Elif Horozoğlu

1. Elif Horozoğlu

2. Smoking Tobacco • Health consequences of tobacco use • Passive smoking • Interventions for reducing smoking rates • Effects of quitting

3. Health consequences of tobacco use the number one preventable cause of death and disability in U.S. more than 440.000 deaths a year, mostly from cancer, cardiovascular disease, and chronic obstructive pulmonary disease Until the mid-1990s, CVD is the first leading smoking-related cause of death. Smoking-related cancer deaths now exceed smoking-related CVD Chronic obstructive pulmonary disease is the third leading cause of death.

4. What is the evidence? • Although experimental studies are lacking, descriptive researches have firmly established a cause and effect relationship between cigarette smoking and lung cancer, heart disease, and chronic obstructive pulmonary disease.

5. Smoking and cancer • plays a role in the development of several cancers, especially lung cancer. • 80% of smoking-related cancer deaths are from lung cancer. • Smoking may be responsible for lip, pharynx, pancreas, esophagus, larynx, trachea, urinary bladder, and kidney cancer. • Relative risk for lung cancer among cigarette smokers is 9.0.(the strongest link between any behavior and a major cause of death). • During the mid 1960s, cigarette consumption began to drop sharply, and then about 25 to 30 years later, lung cancer deaths among men began to decline.

6. Smoking and cardiovascular disease • the leading cause of death in the US and the second largest cause of tobacco-related deaths • Relative risk for CVD among smokers is about 2.0. • Smoking increases the progression of atherosclerosis by as much as 50% during a 3- year period, speeding the plaque formation within the arteries. • Nicotine increases heart rate, blood pressure, and cardiac output. • plaque formation + nicotine stimulation increase smokers’ risk of CVD.

7. Smoking and chronic obstructive pulmonary disease • the third leading cause of death in US, and the third leading cause of tobacco-related deaths • Chronic bronchitis and emphysema are the two most deadly COPDs. • Since 1950s, mortality rates from COPD have increased faster than any other major cause of death except HIV infection. • COPD is relatively rare among nonsmokers. Only 4% of male nonsmokers and 5% of female nonsmokers receive diagnosis of COPD.

8. Other effects of smoking • Smoking has an interactive effect with depression;that is smokers tend to have more depressive symptoms and depressed people tend to smoke more. • periodontal disease, multiple sclerosis • Compared to non-smoker, smokers more likely to • commit suicide • develop common cold • have problem with cognitive functioning • experience accelerated facial wrinkling • hearing loss • macular degeneration( a serious visual impairment)

9. Other effects of smoking • Female smokers double their chances of developing ovarian cysts, and women smoking at least one pack of cigarettes a day, increases their risk of bone fractures. • Smoking makes males older, less attractive in appearance, and increases their chances of becoming sexually impotent.

10. Cigar and pipe smoking • Cigar and pipe smoking may be less dangerous than cigarettes, but they are not safe. • People who smoked only cigars had a risk of 2.9, and those who smoked only pipes had a 2.5 increase in their risk for lung cancer. • However, the combination of cigars or pipes with cigarettes dramatically increased the relative risk for lung cancer. • The relative risk for the combination of cigars and cigarettes is 6.9,whereas the combination of pipes and cigarettes is 8.1!

11. Passive smoking • Environmental tobacco smoke (ETS) or second hand smoke • Lung cancer, breast cancer, heart disease, and a variety of respiratory problems in children

12. Passive smoking and lung cancer • In general, the more smoke people are exposed to and the longer the exposure, the higher the risk for lung cancer. • Exposure from a spouse or from coworkers creates a slightly elevated risk. • People exposed to environmental smoke during childhood have no elevated risk for lung cancer, and those exposed to their spouse’s smoke have only a slight increase.

13. Passive smoking and breast cancer • Although some early research showed that passive smoking was a risk factor for breast cancer, more recent and better research indicated women are not under the elevated risk from their smoking husbands. • Regarding of the husband’s level of smoking, the death rate of women married to smokers for 30 years or more was not more than the death rate of women married to nonsmokers.

14. Passive smoking and CVD • A meta-analysis of researches indicated that the excess risk of heart disease for passive smokers is about 25%. • Although passive smoking kills thousands of people each year, the risk from passive smoking is only about 1/10 the risk from active smoking.

15. Passive smoking and the health of children • Infants whose mother smoke have an increased risk for dying sudden infant death syndrome (SIDS), and the more cigarettes mothers smoke, the greater their infants’ risk for SIDS. • increased risk of bronchitis, pneumonia, asthma, lower respiratory tract illnesses, low birth weight and childhood cancer

16. Smokeless tobacco • Snuffing or chewing tobacco • Although the risk of smokeless tobacco is not as great as cigarette smoking,smokeless tobacco has significant health hazards. • Increased rate of cancer of the oral cavity,periodontal disease and heart disease • People who use smokeless tobacco have a twofold risk for high cholesterol.

17. Interventions for reducing smoking rates • Deterring smoking • Quitting smoking

18. Deterring smoking • Information alone is not an effective way to change behavior. • Smoking prevention programs that use lectures, posters, pamphlets, articles in school newspapers etc. are almost universally ineffective in preventing young people from starting to smoke. • Inoculation programs aimed at buffering young adolescents against the social pressures to smoke have been more effective than educational programs. • buffering techniques + communitywide antismoking campaign long-term positive results

19. Quitting smoking • The decline in smoking rates is not due to fewer people starting to smoke but in large part to increased cessation rates. • Long-term smokers refuse to believe reports of negative effects of smoking. • Optimistic bias and high self-esteem may contribute to the difficulty of quitting smoking. • Addictive qualities of smoking people seeking treatment for alcohol or drugdependence who also smoked reported that cigarettes would be the most difficult to quit.

20. Quitting smoking • Quitting without therapy • Using nicotine replacement therapy • Receiving psychological intervention • Participating in a community campaign

21. Quitting without therapy • Schacter (1987) found that nearly a third of the heavy smokers who quit said they had no problems in quitting. • Schacter’s research suggest that people who quit smoking on their own largely succeed and never attend a clinic. • People who attend clinics are atypical group and their failure rates are too high.

22. Using nicotine replacement therapy • Nicotine patch and nicotine gum are the two most common nicotine replacement therapies. • The nicotine patch maintained 22% success versus 9% for a placebo patch. • Nicotine gum produced 17-18% success versus 11% for a placebo. • The effectiveness of both nicotine patch and nicotine gum is increased when combined with psychological interventions. • Nicotine patch may cause skin reaction and nicotine gum may cause mouth soreness, hiccups, and jaw ache. • Nausea, light headedness, and sleep disturbances are other possible side effects.

23. Receiving a psychological intervention • Behavior moditification, cognitive behavioral approaches, contracts made by smoker and a therapist in which the smoker agrees to stop smoking, group therapy, social support, relaxation training, stress management, booster sessions to prevent relapse are psychological approaches aimed at smoking cessation. • The stages of change model of James Prochaska • Precontemplation stage: no intention to quit • Contemplation stage: aware of the problem-consider quitting sometime in the future.

24. Receiving a psychological intervention • Going from precontemplation to preparation for quitting is more effective than moving only to next step. • Supportive practitioners increase smokers’ self-efficacy. • Verbal persuasion is one of the method for enhancing a smoker’s self-efficacy. It has only limited influence. • Previous successful performance the strongest source of self-efficacy • Smokers who trained stress-coping skills are more likely to quit than those who have not learned these techniques. • Counseling+nicotine replacement therapy the most effective

25. Participating a community campaign • The percentage of people who quit smoking as a result of health campaign is usually quite small, however if their messages reaches people, then thousands of lives may be saved. • Monetary incentives along with telephone counseling to smokers are not effective.

26. Who Quits and Who Does Not? • Gender • Men have had higher quit rates than women over the past 40 years. • Do women have more difficulty quitting than men? • NO! Because women who try to quit have more obstacles to overcome. • Women more participate quitting programs voluntarily. • When women decide to quit, they are as likely as men to quit. • Women have more difficulty during the first 24 hours, but after that they are equal to men.

27. Who quits and who does not? Age • Younger smokers who smoke at high level are less likely to quit than older smokers who smoke at a low level. Educational level • Because smokers with lower levels of education • Begin smoking earlier • Have higher scores on neuroticism • Have lower scores on emotional support • Have low levels of perceived personal control Lower educational level is related to higher smoking rates.

28. Who quits and who does not? • A supportive social network may also help people quit smoking. • Moreover, some researches suggests that problem drinkers who able to stop drinking are also able to quit smoking. • Many people quit both simultaneously.

29. Relapse prevention • Abstinence violation effectone cigarette creates a full relapse, complete with feelings of total failure. • 1/4 of successful self-quitters slip at one time or another. • Thus, a single slip shouldn’t discourage people from continuing their effort to quitting! • 2/3 of self-quitters relapsed after only 2 days and 92% had resumed smoking after 6 months. • Formal smoking cessation programs’ relapse rate is about 70 to 80%.

30. Quitting and Weight Gain • Middle-aged people will gain weight whether they are smokers, have quit, or have never smoked. • The average weight gain for most men and women is relatively modest- about 9 to 11 pounds. • However, some people gain large amounts of weight. • Women are more concerned about weight gain than are men, but their total weight gain after quitting is about the same as that of men. Their percentage of weight gain is more than men because men are heavier than women at baseline.

31. Quitting and weight gain • Exercise can prevent weight gain in both women and men. • Quitting smoking is much more beneficial to health than maintaining lower weight...

32. Health benefits of quitting • After both female and male smokers have quit smoking for 16 years, they had about the same rate of mortality as people who have never smoked. • Smokers who quit can eventually reduce their risk of CVD to that of a nonsmokers, BUT their risk of lung cancer does not change.