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Smoking - Health Risks and Prevention

Smoking - Health Risks and Prevention. Dagmar Schneidrová Tereza Kopřivová Herotová Dept. Of Child and Youth Health Third Medical Faculty Charles University Prague. Tobacco.

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Smoking - Health Risks and Prevention

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  1. Smoking - Health Risks and Prevention Dagmar Schneidrová Tereza Kopřivová Herotová Dept. Of Child and Youth Health Third Medical Faculty Charles University Prague

  2. Tobacco • Tobaccois processed from the leaves of plants of the Nicotiana genus, that contains the drug nicotine. • Tobacco plant is grown in warm climates. After it is picked, it is dried, ground up, and used in different ways. • It can be smoked in a cigarette, pipe, or cigar. It can be chewed (called smokeless tobacco or chewing tobacco) or sniffed through the nose (called snuff).

  3. Specialtypesoftobacco

  4. SNUS – smokeless tobacco Luo et al. Lancet. 2007. Epub ahead of print; • Although used worldwide, the highest consumption of snus is in Sweden (23% of male) Health effects: • Tooth abrasion, gum disease, gum recession • Cancer in the mouth, pharynx, esophagus and pancreas • Heart disease and stroke

  5. Hookah: Waterpipe Tobacco Smoking • Shisha - a mixture of tobacco (30 %), molasses, glycerol, aromatic additives (fruit flavours)is used in the hookah • Water in the hookah cools the smoke, decreases irritation of the respiratory tract and increases inhalation of smoke, it does not diminish tobacco toxicity • A 1-hour session of hookah smoking exposes the user to 100- 200 timesmore volume of smoke, 17-50 times morecarbon monoxide, 30-100 times more tar than inhaled from a single cigarette

  6. Hookah: Waterpipe Tobacco Smoking • Burning process producestoxic substances (heavy metals, CO,PAC, other carcinogens) • It delivers 6 times more nicotine – risk of dependence • Sharing hookah – risk of infections (TBC, hepatitis) • Risks of passive smoking

  7. Vodní dýmka

  8. Smoking water pipe (2007) (%) N = 1606

  9. Smoking water pipe – related to age (%) N = 1606

  10. Smoking water pipe - trend 2007 31.1 % 2011 38.1 %

  11. Vodní dýmka

  12. HISTORY OF TOBACCO USE

  13. History of Tobacco Use • Tobacco has a long history of its use in the early Americas. It became increasingly popular with the arrival of the Europeans by whom it was traded. • Tobacco came to Europe from the New World - AMERICA. Christopher Columbus made the first recorded reference to tobacco in 1492. • The Spanish introduced tobacco to Europeans in about 1518. • In Britain, tobacco was introduced to the Elizabethan court by Sir Walter Raleigh and he was a confirmed smoker until his death on the scaffold at the Tower of London.

  14. History of Tobacco Use • Jean Nicot, French ambassador in Lisbon, sent samples to Paris in 1559. The French, Spanish, and Portuguese initially referred to the plant as the "sacred herb" because of its valuable medicinal properties. • In 1571, a Spanish doctor named Nicolas Monardes wrote a book about the history of medicinal plants of the new world. He claimed that tobacco could cure 36 health problems.

  15. History of Tobacco Use • In 1603, James VI, King of Scotland and James I, King of England, started Britain’s first anti-smoking campaign with ‘A Counterblast to Tobacco.’ • At the same time, James I was in need of money and discovered how easy it was to tax imported tobacco. In 1615, he made the import of tobacco a Royal Monopoly.

  16. Restrictions on Tobacco Use • First commercially produced cigarettes were manufactured in France in 1843 by the state-run Manufacture Francaise des Tabacs. • In 1908selling cigarettes to youngsters under16 in Britain became illegal. • In 1962 the first Royal College of Physicians Report, ‘Smoking and Health’ was published and recommended restrictions on tobacco advertising, sales to children, smoking in public places, increased taxation, and information on tar/nicotine content. The UK’s sales of tobacco dropped for the first time in a decade.

  17. Milestones Increasing Cigarette Smoking 1850s Invention of the safety matches -portable lighting device that enabled one to smoke almost anywhere. Late 1800s Development of tobacco “blends”-reduced harshness of smoke. 1880s Invention of a cigarette rolling machine-greatly increased supply and decreased cost of cigarettes, which were previously made by hand. Early 1900s Modern marketing strategies-increased demand for cigarettes (highly engineered products continually being refined to enhance “acceptability” to smokers - e.g. light cigarettes, flavourings like cocoa, menthol). from Kluger R (1996) Ashes to ashes. New York: Knopf.

  18. Tobacco Industry Marketing Strategies

  19. Cigarettes were 2% of all tobacco intake in 1900; 80% in 1963 Kenneth A. Perkins, Ph.D., The history and epidemiology of cigarette smoking

  20. Epidemiology

  21. EPIDEMIOLOGY • The World Health Organization estimates that tobacco use caused 100 million deaths over the course of the 20th century. • Currently, smoking causes 20% of all deaths in EU and USA. • Centers for Disease Control andPrevention (USA) describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide“.

  22. EPIDEMIOLOGY • In developed countries smoking rates for men have peaked and have begun to decline, for women they continue to climb. • As of 2002, about 20percent of teenagers(13–15 years) smoke worldwide.

  23. EPIDEMIOLOGY • Regular smoking in children = at least one cigarette a week (WHO) • 80,000 to 100,000 children begin smoking every day. • Approximately 90% of adult smokersstarted smoking before the age of 18. • Among adults who have ever smoked daily, 77.0% became daily smokers before the age of20.

  24. Smoking Prevalence in CR (Sovinová, NIPH 2011) • Men smoke more than women (26.9% x 21.3%) • Most smokers among young adults (25-34 years) • Singles and divorced smoke more • Negative relationship to an educational level

  25. Smoking prevalence in the Czech population in 1997 – 2011 (red– at least 1 cigarette a day, blue – less than 1 cigarette a day)

  26. Smoking prevalence related to gender(blue – men, red – women)

  27. GHPSS Data: Prevalence of Current Smoking (21-22 Years Olds Students), CR, 2007

  28. Using electronic cigarettes (%) N = 1797 (2011)(blue – never tried, red – tried once, green - tried more times, violet – don´t know what is it)

  29. Passive smoking - environmental tobacco smoke (ETS) Exposure to ETS • 36.3 % respondents exposed daily to ETS • 29.8 % respondents 1-6 hours/day Attitudes to the total ban on smoking in restaurants • 64 % respondents agree • Higher support in nonsmokers and women

  30. Smoking Prevalence in Children and Youth • International studies (CR involved): • WHO Study „Youth and Health“ (HBSC – The Health Behaviour in School–aged Children) – 11,13,15 year olds • ESPAD – European School Study on Alcohol and Other Drugs – 16 year olds

  31. Trend in regular smoking in boys in 1994-2010 (WHO/HBSC) (at least once a week)

  32. Trend in regular smoking in girls in 1994-2010 (WHO/HBSC) (at least once a week)

  33. Trends in smoking in Czech children and youth in 1994-2010 (WHO/HBSC)

  34. Smoking status related to gender (2010, age group - 15 years) (WHO/HBSC)

  35. Conclusions • Decline in smoking in 15 year old children between 2002 and 2006 might be influenced by regulatory measures (increasing legal age for tobacco products sale from 16 to 18 years, increase of prize due to higher tax, restrictions on advertisements on tobacco products). • Increasing trend in prevalence after 2006 suggests that the effect of regulatory measures has been exhausted and social image of smoking influence more behaviour of girls than boys.

  36. Smoking cigarettes in last 30 days (2011_1a) – ESPAD(16 year old students)

  37. Smoking cigarettes in last 30 days (ESPAD 2011_1b)

  38. Smoking in relation to smoking of parents and friends(WHO/HBSC)

  39. Why children smoke? • Teens are more likely to smoke if parents or friends smoke. • Children imitate their peers and role models.  • If they see a teacher, actor or sports figure smoking, they might be motivated to smoke.

  40. Prevalence of other addictive behaviours in relation to smoking status (WHO/HBSC)

  41. Healthrisks - Active smoking

  42. Nicotine

  43. How does nicotine work? • Nicotine has a chemical structure that resembles the structureof the neurotransmitter acetylcholine. • Nicotine causes a strengthening of the connections responsible for the production of dopamine in the ventral tegmental area of the brain pleasure or reward centre (Nucleus accumbens). • This strengthening results in a release of dopamine. This is the process used by the brain to enforce the behaviour. The nicotine stimulates this process, thus encouraging repetition of the nicotine intake.

  44. Smoking is addictive! • Nicotine is a drug that is responsible for a person’s addiction to tobacco products. • During smoking, nicotine enters the lungs and is absorbed quickly into the bloodstream and travels to the brain in a matter of seconds. • Smoked tobacco is one of the most addictive commonly used drugs. • Nicotine causes addiction that is similar to the addiction produced by using drugs such as heroin and cocaine.

  45. Tobacco and dependence • Using tobacco causes mental and physical dependence. • The degree of nicotine dependence can be detected with the Fagerström Test http://www.tobaccofreeu.org/facts_figures/documents/Fagerstrom-Nicotine-Dependence-Test.pdf

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