer. It is not unusual to find leukoplakia in the mouths of college students who use smokeless tobacco. Complete oral exams on a regular basis are necessary for all users. Addiction and the high nicotine content of smokeless tobacco Experts working with cessation agree that it is even harder to help smokeless tobacco users quit than cigarette smokers. No one is sure why, however the average "pinch" of smokeless tobacco contains much more nicotine than the average cigarette. In addition, the amount of nicotine each smokeless user gets varies depending upon in how much juice one accidentally swallows. All in all, it can add up to a lot of nicotine. The use of the patch and the gum have been less effective for cessation in smokeless tobacco users than for smokers. New studies are underway looking at using larger amounts of nicotine replacement and using the smoking cessation pill for smokeless tobacco users who want to quit. Elbert Glover PhD. is an expert resource in this area. [Tobacco Research Center, West Virginia School of Medicine, The Cancer Center, 1 Medical Center Drive, Morgantown, WV 26506, (304) 293-6988] Resources specific to smokeless tobacco cessation. Book: Enough Snuff: A Guide for Quitting Smokeless Tobacco by Herbert S. Severson Ph.D., Eugene OR, Rainbow Production. 1994 Pamphlet: American Cancer Society's "Beating the Smokeless Habit" Menthol cigarettes Menthol in cigarettes has a cooling effect. This allows smokers to inhale more deeply and to hold the smoke longer. As a consequence, smokers who use mentholated cigarettes are relatively more likely to experience health consequences compared to other cigarette users. Menthol cigarettes are of special health concern to African-American students, because 75% of black American smokers smoke menthol cigarettes compared to 25% of white American smokers. It is easy to see this reflected in the amount and type of advertising for menthol cigarettes. The target market is fairly obvious. Bidis (also spelled beedies and pronounced BEE-deez) No data could be found on the use rate of bidis at the college level. Bidis are hand-rolled shredded tobacco wrapped in tendu leaves and tied with a string. These stubby little brown sticks resemble and smell like marijuana. Bidis originated in India and in that country are called "the poor man's cigarette." Bidis come in a variety of flavors including vanilla, cherry, licorice and menthol. Bidis contain more nicotine than cigarettes, so yes, they can cause addiction. Clove cigarettes Different from bidis, cloves are cigarettes made from tobacco that has been sprayed in clove oil. Students often think cloves are a "safe" alternative to cigarettes and that they don't contain tobacco. This is a myth. Cloves contain large amounts of tobacco and unfiltered organic matter. No matter what it looks like, smells like or tastes like, if it contains tobacco, it can be addictive. Even if it is not addictive, setting organic matter on fire and inhaling it causes health problems. Blunts To put it bluntly, using these just "ain't too bright." The slang term "blunt" refers to cigars that have had some or most of the tobacco removed from the center and then replaced by marijuana and/or other substances such as cocaine, angel dust or heroin. A smoker using blunts exposes his/her body to not only unfiltered tobacco with an alkaline pH, but also unknown types and amounts of chemicals. Quality control on blunts is non-existent and so health risks are anyone's guess. Environmental tobacco smoke (ETS) (Also called secondhand smoke and passive smoke) ETS or "secondhand smoke" is a combination of sidestream smoke (the smoke that comes from burning tobacco) and mainstream smoke (the smoke that is exhaled from a smoker). When a cigarette is smoked, about half the smoke is given off to the environment and never goes through the smoker. The average cigarette burns for eight to 10 minutes. The average cigar burns for hours. A health hazard More than 4,000 chemicals have been identified in ETS including dozens of known carcinogens. Some of these compounds are tar, carbon monoxide, hydrogen cyanide, phenols, ammonia, formaldehyde, benzene, nitrosamine and nicotine. The Environmental Protection Agency (EPA) firmly maintains that the bulk of scientific evidence demonstrates that secondhand smoke causes lung cancer and other significant health threats to children and adults. (EPA report "Respiratory Health Effects of Passive Smoking" EPA/600/6-90/006F). This report "as peer-reviewed by 18 eminent, independent scientists who unanimously endorsed the study's methodology and conclusions. In 1992, the EPA released a report that classified ETS as a Group A carcinogen in a category reserved only for the cancer-causing agents most dangerous to humans. ETS is associated with increased risk for lung cancer, heart disease, asthma, allergies, respiratory infections and sudden infant death syndrome (SIDS). Even by modest count, passive smoking still kills more people than all airborne pollutants regulated by the EPA except asbestos. The EPA estimates that 3,000 lung cancer deaths related to ETS occur annually in non-smokers. An expensive and offensive nuisance ETS isn't just a health problem. ETS is an expensive, irritating and foul-smelling nuisance. Even smokers hate the effects of secondhand smoke. Smoke permeates clothes, hair and furniture. It stings the eyes, irritates mucous membranes and makes the environment and objects smell bad. ETS can damage furniture, walls and draperies. Ashes can burn holes in carpets, upholstery and other surfaces. Dry cleaning, laundry, painting and repairing damaged surfaces gets expensive, and non-smokers often pay the price. In 1986, the Surgeon General said, "The rights of smokers to smoke ends where their behavior affects the health and well-being of others; the choice to smoke cannot interfere with the non-smokers right to breath air free of tobacco smoke." Often the issue gets down to understanding the right of smokers to smoke and the right of non-smokers to breath and live without extra irritation and cost. It has been said, "Your rights and your freedoms stop at the end of my nose." Smoke transgresses the privacy of nasal passages. Just as you have a right to be protected from physical assault, you have a right to be protected from the physical assault of toxic chemicals and obnoxious odors. |
| Updated: August 2001 Content Provider: Linda Hancock Maintained by: Communications Office Design by: Bryan Keplesky VCU HOMEPAGE |