Tobacco Use and Lessons Learned as an RT Delegate to China

1. Tobacco Use and Lessons Learned as an RT Delegate to China Gaylene Lee, M.Ed, RRT-NPS, TTS RT Program Director, SJVC Gaylene.Lee@sjvc.edu 559-790-8795

3. One World One Dream 08/08/08 at 8:08p.m.

6. Year of the Pig • Chinese Zodiac

7. Global Tobacco Use and Mortality • Tobacco use:1.3 Billion Smokers (CDC) • Mortality: Five (5) million/year (National Cancer Institute) • Expected to increase to 10 million/year by 2025 • 20th century – 100 million deaths • 21st century – Expected to be one (1) Billion • Global leading cancer (American Cancer Society) • Lung Cancer: 1.35 million new cases and 1.18 million deaths each year • 600,000 die in China and over 160,000 in the U.S.

8. Global Population • March 2008 • 6.60 billion • China • 1.30 billion • World’s largest and most populated • United States • 3.04 million

9. United States versus China Tobacco Use • United States • 21.65% or 52 million (US Census Bureau of International Database) • China • 30.45% or 320.2 million (US Census Bureau of International Database) • 27% of total worldwide smokers (CDC) • 60% men (defined as15 or >) • < 5% women

10. First Day in China

11. Physicians and Teachers Tobacco Use in China • Physicians (WHO) • 68% • Teachers (WHO) • 65% I hope they don’t see the cigarette behind my back

12. Tobacco Use Mortality Rate in China • Annually • One (1.0) million individuals due to tobacco use • 600,000 due to lung cancer (Ministry of Health and Anti-Cancer Association) • Will increase to 2.2 million by 2020, if nothing done • 100,000 due to second-hand smoke (Ministry of Health)

13. Male and Female Guardian Lions (Foo Dogs)

14. Tobacco Production in China • China National Tobacco Company (Largest Tobacco Company in the World) • Chinese government owned • Formed 1982 • Under the State Tobacco Monopoly Administration (STMA) also formed in 1982 • Objectives • Modernize • Reduce number of factories to fewer than 100

15. Tobacco Production in China cont. • STMA sales to 350 million smokers • China National Tobacco Company responsible for: • Marketing • Production • Distributing • Sales

16. Tobacco Production in China cont. • 12 provinces produce tobacco • Hunan is the largest with 70% of taxes from tobacco (Hometown province for Chinese Tobacco) • 900 Brands of Tobacco in China • Greater than 1.2 trillion cigarettes consumed • 30% of total world consumption • 1,400 cigarettes for every Chinese man, woman, and child

17. Chinese Culture and Smoking • Business Men • “Giving Face” • Goodwill Gesture • “Losing Face” • Wedding Ceremonies

21. Beijing Respiratory Disease Research Institute

22. Dr. Xiao Dan WHO Collaborating Center for Tobacco or HealthDirector of Epidemiological

23. The Beginning of Respiratory Care in China

27. Luo Zujin, RT (AARC Fellow)Janet Boehm, AARC Past President, Leader of Delegation

29. Beijing #6 Hospital

35. The Neurochemistry of Tobacco Addiction

37. Points to Cover • Two forms of nicotine • Definition of addiction • Neurochemistry of tobacco addiction • Nicotine withdrawal symptoms • Discussion of database of U.S. medications used for tobacco dependency treatment • Core competencies for tobacco treatment specialist

38. Two Forms of Nicotine • Bound (tobacco leaf) • Free (altered by pH) • Results when ammonia is added • Immediate impact • More satisfaction http://tobaccodocuments.org/product_design/00044522-4523.html • pH • Cigarette: 5.5 – 6.0 • Spit: up to 8.3 (Source: CDC) • Cigar: 6.2 – 8.2 http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF

39. Absorption of Nicotine • Rate of Absorption • Cigarette : fastest route • Cigar : slower than cigarettes • Spit : slowest rate http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF

40. Is it Addiction? Three or more of the following: • Preoccupation with getting tobacco • Compulsive use • Difficulty with controlling intake • Persistent, even with health problems • Relapse • Tolerance • Withdrawal Source: World Health Organization Diagnostic and Statistical Manual - IV (DSM-IV) How long does it take to become dependent? • Can be after the first cigarette! http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF

42. Count Down from Ten Short-Term Memory • Dopamine • Acetylcholine • Serotonin • Endorphins Medial Forebrain Bundle “Reward Pathway” Reinforcement Ventral Tegmental Area

43. Withdrawal Symptoms • Cravings • Irritability • Hostility • Anxiety • Depressed mood • Difficulty concentrating • Decreased heart rate • Sleep disturbance • Sweating • Increased hand tremor Half-Life of Nicotine • Two hours, but will be increase up to 8 hours

44. We Must Break The Cycle Not a

45. Quitting and Reducing Tobacco Use Inventory of Products Database • https://secure.tobaccofreekids.org/Cessation/ • Database of products being used for cessation • Included: • product name • manufacturer’s name • manufacturer’s address • product website address • directions for use • warnings and disclaimers • ingredients (active and inactive) • claims

46. The Association for the Treatment of Tobacco Use and Dependence (ATTUD) • What standards should be followed when developing a tobacco treatment specialist training program? • Core competencies, for training, and for credentialing of tobacco treatment providers. • http://www.attud.org/docs/Standards.pdf

47. AARC Tobacco Resource Page • http://www.aarc.org/resources/tobacco/index.asp