Notes
Slide Show
Outline
1
Tobacco Facts - 2002
  • Kevin T. Kavanagh, MD FACS


  • For Best Viewing High Speed Cable Modem is Required
2
Origins of Tobacco
--Susquehanna Indian Tribe U.S.A.
  • A wood-nymph of awe-inspiring beauty approached hunters around a campfire who were eating freshly cooked venison.  She appeared to be hungry, so they invited here to join them.  In appreciation she promised that if they would return to the same place after 13 moons had passed, they would collect a reward.  When they came back they found maize growing where the wood-nymph’s right hand had touched the soil, and beans growing where her left hand had been.  Tobacco was growing were she sat..
    (Nicotiana Tabacum, Georg A Brongers, 1964.)
3
Tobacco – Use In Children
  • 80% of adult smokers started smoking before the age of 18.
  • In Kentucky, smoking is well established by the 8th grade.  Somerset High School Survey in 2002 found the average grade of starting smoking was 8.8.
  • 47% of Kentucky high school smokers reported needing a cigarette every day
    ( Kentucky Youth Tobacco Survey – 2000 )
4
Tobacco – Use In Children
5
Tobacco – Use In Children
  • Somerset High School Seniors 2002 
     N = 46  Males = 26, Females = 20
6
Tobacco – Use In Children
  • Question:  Do You Want Your Boy or Girl friend to Use Tobacco Products?
    A total of  23 current tobacco users and 23 non-tobacco users were surveyed.  No respondent answered yes.  There was no significant difference between tobacco users and non-users.
7
Tobacco - Epidemology
  • Tobacco causes more than twice as many deaths as:  Alcohol & Drugs, Homicide & Suicide, Automobile Accidents, HIV/AIDS, COMBINED
  • Tobacco kills more people in 3 years than all the US Soldiers who have died in all the wars in US History.
8
Tobacco - Epidemology
  • Leading Cause of Preventable Death in the United States
  • Causes 87% of all lung cancers, 90% of which are fatal.
  • 30% of all cancer deaths.
  • 430,000 deaths each year
9
Tobacco Health Hazards
  • Health Hazards of Tobacco and Smoking
  • Cancer
  • Emphysema and Chronic Bronchitis
  • High Blood Pressure (Nicotine is a vasoconstrictor)
  • Heart Disease and Stroke
  • Rhinitis and Chronic Sinusitis
  • Gum Disease
  • Premature Skin Wrinkling
10
Tobacco Smoke
  • 4000 Chemicals with 100 identified poisons and 63 known carcinogens.
11
Tobacco - Cancer
  • Tobacco causes 30% of all cancer deaths.
    •  Lung
    •  Larynx (Voice Box)
    •  Oral (Mouth)
    •  Esophagus (Tube from the mouth to the  stomach)
    •  Stomach
12
What the Tobacco Companies Knew !
  • 1967.   "(1)...the carcinogenic effect of smoke is not simple. It may well be a combination of initiators and promoters, a hypothesis that is well founded on other experimental evidence.
     (2) The carcinogenic effect of smoke condensate on mouse skin cannot be accounted for by the presence of benzpyrene known to be there.“   B&W Archive--1967, Document 1227.06  Page 2


  • 1971 "Cigarette smoke condensate does not produce instant tumours. The earliest tumours produced at Battelle have occurred about the 20th week of an experiment, and usually the time is about 28 to 32 weeks.  ...only 15% of the animals escaped becoming tumour-bearing during the remainder of the experiment.
     B&W Archive--1971, Document 1138.04 Page 3 and 4.
13
Tobacco – Lung Cancer
  • Kentucky is First in the nation in smoking and First in the nation in lung cancer deaths.
  • Smokers have approximately one chance in 10 of developing lung cancer over his/her lifetime.
14
Tobacco – Larynx Cancer
  • Exposure to the carcinogens in tobacco can cause permanent genetic damage in the cells and tumors can develop years later.  Fifteen of these patients were treated with a total laryngectomy, or had to have their voice box removed.
15
Tobacco – Larynx Cancer
  • I have evaluated 61 patients with invasive cancer (squamous cell carcinoma) of the voice box (larynx).  59 patients smoked.  58 patients had over a 20 pack year history of smoking (smoking 1/2 pack per day for 40 years).  Two patients had severe GE Reflux and in one patient the cause of the cancer was unknown.
16
Tobacco – Larynx Cancer
  • The average age was 64 years.  The average length of smoking was 58 pack years. 14 patients had quit smoking.  Four patients had quit more than 25 years prior to developing the cancer.
17
Tobacco – Oral Cancer
  • Smoking is by far the major risk factor for developing oral cancer.
  • The use of alcohol and smoking further increases the risk of cancer of the larynx, oral cavity, and esophagus.
  • According the American Cancer Society statistics, there were 28,000 new cases and 7,400 deaths from oral cavity and pharynx cancer in the United States in 2002.
18
Tobacco – Oral Cancer
  • Below is a picture from the New Mexico Dept of Health of a patient who had a "Jaw-Tongue-Neck" procedure.   Surgery and radiation therapy or combination of chemotherapy and radiation therapy are the treatments of choice.
19
Tobacco – Oral Cancer
  • Below is a patient undergoing a Jaw Tongue Neck Operation.  The lip is split, the neck skin and cheeks are reflected.  The Jaw, Tongue, Neck and Part of the Soft Palate can then be removed.
20
Tobacco – Oral Cancer
  • Even if treated, many cancers may recur.  In this patient, a cancer is recurring in his neck as a massive slowly growing fungating mass.  The mass will slowly erode into the carotid artery causing massive bleeding and sudden death.
21
Secondhand Smoke
  • Classified by the EPA as a CLASS A known human carcinogen that causes 3,000 cases of lung cancer and 27,000 other deaths each year.
  • --American Cancer Society--


22
Secondhand Smoke--Chemicals
  • Sidestream Smoke (Secondhand Smoke) has higher concentration of carcinogens than Mainstream Smoke.
    • N-Nitrosodimenthylamine, a potent carcinogen, is found in sidestream smoke at a concentration of 40 to 100 times that found in mainsteam smoke.
23
Secondhand Smoke
  • Nicotine is found in low concentration in Sidestream Smoke.  Tobacco companies have used this chemical to determine non-smokers exposure to passive smoke.
24
Secondhand Smoke
  • 34% increase in the risk of developing lung cancer in non-smokers.
  • More than doubles the risk of infants dying of Sudden Infant Death Syndrome.
  • 30% increase risk of heart disease in non-smokers.
  • Causes the onset of asthma in 26,000 children annually.
25
Tobacco Addiction
  • “The fashion of smoking caught on among colonists and when they were asked why they did it, their only answer was, that they could not do without it any more.”
    --Bishop Bartholomus de las Casas, 1474-1566
    (Nicotiana Tabacum, Georg A Brongers, 1964.)
26
Tobacco Addiction
  • “As the smoking of tobacco has taken very bad effect upon the health and mind of many persons, I ordered that no-one should practice the habit.  My brother Shah Abbas also being aware of its evil effects, has issued a command against the use of it in Iran.”


  • --Mogul Emperor of Hirdustan--Early 17th Century
  • Slitting of lips of smokers and the Death Penalty for Suppliers.  (The International Journal of Addictions, 1973.)
27
Tobacco Addiction
  • “...These people became so addicted to it (tobacco) like Drunkards to Wine and Beer, and they cannot lose the habit of it as by nature it warms people and dopes the brain.”
    --Emanuel van Meeeren, 1598
  • (Nicotiana Tabacum, Georg A Brongers, 1964.)
28
Tobacco Addiction
  • A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black stinking fume thereof, nearest resembling the horrible stygian smoke of the pit that is bottomless.”


  • --James I of England
  • (A Counterblast to Tobacco, 1604)
29
What the Tobacco Companies Knew !
  • 1962 "Lastly, smoking is a habit of addiction that is pleasurable..."
    B&W Archive--1962 Document 1102.02   Page 7
  • 1963 "Moreover, nicotine is addictive. We are then in the business of selling nicotine, an addictive drug effective in the release of stress mechanisms."
    B&W Archive--1963 Document 1200.05   Page 4.
  •  1967 Sir Charles Ellis is reported to have said. "We are in a nicotine rather than a tobacco industry"  
    B&W Archive --1967 Document 1006.01  Page 10 and 11
30
Tobacco Addiction
  • Only 3% of young people have long term success at quitting.  It is as hard or harder to quit tobacco as it is to quit heroin or crack cocaine
31
Tobacco Addiction
  • There are three basic steps to quitting smoking.
  • Want IT,  Plan IT, and Do IT.
  • Set a quit date and stick to it.
  • Make a list of trigger situations and have a strategy to avoid or deal with them.  Anything to keep your mind off of smoking for at least 2 mins. will often work.  Many use Physical Training or exercise for this purpose
  • Reward yourself when you don’t smoke.
  • Ask others not to smoke around you.
32
Tobacco Addiction
  • There are also a number of medications which can help the smoker quit.
  • However, they are not nearly as effective when used alone than they are in combination with counseling and support groups.
  • These medications include:
  • Nicotine Patches - Over-the-counter
  • Nicotine Gum - Over-the-counter  (Used to give a relatively rapid boost in nicotine levels to control sudden cravings.)
  • Nicotine inhalers - Prescription  (Used to give a rapid boost in nicotine levels to control sudden cravings.)
  • Zyban - Prescription (Acts on the brain to control cravings)
  • Mint Snuff Over-the-counter  A smokeless tobacco substitute.


33
Cost in $$$
  • The annual cost of tobacco use is more than $50 billion in direct medical costs, for a total of 97 billion in health care costs and lost productivity.
  • Smokers pay twice as much for life insurance and will die an average of over 12 years sooner than non-smokers.
  • Depending upon where you live in the US a habit of one pack per day can cost up to $1800 per year. Source: USMC National Health Naval Research Center - San Diego, CA
34
Tobacco Quit If You Can !!!
  • If you smoke quit.  If you don’t smoke do not start.  Your life and family depends upon it.