Week 3 - Tobacco Use, Dependence & Treatment

NRSG 316 WELLNESS & HEALTH PROMOTION: TOBACCO USE, DEPENDENCE & TREATMENT, PART 1

Instructor Information

  • Instructor: Selam Stephanos MPH, MPPE, RN

  • Week: 3, Fall Quarter 2025

Tobacco and Mortality

  • Smoking as a Risk Factor

    • Smoking ranks as the leading risk factor for mortality in the United States.

Number of Deaths by Risk Factor (2019)

  • Total Annual Deaths across all age groups and both sexes:

    • Smoking: 136,663 deaths

    • High blood pressure: 104,736 deaths

    • High blood sugar: 102,247 deaths

    • Obesity: 60,572 deaths

    • Alcohol use: 60,229 deaths

    • Drug use: 48,501 deaths

    • Diet low in whole grains: 40,172 deaths

    • Low physical activity: 37,147 deaths

    • Secondhand smoke: 35,583 deaths

    • Diet low in vegetables: 27,977 deaths

    • Unsafe sexual activity: 14,354 deaths

    • Diet low in nuts and seeds: 11,029 deaths

    • Low birth weight: 9,606 deaths

    • Child stunting: 14 deaths

    • Vitamin A deficiency: 0 deaths

    • Source: IHME, Global Burden of Disease (2019), Our World in Data (CC BY).

Annual U.S. Deaths Attributable To Smoking (2005–2009)

  • Total Annual Deaths: >480,000 deaths

    • Cardiovascular and metabolic diseases: 160,600 deaths

    • Lung cancer: 130,659 deaths

    • Pulmonary diseases: 113,100 deaths

    • Secondhand smoke: 41,280 deaths

    • Cancers other than lung: 36,000 deaths

    • Other causes: 1,633 deaths

    • Source: U.S. Department of Health and Human Services (USDHHS).

Current Adult Use of Tobacco Products (2019)

  • Prevalence of Current Adult Use: 20.8% of adults currently use any tobacco product; 3.9% use 2 or more products.

    • Specific Product Usage:

    • Any combustible product: 16.7%

    • Breakdown by product:

      • Cigarettes:

      • E-cigarettes:

      • Cigars:

      • Smokeless tobacco:

      • Regular pipes, waterpipes, hookah:

    • Source: Cornelius ME et al. (2020).

Tobacco Product Use Among High School Students (2018)

  • Total Tobacco Use: 20.8% among high school students.

    • Breakdown of Use:

    • E-cigarettes: 8.1%

    • Cigarettes: 7.6%

    • Cigars: 5.9%

    • Smokeless tobacco: 4.1%

    • Hookah pipe tobacco: 1.1%

    • Source: CDC Vital Signs.

Economic Costs of Smoking

  • Annual Smoking-Attributable Economic Costs: $288.9 billion

    • Healthcare expenditures: $132.5 billion

    • Lost productivity costs due to premature mortality: $156.4 billion

    • Cost per pack of cigarettes smoked: $19.16

    • Source: U.S. Department of Health and Human Services (USDHHS).

Trends in Cigarette Consumption in the U.S. (1900–2011)

Historical Events Impacting Consumption

  • Significant historical events affecting smoking habits:

    • 1964: Surgeon General’s Report on smoking and cancer

    • Federal cigarette tax doubles

    • Master Settlement Agreement

    • California’s ban on smoking in bars

    • Various marketing regulations over the years

Effect of Cigarette Price Increases on Consumption

  • Trends in Cigarette Prices and Sales (1970-2011):

    • Price fluctuation directly correlated with sales change.

    • Increased prices lead to reduced consumption.

Average Cost of Cigarettes by State (as of 2023)

  • State Prices:

    • Prices range from $5.21 to $10.53 in various states, average being $8.57.

    • Source: Wise Voter

Public Health vs. Big Tobacco

  • Tobacco Industry Spending:

    • The tobacco industry spends $23 for every $1 spent on tobacco control by states, undermining public health initiatives.

Legislative Measures Against Tobacco

  • California Ban on Flavored Tobacco Products (SB 793):

    • Bans the sale of flavored tobacco products, including menthol.

    • California voters upheld the law via referendum in November 2022 (Prop 31).

FDA Regulation of Tobacco Products

  • FDA Authority:

    • Regulates cigarettes, smokeless tobacco, e-cigarettes, and more since May 5, 2016.

Health Consequences of Smoking & Smokeless Tobacco

Immediate Health Effects

  • Irritation: Eyes, nose, and throat.

  • Physiological Effects: Increased heart rate and blood pressure, reduced lung function, and other physical changes.

Long-Term Health Effects

  • Pulmonary Disorders: Chronic Bronchitis, Emphysema/COPD, Asthma, etc.

  • Cardiovascular Diseases: Increased risk of heart disease, hypertension, reduced blood flow, etc.

  • Cancer: Elevated risk for multiple cancers including lung, throat, stomach, and bladder.

  • Reproductive Health: Reduced fertility, increased risk of complications in pregnancy.

  • Other Effects: Type 2 diabetes onset, immune function reduction, and postoperative complications.

    • Source: U.S. Department of Health and Human Services (USDHHS).

Oral Hazards of Smoking & Smokeless Tobacco

  • Potential Oral Effects: Periodontal disease, gingival recession, oral cancers, oral leukoplakia, etc.

Smoking Cessation: Reduced Risk of Death

  • Study on Mortality in Smokers:

    • On average, smokers die approximately 10 years younger than nonsmokers. Half who continue smoking will die due to tobacco-related diseases.

Benefits of Quitting

  • Improvement Timeline Post-Quit:

    • 2 weeks to 3 months: Circulation improves.

    • 1 year: Risk of coronary heart disease drops to half.

    • 5 years: Lung cancer death rate drops to half.

    • 10 years: Risk of various cancers reduces significantly.

Tobacco Components & Products

Composition of Tobacco

  • Key Components:

    • Nicotine: Primary psychoactive ingredient.

    • Tar: Sticky residue containing carcinogens.

    • Carbon Monoxide: Affects oxygen transportation in blood.

    • Additional chemicals totaling over 7,000, with at least 250 identified as harmful.

Cigarette Composition

  • Chemicals Found in Cigarettes:

    • Includes nicotine, tar, carbon monoxide, various carcinogens, and additives such as formaldehyde and benzene.

Nicotine Absorption and Excretion

  • Half-Life of Nicotine: Approximately 2 hours, and 16 hours for cotinine.

  • Absorption: Rapidly absorbed via the lungs, skin, and small intestine.

Nicotine Addiction Cycle

Mechanisms of Addiction

  • Dopamine Release: Nicotine stimulates dopamine which leads to pleasure and reward.

  • Tolerance Development: Results require increasing doses for the same effect due to neuroadaptation.

Individual and Environmental Factors in Tobacco Use

Individual Factors

  • Demographics: Education level, gender, socioeconomic status are predictors for smoking.

  • Psychiatric co-occurrence: Higher prevalence in smokers with mental health issues.

Environmental Factors

  • Influential Situations: Peers, family, and exposure to smoking environments influence usage.

Role of Parental and Sibling Smoking

  • Impact of Family: Children with smoking parents are more likely to smoke; however, parental cessation correlates with children quitting.

Assessing Tobacco Use

Nursing Assessment Roles

  • Identify Tobacco Users: History, current level of use, and prior quitting attempts.

  • Pack-Year Calculation: Standardized measure for exposure used in clinical decisions for smoking-related diseases.

    • Formula: Pack-Year = (Number of Packs per Day) x (Number of Years Smoked).

Clinical Application

  • Assessment Tools and Questionnaires:

    • Fagerstrom Test for Nicotine Dependence, Heaviness of Smoking Index, Nicotine Withdrawal Scale, and others.

Conclusion

  • Tobacco Dependence as a Two-Part Problem: Treatment should address both physiological addiction and behavioral habits.