tobacco soc cultural + political economic perspective

public health

health risks associated with smoking

4 paths by which tobacco creates cellular and biochemical damage

path 1 = Carcinogenic Compounds in Tobacco Smoke

path 2= increased reactive oxygen species

path 3= inflammation and immune supression

path 4= nicotine

path 1: Carcinogenic Compounds in Tobacco Smoke

• over 4,000 chemicals

• no “risk free” level of second hand smoke

• approx 70 known carcinogens in smoke, many of which the amounts are unknown

• ex: e.g. acetylaldehyde, benzene, lead, arsenic, nitrosamines

path 2= increased reactive oxygen species

Tobacco smoke also introduces high levels of reactive oxygen species (ROS), highly reactive molecules that can damage cellular structures, including lipids, proteins, and DNA

The accumulation of ROS leads to oxidative stress, a condition that promotes DNA damage and mutations, which increases the likelihood of cancerous changes in lung cells

path 3= inflammation and immune supression

• Chronic tobacco use triggers inflammation in lung tissue, leading to the
  release of cytokines and other inflammatory mediators

• This creates a tumor-promoting environment by suppressing immune surveillance and encouraging the growth of malignant cells.

path 4= nicotine

• Cigarette smoke contains over 7,000 chemicals, including about 70 that cause cancer

• Nearly all tobacco products, including e-cigarettes, contain nicotine

• Youth nicotine use can lead to addiction and can harm the developing brain, impacting learning, memory, and attention

• Menthol increases additive nature of nicotine

Bio chemical effects of smoking

• nicotine activates multiple biological pathways through which smoking increases risk for disease

• Nicotine exposure during fetal development, critical window for brain development, has lasting adverse consequences for brain development

• Causes many birth complications, pre-term and still birth

• Increased risk of adenocarcinoma of the lung in smokers results from changes in the design and composition of cigarettes since the 1950s.

1991 study: tobacco marketing

• analysis of marketing to female smokers

• the value of a female smoker

• Values: Money, material acquisitions, a good job (pays well, more so than gratifies)
  Fears: Risks with commitment to relationships, marriage, children
  Social activism
  Political statements: None

smoking and youth

• nearly all tobacco use begins during youth and progresses during young adulthood

• More than 3,200 children age 18 or younger smoke their first cigarette every day

• 9/10 smokers start before the age of 18, almost all start by age 26

• Every adult who dies early because of smoking is replaced by two new young smokers

• 81X more tobacco marketing in poor countries

Marlboros' “Be Marlboro” campaign and efforts to “stop Marlbor

tobacco and teens

• in 2019, 4 of very 100 middle school students (4.0%) and nearly 11 of every
  100 high school students (10.8%) reported current use of two or more tobacco products in the past 30 days

• in 2019, 11.5% of middle school and (29.9% of HS students said they had ever
  tried two or more tobacco products.

tobacco use by teens and children

• 1885-1902, cigarettes grow in popularity

• By 1900, average male consumes 7 pounds/year, half as chewing tobacco

• 1912, trading cards included, “complete sets” to collect

• “Loosies” 8-9 year olds

• 1920s cities versus rural

american cancer society begins to survey tobacco use

• 1920s, ~ 15% males, ~1.5% women

• more common in white than black amerians

• Parents, public concern begin to prompt anti-tobacco campaigns

teen tobacco use today

• 1.5 M more current youth e-cigarette users in 2018 than 2017. (38%
  increase in one year)

• 4.9 M youth current tobacco users in 2018

• nearly all tobacco use begins in adolescence

how to market to teens

• 3 strategies used by tobacco marketers to reach teens

• sell sex

• throw a party

• make it risky

• examples from public figures

• There is a disproportionate marketing to racial and ethnic minorities and groups of
  lower socio economic status

contemporary marketing

The disproportionate marketing to racial minorities and disproportionate groups makes
tobacco marketing a social justice issue

tobacco legislation

• 1890s, 26/45 states prohibited tobacco sale to minors (14-21 years)
  • 1893, Washington State makes it illegal to “make, buy, sell, give or
  furnish cigarettes…”
  • 3 months later, federal court in Seattle declares this unconstitutional
  because it prevents interstate trade
  • 1893, NY Times, “Smoking of cigarettes may be objectionable, as are
  many other foolish practices…but it is an evil which cannot be
  remedied by law”

early anti-tobacco movements

• 1899 - Chicago, Lucy Page Gaston, Women’s Christian
  Temperance Union, founds Anti-cigarette League “combat and
  discourage”, enact legislation
  • 1908 – 1917 Illinois considered 12 bills to ban
  • 1927 Anticigarette League, education demonstrations and
  pledges
  • Health Education Campaigns – based on idea that information
  will prevent tobacco use

• American’s Non-smokers Rights Foundation advocates against second hand smoke

social learning theory (one theorey to help explain why adolescents initiate smoking and / or tobacco)

social learning theorey (Albert Bandura)

• learning is a cognitive process that takes place in a social context

• can occur purely through observation or instruction

• Goes beyond traditional behavioral theories by placing emphasis on the important roles of internal processes in the learning individual

social learning theorey

• Learning is not purely behavioral; rather, it is a cognitive process that takes place in a social context

• Learning can occur by observing a behavior and by observing the consequences of the behavior (vicarious reinforcement)

• Learning involves observation, extraction of information from observations, and making decisions about the performance of the behavior (modeling)

• Reinforcement plays a role in learning but is not entirely responsible for learning

• The learner is not a passive recipient of information. Cognition, environment, and behavior all mutually influence each other (reciprocal determinism)

theories of addiction

• medical model

• psychdynamic model

• social model

• moral model (criminal justice)

• bio-psycho-social model

medical model

• addiction is a “disease of the brain”

• due to genetic differences, neurotransmitter imbalances

• Disease model: Agent is drug, host is addicted person, vector is dealers/advertisers

psychodynamic model

• drug abusers are “Self-medicating”

• Abuse/addiction is a reflection of underlying problems, a maladaptive coping strategy

• Need to resolve internal conflict. Once done, use of substance will become unnecessary

social model

• substance use is a learned behavior

• people use substances because they are modeled by other people

• peer pressure can play a role in initiating behavior

• Environmental cues lead to behavior (e.g. advertising)

• Can be viewed as a maladaptive relationship negotiation strategy

moral model (criminal justice)

• Addicted persons are weak, but can overcome compulsion to use through willpower

• Use of addicted substances is by choice

• Anti-social view of users

• Addictive substance is evil

bio- psycho - social model

• combines previous models

• Takes a holistic view of psychological, social, and physical reasons for
  use/addiction and treats these as necessary for recovery

• Emphasizes Maslov’s hierarchy of needs

cultural acceptance and norms different in each countries

intervention and political economic perspectives

WHO action on tobacco: the tobacco free initiative

tobacco use is disproportionate in LMICs

• tobacco kills up to half of its users

• Tobacco kills more than 7 million people each year. More than 6 million of those deaths are the result of direct tobacco use

• ~ 1M are the result of non-smokers being exposed to second-hand
  smoke

• Around 80% of the world's 1.1 billion smokers live in low- and middle- income countries

There is no safe level of exposure to second hand tobacco smoke

• In adults, second-hand smoke causes serious cardiovascular and
  respiratory diseases, including CHD and lung cancer. In infants, it
  causes sudden death. In pregnant women, it causes low birth weight

• Almost half of children regularly breathe air polluted by tobacco smoke in public places

side stream and main stream smoke

impact = participation rate x efficacy of the program

Whereby, participation rate = % who get involved in the program
and Efficacy is the proportion of participants who stop using tobacco

Program 1’s Impact with a 20% participation rate and 40% efficacy
= 0.20 * 0.40 = 0.08 (8%)

Program 2’s Impact with a 80% participation rate and 10% efficacy =
0.80 * 0.10 = 0.08 (8%)

the 6 MPOWER measures are:

• monitor tobacco use and prevention policies

• Protect people from tobacco use

• Offer help to quit tobacco use

• Warn about the dangers of tobacco

• Enforce bans on tobacco advertising, promotion and sponsorship

• Raise taxes on tobacco