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Tobacco and Public HealthPrevention, Intervention, Treatment
Deirdre A. Dingman, MPH, CHES, CTTS
Created: September 2012
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Science
Disease
Addiction
Prevalence
Incidence Trends Treatment
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TobaccoDeirdre A Dingman, MPH
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Tobacco ProductsDeirdre A Dingman, MPH
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DISEASESmokeless Vs. Cigarettes
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Smokeless Tobacco Outcomes Oral malignancy - Cancer
Bad breath
Cardiovascular disease (outcomes)
Stained Teeth
Gingival recession/periodontal disease
Abrasion of teethWe do not know about potentially reduced harm products
yet. Including the E cig. See also Modified Tobacco Risk
Products and Potentially Reduced Exposure Products .
See Research and Review by T. Eissenberg, PhD.
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Lung and other cancers: oxidative stress, DNA damage
Breathing problems/COPD: TAR
Heart disease: oxidant gasses
Stroke: oxidant gasses Recently the government reported a link between
smoking, passive and active, with at least 25 diseases:chemicals impact all cells, tissues and organs
Reproductive problems and infant mortality: oxygenflow, hormone levels, toxic chemicals
It also effects young persons athletic performance, lungcapacity and immune systems.
ALSOSecond Hand or Environmental Smoke
Health Effects of Smoking
Deirdre A Dingman, MPH
http://localhost/var/www/apps/conversion/tmp/scratch_2/newSponge_Lge.mpeghttp://localhost/var/www/apps/conversion/tmp/scratch_2/bubblewrap%20convert.MPGhttp://localhost/var/www/apps/conversion/tmp/scratch_2/Artery%20fear%20convert.mpghttp://localhost/var/www/apps/conversion/tmp/scratch_2/Artery%20fear%20convert.mpghttp://localhost/var/www/apps/conversion/tmp/scratch_2/bubblewrap%20convert.MPGhttp://localhost/var/www/apps/conversion/tmp/scratch_2/newSponge_Lge.mpeg7/30/2019 Tobacco and Public Health
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Carbon Monoxide, Tar, and Nicotine
Tar (T.A.R.) Sticky brown substance that condenses on filter and lungs
Contains carcinogens
Comes from the burning of a smokable plant product
Carbon monoxide
Main contributor to coronary heart diseaseBinds to hemoglobin and leads to arthrosclerosis
Nicotine
Addictive component
Increases heart rate, blood pressure and pulse, vasoconstriction
Causes glucose release, higher blood sugar levels than would have if didntuse
Oxidant gasses
Thrombogenic effects
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What part of the cigarettecauses disease?Deirdre A Dingman, MPH
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The SmokeDeirdre A Dingman, MPH
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NicotineIs what keeps a person smoking
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Dopamine pleasure, appetite suppression
GABA reduce anxiety and tension
Norepinephrine arousal, appetite suppression
Nicotine Beta endorphins reduce anxiety and tension
Glutamate learning, memory enhance
Acetylcholine arousal, cognitive enhancement
Serotonin mood modulation, appetite suppression
Neurotransmitters Activated
Adapted from N. Benowitz, Am Jour of Med; 2008
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PrevalenceWho is using tobacco and how do we know?
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WHOOne Billion SmokersDeirdre A Dingman, MPH
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Self Report(operationalization)
Sample? Written? Telephone?
Have you smoked at least 100 cigarettes in
your entire life?Smoked cigarettes on 20 or more days, in last 30
days. US6.4%, NC 6.8% Males higher than females
Do you now smoke cigarettes every day, some
days, or not at all? (2010) 19.3% US Adults
On any day, in the last 30 days, have you smoked one
cigarette? (2009) 18% Youth smokers
Similar Qs for smokeless, less useregionaleffect!
Independent research also
adds to the numbers
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Cessation and Trends
First Surgeon GeneralReport1965
Prevalence was 42% 2005 20.6%
2010 19.3%
Quitters: White 6%
Black 3% (the menthol theory)
68% desire to quit!
During the past 12 months, have you stopped smoking for
one day or longer because you were trying to quit smoking?(BRFSS)
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INCIDENCEAt what age are people most likely to startsmoking or using tobacco?
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Who does this capture?(sample wise)
In a nationwideMonitoring the Futuresurvey,
8.8 percent of eighthgrade students reportedhaving first smoked bythe fifth grade (ages 10and 11), and
22.3 percent of eighthgraders tried smokingby the eighth grade.
Two out of three 12th-graders who werecurrent smokers hadstarted smoking by theend of ninth grade.
4000 teens try cigarettes every day
and 1000 become smokers.
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Public Health and Tobacco
Prevention
Intervention
Treatment
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Health Education/Promotion
Prevention - Keeping people
(youth) from ever starting.
Intervention - Behavior
Change TheoryStages of
Change. Quitting!
Treatment- Evidence based
cessation methods.
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Counter the MarketingGlamor and
Branding
{note: blank labels and display bans}
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CDCQuit SmokingDeirdre A Dingman, MPH
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Stages of change
Copyright 2004 BMJ Publishing Group Ltd.
Stages of change in process of stopping smoking. Adapted from Prochaska et al. Clin Chest Med 1991;12: 727-35 West, R. BMJ2004;328:338-339
Pre-Contemplation Contemplation
Maintenance Action
Preparatio
n
Termination
I Cant /I Wont
I May
I Will
I Am
I Still Am
I Did
Relapsing
Stages of Changean Intervention Model
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Motivational Interviewing with SOC
I Cant Efficacy
I Wont Relevance
I May Decisional Balance
I Will Quit Date/Meds/Tools
I Am Follow up/Support
I Still Am Monitor
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ClinicalEvidence Based
Treatment
Minimally Effective
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Non-NRT Quit Meds Bupropion SR (Zyban, Wellbutrin)
Varenicline (Chantix)
NRT Nicotine gum
Nicotine inhaler
Nicotine nasal spray Nicotine lozenge
Nicotine patch
First-line Pharmacotherapy
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Other Methods
The following do not have evidence-based efficacy
Hypnosis
Acupuncture
Anticholinergic shots
Laser therapy
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Set a Quit Date
Tell Others
Anticipate theChallenges
Remove TobaccoProducts
STARmethod
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We must be anti-tobacco use,
anti-disease, and anti-disability,
but never anti-smoker.
Deirdre A Dingman, MPH