SMOKING CESSATION (Treating Tobacco Use and Dependence)

1. SMOKING CESSATION(Treating Tobacco Use and Dependence) Public Health Department Faculty of Medicine UNPAD

2. DR. ArdiniSaptaningsih RAKSANAGARA dr.,MPH Date of Birth: 21 Mei 1960 Address : Jalan Pasang 26, Bandung-40114. Education 1986, Dokter : FakultasKedokteran, Unpad. 1992, Master of Public Health (MPH): University of Wollongong, Wollongong, Australia. 2004, Doktor : Pascasarjana, Unpad Work Experience 1987 - now : LecturePublic Health Department Faculty of Medicine Unpad 2007 - 2010 : Director PublicHealthPostgraduateProgramFaculty of Medicine Unpad 2010 - 2011 : Head Department of PublicHealthFaculty of Medicine Unpad Ardini Saptaningsih RAKSANAGARA Jalan Pasang 26. Bandung 40114. Phone : 022-7276326 Mobile phone : 0811 237 159 Email : araksanagara@yahoo.com

3. WHY IS TOBACCO A PUBLIC HEALTH PRIORITY ? • Tobacco  Public Health Problem ! • Tobacco is the second major cause of death in the world.

4. 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

5. 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.

6. 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.

11. 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

14. WILLINGNESS TO QUIT

18. Unwilling to quit • 5 R’S • Relevance • Risks • Rewards • Roadblocks • Repetition

19. UNWILLING TO QUIT

22. Percentage of smokers (groups of age)

23. Everyday smokers • Male : 45 % • Female : 3 % • Urban : 21.2 % • Rural : 25.3 %

24. Household expenditure

25. 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 %

26. 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

27. Why tobacco control? • Illnesses caused by tobacco are completely preventable

29. Why progress difficult? • Tobacco industry • Economic self-interest :  to get as many people to smoke as many cigarettes as possible

30. Reducing tobacco use • Educational • Clinical • Regulatory • Economic • Social or comprehensive

31. 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

32. Clinical • Pharmacologic • Behavioral Regulatory • Product manufacture • Filter, low tar • Promotion, marketing • Sale • Smoking restriction • Public venues • worksites

33. Economic • Modify taxation • Tariffs • Trade policy Comprehensive approach • Reduce demand and supply

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

35. What are the tobacco-related diseases that are contributing to all these deaths?

36. Tobacco use: The single largest cause of preventable death.

37. Arteriosclerosis & Atherosclerosis: Healthy artery Damaged artery

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

39. Peripheral Vascular Disease

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

41. Emphysema: Emphysematic lung Healthy lung Symptoms Include • Shortness of breath • Chronic cough • Wheezing • Anxiety • Weight loss • Ankle, feet and leg swelling • fatigue

42. Lung Cancer:The uncontrolled growth of abnormal cells in one or both lungs Lung cancer kills more people than any other type of cancer

43. Fetal Damage: • Fetal Smoking Syndrome: • Birth defects • Premature stillbirth • Low birthweight • Prone to Sudden Infant Death Syndrome • Lowered immune capacity

44. 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

45. Common Consequences: • Stained teeth • Gum inflammation • Black hairy tongue • Oral cancer • Delayed healing of the gums Dental Problems: Above: Cavities Below: Gingivitis Overall poor oral health

46. Consequences of chewing tobacco: Leukoplakia Oral cancer

47. 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

48. If smoking is so bad for us, why do we start?

49. 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!

50. What is a cigar? • A cigar has larger amounts of tobacco than a cigarette • A cigar is tobacco rolled up in a tobacco leaf • A cigar does not have a filter