Keep Our University Free From Smoking

1. Keep Our University Free From Smoking Submitted To King Saud University Program: Ata Ulhaq, MD, FACEP, MPH Smoke - Free Environment 2009 Atwood & Clark Consultants

2. Smoking Cessation [stopping smoking] • Represents the single most important step to enhance length and quality of life • Quitting smoking is not easy, but you can do it • To have the best chance of success in quitting, you need to know: • what you're up against • what your options are • where to go for help 2009 Atwood & Clark Consultants

3. Acute myeloid leukemia Alzheimer’s Lupus SIDS Colic in babies Impotence Various cancers Macular degeneration Rheumatoid arthritis Acid reflux Breast cancer Depression Thyroid disease Pathology of Smoking 2009 Atwood & Clark Consultants

4. Cardiovascular Pathology • Firmly established risk factor for coronary heart disease and peripheral vascular disease • Twofold or greater risk of coronary heart disease among smokers • Severe atherosclerosis of the abdominal aorta much greater risk of aortic aneurysm peripheral vascular disease 2009 Atwood & Clark Consultants

5. Atherosclerosis development of atherosclerosis in an artery 2009 Atwood & Clark Consultants

6. Physiologic Responses • Accelerating atherogenesis or increasing the probability of thrombosis  reduction in plasma high-density  lipoprotein cholesterol concentration  elevation in plasma fibrinogen concentration  elevation in white blood cell count 2009 Atwood & Clark Consultants

7. Smoker vs. Non Smoker • 31 year old non-smoker • 30 year old smoker 2009 Atwood & Clark Consultants

8. Reversible • The rapid amelioration of the risk of cardiovascular disease after cessation of smoking suggests that these processes are readily reversible 2009 Atwood & Clark Consultants

9. Cancers • Aside from the obvious lung cancer, smoking contributes to many other cancers of the body 2009 Atwood & Clark Consultants

10. Cancer of the Oral Cavity 2009 Atwood & Clark Consultants

11. Pharynx 2009 Atwood & Clark Consultants

12. Esophagus 2009 Atwood & Clark Consultants

13. Stomach 2009 Atwood & Clark Consultants

14. Bladder 2009 Atwood & Clark Consultants

15. Cervix 2009 Atwood & Clark Consultants

16. Kidney Cancer Advanced renal carcinoma Papillary renal carcinoma 2009 Atwood & Clark Consultants

17. Pancreas 2009 Atwood & Clark Consultants

18. Carbon Monoxide - CO • What Carbon Monoxide is: • CO is a poisonous, colorless, odorless gas produced as a result of incomplete burning of carbon-containing fuels 2009 Atwood & Clark Consultants

19. CO • What Happens When CO is Inhaled: • When inhaled, CO quickly binds with hemoglobin in red blood cells in the lungs, creating COHb • This can affect the amount of hemoglobin available for the transport of oxygen throughout the body • May in turn lead to symptoms of CO poisoning 2009 Atwood & Clark Consultants

20. Carbon Monoxide in Cigarette Smoke • Cigarette smoke can contain high levels of carbon monoxide • Smokers generally have COHb levels in the blood that are many times greater than those who do not smoke 2009 Atwood & Clark Consultants

21. CO and Secondhand Smoke • Because secondhand smoke may also contain high levels of CO, nonsmokers who breathe in ETS (Environmental Tobacco Smoke) have increased levels of CO in their blood as well 2009 Atwood & Clark Consultants

22. CO and Secondhand Smoke • Secondhand smoke is a toxic cocktail of: • over 4,000 chemical compounds • 200 of which are known to be poisonous • upwards of 60 that have been identified as carcinogens 2009 Atwood & Clark Consultants

23. Smoking During Pregnancy • When a pregnant woman smokes, her baby does too • Poisons like carbon monoxide and nicotine travel to the growing baby • Prevents as much as 25 % of oxygen from reaching the placenta • Keeps baby from getting enough food • More likely to deliver early or baby of low birth weight 2009 Atwood & Clark Consultants

24. Smoking and Pregnancy • Mothers can pass nicotine through breast milk • Nicotine can be found in mucus from the cervix of a female smoker • Nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants 2009 Atwood & Clark Consultants

25. Smoking During Pregnancy, cont’d. • Children born to women who smoked during pregnancy are more likely to develop asthma and other lung problems as they grow older • May learn more slowly • Infants are more likely to develop colds, bronchitis, and other respiratory diseases if secondhand smoke is present in the home 2009 Atwood & Clark Consultants

26. Smoking and Women • Female smokers are nearly 13 times more likely to die from COPD • Smoking is directly responsible for more than 90% of chronic obstructive pulmonary disease (COPD), or emphysema and chronic bronchitis deaths each year • Women who smoke also have an increased risk for developing cancers of the oral cavity, pharynx, larynx (voice box), esophagus, pancreas, kidney, bladder, and uterine cervix 2009 Atwood & Clark Consultants

27. Smoking and Women • Women who smoke double their risk for developing coronary heart disease • Postmenopausal women who smoke have lower bone density • Women who smoke have an increased risk for hip fracture • Cigarette smoking also causes skin wrinkling that could make smokers appear less attractive and prematurely old 2009 Atwood & Clark Consultants

28. Smoking and Women • Women who quit smoking relapse for different reasons than men • Stress • Weight control • Negative emotions 2009 Atwood & Clark Consultants

29. Smoking Among Seniors • Seniors face increased risks associated with smoking • hip fractures (both men and women) • Cataracts • COPD • Smoking reduces bone density among menopausal women • nuclear cataracts of the lens of the eye (2-3 times the risk of nonsmokers) 2009 Atwood & Clark Consultants

30. Thank You 2009 Atwood & Clark Consultants

31. Nicotine and Addiction Part II 2009 Atwood & Clark Consultants

32. Nicotine & Addiction Why is quitting and staying quit hard for so many people? Answer = Nicotine 2009 Atwood & Clark Consultants

33. Addiction • Compulsive physiological/psychological need for a habit-forming substance • Dependence on a behavior or substance that one is powerless to stop • One of the most costly public health problems 2009 Atwood & Clark Consultants

34. Addiction • A progressive syndrome; increases in severity over time unless treated • Characterized by frequent relapse, or return to the abused substance • Abusers often make repeated attempts to quit before they are successful 2009 Atwood & Clark Consultants

35. Nicotine & Addiction Nicotine: • Drug found naturally in tobacco • Highly addictive -- as addictive as heroin or cocaine • Over time, a person becomes physically/emotionally addicted to nicotine • Studies show smokers must deal with both the physical and psychological (mental) dependence to quit and stay quit 2009 Atwood & Clark Consultants

36. Physical Dependence • “the appearance of characteristic withdrawal symptoms when the use of a substance is suddenly discontinued" • Nicotine is considered physically addictive because it physically alters your brain function • It produces withdrawal symptoms when you stop smoking 2009 Atwood & Clark Consultants

37. Physical Dependence • Physical dependence is defined by the appearance of withdrawal symptoms when use is discontinued • Opiates (such as Herion) • Benzodiazepines • Barbiturates • Alcohol • Nicotine Induce physical dependence 2009 Atwood & Clark Consultants

38. Physiological Effects • When you inhale, nicotine is carried deep into your lungs • Absorbed quickly into the bloodstream • Nicotine inhaled reaches the brain faster than drugs that enter the body intravenously (IV) 2009 Atwood & Clark Consultants

39. Physiological Effects • Nicotine affects many parts of the body: • heart • blood vessels • hormones • metabolism • brain 2009 Atwood & Clark Consultants

40. Physiological Effects cont’d. • Nicotine produces pleasant feelings • Makes the smoker want to smoke more 2009 Atwood & Clark Consultants

41. Physiological Effects cont’d. • Acts as a depressant by interfering with the flow of information between nerve cells • As the nervous system adapts to nicotine, smokers increase the number of cigarettes they smoke • This, in turn, increases the amount of nicotine in the smoker's blood 2009 Atwood & Clark Consultants

42. dizziness (which may only last 1 to 2 days after quitting) depression feelings of frustration, impatience, and anger anxiety irritability increased appetite sleep disturbances, i.e. trouble falling asleep/staying asleep, bad dreams or even nightmares trouble concentrating restlessness headaches tiredness Withdrawal Symptoms 2009 Atwood & Clark Consultants

43. Psychological Addiction • Much more complex than physical addiction • Does not involve the nicotine in cigarettes or the physical effects the nicotine has on your brain • Psychological dependence transpires when a person develops a daily routine and a habit of actually smoking the cigarettes 2009 Atwood & Clark Consultants

44. Psychological Addiction: Pleasure • Smoking gives pleasure • This "pleasure" comes in many ways: • the tactile pleasure of handling the cigarette • oral pleasure of drawing on the cigarette • "quick fix" in times of anxiety • anger and stress • social pleasure of smoking in situations of good feelings such as bars, pubs or sporting events. 2009 Atwood & Clark Consultants

45. Addiction: Psychological Aspects • To feel good (sensation seeking) • To feel better (self-medicating) • Move quickly from the voluntary period of drug use to compulsive behavior motivated by craving 2009 Atwood & Clark Consultants

46. Addiction: Psychological Aspects • Loss of control over use • Continued use despite negative physical and social consequences • Believed to be strongly associated with brain’s reward system 2009 Atwood & Clark Consultants

47. Psychological Dependence • Dependency of the mind • Leads to psychological withdrawal symptoms • Cravings • Irritability • Insomnia • Depression • Anorexia, etc. • Addiction can be derived from any rewarding behavior 2009 Atwood & Clark Consultants

48. Psychological Triggers • These triggers are usually brought on by stressful situations such as an argument, vehicle accident, not getting enough sleep or other demanding situations • You need to be able to recognize these stressful situations and react to them appropriately 2009 Atwood & Clark Consultants

49. Psychologically Hooked • Over time, you become used to smoking in these situations • Your mind associates smoking with them and the pleasure that comes with them • You find yourself lighting up even if you aren't physically craving the nicotine...without even thinking about it! • At this point, you are psychologically hooked 2009 Atwood & Clark Consultants

50. Start Desire to look cool Seduced to try tobacco by glamorization of smoking in movies and advertisements Peer pressure Rebellion Poor coping skills Social habit became addiction Continue Physical addiction Mental addiction Stress Around other smokers Rely on pills/patches rather than willpower Why People Start& Continue Smoking 2009 Atwood & Clark Consultants