How Big Tobacco capitalizes on people with mental illness

On Nov. 19, North Dakota State University Health Promotion hosted a “Think Talk” about tobacco and mental health.

Clay County Public Health representative, Sarah Dixon-Hackey, spoke at the event. Her presentation outlined the history of big tobacco and its future, as well as the extra effects tobacco has on individuals with mental illnesses.

“Our society has normalized [tobacco] use and put it on a shelf of untouchables,” Dixon-Hackey said.

Dixon-Hackey started the presentation with the history of tobacco in the United States. Tobacco was originally marketed as something healthy for the consumer. Doctors were featured on cigarette ads even recommending certain brands.

“Tobacco companies were actually hiring actors. Most of the time these were not actual physicians,” Dixon-Hackey said. “Any research [that was] done, was done by tobacco companies, not any external source.”

Tobacco companies also advertised using cartoon charters. A Winston cigarette ad, shown during the presentation, featured characters from the cartoon “The Flintstones.”

Statements from Philip Morris executives were recovered on targeting advertising to teenagers. The statements included, “Today’s teenager is tomorrow’s potential regular customer,” and “The base of our business is the high school student.”

“We’re dealing with an organization that wasn’t doing this naïvely. It was very much a knowledge field direction,” Dixon-Hackey said.

“Our society has normalized [tobacco] use and put it on a shelf of untouchables.”

Sarah Dixon-Hackey, Clay County Public Health representative

After the 1990 Surgeon General report, advocating for individuals to quit smoking, research surged on the medical effects of tobacco. The research uncovered many of the negative effects tobacco has on the body known today.

Smoking cigarettes and combustible tobacco have continued to decline. From 2015-2017 smoking rates decreased around 21 percent from 20.9 percent in 2015 to 14 percent in 2017.

“We didn’t anticipate that during that time that there was another form of smoking on the horizon,” Dixon-Hackey said.

E-cigarette use in high school students increased by 78 percent from 2017-2018. A rate of 11.7 percent to 20.8 percent.

“The industry keeps modifying itself at a pace that sometimes is hard to keep up with,” Dixon-Hackey said. “We’re seeing a growth that is exponential that the industry has not seen in any form of addictive substance.”

In December 2018, the Surgeon General made a formal declaration that vaping was an epidemic among youth. That same month, the tobacco company Altria invested a 35 percent stake in Juul Labs Inc. This investment increased Juul’s company value to around $38 billion.

“Juul right now is the number one e-cigarette company out there, as far as profits,” Dixon-Hackey said.

Chemicals, besides nicotine, contained within a vape cloud include acetaldehyde, benzene, cadmium, formaldehyde, isoprene, lead, nickel and others. Like cigarettes, vaping exposes people to secondhand smoke as well as thirdhand smoke.

Thirdhand smoke leaves residue on walls, ceilings, and other objects. Thirdhand smoke from cigarettes forms a brown residue while residue from vaping thirdhand smoke is colorless.

Among people with mental illness, tobacco use is the number one cause of death. Around 44 percent of the tobacco market is people with mental illnesses and substance use disorders.

“One in three people who smoke in the U.S. have a diagnosed mental illness,” Dixon-Hackey said

Nicotine affects dopamine transmitters in the brain. People with schizophrenia and other psychotic disorders have more sensitive dopamine transmitters. With nicotine use, these people can experience a temporary reduction in symptoms.

“The problem with nicotine, like with any other substances, you get the hit then you get the drop,” Dixon-Hackey said.

Life-time smoking rates disproportionally affect people with mental illnesses. For people without any mental illness, the life-time smoking rate is 32 percent. For people with psychotic disorders, the life-time smoking rate increases to 90 percent. For people with bipolar disorder, the life-time smoking rate is 83 percent. People with major depression, the life-time smoking rate is 59 percent.

For more information about mental health services offered at NDSU or information about trying to quit smoking, visit the Student Health Services in the Wallman Wellness Center in room 102.