Tobacco Use is Leading Cause of Preventable Death

1. Smoking vs. Health Tobacco Use is Leading Cause of Preventable Death

2. Toll of Smoking • USA: 400,000premature deaths annually • one every 45 sec • annual health care costs $50 billion (1993) • Worldwide: 3,000,000 deaths annually • one every 10 sec • 1 billion people smoke about 6 trillion cigarettes a year Revenues of US tobacco companies: $32 billion (1991) Marketing & promotional budget: $6 billion (1993))

3. President Clinton August 23, 1996 • "Cigarette smoking is the most significant public health problem facing our people. More Americans die every year from smoking-related diseases than from AIDS, car accidents, murders, suicides and fires — combined." … during speech declaring nicotine an addictive drug

4. Do tobacco companies target kids? • Tobacco industry “needs” to replace 3,000 smokers who die or quit each day • Very small percentage of smokers begin after teens • Go figure …

5. “Today, nearly 3,000 young people across our country will begin smoking regularly. Of these 3,000 young people, 1,000 will lose that gamble to the diseases caused by smoking. The net effect of this is that among children living in America today, 5 million will die an early, preventable death because of a decision made as a child.” Donna E. Shalala, PhD (Syracuse)(Former) Secretary, U.S. Department of Health and Human Services

6. Are teens influenced by advertising? Period of study 1973-1993

13. Former snuff user … died of cancer at age 27 — subsequent to amputation of jaw

17. Nicotine — is it addictive? C10H14N2

18. Nicotine dependence • Addiction/dependence • can’t stop when you want to • continue use, despite clear evidence of harm • clear withdrawal symptoms • nicotine: depressed mood, insomnia, irritability, difficulty concentrating • but no intoxication • unlike cocaine, heroin, alcohol Approx. 44% of the cigarettes smoked in the United States aresmoked by the mentally ill. — Harvard Medical School study (11/2000)

19. Brain regions & pathways judgment reward

20. Nicotine action • Accelerates release of neurotransmitter dopamine in the brain’s NA*& increases metabolism in NA • dopamine ~ pleasure, emotions, addiction… “reward system” nucleusaccumbens amygdala *NA = nucleus accumbens

21. Dopamine as a neurotransmitter

22. What else besides lung cancer? • cancer of the mouth, throat, pancreas, kidney, bladder, and other organs • heart disease and strokes • emphysema • sudden infant death syndrome (SIDS)? • impotence • and much much more …

23. From ASH, Australia

25. Tobacco smoke • ~4,000 chemicals • 43 known carcinogens • smoking gun (1996 finding) • benzo[]pyrene product (BP  BPDE) • BPDE damages p53 tumor suppressor gene! • http://heat.usc.edu/chemical/bap.html • http://www.tobacco.neu.edu/tot/Nov96/smoking_gun.htm benzo[]pyrene

26. Tobacco Documents • Tobacco industry • knew about nicotine addiction • adjusted nicotine levels • targeted youngsters in ads • Liggett Group caves in first (3/97) • Leads to $246 billion deal (thru 2025) between (attorneys general of) 46 states and the major tobacco companies • Also underwrite campaign to cut under-age smoking and substance abuse, and educate smokers about diseases related to tobacco

27. 1996 Book on Tobacco Documentsby Stanton Glantz (UCSF) et al. http://www.library.ucsf.edu/tobacco/cigpapers/book/

28. True story of tobacco executive-turned-whistleblower, Jeffrey Wigand

29. Supreme Court on FDA • Supreme Court* decided, in March 2000, that F.D.A. needs specific authority from Congress before it can regulate tobacco (again; as a drug) • 1998 tobacco bill before the Senate provided for F.D.A. regulation, but was blocked by Senate leadership. *tobacco “poses perhaps the single most significant threat to public health in the United States.”

30. Florida Class-Action Lawsuit • $145-billion punitive award against the five major tobacco companies (7/14/2000) • The class: 300,000–700,000 sick smokers • Appeals process will take (many) years

31. Whiteley Case • Leslie Whiteley (Ojai, CA) • Mother of four; had started smoking at age 13 • Marlboros and Camels • This was after warning labels appeared (1965). • Diagnosed w. lung cancer in 1998 • Then spread to liver and brain • San Francisco jury ordered Philip Morris and R. J. Reynolds to pay $1.7M in compensatory & $20M in punitive damages (3/27/2000) • Her lawyer, Madelyn Chaber, asserted fraud by PM & RJR to overcome ’92 Supreme Court decision about labeling • Died 7/3/2000 at age 40

32. Female smoking deaths double By Rita RubinUSA TODAY 3/28/2001 WASHINGTON -- Four out of every 10 Americans who die from smoking are women, a proportion that has more than doubled since 1965, according to a report Tuesday by Surgeon General David Satcher. ''Women who smoke like men die like men,'' Satcher says. Since the surgeon general's last report on women and smoking in 1980, 3 million women have died prematurely from smoking-related ailments. Although breast cancer generates more anxiety, lung cancer surpassed it in 1987 as the deadliest malignancy in women. Satcher says 68,000 women will die this year of lung cancer, about 25,000 more than will die of breast cancer.

33. Women also are susceptible to smoking-related reproductive problems, such as cervical cancer and early menopause. And he says smoking during pregnancy remains a public health problem, increasing the risk of stillbirth and sudden infant death syndrome. In 1964, 52% of men smoked, compared with 34% of women. Today, about 26% of men and 22% of women smoke. Satcher blames aggressive marketing for the continuing appeal of cigarettes. The Federal Trade Commission says the five leading cigarette companies spent $8.24 billion on marketing in 1999, up 22% from '98. …

34. If you smoke, please quit!