Every Cigarette Is doing YOU Damage

1. Every Cigarette Is doing YOU Damage Stories Additives Smokeless Products By Cory Bendall RRT BHSc.(RT) CCE IHA Community Respiratory Therapist – North Okanagan B.C. Cancer Agency Cancer Prevention Coordinator - Okanagan

3. Why we are Here • Between 1988 to 1999 the mortality rate among women with COPD has  by 53% • COPD causes more death in Canada than diabetes and renal disease Combined • Now more women are dying of Lung Cancer than Breast Cancer. Mortality rate of 5.0% compared to 3.5% O’Donnell, D.E. et al. 2003. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease.

4. “Imagine That” There is one substance that: • Kills ½ the people who use it as the maker intends. • Kills 6000 people a year in B.C. about 500 of whom have never actually used it – just been around it. • Makes thousands of people ill every year including children who can do little to escape exposure to it. • Is highly marketed using deceptive marketing. • Is legal, addictive with no safe level of exposure.

5. From Anonymous: “My maternal grandmother died in January. She had smoked 3 packs a day for 50 years. She came to live with me in November. She couldn’t sleep for more than an hour before having to wake up to cough.” “I am quitting because I don’t want my grandchildren to have to change my diapers and bathe me and dress me like I had to do for her.” Retrieved June1st from http://www.quitsmokingsupport.com/remembering.htm

6. Tobacco Companies want YOU • Additives are used to influence the effects of nicotine – to make the taste more appealing to young smokers – mask the taste & harshness of the smoke. • 90% of new smokers are children and teenagers – the companies need to replace the smokers who have died prematurely from a smoking related disease. Russell, J.(2001). June Russell’s health facts: Smoking – teens. Retrieved May 14th, 2007, from http://www.jrusselshealth.com/smokteens.html

7. Cigarette vs. Lip Gloss Tobacco companies match: • Flavours • Packaging • Vernon Price - $3.39 compared to $3.32 Smoking DOESN’T keep you slim! McGill University found that teenage girls gain weight at exactly the same rate whether they smoked or not. Karp, I. et al. (2005) Smoking trajectories of adolescent novice smokers in a longitudinal study of tobacco use [Electronic version]. Ann Epidemiol. Jul; 15(6): 445-52.

8. Your Lungs

9. From Mike: “My father was a 2 pack a day smoker. He died of lung cancer when I was 12 years old, leaving my mother with 3 teenage boys to raise. Nothing prepares a 12 year old boy to deal with a dying father who is so medicated he can’t even remember your name.” Retrieved May 15th, 2007 from http://www.quitsmokingsupport.com/remembering.htm

10. Almost 5 Million Canadians Smoke • Smoking is the #1 preventable cause of death in Canada. • 22% of all deaths in Canada are as a result of smoking. • More than 45,000 Canadians die due to smoking each year. Based on 1998 data Health Canada Canadian Tobacco Use Monitoring Survey 2005, Summary of Annual Results Makomaski, Illing, E.M., Kaiserman. Can J Public Health 2004; 95: 38-44.

11. Smoking in Interior Health • 21% of residents in the IHA are smokers. • 119,625 smokers. • Highest usage is in 20-24 year olds (36%). • In B.C. 5700 deaths/year: 520 have never smoked • In B.C. 28% of smokers say they are seriously thinking of quitting within the next 30 days and 63% within the next 6 months. B.C. Statistics. March 2007.

12. Teen’s Smoking in B.C. • Teens from disadvantaged households most likely to smoke (34%). • First cigarette often a result of a desire for status and approval in a peer group. • Teens were concerned about protecting infants and young children from cigarette smoke but their own exposure did not appear to be a large concern! Heart & Stroke Foundation of Canada. (Sept., 1997). Executive summary. Retrieved June 4th, 2007 from http://www.healthservices.gov.bc.ca/tobacrs/teen/teen1.html#1.2

13. The Psychological Side What’s different about today’s Smokers? • More likely to have depression • More likely to have other addictions • More severely dependent • Often lack effective alternative coping skills Baker, R. (2007). Nicotine dependence: Treatment update. University of British Columbia. Oral presentation.

14. Cigarettes = Tar

15. Low Tar = Safer Cigarette? Not necessarily… • Small holes in the filter reduce the tar and nicotine that the smoker inhales. • The smoker compensates by smoking the cigarette more intensively in order to obtain the same satisfying dose of nicotine • Thus for the same dose of nicotine the smoker is actually consuming more noxious smoke. Bates, C., Jarvis, M. & Connolly, G. (1999, July). Tobacco additives: Cigarette engineering and nicotine addiction. Retrieved May 14th, 2007 from http://www.ash.org.uk/html/regulation/html/additives.html

16. Cigarette Smoke • “According to R J Reynolds tobacco company chemists cigarette smoke is 10,000 times more concentrated than the automobile pollution at rush hour on the freeway.” • Burning of tobacco generates more than 150 billion tar particles /cu.in. = visible portion of the smoke. • But the visible portion is only 5-8% of the total output of a cigarette… Ginzel, K.H.(n.d.). What’s in a cigarette? Retrieved June 5th, 2007, from http://www.quitsmokingsupport.com/whatsinit.htm

17. Carbon Monoxide • Inhaled with every puff of a cigarette odorless, colourless. • Competes with oxygen for the hemoglobin in your blood and wins – 210 times better at binding to the receptors. • Attacks artery walls your body uses LDL cholesterol to fix the holes = atherosclerosis (plaques around artery walls) = heart disease. Interior Health Tobacco Cessation & Reduction Programs. Retrieved June 5th, 2007, from http://www.quitnow.ca Kacmarek, R.M., Mack, C.W., & Dimas, S.(1985). The essentials of Respiratory therapy. (2nd ed.). Chicago, Il: Year Book Medical.

19. Cigarettes = Blocked Arteries

20. Cigarette Additives “At no stage in the 25 year period has the Dept. of Health been provided with information regarding which additive have been used in tobacco products.” “the 1997 Voluntary agreement requires the tobacco companies to provide toxicological data on new additives but this does not include the 600 existing approved additives.” Bates, C., Jarvis, M. & Connolly, G. (1999, July). Tobacco additives: Cigarette engineering and nicotine addiction. Retrieved May 14th, 2007 from http://www.ash.org.uk/html/regulation/html/additives.html

21. From Sherma: “My uncle smoked for as long as I knew him. Later he had to go on oxygen 24 hours a day. What a shame to have to live your life not being able to go anywhere without a tube in your nose and an oxygen bottle.” “It seems like all my memories of him revolve around watching him gasp for breath.”

22. Is this what You want ?

23. Nicotine alters Brain Physiology • Nicotine binds to receptors in the brain and causes a release of Dopamine = feelings of pleasure and calmness. • Between cigarettes, Dopamine levels drop = feelings of stress and irritation. • The smoker will crave more nicotine to artificially restore the feelings of pleasure and calmness. • Chronic exposure to nicotine causes desensitization and compensatory receptor up-regulation ( # of receptors). • Withdrawal symptoms occur with prolonged absence of nicotine (4-6hrs), as nicotine levels  this large # of receptors become resensitized. Foulds, J. Int J Clin Pract. 2006: 60:571-575. Fagerstrom, K. Drugs. 2002;62(suppl2): 1-9. Jarvis, M.J. BMJ 2004; 328:277-279. Rigotti, N.A. NEngl J Med 2002:346:506-512. Dani, J.A. De Biasi, M. Pharmacol Biochem Behav. 2001; 70: 439-446

24. Ammonia • Adding Ammonia increases the pH of the smoke. • This allows more nicotine to remain unbound in the bloodstream longer. • So the physiological effect of the nicotine lasts longer. • Ammonia added to the cigarette delivers 29% more nicotine to the body. Bates, C., Jarvis, M. & Connolly, G. (1999, July). Tobacco additives: Cigarette engineering and nicotine addiction. Retrieved May 14th, 2007 from http://www.ash.org.uk/html/regulation/html/additives.html

25. Acetaldehyde • Acetaldehyde and Nicotine work together to strengthen the addictive properties of nicotine. • When sugar is added to the cigarette for flavour – burning this sugar creates the Acetaldehyde. • The level of Acetaldehyde in Marlboro cigarettes has ↑ by 40 % in 10 years. • ↑ Aging due to destruction of connective tissue in the skin. • Caused respiratory tract tumors in hamsters when inhaled. Bates, C., Jarvis, M. & Connolly, G. (1999, July). Tobacco additives: Cigarette engineering and nicotine addiction. Retrieved May 14th, 2007 from http://www.ash.org.uk/html/regulation/html/additives.html Haas, E.M. (n.d.). In Staying healthy with nutrition: What does nicotine do to your body? Retrieved June 5th, 2007, from http://www.quitsmokingsupport.com/whatsinit.htm

26. Cigarettes = Tumors

27. Genetic Damage “People with the worst DNA damage weren’t necessarily the ones who had smoked the longest, but those that began at an early age.” “Smoking while the lungs are still developing appears to permanently hamper normal cell repair” Russell, J.(2001). June Russell’s health facts: Smoking – teens. Retrieved May 14th, 2007, from http://www.jrusselshealth.com/smokteens.html

28. Formaldehyde • Added by the tobacco companies as a preservative? • Analysis shows a particularly high concentration of Formaldehyde in the 1st puff. • Formaldehyde damages the cilia in your airways – stops the cough. • Sidestream smoke contains up to 40 ppm of Formaldehyde – approx. 15 ppm associated with cancer of the nose and throat. MFL Occupational Health Centre. (1999, Sept). Formaldehyde. Retrieved June 5th, 2007, from http://www.mflohc.mb.ca/fact_sheets_folder/formaldehyde.html Baker, R.R. (2006, June). The generation of formaldehyde in cigarettes – Overview and recent experiments. Food Chem Toxicol. 44(11): 1799-822. Retrieved June 5th, 2007, from http://www.ncbi.nlm.nih.gov

29. From Laurel : “My wonderful dad passed just over week ago with COPD after 45 years of smoking. I loved my Daddy dearly and wish he were still here, if it weren’t for tobacco and addiction, he still would be.” “I’m encouraging everyone out there to QUIT SMOKING before we lose more loved ones to this evil drug.” Written: Thursday March 29th, 2007 Retrieved June 5th, 2007, from http://www.lung.ca/involved-impliquez/share-partagez_e.cfm

30. Phenol • Phenol is used to maintain the tobacco moisture content? “↑ mainstream flavour and side stream aroma.” • Patented process to preserve additives added to the filter so that the additives will be released into the smoke once lit. • Registered pesticide corrosive to the eyes. United States Patent Office. (n.d.). Smoking compositions containing a dicarbonate ester flavorant-release additive. Retrieved June 5th, 2007, from http://www.freepatentonline.com/4578486.html Runeckles, V.C. (1999, Nov.). BATCo Documents for the Prov. Of B.C.: Project NO. 0331-01. Retrieved June 5th, 2007, from http://www.freepatentsonline.com/4578486.html Scorecard: Pollution Information Site. (n.d.). Phenol. Retrieved June 5th, 2007, from http://www.scorecard.org/chemical-profiles/html/phenol.html

31. Propylene glycol • Maintains moisture, prolongs shelf-life. • Helps to release other additives into the smoke to make the smoke less irritating. • Food additive - but remember we don’t have the powerful digestive enzymes and detoxifying metabolic pathways of the digestive system in our lungs. • Eye and skin irritant, affects your DNA. American Legacy Foundation. (1999, July). Tobacco documents online: Propylene gylcol. Retrieved June 5th, 2007, from http://www.tobaccodocuments.org/profiles/propylene_gylcol.html

32. Cigarettes = Lost Vision

33. From Valerie: “My father died of COPD April 15th, 2007. I watched my strong independent father slowly suffocate, he struggled for every breath. This is a horrible disease. No one deserves to die as my father did. Save yourselves and quit ....” “Dad you were the strongest and best Dad to me. And I’ve learned a lot from you. You will be forever missed and remembered.” Retrieved June 5th, 2007, from http://www.lung.ca/involved-impliquez/share-partagez_e.cfm

34. Butane • ↑ pH of the cigarette ↓ its ability to burn but cigarettes don’t go out when left alone? • Butane keeps the cigarette burning at a very hot temperature so that the nicotine will vaporize – better delivery into your lungs. • Chemicals added to enhance burning are among the major causes of fire deaths. Haas, E.M. (n.d.). In Staying healthy with nutrition: What does nicotine do to your body? Retrieved June 5th, 2007, from http://www.quitsmokingsupport.com/whatsinit.htm

35. Cadmium • Carcinogenic metal that is accumulated and concentrated by the leaves of the tobacco plant. • Linked to osteoporosis, kidney failure, cancer and stoke. • 38-50% of Cadmium is in second-hand smoke – hazard to non-smokers. • Cadmium pigments produce intense yellow colour - teeth Menden, E.E., Elia, V.J., Michael, L.W. & Petering, H.G. (1972) Distribution of cadmium and nickel during cigarette smoking. Retrieved June 5th, 2007, from http://pubs.acs.org/cgi-bin/abstract.cgi/esthag/1972/6/i09/f-pdf/f_es60068a008.pdf?sessid=6006l3 GlaxoSmithKline. (n.d.). Levels of Cadmium in the environment: Cadmium in tobacco smoke. Retrieved June 5th, 2007, from http://www.cadmium.org/env_lev.html

36. From Steve: “Mum had a dense stroke a year ago, and spent the following year learning how to swallow, how to stand and walk. When she was released from hospital, she was mostly confined to a wheelchair, paralysed on the left side and unable to form coherent sentences, although she was aware of what she wanted to say…” “Tobacco should be criminalized” Retrieved June 5th, 2007, from http://www.lung.ca/involved-impliquez/share-partagez_e.cfm

37. Cigarettes = Stroke

38. Smokeless Tobacco • Products include: • Chew – loose leaf, plugs or twists of tobacco • Snuff – dry or moist loose leaf or pouches, placed in the cheek or inhaled in the nose. • 1 cigarette has 8-11 mg of nicotine. • Chew user-pinch of chew contains 13-23 mg of nicotine.

39. SUGARS ABRASIVES

40. Dose of Nicotine • Cigarette – 1.8 mg • Moist snuff – 3.6 mg • Chewing Tobacco – 4.5 mg

41. Marketing to Youth • First time users usually get sick from stronger brands such as Copenhagen or Skoal. • Tobacco companies love the under 18 age group because they know that 90% of tobacco users start before the age of 18. • They call this age range: Sub Culture Urban Marketing. SCUM for short.

42. Chew and sports • Nicotine causes your reaction time to be slowed down although the nicotine will also make it seem faster. Not a good situation for players.

43. Health EffectDipper’s Pouch

44. Health Effect • Black Hairy Tongue

45. Health Effect • Stained teeth

46. Health Effect • Leukoplakia

47. Health Effect • Peridontal disease

48. Health Effect • Oral cancers

49. Health Effect • Cancer of the throat, jaw bone, esophagus, stomach

50. Sean “…the base of our business is the High School student.”