Chapter 15: Toward a Tobacco-Free Self and Society

Introduction

This chapter explores the determinants of tobacco use, the health consequences of smoking, the addictive nature of nicotine, and strategies for quitting. It also examines the societal and environmental impacts of tobacco, including secondhand smoke and public health policies.

Young People, Tobacco, and Other Drugs

Prevalence and Access

• Underage Consumption: Despite legal bans, minors in Canada consume approximately 800 million cigarettes annually, often obtained from social sources, family, or illicit purchases.

• Smokeless Tobacco: Less common than cigarette use among youth.

• Drug Use Correlation: Tobacco use is significantly higher among individuals with substance abuse or mental health disorders (e.g., major depression, anxiety disorders). For example, 70% of people with alcohol use disorder and 97% of heroin users are smokers.

Initiation and Risk Factors

• Early Experimentation: Many begin experimenting with smoking by grade 6; 80% of smokers start before age 18.

• Risk Factors (Health Canada Youth Smoking Survey):

  • Family members (parent/sibling) who use tobacco

  • Peer tobacco use

  • Low-income or blue-collar family background

  • Single-parent households

  • Poor academic performance or school dropout

  • Positive attitudes toward tobacco use

Media Influence and Rationalization

• Media Portrayal: Films often depict smokers as successful and attractive, though in reality, smokers tend to have lower incomes and less education.

• Rationalization: Many young people believe they are too intelligent to become addicted or can quit at any time.

Nicotine Addiction

Mechanism of Addiction

• Highly Addictive: Nicotine is as addictive as cocaine and heroin.

• Neurochemical Effects: Nicotine stimulates the release of epinephrine, norepinephrine, and dopamine in the brain, leading to pleasurable sensations and reinforcing use.

• Loss of Control: Users develop tolerance and experience withdrawal symptoms, making quitting difficult.

Immediate and Short-Term Effects of Smoking

• Nicotine Poisoning: Beginners may experience nausea, vomiting, and diarrhea.

• Stimulation: Nicotine stimulates the cerebral cortex and adrenal medulla, increasing adrenaline release.

• Toxic Smoke: Tobacco smoke contains carcinogens, carbon monoxide (CO), and tar. CO levels are 400 times higher than safe limits. Most inhaled substances remain in the lungs, and filter effectiveness decreases as the cigarette burns down.

Long-Term Effects of Smoking

• Cardiovascular Disease: Smoking is a major cause of coronary heart disease (CHD), which results from atherosclerosis.

• Cancer: Increases risk of lung cancer and other cancers.

• Respiratory Diseases: Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis.

• Other Health Concerns: Ulcers, erectile dysfunction, reproductive health problems, dental disease, diminished senses, injuries, cosmetic issues, and economic costs.

• Cumulative Effects: Reduced life expectancy and quality of life.

Environmental Tobacco Smoke (ETS)

Secondhand Smoke

• Components: Includes mainstream (exhaled) and sidestream (from burning end) smoke. Sidestream smoke is unfiltered and more toxic.

• Health Risks: Exposure increases risk of bronchitis, pneumonia, and respiratory infections in children, and lung cancer and COPD later in life.

Smoking and Pregnancy

• Infant Mortality: Maternal smoking causes an estimated 100 infant deaths per year in Canada.

• Pregnancy Complications: Increased risk of premature delivery, placental issues, and low birthweight.

• Developmental Challenges: Children born to mothers who smoke heavily may face developmental problems.

Public Health Policies and Economic Factors

Bans and Taxes

• Smoking Bans: Many Canadian jurisdictions ban smoking in public places to protect non-smokers and reduce tobacco use.

• Taxation: High taxes on cigarettes are used as a deterrent and to fund public health initiatives.

Benefits of Quitting Smoking

Options and Strategies for Quitting Smoking

• No Universal Method: Quitting strategies must be individualized.

• Support Resources: Health Canada provides help-lines and resources for smokers seeking to quit.

• Support Systems: Family, friends, and support groups can increase chances of success.

• Nicotine Replacement Therapy: Products such as patches, gum, and lozenges can help manage withdrawal symptoms.

• Dealing with High-Risk Situations: Identifying triggers and developing coping strategies is essential for long-term success.