SMOKING CESSATION (Treating Tobacco Use and Dependence) Public Health Department Faculty of Medicine UNPAD
Feb 24, 2016
SMOKING CESSATION(Treating Tobacco Use and Dependence)
Public Health Department Faculty of Medicine UNPAD
DR. Ardini Saptaningsih RAKSANAGARA dr.,MPH
Date of Birth: 21 Mei 1960Address : Jalan Pasang 26, Bandung-40114. Education
1986, Dokter : Fakultas Kedokteran, Unpad.1992, Master of Public Health (MPH): University of Wollongong,
Wollongong, Australia.2004, Doktor : Pascasarjana, Unpad
Work Experience1987 - now : Lecture Public Health Department Faculty of Medicine
Unpad2007 - 2010 : Director Public Health Postgraduate Program Faculty
of Medicine Unpad2010 - 2011 : Head Department of Public Health Faculty of Medicine
Unpad
Ardini Saptaningsih RAKSANAGARAJalan Pasang 26. Bandung 40114. Phone : 022-7276326Mobile phone : 0811 237 159Email : [email protected]
WHY IS TOBACCO A PUBLIC HEALTH PRIORITY ?
• Tobacco Public Health Problem !
• Tobacco is the second major cause of death in the world.
• It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year)
• Tobacco is the fourth most common risk factor for disease worldwide
• If current smoking patterns continue, it will cause some 10 million deaths each year by 2025.
• Half the people that smoke today – that is about 650 million people– will eventually be killed by tobacco.
WHY IS TOBACCO A PUBLIC HEALTH PRIORITY?
• The economic costs of tobacco use are equally devastating. – high public health costs of treating– tobacco-caused diseases, – tobacco kills people at the height of their
productivity, depriving families of breadwinners and nations of a healthy workforce.
– Tobacco users are also less productive while they are alive due to increased sickness.
Every day, there will be patients come to your practice to consult about their symptoms/ diseases.
Still, even though they will not complain about their smoking habits, you as a good doctor has to screen them for tobacco
dependence as a routine procedure
WILLINGNESS TO QUIT
Unwilling to quit• 5 R’S
– Relevance– Risks– Rewards– Roadblocks– Repetition
UNWILLING TO QUIT
0.7
17.3
29 30.232.4 31.8
28.8 27.8
0
5
10
15
20
25
30
35
10'-14 15'-24 25'-34 35'-44 45'-54 55'-64 65'-74 75+
Percentage of smokers (groups of age)
Everyday smokers
• Male : 45 %• Female : 3 %
• Urban : 21.2 %• Rural : 25.3 %
0
25
50
75Q1
Q2
Q3Q4
Q5
everyday not ED ex not smoking
Household expenditure
• Smokers : 29.2 %– M : 55.7 %– F : 4.4 %– Age 10 – 14 : 2.0 %
• No of cigarettes / day: 12 ( 8.5 – 18.5)– M : 11.7 %– F : 15.7 %– Age 10 – 14 : 10 %
• Prevalence smoking in the house with member of family : 85.4 %
Why tobacco ?• Harmful agent of harm• Cause of death
– Responsible for 1 in 5 death (USA)– Reduce life expectancy : 12 years– Major killer of middle age– Cause of 80 % cases of CHD– Each year :
• Cancer deaths : 155,000• Cardiovascular deaths : 122,000• Chronic lung diseases deaths ; 72,000• Others : 81,000
Why tobacco control?
• Illnesses caused by tobacco are completely
preventable
Why progress difficult?
• Tobacco industry
• Economic self-interest : to get as many people to smoke as many cigarettes as possible
Reducing tobacco use
• Educational• Clinical• Regulatory• Economic• Social or comprehensive
Educational • School based curriculum
– Conducted in conjunction with community and media –based activity
• Mass media or counter-advertising program
• Media campaign change social norms around tobacco used– Decrease adolescent initiation– Increase adults cessation
Clinical• Pharmacologic• Behavioral
Regulatory• Product manufacture
– Filter, low tar– Promotion, marketing
• Sale• Smoking restriction
– Public venues– worksites
Economic• Modify taxation• Tariffs• Trade policy
Comprehensive approach• Reduce demand and supply
Smoking 400,000
Accidents 94,000
2nd Hand Smoke 38,000
Alcohol 45,000
HIV/AIDS 32,600
Suicide 31,000
Homicide 21,000
Drugs 14,200
Consequences of Tobacco-Use: Preventable Causes of Death
What are the tobacco-related diseases that are contributing to all
these deaths?
Tobacco use: The single largest cause of preventable death.
Arteriosclerosis & Atherosclerosis:
Healthy artery
Damaged artery
Heart Attack:
Quitting smoking rapidly reduces the risk of coronary
heart diseaseTorn heart wall: Result of over-worked heart muscle
Smokers are twice as likely as Nonsmokers to
have a heart attack
Peripheral Vascular Disease
Stroke:
This brain shows stroke
damage, which can
cause death or severe mental or physical disability
Emphysema: Healthy lung Emphysemati
c lung
Symptoms IncludeShortness of breath
Chronic coughWheezingAnxiety
Weight lossAnkle, feet and leg swelling
fatigue
Lung Cancer:The uncontrolled growth of abnormal cells in one or both lungs
Lung cancer kills more people than any other type of cancer
Fetal Damage:
Fetal Smoking Syndrome:
• Birth defects• Premature stillbirth• Low birthweight• Prone to Sudden Infant
Death Syndrome• Lowered immune
capacity
Laryngeal CancerSymptoms:• Persistent hoarseness
• Chronic sore throat
• Painful swallowing
• Pain in the ear• Lump in the neckOver 80% of deaths from laryngeal cancer are
linked to smoking
Dental Problems:
Above: CavitiesBelow: Gingivitis
Overall poor oral health
Common Consequences
:• Stained teeth• Gum
inflammation• Black hairy
tongue• Oral cancer• Delayed
healing of the gums
Consequences of chewing tobacco:
Leukoplakia
Oral cancer
Chemical Box:
What’s in Tobacco? Tar: black sticky substance used
to pave roads Nicotine: Insecticide Carbon Monoxide: Car exhaust Acetone: Finger nail polish
remover Ammonia: Toilet Cleaner Cadmium: used batteries Ethanol: Alcohol Arsenic: Rat poison Butane: Lighter Fluid
If smoking is so bad for us, why do we start?
Tobacco Myths• Myth: Clove cigarettes are less harmful than
regular cigarettes.
• Myth: Cigars are safe
• Myth: It’s OK to smoke as long as it’s a “natural” cigarette
Conclusion: All tobacco products are addictive (which takes your independence away), cause
cancer, and harm non-smokers all around you. The average tobacco user is addicted for seven years before they can finally kick this enslaving habit!
What is a cigar? A cigar has larger amounts of tobacco than
a cigarette A cigar is tobacco rolled up in a tobacco leaf A cigar does not have a filter
Cigar Use:Using beauty and fame to promote a dirty, devastating habit
Hookahs:
• Not safer than regular tobacco smoke.
• Causes the same diseases• Raises the risk of lip
cancer, spreading infections like tuberculosis.
• Users ingest about 100 times more lead from hookah smoke than from a cigarette.
The Quit Plan:• Treat yourself well• Drink lots of water
• Change your routines• Reduce stress
• Deep breathing• Regular exercise
• Do something enjoyable every day• Increase non-smoking social support
• Other ideas?
Get Medication and Use It Correctly
Talk to your health care provider about which medication will work for you:
Available by prescription:• Zyban (Wellbutrin, Bupropion)• Nicotine Inhaler• Nicotine Nasal Spray
Available over-the-counter:• Nicotine Patch (Has an increase in efficacy when combined
with Zyban) • Nicotine Gum and lozenge
Conclusion• All patients should be asked if they use tobacco and should
have their tobacco-use status documented on a regular basis.
• Once a tobacco user is identified and advised to quit, the clinician should assess the patient’s willingness to quit at this time.
• All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates.
• Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates.
• Proactive telephone counseling, group counseling, and individual counseling formats are effective and should be used in smoking cessation interventions.
• All patients who receive a tobacco dependence intervention should be assessed for abstinence at the completion of treatment and during subsequent clinic contacts.
• Three types of counseling and behavioral therapies result in higher abstinence rates :
(1) providing smokers with practical counseling (problem solving skills/skills training); (2) providing social support as part of treatment; and (3) helping smokers obtain social support outside of treatment.
These types of counseling and behavioral therapyshould be included in smoking cessation interventions.
Thank you