Nicotine Addiction Snapshot: Neuronal Mechanisms, Devices of Tobacco Use, Society Burden and Resources

Transcription

1 Nicotine Addiction Snapshot: Neuronal Mechanisms, Devices of Tobacco Use, Society Burden and Resources Maegan Weltzin, PhD Fairbanks Manager

2 Healthy Air, Healthy People, Healthy Communities The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease. Education Advocacy Research Our vision is a world FREE OF LUNG DISEASE. 2

3 Our Vision: A World Free of Lung Disease Lung Health Tobacco Control Healthy Air 3

4 Tobacco & Health 4

5 Tobacco is the leading cause of preventable deaths Approximately 1 billion people around the globe smoke tobacco (Ng, M et al., 2014; Dani, JA et al., 2009) Tobacco use causes approximately 5.4 million deaths world wide and is expected to increase to > 8 million a year by 2030 (CDC). Smoking any tobacco product, %, Males Smoking any tobacco product, %, Females 5

6 Tobacco & Health Smoking causes nearly one in five deaths in the US, resulting in > 480,000 deaths annually, with an estimated 49,000 of these deaths from exposure to second hand smoke (2014 Surgeon General s report; Centers for Disease Control and Prevention) 6

7 Tobacco & Health >16 million Americans suffer from a disease caused by smoking (2014 Surgeon General s report). Tobacco use and secondhand smoke causes many illnesses (2014 Surgeon General s report). m_smoking-smoking_can_damage_every_part_of_the_body.png/1024px- Risks_form_smoking-smoking_can_damage_every_part_of_the_body.png 7

8 Mechanisms of Nicotine's Effects on Humans 8

9 What is nicotine? Main psychoactive and addictive component found in tobacco products Nicotine A natural insecticide for the tobacco plant Can easily cross biological membranes and the blood-brain barrier 9

10 Nicotine and Our Bodies When smoked, nicotine enters the bloodstream mainly through the lungs and reaches the brain in tens of seconds (Benowitz, NL et al., 2009) Two routs to interact with the body: 1) About 31% of the nicotine will pass through lipid membranes and directly alter intracellular signaling (Rezvani, K et al., 2007) 2) About 69% of the nicotine binds to nicotinic acetylcholine receptors (nachrs) 10

11 Nicotinic Acetylcholine Receptors (nachrs) Receptor that binds acetylcholine, nicotine, etc. Pentameric (5 subunits) nachr: Nine α subunits (α2 - α10) and three β subunits (β2-4) nachr- lots of subtypes -Homomeric Made up of α7, α9 and/or α10 -Heteromeric Combinations of α and β subunits Can get receptor isoforms Extracellular domain Intracellular domain Transmembrane domain 11

12 Nicotinic Acetylcholine Receptors (nachrs) Gotti C.,

13 Acetylcholine Acetylcholine (ACh): functions in the brain and body of many types of animals as a neurotransmitter (a chemical released by nerve cells to send signals to other cells). In the brain, ACh plays an important role in arousal, attention, memory, and motivation. 13

14 Nicotine s mechanism of action-receptor level Na 2+, Ca 2+ Extracellular domain ACh Transmembrane domain Intracellular domain Wells,

15 Nicotine s mechanism of action-receptor level ACh α7 α4β2 Traces from Jonsson M, et al.,

16 Nicotine s mechanism of action-receptor level Nicotine is a cholinergic agonist Competes with acetylcholine (ACh) for the orthosteric binding site on nicotinic acetylcholine receptors (nachr) Extracellular domain ACh, nicotine, etc. Transmembrane domain Intracellular domain Wells,

17 Nicotine s mechanism of action-neurophysiology nachr can regulate both neuronal excitability, neurotransmitter release and intracellular processes Exposure to nicotine changes expression and function of nachr Feduccia et al.,

18 U.S. and Alaska Populations Who Use Tobacco 18

19 2014 US Cigarette Use 19

20 US and Alaska Adult Smoking Rates U.S.A Alaska All Adults American Indians/ AK Natives Low socioeconomic status Young Adults (18-24) % % All Adults 29.2% 47% AK Native Adults 26.3% Low socioeconomic status Young Adults (18-29) % % 28% 33% 42% Centers for Disease Control and Prevention ( ) Alaska Behavior Risk Factor Surveillance System, 1996 &

21 2014 Smoking Rate vs. Education No diploma GED Certificate High School Diploma 22.9% 21.7% 43.0% 47% Associate s Degree 17.1% Undergraduate Degree 7.9% Graduate Degree 5.4%0 Centers for Disease Control and Prevention ( ) 21

22 Alaska Youth Smoking Rate 1995 Youth Smoking Rate 37% 2013, 2015 Youth Smoking Rate 11% 2015 Youth E-cig Use 18% % Use Alaska Youth Risk Behavior Survey, 1995, 2013 and

23 What are the differences between cigarettes and e-cigarettes? 23

24 What are e-cigs? E-cigarette use among youth who never smoked traditional cigarettes increased threefold from (Bunnel et al., 2014; Notes from the field, 2013). 24

25 Cigarettes vs. E-cigarettes Cigarettes Tobacco smoke contains >7,000 chemicals and compounds, including hundreds that are toxic and at least 69 carcinogens (U.S. Dept. of Health and Human Services, 2010). E-Cigarettes Chemical compounds found in e-cigarettes: Acetaldehyde Lead Acetone Nicotine Cadmium Formaldehyde Acrolein Carcinogenic, addictive in addition to respiratory, cardiovascular and reproductive toxins (Cheng T, 2014; Department of Health and Human Services FDA; Papousek et al., 2014). 25

26 The Economic Burden of Tobacco Use 26

27 US Economic Burden Total economic cost of smoking per year: >$300 billion Direct medical care for adults: ~ $170 billion (Xu X et al., 2014) Lost productivity due to premature death and exposure to secondhand smoke: >$156 billion (U.S. Department of Health and Human Services, 2014). 27

28 Alaska Economic Burden AK s Annual Cost of Tobacco Use [VALUE]M [VALUE]M [VALUE]M [VALUE]M For every pack of cigarettes, it costs AK $20 in healthcare and lost productivity $2 State tax per pack $20 Smoking-caused costs per pack Medical Costs for Tobacco Use Lost of Productivity due to Tobacco-related Deaths Revenue from Tobacco TPC Program Budget 10% 6-7% Every 10% increase in cigarette price reduces the number of: Kids who smoke by 6-7% Pregnant women who smoke by 7% FY 2016 AK Tobacco Prevention and Control Program Alaska Department of Health and Social Services 28

29 Alaska Death Rate Death Rate Number of 2012 deaths due to selected causes in Alaska Alaska Tobacco Facts, 2015 Update 29

30 Alaska s Grades A Tobacco Prevention F Smokefree Air C Cigarette Tax F Cessation State of Tobacco Control

31 American Lung Association Programs and Services Smokefree Anchorage Coalition 31

32 Come Help Out!! Volunteer Testify Donate $ Maegan Weltzin, PhD Fairbanks Manager Maegan.Weltzin@lung.org 32

33 Citations 1. Centers for Disease Control and Prevention. Cigarette Smoking in the United States. Available at 2. Alberg AJ, Shopland DR, Cummings KM. The 2014 Surgeon General s report: commemorating the 50th anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and updating the evidence on the health consequences of cigarette smoking. Am J epidemiol. 2014;179(4): De Biasi, M and Dani, JA Reward, Addiction, Withdrawal to Nicotine. Annu Rev Neurosci, 34: Wells, GB Structural answers and persistent questions about how nicotinic receptors work. Frontiers in Biosciences U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Dec 11]. 6. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual Healthcare Spending Attributable to Cigarette Smoking: An Update[PDF 157 KB]. American Journal of Preventive Medicine 2014;48(3): Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults United States, Morbidity and Mortality Weekly Report 2015;64(44): [accessed 2016 Mar 14]. 8. US Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavior Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, Nation Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Bunnell RE, Agaku IT, Arrazola RA et al. Intentions to smoke cigarettes among never-smoking U.S. middle and high school electronic cigarette users, National Youth Tobacco Survey, Nicotine Tob. Res. 17(2), (2014). 10. Notes from the field: electronic cigarette use among middle and high school students USA, MMWR Morb. Mortal. Wkly Rep. 62(35), (2013). 11. Cheng T. Chemical evaluation of electronic cigarettes. Tob. Control 23(Suppl. 2), ii11 ii17 (2014). 12. Department of Health and Human Services FDA. Harmful And Potentially Harmful Constituents In Tobacco Products And Tobacco Smoke; Established List. Food and Drug Administration H 77, (2014). 13. Papousek P, Pataj Z, Novakova P, et al. Determination of Acrylamide and Acrolein in Smoke from Tobacco and E-Cigarettes. Chromatoraphia, 77 (17): Ussher MH, Taylor AH, West R, et al. Does exercise aid smoking cessation? A systematic review. Addiction 2000; 95: