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U of M PUBH 3003 - Exam 2 Study Guide

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PUBH 3003 1st EditionExam#2 Study Guide Lectures 9-16Lecture 9( February 24th)I. Surgeon General ReportsII. Age of onsetIII. Why do people smoke?IV. Nicotine delivery V. E-cigarettesa. Health risks Current Lecture:Cigarettes did not become popular until after World War 1- Invention of machine to mass produce cigarettes in the 1880s- General Pershing: said cigarettes for troops as important as bullets - In the early 1960s 40% of US adults were smokersSurgeon General Reports- 1964 Report: Major health scare, drop in smoking- 1986 Report: Secondhand smoke- 1988 Report: Nicotine Addiction- 2004 Report: Smoking affects nearly every organ of the body- 2014 Report: Health consequences of smoking- 50 years of progress Smoking has decreased sharply- Overall less than 19% than adult population- Minnesota’s smoking rate down to 14.4%- Higher prevalence of occasional smokers- Major disparities: education, employment, income- Co-morbidities: substance abusers- Severe mental illness, depressionAge of onset- Those who start earlier tend to be more dependent- Risk of lung cancer greater for those who start earlier, even when adjusted for pack years smoked- Smoking is initiated in childhood or adolescence, although some individuals take it up in their 20s or even later- Even delaying onset has health benefits- American Legacy Foundation Truth Campaign Why do people smoke?- Peer influence important - Initial effects can be quite unpleasant: dizziness, nausea- Little consideration of possible long term consequences - Later tend to be addicted to nicotine- For some smokers one of very few pleasures Nicotine Delivery - The cigarette is very efficient nicotine delivery device - Hit to the brain in approximately 10 seconds- Repeated reinforcement with millions of puffs possible over a smoking career- Nicotine has a very short (20 minute) half life- Thus need to continue to smoke to maintain constant nicotine blood levels throughoutthe day- Smokers develop tolerance- First cigarette of the usually provides greater effect- Nicotine withdrawal can be exceedingly unpleasant but not life changing- Nicotine promotes release of dopamine - Smokers can function effectively while on nicotine including driving and performing cognitive facts- Nicotine may be an aid to alertness and concentration- Those with schizophrenia often use nicotine to self medicate- Used to suppress appetite- for weight maintenance loss and to reduce hunger pangs - More than 20 million Americans have died from smoking since release of 1964 Report- Even 50 years after the first report , research continued to newly identify diseases caused by smoking- February 12th, 2015, New England Journal of Medicine: even more diseases associated with smoking - Exposure to secondhand tobacco smoke has been casually linked to cancer, respiratoryand cardiovascular diseases, and to adverse effects on health infants and children- Two sources of smoke from cigarettes: mainstream and side stream- Side Stream smoke has higher concentration of carcinogens- Environmental protection agency classified tobacco smoke as a Class A or known human carcinogen- Cause of lung cancer and heart disease - Third hand smoke residue E- Cigarettes- Heat a solution (nicotine and other additives) producing a vapor that is inhaled without combustion- E-cigarettes vary widely in quality, safety, size, and efficiency of nicotine delivery - Almost certainly less harmful to individual users than conventional users - Long-term health effects unknown Risks of E-Cigarettes currently unknown - FDA analyzed components of e-cigarette cartridges- Found to contain nitrosamines (a known carcinogen) as well as other toxic chemicals including diethylene glycol found in anti-freeze- Impurities found in tobacco suspected of causing adverse health effects also detected including anabasine, myosmine, and B- nicotyrineLegal Status and Regulation - Currently, little or no government oversight of e-cigarettes either from manufacturing or advertising and marketing - As of May 2014, 34 states have prohibited sale to minors- Three states and 172 local governments have included e-cigarettes in their indoor air laws and smoking bans- US department of Transportation has been proposed ban on use of airplanes Marketing - Widespread marketing and entry of the three big US tobacco companies - Sales approached $2 billion in 2013 and are estimated to surpass $10 billion by 2017- E-cigarettes have been endorsed by several celebrities and have appeared on cable television- Some e-cigarette companies have made health related claims and marketed as a way to circumvent smoking vans - E-cigarettes are generally perceived to be less harmful than regular cigarettes by users - Commonly cited reasons for use:o Less harmful, less expensiveo Help reduce tobacco craving/withdrawal o Reduce amount smoked and use as reduction/ cessation aido Prevent relapse to regular cigarettesElectronic Cigarette Liquid Packaging - Concentrated liquids used in these products can lead to nicotine poisoning - E-liquid comes in a variety of flavors- Much of the e-liquid on the market contains nicotine - Teaspoon of 1.8% nicotine concentrated could be fatal for 200 pound person- In 2013 over 1,000 calls to poison control centers linked to liquid nicotine exposure How to quit- Most people quit on their own- Clinician advice associated with increased likelihood of quitting- Individual, group or telephone counseling - Problem solving, anticipating difficult situations- Text to quit- 1-800- Quit-nowCDC Best Practices for Comprehensive Tobacco Control Programs- State and community interventions – policies and programs including eliminating exposure to secondhand smoke- Strategic, culturally appropriate, and high impact messages through sustained media campaigns- Comprehensive cessation programs- in health systems expanding insurance coverage, quit lines- Surveillance and education - Infrastructure: administration and management – strategic planning, funding, dedicated staff, training and technical assistance Lecture 10 ( February 26th)I. Costs to SocietyII. Proof and Alcohol by volume III. BACa. Alcohol levelIV. Alcohol and the CNS a. Toleranceb. AbsorptionV. Men and Women and alcohola. Long term useb. Age and use Current Lecture: AlcoholCosts to Society- Alcohol is involved in ~40% of all traffic fatalities- Alcohol plats a major role in sexual assault, violence, burglaries, homicide, suicide, etc.o Approx. ½ of homicide offenders were under


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