From Cells to Society: From Cells to Society: The Multidisciplinary The Multidisciplinary

Nature of Tobacco ControlNature of Tobacco Control

Michael ChaitonMichael.chaiton@utoronto.ca

Why Focus on Tobacco?

Reducing tobacco use offers the greatest potential for immediate impact at the population-level.

Tobacco Problem in Canada

Smoking, along with other forms of tobacco use, remains the leading cause of illness and death in western societies.

Tobacco Problem in Canada

In 2002, smoking accounted for 17% of all deaths in Canada

21% for men and 12% for women.

Tobacco Problem in Canada

Tobacco use is responsible for three times as many deaths as the combined total of alcohol, drugs, suicide, homicide, injuries sustained from car crashes, and AIDS.

Tobacco Problem in Canada

37,000 Deaths515,607 Years of Life Lost2,210,155 hospital daysCancer was the leading cause of death

(17,679 deaths) followed by cardiovascular disease (10,853) and respiratory disease (8,282)

Framework

VECTOR

HOST

ENVIRONMENT

AGENT

Framework

Mosquito

Person

Environment

Parasite

Framework

Tob Ind

Person

Environment

Cigs

Host

Risk taking! Extroversion! Excitement! Glamorous identity!

Higher rates of depression and other mental health issues

Genetic factors Physiological differences: pre-natal exposure Drug reward and satisfaction

The Reward Pathway

12

Agent Factors

13

The drug must gain access to the brain (cross the blood/brain barrier) Blood flow, lipid solubility, molecular size,

presence of active transport processes The faster the drug reaches the brain, the

more likely self-administration is to occur Crack vs. cocaine; heroin vs. morphine;

smokeless vs. cigarette

0

100

200

300

400

500

600

700

800

0.74 0.78 0.82 0.86 0.90 0.96 1.00 1.04 1.08+

Midpoint elasticity

Med

ian

sale

s (in

mill

ions

of c

igar

ette

s) p

er g

roup

Environmental Factors

15

Gin Epidemic Surplus grain in

England "An Act for the

Encouraging of the Distillation of Brandy and Spirits from Corn”

Legislation created epidemic

Environmental Factors

16

Vietnam veterans Epidemic of heroin

use among American soldiers in Vietnam

Nearly all quit on return or with minimal intervention

Lack of availability and behavioural cues

WWI veterans Prime event in diffusion to

widespread use Cigarettes packaged as rations

thanks to the ‘generosity’ of tobacco companies

The Vector

https://ams-wd.utoronto.ca/sap/bc/gui/sap/its/zf_logon_mrol?sap-client=010

Agent Lectures The cigarette (Kaiserman)

Host Lectures Health effects (Ferrence)

Global impact (Jha)

Addiction (Clarke; O’Loughlin)

Genetics (Tyndale)

Host Lectures Medical interventions (Selby)

Hospital Based Interventions (Pipe)

Psychology of smoking (Hammond)

Fertility (Holloway)

Physical Activity (Faulkner)

Environment Lectures Smoking and the Movies

(Glantz) Mass Media (Wakefield) Economics (Chaloupka) Global issues (Cohen) Policy (Fong)

Vector Lectures

Marketing (Dewhirst)

Contraband (Perley)

Tobacco and activism (Mahood)

This course is partly funded by the Canadian Cancer Society (award #702160)