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Smoking
Additives
 Cigarettes are more than just tobacco leaves
rolled in paper.
 Cigarettes have approximately 597 other
ingredients in them.
Additives
 Some additives are used to improve the flavor
(i.e. to decreases the bitterness of the tobacco).
 Most additives are used to increase the
tobacco’s potency resulting in increased
addictiveness.
 When burnt, the mix results in over 4,000
chemicals, including over 40 known
carcinogenic compounds and 400 other toxins.
Smoke Constituents
(according to Phillip Morris)
 Tobacco smoke contains thousands of different
chemicals, including tar, nicotine and carbon
monoxide (CO).
 In addition to tar, nicotine, and CO, nearly 5,000
chemicals have been identified in tobacco
smoke to date.
 Public health authorities have classified between
45 and 70 of those chemicals, including
carcinogens, irritants and other toxins, as
potentially causing the harmful effects of
tobacco use.
Some of the Harmful Chemicals
in Cigarettes
 Cyanide
 Benzene
 Formaldehyde
 Methanol (wood alcohol)
 Acetylene (the fuel used in
welding torches)
 ammonia
 Poisonous Gases
 Nitrogen oxide
 Carbon monoxide
Surgeon General’s Report
on Smoking (2004)
 Smoking causes diseases in nearly every organ of
the body.
 “The toxins from cigarette smoke go everywhere
the blood flows.” – Dr. Carmona
 Smoking kills an estimated 440,000 Americans
each year.
 On average, men who smoke cut their lives short
by 13.2 years, and female smokers lose 14.5
years.
Surgeon General’s Report
on Smoking (2004)
 The economic tolls exceeds $157 billion each
year in the United States - - $75 billion in direct
medical costs and $82 billion in lost productivity.
 Statistics indicate that more than 12 million
Americans have died from smoking since the
1964 report of the surgeon general, and another
25 million Americans alive today will most likely
die of a smoking-related illness.
 Smoking the low-tar or low-nicotine cigarettes
does NOT offer a health benefit over smoking
regular or “full-flavor” cigarettes.
Surgeon General’s Report
on Smoking (2004)
 Quitting smoking has immediate and long-term
health benefits, reducing risks for diseases caused
by smoking and improving health in general.
 “Within minutes and hours after smokers inhale
their last cigarette, their bodies begin a series of
changes that continue for years,” Dr. Carmona
said.
 Quitting smoking at age 65 or older reduces by
nearly 50% a person’s risk of dying of a smokingrelated disease.
Diseases Linked To Smoking
 Lung cancer
 Throat cancer
 Larynx cancer
 Cardiovascular disease
 Chronic bronchitis
 Reproductive effects
 Bladder cancer
 Cataracts
 Esophageal cancer
 Pneumonia
 Mouth cancer
 Acute myeloid leukemia
Diseases Linked To Smoking
 Abdominal aortic aneurysm
 Stomach cancer
 Pancreatic cancer
 Cervical cancer
 Periodontitis
Cigarette Smoking and
Cancer
 Cigarette smoking causes 87 percent of lung
cancer deaths and is responsible for most
cancers of the larynx, oral cavity, pharynx,
esophagus, and bladder.
 Secondhand smoke is responsible for an
estimated 3,000 deaths among U.S. nonsmokers
each year.
Cigarette Smoking and
Cancer
 Tobacco smoke contains thousands of chemical
agents, including over 60 substances that are
known to cause cancer.
 The risk of developing smoking-related cancers,
as well as noncancerous diseases, increases with
total lifetime exposure to cigarette smoke.
 Smoking cessation has major and immediate
health benefits, including decreasing the risk of
lung and other cancers, heart attack, and
chronic lung disease.
Chronic Bronchitis
 Chronic bronchitis is a disease where the airways
produce too much mucus, forcing the smoker to
cough it out.
 The lungs start to produce large amounts of
mucus and do it more often.
 The airways become inflamed and the cough
becomes chronic.
 Airways get blocked by scars and mucus.
 Serious infections can result.
Emphysema
 Cigarette smoking is the major cause of
emphysema.
 The disease slowly destroys a persons ability to
breathe.
 Oxygen gets into the blood by moving across a
large surface area in the lungs.
Emphysema
 Normally, thousands of tiny sacs make up this
surface area.
 In emphysema, the walls between the sacs break
down making larger, but fewer sacs.
 This decreases the surface area, which lowers the
amount of oxygen reaching the blood.
 Overtime, the surface area can become so small
that the person must gasp for breath.
Emphysema (Early Signs)
 Shortness of breath (especially when lying down).
 A mild cough that doesn’t go away (often
dismissed as “smoker’s cough”).
 Feeling tired.
 Sometimes weight loss.
Emphysema (Later stages)
 Patients can only breathe comfortably with the
help of an oxygen tube under the nose.
 More susceptible to other problems linked to
weak lung function, including pneumonia.
 Emphysema cannot be reversed, but it can be
slowed – especially if the person stops smoking.
Chronic Obstructive
Pulmonary Disease
 More than 7 million current and former smokers
suffer from chronic and obstructive pulmonary
disease (COPD).
 Bronchitis and emphysema are types of COPD.
 COPD is the fourth leading cause of death in
America.
Chronic Obstructive
Pulmonary Disease
 Smoking is the main risk factor for COPD.
 The late stage of chronic lung disease is one of
the most miserable of all medical problems.
 It creates a feeling of gasping for breath all the
time – much like the feeling of drowning.
Smoker’s Cough
 Chemicals and heat from the smoke destroy
cilia.
 Cilia are tiny hairlike formations that beat
outward and sweep harmful material out of the
lungs.
 Cigarette smoke slows the sweeping action.
 Some of the poisons in the smoke stay in the
lungs and the mucus stays in the airways.
Smoker’s Cough
 While a smoker sleeps, some of the cilia recover
and begin working again.
 After waking up, the smoker coughs because the
lungs are trying to clear away the irritants that
built up the day before.
 The cilia will completely stop working after they
have been exposed to smoke for a long period
of time.
 This makes the smoker’s lungs even more
exposed and prone to infection and irritation.
Smoking and Heart Disease
 Smoking increases the risk of heart disease, which
is the number one cause of death in the United
States.
 Smoking, high blood pressure, high cholesterol,
physical inactivity, obesity, and diabetes are all
risk factors for heart disease, but cigarette
smoking is the biggest risk factor for sudden
death from a heart attack.
 A smoker who has a heart attack is more likely to
die within an hour of the heart attack than a
non-smoker.
Smoking and Pregnancy
 Smoking during pregnancy is linked with a
greater chance of miscarriage, premature
delivery, stillbirth, infant death, low birth-weight,
and sudden infant death syndrome (SIDS).
 Up to 5% of infant deaths could be prevented if
pregnant women did not smoke.
Secondhand Smoke
 Secondhand smoke is also known as
environmental tobacco smoke (ETS).
 ETS is a combination of the smoke coming from
the lit end of a cigarettes plus the smoke exhaled
by a person smoking.
Secondhand Smoke
 Public health officials have concluded that
secondhand smoke from cigarettes causes
disease, including lung cancer and heart
disease, in non-smoking adults, as well as causing
conditions in children such as asthma, respiratory
infections, cough, wheeze, otitis media (middle
ear infection) and Sudden Infant Death
Syndrome.
 Secondhand smoke can exacerbate adult
asthma and cause eye, throat and nasal
irritation.
Helping Smokers Quit
 A guide for Clinicians from the U.S. Department of
Health & Human Services
 “Even brief tobacco dependence treatment is
effective and should be offered to every patient
who uses tobacco.” - Public Health Service (PHS)
Clinical Practice Guideline, Treating Tobacco Use
and Dependence: 2008 Update
Helping Smokers Quit
 Ask
 Advise
 Assess
 Assist
 Arrange
Ask
 Ask about tobacco frequency at every visit.
 Implement a system in your clinic that ensures
that tobacco-use status is obtained and
recorded at every patient visit.
Advise
 Advise all tobacco users to quit.
 Use clear, strong, and personalized language.
 For example:
 “Quitting tobacco is the most important thing you
can do to protect your health.
Assess
 Assess readiness to quit.
 Ask every tobacco user if he/she is willing to quit
at this time.
 If willing to quit, provide resources and assistance.
 If unwilling to quit at this time, help to motivate the
patient:
 Identify reasons to quit in a supportive manner.
 Build patient’s confidence about quitting.
Assist
 Assist tobacco users with a quit plan.
 Assist the smoker to:
 Set a quit date, ideally within 2 weeks.
 Remove tobacco products from their environment.
 Get support from family, friends, and coworkers.
 Review past quit attempts – what helped, what led
to relapse.
 Anticipate challenges, particularly during the critical
first few weeks, including nicotine withdrawal.
 Identify reasons for quitting and benefits of quitting.
Assist
 Give advice on successful quitting:
 Total abstinence is essential – not even a single puff.
 Drinking alcohol is strongly associated with relapse.
 Allowing others to smoke in the household hinders
successful quitting.
Assist
 Encourage use of medication:
 Recommend use of over-the-counter nicotine
patrch, gum, or lozenge; or give prescription for
varenicline, bupropion, SR, nicotine inhaler, or nasal
spray, unless contraindicated.
 Provide resources:
 Recommend the toll free 1-800-QUIT NOW (7848669), the national access number to State-based
quitline services.
Assist
 Refer to Web Sites for free materials:
 Agency for Healthcare Research and Quality:
 www.ahrq.gov/path/tobacco.htm
 U.S. Department of Health and Human Services:
 www.smokefree.gov
Arrange
 Arrange followup visits.
 Schedule followup visits to review progress
toward quitting.
 If a relapse occurs, encourage repeat quit
attempt.
 Review circumstances that caused relapse. Use
relapse as a learning experience.
 Review medication use and problems.
 Refer to 1-800-UIT NOW (784-8669).
Help for Smokers and Other
Tobacco Users
 Quit Smoking
 You can quit. Quitting is hard. Many people try
several times before they quit for good, but they
do succeed.
Good Reasons for Qutting
 You will feel better.
 You will have more energy and breathe easier.
 Your chances of getting sick will go down.
 Smoking is dangerous.
 More than 435,000 Americans die each year from
smoking.
More Good Reasons for
Quitting
 If you are pregnant, your baby will be healthier.
 Your baby will get more oxygen.
 The people around you, especially your children,
will be healthier.
 Breathing in other people’s smoke can cause
asthma and other health problems.
 You will have more money. If you smoke one
pack per day, quitting smoking could save you
up to $150 a month.
Savings Per Month
If you smoke
(packs per day)
You pay
(per day)
Quitting saves
(per month)
1
$5.00
$150
2
$10.00
$300
3
$15.00
$450
There Has Never Been a
Better Time to Quit
 A combination works best.
 Set a quit date.
 Get support.
 Take medicine.
 Get Ready + Get Help + Get Medicine = Stay
Quit!
Get Ready
 Set a quit date.
 No smoking after: ____________________
 Change the things around you.
 Get rid of all cigarettes in your home, car, and place
of work.
 Do not let people smoke in your home.
 After you quit, don’t smoke – not even a puff!
Don’t use any tobacco!
Get Medicine
 You can buy nicotine gum, the nicotine patch, or
the nicotine lozenge at a drug store.
 You can ask your pharmacist for more
information.
Get Medicine
 Ask your doctor about other medicines that can
help you.
 Nicotine nasal spray.
 Nicotine inhaler.
 Bupropion SR (pill)
 Vaerenicine (pill)
 Most health insurance companies will pay for
these medicines.
Get Help
 Tell your family, friends, and people you work with
that you are going to quit. Ask for their support.
 Talk to your doctor, nurse, or other health care
worker. They can help you quit.
 Call 1-800-QUIT NOW (784-8669) to be connected
to the quitline in your State.
 It’s free. They will set up a quit plan with you.
Stay Quit
 If you “slip” and smoke or chew tobacco, don’t
give up. Try again soon. Set a new quit date
and get back on track.
 Avoid alcohol.
 Avoid being around smoking.
 Eat healthy food and get exercise.
 Keep a positive attitude. You can do it!
You Can Quit
 Most people try several times before they quit for
good.
 Quitting is hard, but – You Can Quit!
Quitting During a Hospital
Stay
 You hospital visit is a great time to quit smoking.
 Why should I quit now?
 Smoking may slow your recovery from surgery and
illness.
 It may also slow bone and wound healing.
 All hospitals in the United States are smoke free.
 You will be told NOT to smoke during your hospital
stay – now is a great time to quit.
Quitting During a Hospital
Stay
 How do I quit in the hospital?
 Talk to your doctor or other hospital staff about a
plan for quitting.
 Ask for help right away.
 Your doctor may give you medicine to help you
handle withdrawal while in the hospital and beyond.
Quitting During a Hospital
Stay
 Helpful hints to stay quit.
 Ask your friends and family for support
 Continue your quit plan after your hospital stay.
 Make sure you leave the hospital with the right
medicines or prescriptions.
 If you “slip” and smoke, don’t give up. Set a new
date and get back on track.
 For help in quitting, call the National Quitline toll free:
1-800-QUIT NOW.
Effects of Quitting
 20 minutes after quitting
 Your heart rate and blood pressure drop
 12 hours after quitting
 The carbon monoxide level in your blood drops to
normal
 2 weeks to 3 months after quitting
 Your circulation improves and your lung function
increases
Effects of Quitting
 1 to 9 months after quitting
 Coughing and shortness of breath decrease; cilia
(tiny hairlike structures that move mucus out of the
lungs) regain normal function in the lungs, increasing
the ability to handle mucus, clean the lungs, and
reduce the risk of infection.
 1 year after quitting
 The excess risk of coronary heart disease is half that
of a smoker’s.
Effects of Quitting
 5 years after quitting
 Your stroke risk is reduced to that of a non-smoker 5
to 15 years after quitting.
 10 years after quitting
 The lung cancer death rate is about half that of a
person who is still smoking. The risk of cancer of the
throat, esophagus, bladder, cervix, and pancreas
decreases.
 15 years after quitting
 The risk of coronary heart disease is that of a nonsmoker’s.
Benefits That Will Be Seen
Right Away
 Food will taste better.
 Your sense of smell returns to normal.
 Your breath, hair, and clothes smell better.
 Your teeth and fingernails stop yellowing.
 Ordinary activities leave you less out of breath
(i.e. climbing a flight of stairs or housework).
 Stops premature aging of skin and gum disease
from smoking.
Organizations That Can
Help
 American Cancer Society Toll-free number: 1800-ACS-2345 (1-800-227-2345) Web site:
www.cancer.org
 American Heart Association Toll-free number: 1800-AHA-USA-1 (1-800-242-8721) Web site:
www.americanheart.org
 American Lung Association Toll-free number: 1800-LUNG-USA (1-800-548-8252) Web site:
www.lungusa.org
Organizations That Can
Help
 National Cancer Institute Toll-free number: 1877-448-7848 (smoking cessation help) 1-800-4CANCER (1-800-422-6237) for cancer
information Web site: www.cancer.gov
 Centers for Disease Control and Prevention Tollfree number: 1-800-CDC-INFO (1-800-232-4636)
Web site:
www.cdc.gov/tobacco/quit_smoking/index.htm
Organizations That Can
Help
 Smokefree.gov (Info on state phone-based
quitting programs) Toll-free number: 1-800QUITNOW (1-800-784-8669) Web site:
www.smokefree.gov