# Presentation: 564307

## Tobacco 101 Presentation

- Marcia Brown-Machen, M.P.H.
- Program Director

- City of Berkeley Tobacco Prevention Program
- (510) 981-5330

**Notes:**
Purpose of presentation: to present some information on the consequences of using tobacco and to talk about why people use tobacco. The goal of this presentation is not to judge anyone about using tobacco. We know that it is a personal decision that everyone needs to make themselves. 

## Consequences of Tobacco-Use: Preventable Causes of Death

**Smoking 400,000**

**Accidents  94,000**
**2****nd**** Hand Smoke 38,000**
**Alcohol  45,000**
**HIV/AIDS  32,600**
**Suicide  31,000**
**Homicide  21,000**
**Drugs  14,200**

- Consequences of Tobacco-Use: Preventable Causes of Death

**Notes:**
Coincides with BB presentation: use script from original Tobacco 101 presentation
“If you add smoking and SHS, it equals 438,000. If you add up all the non tobacco-related causes, it equals 1⁄2 of the people from tobacco-related. Given these numbers, helping people quit or reduce SHS exposure needs to be a health priority. Half of all teens who start to smoke will die of tobacco-related disease.”

## Tobacco Kills More Americans Each Year Than Alcohol, Cocaine, Crack, Heroin, Homicide, Suicide, Car Accidents, Fires and AIDS combined:

*(Chart of health effects- to be scanned in)*

**Notes:**
Causes of death chart

## What are the tobacco-related diseases that are contributing to all these deaths?

**Notes:**
Gather audience responses

## Tobacco use: The single largest cause of preventable death. 

**Tobacco use: The single largest cause of preventable death.**

**Notes:**
Tobacco use is the single largest cause of preventable death. Every person who begins smoking is guaranteed to experience negative health consequences- from reduced lung function to premature death. Worldwide, smoking causes an estimated 5 million deaths from the following conditions every year:

## Arteriosclerosis & Atherosclerosis: 

*Healthy artery*

*Damaged artery*

**Notes:**
Nicotine affects fatty acids in the blood, increasing the overall blood cholesterol level. When cholesterol is too high, a hard substance called plaque builds up on the inside walls of the blood vessels. This condition is known as atherosclerosis. Plaque can clog the blood vessels, forcing the heart to pump harder. Smoking also constricts the arteries, leading to arteriosclerosis, or hardening of the arteries. These conditions greatly increase the risk for heart attacks or strokes.

Arteriosclerosis (hardening of the arteries) is a major cause of heart attack and stroke. Smoking speeds up the development of arteriosclerosis. The lower left photo shows the smooth inside surface of a normal blood vessel. The photo to the right of  it shows the rough inside surface of a diseased artery. The upper right photo shows an artery clogged with a fatty substance.

## Heart Attack: 

***Quitting smoking rapidly reduces the risk of coronary heart disease***

*Torn heart wall: R**esult of over-worked heart muscle*

- Smokers are twice as likely as Nonsmokers to have a heart attack

**Notes:**
A heart attack is when the heart is damaged by a sudden lack of blood flow to the heart muscle. This happens because the arteries to the heart muscle become narrowed or blocked. Nicotine in cigarette smoke causes blood vessels to become narrow, reducing the oxygen supply to the heart muscle. This may be why smokers are more likely to have heart attack than nonsmokers. 

Nicotine increases a smoker’s heart rate minutes after he or she first inhales. Nicotine also causes the arteries to become narrower every time a person smokes, contributing to high blood pressure. The carbon monoxide found in cigarette smoke reduces the amount of oxygen in the blood, causing the heart to work harder and provide the body with a sufficient oxygen supply. Carbon monoxide also strains the heart by damaging the linings of the blood vessels and contributing to arteriosclerosis. An increased heart rate combined with higher blood pressure can lead to a fatal heart attack
This arrow points to a hole in the heart wall. Smoking weakens the heart and increases blood pressure while contributing to clogged and constricted arteries. Severe damage like this may occur.

## Peripheral Vascular Disease 

**Notes:**
Peripheral vascular disease, or PVD, is caused by the gradual narrowing of the arteries in the arms and legs. Smoking greatly increases the risk and severity of this disease by contributing to atherosclerosis in these tiny arteries. PVD causes painful cramping during exercise, numbness and tingling, and weakness in the affected limbs. Disability may result as the risk of infection or amputation increases. The narrowing of the arteries that causes PVD also causes impotence,wrinkles and dental problems.

## Stroke:

*This brain shows stroke damage, which can cause death or severe mental or physical disability*

**Notes:**
A stroke occurs when an artery becomes clogged or bursts. Strokes can cause paralysis, brain damage, or death. Hardened arteries, high blood pressure, and clotting problems- all of which can be cause by smoking – increase the risk for strokes. The dark red area in the photo is where bleeding occurred. 

## Emphysema: 

*Healthy lung*

*Emphysematic lung*

_**Symptoms Include**_
**Shortness of breath**
**Chronic cough**
**Wheezing**
**Anxiety**
**Weight loss**
**Ankle, feet and leg swelling**
**fatigue**

**Notes:**
	Your lungs have thousands of delicate air sacs- alveoli (air sacs). tiny, soft structures surrounded by very small blood vessels. In these air sacs, carbon dioxide gases from the body are exchanged for fresh air from the outside. Emphysema damages these delicate air sacs, and they lose their ability to exchange air. With damaged air sacs, you cannot get enough air to breathe, and always feel that you cannot catch your breath. Emphysema takes years to develop, but the damage cannot be undone. Cigarette smoke is the most common cause of the disease. The photo on the left shows a clean lung. The black specks are from having breathed smoggy air. Compare the smooth surface of this lung with the rough, ugly surface of the lung with emphysema, on the right. Note the hollow bubbles in what was once healthy lung tissue. Are cigarettes worth this kind of permanent damage to your lungs?
	Tars in cigarette smoke cause irritation and reduce elasticity in the alveoli. As a result, the lungs lose their ability to transfer oxygen to the bloodstream- a condition called emphysema. People with emphysema cannot completely expel air, causing chronic shortness of breath. Although some treatments can ease the symptoms of emphysema, there is no cure and the damage is irreversible. Question: Is smoking worth this permanent type of damage to your lungs?
Activity #1: Straw Activity
Tell the group that to help demonstrate how hard it is with someone with emphysema to breathe, you are going to pass around STRAWS. (Pass straws around). When you get your straw use one hand to hold it in your mouth while you squeeze your nose shut. Take at least ten breaths. As you can see, breathing becomes very difficult. Imagine not being able to remove the straw, to not even be able to climb a flight of stairs without losing your breath. Again, is smoking really worth the risk?
Activity #2: Pass lungs around
Point out the small holes caused by hot air entering the lungs and popping the delicate, tiny air sacks within the lung, called the alvioli. POP BUBBLE WRAP TO DEMONSTRATE HOW THESE LITTLE, IMPORTANT AIR SAKCS GET POPPED WITH THE INHALATION OF ANY HOT SMOKE INTO THE LUNGS. When this happens, it’s very, very difficult to get enough air to breathe.

## Lung Cancer:The uncontrolled growth of abnormal cells in one or both lungs

*Lung cancer kills more people than any other type of cancer*

**Notes:**
Smoking causes more than 80% of all cases of lung cancer. While a tumor in the lung sometimes causes symptoms such as coughing up blood or difficulty breathing, there are often no symptoms of lung cancer until it is advanced. By the time it is detected, lung cancer often has spread to other places in the body, including the bones, liver, brain, and adrenal glands. The photo on the far left is a model of a cancerous lung. Pictured on the far right is a real lung, with the grayish-white bumps on and in the lung being cancerous growths. It is the tars and carcinogens in cigarette smoke that cause tumors to develop. 

## Fetal Damage: 

_*Fetal Smoking Syndrome:*_
*Birth defects*
*Premature stillbirth*
*Low birthweight*
*Prone to Sudden Infant Death Syndrome*
*Lowered immune capacity*

**Notes:**
During pregnancy, everything a mother takes into her body is shared with the fetus- including tobacco smoke. Carbon monoxide in the tobacco smoke prevents the fetus from getting enough oxygen. Women who smoke during pregnancy have an increased risk of pregnancy complications, stillbirth, and miscarriage. Babies who are born to women who smoke have an increased risk of birth defects, premature birth, low birthweight, and are more prone to sudden infant death syndrome (SIDS). Maternal smoking weakens the child’s lungs and can lead to an increase in illness. Even after infancy, children whose mothers smoked while pregnant are more likely to have conduct or learning disorders, lack self-control, or be hyperactive.

## Laryngeal Cancer

_*Symptoms:*_
*Persistent hoarseness*
*Chronic sore throat*
*Painful swallowing*
*Pain in the ear*
*Lump in the neck*

*Over 80% of deaths from laryngeal cancer are linked to smoking*

**Notes:**
The larynx – or voice box – is located above the esophagus. Not only is the larynx necessary for speaking, but is also protects the lungs. Advanced cases of laryngeal cancer sometimes require surgical removal of the larynx; patients are then fitted with an electronic voice box. Depending on how much a person smokes, the risk of laryngeal cancer is up to 35 times higher for a smoker than a nonsmoker. 

As cigarette smoke is breathed in, it passes down the throat, through the larynx (voice box) into the lungs. This exposes the voice box to poisons in the smoke, poisons that can cause cancer. If cancer develops in the voice box, the voice box must be removed. The upper left photo shows a voice box with cancer as the bumpy area in the middle. 

## Dental Problems: 

- _Dental Problems: _

***Above******: Cavities***
***Below:****** Gingivitis***

*Overall poor oral health*

*Common Consequences:*
*Stained teeth*
*Gum inflammation*
*Black hairy tongue*
*Oral cancer*
*Delayed healing of the gums*

**Notes:**
Gum diseases such as gingivitis and periodontitis cause the gums to swell and bleed easily. Pockets of plaque between the teeth and gums can cause tooth decay and lead to tooth loss. People who smoke lose more teeth than people who don’t smoke. Teens who smoke are three times more likely to develop gum disease by the time they are 25 than  people who do not smoke.

## Consequences of chewing tobacco:

*Leukoplakia*

*Oral cancer*

**Notes:**
Leukoplakia is a condition which, in the mouth, can develop into cancer. Cigarette smoke – and smokeless tobacco – can cause this dangerous condition. The photo shows leukoplakia as the white patch on the inside of the cheek, between the teeth. 

Oral cancer occurs in or on the mouth, lips, tongue, and lining of the cheek. Oropharyngeal cancer occurs in the throat, or oropharynx. This includes the tonsils, base of the tongue, and the back of the throat. Around 90% of all cases of these types  of cancer are directly related to the use of tobacco products. These cancers can be treated, but the surgery to remove the tumors often leaves the patient disfigured. As many as 25% of all oral cancer patients die due to late detection and treatment. 

The sore on the tongue on the right hand side photo is cancer. It will spread unless it is removed. 

## Secondhand smoke: 

**Notes:**
Both smokers and non-smokers experience eye irritation, sore throats, headaches, nausea, and dizziness when exposed to cigarette smoke. Exposure to secondhand smoke can also cause nonsmokers to experience the same devastating health effects as smokers- including cardiovascular disease, lung cancer, and COPD. Secondhand smoke contains twice as much tar and nicotine as that which is inhaled by the smoker and is responsible for over 63,000 deaths among nonsmokers every year in the United States. One of the most significant actions we can take to reduce the consequences from second hand smoke exposure is to set up rules to not allow smoking in our homes or in our cars. 
Discussion:
How many people here have family or friends who allow smoking in their home or their car? 
How many people have family or friends who allow smoking around children?

## Chemical Box: 

-  _What’s in Tobacco?_
- Tar: black sticky substance used to pave roads
- Nicotine: Insecticide
- Carbon Monoxide: Car exhaust
- Acetone: Finger nail polish remover
- Ammonia: Toilet Cleaner
- Cadmium: used batteries
- Ethanol: Alcohol
- Arsenic: Rat poison
- Butane: Lighter Fluid

**Notes:**
There are over 4,000 chemicals in cigarette smoke. These chemicals irritate the throat and cause cancer, lung and heart disease. Chemicals are added to: Make tobacco burn smoothly; Make the paper burn evenlyEnhance the flavor; Boost the nicotine (ammonia); Kill the tobacco slugsMake sure the cigarette doesn’t go out in the ashtray when not puffing on it.Other chemicals found in tobacco include: 
Benzene: found in moth balls
Denatured alcohol: used to keep cigarettes burning
Toluene: now illegal to put in top coat solution for polishing your nails.
DDT: Insecticides
Arsenic: found in rat poison
Formaldehyde: dead body preserver
Tar: a pack a day smoker would accumulate 1 quart of tar a year In their lungs. Contains most of the cancer-causing agents of tobacco smoke. 

“Activity”:
Show each chemical & read warning label of each (benzene, denatured alcohol, toluene, acetone)

## If smoking is so bad for us, why do we start?

**Notes:**
Gather audience responses, write on a board.Ask people to call out the brands they, their friends or family smoke. Thiswill undoubtedly include Marlboro, Camel, Newport, Kool.The single greatest contributor to starting smoking is advertising. None ofus want to believe that we are influenced by advertising, but if we weren't,the tobacco industry wouldn't find it cost effective to spend $12.5 billiondollars a year promoting their products in the US. If they stoppedadvertising for just today and gave us the money ($34 million dollars), wecould each walk out of here with: Number of people/ $34 million. Who wouldagree to that?

## Slide 19

**Notes:**
	To sell their products, advertisers use images that get you to use the right side of your brain. This is the side that responds to emotional reactions, pleasures, sensations and creativity. It does not use logic, like the left side of your brain. The tobacco industry needs to stimulate the non-logical side to sell their products, since logically, everyone knows tobacco kills you. Adults don’t really start smoking, so tobacco makers have to get kids to start using their product. Once they start smoking, their can’t usually stop. 
	Ask the group if they can see what the tobacco advertisers are trying to get you to believe about their product. After analyzing each ad, be sure to mention that this is another deceptive tactic of the tobacco industry to get people to buy their brands and start smoking and chewing. None of these things are actually associated with smoking – really it would cause fewer friends and dates, it stinks and makes everything around it stink. 
	For instance, this ad uses emotional responses, and lacks logic. 
Observations: 
“Mighty tasty” message and colorful food dishes: taps into pleasure center – eating responds to the hunger sensation. Even smokers would agree that cigarettes are not tasty; they only feed an addiction.
Facial gestures: The woman at the table appears angry/jealous of the attractive smoker. The butler certainly appears attracted to the smoker, while the man on the right seems nervous about the whole situation. 
Warning and ratings: movie and CD ratings help parents keep violence and sex away from kids. Kids who want to be rebellious are drawn toward a warning that “viewer discretion is advised”. It is almost mocking cigarette warning labels, so that they might be ignored. 
*Question: Why is it “mighty tasty” that someone is dropping cigarette ashes into your food? How does that make any sense?

## Slide 20

**Notes:**
This ad uses sensual images to sell tobacco. 

Observation:
Promoting an image of cigarette smokers as “classy” and beautiful (as if smoking preserves youth!)
Mixed-ethnicity woman who a lot of cultures can associate with (eyes, hair, jewelry, full lips)- very pleased with smoking
Smoking as an exclusive, exotic act; distinguished from the crowd (as if smoking will earn you a private room at a club)

## Slide 21

**Notes:**
This ad uses creative and artistic images, and also targets the youth and hip-hop culture. 
Observations: 
“The perfect mixx”: picturing menthol cigarettes juxtaposed with a DJ booth promotes the idea that smoking is a compliment to hip-hop culture (that is why kool sponsors so many hip-hop club nights)
Kool cigarette box: represents sound adjusters for mixing records, with a lush waterfall in the background. Lacks logic. 
“The house of menthol”: cigarette smoking portrayed as entertainment, not a behavior that can kill you.
Appealing to youth & African American culture, both associated with hip-hop culture.

Question: What is the perfect mix? The two spinning records or the blend of tobacco (complete with arsenic, carbon monoxide, and carcinogens)

## Tobacco Myths

- Myth: Clove cigarettes are less harmful than regular cigarettes.
- Myth: Cigars are safe
- Myth: It’s OK to smoke as long as it’s a “natural” cigarette
**	**

**Conclusion**: All tobacco products are addictive
- (which takes your independence away), cause cancer, and harm non-smokers all around you. The average tobacco user is addicted for _*seven years*_ before they can finally kick this enslaving habit!

**Notes:**
Fact 1: Clove cigarettes have been marketed as natural, but are far more dangerous than cigarettes. They contain nearly twice the tar, nicotine, and carbon monoxide of regular cigarettes. The health hazards of clove cigarettes include 
	* Lung bleeding and coughing up blood
	* Chest pain and vomiting
	* Severe and fatal lung infections

Fact 2: Cigar smokers have 5-10 times as much mouth and throat cancer. Cigar smoke in teens slows lung growth and reduces athletic performance. 

Fact 3: So-called “Indian” or “New Age” cigarettes have most of the same chemicals as the others. According to the Rural Indian Health Board, tobacco was offered and held in the hand and not smoked in its traditional use. They also say that using tobacco (even free of additives) causes cancer. The Native American spiritual belief is that your body is a gift and a temple to be kept in good health to serve the planet and the great sprit, and the nontraditional use of tobacco violated this belief.   You are not supporting Native Americans by purchasing these products – you are supporting the tobacco industry. 

## What is a cigar?

-   A cigar  has larger amounts of tobacco than a      	cigarette
-   A cigar is tobacco rolled up in a tobacco leaf
-   A cigar does not have a filter

## Cigar Use:Using beauty and fame to promote a dirty, devastating habit

**Notes:**
Familiar with these faces? Your children probably are, as well.

## What is marijuana?

- 	A drug obtained from the flowering tops of the female cannabis or hemp plant

**Notes:**
THE LOWDOWN ON THC     				
 Delta-9-tetrahydrocannabinol (THC) is the main active chemical in marijuana. For many people, it causes:
 - Paranoia and anxiety
- Loss of coordination and sense of balance
- Difficulty storing short-term memory into long-term memory 
- Slower reaction time, causing car accidents
- Rapid heartbeat (sometimes called palpitations)
- Increased risk for psychotic symptoms (like hallucinations, confused thinking, and delusions)
- Exacerbation of latent or present mental disorders like schizophrenia  

* THC can hurt your performance if you want to play sports or do well in school. Under the influence of THC, you may do something you regret (unsafe sex, driving while intoxicated).

* Today, the cannabis plant can be selectively bred to contain more THC than in previous decades. 

BUT MARIJUANA IS SAFE, RIGHT?

- Marijuana smoke is unfiltered and burns at a higher temperature than tobacco smoke. It is held for a longer time in the lungs. A regular marijuana smoker can have chronic bronchitis, wheezing, and excess phlegm.
- Tar deposits form in the lungs, due to marijuana being inhaled deeper than tobacco.
- Fungi and molds can get into your lungs, because their spores grow on the cannabis plant and usually aren’t washed off.
People who smoke 1-3 joints a day have similar respiratory problems as a pack-a-day cigarette smoker who is ten years older. 

## What is a blunt?	

- _What is a blunt?__	_

- A blunt is when you take a cigar and
- slice it open removing the tobacco and
- replacing it with marijuana.

**Notes:**
Blunts are made either by taking a small cigar, emptying the loose tobacco and filling it with marijuana or by rolling marijuana is a pre-made tobacco leaf wrapper that is sometimes flavored. 

Popular culture (music videos, song lyrics) can glamorize smoking blunts. They make it look fun and harmless. What they don’t mention, of course, are the health consequences that can come with smoking blunts. 

WHAT’S THE BIG DEAL?  			
 * Since blunts combine marijuana and tobacco, you’re smoking two substances that can be dangerous to your health.  

Smoking tobacco is known to cause:                                
- All kinds of cancer
- Asthma
- Strokes
- Heart attacks
- Wrinkles
- Halitosis (stinky breath)
- Impotence for men (the penis can’t get erect)
- And many, many more health problems

Since cigar wrappers contain nicotine, you risk getting addicted to tobacco when you smoke blunts. Nicotine is as addictive as heroin and cocaine – maybe more so! 

Those fruity wrappers:
 Blunts have changed the tobacco industry. Now the industry has started marketing cigar wrappers (intended for rolling blunts) aimed toward youth. Wrappers come in many flavors – butterscotch, peach, black cherry, even cognac! They may appear in the candy sections of mini-markets, but they’re not candy. Fruity wrappers are there to get youth hooked on tobacco, via blunts. 

## Hookahs:

- Not safer than regular tobacco smoke.
- Causes the same diseases
- Raises the risk of lip cancer, spreading infections like tuberculosis.
- Users ingest about 100 times more lead from hookah smoke than from a cigarette.

**Notes:**
The water pipes known as hookahs, narghiles, sheeshas, or hubble-bubbles have been around for centuries and they are attracting new and younger audiences all over the world who desire “the glamour of being on the cusp of a trend.”

Not safer than regular tobacco smoke.  It causes the same diseases as other tobacco smoking including oral, esophageal, and lung cancer as well as heart disease, emphysema, heart disease, chronic bronchitis, and of course, nicotine addiction. 

Even though hookah smoke is water-cooled and filtered; furthermore, hookah smoke contains the same cancer-causing particulates found in secondhand smoke. 

Hookah smoke is classified as clastogenic, capable of causing breakage of chromosomes, and genotoxic, damaging to DNA and thereby capable of causing mutations or cancer, for human beings.

The charcoal used in the tobacco heating process produces a toxin known as carbon monoxide; the carbon monoxide hazard is as high with hookah smoking as with cigarette smoking.

## Think About Quitting

- Pick a quit date
- Keep a record of why, when, where and with whom you smoke
- Get support and encouragement from your family, friends, and health providers.
- Join a quit group: call 981-5330
-               QuitNow@ci.berkeley.ca.us
- Get individual counseling:  1-800-NO-BUTTS

## The Quit Plan:

- Treat yourself well
- Drink lots of water
- Change your routines
- Reduce stress
- Deep breathing
- Regular exercise
- Do something enjoyable every day
- Increase non-smoking social support
- Other ideas?

## Get Medication and Use It Correctly

**Talk to your health care provider about which medication will work for you: **
_**Available by prescription:**_
**Zyban (Wellbutrin, Bupropion)**
**Nicotine Inhaler**
**Nicotine Nasal Spray**
_**Available over-the-counter:**_
**Nicotine Patch (Has an increase in efficacy when combined with Zyban) **
**Nicotine Gum and lozenge**

## Contact Information:

- City of Berkeley Tobacco Prevention program (510) 981-5330
- _[QuitNow@ci.berkeley.ca.us](mailto:QuitNow@ci.berkeley.ca.us)_
- _[Mbrown-machen@ci.berkeley.ca.us](mailto:Mbrown-machen@ci.berkeley.ca.us)_
- Special thanks to Molly Ward,
- UCB Student and Public Health Intern,
- for adapting this presentation to PowerPoint

**Notes:**

Q & A session
Pass out: gold cards, handout of local cessation programs