Tag Archives: nicotine tar

National Association of Psychiatric Health Systems Teleconference Notes
















Approved by the NASMHPD Membership on July 10, 2006

In a health care system:

  • Figure out who smokes
  • Educate staff
  • Integrate smoking cessation into mental health tx

Smoke Free Facilities




  • Additional inpatient benefits:
  • Former smoking areas freed up space for alternate use
    access to cigarettes, all disappeared
  • Census and pt satisfaction remained stable
    no longer an issue
  • Pt violence decreased on inpatient units without tobacco available.

From The National Association of Psychiatric Hospital Systems, July, 2007



EMPLOYER BENEFITS of investing in a smoke-free workforce:


Additional teleconference notes:










There are 11 PROVEN human carcinogens in tobacco smoke.

Fifty more are not yet proven, but suspected.


20.9% of adults smoke in the general population.

the mental health population.


35% people with panic disorder smoke

49% with depression smoke

80% with EOTH dependence smoke

88% with schizophrenia/bipolar disorder smoke



Alcoholics have an increased urge to drink when they smell cigarettes.





To TX Smoking Cessation and Depression

  • NRT (nic replacement therapy) alone is insufficient
    attempt, can be combined with Bupropion, NRT, and Varenicline
    to extend beyond usual 3-6 months.
  • Adding CBT has had mixed results.

*Anxiety and Smoking Cessation

    quit attempt.


  • Bupropion tolerated and effective

*Alcohol Dependence

  • Standard cessation treatments are effective.
  • Alcohol abstinence days are greatest for those who quit smoking.
    Continued smoking diminishes recuperation from alcohol-related cognitive defecits during alcohol

*Cessation for Shizophrenia and Bipolar Disorder

  • Traditional cessation treatments may be inadequate.
  • Harm reduction and NRT
  • Hospitalization may be unique opportunities to initiate tx.
  • Bupropion can lead to quit rates comparable with general population.
  • Quit rates enhanced with CBT
  • Overall symptoms not worsened.

Resistance to Smoking Cessation for People with Mental Illness

  • Loved ones resist helping them quit
  • And second-hand smoke imperils loved ones and workers

Barriers to Successful Smoking Cessation

  • Provider inattention/pessimism
  • Belief that smoking cessation will adversely affect SA/MH tx
  • Co-dependency and mental illness
  • Mental health staff smoke
  • Historic attitudes about smoking in mental health community
  • No coverage for cessation drugs
  • Improper use of the drugs
  • Ignorance of quitlines 1-800-QUIT NOW
  • Lack of knowledge or risks/current research
  • Social isolation of the mentally ill
  • Recovery from mental illness a relatively new concept
    private insurers don’t.)

Benefits From Treating Tobacco Dependence

  • Reduced morbity
    relapse to active substance abuse)
  • Reduce financial burden
  • Increase self-confidence
  • Increase focus on mental health and wellness
    other health intervention could make such a huge difference!
    feelings, social stigma

The National Partnership on Wellness and Smoking Cessation
NAPHS (National Association of Psychiatric Health Systems)
Free Living in Psychiatric Settings

Depression and Bipolar Support Alliance
NASW (National Association of Social Workers)
+ approx. 20 other organizations and growing
Smoking Cessation Leadership Center Mental Health section web site:

Notes from Sally Caltrider [Retreath Healthcare, Brattleboro, VT]
Conference: July 26, 2007]

Cigarette Ingredients and Composition

Cigarettes look deceptively simple, consisting of paper tubes containing chopped up tobacco leaf, usually with a filter at the mouth end.

In fact, they are highly engineered products, designed to deliver a steady dose of nicotine.

Cigarette tobacco is blended from two main leaf varieties: yellowish ‘bright’, also known as Virginia where it was originally grown, contains 2.5-3% nicotine; and ‘burley’ tobacco which has higher nicotine content (3.5-4%).

US blends also contain up to 10% of imported ‘oriental’ tobacco which is aromatic but relatively low (less than 2%) in nicotine.

In addition to the leaf blend, cigarettes contain ‘fillers’ which are made from the stems and other bits of tobacco, which would otherwise be waste products. These are mixed with water and various flavorings and additives. The ratio of filler varies among brands.

For example, high filler content makes a less dense cigarette with a slightly lower tar delivery. Additives are used to make tobacco products more acceptable to the consumer.

They include humectants (moisturizers) to prolong shelf life; sugars to make the smoke seem milder and easier to inhale; and flavorings such as chocolate and vanilla. While some of these may appear to be quite harmless in their natural form they may be toxic in combination with other substances.

Also when the 600 permitted additives are burned, new products of combustion are formed and these may be toxic.

The nicotine and tar delivery can also be modified by the type of paper used in the cigarette. Using more porous paper will let more air into the cigarette, diluting the smoke and (in theory) reducing the amount of tar and nicotine reaching the smoker’s lungs.

Filters are made of cellulose acetate and trap some of the tar and smoke particles from the inhaled smoke. Filters also cool the smoke slightly, making it easier to inhale. They were added to cigarettes in the 1950s, in response to the first reports that smoking was hazardous to health. Tobacco companies claimed that their filtered brands had lower tar than others and encouraged consumers to believe that they were safer.

Tobacco smoke is made up of “sidestream smoke” from the burning tip of the cigarette and “mainstream smoke” from the filter or mouth end.


Many toxins are present in higher concentrations in sidestream smoke than in mainstream smoke and, typically, nearly 85% of the smoke in a room results from sidestream smoke.


One study has established the link between smoking and lung cancer at the cellular level. It found that a substance in the tar of cigarettes, benzo(a)pyrene diol epoxide (BPDE), damages DNA in a key tumour suppresser gene.

What is Cigarette Tar?

“Tar”, also known as total particulate matter, is inhaled when the smoker draws on a lighted cigarette. In its condensate form, tar is the sticky brown substance (filled with chemicals) which can stain smokers’ fingers and teeth yellow-brown. All cigarettes produce tar but the brands differ in amounts.

The average tar yield of cigarettes has declined from about 30mg per cigarette in the period 1955 to 61 to 11mg today. There have also been reductions in nicotine (from an average of about 2mg in 1955, 61 to about 0.9mg by 1996). Until January 1992, information about tar yields of cigarettes was given in a general fashion on cigarette packets and advertisements as a result of a voluntary agreement between the tobacco industry and the Government.

Due to labeling (Safety) regulations requirements for health warnings on tobacco, cigarette packets must include a statement of both the tar and the nicotine yield per cigarette on the packet itself. The same figures are printed on cigarette advertising, along with the health warning, as part of a voluntary agreement between the industry and health regulators.

Following the discovery in the 1950s that it was the tar in tobacco smoke which was associated with the increased risk of lung cancer, tobacco companies, with the approval of successive governments, embarked on a program to gradually reduce the tar levels in cigarettes.

Although there is a moderate reduction in lung cancer risk associated with lower tar cigarettes, research suggests that the assumed health advantages of switching to lower tar may be largely offset by the tendency of smokers to compensate for the reduction in nicotine (cigarettes lower in tar also tend to be lower in nicotine) by smoking more or inhaling more deeply.

Also, a study by the American Cancer Society found that the use of filtered, lower tar cigarettes may be the cause of adenocarcinoma, a particular kind of lung cancer. There is no evidence that switching to lower tar cigarettes reduces coronary heart disease risk.

Cigarette IngredientsNicotine, an alkaloid, is an extremely powerful drug. The Royal College of Physicians in England and the Surgeon General in USA have affirmed that the way in which nicotine causes addiction is similar to drugs such as heroin and cocaine.

Only 60mg of pure nicotine (contained in two packs of cigarettes) placed on a person’s tongue would kill within minutes.

Nicotine is contained in the moisture of the tobacco leaf: when the cigarette is lit, it evaporates, attaching itself to minute droplets in the tobacco smoke inhaled by the smoker. It is absorbed by the body very quickly, reaching the brain within 7-15 seconds.

It stimulates the central nervous system, increasing the heart beat rate and blood pressure, leading to the heart needing more oxygen. Carbon Monoxide, the main poisonous gas in car exhausts, is present in all cigarette smoke. It binds to haemoglobin much more readily than oxygen, thus causing the blood to carry less oxygen.

Heavy smokers may have the oxygen carrying power of their blood cut by as much as 15%.

Source: Emirates Hospital, Dubai – U.A.E


— *~ When fate closes a door go in through a window~*

Dangers of 69 Cancer Causing Chemicals in Cigarettes to Men, Women and Unborn Babies

There are 69 known cancer-causing chemicals in tobacco smoke.

While nicotine itself isn’t thought to be carcinogenic, it’s the reason why smokers continue the habit.

This highly addictive drug is toxic and potentially lethal in large doses.

Apart from its use in tobacco products, nicotine is a scheduled poison under the State Poisons Act. When they get their dose of nicotine, smokers also inhale about 4,000 other chemicals.

Most of these compounds are chemically active, and trigger profound and damaging changes in the body.

Tobacco smoke contains dangerous chemicals. The most damaging compounds in tobacco smoke include:


Ammonia – ammonia is a strong chemical, found in household cleaners and formaldehyde (used for preserving organs of dead people in morgues), which also damages the lungs.



Benzene – is a solvent used to manufacture other chemicals, including petrol. It is well-established that benzene can cause cancer, particularly leukemia. It could account for between a tenth and a half of the deaths from leukemia caused by smoking.


Carbon monoxide – this odor less gas is fatal in large doses because it takes the place of oxygen in the blood. Each red blood cell contains a complicated protein called hemoglobin; oxygen molecules are transported around the body by binding to, or hanging onto, this protein. However, carbon monoxide has an even greater affinity for binding to hemoglobin than does oxygen. This means that the heart of a smoker has to work much harder to get enough oxygen to the brain, heart, muscles and other organs.


Hydrogen cyanide – the lungs contain tiny hairs (cilia) that help to ‘clean’ the lungs by moving foreign substances out. Hydrogen cyanide stops this lung clearance system from working properly, which means the poisonous ingredients of tobacco smoke are allowed to remain inside the lungs.

Metals – tobacco smoke contains dangerous metals including arsenic, cadmium and lead. Many of these metals are carcinogenic.

Nitrogen oxides – animal experiments have shown that nitrogen oxides damage the lungs. It is thought that nitrogen oxides are some of the particular chemicals in tobacco smoke that cause the lung disease emphysema.

Polonium-210 – is a rare, radioactive element and polonium-210 is its most common form. Polonium strongly emits a very damaging type of radiation called alpha-radiation that can usually be blocked by thin layers of skin. But tobacco smoke contains traces of polonium, which become deposited inside their airways and deliver radiation directly to surrounding cells.

Chemical properties of polonium-210

Radioactive compounds – tobacco smoke contains radioactive compounds, which are known to be carcinogenic.

Tar – this is the collective term for all the various particles suspended in tobacco smoke. The particles contain chemicals including nitrogen oxides, carbon dioxide and carbon monoxide. Tar is sticky and brown, and stains teeth, fingernails and lung tissue. Tar contains the carcinogen benzo(a)pyrene that is known to trigger tumour development (cancer).

Smoking Effects on the Respiratory system

The effects of tobacco smoke on the respiratory system include:
–Irritation of the trachea (windpipe) and larynx (voice box).
–Inability of the lungs to cough out and clear poisonous substances, which results in lung irritation and damage.

Smoking and the Circulatory system

The effects of tobacco smoke on the circulatory system include:
–Raised blood pressure and heart rate.
–Constriction (tightening) of blood vessels in the skin, resulting in a drop in skin temperature.
–Less blood, which carries oxygen, available to the body.
–Stickier blood, which is more prone to clotting.
–Damage to the lining of the arteries, which is thought to be a
–Increased risk of stroke and heart attack due to blockages of the blood supply.

Cigarettes Effects on the Immune system

The effects of tobacco smoke on the immune system include:
–The immune system doesn’t work as well.
–The person is more prone to infections.
–It takes longer to get over an illness.

Smoking Addiction Dangers to Musculoskeletal System

The effects of tobacco smoke on the musculoskeletal system include:
–Reduced blood flow to extremities like fingers and toes
–Tightening of the muscles
–Reduced bone density.

Other Effects Of Smoking On the Body

Other effects of tobacco smoke on the body include:
–Irritation and inflammation of the stomach and intestines
–Increased risk of bleeding ulcers along the digestive tract
–Reduced ability to smell and taste
–Premature wrinkling of the skin
–Higher risk of blindness and hearing loss
–Gum disease.

Smoking and The Male Body

The specific effects of tobacco smoke on the male body include:
–Lower sperm count
–Higher percentage of deformed sperm
–Reduced sperm mobility
–Lower sex drive
–Reduced levels of male sex hormones
–Impotence, caused by reduced blood flow to the penis
–Increased risk of reproductive system cancers, including penile cancer.

Smoking Effects on the Female Body

The specific effects of tobacco smoke on the female body include:
–Reduced fertility.
–Lower sex drive.
–Reduced levels of female sex hormones.
–Menstrual cycle irregularities or absence of menstruation.
–Menopause reached one or two years earlier.
–Increased risk of reproductive system cancers, including cancers of the cervix, vulva and breast.
–Can increase facial hair.
–Can lead to depression.

Smoking Dangers to the Unborn Baby

The effects of maternal smoking on the unborn baby include:
–Increased risk of miscarriage, stillbirth and premature birth.
–Low birth weight.
–Increased risk of cleft palate and cleft lip.
–Greater risk of developmental problems, such as attention deficit
hyperactivity disorder (ADHD).
–Paternal smoking can also harm the fetus if the non-smoking mother is exposed to passive smoking.

If the mother continues to smoke during her baby’s first year of life, the child has an increased risk of ear infections, respiratory illnesses such as asthma, sudden infant death syndrome (SIDS) and childhood cancers such as acute lymphocytic leukaemia.

Diseases Caused by Long Term Smoking

lethal diseases, including:
All types of cancer, such as cancer of the lung, mouth, nose, throat,
pancreas, blood, kidney, penis, cervix, bladder and anus. Lung diseases such as chronic bronchitis, chronic obstructive pulmonary disease and emphysema. Coronary artery disease, heart disease and heart attack. Ulcers of the digestive system. Osteoporosis. Poor blood circulation in extremities, which can lead to amputation.

Things to Remember

Most of the 4,000 chemicals in tobacco smoke are chemically active and
trigger profound and potentially fatal changes in the body.

The most damaging substances in tobacco smoke include tar, carbon monoxide, nitrogen oxides, hydrogen cyanide, metals, ammonia and radioactive compounds.

Sources: Surgeon General, U.S
National Center For Chronic Disease Prevention and Health Promotion
UK’s “Smoke is Poison” campaign, funded by the Department of Health.