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Tobacco
219
Injuries and Trauma
One in two household fires is related to smoking with an estimated 30 deaths per
year. Ingestion of tobacco butts is toxic to infants
Trauma
The word “trauma” is most commonly used to describe a bodily injury that is severe,
sudden, and immediately life-threatening. The medical community has an entire
system for ranking and triaging patients who present with these sorts symptoms,
and professionals in these fields usually have a more streamlined way of classifying
injuries as traumatic or just serious; in general, though, it can be hard to set out a
specific definition because of how widely cases can vary. A traumatic brain injury is
different from blunt force to the leg, for instance. People can also suffer emotional
trauma, which is not always as immediately noticeable but can be just as serious.
Broad Categories and Causes
In general, traumatic injuries are those that significantly impair the functioning of at
least one part of the body. They are usually also life threatening, or at least run the
risk of death as a possible outcome, and typically happen as a result of accident
or act of violence. As a result, medical professionals often reserve the description
“traumatic” for injuries that are the most serious or the most complicated to solve.
A lot of things can qualify, but conditions that usually don’t include illnesses and
diseases that progress over time; superficial wounds; and complications or conditions
that were expected, as in a surgery.
People can also experience psychological trauma, which is an injury to mental
health most commonly brought on by an emotionally shocking, painful, or intensely
disturbing event. It’s fairly common for people who’ve witnessed traumatic injuries,
either to themselves or loved ones, to develop psychological responses; this is
particularly true of survivors of natural disasters and other mass-casualty events.
First responders are often also impacted. Of course, these sorts of mental responses
can also be caused by more specific instances and personal experiences. People
don’t usually show outward signs of injury or distress, but the turmoil they feel
inside is very real.
Medical Response
Medical teams are usually trained to handle traumatic injuries slightly differently
than other injuries, and the personnel in the Emergency Room are usually at the
front lines. In some hospitals, special trauma centers have been established to
quickly react to the immediate needs of the critically ill patient. People treated in
these sorts of units are usually those who have been involved in various types of
accidents, collisions, or violent attacks. It is normally staffed by specialized doctors
and surgeons who are prepared to deal with extensive injuries resulting from blunt
force.
220
The first few hours after an injury of this caliber are the most critical to a patient’s
chance of survival. Certain modes of medical transportation are often really helpful
when it comes to quickly dispatching a care team to an accident site. It is not
uncommon for these teams to arrive in a medical helicopter, which is typically
much faster than an ambulance.
Once the medical team is on site, its members work quickly to stabilize patients
for transportation. Cardiopulmonary resuscitation (CPR), intravenous therapy, the
application of a tourniquet or other life-saving techniques can be performed to
prepare the patient for air rescue service to the hospital. Once the victim arrives,
emergency surgery or other extraordinary measures can be performed to save the
life of the patient.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://images.wisegeek.com/man-in-trauma-room-near-doctors.jpg
Recovery and Prognosis
Once the immediate danger has been addressed and a patient has been stabilized,
he or she is often transferred to a standard care center in the hospital or out-patient
care facility. Seriously injured people will often begin recovery in an intensive care
unit (ICU) where they will receive round-the-clock attention to be sure they remain
stable. Most people who get quick treatment are able to make a full recovery, but
a lot of this depends on how serious things were at the beginning.
Emotional Dimensions
In addition to physical injuries, patients often experience psychological or emotional
effects after an extremely distressing or shocking incident, or even a chain of events
that causes the person to feel overwhelming anguish. Usually, this transpires when
something horrible happens unexpectedly and the individual is powerless to stop it.
Someone who has suffered child abuse or has been kidnapped may also experience
Tobacco
these effects, right after the event or years into the future. Often, in adults, a form
of neurosis like this can manifest due to a traumatic event that occurred during
childhood. Symptoms generally include nightmares, reliving frightening aspects of
the event, paranoia, or feelings of imminent danger. These can consume the victim
and severely impact his or her life. Psychological treatment, as early as possible,
can help ease this pain and avert long-term mental conditions, and pharmaceutical
interventions can often help, too.
221
Environmental Tobacco Smoke (ETS)
Tobacco smoke in the environment is derived from two sources:
■ downstream smoke — exhaled by smokers
■ sidestream smoke — arising from the burning end of the cigarette
The adverse effects of environmental tobacco exposure are similar to direct smoking
for many conditions including:
■ ischaemic heart disease
■ cancer — lung and sinuses
■ asthma
■ chronic obstructive airway disease
■ acute respiratory disease in children
■ sudden infant death syndrome
Environmental tobacco smoke (ETS) is the combination of two forms of smoke from
burning tobacco products:
■ Sidestream smoke, or smoke that is emitted between the puffs of a burning
cigarette, pipe, or cigar, and
■ Mainstream smoke, or the smoke that is exhaled by the smoker. When a
cigarette is smoked, about one-half of the smoke generated is sidestream
smoke. This form of smoke contains essentially all of the same carcinogenic
(cancer-causing) and toxic agents that have been identified in the mainstream
smoke inhaled by the smoker, but at greater levels.
More than 4,000 individual compounds have been identified in tobacco and tobacco
smoke. Among these are about 60 compounds that are carcinogens, tumor initiators
(substances that can result in irreversible changes in normal cells), and tumor
promoters (substances that can lead to tumor growth once cell changes begin).
Some of these compounds are tar, carbon monoxide, hydrogen cyanide, phenols,
ammonia, formaldehyde, benzene, nitrosamine, and nicotine.
222
The exposure of nonsmokers to ETS is referred to as involuntary smoking, passive
smoking, and secondhand smoke. Nonsmokers who are exposed to ETS absorb
nicotine and other compounds just as smokers do, and the greater the exposure to
ETS, the greater the level of these harmful compounds in the body.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://bazaarnest.com/description/tobacco1.png
Although the smoke to which an involuntary smoker is exposed is less concentrated
than that inhaled by smokers, research has demonstrated that the health risk from
inhaling smoke is significant. For example, scientists estimate that ETS causes about
3,000 lung cancer deaths each year.
How Strong Is the Evidence Linking ETS With Lung Cancer?
In 1986, two reports were published on the association between ETS exposure and
adverse health effects in nonsmokers: one by the U.S. Surgeon General and the
other by the Expert Committee on Passive Smoking, National Academy of Sciences’
National Research Council (NAS/NRC). Both of these reports concluded that:
■ ETS can cause lung cancer in healthy adult nonsmokers;
■ Children of parents who smoke have more respiratory symptoms and acute
lower respiratory tract infections, as well as evidence of reduced lung
function, than do children of nonsmoking parents; and
■ Separating smokers and nonsmokers within the same air space may reduce
but does not eliminate a nonsmoker’s exposure to ETS.
More recent epidemiologic studies support and reinforce these earlier reports. The
firmly established causal relationship between lung cancer and mainstream smoke,
coupled with the chemical similarities between ETS and the smoke inhaled by
smokers, led researchers to conclude that involuntary smoking is likely to have
Tobacco
similar effects on the lung. In light of the widespread presence of ETS in both
the home and workplace and its absorption by the body, the U.S. Environmental
Protection Agency (EPA) released a report in 1992 in which ETS was classified as
a Group A carcinogen a category reserved only for the most dangerous cancercausing agents in humans.
The overall results of 30 epidemiologic studies of lung cancer and involuntary
smoking further justify a Group A classification. In these studies, female neversmokers who are married to smokers are compared with female never- smokers
who are married to nonsmokers. Higher exposures cause higher risks, and people
whose spouses smoke in the home face a higher risk than that of people whose
spouses do not smoke at home. In studies of ETS in the workplace, exposures are
often even greater than exposure at home from spousal smoking.
While the EPA report focuses only on the respiratory health effects of involuntary
smoking, there may be other health effects of concern as well. Recent studies suggest
that ETS exposure also may be a risk factor for cardiovascular disease. In addition,
a few studies link ETS exposure to types of cancer other than lung.
223
Ciattion: http://howtoquitsmoking24h.com/wp-content/uploads/2015/10/Kid-Child-Teen-
and-Smoking-8.jpg
ETS Exposure in Infants and Children
Studies dating from the early 1970s have consistently shown that children and
infants exposed to ETS in the home have significantly elevated rates of respiratory
symptoms and respiratory tract infections. More than 50 recently published studies
confirm these previous conclusions:
■ ETS exposure due to parental smoking, especially the mother’s, contributes
to 150,000 to 300,000 cases annually of lower respiratory tract infection
224
(pneumonia, bronchitis, and other infections) in infants and children under
18 months of age; 7,500 to 15,000 of these cases require hospitalization.
■ ETS exposure is associated with increased respiratory irritation (cough,
phlegm production, and wheezing) and middle ear infections, as well as
upper respiratory tract symptoms (sore throats and colds) in infants and
children.
■ ETS exposure increases the number of episodes and the severity of asthma
in children who already have the disease. The EPA report estimates that
ETS worsens the condition in 200,000 to 1 million asthmatic children.
Moreover, ETS exposure increases the number of new cases of asthma in
children who have not previously exhibited symptoms.
■ ETS exposure “in utero” and in infancy can alter lung function and structure
and create other changes that are known to predispose children to longterm pulmonary risks.
■ In the United States, sudden infant death syndrome (SIDS) is the major
cause of death in infants between the ages of 1 month and 1 year, and
the linkage with maternal smoking is well established. Current evidence
strongly suggests that infants whose mothers smoke are at an increased
risk of dying of SIDS. This risk is independent of other known risk factors
for SIDS, including low birth weight and low gestational age, both of
which are specifically associated with active smoking during pregnancy.
Additional studies are needed to determine whether the increased risk is
related to “in utero” or postnatal exposure to tobacco smoke, or to both.
These findings prompted recommendations that ETS be eliminated from the
environment of small children. Thus, smoking should not be allowed in day care
centers, nurseries, or other settings where infants and young children are cared for.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
ETS Exposure in Nonsmokers with Existing Health Problems
ETS can worsen existing pulmonary symptoms in people with asthma and chronic
bronchitis, as well as for people with allergic conditions. Even individuals who are
not allergic can suffer eye irritation, sore throat, nausea, and hoarseness. Contact
lens wearers can find tobacco smoke very irritating.
Tobacco
Citation: http://mediad.publicbroadcasting.net/p/kcur/files/styles/x_large/public/201509/E-
cigs.JPG
225
Public Policies Restricting Smoking
Following the release of the Surgeon General’s report and the NAS/NRC review,
many new laws, regulations, and ordinances were enacted that severely restrict
or ban public smoking. With the release of the EPA report, many more such laws
can be expected:
■ On the Federal level, the General Services Administration issued regulations
restricting smoking to designated areas only in Federal office buildings. Many
agencies within the Public Health Service, which includes the National
Institutes of Health, have banned smoking completely.
■ By law, all airline flights of 6 hours or less within the United States and
all interstate bus travel are smoke free.
■ ETS meets the criteria of the Occupational Safety and Health Administration
(OSHA) for classification as a potential occupational carcinogen. (OSHA
is the Federal agency responsible for health and safety regulations in the
workplace.)
■ The National Institute for Occupational Safety and Health (NIOSH) is another
Federal agency that is concerned with ETS exposure in the workplace.
NIOSH conducts ETS-related research, evaluates worksites for possible health
hazards, and makes safety recommendations. NIOSH recommends that
ETS be regarded as a potential occupational carcinogen, in conformance
with the OSHA carcinogen policy, and that exposures to ETS be reduced
to the lowest possible levels.
■ Currently, nearly every state has some form of legislation to protect
nonsmokers; some states require private employers to enact policies that
protect employees who do not smoke. In addition to state legislation, more
than 560 local jurisdictions have enacted ordinances addressing nonsmokers’
rights, and most are more restrictive than their state counterparts.
226
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Health Dangers of Smoking for Nonsmokers
Cigarettes do not just harm the people who smoke. They also harm the people who
are near cigarettes and breathe the smoke. This includes fetuses (unborn babies still
inside their mothers) and small children. They are breathing second hand smoke.
Second hand smoke is the smoke that comes out of the lit end of a cigarette and
that a smoker exhales (breathes out). Second hand smoke is also called passive
smoke, involuntary smoke, and environmental tobacco smoke (ETS).
About 53,000 people die from second hand smoke every year. When we breathe
second hand smoke, we are breathing the same 4,000 chemicals a cigarette smoker
breathes. 51 of those chemicals cause cancer. That is why a U.S. government agency
called the Environmental Protection Agency (EPA) has labelled cigarettes as a Group
A carcinogen. A carcinogen is something that causes cancer. The EPA put cigarettes
in the same group with arsenic, which is a deadly poison, and asbestos, a cancer
causing material that used to be put around pipes to insulate them.
Citation: http://healthliteracy.worlded.org/docs/tobacco/images/72.gif
In 1986 the Surgeon General of the U.S. wrote about the dangers of second hand
smoke. He listed three conclusions:
■ First: Involuntary smoking is a cause of disease,including lung cancer, in
healthy nonsmokers.
■ Second: The children of parents who smoke compared to children of
nonsmoking parents have an increased frequency of respiratory infections,
increased respiratory symptoms and slightly smaller rates of increase in
lung function as the lung matures.
■ Third: Simple separation of smokers and non-smokers within the same
airspace may reduce, but does not eliminate, exposure of nonsmokers to
environmental tobacco smoke.
Tobacco
Environmental tobacco smoke (ETS) is dirtier than the smoke that is inhaled in a
cigarette because it is not filtered. The filter on the end of a cigarette removes some
the harmful chemicals. ETS is the largest source of indoor air pollution. Restaurants
that allow smoking can have six times the pollution of a busy highway.
When people breathe ETS or second hand smoke on a regular basis in the workplace,
their lungs are affected. Their lungs look as if the people smoked one to 10 cigarettes
a day. That means nonsmoking workers in a smoking office have the same lung
damage as a mild smoker. They have a 34% higher risk of getting lung cancer than
workers who do not smoke or breathe second hand smoke on the job.
Every year second hand smoke causes 3,000 deaths from lung cancer in nonsmokers
over 35 years old. These deaths are not just from people breathing cigarette smoke
in the workplace. Second hand smoke increases the risk of lung cancer even in
dogs. It increases the risk of heart disease in human beings by 30%. Every year
37,000 nonsmokers die from heart disease caused by exposure to ETS.
227
Nicotine Dependence and Withdrawal
These three questions can help you decide if you are dependent on nicotine:
■ Do you smoke within 30 minutes of waking?
■ Do you smoke 10 or more cigarettes each day?
■ Did you experience cravings and withdrawals last time you tried to quit?
If you answered yes to any of these questions then you are dependent on nicotine
The good news about quitting
Quitting smoking has immediate and long-term health benefits. From your first
day of quitting your body begins to repair itself. Within days your smell and taste
improves and your breathing improves making exercise easier. Within one to nine
months, coughing and shortness of breath also decrease.
Nicotine Withdrawal
People experience nicotine withdrawal differently. Some people find it more
challenging than others. Many people find nicotine withdrawal is worst in the first
24 - 48 hours of quitting.
Most people experience some of the symptoms of nicotine withdrawal and they
usually don’t all happen at once. Withdrawal occurs over time as your body begins
to get rid of its dependence on nicotine. It helps to think of the nicotine withdrawal
symptoms as ‘recovery symptoms.’ After about two weeks, recovery symptoms are
usually less severe.
Using nicotine replacement therapy (NRT) products (patch, gum, lozenge, inhalator,
oral strips and mouth spray) can dramatically reduce symptoms of nicotine withdrawal,
228
provided you use enough NRT each day to control withdrawal symptoms and
cravings and consistently use NRT for 8-12 weeks.
If you are trying to stop using tobacco products, you may want to try a form of
nicotine replacement therapy, such as gum or patches, to help you overcome this
addiction. It might also be a good idea to have plenty of candy or chewing gum
on hand, especially if you have used chewing tobacco. In some cases, taking a
walk or performing rigorous outdoor exercise can help alleviate cravings. Quitting
with a friend is often easier than trying by yourself, so you may want to develop
a plan for handling nicotine withdrawal with a buddy.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://www.natural-health-news.com/wp-content/uploads/2016/02/Nicotine-
addiction-smoking-vs.-e-cigarettes.jpg
One nicotine withdrawal side effect can be extreme hunger. This often means
you might eat more than usual while you are trying to quit smoking or chewing.
Having some readily available healthy snacks, such as carrot or celery sticks, can
sometimes help ease cravings while keeping hunger pangs at bay. It can also help
you minimize the weight gain sometimes associated with giving up tobacco.
Keep some gum or hard candy with you at all times in case you get a craving for
nicotine. Many times, chewing on a stick of gum or sucking on a piece of hard
candy helps to minimize these urges. In some cases, a menthol cough drop can
also aid in relieving withdrawal symptoms.
You may want to consider trying products like nicotine patches, gum, or lozenges.
These usually allow you to gradually reduce the level of nicotine in the body, so
the withdrawal symptoms are normally less severe. If you smoke, these could help
you concentrate on breaking the habit of using the hands to smoke, rather than
worrying about the actual nicotine withdrawal.
Exercise can be a good way to ease the signs of nicotine withdrawal. Get up and
take a walk whenever you feel an intense craving for nicotine. You could also go
jogging or ride a bicycle to help clear your mind and lungs while delivering oxygen