1 Smoking quiz Robert West University College London Rio de Janeiro 2006

2 Introduction “Any fool can ask a question that a wise person cannot answer” “An idiot is someone who doesn’t know something that one has just learned oneself” The answers to some of these questions are very well known, some are less well known and some may seem surprising. If you know the answer to a question it may seem trivially easy but remember that what is obvious to a pharmacologist may not be known to an epidemiologist and vice versa.

3 The questions For each statement just state whether it is ‘True’ or ‘False’ or leave it blank if you do not know

4 Smoking and Health 1.More than 4 million people will die prematurely in 2006 as a result of smoking 2.The British Doctors study found that stopping smoking at age 40 increased life expectancy by about 9 years 3.The British Doctors study found that stopping smoking at age 60 increased life expectancy by 1 year 4.Smoking has been found to increase risk of stroke 5.In terms of lung cancer risk, working full time in a smoky bar is equivalent to smoking about five cigarettes per day

5 Smoking and health 6.Smokeless tobacco (chewing tobacco and ‘snus’) is just as harmful as smoking 7.Smokers are more likely to suffer from pre-eclampsia (dangerously high blood pressure during pregnancy) than non-smokers 8.Resting blood pressure typically goes down when people stop smoking 9.The weight gain that many smokers experience when they stop usually lasts less than a year 10.Nicotine has been found to cause fetal abnormalities in animals

6 Clinical issues 11.The nicotine withdrawal symptom, irritability, usually last about 8 weeks 12.Nicotine gum was the first medication licensed as an aid to smoking cessation 13.Being exposed to paint stripper fumes can lead to high levels of expired-air carbon monoxide 14.Brief opportunistic advice from a GP leads about 5% of smokers to stop for at least 6 months 15.Acute forms of nicotine delivery such as gum, lozenge and nasal spray have been found to reduce urges to smoke but nicotine patches have not

7 Clinical issues 16.The threshold for expired-air carbon monoxide concentration to detect smoking is usually set at 3+ ppm 17.Clinical trials have found that face-to-face counselling helps an average of 10% of smokers to stop for at least 6 months 18.The more smokers enjoy smoking the less likely they are to succeed in their attempts to stop 19.Trials directly comparing varenicline and bupropion to aid smoking cessation have found varenicline to yield higher 12-month continuous abstinence rates 20.Trials of nicotine patches for smoking cessation have been found to increase 12-month continuous abstinence rates by 5-7% compared with placebo

8 Pharmacology 21.The plasma half life of nicotine is typically less than 3 hours 22.Nicotine binds with greater affinity to the alpha4-beta2 NAch receptor than the alpha7 receptor 23.Stopping smoking is associated with an increase in adrenaline output 24.Smokers typically ingest between 1.0 and 1.5mg of nicotine per cigarette 25.Studies have failed to find that nicotine reduces anxiety in non-smokers

9 Economics 26.In most economies putting the price of cigarettes up by 10% in real terms would be expected to lead to an approximate 4% reduction in quantity of cigarettes sold 27.Population studies have found that low income smokers are less likely to try to stop smoking than more affluent smokers 28.Pregnant smokers have been found to be more responsive to increases in the price of cigarettes than other women of the same age 29.Stopping smoking results in less use of healthcare resources even within the first year 30.Adolescents are less responsive to cigarette price rises than adults

10 The answers Red=True Black=False

11 Smoking and Health 1.More than 4 million people will die prematurely in 2006 as a result of smoking 2.The British Doctors study found that stopping smoking at age 40 increased life expectancy by about 9 years 3.The British Doctors study found that stopping smoking at age 60 increased life expectancy by 1 year (it was 3 years) 4.Smoking has been found to increase risk of stroke 5.In terms of lung cancer risk, working full time in a smoky bar is equivalent to smoking about five cigarettes per day (it is much less, though still significant)

12 Smoking and health 6.Smokeless tobacco (chewing tobacco and ‘snus’) is just as harmful as smoking (it is much less harmful) 7.Smokers are more likely to suffer from pre-eclampsia (dangerously high blood pressure during pregnancy) than non-smokers (paradoxically smokers are LESS likely to suffer pre-eclampsia) 8.Resting blood pressure typically goes down when people stop smoking (it actually goes up slightly) 9.The weight gain that many smokers experience when they stop usually lasts less than a year (it is normally permanent) 10.Nicotine has been found to cause fetal abnormalities in animals

13 Clinical issues 11.The nicotine withdrawal symptom, irritability, usually last about 8 weeks (it usually lasts up to 4 weeks) 12.Nicotine gum was the first medication licensed as an aid to smoking cessation (Tabex – cytisine – was licensed in Soviet bloc countries in the 1960s) 13.Being exposed to paint stripper fumes can lead to high levels of expired-air carbon monoxide 14.Brief opportunistic advice from a GP leads about 5% of smokers to stop for at least 6 months (the effect is about 2%) 15.Acute forms of nicotine delivery such as gum, lozenge and nasal spray have been found to reduce urges to smoke but nicotine patches have not (they have all been shown to reduce urges)

14 Clinical issues 16.The threshold for expired-air carbon monoxide concentration to detect smoking is usually set at 3+ ppm (it is usually set at 8+ or 10+) 17.Clinical trials have found that face-to-face counselling helps an average of 10% of smokers to stop for at least 6 months (the effect is about 5%) 18.The more smokers enjoy smoking the less likely they are to succeed in their attempts to stop (we have found no relationship at all in clinic studies) 19.Trials directly comparing varenicline and bupropion to aid smoking cessation have found varenicline to yield higher 12-month continuous abstinence rates 20.Trials of nicotine patches for smoking cessation have been found to increase 12-month continuous abstinence rates by 5-7% compared with placebo

15 Pharmacology 21.The plasma half life of nicotine is typically less than 3 hours 22.Nicotine binds with greater affinity to the alpha4-beta2 NAch receptor than the alpha7 receptor 23.Stopping smoking is associated with an increase in adrenaline output (adrenaline output decreases for up to 10 days) 24.Smokers typically ingest between 1.0 and 1.5mg of nicotine per cigarette 25.Studies have failed to find that nicotine reduces anxiety in non-smokers

16 Economics 26.In most economies putting the price of cigarettes up by 10% in real terms would be expected to lead to an approximate 4% reduction in quantity of cigarettes sold 27.Population studies have found that low income smokers are less likely to want to stop smoking than more affluent smokers (in the UK at least they want to stop just as much as high income smokers) 28.Pregnant smokers have been found to be more responsive to increases in the price of cigarettes than other women of the same age 29.Stopping smoking results in less use of healthcare resources even within the first year (use of healthcare resources goes up and it is not clear why) 30.Adolescents are less responsive to cigarette price rises than adults (they are MORE responsive)

17 Your score Add 1 for every correct answer Deduct 1 for every incorrect answer