Test on Smoking Prevention Materials (Videos and PowerPoint Presentations)
“Teenage Smokers Now” (Confessions) http://www.youtube.com/watch?v=JWSR5ovPowo (Video 1)
Note: (To open web based YouTube Videos, Right Click and "Open in New Window")
True or False
The teenage smokers in the Video made the following statements about quitting :
1. “I don’t have that control over myself and I really wish I did”
2. “ I don’t think I could go three hours without a cigarette”
3. “It’s just like a drug”
4. “Quitting is easy. I already did it 5 times!”
5. “After about 4 hours of not having a cigarette, that’s all that’s on my mind”
6. “I say NO! and the cigarettes say YES! and they keep coming in”
7. “Every so often I say I’m going to stop smoking cigarettes BUT I CAN’T! “
8. “I’M GOING TO SMOKE TIL I DIE!”
9. “It’s my life and it’s a free country!”
10. “I love it! I don’t want to quit!”
The teenage smokers in the Video made the following statements on dating:
11. "I asked her out and she answered, BUT YOU’RE A SMOKER! That was her answer!"
12. “My last boyfriend broke up with me because he didn’t like how my breath always smelled”
13. “My boyfriend also smokes so it’s Ok”
The teenage smokers in the Video made the following statements on sports and athletic ability:
14. “I used to play soccer but because of smoking I couldn’t keep up with the rest of the team and I got cut”
15. “Cigarettes started catching up to me. I’d be running up the (basketball) court and I’d have to get out because I don’t have any
more breath”
16. “I got tired every time I ran. I got slower in every thing I’ve done”
17. “How am I gonna be a gym teacher when I’m smoking man!”
18. “It’s really hard to play sports when you smoke!”
The teenage smokers in the Video made the following statements on their health:
19. “I wake up coughing and hacking. Phlegm comes up. It’s nasty. Even during the day you hack and cough and spit up!”
20. “My lungs must look like a prehistoric mash pit of tar”
21. “It’s terrible! It’s just a slow painful way of killing yourself!” “I wish I never started”
22. “I’m worried about getting cancer or a heart attack”
ANSWERS
4, 9, 10, 13 and 22 ARE FALSE. All the others are TRUE
COMMENTS:
MORE THAN 80% OF SMOKERS START BEFORE THE AGE OF 18.
TEENAGERS AND PRETEENAGERS ARE UNIQUELY SUSCEPTIBLE TO NICOTINE ADDICTION. COMPARED TO ADULTS, NICOTINE ADDICTION AMONG YOUTHS REQUIRES LESS EXPOSURE, IS MORE FREQUENT, MORE SEVERE, LONGER LASTING AND LESS LIKELY TO BE OVERCOME. MANY YOUTHS BECOME ADDICTED FOR LIFE.
STATISTICS SHOW THAT THE GREAT MAJORITY OF TEENAGERS DO NOT SMOKE AND PREFER TO DATE NON-SMOKERS. MORE AND MORE THE TEENAGE SMOKER IS BECOMING THE ODD MAN OUT. TEEN SMOKING IN THE UNITED STATES HAS SIGNIFICANTLY DECREASED OVER RECENT YEARS AND IS ON THE DECLINE.
THE HEALTH CONSEQUENCES OF SMOKING IN YOUTHS INCLUDE SHORTNESS OF BREATH (WHICH IMPAIRS ATHLETIC ABILITY AND PLAYING SPORTS), CHRONIC BRONCHITIS (CHRONIC COUGH AND SPUTUM PRODUCTION), SILENT VASCULAR DAMAGE (WHICH INCREASES THE RISK OF LATER HEART ATTACKS), DNA CHANGES IN LUNG CELLS (WHICH INCREASES THE RISK OF LATER LUNG CANCER) AND DECREASED GROWTH AND DEVELOPMENT OF THE LUNGS (WHICH INCREASES THE RISK OF LATER EMPYHSEMA.)
“Teenage Smokers Now and Later” (Health and Science)
http://www.youtube.com/watch?v=lfetYfRsq1k&feature=em-share_video_user (Video 2)
Note: (To open web based YouTube Videos, Right Click and "Open in New Window")
True or False
1. In the Video, a patient’s wife pointed to his face and said, “That’s where the cancer is coming back and that comes from
cigarettes!”
True: The patient had a disfigured face from a far advanced smoking related cancer of the mouth. The consequences of smoking, like cancer, not
only affects patients, it also affects their families who share their fear and misery.
2. In the Video, a patient who underwent a laryngectomy and tracheotomy for smoking related throat cancer, continued
smoking thru the hole his throat (tracheostomy).
True: Nicotine addiction is so severe and overwhelming that patients not infrequently continue smoking despite having a life threatening smoking
related disease. (E.g. some patients like the one in the Video keep smoking even after surgery for cancer of the throat. Some patients with
emphysema keep smoking even though they can barely breathe or they smoke near their oxygen knowing that they could burst into flames at any
moment.)
3. Harmful chemicals in inhaled tobacco smoke cause mouth throat and lung cancer by damaging DNA in exposed mouth, throat
and lung cells.
True
4. In the Video, the patient with lung cancer was cured by surgery.
False: His cancer had spread and could not be removed by surgery. Unfortunately, this is most often the case. Even radiation and chemotherapy
failed. Lung Cancer is the most common cause of cancer death. Almost 90% of lung cancer comes from smoking! We need a vaccine against lung
cancer. We have one. It’s called “DON”T SMOKE!”
5. When cancer cells break away from the original tumor site and travel through the body to form new tumors in distant sites
like the brain, bone and liver, this is called “homeostasis”.
False: This is called “metastasis”. Metastasis is a main reason why cancer is so lethal. Homeostasis is the tendency of our physiological systems to
maintain internal stability. (For example we shiver when it’s cold and we sweat when it’s hot to maintain a stable normal body temperature.)
6. The Patient in the Video with emphysema stated “Walking 10 or 15 feet gets me out of breath. Talking gets me out of breath.
Everything gets me out of breath.”
True
7. Patients with emphysema have small shrunken lungs.
False: Patients with emphysema have air flow obstruction mainly on exhaling. This results in very large hyper-inflated lungs because of air
entrapment. In the Video the patient with emphysema had a chest x-ray that showed lungs that were twice normal in size.
8. Harmful chemicals in tobacco smoke that inflame and damage the air sacs of the lung cause emphysema. Air sacs lose
elasticity and rupture. Air that flows into them can’t flow out easily resulting in over distended hyper-inflated lungs.
True: In addition, patients with emphysema struggle not only to exhale but also to inhale and often panic to get enough air into their already
hyper-inflated lungs. In the Video the patient is seen using his neck muscles to inhale even though he was sitting in a chair at rest.
9. Chronic bronchitis is caused by harmful chemicals in tobacco smoke that chronically inflame the bronchial tubes. This leads
to a marked increase in the mucous glands in the bronchial wall that secrete a large amount of mucous, which is constantly
coughed up.
True: The patient in the Video with chronic bronchitis almost drowned in his own secretions and required a tracheotomy (a surgically placed hole
into his windpipe) thru which the secretions could be suctioned out.
10. Smoking damages the linings of arteries including the arteries of the heart.
True: This reduces the flow of blood to the heart and can lead to a heart attack. Damage to the arteries of the feet from smoking can also cause
gangrene of the toes requiring amputation. The smoker in the Video had both a heart attack and gangrene of the toes requiring amputation.
Damage to the arteries of the brain from smoking causes strokes.
11. Smoking slows the heart rate and lowers the blood pressure.
False: Just the reverse. Smoking increases the heart rate and raises the blood pressure. This puts a chronic increased strain on the heart.
12. Smoking increases blood carbon monoxide.
True: Carbon monoxide robs the blood of oxygen including blood flowing to the heart. So smoking adversely affects the heart 3 ways. By damaging
the lining of arteries less blood gets to the heart, by increasing blood carbon monoxide, less oxygen gets to the heart and by raising the heart rate
and blood pressure the heart must work harder. Triple Jeapardy! Coronary Heart Disease is the leading cause of death in the United States and
smoking causes almost 20% of it!
13. The women in the Video who smoked during their pregnancy had premature babies (2 pounds 4 oz.) with severe breathing
problems but only because they smoked marijuana.
False: They smoked tobacco not marijuana. It is well known that smoking tobacco during pregnancy causes prematurity and respiratory problems
in newborns. The fetus receives all of the poisons in the tobacco smoke including carbon monoxide. Puff for puff however, marijuana could be even
more toxic to the fetus since marijuana smoke has much higher levels of carbon monoxide then tobacco smoke.
14. Although smoking damages internal organs it causes no permanent damage to a smoker’s external appearance.
False: Smoking reduces blood and oxygen supply to the skin, damages collagen and elastin and speeds up the skin’s normal
aging process. These changes may occur after only 10 years of smoking. The result is facial wrinkles especially around the eyes
and mouth that are not reversible. In the Video the faces of smokers and nonsmokers of the same age and sex are compared.
As seen, the smoker’s faces are much more wrinkled. Studies have shown that smokers in the 40-49 year age group are likely
to prominently wrinkle as non-smokers who are 20 years older.
15. In the Video, an experiment was performed where the smoke from a single filter tip cigarette was blown through a clean
tissue. Very little tar was deposited in the tissue because it was trapped in the filter.
False: As seen, the tissue was heavily stained with tar despite the filter tip on the cigarette. Cigarette smoke contains over 7000 chemicals, over 250
are known to be harmful and over 60 are known to cause cancer. Much of this toxic material is in the tar and, as seen in the Video, this is what you
inhale when you smoke only one cigarette even if the cigarette has a filter.
16. When the 19 year old smoker in the Video had pulmonary function testing of his small airways at the University of Miami
Medical Center after only 3 years of smoking, the tests showed that he already had the lungs of a 66 -year old non-smoking
man.
True: Smoking damages small airways (<2 mm in diameter) first. and then progresses to damage the larger airways. Growing lungs are uniquely
susceptible to tobacco smoke which impairs their growth, development and function. This increases the risk for later emphysema.
“How Nicotine Causes Addiction”
http://ren.mededu.miami.edu/MD_Curriculum/Tobacco/How_Nicotine_Causes_Addiction.pps (PowerPoint Lecture 1)
Note: (To open web based YouTube Videos, Right Click and "Open in New Window")
True or False
1. 46 Million Americans currently smoke and the majority do not wish to quit.
False: statistics show that 70% say they would like to quit and 40% try every year. Because of the severity of nicotine addiction, on any unaided
quit attempt, less then 5% succeed even for one year.
2. Nicotine addiction is stronger then cocaine and heroin addiction.
True: According to world experts and many people with dual addictions, you are more likely to become addicted to nicotine if you start smoking
and less likely to quit smoking once addicted to nicotine even compared to heroin and cocaine. So by this definition, nicotine addiction (tobacco
use with loss of control) is stronger then cocaine and heroin addiction.
3. There are three major mechanisms of nicotine addiction:
a) The addictive property of nicotine is related to the rate of delivery of nicotine to the brain.
True: Since the fastest method of nicotine delivery to the brain is thru the inhalation of tobacco smoke (even faster than the intravenous
route), the cigarette is therefore the most efficient nicotine delivery device and therefore most addicting.
b) Nicotine releases gratification chemicals in the brain.
True: The most important gratification chemical released in the brain by nicotine is dopamine. This is the same gratification chemical that is
released in the brain by cocaine and heroin so the mechanism of addiction is similar.
c) Long term use of nicotine produces functional and structural changes in the brain.
True: Nicotine receptors become desensitized and then increase in number and density. In addition, long lasting (sometimes lifetime)
neuronal memory circuits are established in the cerebral cortex which sub-serve memory where external every day cues can trigger nicotine
cravings. Illustrations (tissue specimens and PET scans) of these nicotine induced functional and structural changes in the brain are shown in
the PowerPoint Lecture. Because of these abnormal functional and structural changes in the brain, nicotine addiction is now classified as a
chronic disease by every major Health Agency.
4. When a nicotine addicted smoker tries to quit, physiological withdrawal symptoms (e.g. irritability, insomnia, anxiety) start
within days and last years.
False: Physiological withdrawal symptoms start within hours of quitting and last weeks to perhaps a month. In contrast, cravings for nicotine
(e.g. in response to external cues like seeing someone smoke or smelling the smoke or external stress) can last years or even a lifetime, especially
if the onset of smoking was during adolescence. It is both the physiological withdrawal symptoms and nicotine cravings that cause failed quit
attempts after hours, days or years of abstinence.
“Consequences and Therapy of Nicotine Addiction”
http://ren.mededu.miami.edu/MD_Curriculum/Tobacco/Consequences_and_Therapy_of_Nicotine_Addiction.pps (PowerPoint Lecture 2)
Note: (To open web based YouTube Videos, Right Click and "Open in New Window")
True or False
1. Smoking causes over 5 million deaths annually in the world and the premature death of every other long-term smoker.
True: Tobacco and obesity are the two top causes of preventable death both globally and in the United States. The average weight gain of 8-10
pounds after quitting smoking is preventable and poses MUCH less health risk than continuing to smoke. Furthermore, recent studies have shown
that adolescent smokers don’t gain weight after quitting.
2. Breast cancer is the most common cause of cancer death.
False: Lung cancer is the most common cause of cancer death and 90% of lung cancer comes from smoking.
3. Pneumonia and Asthma are the most common causes of chronic respiratory disease death.
False: COPD (emphysema and chronic bronchitis) is the most common cause of chronic respiratory disease death and 90% of COPD comes from
smoking.
4. Coronary heart disease is the most common cause of cardiovascular death.
True: and 20% of coronary heart disease comes from smoking
5. Cutting down from smoking a pack a day (20 cigarettes /day) to smoking 1-2 cigarettes per day significantly reduces the risk
for a heart attack or stroke.
False: Smoking fewer cigarettes/day (like 1 or 2 a day) DOES NOT significantly reduce the risk for cardiovascular disease (i.e. heart attack or stroke).
6. Smoking affects sexual and reproductive health but only in female smokers.
False: Heavy smoking reduces blood flow to the penis, which contributes to impotence (erectile dysfunction). Male smokers are also at greater risk
for infertility, since smoking decreases sperm density and motility (ability to move). In addition, there is consistent evidence that links smoking in men
to DNA damage in sperm affecting male fertility, pregnancy viability and anomalies in offspring.
7. Smoking while using birth control pills does not increase the risk of the birth control pills.
False: Women who smoke and use birth control pills have a particularly higher risk of coronary heart disease and pulmonary embolism especially if
they are over 35 years of age.
8. Smoking increases the risk for cancer of the mouth, throat, esophagus, stomach, pancreas. kidney, bladder, uterine cervix and
leukemia.
True: Smoking significantly increases the risk of many cancers besides lung cancer.
9. Smoking increases the risk for osteoporosis (fragile bones).
True: Smoking increases the risk of osteoporosis by killing osteoblasts (bone forming cells) and decreasing blood supply to bone. This increases the
risk of hip and other bone fractures
10. Smoking is associated with poor wound healing and adverse surgical outcomes.
True: If you’re undergoing surgery, you should quit smoking in advance of the surgery. Even stopping a few weeks before the surgery and during the
healing process can reduce this risk.
11. Exposure to second hand smoke is responsible for about 50,000 cardio-vascular deaths per year.
True: In fact, the risk of stroke from chronic exposure to second hand smoke is almost the same as that for direct smoking.
12. Fifteen years after quitting (if you’re still ok) overall risk of disease or death approaches that of never smokers.
True
13. Evidence based effective smoking cessation therapy consists of Pharmacotherapy (drugs), Behavioral Therapy and Social
Support.
True: Pharmacotherapy is most useful to alleviate the short term nicotine physiological withdrawal symptoms on quitting (i.e. “the nicotine fits”).
Behavioral therapy is most useful to control the longer term cravings for nicotine brought on by external trigger factors (i.e. external stress, morning
coffee etc.). Social support is useful in general. The three used in conjunction can increase the long-term quit rate (e.g. >1 year) on any given quit
attempt from less than 5% to over 30% and this has HUGE health benefits. The successful long-term quitter did so on average after 5 or more tries
by learning from their mistakes so if a patient fails or relapses we encourage them to try again and we help them try again!
14. Why do smokers quit smoking?
a) They fear physiological withdrawal symptoms on quitting.
True: We treat this with pharmacotherapy.
b) Smoking has become part of their daily routine. They are behaviorally conditioned.
True: We treat this with behavioral therapy (i.e. behavioral de-conditioning).
c) They love and crave the psychogenic reward.
True: We treat this with pharmacotherapy to control the cravings and with behavioral therapy to substitute other rewards
d) They fear weight gain.
True: We treat this by warning them against it and prescribing a healthy diet and exercise.
c) They love to spend money.
False
“Teenage Smokers Now” (Confessions) http://www.youtube.com/watch?v=JWSR5ovPowo (Video 1)
Note: (To open web based YouTube Videos, Right Click and "Open in New Window")
True or False
The teenage smokers in the Video made the following statements about quitting :
1. “I don’t have that control over myself and I really wish I did”
2. “ I don’t think I could go three hours without a cigarette”
3. “It’s just like a drug”
4. “Quitting is easy. I already did it 5 times!”
5. “After about 4 hours of not having a cigarette, that’s all that’s on my mind”
6. “I say NO! and the cigarettes say YES! and they keep coming in”
7. “Every so often I say I’m going to stop smoking cigarettes BUT I CAN’T! “
8. “I’M GOING TO SMOKE TIL I DIE!”
9. “It’s my life and it’s a free country!”
10. “I love it! I don’t want to quit!”
The teenage smokers in the Video made the following statements on dating:
11. "I asked her out and she answered, BUT YOU’RE A SMOKER! That was her answer!"
12. “My last boyfriend broke up with me because he didn’t like how my breath always smelled”
13. “My boyfriend also smokes so it’s Ok”
The teenage smokers in the Video made the following statements on sports and athletic ability:
14. “I used to play soccer but because of smoking I couldn’t keep up with the rest of the team and I got cut”
15. “Cigarettes started catching up to me. I’d be running up the (basketball) court and I’d have to get out because I don’t have any
more breath”
16. “I got tired every time I ran. I got slower in every thing I’ve done”
17. “How am I gonna be a gym teacher when I’m smoking man!”
18. “It’s really hard to play sports when you smoke!”
The teenage smokers in the Video made the following statements on their health:
19. “I wake up coughing and hacking. Phlegm comes up. It’s nasty. Even during the day you hack and cough and spit up!”
20. “My lungs must look like a prehistoric mash pit of tar”
21. “It’s terrible! It’s just a slow painful way of killing yourself!” “I wish I never started”
22. “I’m worried about getting cancer or a heart attack”
ANSWERS
4, 9, 10, 13 and 22 ARE FALSE. All the others are TRUE
COMMENTS:
MORE THAN 80% OF SMOKERS START BEFORE THE AGE OF 18.
TEENAGERS AND PRETEENAGERS ARE UNIQUELY SUSCEPTIBLE TO NICOTINE ADDICTION. COMPARED TO ADULTS, NICOTINE ADDICTION AMONG YOUTHS REQUIRES LESS EXPOSURE, IS MORE FREQUENT, MORE SEVERE, LONGER LASTING AND LESS LIKELY TO BE OVERCOME. MANY YOUTHS BECOME ADDICTED FOR LIFE.
STATISTICS SHOW THAT THE GREAT MAJORITY OF TEENAGERS DO NOT SMOKE AND PREFER TO DATE NON-SMOKERS. MORE AND MORE THE TEENAGE SMOKER IS BECOMING THE ODD MAN OUT. TEEN SMOKING IN THE UNITED STATES HAS SIGNIFICANTLY DECREASED OVER RECENT YEARS AND IS ON THE DECLINE.
THE HEALTH CONSEQUENCES OF SMOKING IN YOUTHS INCLUDE SHORTNESS OF BREATH (WHICH IMPAIRS ATHLETIC ABILITY AND PLAYING SPORTS), CHRONIC BRONCHITIS (CHRONIC COUGH AND SPUTUM PRODUCTION), SILENT VASCULAR DAMAGE (WHICH INCREASES THE RISK OF LATER HEART ATTACKS), DNA CHANGES IN LUNG CELLS (WHICH INCREASES THE RISK OF LATER LUNG CANCER) AND DECREASED GROWTH AND DEVELOPMENT OF THE LUNGS (WHICH INCREASES THE RISK OF LATER EMPYHSEMA.)
“Teenage Smokers Now and Later” (Health and Science)
http://www.youtube.com/watch?v=lfetYfRsq1k&feature=em-share_video_user (Video 2)
Note: (To open web based YouTube Videos, Right Click and "Open in New Window")
True or False
1. In the Video, a patient’s wife pointed to his face and said, “That’s where the cancer is coming back and that comes from
cigarettes!”
True: The patient had a disfigured face from a far advanced smoking related cancer of the mouth. The consequences of smoking, like cancer, not
only affects patients, it also affects their families who share their fear and misery.
2. In the Video, a patient who underwent a laryngectomy and tracheotomy for smoking related throat cancer, continued
smoking thru the hole his throat (tracheostomy).
True: Nicotine addiction is so severe and overwhelming that patients not infrequently continue smoking despite having a life threatening smoking
related disease. (E.g. some patients like the one in the Video keep smoking even after surgery for cancer of the throat. Some patients with
emphysema keep smoking even though they can barely breathe or they smoke near their oxygen knowing that they could burst into flames at any
moment.)
3. Harmful chemicals in inhaled tobacco smoke cause mouth throat and lung cancer by damaging DNA in exposed mouth, throat
and lung cells.
True
4. In the Video, the patient with lung cancer was cured by surgery.
False: His cancer had spread and could not be removed by surgery. Unfortunately, this is most often the case. Even radiation and chemotherapy
failed. Lung Cancer is the most common cause of cancer death. Almost 90% of lung cancer comes from smoking! We need a vaccine against lung
cancer. We have one. It’s called “DON”T SMOKE!”
5. When cancer cells break away from the original tumor site and travel through the body to form new tumors in distant sites
like the brain, bone and liver, this is called “homeostasis”.
False: This is called “metastasis”. Metastasis is a main reason why cancer is so lethal. Homeostasis is the tendency of our physiological systems to
maintain internal stability. (For example we shiver when it’s cold and we sweat when it’s hot to maintain a stable normal body temperature.)
6. The Patient in the Video with emphysema stated “Walking 10 or 15 feet gets me out of breath. Talking gets me out of breath.
Everything gets me out of breath.”
True
7. Patients with emphysema have small shrunken lungs.
False: Patients with emphysema have air flow obstruction mainly on exhaling. This results in very large hyper-inflated lungs because of air
entrapment. In the Video the patient with emphysema had a chest x-ray that showed lungs that were twice normal in size.
8. Harmful chemicals in tobacco smoke that inflame and damage the air sacs of the lung cause emphysema. Air sacs lose
elasticity and rupture. Air that flows into them can’t flow out easily resulting in over distended hyper-inflated lungs.
True: In addition, patients with emphysema struggle not only to exhale but also to inhale and often panic to get enough air into their already
hyper-inflated lungs. In the Video the patient is seen using his neck muscles to inhale even though he was sitting in a chair at rest.
9. Chronic bronchitis is caused by harmful chemicals in tobacco smoke that chronically inflame the bronchial tubes. This leads
to a marked increase in the mucous glands in the bronchial wall that secrete a large amount of mucous, which is constantly
coughed up.
True: The patient in the Video with chronic bronchitis almost drowned in his own secretions and required a tracheotomy (a surgically placed hole
into his windpipe) thru which the secretions could be suctioned out.
10. Smoking damages the linings of arteries including the arteries of the heart.
True: This reduces the flow of blood to the heart and can lead to a heart attack. Damage to the arteries of the feet from smoking can also cause
gangrene of the toes requiring amputation. The smoker in the Video had both a heart attack and gangrene of the toes requiring amputation.
Damage to the arteries of the brain from smoking causes strokes.
11. Smoking slows the heart rate and lowers the blood pressure.
False: Just the reverse. Smoking increases the heart rate and raises the blood pressure. This puts a chronic increased strain on the heart.
12. Smoking increases blood carbon monoxide.
True: Carbon monoxide robs the blood of oxygen including blood flowing to the heart. So smoking adversely affects the heart 3 ways. By damaging
the lining of arteries less blood gets to the heart, by increasing blood carbon monoxide, less oxygen gets to the heart and by raising the heart rate
and blood pressure the heart must work harder. Triple Jeapardy! Coronary Heart Disease is the leading cause of death in the United States and
smoking causes almost 20% of it!
13. The women in the Video who smoked during their pregnancy had premature babies (2 pounds 4 oz.) with severe breathing
problems but only because they smoked marijuana.
False: They smoked tobacco not marijuana. It is well known that smoking tobacco during pregnancy causes prematurity and respiratory problems
in newborns. The fetus receives all of the poisons in the tobacco smoke including carbon monoxide. Puff for puff however, marijuana could be even
more toxic to the fetus since marijuana smoke has much higher levels of carbon monoxide then tobacco smoke.
14. Although smoking damages internal organs it causes no permanent damage to a smoker’s external appearance.
False: Smoking reduces blood and oxygen supply to the skin, damages collagen and elastin and speeds up the skin’s normal
aging process. These changes may occur after only 10 years of smoking. The result is facial wrinkles especially around the eyes
and mouth that are not reversible. In the Video the faces of smokers and nonsmokers of the same age and sex are compared.
As seen, the smoker’s faces are much more wrinkled. Studies have shown that smokers in the 40-49 year age group are likely
to prominently wrinkle as non-smokers who are 20 years older.
15. In the Video, an experiment was performed where the smoke from a single filter tip cigarette was blown through a clean
tissue. Very little tar was deposited in the tissue because it was trapped in the filter.
False: As seen, the tissue was heavily stained with tar despite the filter tip on the cigarette. Cigarette smoke contains over 7000 chemicals, over 250
are known to be harmful and over 60 are known to cause cancer. Much of this toxic material is in the tar and, as seen in the Video, this is what you
inhale when you smoke only one cigarette even if the cigarette has a filter.
16. When the 19 year old smoker in the Video had pulmonary function testing of his small airways at the University of Miami
Medical Center after only 3 years of smoking, the tests showed that he already had the lungs of a 66 -year old non-smoking
man.
True: Smoking damages small airways (<2 mm in diameter) first. and then progresses to damage the larger airways. Growing lungs are uniquely
susceptible to tobacco smoke which impairs their growth, development and function. This increases the risk for later emphysema.
“How Nicotine Causes Addiction”
http://ren.mededu.miami.edu/MD_Curriculum/Tobacco/How_Nicotine_Causes_Addiction.pps (PowerPoint Lecture 1)
Note: (To open web based YouTube Videos, Right Click and "Open in New Window")
True or False
1. 46 Million Americans currently smoke and the majority do not wish to quit.
False: statistics show that 70% say they would like to quit and 40% try every year. Because of the severity of nicotine addiction, on any unaided
quit attempt, less then 5% succeed even for one year.
2. Nicotine addiction is stronger then cocaine and heroin addiction.
True: According to world experts and many people with dual addictions, you are more likely to become addicted to nicotine if you start smoking
and less likely to quit smoking once addicted to nicotine even compared to heroin and cocaine. So by this definition, nicotine addiction (tobacco
use with loss of control) is stronger then cocaine and heroin addiction.
3. There are three major mechanisms of nicotine addiction:
a) The addictive property of nicotine is related to the rate of delivery of nicotine to the brain.
True: Since the fastest method of nicotine delivery to the brain is thru the inhalation of tobacco smoke (even faster than the intravenous
route), the cigarette is therefore the most efficient nicotine delivery device and therefore most addicting.
b) Nicotine releases gratification chemicals in the brain.
True: The most important gratification chemical released in the brain by nicotine is dopamine. This is the same gratification chemical that is
released in the brain by cocaine and heroin so the mechanism of addiction is similar.
c) Long term use of nicotine produces functional and structural changes in the brain.
True: Nicotine receptors become desensitized and then increase in number and density. In addition, long lasting (sometimes lifetime)
neuronal memory circuits are established in the cerebral cortex which sub-serve memory where external every day cues can trigger nicotine
cravings. Illustrations (tissue specimens and PET scans) of these nicotine induced functional and structural changes in the brain are shown in
the PowerPoint Lecture. Because of these abnormal functional and structural changes in the brain, nicotine addiction is now classified as a
chronic disease by every major Health Agency.
4. When a nicotine addicted smoker tries to quit, physiological withdrawal symptoms (e.g. irritability, insomnia, anxiety) start
within days and last years.
False: Physiological withdrawal symptoms start within hours of quitting and last weeks to perhaps a month. In contrast, cravings for nicotine
(e.g. in response to external cues like seeing someone smoke or smelling the smoke or external stress) can last years or even a lifetime, especially
if the onset of smoking was during adolescence. It is both the physiological withdrawal symptoms and nicotine cravings that cause failed quit
attempts after hours, days or years of abstinence.
“Consequences and Therapy of Nicotine Addiction”
http://ren.mededu.miami.edu/MD_Curriculum/Tobacco/Consequences_and_Therapy_of_Nicotine_Addiction.pps (PowerPoint Lecture 2)
Note: (To open web based YouTube Videos, Right Click and "Open in New Window")
True or False
1. Smoking causes over 5 million deaths annually in the world and the premature death of every other long-term smoker.
True: Tobacco and obesity are the two top causes of preventable death both globally and in the United States. The average weight gain of 8-10
pounds after quitting smoking is preventable and poses MUCH less health risk than continuing to smoke. Furthermore, recent studies have shown
that adolescent smokers don’t gain weight after quitting.
2. Breast cancer is the most common cause of cancer death.
False: Lung cancer is the most common cause of cancer death and 90% of lung cancer comes from smoking.
3. Pneumonia and Asthma are the most common causes of chronic respiratory disease death.
False: COPD (emphysema and chronic bronchitis) is the most common cause of chronic respiratory disease death and 90% of COPD comes from
smoking.
4. Coronary heart disease is the most common cause of cardiovascular death.
True: and 20% of coronary heart disease comes from smoking
5. Cutting down from smoking a pack a day (20 cigarettes /day) to smoking 1-2 cigarettes per day significantly reduces the risk
for a heart attack or stroke.
False: Smoking fewer cigarettes/day (like 1 or 2 a day) DOES NOT significantly reduce the risk for cardiovascular disease (i.e. heart attack or stroke).
6. Smoking affects sexual and reproductive health but only in female smokers.
False: Heavy smoking reduces blood flow to the penis, which contributes to impotence (erectile dysfunction). Male smokers are also at greater risk
for infertility, since smoking decreases sperm density and motility (ability to move). In addition, there is consistent evidence that links smoking in men
to DNA damage in sperm affecting male fertility, pregnancy viability and anomalies in offspring.
7. Smoking while using birth control pills does not increase the risk of the birth control pills.
False: Women who smoke and use birth control pills have a particularly higher risk of coronary heart disease and pulmonary embolism especially if
they are over 35 years of age.
8. Smoking increases the risk for cancer of the mouth, throat, esophagus, stomach, pancreas. kidney, bladder, uterine cervix and
leukemia.
True: Smoking significantly increases the risk of many cancers besides lung cancer.
9. Smoking increases the risk for osteoporosis (fragile bones).
True: Smoking increases the risk of osteoporosis by killing osteoblasts (bone forming cells) and decreasing blood supply to bone. This increases the
risk of hip and other bone fractures
10. Smoking is associated with poor wound healing and adverse surgical outcomes.
True: If you’re undergoing surgery, you should quit smoking in advance of the surgery. Even stopping a few weeks before the surgery and during the
healing process can reduce this risk.
11. Exposure to second hand smoke is responsible for about 50,000 cardio-vascular deaths per year.
True: In fact, the risk of stroke from chronic exposure to second hand smoke is almost the same as that for direct smoking.
12. Fifteen years after quitting (if you’re still ok) overall risk of disease or death approaches that of never smokers.
True
13. Evidence based effective smoking cessation therapy consists of Pharmacotherapy (drugs), Behavioral Therapy and Social
Support.
True: Pharmacotherapy is most useful to alleviate the short term nicotine physiological withdrawal symptoms on quitting (i.e. “the nicotine fits”).
Behavioral therapy is most useful to control the longer term cravings for nicotine brought on by external trigger factors (i.e. external stress, morning
coffee etc.). Social support is useful in general. The three used in conjunction can increase the long-term quit rate (e.g. >1 year) on any given quit
attempt from less than 5% to over 30% and this has HUGE health benefits. The successful long-term quitter did so on average after 5 or more tries
by learning from their mistakes so if a patient fails or relapses we encourage them to try again and we help them try again!
14. Why do smokers quit smoking?
a) They fear physiological withdrawal symptoms on quitting.
True: We treat this with pharmacotherapy.
b) Smoking has become part of their daily routine. They are behaviorally conditioned.
True: We treat this with behavioral therapy (i.e. behavioral de-conditioning).
c) They love and crave the psychogenic reward.
True: We treat this with pharmacotherapy to control the cravings and with behavioral therapy to substitute other rewards
d) They fear weight gain.
True: We treat this by warning them against it and prescribing a healthy diet and exercise.
c) They love to spend money.
False