Neuroscience of Nicotine

Mechanisms and Treatment

Victor R Preedy

• Editorial: Academic Press
• Año: 2019
• ISBN:
  9780128130360
• Categoría: Psychologie
• Categoría: Neuropsychologie

Neuroscience of Nicotine: Mechanisms and Treatment presents the fundamental information necessary for a thorough understanding of the neurobiological underpinnings of nicotine addiction and its effects on the brain. Offering thorough coverage of all aspects of nicotine research, treatment, policy and prevention, and containing contributions from internationally recognized experts, the book provides students, early-career researchers, and investigators at all levels with a fundamental introduction to all aspects of nicotine misuse.

With an estimated one billion individuals worldwide classified as tobacco users—and tobacco use often being synonymous with nicotine addiction—nicotine is one of the world's most common addictive substances, and a frequent comorbidity of misuse of other common addictive substances. Nicotine alters a variety of neurological processes, from molecular biology, to cognition, and quitting is exceedingly difficult because of the number of withdrawal symptoms that accompany the process.

• Integrates cutting-edge research on the pharmacological, cellular and molecular aspects of nicotine use, along with its effects on neurobiological function
• Discusses nicotine use as a component of dual-use and poly addictions and outlines numerous screening and treatment strategies for misuse
• Covers both the physical and psychological effects of nicotine use and withdrawal to provide a fully-formed view of nicotine dependency and its effects

Chapter 1

Understanding Tobacco Use in Different Countries

Fabrizio Ferretti School of Social Sciences, Department of Communication and Economics (DCE), University of Modena and Reggio Emilia (UNIMORE), Reggio Emilia, Italy

Abstract

Understanding the economic determinants of tobacco consumption and measuring tobacco use across countries are essential to design and implement effective tobacco prevention programs. This chapter is a brief guide to some basic concepts of tobacco epidemiology and economics. Firstly, we introduce the main indicators usually employed to assess tobacco consumption in a given population. Secondly, we develop a simple demand model to illustrate how prices, consumers’ income and tastes, and tobacco control measures interact in determining the quantity consumed and the number of smokers. Finally, we use the latest estimations available to provide an overview of tobacco use worldwide.

Keywords

Cigarettes consumption; Price elasticity; Smoking intensity; Smoking prevalence; Tobacco demand

Abbreviations

CDC Centers for Disease Control and Prevention, United States

NIH National Institutes of Health, United States

OECD Organisation for Economic Co-operation and Development

WBG The World Bank Group

WHO World Health Organization

GBD Global Burden of Diseases

IARC International Agency for Research on Cancer

1.1 Introduction

There is a good variety of tobacco-based products that allow people around the world to consume tobacco in many different forms, according to local preferences and customs. For instance, tobacco products may be combusted (e.g., cigarettes and bidis), heated (e.g., water pipes and hookah), or even taken orally or nasally (e.g., snuff, betel quid, and chewing tobacco). Each population has its own cultural traditions—for example, bidis in India or hookah and snuff in the Middle East and South Asian countries, respectively (Hammond, 2009, p. 3).

However, along with industrialization, urbanization, and globalization, the consumption of manufactured cigarettes has grown sharply and spread across virtually all countries over the last century. As a result, cigarettes nowadays have become the predominant form of tobacco use worldwide, accounting for about 92% of total tobacco product sales globally. This is why in tobacco epidemiology, looking at current public health challenges, the terms “tobacco use” and “cigarette smoking” are often used as synonyms (NIH, 2016, chap. 2).

1.2 Basic Concepts of Tobacco Epidemiology

In each population, the magnitude and pattern of tobacco consumption result from the interplay between various individual and collective influences (Warner & MacKay, 2006). An adapted epidemiological “triangle model” of agent, host, vector, and environment, as depicted in Fig. 1.1, provides a useful framework to describe and conceptualize these complex relationships (Penn State, 2016; Slade, 1993, chap. 1). Tobacco—in the form, for instance, of cigarette smoking—acts as the agent (i.e., the “necessary” factor that is required for a disease to occur, although it may not inevitably lead to disease). All habitual smokers are hosts who, at least potentially, due to cigarette consumption, may develop one or more tobacco-related diseases (that usually result in disability and death). The tobacco companies play the role of vectors (i.e., anything that transports and disseminates the agent to susceptible individuals) by producing cigarettes and promoting their use within the population to expand the size of the market (i.e., the number of smokers and the number of cigarettes consumed per smoker). Finally, hosts and vectors operate and interact in a social environment determined by the interplay of a wide range of psychological, cultural, legal, and economic factors (Giovino, 2002).

Fig. 1.1 Interactions between agent, hosts, vectors, and environment in tobacco epidemic. From: Penn State. (2016). Epidemiologic Triad. Department of Statistics. Pennsylvania State University. Available at: https://onlinecourses.science.psu.edu/stat507/node/25. Originally adapted from Egger, G., Swinburn, B., & Rossner, S. (2003). Dusting off the epidemiological triad: could it work with obesity? Obesity Reviews 4(2), 115–119.

Given the outstanding role of tobacco as a major risk factor for several chronic noncommunicable diseases (such as cardiovascular and respiratory diseases and many types of cancer), measuring the distribution and intensity of tobacco use across the world is crucial for (1) better understanding the determinants of smoking behavior, (2) developing effective public health programs, and (3) monitoring countries’ progress (GBD, 2015). Overall, to study the pattern of tobacco use and to simulate the impact of tobacco control policies in specific populations, epidemiologists rely today on aggregate (i.e., compartmental) and individual (i.e., agent-based) comprehensive and sophisticated models (CDC, 2014, chap. 15). However, the “bread and butter” of monitoring tobacco use at country level and over time still consists of measuring (or better estimating) two key health policy variables—the prevalence of smoking and the intensity of smoking—by using either a direct and an indirect approach or both (IARC, 2008, chap. 3).

The prevalence of smoking in a given population is usually assessed using a direct approach—that is, by asking a sample of representative subjects their smoking status and behavior (Bonnie, Stratton, & Wallace, 2007). These surveys provide information about the identity of smokers (e.g., age, gender, ethnicity, educational attainment, and income levels) and about each smoker's habits and attitudes. Specifically, according to self-reported information, respondents are classified, as shown in Fig. 1.2, into three main categories: never, current, and former smokers (CDC, 2014, chap. 15). The number of people in each group is a stock variable (i.e., a quantity measured at a given point in time). Monitoring of the population under study over time gives the number of smoking initiations, cessations, and relapses. These are flow variables (i.e., quantities measured over a period of time) that represent the amount of change in each stock during a given time lapse (for instance, a year).

Fig. 1.2 Stock and flow variables in tobacco epidemiology.

Data on stock and flow variables are more meaningful if converted into rates by dividing the number of cases in a given category (e.g., the number of smokers) by the corresponding number of people in the population at risk (the sum of never, current, and former smokers), where both the numerator and denominator may refer to the entire sample under study (usually composed of the population aged 15 and over) or to a specific subset, disaggregated by sex, gender, age, and so on (Bonita, Beaglehole, & Kjellstrom, 2006, chap. 2). Advanced statistical techniques are usually applied to gather results from different surveys of a given population to obtain country-level estimates of the prevalence of smoking. Within this framework, the prevalence rate of smoking among the general population provides information on the proportion of current tobacco users in a given country. Finally, these national simple (crude) rates are age-standardized to allow fair comparisons across countries with populations of different age structures (WHO, 2015).

Tobacco use surveys also register self-reported data on the number of cigarettes consumed per day by each smoker. These figures, combined with prevalence data, yield estimates of the total number of cigarettes consumed in the population under study over a given period of time (usually a year). Total cigarette consumption is a basic indicator of the size of the tobacco market in a given economy. Dividing aggregate consumption by the country's number of smokers gives the average number of cigarettes consumed by each smoker. This is a useful country measure of the intensity of smoking, typically expressed as mean daily consumption—that is, the number of cigarettes consumed by the “average smoker” per day (Guindon & Boisclair, 2003). Total and average cigarette consumption, however, are also assessed at country level by using an indirect approach. Indirect estimates are mainly based on national commodity balance-sheet statistics. In fact, the ...