Tobacco

Question 1

Pathophysiology of smoking

Answer 1

Tissue destruction contributing to
lung disease
cellular changes contributing to cancer
cellular and molecular reinforcing effects leading to dependence

The hemodynamic and hormonal changes in response to nicotine may contribute directly to this risk

Repeated exposure to carbon monoxide (CO)  cardiac events

Direct dose-response relationship between CO levels and angina

CO rapidly binds hemoglobin (Hb) and changes its form to carbooxyhemoglobin (COHb). COHb reduces the availability of Hb for oxygen (O2)  impairment of oxygen supply to tissues (i.e., hypoxia)

Oxidant chemicals contribute directly to endothelium injury and dysfunction in arteries in the heart and the peripheral system

This initiates the pathology of atherogenesis and reduces the threshold for acute cardiovascular events

Other compounds, such as nitric oxide, are ineffective in promoting vasodilation

Nicotine  decreased elasticity of both carotid and brachial arteries  arterial stiffness  accelerates atherosclerosis

Nicotine  coronary vascular resistance
 plaque rupture in vulnerable individuals
 abnormalities in myocardial perfusion  coronary ischemia

Smoking  endothelium functions  impairment in flow-mediated dilatation

Smoking influences the clotting system  increase risk for thrombosis and acute cardiac events

CO  reducing oxygen carrying capacity of hemoglobin  increase red blood cells  propensity to thrombosis

Smoking  total cholesterol, triglyceride levels and decreases high-density lipoprotein cholesterol – in a dose-dependent manner

Smoking  platelet activation over 100 folds from baseline after 2 cigarettes atherosclerosis
Platelet-derived growth factor  atherogenic promoter of smooth-muscle cell growth

Question 2

Risk Factors

Answer 2

Psychosocial factors
Peer pressure
Industry marketing/promotion
Cost of the product
Minor’s access
Biological susceptibility

Question 3

High Risk Populations

Answer 3

Adolescents
People with low income
People with less education
Racial and ethnic minorities

Question 4

Poverty and Smoking

Answer 4

Poor people are:
More likely to take up smoking
Less likely to quit
More heavily exposed to other people’s smoke
Become more nicotine dependent
Much more likely to die prematurely from smoking

Question 5

Indicators of socio-economic status

Answer 5

Occupational class
Educational level
Housing tenure
Car ownership
Unemployment
Living in crowded accommodation
Single parenthood
Divorced or separated

Question 6

Why do people smoke?

Answer 6

Modifiable risk factors
Social and individual factors
Industry advertising and promotion
Access
Social norms
Inadequate understanding of risk

Question 7

Why do people continue to smoke?

Answer 7

Nicotine dependence

Other factors as above

Question 8

reward pathway

Answer 8

VTA->nucleus accumbens->prefrontal cortex

Question 9

Reinforcing Effects

Answer 9

Mesolimbic system
Dopamine pathways
Release of dopamine

Pleasure
Mood modulation
Enhanced cognitive and motor performance
Weight reduction

Question 10

Tolerance

Answer 10

Reduced responsiveness of drug at site of action

Increased number of nicotinic receptors

Question 11

Withdrawal Symptoms

Answer 11

Negative affect
Problems with concentration
Sleep problems
Increased appetite and weight

Question 12

Addictive Property

Answer 12

Speed of delivery