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Demographics and Health Effects

Demographics and Health Effects. Revised 05/06. Demographics and Health Effects Section. Chair Ann Malarcher Centers for Disease Control and Prevention, Atlanta, USA Peter Anderson Indept. Consultant in Public Health, Spain Mary-Jane Ashley University of Toronto, Canada

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Demographics and Health Effects

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  1. Demographics andHealth Effects Revised 05/06

  2. Demographics and Health Effects Section Chair Ann Malarcher Centers for Disease Control and Prevention, Atlanta, USA Peter Anderson Indept. Consultant in Public Health, Spain Mary-Jane Ashley University of Toronto, Canada Shanta R Dube Centers for Disease Control and Prevention, Atlanta, USA Linda PedersonCenters for Disease Control and Prevention, Atlanta, USA Jonathan Samet Johns Hopkins University, School of Hygiene and Public Health, Baltimore, USA Michael Thun American Cancer Society, Atlanta, USA Revised 05/06

  3. Health and Economic Costs of Tobacco Use

  4. Global burden of disease and injury attributableto selected risk factors, 2000 (Total in thousands) Estimates are based on data and information from the World Health Organization * Childhood and maternal under nutrition includes: vitamin A Deficiency, zinc, iron; under weight 1 Years of life lost

  5. AFROAfrican Region AMERORegion of the Americas EMROEastern Mediterranean Region EUROEuropean Region SEAROSouth-East Asia Region WPROWestern Pacific Region

  6. Projected global burden of lung cancer in 2030 Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization

  7. Projected global burden of ischemic heart disease in 2030 Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization

  8. Projected global burden of COPD in 2030 Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization

  9. Projected global burden of cerebrovascular disease in 2030 Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization

  10. Burden of disease and injury attributable to tobacco use, 2000 Estimates are based on data and information from the World Health Organization 1 Years of life lost

  11. Cancer Death Rates*, for Men, US,1930-2003 Rate Per 100,000 Lung Stomach Prostate Colon & rectum Pancreas Leukemia Liver *Age-adjusted to the 2000 US standard population. US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

  12. Cancer Death Rates*, for Women, US,1930-2003 Rate Per 100,000 Lung Uterus Breast Colon & rectum Stomach Ovary Pancreas *Age-adjusted to the 2000 US standard population. US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

  13. Smoking-Attributable Mortality Fractions Among Males in the United States, 2001 Percentage CDC, Adult SAMMEC, http://apps.nccd.cdc.gov/sammec/

  14. Smoking-Attributable Mortality Fractions Among Females in the United States, 2001 Percentage CDC, Adult SAMMEC, http://apps.nccd.cdc.gov/sammec/

  15. Nearly 440,000 Average Annual Deaths Attributable to Cigarette Smoking – United States, 1997-2001 Ischemic Heart Disease; 86,801 CDC. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 1997-2001. MMWR 2005;54(25): 625-628

  16. Annual Deaths from Smoking Compared with Selected Other Causes in the United States Number of death (thousands) National Center for Health Statistics, Deaths: Final Deaths 2003. National Vital Statistics Report, 2006; 54(13); Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses- United States, 1997-2001; MMWR. 2005:54(25):625-628.

  17. One out of two lifelong adult smokers will die from a smoking related disease. CDC. Projected smoking-related deaths among youth – United States. MMWR 1996;45(44):971-974

  18. Smoking and Health Among Adolescents • Rapid addiction to nicotine from early smoking • More likely to use other drugs (alcohol, marijuana, & cocaine) • More likely to be involved in other risky behaviors • Poorer overall health • Increased resting heart rates USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994; Arday, DR, et al. Cigarette smoking and self-reported health problems among US high school seniors, 1982-1989Am J of Health Promotion 1995;10(2):111-116.

  19. Smoking and Health Among Adolescents Increased effects on the respiratory system • Increased wheezing, gasping and shortness of breath • Increased coughing and phlegm production • Decreased physical performance • Decreased endurance • Reduced lung function • Slowed growth of lung function USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994; Arday et al. Cigarette smoking and self-reported health problems among US high school seniors, 1982-1989. Am J Health Promot 1995;10: 111-116.

  20. Effects of Smoking and Pregnancy/Reproduction • Reduced Fertility • Reduced risk for preclampsia • Fetal growth restriction • Increased risk of premature rupture of the membranes, placenta previa, & placental abruption • Increased risk of preterm delivery & shortened gestation USDHHS. The Health Consequences of Smoking: A Report of the Surgeon General, 2004.

  21. Effects of Smoking and Pregnancy/Reproduction • Increased risk of low birth weight • Increased risk of perinatal mortality (stillbirth & neonatal deaths) • Increased risk of reduction of lung function in infants • Increased risk of sudden infant death syndrome (SIDS) USDHHS. The Health Consequences of Smoking: A Report of the Surgeon General, 2004.

  22. Health Effects of Secondhand Smoke

  23. Contents of Secondhand Smoke (SHS) • Cigarette smoke contains more than 7000 chemical compounds • Sixty nine chemicals in tobacco smoke are known or probable carcinogens • SHS is a known human carcinogen USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.

  24. “An hour a day in a room with smoke is nearly a hundred times more likely to cause lung cancer in a non-smoker than 20 years spent in a building containing asbestos.”-Sir Richard Doll, 1985

  25. Health Effects of Secondhand Smoke - Adults • SHS exposure causes lung cancer among lifetime nonsmokers • SHS exposure associated with living with a smoker increases risk of lung cancer by 20%-30%. • SHS exposure causes coronary heart disease morbidity and mortality • SHS exposure increases risk of heart disease by 25%-30% • SHS exposure causes increased respiratory symptoms of odor annoyance & nasal irritation USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.

  26. Health Effects of Secondhand Smoke -Children • SHS exposure causes sudden infant death syndrome (SIDS) • Maternal exposure to SHS during pregnancy causes a small reduction in birth weight • SHS exposure after birth causes a lower level of lung function • SHS exposure from parental smoking causes lower respiratory illness in infants and children USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.

  27. Health Effects of Secondhand Smoke -Children • SHS from parental smoking causes cough, phlegm, wheeze and breathlessness in school age children • SHS from parental smoking causes exacerbations of asthma • SHS exposure from parental smoking causes the onset of wheeze illness in early childhood • SHS exposure from parental smoking causes middle ear disease (acute and recurrent otitis media, chronic middle ear effusion) USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.

  28. Approximately, 5 million people will die from tobacco related illness this year. By 2030, 10 million people will die each year. World Health Organization. The Tobacco Atlas (2002). http://www.who.int/tobacco/en/atlas11.pdf Ezzati & Lopez. Estimates of Global Mortality Attributable to Smoking in 2000. Lancet 2003; 362: 847-852.

  29. Benefits of Cessation

  30. Benefits of Cessation Overall • Former smokers live longer compared with continuing smokers • Smoking cessation reduces risk of premature death • Risk of death decrease shortly after quitting • Smoking cessation benefits almost every part of the body USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

  31. Smoking Cessation and Lungs • Lung function starts to improve 2-3 months after quitting • Smoking cessation reduces risk of lung cancer, 10 years after quitting, the risk of lung cancer decreases to 30- 50% that of a continuing smoker USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

  32. Smoking Cessation and the Respiratory System • Risk of death from Chronic Obstructive Pulmonary Disease is decreased after quitting • Risk of upper and lower respiratory illness such as colds, flu, bronchitis and pneumonia is lowered • Coughing, sinus congestion, fatigue and shortness of breath decrease 2-3 months after quitting • Smoking cessation lowers risk of larynx cancer USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

  33. Smoking Cessation and the Heart • Smoking cessation reduces the excess risk of dying from abdominal aortic aneurysm by 50% among former smokers • Risk of coronary heart disease decreases by half 1-2 years after quitting • After 15 years of quitting, coronary heart disease risk is nearly that of a non-smoker • Among persons diagnosed with cardiovascular heart disease, smoking cessation reduces risk of recurrent infarction and cardiovascular death • After quitting peripheral artery disease decreases USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

  34. Smoking Cessation and Other Parts of the Body • Stroke risk is reduced to that of a never smoker after 5 to 15 years of cessation • Risk of mouth, throat, and esophagus cancers are halved five years after quitting • Bladder cancer risk is halved a few years after quitting • Smoking cessation lowers the risk of kidney, stomach, pancreatic and cervical cancer • Smoking cessation lowers risk of peptic ulcers USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

  35. Smoking Cessation and Pregnancy • Quitting smoking before or early during pregnancy lowers risk of miscarriage, low birth weight of baby and SIDS • Although abstinence early in pregnancy will produce the greatest benefits to the fetus and expectant mother, quitting at any point in pregnancy can yield benefits USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

  36. Summary: Health Benefits of Smoking Cessation • Smoking cessation has major and immediate health benefits for men and women of all ages • Benefits apply to persons with and without smoking-related diseases • Former smokers live longer than continuing smokers • Smoking cessation decreases the risk of lung and other cancers, heart attack, stroke, and chronic lung disease • Smoking cessation improves reproductive outcomes USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

  37. Tobacco Dependence

  38. "In a sense, the tobacco industry may be thought of as being a specialized, highly ritualized, and stylized segment of the pharmaceutical industry. Tobacco products uniquely contain and deliver nicotine, a potent drug with a variety of physiological effects."-1972 Claude Teague memo "RJR Confidential Research Planning Memorandum on the Nature of the Tobacco Business and the Crucial Role of Nicotine Therein”

  39. Frequency of Cigarette Use, 2004 Percentage SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health

  40. Tobacco Dependence in the United States, 2004 • 35.5 million Americans 12 years or older met the criteria for nicotine dependence in the past month based on their cigarette use • 1.1 million youth 12 to 17 years old are nicotine dependent cigarette smokers • The rate of dependence is higher for those who start smoking at an earlier age than for those who initiate cigarette use later in life SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health

  41. Nicotine Dependence among Past Month Smokers, by age, 2004 SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health

  42. Relapse Rate Over Time 100 Heroin 90 Smoking 80 Alcohol 70 60 Abstainers (%) 50 40 30 20 10 0 0 1 2 3 4 5 6 7 8 9 10 11 12 Time (Months) 2 Weeks USDHHS. The Health and Consequences of Tobacco: Nicotine Addiction. A Report of the Surgeon General, 1988.

  43. 80,000 to 100,000 young people around the world become addicted to tobacco, everyday. World Bank, Curbing the Epidemic: Governments and the Economics of Tobacco Control (Washington: World Bank, 1999).

  44. Effective Treatment Interventions

  45. Effective Treatment Interventions • Brief advice to quit from doctors, nurses and other healthcare providers • Group counseling • Individual counseling • Telephone counseling • Pharmacotherapy Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

  46. Identification and Assessment of Tobacco Use • Assisting the patient in quitting (5A’s) • Ask – Systematically identify all tobacco users at every visit • Advise – Strongly urge all tobacco users to quit • Assess – Determine willingness to make a quit attempt • Assist – Aid the patient in quitting • Arrange – Schedule follow-up contact Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

  47. Effective counseling treatment for tobacco use and dependence • Practical counseling (problem solving/skills training) • Intra-treatment social support Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

  48. Elements of counseling • Practical Counseling • Recognize danger situations • Develop coping skills • Provide basic information • Supportive Counseling • Encourage the patient in the quit attempt • Communicate caring and concern • Encourage the patient to talk about the quitting process Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

  49. Effective pharmacotherapy for smoking cessation • Pharmacotherapy that reliably increase long term smoking abstinence rates • Bupropion • Nicotine gum, inhaler, nasal spray, lozenge and patch • Varenicline • Clonidine and Nortriptyline can be used if other pharmacotherapy is not effective

  50. Motivational intervention for those unwilling to quit consist of the 5 R’s • Relevance – Encourage patient to identify why quitting is relevant • Risks – Ask patient to identify potential negative consequences of tobacco use • Rewards – Ask patient to identify potential benefits of quitting • Roadblocks – Ask patient to identify barriers to quitting • Repetition – Repeat motivational intervention every time unmotivated patient enters a clinical setting Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

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