HE ED 110 - Exam #3 Review Notes

Why do people drink

• Relaxation / feeling good

• Celebration

• During business deals

• Self medicating

• Imitate or comply with others

• Enhance a meal

• Be sociable or polite

Alcohol

An intoxicating ingredient (ethanol / ethyl alcohol) in fermented or distilled beverages

• Organic compound (water soluble, moves rapidly through membranes of the body and gets to the brain fast)

• One drink = 13.6 grams of pure alcohol

• Average age to start drinking in Alberta is 17.2 years

• High risk drinking and gender?

  • Men are more likely to engage in high risk drinking

  • Women are less tolerant of alcohol (get drunk faster)

• Drinking peaks among youth aged 18-24

• How much is too much?

  • Weekly intake limit (about 15 standard drinks for males and 10 standard drinks for females)

  • Daily consumption limit (about 4 drinks for men and 3 drinks for women)

• Alcohol has been linked to certain cancers, and now they say 1-2 drinks per week is the maximum recommended intake

Alcohol absorption and metabolism

• Absorbed in bloodstream from mouth (5%), stomach (20%), and small intestine (75%)

• The rate your body absorbs alcohol will affect how quickly you feel drunk or how quickly your behaviour is impaired

• Many factors determine the rate of absorption:

  • How fast you drink

  • How fast your stomach empties its contents

  • How much and what type of food and other drugs are in your system

  • The kind of alcohol

  • Sex of a person

  • Ethnicity

• Most is metabolized in the liver

• Some is metabolized by Alcohol Dehydrogenase (ADH)

Alcohol intake and BAC

• BAC: blood alcohol concentration

  • Influenced by many factors

  • Ex. people with more body fat will have lower tolerances for alcohol (since it’s water soluble, and fat has less water than muscle, it stays concentrated in the bloodstream)

  • Ex. how fast you’re drinking, percentage of alcohol of the drink, how full your stomach is, whether the alcohol is mixed with other alcohols (increases concentration), mood (if you’re stressed, you’ll absorb it faster and get drunk faster)

• Heavy/frequent drinkers metabolize alcohol faster

Binge drinking

Pattern of alcohol use that rapidly bring a person’s BAC up to 0.08 or above

• ~5 drinks for men or ~4 drinks for women within 2 hours

• Will raise BAC very quickly

BAC and body weight

Alcohol impairment chart

Note that:

• In all of Canada, operating a vehicle at BAC 0.08 is criminal

• In only 3 provinces there is no legislation prohibiting driving at some level below 0.08 (Yukon, Alberta and Quebec)

• Intoxication is a form of “poisoning”

Impact of alcohol

• Bloodstream ~15 minutes

• Peak concentration ~1 hour

• Diuretic (dehydrates, increases urination)

• Lowers body temperature, dilates blood vessels

• 7 cal./g

• Stimulates appetite

• Exercise doesn’t help metabolize alcohol

• Drinking coffee or taking other drugs while drinking alcohol is bad because it causes heightened impairment (makes effects of alcohol worse)

Short term effects of alcohol

• Loss of self-control and/or inhibition

• Feeling content/happy

• Loss of physical coordination and balance 

• Double vision

• Mood swings

• Cardiorespiratory system impairment

BAC chart

Long term effects of alcohol

• Shrinkage in brain size

• Cardiomyopathy (heart disease)

• Liver problems leading to death (ex. cirrhosis) 

• Stomach problems (ex. ulcers)

• Increases risk of cancer

• Blocks absorption of calcium (can lead to osteoporosis)

• Decreased immune function (more susceptible to illness)

Alcohol during pregnancy

• Damage to the fetus depends on how much alcohol is consumed

• In early pregnancy, heavy drinking can cause abortion and miscarriage

• Can cause a range of disabilities called fetal alcohol spectrum disorder (FASD)

• Most severe is fetal alcohol syndrome (a characteristic group of birth defects caused by alcohol consumption during pregnancy; can include facial deformities, heart defects, and physical and mental disabilities)

• Can also include alcohol-related neurodevelopmental disorder (ARND) - cognitive and behavioural problems seen in people whose mothers drank during pregnancy

• No alcohol during pregnancy is safe

• Nursing mothers should also avoid alcohol because it can travel through breast milk and affect the baby’s brain development

Warning signs of alcoholism

• ≥ 4 (females) or ≥ 5 (males) drinks on a single occasion at least once per week

• Failure to fulfill major work obligations

• Continued use of alcohol despite adverse consequences

• Use of alcohol in situation in which it is dangerous

Signs of alcohol poisoning

• Mental confusion, stupor, coma

• Vomiting

• Seizures

• Slow or irregular breathing

• Hypothermia, bluish skin colour, paleness

If you suspect it:

• Know the danger signals

• Do not wait for all symptoms to be present

• Be aware that a person who has passed out may die

• Perform the Bacchus Maneuver

• If there is any suspicion of an alcohol overdose, call 911 for help. Don’t try to guess the level of drunkness

Causes of alcohol dependence

• Genetics

• Environment (ex. seeing parents who drink a lot)

• Stress and traumatic experiences

• Parental alcoholism

• Drug abuse

Possible health benefits of alcohol

• Reduced risk of heart attack

• Light to moderate drinking may improve heart health, thinning the blood, and reducing inflammation

• However, there are doubts about these claims

• Older people who drink can experience slight reductions in heart function

• Currently, there is no evidence that drinking on one’s 20s and 30s has any health benefits

• No actual evidence of alcohol being beneficial to one’s health

Drink strength

• Beer usually contains 3-6% alcohol

• Ales and malt liquors usually contain 6-8% alcohol

• Wines often contain 9-14% alcohol

• Hard liquor (ex. gin, rye, rum, tequila, vodka, liqueur) can contain anywhere from 35-50% alcohol or more

Standard drinks vs actual servings

• One drink means the amount of a beverage that typically contains 13.6g of “pure” alcohol

• The typical serving of most alcoholic beverages is larger than the standard serving (especially mixed drinks)

Alcohol metabolism and excretion

• Once alcohol is absorbed, it’s metabolized (the body transforms it into usable substances and waste)

• Alcohol moves easily through most biological membranes, meaning it’s rapidly distributed throughout most bodily tissues

• Most is metabolized in the liver

• 2-10% of alcohol is not metabolized in the liver but excreted unchanged by the lungs, kidneys, and sweat glands (which is why breathalyzer and urine tests exist)

• Chronic heavy use can cause loss of brain function and changes in brain structure

• Alcohol interferes with new brain cell production in unborn children, young children, adolescents, and young adults

Low concentrations of alcohol

• Effects can first be felt at BAC of 0.03-0.05

• Include:

  • Light-headedness

  • Relaxation

  • Release of inhibitions 

  • Mild euphoria

  • Sociability

Higher concentrations of alcohol

• Pleasant effects are usually replaced by negative effects

• Include:

  • Interfering with motor coordination

  • Verbal performance

  • Intellectual functions

  • Anger/irritability

• At BAC 0.2, most people are completely unable to function

• At BAC 0.35, people often go into a coma

• Any higher level can result in death

• Chronic heavy drinking can reduce testosterone levels and impair sperm production

• Large amounts of alcohol disturb sleep patterns

Hangovers

• Symptoms include:

  • Headache

  • Shakiness

  • Nausea

  • Diarrhea

  • Fatigue

  • Impaired mental functioning

• Heart rate and blood pressure increase (more vulnerable to heart attacks)

• Most likely caused by a combination of the toxic products of alcohol breakdown, dehydration, and hormonal effects

• Driving ability is impaired while hungover

Alcohol poisoning

• Often causes death

• Caused by drinking large amounts of alcohol in a short time

• Death can be caused by CNS and respiratory depression of by inhaling fluid or vomit into the lungs

Alcohol with other drugs

• Alcohol-drug combinations are a leading cause of drug-related deaths

• When cocaine and alcohol are combined, they form a toxic substance in the liver (cocaethylene) which can produce effects that neither drug does alone

• Combining alcohol with caffeine is dangerous because:

  • Alcohol absorption is increased but its metabolism is not

  • People think they’re less impaired than they actually are

  • People think they’re more alert than they are

• In Canada, pre-packaged alcoholic drinks that contain caffeine are illegal

Alcohol related injuries and death

• Combination of impaired judgment, weakened sensory perception, reduced inhibitions, impaired motor coordination, and increased aggressiveness and hostility can be dangerous and deadly

• Alcohol is responsible for 15,000 deaths, 90,000 hospital admissions, and 2,400,000 years of life lost every year

• Alcohol more than triples the chance of fatal injuries during leisure activities

Alcohol and aggression

• Associated with more acts of aggression and violence than any other legal or illegal drug

• Parents who are heavy drinkers are more likely to abuse their children

• People who are predisposed to aggressive tendencies can become even more aggressive under the influence of alcohol

Alcohol and sexual behaviour

• Impairs people's ability to make smart decisions about sex

• Frequent binge drinkers are 5x more likely to engage in unplanned sex and 5.5x more likely to have unprotected sex

• Rates of STIs and unwanted pregnancies are higher among heavy drinkers

• Binge drinkers are at increased risk of sexual assault as well

Drinking and driving

• Remains a leading criminal cause of death

• Particularly problematic among young people

• Some driving skills are affected at BAC 0.02 or lower

• At 0.05, visual perception, reaction time, and some steering tasks are impaired

• Risk of fatal crashes are 380x higher at BACs above 0.14

Effects of chronic alcohol misuse

• Affects many different tissues and organs

• Issues associated with chronic use include:

  • Damaged brain cells

  • Impaired memory

  • Loss of sensation in limbs

  • Brain atrophy (loss of neurons and connections between neurons)

  • Cirrhosis

  • Hepatitis

  • Inflamed stomach and pancreas

  • Increased risk of cancers in the GI tract

Digestive system

• Even within a few days of heavy alcohol consumption, fat begins to accumulate in liver cells, causing fatty liver

• If drinking persists, the liver can become inflamed, causing alcoholic hepatitis

• Both fatty liver and alcohol hepatitis are reversible if the person stops drinking

• Even more alcohol use causes liver cells to become damaged and destroyed, and they’re replaced by fibrous scar tissue, causing cirrhosis

• Overuse of alcohol often causes GI bleeding

Cardiovascular system

• High doses can harm this system

• More than two drinks a day may elevate blood pressure, making strokes and heart attacks more likely

• Some people with alcohol use disorder develop cardiac myopathy (weakening of the heart muscle)

Cancer

• Alcohol is a known human carcinogen

• It is a risk factor for cancers in the:

  • Breasts

  • Colon

  • Rectum

  • Esophagus

  • Larynx

  • Liver

  • Mouth

  • Pharynx

• Genetics and other biological factors also determine whether a person is likely to get cancers or not

Brain damage

• Tempered by a person’s physiology and genetics

• Alcoholics often experience brain shrinkage, loss of grey and white matter, reduced blood flow, and slowed metabolic rates in some brain regions

• Brain shrinkage can be somewhat reversed if a person stops drinking

• Heavy drinkers often suffer from memory loss, dementia, and compromised problem solving and reasoning abilities

Mortality

• Alcohol consumption is related to over 200 conditions, diseases, and injuries

• Around 5% of all deaths worldwide are caused by harmful use of alcohol

• People with an alcohol use disorder are expected to live 15 years less than those without this disorder

Canada’s low risk drinking guidelines

• ¼ of Canadians report heavy drinking (5+ drinks for males and 4+ for females) on one occasion, at least once a month in the past year

• Heavy drinking is highest among people 20-24

• No more than 10 drinks a week for women (no more than 2 per day) and no more than 15 for men (no more than 3 per day)

• On special occasions, women shouldn’t drink more than 3 drinks and men no more than 4

• Pregnant people, underaged people, and people who plan to drive or are taking certain medications shouldn’t drink at all

Alcohol use disorder

• A disorder that combines alcohol abuse and alcohol dependence; diagnosed as mild, moderate, or severe depending on the number of criteria and individual meets over a 12 month period

• After a period of abstinence, people who are addicted to alcohol often attempt controlled drinking, which almost inevitably leads to an escalation in drinking and more problems

• Mild:

  • Alcohol misuse: recurrent alcohol use that has negative consequences, such as drinking in dangerous situations or drinking patterns that result in academic, professional, interpersonal, or legal difficulties

• Severe:

  • Alcoholism: a pathological use of alcohol or impairment in functioning due to alcohol; characterized by tolerance to alcohol and withdrawal symptoms

Health effects

• Heavy users may have to consume 50% more than they originally needed to experience the same degree of intoxication

• Withdrawal symptoms include:

  • Trembling hands

  • Rapid pulse

  • Accelerated breathing rate

  • Insomnia

  • Nightmares

  • Anxiety

  • GI issues

• More severe symptoms include:

  • Seizures

  • Confusion

  • Hallucinations

  • Delirium tremens (a state of confusion brought on by the reduction of alcohol intake in a person addicted to alcohol; other symptoms are sweating, trembling, anxiety, hallucinations, and seizures)

    • Mortality rate can be as high as 15%

• Memory gaps are common as well

Social and psychological effects

• For every person addicted to alcohol, 3 or 4 people are directly affected

• Major source of trouble in many families

• More likely than those without alcohol addiction to experience clinical depression, panic disorder, schizophrenia, borderline personality disorder, or antisocial personality disorder

• Alcohol use disorder often co-occurs with other substance use problems

Causes of severe alcohol use disorder

• Precise causes are unknown, but many factors are likely involved

• Some factors include:

  • Genetics

  • Environment

  • Certain personality disorders

  • Growing up in a violent/troubled household

  • Bad role models

  • Urbanization

  • Disappearance of extended family

  • Loosening of kinship ties

  • Increased mobility

  • Changing values

Treatment of severe alcoholism

• Some people stop of their own accord, especially if they experience an alcohol related crisis (ex. car crash, blackout, health problem, threat of being fired)

• Self help groups (ex. AA)

• Groups for affected people, that show how they enable drinking behaviours

• Inpatient hospital rehabilitation is also an option, especially if the person has serious medical or psychological problems

• There are also medications being developed to help

• Antidepressants can help if the person using alcohol has severe depression or anxiety

Sex differences (alcohol)

Females

• More abstain from alcohol completely or are low risk drinkers when compared to males

• Tend to become addicted at a later age and with fewer years of heavy drinking

• Women with severe alcohol use disorder develop cirrhosis and other medical conditions more often and after a shorter period of drinking

• Higher death rates due to their disorder

• Some alcohol-related health problems are unique to females, such as increased risk of breast cancer, menstrual disorders, infertility, and in pregnant women, giving birth to a child with FASD

Males

• A greater percentage of Canadian males report drinking patterns that exceed Canada’s low risk drinking guidelines

• Excessive drinking often begins in the teens or 20s for white men in North America

Provincial differences

Quebec had the highest rate for drinking and Ontario had the lowest in 2019

First nations and drinking

• Problematic alcohol use is a widespread and severe issue in many First Nations communities, especially for adolescents and young adults

• The prevalence of binge drinking was significantly higher among First Nations men and women living both on and off reserve than non Indigenous Ontarians in 2017

• Social determinants such as unemployment, low education, social exclusion, and poor social support are also related to the increased likelihood of alcohol misuse within some Indigenous communities

Responsible drinking

• Drink slowly

• Space out your drinks

• Eat before and while drinking

• Know your limits and your drinks

Encourage responsible attitudes

The choice to abstain from using alcohol is not odd or unusual, and should be respected

Be a Responsible Host

• Serve non-alcoholic beverages as well as alcohol

• Have a moderate amount of alcohol on hand

• Always serve food with alcohol

• Arrange carpools with designated drivers

• Insist that people who drank too much find a safe way home

• Plan something without alcohol

Hold the Drinker Responsible

• Do not pardon unacceptable behaviour from someone under the influence

• Speak up against unacceptable behaviour

Take Community Action

• Consider joining OSAID or something similar

Who uses tobacco?

• 18% of Canadians 15 and older reported using tobacco at least once the preceding month in 2017

• Smoking has become more common

• However, Canada has one of the lowest smoking rates in the world

• Less educated people tend to smoke cigarettes more, but more educated and affluent people smoke cigars more

• There has been a gradual increase in the amount of occasional smokers

• Occasional smokers are equally likely to suffer health consequences and are less likely to quit

• More than 80% of tobacco users wish to quit

• It takes between 3.2 and 29 attempts to quit

Tobacco and other drugs

• People with other drug issues tend to use tobacco as well

• Smoking is 2-4x as prevalent among people with mental health diagnoses

Nicotine addiction

• Tobacco: the leaves of cultivated tobacco plants prepared for smoking or chewing or for use as snuff

• Nicotine: a poisonous, addictive substance found in tobacco and responsible for many of the effects of tobacco

• Some studies indicate that nicotine acts on the brain in similar ways as cocaine and heroin

• In low doses, it acts as a stimulant (but the opposite in teens who smoke)

• In some circumstances, it can act as a mild sedative

Loss of control

• Around half of Canadian smokers want to quit

• Of people who quit, around 60% relapse within the first 3 months and 75% within the first 6 months

• Most religions agree to some degree that smoking is wrong because it harms the body

Tolerance and withdrawal

• Tobacco builds tolerance

• For regular tobacco users, sudden abstinence can cause withdrawal symptoms including:

  • Severe cravings

  • Insomnia

  • Confusion

  • Tremors

  • Difficulty concentrating

  • Fatigue

  • Muscle pains

  • Headache

  • Nausea

  • Irritability

  • Anger

  • Depression 

• Most physical symptoms pass within 2 or 3 days, but the craving associated with addiction stays

Social and psychological factors (tobacco)

• Many people have established the habit of smoking with doing other things (ex. talking, working, drinking, etc)

• It can be difficult to break the habit because the people continue to do the things they associate with smoking (known as secondary reinforcers)

• Secondary reinforcer: stimuli that are not necessarily pleasurable in themselves but are associated with other stimuli that are

Genetic factors (t)

• Genes affect how nicotine is metabolized

• Slow metabolizers are less likely to continue smoking because it causes them nausea and dizziness

Why start using tobacco?

• Around 80% of smokers started before they were 18

• Many factors can influence this, including:

  • A parent or sibling uses tobacco

  • Peers use tobacco

  • The child comes from a blue collar family

  • The child comes from a low income home

  • The family is headed by a single parent

  • Poor school performance

  • The child drops out of school

  • The child has positive attitudes toward tobacco use

• Sometimes, young men will start using tobacco to emulate their favourite athletes

• Young women may start because they think it’ll help them lose weight/stay thin

• Most often, young people start because their peers are doing it

Emulating smoking in media

• More and more tobacco use is being shown in movies and other media

• By showing smoking in an unrealistically positive light, films may be acting as an advertisement for tobacco

• There has been a strong association found between seeing tobacco use in films and trying cigarettes for adolescents

Tobacco smoke

• Contains hundreds of damaging chemical substances, including:

  • Acetone

  • Ammonia

  • Hexamine (lighter fluid)

  • Toluene (industrial solvent)

• There are many particles in tobacco smoke, which, when condensed, form a brown sticky mass called cigarette tar

Carcinogens and poisons

• At least 43 chemicals in tobacco smoke are linked to cancer development

• Carcinogen: substance that causes cancer (ex. urethane)

• Cocarcinogen: substances that work with a carcinogen to cause cancer (ex. formaldehyde)

• Nicotine can be fatal in high doses

• Cigarette smoke contains carbon monoxide, which displaces oxygen in red blood cells, depleting the body’s supply of oxygen needed for extra work, and can also impair visual acuity (sharpness)

Additives

• Manipulate the taste and effect of cigarettes and other tobacco products

• Account for roughly 10% by weight of a cigarette

• Added sugars mask the harsh, bitter taste of tobacco and when they burn, they produce acetaldehyde (a chemical that enhances the additive effect of nicotine and is a carcinogen)

• Other flavour components open the lungs’ airways and make it easier for nicotine to get into the bloodstream

• Ammonia increases the amount of nicotine delivered by cigarettes

• Some additives are intended to make sidestream smoke (the inhaled smoke from a burning cigarette) less obvious and objectionable

Results of inhaling tobacco smoke

• All smokers absorb gases, tar, and nicotine from cigarette smoke, and those who inhale bring most of these substances into their bodies where they stay

• More chemicals are absorbed in the last third of a cigarette than the first because the unburned tobacco acts as a filter

• However, any gains will be offset by smoking more cigarettes, inhaling more deeply, or puffing more frequently

Light/low tar cigarettes

• These are not actually healthier alternatives, as all cigarettes are unsafe 

• People who switch to these often end up smoking more cigarettes, inhaling more deeply, taking larger/more frequent puffs, and/or blocking ventilation holes with lips or fingers

• People who smoke “light” cigarettes inhale up to 8x as much tar and nicotine as printed on the label

• Users of “light” cigarettes are less likely to quit because they believe these cigarettes are safer

Menthol cigarettes

• Menthol is a bronchodilator (opens airways and makes it easier for nicotine to enter the bloodstream)

• It also has an anesthetizing effect, which allows smokers to inhale more deeply and hold smoke in their lungs longer

Immediate effects of smoking

• Beginner smokers often have symptoms of mild nicotine poisoning:

  • Dizziness

  • Faintness

  • Rapid pulse

  • Cold, clammy skin

  • Nausea

  • Vomiting

  • Diarrhea 

• The effects of nicotine vary depending on the size of the dose and how much tolerance the person has

• Nicotine also:

  • Stimulates the cerebral cortex and adrenal glands

  • Inhibits the formation of urine

  • Constricts blood vessels

  • Accelerates heart rate

  • Elevates blood pressure

• Smoking depresses hunger contractions and dulls taste buds

• Not useful for weight loss

Long term effects of smoking

• Total amount of tobacco smoke inhaled is a key factor contributing to disease

• Frequent, heavy smokers are more at risk that moderate/non smokers

• Most costly diseases found currently include:

  • Cardiovascular diseases

  • Respiratory diseases (ex. emphysema and lung cancer)

  • Other cancers

Cardiovascular disease

• Coronary heart disease is the most widespread single cause of death for cigarette smokers

• Often results from atherosclerosis (fatty deposits called plaques form on the inner walls of heart arteries, causing them to narrow and stiffen)

• Vulnerable to myocardial infarctions (a heart attack caused by the complete blockage of a main coronary artery)

• Can also interfere with the heart’s electrical activity

• People under 40 who smoke are 5x more likely than those who do not to have a heart attack

• Also responsible for other CVDs, including

  • Stoke

  • Aortic aneurysm

  • Pulmonary heart disease

Lung cancer

• Cigarette smoking is the primary cause of lung cancer

• Benzopyrene (a chemical found in tobacco smoke) causes genetic mutations in lung cells that are identical to those found in many patients with lung cancer

COPD

Chronic obstructive pulmonary disease

• The lungs of smokers are forced to work harder to function adequately

• Stresses placed on the lungs by smoking can permanently damage lung function and lead to COPD

• It is a progressive and disabling disorder which consists of several different but related diseases, with emphysema and chronic bronchitis being the main two

• Between 80 and 90% of COPD cases in Canada are mainly due to cigarette smoking, however air pollution also plays a role and exposure to both is more dangerous than either by itself

Emphysema

A disease characterized by a loss of lung tissue elasticity and breakup of the air sacs, impairing the lungs’ ability to obtain oxygen and remove carbon dioxide

• People with this disease are often breathless, constantly gasping for air, and have the feeling of drowning

• Heart must pump harder and may become enlarged

• Often die from a damaged heart

• It is irreversible

Chronic bronchitis

• Recurrent, persistent inflammation of the bronchial tubes

• When the cell lining of the bronchial tubes is irritated, it secretes excess mucus, causing bronchial congestion, which is followed by a chronic cough

• If smokers have chronic bronchitis, they face a greater risk of lung cancer, regardless of their age or how much they smoke

Other respiratory damage

• Even when someone shows no signs of lung impairment or disease, cigarette smoking damages the respiratory system

• Cigarette smoke first slows then stops the action of the cilia (which usually protect the body from certain harmful airborne substances)

• Eventually, cigarette smoke destroys the cilia

• Smoking also makes macrophages (a type of white blood cell that works to remove foreign particles from the respiratory tract) work less efficiently

• Smoking can also worsen allergy and asthma symptoms and increase susceptibility to colds

• Not all damage is permanent, and much can be reversed if the smoker quits

Health, cosmetic, and economic concerns

More likely to suffer from:

• Peptic ulcers

• Erectile dysfunction due to affected blood flow in the veins and arteries

• Reproductive health problems, such as reduced fertility, menstrual disorders, early menopause, and pregnancy complications

• Dental diseases such as tooth decay and gum and periodontal diseases 

• Diminished physical senses

• Higher rate of injury

• Premature skin wrinkling, baldness, stained teeth, discoloured fingers, and persistent tobacco smell

• Cigarette costs can add up

• Osteoporosis

• Complications from diabetes

• Accelerated multiple sclerosis

Cumulative effects of smoking

• Reduced life expectancy

• Additional sick days taken

• More Canadian women die from lung cancer than breast cancer

• Women are more at risk for smoking related blood clots and strokes

• Women are less successful than men in quitting

• Men and women respond differently to medications that are designed to help them quit

cumulative

Other forms of tobacco use

• Spit tobacco

• Cigars

• Cigarillos

• Pipes

• Clove cigarettes

• Bidis

**They are not safe alternatives

Spit tobacco

• Especially common among Indigenous and rural Canadians, adolescent males, and male athletes

• Highly addictive

• Some people keep it in their mouth while sleeping

• Has a high nicotine content

• Can irritate gums and lips 

• Can lead to oral cancer

• Some chemicals are believed to pose risks to developing fetuses

Cigars and pipes

• Most popular among white males 25-44 with higher-than-average income and education

• Large cigars contain as much tobacco as an entire pack of cigarettes

• Contains the same chemicals as cigarettes and sometimes in much larger quantities

• Smoking a cigar immediately impaired blood vessels’ ability to dilate, reducing the amount of oxygen delivered to the tissues

• Little evidence suggest occasional cigar smoking leads to addiction for adults, but it very likely will in young adults

Clove cigarettes and bidis

• Clove cigarettes are made of tobacco mixed with chopped cloves

  • Contain almost twice as much tar, nicotine, and carbon monoxide as conventional cigarettes

• Bidis are available in different flavours

  • Can contain up to 4x as much nicotine and 2x as much tar as North American cigarettes

  • Popularity has grown among teens

E-cigarettes

• More people over 15 are using e-cigarettes

• Instead of containing tobacco, it has a changeable filter that contains one or more chemicals, including nicotine, flavourings, and other compounds

• Have been advertised to help smokers quit, but there’s no evidence to support that

• Claimed to be a safer cigarette but it still contains many harmful chemicals, including some carcinogens

• Vapour cigarettes (vapes) are marketed as safer but it still has nicotine and is not healthy

Individual action

• Non-smokers have the right to clean air

• People can do many things, including but not limited to:

  • Complain when people smoke in non-smoking areas

  • Report minors buying nicotine products

  • Support people in quitting

  • Cancel subscriptions to things that advertise tobacco products

  • Volunteer with the Canadian Lung Association, Canadian Cancer Society, or Heart and Stroke Foundation of Canada

Local action

Pass ordinances designed to discourage public smoking

Private action

Most provinces have enacted smoke-free workplaces legislation

Provincial action

• Support tobacco control strategies through the use of strategic taxation

• Bans on second hand smoking

Federal action

• Implemented educational campaigns about the effects of smoking

• Ban flavours and additives to tobacco products

• Restricting advertising of tobacco products

• Requiring health warning messages

• Targeting contraband cigarettes

International action

• Smoking is banned on most airplanes, restaurants, hotels, public transportation, etc

• WHO made world no tobacco day, encouraging smokers to quit for 1 day (taking the first step)

Quitting tobacco use

• Long-term, intricate process

• Quitters move through predictable stages:

  • Disinterest in quitting

  • Thinking about change

  • Making a concerted effort to stop

  • Finally maintaining abstinence

• Most attempt to quit many times before they succeed, and relapse is normal

Benefits of quitting

• Provides immediate health benefits

• Food tastes better

• Sense of smell sharpens

• Circulation improves

• Heart rate and blood pressure drop

• Lung function and heart efficiency increase

• More energetic and alert

• Fewer headaches

• Complexion may improve

• Positive effect on long-term disease risk

• Decreased risk of cancers, heart attack, stroke, and other CVDs 

• Longer life expectancy than continuing smokers

• Even those who have developed chronic bronchitis or emphysema may show some improvement

Options for quitting

• Can include:

  • Pharmacological interventions

  • Nicotine replacement therapy

  • Behavioural strategies

  • Motivational interviewing: cognitive behaviour change strategy aimed at helping smokers increase motivation to quit by decreasing ambivalence and eliciting change talk

• Behavioural factors that have been shown to increase chances of a smoker’s permanent quitting include support from others and regular exercise

• Nicotine replacement comes in many forms, including patches, gum, lozenges, nasal sprays, and inhalers, although some of these may have adverse effects of their own

• Quitline counsellors are also an option, and help smokers make a personalized plan for quitting

Smoking on body parts

1. Brain: 

   • Alters mood regulating chemicals 

   • Stimulates cravings for more nicotine

2. Mouth and throat:

   • Dulls taste buds

   • Irritates the membranes

3. Lungs:

   • Damages air sacs, which affects the lungs’ ability to to bring in oxygen and remove carbon dioxide

   • Increases mucus secretion in the bronchial tubes, which narrows air passages

4. Heart:

   • Increases heart rate

   • Increases blood pressure by constricting blood vessels

   • Affects the oxygen-carrying ability of hemoglobin so less oxygen reaches the heart

5. Adrenal glands:

   • Stimulates adrenaline production

6. Kidneys:

   • Inhibits formation of urine

   • Damages kidneys

Smoking and the lungs

Smoking on the heart

• Nicotine speeds up the heart

• Smoking raises blood pressure

• Smoking reduces the amount of oxygen the blood can carry

• Formation of clots is more likely

Second hand smoking

• Most hazardous form of indoor air pollution

  • Mainstream smoke (what a smoker exhales)

  • Sidestream smoke (comes from the burning of the cigarette)

    • Higher levels of tar, nicotine, and carbon monoxide

• People exposed to this may start coughing, develop headaches, experience breathing difficulties, have sinus problems, and have an increased risk of cancer and CVD

• If a child is exposed to secondhand smoke, they’re 3x more likely to experience SIDS

Smoking and pregancy

Dangers:

1. Miscarriage or stillbirth

2. Placental abruption

3. Ectopic pregnancy

4. Birth defects

5. Low birth weight

6. Asthma attacks

7. Ear infections

8. Sudden infant death syndrome (SIDS)

Nutrition

The science of food and how the body uses it in health and disease

Nutritional requirements

• Essential nutrients: substances the body must get from food because it cannot make them itself or make fast enough to meet its needs; include proteins, fats, carbohydrates, vitamins, minerals, and water

• Macronutrients: essential nutrients the body requires in relatively large amounts

• Micronutrients: essential nutrients the body requires in small amounts

• Digestion: the process of breaking down foods in the GI tract into compounds the body can absorb

Nutrient table

Nutrient	Function	Major sources
Protein (4 cals/g)	Form important parts of muscles, bone, blood, enzymes, some hormones and cell membranes Repair tissue Regulate water and acid-base balance Help growth Supply energy	Meat Fish Poultry Eggs Milk products Legumes Nuts
Carbs (4 cals/g)	Supply energy to brain cells, nervous system, and blood Supply energy to muscles during exercise	Grains Gruits Vegetables  Milk
Fats (9 cals/g)	Supply energy Insulate Support Cushion organs Provide medium for absorption of fat-soluble vitamins	Animal goods Grains Nuts Seeds Fish Vegetables
Vitamins	Promote specific chemical reactions within cells	Fruits Vegetables Grains Meat Milk products
Minerals	Help regulate body functions Aid in growth and maintenance of body tissues Catalysts for release of energy	Found in most food groups
Water	Makes up around 60% of body weight Provides medium for chemical reactions Transports chemicals Regulates temperature Removes waste products	Fruits Vegetables Liquids

Calories

• Kilocalories: measure of energy content in food; 1 kilocalorie represents the amount of heat needed to raise the temperature of 1 litre of water by 1 degree celsius; commonly referred to as a calorie

• 1 kilocalorie contains 1000 calories

• A person usually requires approximately 2000 KILOcalories per day

Proteins

• Essential nutrient; a compound made of amino acids that contain carbon, hydrogen, oxygen, and nitrogen

Amino acids

• Building blocks of proteins

• 11/20 amino acids can be found naturally in the body

• 9/10 are essential amino acids and need to be gained through food intake

Complete vs incomplete proteins

1. Have all essential amino acids

2. Have some essential amino acids

Recommended protein intake

• Healthy adults require 0.8g of protein for every kg of body weight

• Eating too much protein can actually result in fat gain because it gets turned into fat because it’s not used

• Very high protein can put strain on the kidneys

Fats

• Also known as lipids

• 9 calories/g

• Add important flavour and texture to food

• Major fuel source for the body during rest and light activity

• A high fat diet can make weight management quite difficult

• Diets that are high in fatty red meat are associated with an increased risk of certain forms of cancer, colon cancer especially

Types and sources of fats

• Can be saturated or unsaturated

• Saturated fats are solid at room temperature

• Unsaturated fats are liquid at room temperature

Hydrogenation

A process by which hydrogens are added to unsaturated fats, increasing the degree of saturation and turning liquid oils into solid fats; produces a mixture of saturated fatty acids and saturated and trans forms of unsaturated fatty acids

• Trans fatty acids: a type of unsaturated fatty acid produced during the process of hydrogenation; trans fats have an atypical shape that affects their chemical activity

• Mainly found in fried foods, margarine, snack foods, muffins, pastries, and breaded foods

• Small amounts can also be found in meat and milk

• Fish and oils derived from animal sources are rich in polyunsaturated fats