Tobaccos Impact on Seniors Cliff Douglas for the

Tobacco’s Impact on Seniors Cliff Douglas for the Smoke-Free Environments Law Project (www. tcsg. org/sfelp/home. htm) August 27, 2003

Future Older Person

A HEALTHY OLD AGE EQUALS NO SMOKING, and NO SECONDHAND SMOKING, EITHER

Introduction: The Health Facts • Smoking is associated with all three major causes of death among the elderly – Heart disease – Cancer – Stroke Together, responsible for 70% of deaths among the elderly. In 65 -74 age group, heart diseases and cancers are equally prevalent as causes of death. As age advances, heart disease causes an increasing share of deaths, making heart disease the leading cause of death among the elderly.

• Smokers are three times more likely to die between the ages of 45 and 64 than those who never smoked • Two times more likely to die between the ages of 65 and 84 than never-smokers • 33% of non-smokers live to age 85, compared to only 12% of smokers • In other words, smoking-related deaths have their most dramatic impact on the young-old, especially those in the 50 to 70 year old age range. These smokers are denied the opportunity to experience an old age, to say nothing of a healthy old age.

• Smokers have more acute and chronic illnesses and more restricted-activity days, more bed-disability days and more work absenteeism than former smokers or those who never smoked. • Smokers also make about six more visits to health care facilities annually than nonsmokers.

The suffering and pain, the lack of normal physical mobility, and the dependency which accompany so many smoking-related illnesses cannot be communicated adequately just with statistics. Anyone who has had to assist a family member or friend through the final stages of lung cancer, stroke, heart disease, or emphysema can barely find it possible to describe the horrible suffering and loss of personal dignity that the victim endured. These are among the most terrifying effects of tobacco use.

Dangers of secondhand smoke Any amount of exposure is unsafe • Exacerbates existing health problems (asthma, respiratory ailments, etc. ) • Even more serious for vulnerable individuals, such as seniors

Secondhand Smoke. . . Contains over 4, 000 compounds -more than 40 of which are Group A carcinogens which cause cancer in humans or animals. Includes: ammonia, arsenic, benzene, cadmium, carbon monoxide, chromium VI, DDT, formaldehyde, hydrogen cyanide, lead, nickel, Nnitrosamines, sulfur dioxide, vinyl chloride. Also includes pesticide residues. International Agency for Research on Cancer chart, 1986; U. S. Surgeon General’s Report of 1989; California EPA Report, September, 1997.

So it’s little wonder that Secondhand Smoke. . . s Kills s Poses unacceptable risks s Cannot be controlled by ventilation

Given the health facts, indoor public places and worksites should be smoke-free: • • Retirement facilities and nursing homes; All county and municipal buildings and vehicles; All indoor sports and convention facilities; Museums, theaters, entertainment venues; Retail stores, banks, factories, laundromats; Educational facilities; Community centers, homeless shelters; Health clubs, bowling alleys, bingo games, indoor swimming pools • Common areas of hotels, motels, apartments, office buildings, malls, etc. • Professional offices, medical and dental clinics, health care facilities, law offices, etc.

For older persons, there are two major needs related to tobacco – Access to smoke-free environments: affects all older persons, especially those with respiratory problems such as emphysema, COPD, etc. –Access to smoking cessation: directly affects the 10 -12% of persons aged 65 and over who smoke, and also indirectly affects their spouses and families –

Seniors, Nicotine Addiction & Smoking Cessation

In their book Successful Aging, Drs. John Rowe and Robert Kahn defined successful aging as … “the ability to maintain three key behaviors or characteristics: low risk of disease and disease -related disability; high mental and physical function; and active engagement with life. ”

Smoking is a direct or indirect factor in the quality of life surrounding each of these three characteristics.

Rowe and Kahn point out that “the notion that abilities, once lost in old age, are lost forever is another of the dismal assumptions proved wrong by [recent research on successful aging]. ” They point out that changes in lifestyle, such as smoking cessation, can cause immediate and long-term improvements in health status, and that “by harnessing the power of proper diet, exercise, smoking cessation, and so on, we can prevent or defuse” even genetic factors which many people assume pre-determine and make inevitable diseases such as cancer, heart disease, etc.

They echo the U. S. Surgeon General > 1990 Report on The Health Benefits of Smoking Cessation

Smoking Cessation Improves Seniors’ Health Immediately • Upon quitting smoking, healing begins immediately – Within 20 minutes of quitting, your blood pressure and pulse rates begin to drop to normal and your body temperature increases to normal – Within 24 hours, the chance of heart attack begins to decrease – Within 48 hours, food will begin to taste and smell better – Within 72 hours, bronchial tubes relax and breathing becomes easier and lung capacity increases

– Between 1 and 9 months after quitting smoking, coughing, sinus congestion and shortness of breath all decrease – Self-image and self-esteem improve and the sense of control over one’s life increases during the first year after quitting

Longer-Term Benefits of Quitting • People who quit smoking before age 50 have one-half the risk of dying over the next 15 years compared to people who continue to smoke • The risk of coronary heart disease falls abruptly within months, and within 3 -5 years the risk of coronary heart disease falls to a level indistinguishable from that of individuals who have never smoked. This is true no matter how long or how much one smoked. • The risk of lung cancer declines steadily, so that after 10 years the risk is 30 -50% of that in continuing smokers. By 15 years, the risk of lung cancer is almost as low as if you had never smoked.

James Morgan Deposition Broin Case (April 14, 1997) Q. Do you believe that cigarette smoking is addictive? A. Pharmacologically, my answer is no. If they are behaviorally addictive or habit forming, they are much more like caffeine, or in my case, Gummy Bears. I love Gummy Bears. . . and I want Gummy Bears, and I like Gummy Bears, and I eat Gummy Bears, and I don't like it when I don't eat my Gummy Bears, but I'm certainly not addicted to them.

“We are not going to tell you smoking does not cause throat cancer. But inhaling large amounts of sawdust also increases the chances. ” - Dan Webb, lawyer for Philip Morris, in closing argument in the Engle case (Nov. 3, 1999)

“Where did [her cancer] come from? The answer is that nobody can tell us. There are still mysteries about cancer. ” - Ben Reid, lawyer for R. J. Reynolds, in closing argument in the Engle case (Nov. 3, 1999)

1972

“The primary incentive to cigarette smoking is the immediate salutory effect of inhaled smoke upon bodily function … The physiological effect serves as the primary incentive; all other incentives are secondary. …

“Without nicotine … there would be no smoking. … No one has ever become a cigarette smoker by smoking cigarettes without nicotine. … The physiological response to nicotine can readily be elicited by cigarettes delivering in the range of 1 mg. of nicotine. …

“Why then is there not a market for nicotine per se, to be eaten, sucked, drunk, injected, inserted or inhaled as a pure aerosol? …

“The answer, and I feel quite strongly about this, is that the cigarette is in fact among the most awe-inspiring examples of the ingenuity of man. Let me explain my conviction. …

“The cigarette should be conceived not as a product but as a package. The product is nicotine. The cigarette is but one of many package layers. …

“There is the carton, which contains the pack, which contains the cigarette, which contains the smoke. …

“The smoke is the final package. The smoker must strip off all these package layers to get to that which he seeks. …

“Think of the cigarette pack as a storage container for a day’s supply of nicotine. …

“Think of the cigarette as a dispenser for a dose unit of nicotine. …

“Think of a puff of smoke as the vehicle of nicotine. …

“Smoke is beyond question the most optimized vehicle of nicotine and the cigarette the most optimized dispenser of smoke. ” William L. Dunn, chief of Behavioral Research Group, Philip Morris, “Motives and Incentives in Cigarette Smoking, paper presented at secret tobacco industry conference sponsored by Council for Tobacco Research on St. Martin, N. A. , 1972.

1963 “… Moreover, nicotine is addictive. We are, then, in the business of selling nicotine, an addictive drug effective in the relief of stress mechanisms. ” Brown & Williamson general counsel Addison Yeaman in a memo dated July 17, 1963. (Yeaman and other executives decided to withhold their company’s findings on the addictiveness of nicotine from Surgeon General Luther Terry, who was then preparing the landmark 1964 Surgeon General’s report. )

Anatomy of a Cigarette

1. Reconstituted “Tobacco” 2. Blended Tobacco 3. Ammonia Chemistry 4. Filter Technology 5. Ventilation Technology 6. Genetic Engineering 7. Psychoactive Additives Sources: Internal tobacco company documents; U. S. Food and Drug Administration investigation; testimony under oath of former tobacco company executives and scientists.

1. RECONSTITUTED “TOBACCO” Adding extraneous nicotine to fortify tobacco stems, scraps, and other waste products, which are processed into “reconstituted tobacco, ” an artificial, manufactured product not found in nature, that is used in significant quantities in virtually all major cigarette brands.

2. BLENDED TOBACCO Adjusting tobacco blends by using high -nicotine tobaccos and higher-nicotine parts of the tobacco leaf to raise the nicotine content, particularly in socalled low tar cigarettes.

3. AMMONIA CHEMISTRY Adding ammonia compounds (which the companies claim are used for “taste”), which prompt a chemical reaction that speeds the delivery of free -base (i. e. , chemically unbound) nicotine to smokers by raising the p. H (alkalinity) of cigarette smoke.

4. FILTER TECHNOLOGY Using filter systems that selectively remove a higher percentage of tar than nicotine, thus sustaining addiction while providing a dubious health benefit. (Note: Filtered cigarettes have also been found to be more mutagenic than non-filtered cigarettes. )

5. VENTILATION TECHNOLOGY Employing patented laser technology to produce hidden ventilation holes in cigarette filters that dilute nicotine delivery in machine tests (resulting in lower advertised nicotine levels), but which are covered by the fingers and lips of unsuspecting smokers, who consequently inhale much higher levels of the drug.

6. GENETIC ENGINEERING Genetically engineering super-charged tobacco plants to substantially increase nicotine content.

7. PSYCHOACTIVE ADDITIVES Using a variety of psychoactive chemicals, such as acetaldehyde and pyridine, that act synergistically to strengthen nicotine’s effects on the brain and central nervous system.

What You Can Do. . . • Tell state legislators to allocate tobacco settlement money to tobacco prevention and cessation programs – for people of all ages • Tell your county commissioner to support passage of a strong smoke-free regulation • Tell your U. S. senators and member of Congress to support effective FDA regulation of tobacco • Support higher tobacco excise taxes *** ABOVE ALL, SPEAK OUT! *** (Remember the “ 200” Rule: You’re more powerful than you may think. )

Do it for your kids!

IF YOU THINK YOU’RE TOO SMALL TO BE EFFECTIVE, YOU HAVE NEVER BEEN IN BED WITH A MOSQUITO.