HEALTH RISK

Tobacco use remains the leading preventable cause of death and disease in our society. Each year, smoking kills more people than AIDS, alcohol, drug abuse, car crashes, murders, suicides, and fires-combined. Cigarette smoking accounts for about 434,000 deaths, or one fifth of all deaths in the United States with an annual cost of more than $50 billion in direct medical costs.

Tobacco use is a major risk factor for diseases of the heart and blood vessels; chronic bronchitis and emphysema; cancers of the lung, larynx, pharynx, oral cavity, esophagus, pancreas, and bladder; and other problems such as respiratory infections and stomach ulcers. Smoking accounts for 21% of all coronary heart disease deaths, 87% of lung cancer deaths, and 30% of all cancer deaths. Cigarette smoking during pregnancy accounts for 20 to 30% of low birth weight babies, up to 14% of pre-term deliveries, and about 10% of all infant deaths.

Tobacco contains an addictive drug, nicotine, as well as other substances that contribute to death from cardiovascular disease, cancer, and chronic lung disease. Cigarettes are highly addictive. Fewer than 10% of people who quit smoking for a day are still abstinent 1 year later. Nicotine, like other highly addictive substances, acts on the dopaminergic mesolimbic pathway, the brain reward pathway that controls motivated behaviors. The use of nicotine is self-reinforcing, leading to compulsive use. Nicotine produces a withdrawal syndrome that begins within a few hours of abstinence, peaks within the first week, and continues for several weeks. The withdrawal syndrome includes dysphoria, insomnia, irritability, anxiety, difficulty in concentrating, restlessness, slowed heart rate, and increased appetite.

Smoking cessation reduces mortality dramatically. The risk of some diseases (e.g., myocardial infarction and stroke) declines rapidly within a few years of quitting.

ENVIRONMENTAL TOBACCO SMOKE

Exposure to environmental tobacco smoke (ETS) or "second-hand smoke" has been causally linked to: 1) developmental effects in children including low birthweight and Sudden Infant Death Syndrome (SIDS); 2) respiratory illnesses, including bronchitis, pneumonia, asthma, middle ear infections, and chronic respiratory symptoms in children and eye and nasal irritation in adults; 3) lung and nasal sinus cancer; and 4) heart disease. Evidence suggests a causal link to spontaneous abortion, adverse impacts on cognition and behavior, exacerbation of cystic fibrosis, decreased pulmonary function, and cervical cancer. More research on these effects is in progress.

SMOKING IN ALASKA

Alaska has one of the highest prevalence rates of smoking in the country. Among Alaskan adults, 28% currently smoke cigarettes regularly. (National BRFSS Range 15.60 to 30.47%, National BRFSS Median 22.17%). It is higher among females (29%) than males (27.1%).

Over half of all the people surveyed (55.8%) had smoked at least 100 cigarettes in their lifetime. Most (83.7%) started smoking between the ages of ten and 20 years old. Of those who currently smoke, 79% smoke less than a pack a day, 18% smoke more than one pack a day and 3% report smoking occasionally. Of all the people who had smoked during their lifetime, half (48.3%) have quit. Most former smokers (58.6%) quit smoking over five years ago. A little over half (58%) of the persons who still smoke, have quit smoking for one day or longer within the last year.

YEAR 2000 NATIONAL HEALTH OBJECTIVES

Reduce cigarette smoking to a prevalence of no more than 15% among people aged 20 and older.

Increase to at least 50% the proportion of cigarette smokers aged 18 and older who stopped smoking cigarettes for at least one day during the preceding year.

HEALTH RISK

Oral cancer has been shown to occur several times more frequently among smokeless tobacco users than among nonusers and may be 50 times as frequent among long-term snuff users.

The consumption of smokeless tobacco in the United States increased 40% between 1970 and 1986. Most new users of smokeless tobacco products are adolescent males. In 1988, 6.6% of males aged 12 through 17 had used some form of smokeless tobacco in the preceding month. The prevalence of smokeless tobacco use among males aged 18 through 24 was 8.9% in 1987. Between 1970 and 1986, the prevalence of snuff use increased fifteenfold and chewing tobacco use increased more than fourfold among men aged 17 through 19.

All smokeless tobacco products contain substantial amounts of nicotine their use can support nicotine dependence and may lead to cigarette use.

SMOKELESS TOBACCO USE IN ALASKA

Of all Alaskan adults, 31.8% reported to have ever used or tried chewing tobacco or snuff or both. Of men, 52.4% have used or tried such products, and 8.2 % of women.

Among Alaskan adults, 5.4% are current smokeless tobacco users. The prevalence of smokeless tobacco use is higher among males (9.0%) than females (1.4%).

Smokeless tobacco use is highest among the 18 to 24 year old group (11%). Among the 18 to 24 year old males, 17% use smokeless tobacco and among the 18 to 24 year old females 4% use smokeless tobacco.

YEAR 2000 NATIONAL HEALTH OBJECTIVES

Reduce smokeless tobacco use by males aged 12 to 24 to a prevalence of no more than 4%.