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YourHealthTodayChapter9.pptx

9: Alcohol and Tobacco

Your Health Today, 6th edition

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Understanding Alcohol Use

Alcohol is a psychoactive drug, which means it causes changes in brain chemistry and alters consciousness

Intoxication: altered state of consciousness as a result of drinking alcohol or ingesting other substances

It can have wide-ranging effects on all aspects of our thinking, emotions, and behavior

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Patterns of Alcohol Use

About 71% of American adults drink at least occasionally

About 25–30% are abstainers

Of those who do drink, 25% are at-risk drinkers

Low-risk drinking:

For men, no more than 14 drinks per week and no more than 4 on any one day

For women, no more than 7 drinks per week and no more than 3 on any one day

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Figure 9.1 What is “one drink”?

Each drink contains about 0.5 ounce (or 15 grams) of alcohol.

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Who Drinks?

People are more likely to drink at certain stages in the lifespan

Adolescence and early adulthood; threshold of middle age; and following retirement

Older adults drink less than younger adults

Women drink less and start later than men

Among adults who had at least one heavy drinking day in the past year, 21.7% are Hispanic, 30.6% are non-Hispanic Whites, and 16.4% are non-Hispanic Black adults

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Who Drinks? (2)

Differences in consumption among ethnic groups are strongly influenced by sociocultural, environmental, and economic factors

Alcohol use is generally lower among African Americans

Among Native Americans, alcoholism is recognized as the number one health problem

Asian Americans have lower consumption rates than White Americans, possibly due to genetic biological reactions referred to as the flushing effect

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Why Do Some People Have Problems with Alcohol?

Individual, psychological, and sociocultural factors

Family history of alcoholism

Family dysfunction in general

Cultural attitudes

Economic factors

Laws

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Drinking on the College Campus

Up to 80% of college students drink

Binge drinking, or heavy episodic drinking: within two hours, 5 or more drinks for men, 4 or more for women, at least once in a two-week period

Survey from the National Institute on Alcohol Abuse and Alcoholism found that 40% of college students aged 18–22 binge drank in the previous 30 days

Extreme drinking is now used to describe alcohol consumption that goes well beyond binge drinking

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Consequences of Binge Drinking in College

Injury

Commission of a crime or falling victim to crime

Driving while intoxicated

Unintended and unprotected sexual activity

Decreased academic performance

Increased risk of alcohol abuse and dependence 10 years after college

“Secondhand effects” for other students, such as arguments, assault, property damage, interrupted sleep or studying, unwanted sexual advances, etc.

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Why Do College Students Binge Drink?

To ease social inhibitions and fit in with peers

In imitation of role models

Stress reduction

To deal with negative emotions and cope with academic pressure

Mistaken belief that alcohol increases sexual arousal and performance

Social norms and the campus culture

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Pre-Gaming and Spring Break

Pre-gaming is the excessive consumption of alcohol prior to attending an event or activity in which alcohol will be served

High-risk because it involves heavy consumption in a short period of time

Freshmen are more likely to pre-game

Spring break environment is made to be conducive to excessive drinking

Collapse, sexual assaults, and unprotected sex are common

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Powdered Alcohol and Flavored Alcohol

Powdered alcohol was approved at the federal level for sale in 2015 and is available in diverse flavors

Marketed as convenient for outdoor activities and travel

Banned by more than half the states because of its potential to increase underage drinking

Flavored alcoholic beverages have increased in popularity

Malt-based (7.8% alcohol)

Ready-to-drink cocktails (14.2%)

Supersized alcopops (10.8%)

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Addressing the Problem

Strategies for addressing the problem:

Screening interviews to identify high-risk students

Enforcing college alcohol policies

Punishing students who violate policies or break the law

Mandating treatment for substance-related offenses

Educating students to resist peer pressure

Helping students cope with stress and time management issues

Targeting prevention messages to high-risk events

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Effects of Alcohol on the Body

Alcohol is quickly distributed to all the cells of the body

Once it reaches the brain, alcohol alters brain chemistry and neurotransmitter functions

Alcohol is a central nervous system depressant that impairs thinking, balance, and motor functions

As alcohol concentrations increase, more functions are depressed, and greater impairment occurs

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The Path of Alcohol in the Body (Figure 9.3)

Alcohol enters the body

Some alcohol is absorbed in the stomach, but most goes on to the small intestine

Most of the alcohol is absorbed into the bloodstream through the walls of the small intestine

The heart pumps alcohol throughout the body

Alcohol alters brain chemistry and disrupts brain functions

Alcohol is metabolized by the liver at a rate of about 0.5 ounce (about one drink) per hour

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Alcohol Absorption

Many factors affect alcohol absorption

Food in the stomach

Gender and age

Body fat

Drug interactions

Cigarette smoke

Mood and physical condition

Alcohol concentration

Carbonation

Artificial sugars from diet soda

Individual tolerance level

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Alcohol Metabolism

A small amount of alcohol is metabolized in the stomach; however, 90% is metabolized by the liver

Between 2% and 10% is not metabolized at all but is excreted unchanged through the skin, urine, or breath

Liver allows conversion of alcohol to acetaldehyde by an enzyme, alcohol dehydrogenase (ADH)

If more alcohol arrives than can be processed, it circulates through the brain, liver, and other organs until enzymes are available

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Blood Alcohol Concentration

Blood alcohol concentration (BAC): the amount of alcohol in grams in 100 milliliters of blood, expressed as a percentage

100 milligrams of alcohol in 100 milliliters of blood is equivalent to a BAC of 0.10%

Breath analyzers are valid based upon alcohol concentrations in the breath that correspond well to levels of alcohol in the brain

Amount of body water and body fat influences the BAC levels in the body

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Figure 9.4 Blood alcohol concentration over time.

The shape of this BAC curve is affected by variables such as gender, body size and build, amount and type of alcohol, duration of drinking, and presence or absence of food in the digestive tract.

Source: Figure 8, Drunk Driving Defense, 2015, www.drunkdrivingdefense.com/resources/ how-to-calculate-your-estimated-blood-alcohol-content-bac/.

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Gender Differences in Alcohol Absorption and Metabolism

Women are generally more susceptible to the effects of alcohol and have a higher BAC than men

Generally smaller than men

Higher body fat percentage

Metabolize alcohol less efficiently

As a result, women are more vulnerable to health consequences

Liver disease

Heart disease

Brain damage

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Rates and Effects of Alcohol Metabolism

Because alcohol is metabolized more slowly than it is absorbed, the concentration of alcohol builds when additional drinks are consumed

A person with a BAC of 0.08% is considered legally drunk in all states, but people experience impairment at different BAC levels

Current alcohol ingestion fads are dangerous

Mixing alcohol with energy drinks

Vaporizing alcohol

Alcohol enema

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Table 9.1 Stages of Effects of Alcohol

BAC	Effects	Impaired Functions
0.01–0.05	Relaxation; sense of well being; loss of inhibition	Decreased alertness; and impaired concentration, judgment, and coordination (especially fine motor skills)
0.06–0.10	Euphoria; blunted feelings; nausea; sleepiness	Slower reflexes; impaired reasoning; impaired visual tracking; reduced depth perception
0.11–0.20	Emotional arousal; mood swings; anger or sadness; boisterousness	Slowed reaction time; staggering gait; slurred speech; impaired balance
0.21–0.30	Aggression; reduced sensations; depression; stupor	Lethargy; increased pain threshold; severe motor impairment; memory blackout
0.31–0.40	Unconsciousness; coma; death possible	Loss of bladder control; impaired temperature regulation; slowed breathing; slowed heart rate
0.41 and up	Death	Respiratory arrest

Source: “Effects at Specific B.A.C. Levels,” by B.R.A.D.21, n.d., www.brad21.org/effects_at_specific_bac.html.

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Rates and Effects of Alcohol Metabolism (2)

Visible effects of alcohol consumption include deeper wrinkles, red cheeks, and weight gain

Acute alcohol intoxication: life-threatening blood alcohol concentration which can produce a collapse of vital body functions

Blackout: period of time during which a drinker is conscious but has partial or complete amnesia about events

Hangovers are a result of a common reaction to alcohol toxicity characterized by headache, stomach upset, thirst, and fatigue

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Medical Problems Associated with Alcohol Use

Fetal alcohol syndrome (FAS): set of birth defects associated with use of alcohol during pregnancy

Heart disease and stroke

Alcoholic cardiomyopathy: degenerative disease of the heart muscle

Heart arrhythmias (irregular heartbeat) and coronary heart disease

Liver disease

Fatty liver: liver swells with fat globules

Alcoholic hepatitis: inflammation of the liver

Cirrhosis: scarring of the liver tissue

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Medical Problems Associated with Alcohol Use (2)

Several types of cancer, particularly cancers of the head and neck, cancers of the digestive tract, and breast cancer

Heavy alcohol consumption causes anatomical changes in the brain and directly damages brain cells

Recent studies suggest that alcohol abuse causes dysfunction in lung cells

Drunkorexia is the combination of three dangerous behaviors: excessive alcohol consumption, excessive exercising, and disordered eating

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Social Problems Associated with Alcohol Use

Reduction of inhibitions, which may lead to high-risk sexual activity and a lowered likelihood of practicing safe sex

Violence, including robbery, assault, rape, domestic violence, and homicide

Risk of injury

Drunk driving

Suicide risk

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Alcohol Misuse, Abuse, and Dependence

Alcohol misuse: consumption to the point of physical, social, and moral harm to the drinker

Problem drinking: pattern of use that impairs the drinker’s life, causing personal difficulties and difficulties for others

Alcohol abuse: continued use of alcohol despite negative consequences

Alcohol dependence: a strong craving for alcohol, the development of tolerance, and symptoms of withdrawal if alcohol consumption stops abruptly—also known as alcoholism

Chronic, progressive, and often fatal disease

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Another View: Health Benefits

Moderate alcohol consumption may have some health benefits

Anticlotting effect on the blood

Enhances body’s sensitivity to insulin

Stress reduction

Diuretic effect of beer may help prevent kidney stones

Increase in HDL cholesterol

Pattern of drinking is key

Binge drinking has no protective benefits and can increase the risk for heart disease

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Treatment Options

Brief interventions

Alcohol Skills Training Program; Brief Alcohol Screening and Intervention for College Students (BASICS); AlcoholEdu

Inpatient and outpatient treatment

Residential facilities

Detoxification and withdrawal

Medications

Counseling

Self-help programs

Support groups (AA, Al-Anon, Alateen, Adult Children of Alcoholics, others)

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Treatment Options (2)

Harm reduction approach

Focuses on reducing the harm associated with drinking, both to the individual and to society

An example is controlled drinking, which emphasizes moderation rather than abstinence

Public policies and laws aimed at harm reduction

Minimum drinking age laws

Drunk driving laws

Ankle bracelet breathalyzers

Restrictions on liquor sales and outlets

Taxes on alcohol

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Are You at Risk?

“Yes” to one or more questions on the CAGE questionnaire suggests you may be at risk

C for cut down: Have you ever tried to cut down on your drinking?

A for annoyed: Have you ever been annoyed by criticism of your drinking?

G for guilty: Have you ever felt guilty about your drinking?

E for eye-opener: Have you ever had a morning “eye-opener”?

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Developing a Behavior Change Plan

Following a behavior change plan can assist you with reducing alcohol consumption

Record behavior patterns

Analyze your drinking diary

Establish goals

Implement your plan

Evaluate your results

You can also be an advocate for both abstinence and responsible drinking

BACCHUS network and GAMMA

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In Review: Alcohol

Why do people drink, and why do some people develop problems with alcohol?

What are alcohol’s effects on the body?

What are the health risks of alcohol consumption?

What are treatment approaches for problem drinking?

What kinds of actions can one take to reduce harm caused by alcohol?

Understanding Tobacco Use

Use of tobacco causes an array of health problems, both for users and for those around them

Tobacco is the leading preventable cause of death in the United States

Almost 1 in 5 adult Americans smokes

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Who Smokes? Patterns of Tobacco Use

About 18% of the adult population in the United States are smokers, down from nearly 42% in 1965

Decline is largely because of public health campaigns about the hazards of smoking

Rate of decline has slowed since 1990

More men than women smoke, and rates are higher among young people

About 12% of college students smoke

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Figure 9.6 Percentages of U.S. adults who were smokers in 2015.

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Source: “Adult Cigarette Smoking in the United States Current Estimate,” Centers for Disease Control and Prevention, www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/ index.htm.

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Substances in Tobacco

Tar is a thick, sticky residue formed when tobacco leaves burn, containing hundreds of chemical compounds and carcinogenic substances

One of the most hazardous gaseous compounds in burning tobacco is carbon monoxide, an odorless gas that interferes with the ability of red blood cells to carry oxygen to vital body organs

Nicotine is the primary addictive ingredient; it is both a poison and a powerful psychoactive drug

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Tobacco Products

Cigarettes are by far the most popular tobacco product, followed by cigars and chewing tobacco

Sales of e-cigarettes may surpass those of regular cigarettes by 2025

Although marketed as a safe cigarette, they still contain nicotine and have other health risks

Secondhand heath effects, especially on children, are of particular concern

“Smart packs” are a new type that can connect to others and share owners’ information

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Tobacco Products (2)

Hookahs are a potentially greater risk than cigarettes because of the frequency and number of puffs

About 9% of college students smoke a hookah

Cigars have more tobacco and nicotine than cigarettes, take longer to smoke, and generate more smoke and harmful combustion products

Nicotine absorbed in the mucus membranes of the mouth presents a higher risk for oral cancers

Pipe smoke has more toxins than cigarette smoke

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Tobacco Products (3)

Smokeless tobacco

Snuff, chewing tobacco or spit tobacco, and snus

Use of spit tobacco is believed to cause about 10–15% of oral cancers

Dissolvable tobacco products

Small pellets, sticks, or strips that consist of finely ground and pressed tobacco

Ingested orally like a breath mint

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Why Do People Smoke?

Nicotine is a highly addictive psychoactive drug

Some health experts believe it is the most addictive of all the psychoactive drugs

Increases in release of the neurotransmitter dopamine produce feelings of pleasure and a desire to repeat the experience

Behavioral dependence develops

Many smokers have a harder time imagining their future life without cigarettes than they do dealing with the physiological symptoms of withdrawal

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Why Do People Smoke? (2)

Weight control is one of the major reasons young women give for smoking

Nicotine suppresses appetite and slightly increases basal metabolic rate

People who start smoking often lose weight, and continuing smokers gain weight less rapidly than nonsmokers

Tobacco marketing and advertising has an effect

Because most smokers get hooked in adolescence, children and teenagers are prime targets of tobacco advertising

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Short-Term Effects of Tobacco Use

Nicotine effects can reach the brain within 7–10 seconds, producing stimulation and sedation

Smoke quickly affects heart rate, blood pressure, and body temperature

Tar and toxins damage cilia, the hair-like structures that prevent toxins and debris from reaching delicate lung tissue

The cardiovascular system cannot effectively deliver oxygen to muscle cells

Long-Term Effects of Tobacco Use

Cardiovascular disease

Cancer

Chronic obstructive pulmonary disease

Emphysema: abnormal condition of the lungs that enlarges the alveoli (air sacs) and decreases elasticity

Chronic bronchitis: mucus secretion, cough, and increasing difficulty breathing

Asthma: respiratory disorder characterized by difficulty breathing, wheezing, coughing, and thick mucus

Premature skin wrinkling, increased risk during surgery, and other health problems

Special Health Risks for Women

Fertility problems, menstrual disorders, early menopause, problems in pregnancy, lung cancer, heart disease, and respiratory diseases

Smoking during pregnancy increases risk for miscarriage, stillbirths, pre-term delivery, low birth weight, and perinatal death

Infants are at increased risk for sudden infant death syndrome (SIDS)

Special Health Risks for Men

Greater use of other forms of tobacco (cigars, pipes, smokeless tobacco) places men at higher risk for cancers of the mouth, throat, esophagus, and stomach

Men may also experience problems with sexual function (impotence) and fertility (motility and number of sperm)

Special Health Risks for Ethnic Minority Groups

Mortality rates from several diseases associated with tobacco use—including cardiovascular disease, cancer, and SIDS—are higher for ethnic minority groups than for Whites

African American men and women are more likely to die from lung cancer, heart disease, and stroke than are members of other ethnic groups, despite lower rates of tobacco use

Benefits of Quitting

Risks for many health problems are reduced when smokers quit

Health benefits begin immediately and are more significant over time

Respiratory symptoms decrease quickly

Recovery from illness is more rapid

Taste and smell return

Circulation improves

Table 9.2 When You Quit Smoking

Immediately: you stop polluting the air with secondhand smoke; the air around you is no longer dangerous to children and adults

20 minutes: blood pressure decreases; pulse rate decreases; temperature of hands and feet increases

12 hours: carbon monoxide level in blood drops; oxygen level in blood increases to normal

24 hours: chance of heart attack decreases

48 hours: nerve endings start to regrow; exercise gets easier; senses of smell and taste improve

72 hours: bronchial tubes relax, making breathing easier; lung capacity increases

Source: Health Canada: On the Road to Quitting, Health Canada, 2008, www.hc-sc.gc.ca.

Table 9.2 When You Quit Smoking (Continued)

2–12 weeks: circulation improves; lung functioning increases up to 30%

1–9 months: fewer coughs, colds, and flu episodes; fatigue and shortness of breath decrease; lung function continues to improve

1 year: risk of smoking-related heart attack is cut by half

5 years: risk of dying of heart diseases and stroke approaches that of a nonsmoker; risk of oral and esophageal cancers is cut by half

10 years: risk of dying from lung cancer is cut by half

10–15 years: life expectancy reaches that of a person who never smoked

Source: Health Canada: On the Road to Quitting, Health Canada, 2008, www.hc-sc.gc.ca.

Effects of Environmental Tobacco Smoke

Environmental tobacco smoke (ETS): smoke from other people’s tobacco products, also known as secondhand smoke or passive smoke

Significant evidence indicates that inhaling ETS has serious health consequences

Infants and children are especially vulnerable to the effects of ETS

Quitting and Treatment Options

Treatment programs to quit smoking

Of smokers who enter good treatment programs, 20–40% are able to quit for at least a year

Medications

Nicotine replacement therapy (NRT)—transdermal patch, nicotine inhaler, nicotine patch, hand gel (Nicogel)

Prescription drugs—Zyban, Wellbutrin, Chantix

Experimental vaccine—NicVax

Quitting and Treatment Options (2)

Quitting on your own can be aided by developing a behavior change plan

Record and analyze your smoking patterns

Establish goals

Prepare to quit

Implement your plan

Prevent relapse

Figure 9.3 What to Expect When You Quit

Symptom	Reason	Duration	Relief
Irritability	Body craves nicotine.	2–4 weeks	Take walks, hot baths; use relaxation techniques.
Fatigue	Nicotine is a stimulant.	2–4 weeks	Take naps; don’t push yourself.
Insomnia	Nicotine affects brain waves.	2–4 weeks	Avoid caffeine after 6 p.m.; use relaxation techniques.
Coughing, dry throat, nasal drip	Body is getting rid of excess mucus.	A few days	Drink fluids; try cough drops.
Poor concentration	Nicotine is a stimulant, boosts concentration.	1–2 weeks	Get enough sleep; exercise; eat well.
Tightness in chest	Muscles are tense from nicotine craving or sore from coughing.	A few days	Use relaxation techniques, especially deep breathing; take hot baths

Source: www.quitnet.com.

Figure 9.3 What to Expect When You Quit (Continued)

Symptom	Reason	Duration	Relief
Constipation, gas, stomach pain	Intestinal movement decreases for brief time.	1–2 weeks	Drink fluids; add fiber to diet.
Hunger	Nicotine craving can feel like hunger	Up to several weeks	Drink water or low-calorie drinks; have low-calorie snacks.
Headaches	Brain is getting more oxygen.	1–2 weeks	Drink water; use relaxation techniques.
Craving for a cigarette	Withdrawal from nicotine.	Most acute first few days; can recur for months	Wait it out; distract yourself; exercise; use relaxation techniques.

Source: www.quitnet.com.

Confronting the Tobacco Challenge

Tobacco has been part of the economy of the country since colonial times

It is a multibillion-dollar industry with tremendous lobbying power and a huge impact on the nation’s economic health

Significant inroads have been made in confronting the challenge posed by tobacco in the U.S.

Confronting the Tobacco Challenge (2)

Awareness of nonsmokers’ rights and the damage inflicted by tobacco has grown since the 1970s

Lawsuits and court settlements

1998 Master Settlement Agreement (MSA): tobacco industry agreed to pay $206 billion to 46 states over a 25-year period

Limiting access to tobacco

Raising cigarette taxes reduces demand

Laws restricting sales to minors

Restrictions on tobacco marketing

Confronting the Tobacco Challenge (3)

Family Smoking Prevention and Tobacco Control Act of 2009 granted authority to the FDA to regulate tobacco

Larger and more explicit health warning labels have so far been successfully challenged by cigarette makers

“Light,” “low,” or “mild” on packaging prohibited

Sale of cigarettes and smokeless tobacco to anyone under 18 years prohibited

Cigarette machines only allowed in 18+ venues

Single cigarette sales, free samples, and product tie-ins prohibited

Confronting the Tobacco Challenge (4)

In June 2011, the FDA released nine proposed graphic images intended to promote behavior change

Four of the top five U.S. tobacco companies sued

Case may ultimately go to the Supreme Court

Tobacco-Free College Campuses

Should college campuses be tobacco free?

1,620 of 6,000 are now smoke- or tobacco-free

Real enforcement—warnings and then fines—may be necessary to make policies effective

In Review: Tobacco

Who smokes, and why is it a problem?

What are the main tobacco products?

What are tobacco’s effects on health?

What treatment options are available for quitting tobacco?

What are various governmental and public health approaches to the tobacco challenge?

Appendix A

Long image descriptions

Figure 9.6 Percentages of Smokers in 2015 Appendix

20.5% of adult men in the U.S. were smokers

11.3% of women

26.1% of American Indians and Alaska Natives (non-Hispanic)

26.1% of Asians (non-Hispanic; and excluding Native Hawaiians and Pacific Islanders)

19.4% of non-Hispanic Whites

18.3% of non-Hispanic Blacks

12.1% of Hispanics

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