Why We Should Care About Smoking Steven A. Schroeder, MD Federal Occupational Health: Workplace Wellness Program, San Francisco, August 15, The Smoking.

Slides:



Advertisements
Similar presentations
Effects & Hazards of Smoking. § Causes millions of deaths each year current § Is expected to cause the premature deaths of half of all current smokers.
Advertisements

Tobacco & Cancer. Tobacco Use And Cancer Tobacco use, the most preventable cause of death in our society, accounts for at least 30% of all cancer deaths.
EFFECTS OF SMOKING ALLY ZITZMAN TECHNOLOGY AND ASSESSMENT SECTION: 8 AM GEARED TOWARDS HIGH SCHOOL STUDENTS.
The chemicals in all tobacco products harm the body.
Toward a Tobacco-Free Society Chapter Use of Tobacco  Why People use Tobacco  Nicotine  Powerful psychoactive drug  Reaches Brain via bloodstream.
Secondhand Smoke Exposure, Smoking and Children’s Health Coordinator Name Alabama Dept. of Public Health.
Action on Smoking and Health The evolving fight against tobacco Clive Bates Director Action on Smoking and Health.
Chapter 12 Tobacco. Tobacco Use: Scope of the Problem  Cigarette smoking is the major, most pre- ventable cause of disease and premature death in the.
Tobacco Chapter 8 ???? ____ % of new smokers are adolescents/teenagers ???? Smokers have about a _____% greater risk of dying from coronary heart disease.
Update on Tobacco Control Steven A. Schroeder, MD Global Oral Health Symposium, 2013 Presentation courtesy of The Smoking Cessation Leadership Center and.
Health Consequences of Tobacco Use Created by the Registered Nurses’ Association of Ontario.
Tobacco.
TOBACCO FACTS. IS IT REALLY WORTH IT???. WHAT DO THEY DO, AND HOW THEY ARE ADDICTING. Brain. * Nicotine, the drug that makes tobacco addictive, goes to.
Bulletin Board By Sophia Brancazio Oberlin College, Oberlin, OH
Stop smoking or stop breathing By : Karen Bonilla 2nd period.
Cigarette Smoking in America Today Mike Kelly Dr. Freymiller.
It’s Quitting Time! Educating African American Women the Importance of Smoking Cessation Brittinae Bell HSCI 5108: Instructional Media Western University.
Infant Safe Sleep Resources North Carolina Carolinas Medical Center Charlotte, NC September 5, 2007 Christine O’Meara, MA, MPH.
CHAPTER 13 n TOBACCO Since Jan. 1, 1966, all cigarette packages sold in the United States have carried health warnings. Cigarette advertising on television.
Tobacco What You Should Know.
Tobacco Unit 9.
Smoking. { Why Do People Start Smoking? -seem mature -independent -popularity -weight management -media influence -family -curiosity.
20th Century World War 1 (soldier’s relief) 1920’s beginning of heavy marketing World War II Marlboro Man 1964 Smoking linked to cancer 1971 advertisements.
Evidence-based/Best Practices Tobacco Control Hadii Mamudu, PhD, MPA COPH-China Institute November 17, 2011.
Smoking Cigarettes Are they worth it to you?. Tobacco use leads to disease and disability. Smoking causes cancer, heart disease, stroke, and lung diseases.
Quittin’ Time: Helping Employees Become Tobacco-free June 2005.
What Physicians Should Know about Smoking:2012 Steven A. Schroeder, MD Medical Grand Rounds, Oct 4, 2012 The Smoking Cessation Leadership Center and Rx.
Module 4: Secondhand Smoke Exposure & the Benefits of being Smoke Free
Economics of Tobacco Use and Help-Seeking Behavior Bishwa Adhikari, Ph.D., Economist Office on Smoking and Health Centers for Disease Control and Prevention.
Smoking Cessation: the pharmacotherapeutic and non-pharmacotherapeutic approaches to addictive behavior Andrea C. McKean February 22, 2007.
Tobacco Prevention. What Kills the Most Americans Every Year? Rank them in order from 1-10 AIDS Suicide Alcohol Fires Secondhand Smoke Heroin Tobacco.
Cigarette Smoking in America Today Mike Kelly Dr. Freymiller.
TOBACCO. What is it? An agricultural crop Also known as “chew” “dip” “smoke” Can be smoked, chewed, dipped and spit out Brown cut up leaves Main ingredient.
TOBACCO PREVENTION AND CONTROL PROGRAM Mike Maples, Assistant Commissioner Mental Health and Substance Abuse Services.
Brandi Settegast, Department of Biological Sciences, Honors College Susan Eve, Faculty Mentor, Honors College.
Public Health & Hospital Health Care System Rural Cessation Collaboration to Improve Health.
 Tobacco is an agricultural product, recognized as an addictive drug, processed from the fresh leaves of plants in the genus Nicotiana.  Its all natural.
1 Mansel Nelson, ITEP Environmental Tobacco Smoke.
Page 1 Author: Bokor Emőke – Anita (University of Medicine and Pharmacy Tîrgu-Mure, General Medicine, 6 th year) Supervisor: Dr. Germán - Salló Márta,
Copyright © 2008 Delmar. All rights reserved. Chapter 28 Populations with Substance Abuse.
Identifying the Risks of Smoking Lesson 3. Truth #1 Tobacco is as much a part of Kentucky’s culture as Bourbon and Horseracing.
TOBACCO USE & OLDER SMOKERS. OLDER SMOKERS In 2004, 3.7 million people aged 65 and older were smokers and 16% of all people aged 50 and older smoked;
Chapter 14 Tobacco Lesson 4 Costs to Society. Building Vocabulary secondhand smoke Air that has been contaminated by tobacco smoke mainstream smoke The.
TOBACCO April 26, 2003 Presented By: Lisa M. Ryder Karen Lara.
Section 16.3 Risks of Tobacco Use Objectives
Smoking and the Movies Jonathan M. Samet, MD, MS MPAA, Hollywood, California February 23, 2007 Department of Epidemiology.
Living Tobacco-Free It really is possible!. Agenda Statistics and mortality risks Health risks Benefits of quitting Ways to quit.
Steven A. Schroeder, MD Professor of Medicine University of California San Francisco San Francisco, California Get Your Patients with HIV/AIDS to Stop.
Tobacco.
Top Reasons why Teenagers begin using Tobacco. The Desire to Look Cool.
Smoking in The United States Alexandra M. Lippert 1/30/13 ECO 5550 Presentation.
Wellness Chapter 20 Tobacco Lesson One The Health Risks of Tobacco Use.
“Smoking can’t kill me.” Fact? or Fiction?. The Risk of ONE Cigarette The Tobacco Atlas, WHO.
Choosing a Tobacco-Free Lifestyle
© 2007 McGraw-Hill Higher Education. All rights reserved. Chapter Thirteen Tobacco: The Smoking Challenge Tobacco: The Smoking Challenge.
Tobacco. Nicotine is a stimulant drug found in tobacco products, including cigarettes, clove cigarettes, cigars, chewing tobacco, pipe tobacco, and snuff.
Keven Chinchilla Intro to Biology Dr. David Lang UHD-Spring 2014.
Eliminating Cancer in Alaska— A Roadmap John Killpack, Western Region Managing Director Emily Nenon, Alaska Government Relations Director February 18,
Tobacco was first discovered in 1492 and soon people started to use it and a majority of people got addicted to it. Tobacco addiction is a worldwide.
Tobacco Chapter 11. Tobacco Use: Scope of the Problem Tobacco use is the leading preventable cause of disease and premature death in the United States.
Chapter 14 Tobacco Lesson 4 Costs to Society.
Substance Abuse Unit Lesson 4
Racial Disparity in Smoking-Attributable Mortality, Years of Potential Life Lost: Case of Missouri Noaman Kayani, PhD Chronic Disease and Nutrition.
The Burden of Tobacco Use
Tobacco Review.
Presentation transcript:

Why We Should Care About Smoking Steven A. Schroeder, MD Federal Occupational Health: Workplace Wellness Program, San Francisco, August 15, The Smoking Cessation Leadership Center and Rx for Change

Facts About Smoking and Health

Tobacco’s Deadly Toll 443,000 deaths in the U.S. each year 443,000 deaths in the U.S. each year 4.8 million deaths world wide each year 4.8 million deaths world wide each year 10 million deaths estimated by year million deaths estimated by year ,000 deaths in the U.S. due to second-hand smoke exposure 50,000 deaths in the U.S. due to second-hand smoke exposure 8.6 million disabled from tobacco in the U.S. alone 8.6 million disabled from tobacco in the U.S. alone 45.3 million smokers in U.S. (78% daily smokers, averaging 15 cigarettes/day, 2010) 45.3 million smokers in U.S. (78% daily smokers, averaging 15 cigarettes/day, 2010)

Annual U.S. Deaths Attributable to Smoking, 2000–2004 Centers for Disease Control and Prevention. MMWR 2008;571226– % 28% 23% 11% 8% <1% TOTAL: 443,595 deaths annually Cardiovascular diseases128,497 Lung cancer125,522 Respiratory diseases103,338 Second-hand smoke49,400 Cancers other than lung35,326 Other1,512 Percent of all smoking- attributable deaths

Health Consequences of Smoking U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, Cancers Cancers –Acute myeloid leukemia –Bladder and kidney –Cervical –Esophageal –Gastric –Laryngeal –Lung –Oral cavity and pharyngeal –Pancreatic –Prostate ( ↑ incidence and ↓ survival) Pulmonary diseases Pulmonary diseases –Acute (e.g., pneumonia) –Chronic (e.g., COPD) Cardiovascular diseases Cardiovascular diseases –Abdominal aortic aneurysm –Coronary heart disease –Cerebro-vascular disease –Peripheral arterial disease –Type 2 diabetes mellitus Reproductive effects Reproductive effects –Reduced fertility in women –Poor pregnancy outcomes (e.g., low birth weight, preterm delivery) –Infant mortality; childhood obesity Other effects: cataract, osteoporosis, periodontitis, poor surgical outcomes, Alzheimers; rheumatoid arthritis Other effects: cataract, osteoporosis, periodontitis, poor surgical outcomes, Alzheimers; rheumatoid arthritis

Epidemiology of Tobacco Use

TRENDS in ADULT SMOKING, by SEX—U.S., 1955–2010 Percent Male Female 21.0% 17.8% Year Trends in cigarette current smoking among persons aged 18 or older Graph provided by the Centers for Disease Control and Prevention Current Population Survey; 1965–2010 NHIS. Estimates since 1992 include some-day smoking. 70% want to quit 19.3% of adults are current smokers

Adult Smoking Prevalence U.S.A Source: Centers for Disease Control and Prevention (Schroeder and Warner, NEJM, July 2010)

Smoking Prevalence and Average Number of Cigarettes Smoked per Day per Current Smoker Source: Centers for Disease Control and Prevention ( ). NHIS Percent/Number of Cigarettes Smoked Daily

PREVALENCE of ADULT SMOKING, by RACE/ETHNICITY—U.S., % Asian* 31.4% American Indian/Alaska Native* 20.6% Black* 21.0% White* 14.5% Hispanic Centers for Disease Control and Prevention. (2010). MMWR. * non-Hispanic.

PREVALENCE of ADULT SMOKING, by EDUCATION—U.S., % Undergraduate degree 26.4% No high school diploma 49.1% GED diploma 25.1% High school graduate 23.3% Some college 5.6% Graduate degree Centers for Disease Control and Prevention. (2008). MMWR 57:1221–1116.

Tobacco Control Policies

Federal Tobacco Tax Per Pack of Cigarettes  1951—8 cents  1982—16 cents  1991—20 cents  1993—24 cents  2001—34 cents  2002—39 cents  2009—$1.01

State Tobacco Revenue (taxes and settlement funds) State Tobacco Program Budgets $0.5 billion Total CDC- Recommended Spending Level Tobacco Industry Marketing & Promotion Spending (2008) $10.5 billion $25.6 billion $3.7 billion Cigarettes Federal Cigarette Tax Revenues $15 billion Smokeless Tobacco Industry is Outspending Prevention Efforts 23:1 Campaign for Tobacco Free Kids, Federal Trade Commission, American Heart Association American Cancer Society, American Lung Association, SmokeLess States National Tobacco Policy Initiative

Number of Smokers = New Smokers + Old Smokers - Quitters

Number of Quitters = Number of Quit Attempts X% of Quitters Price Clean indoor air Clinician advice Counseling Medications Counter- Marketing

New FDA Graphic Warnings

WARNING: Cigarettes are addictive. Tobacco use can rapidly lead to the development of nicotine addiction, which in turn increases the frequency of tobacco use and prevents people from quitting. Research suggests that nicotine is as addictive as heroin, cocaine, or alcohol.

WARNING: Tobacco smoke can harm your children. Secondhand smoke can cause serious health problems in children. Children who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances and poisons as smokers.

WARNING: Cigarettes cause fatal lung disease. Smoking causes lung diseases such as emphysema, bronchitis, and chronic airway obstruction. About 90 percent of all deaths from chronic obstructive lung disease are caused by smoking.

WARNING: Cigarettes cause cancer. Smoking causes approximately 90 percent of all lung cancer deaths in men and 80 percent of all lung cancer deaths in women. Smoking also causes cancers of the bladder, cervix, esophagus, kidney, larynx, lung, mouth, throat, stomach, uterus, and acute myeloid leukemia. Nearly one-third of all cancer deaths are directly linked to smoking.

WARNING: Cigarettes cause strokes and heart disease. More than 140,000 deaths from heart disease and stroke in the United States are caused each year by smoking and secondhand smoke exposure. Compared with nonsmokers, smoking is estimated to increase the risk of coronary heart disease and stroke by 2 to 4 times.

WARNING: Smoking during pregnancy can harm your baby. Smoking during pregnancy can increase the risk of miscarriage, stillborn or premature infants, infants with low birth weight and an increased risk for sudden infant death syndrome (SIDS).

WARNING: Smoking can kill you. More than 1,200 people a day are killed by cigarettes in the United States alone, and 50 percent of all long-term smokers are killed by smoking-related diseases. Tobacco use is the cause of death for nearly one out of every five people in the United States, which adds up to about 443,000 deaths annually.

WARNING: Tobacco smoke causes fatal lung disease in nonsmokers. Nonsmokers who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances and poisons as smokers. Nonsmokers who are exposed to secondhand smoke increase their risk of developing lung cancer by 20–30 percent.

WARNING: Quitting smoking now greatly reduces serious risks to your health. Quitting at any age and at any time is beneficial. It's never too late to quit, but the sooner the better. Quitting gives your body a chance to heal the damage caused by smoking.

Clinical Issues

Ad campaigns from the 1950s featured physicians and assured the public that cigarettes were safe.

Health Professionals’ Smoking Rates, 2004 * Primary Care Physicians - 1.7% Emergency Physicians - 5.7% Psychiatrists - 3.2% RN’s % Dentists - 5.8% Dental Hygienists - 5.4% Pharmacists – 4.5% * E. Tong et al, Nicotine & Tobacco Research (Nicotine and Tobacco Research, May 27, 2010)

Reasons for Not Helping Patients Quit 1. Too busy 2. Lack of expertise 3. No financial incentive 4. Lack of available treatments and/or coverage 5. Most smokers can’t/won’t quit 6. Stigmatizing smokers 7. Respect for privacy 8. Negative message might scare away patients 9. I smoke myself

Nicotine enters brain Stimulation of nicotine receptors Dopamine release Dopamine Reward Pathway Prefrontal cortex Nucleus accumbens Ventral tegmental area

Chronic Administration of Nicotine: Effects on the Brain Perry et al. (1999). J Pharmacol Exp Ther 289:1545–1552. Nonsmoker Smoker Human smokers have increased nicotine receptors in the prefrontal cortex. High Low Image courtesy of George Washington University / Dr. David C. Perry

Nicotine Pharmacodynamics: Withdrawal Effects Irritability/frustration/anger Anxiety Difficulty concentrating Restlessness/impatience Depressed mood/depression Insomnia Impaired performance Increased appetite/weight gain Cravings Hughes. (2007). Nicotine Tob Res 9:315–327. Most symptoms manifest within the first 1–2 days, peak within the first week, and subside within 2–4 weeks.

LONG-TERM (  6 month) QUIT RATES for AVAILABLE CESSATION MEDICATIONS Data adapted from Cahill et al. (2008). Cochrane Database Syst Rev; Stead et al. (2008). Cochrane Database Syst Rev; Hughes et al. (2007). Cochrane Database Syst Rev Percent quit

Quitlines

What Are “Tobacco Quitlines”? Tobacco cessation counseling, provided at no cost via telephone to all Americans Tobacco cessation counseling, provided at no cost via telephone to all Americans Staffed by trained specialists Staffed by trained specialists Up to 4 – 6 personalized sessions (varies by state) Up to 4 – 6 personalized sessions (varies by state) Some state quitlines offer nicotine replacement therapy at no cost (or reduced cost) Some state quitlines offer nicotine replacement therapy at no cost (or reduced cost) Up to 30% success rate for patients who complete sessions Up to 30% success rate for patients who complete sessions Most health-care providers, and most patients, are not familiar with tobacco quitlines.

43 California’s NO BUTTS —

Quitline Calls Are Increasing # callers to all national quitlines was 222,000 in 2005, 516,000 in 2009 In a period when smoking prevalence was declining and states were cutting back on marketing budgets 63% North Carolina callers reported history of mental illness New studies showing that web-based cessation protocols yield better results when linked to quitlines

Conclusions

The Electronic Cigarette * Aerosolizes nicotine in propylene glycol soluent Aerosolizes nicotine in propylene glycol soluent Cartridges contain about 20 mg nicotine Cartridges contain about 20 mg nicotine Safety unproven, but >cigarette smoke Safety unproven, but >cigarette smoke Bridge use or starter product? Bridge use or starter product? Probably deliver < nicotine than promised Probably deliver < nicotine than promised Not approved by FDA Not approved by FDA My advice: avoid unless patient insists My advice: avoid unless patient insists * Cobb & Abrams. NEJM July 21, 2011

Tobacco Tipping Point? California 11.9% adult smoking prevalence in 2010 National prevalence in 2007 at modern low— (19.8%), 20.6% in 2008 and 2009; 19.3% in 2010!! Smokers smoke fewer cigarettes Northern California Kaiser Permanente at 9% Physician smoking prevalence at 1% New FDA warning photos on cigarette packs

Tobacco Tipping Point (2) Proliferation of smoke-free areas Proliferation of smoke-free areas Higher insurance premiums for smokers Higher insurance premiums for smokers April cent/pack federal tax increase Lung cancer deaths in women start to fall Increasing stigmatization of smoking National mass media campaigns—FDA and CDC—in 2012