Truth  Intuitive:

https://truthinitiative.org/research-resources/smoking-pop-culture/renormalization-tobacco-use-streaming-content-services

https://truthinitiative.org/research-resources/tobacco-pop-culture/played-smoking-videogames

Real Cost Campaign: 

https://www.youtube.com/watch?time_continue=3&v=7MLt73rudds

1. After reviewing the links above, reflect on the movies/shows/video games you watch/play. Do you believe what teens watch/play have an impact on whether they smoke or use vape products?

2. Do you believe you have been targeted by tobacco companies in the past?  Explain and give examples.

3. If you were to create a health promotion campaign or program on tobacco or e-cigarette prevention for youth, what messages would be in your campaign or what program would you implement. Explain.

Chapter 4 Tobacco Use Background • 1964 Surgeon General’s Report on Smoking o Definitive report that smoking caused lung cancer that changed the culture of smoking in the US • Prior to this, approximately 42% of Americans smoked; now that rate is close to 20%.  Healthy People 2020 goal = 12% • As of April 1, 2014, thirty-six states and the District of Columbia had enacted comprehensive smoke-free laws banning smoking in all workplaces, restaurants, and bars. Tobacco Use • Single most preventable cause of death and disease in the United States • The person most likely to smoke is between 15-45 years old, below the poverty level, and of low education. • Although the use of cigarettes has declined, the use of smokeless tobacco has increased. Adolescents • 80% of adult smokers begin by the age 18.  Most susceptible to tobacco marketing and easily influenced by peers and social pressure. • Rates dropped from 24% in 2005 to 19% in 2011 but still considered to be at “epidemic” levels. Smoking-Related Deaths and Illnesses Tobacco-Related Costs • Direct costs: $96 billion annually • Indirect costs: $97 billion annually  Based on 5.1 million years of potential life lost.  This does not include lost productivity related to disability, employee absenteeism, or secondhand smoke mortality. Cancer • Cigarettes contain numerous carcinogens, compounds that can damage DNA and lead to cancerous growth of cells. Cardiovascular Disease • More than one-third of all deaths from CVD can be attributed to smoking. • There is no safe level of smoke exposure.  Smoking cessation is the only way to reduce risk of CVD. • CVD occurs when arteries that deliver blood to the heart become clogged, the valves of the heart are damaged, or the heart does not pump effectively. Cardiovascular Disease • Nicotine increases resting heart rate, a possible risk for CVD • Carbon monoxide binds with hemoglobin which means the body is left with less oxygen released to the cells. • Most red bloods are produced to compensate which then creates thicker blood, which is more difficult to pump through veins and arteries. • Cigarettes smoking also reduces the amount of health-promoting antioxidants found in the body. Pulmonary Disease • When a smoker inhales on a cigarette, the smoke travels the same path as oxygen does from the mouth, through the trachea, to the upper lungs, and ultimately to the alveoli where gas exchange occurs. • Along this path, the carcinogens present in cigarette smoke damage the respiratory system. • Nearly 60% of the inhaled particles from cigarette smoke are not removed and remain in the lower lung. • The presence of these particles and tar create inflammation, which in turn creates oxidative stress from an immune response to the carcinogens. Smokeless Tobacco and Chronic Disease • Smokeless tobacco is a tobacco product that is not smoked but rather placed directly in the mouth, cheek, or lip to be sucked or chewed; the saliva is either swallowed or spit out and is commonly referred to in the United States as dip, chew, or snuff. • E-cigarettes are devices that vaporize a mixture of water, propylene glycol, nicotine, and flavorings.  Often seen as the “safe” alternative to cigarettes and used as a “harm reduction” strategy, but are not regulated by the FDA • Smokeless tobacco does still increase an individual’s risk for developing cancer and cardiovascular disease and contributes to complications during and after pregnancy as well as oral complications such as gum disease and tooth loss. Secondhand Smoke Exposure and Chronic Disease • Research indicates that secondhand smoke can result in premature death and disease in children and adults. • It is estimated that secondhand smoke exposure causes approximately three thousand deaths from lung cancer and fortysix thousand deaths from heart disease. • 43% of the population greater than 4-years old are exposed to tobacco smoke. Political and Cultural History of Tobacco Use • Evolution of warning labels  1966: “Cigarette Smoking May be Hazardous to Your Health”  1970-1985: “The Surgeon General Has Determined that Cigarette Smoking is Dangerous to Your Health”  Post-1985:  “Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy”  “Quitting Smoking Now Greatly Reduces Serious Risks to Your Health”  “Smoking by Pregnant Women May Result in Fetal Injury, Premature Birth, And Low Birth Weight”  “Cigarette Smoke Contains Carbon Monoxide”  *Most inconspicuous labels compared to other developed countries Federal Actions • Purchasing Restrictions  • Legal age for purchasing tobacco products in most states is 18; there is no law restricting the use of tobacco products, though. Taxation  Federal and state taxes on tobacco products are an important step in decreasing the numbers of users.  2009: federal tobacco tax increase from $0.62 to $1.01  State taxes range from $0.17 (Missouri) to $4.35 (New York); national average is $1.68 1998 Master Settlement Agreement • The Master Settlement Agreement (MSA) is a joint lawsuit that was settled by fortysix states in November 1998.  The settlement payout is $246 billion over twenty-five years; each state is awarded a yearly payment Recent Efforts to Reduce Tobacco Use • National Policy  Family Smoking Prevention and Tobacco Control Act of 2009  Contains over twenty provisions with a main goal of preventing and reducing tobacco use by adolescents under the age of eighteen. • State Policy  States are awarded funds each year under the MSA but these funds are not required to be used on anti-tobacco measures.  Only two states use the settlement money on anti-tobacco measures that reach the CDC’s recommended levels (North Dakota and Alaska) while 29 fund at less than 25%. Effective Programs that Discourage Tobacco Use • Healthy People 2020 • List of 20 objectives to meet the goal of reducing tobacco use and guide the formation of programs. Population-Based Strategies • Multimedia Campaigns  Truth  Tips from Former Smokers  EX • Work Site Initiatives  Quest Diagnostics  Union Pacific Railroad • School Initiatives  West Virginia Schools: Reduced high school smoking rate by 6% in two years.  South Carolina Schools: Comprehensive, community roundtable model • Community Initiatives  CDC recommends focusing on changing social norms related to smoking by advocating and initiating policy changes at the state level.  Little evidence that community initiatives alone help. • Individual Programs  Brief clinical interventions; individual, group, or telephonic counseling; behavioral counseling; and OTC and prescription medications. Challenges to Reducing Smoking • Access to Treatment  Not covered by insurance • Addictive Property of Nicotine  Quitting smoking involves overcoming physical withdrawal symptoms • Tobacco Industry Practices  Regularly lobby against tobacco tax increases, the implementation of local and state Clean Indoor Act acts, graphic cigarette warning labels, and restrictions on selling to adolescents.  Develop new products that are specifically geared to attract adolescents.

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