SMOKING CESSATION Treating Tobacco Use and Dependence Public

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 1960 Address : Jalan Pasang 26, Bandung-40114. Education 1986, Dokter : Fakultas Kedokteran, Unpad. 1992, Master of Public Health (MPH): University of Wollongong, Australia. 2004, Doktor : Pascasarjana, Unpad Work Experience 1987 - now : Lecture Public Health Department Faculty of Medicine Unpad 2007 - 2010 : Director Public Health Postgraduate Program Faculty of Medicine Unpad 2010 - 2011 : Head Department of Public Health Faculty of Medicine Unpad Ardini Saptaningsih RAKSANAGARA Jalan Pasang 26. Bandung 40114. Phone : 022 -7276326 Mobile phone : 0811 237 159 Email : araksanagara@yahoo. com

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

Percentage of smokers (groups of age)

Everyday smokers • Male : 45 % • Female : 3 % • Urban : 21. 2 % • Rural : 25. 3 %

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 supply

Consequences of Tobacco-Use: Preventable Causes of Death Smoking 400, 000 Accidents 94, 000 2 nd Hand Smoke 38, 000 Alcohol 45, 000 HIV/AIDS 32, 600 Suicide 31, 000 Homicide 21, 000 Drugs 14, 200

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: Smokers are twice as likely as Nonsmokers to have a heart attack Torn heart wall: Result of over-worked heart muscle Quitting smoking rapidly reduces the risk of coronary heart disease

Peripheral Vascular Disease

Stroke: This brain shows stroke damage, which can cause death or severe mental or physical disability

Emphysema: Emphysematic lung Healthy lung Symptoms Include «Shortness of breath «Chronic cough «Wheezing «Anxiety «Weight loss «Ankle, 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 Cancer Symptoms: • Persistent hoarseness • Chronic sore throat • Painful swallowing • Pain in the ear • Lump in the neck Over 80% of deaths from laryngeal cancer are linked to smoking

Dental Problems: Common Consequences: • Stained teeth • Gum inflammation Above: Cavities • Black hairy tongue Below: Gingivitis • Oral cancer Overall poor oral health • 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 « A cigar is tobacco rolled up in a tobacco leaf « A cigar does not have a filter cigarette

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 therapy should be included in smoking cessation interventions.

Thank you