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 1960Address : Jalan Pasang 26, Bandung-40114. Education

1986, Dokter : Fakultas Kedokteran, Unpad.1992, Master of Public Health (MPH): University of Wollongong,

Wollongong, Australia.2004, Doktor : Pascasarjana, Unpad

Work Experience1987 - now : Lecture Public Health Department Faculty of Medicine

Unpad2007 - 2010 : Director Public Health Postgraduate Program Faculty

of Medicine Unpad2010 - 2011 : Head Department of Public Health Faculty of Medicine

Unpad

Ardini Saptaningsih RAKSANAGARAJalan Pasang 26. Bandung 40114. Phone : 022-7276326Mobile phone : 0811 237 159Email : 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

0.7

17.3

29 30.232.4 31.8

28.8 27.8

0

5

10

15

20

25

30

35

10'-14 15'-24 25'-34 35'-44 45'-54 55'-64 65'-74 75+

Percentage of smokers (groups of age)

Everyday smokers

• Male : 45 %• Female : 3 %

• Urban : 21.2 %• Rural : 25.3 %

0

25

50

75Q1

Q2

Q3Q4

Q5

everyday not ED ex not smoking

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 and supply

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

Consequences of Tobacco-Use: Preventable Causes of Death

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:

Quitting smoking rapidly reduces the risk of coronary

heart diseaseTorn heart wall: Result of over-worked heart muscle

Smokers are twice as likely as Nonsmokers to

have a heart attack

Peripheral Vascular Disease

Stroke:

This brain shows stroke

damage, which can

cause death or severe mental or physical disability

Emphysema: Healthy lung Emphysemati

c lung

Symptoms IncludeShortness of breath

Chronic coughWheezingAnxiety

Weight lossAnkle, 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 CancerSymptoms:• Persistent hoarseness

• Chronic sore throat

• Painful swallowing

• Pain in the ear• Lump in the neckOver 80% of deaths from laryngeal cancer are

linked to smoking

Dental Problems:

Above: CavitiesBelow: Gingivitis

Overall poor oral health

Common Consequences

:• Stained teeth• Gum

inflammation• Black hairy

tongue• Oral cancer• 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 cigarette A cigar is tobacco rolled up in a tobacco leaf A cigar does not have a filter

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 therapyshould be included in smoking cessation interventions.

Thank you