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Elif Horozoğlu
Smoking Tobacco
Health consequences of tobacco use
Passive smoking
Interventions for reducing smoking rates
Effects of quitting
Health consequences of tobacco use
the number one preventable cause of death
and disability in U.S.
more than 440.000 deaths a year, mostly from
cancer, cardiovascular disease, and chronic
obstructive pulmonary disease
Until the mid-1990s, CVD is the first leading
smoking-related cause of death. Smokingrelated cancer deaths now exceed smokingrelated CVD
Chronic obstructive pulmonary disease is the
third leading cause of death.
What is the evidence?
Although experimental studies are lacking,
descriptive researches have firmly established a
cause and effect relationship between
cigarette smoking and lung cancer, heart
disease, and chronic obstructive pulmonary
disease.
Smoking and cancer
plays a role in the development of several cancers,
especially lung cancer.
80% of smoking-related cancer deaths are from lung
cancer.
Smoking may be responsible for lip, pharynx, pancreas,
esophagus, larynx, trachea, urinary bladder, and kidney
cancer.
Relative risk for lung cancer among cigarette smokers is
9.0.(the strongest link between any behavior and a major
cause of death).
During the mid 1960s, cigarette consumption began to
drop sharply, and then about 25 to 30 years later, lung
cancer deaths among men began to decline.
Smoking and cardiovascular
disease
the leading cause of death in the US and the second
largest cause of tobacco-related deaths
Relative risk for CVD among smokers is about 2.0.
Smoking increases the progression of atherosclerosis by
as much as 50% during a 3- year period, speeding the
plaque formation within the arteries.
Nicotine increases heart rate, blood pressure, and
cardiac output.
plaque formation + nicotine stimulation
increase
smokers’ risk of CVD.
Smoking and chronic obstructive
pulmonary disease
the third leading cause of death in US, and the
third leading cause of tobacco-related deaths
Chronic bronchitis and emphysema are the two
most deadly COPDs.
Since 1950s, mortality rates from COPD have
increased faster than any other major cause of
death except HIV infection.
COPD is relatively rare among nonsmokers.
Only 4% of male nonsmokers and 5% of female
nonsmokers receive diagnosis of COPD.
Other effects of smoking
Smoking has an interactive effect with depression;that is
smokers tend to have more depressive symptoms and
depressed people tend to smoke more.
periodontal disease, multiple sclerosis
Compared to non-smoker, smokers more likely to
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commit suicide
develop common cold
have problem with cognitive functioning
experience accelerated facial wrinkling
hearing loss
macular degeneration( a serious visual impairment)
Other effects of smoking
Female smokers double their chances of developing
ovarian cysts, and women smoking at least one pack of
cigarettes a day, increases their risk of bone fractures.
Smoking makes males older, less attractive in
appearance, and increases their chances of becoming
sexually impotent.
Cigar and pipe smoking
Cigar and pipe smoking may be less dangerous than
cigarettes, but they are not safe.
People who smoked only cigars had a risk of 2.9, and
those who smoked only pipes had a 2.5 increase in their
risk for lung cancer.
However, the combination of cigars or pipes with
cigarettes dramatically increased the relative risk for lung
cancer.
The relative risk for the combination of cigars and
cigarettes is 6.9,whereas the combination of pipes and
cigarettes is 8.1!
Passive smoking
Environmental tobacco smoke (ETS) or second hand
smoke
Lung cancer, breast cancer, heart disease, and a variety
of respiratory problems in children
Passive smoking and lung cancer
In general, the more smoke people are exposed to and
the longer the exposure, the higher the risk for lung
cancer.
Exposure from a spouse or from coworkers creates a
slightly elevated risk.
People exposed to environmental smoke during
childhood have no elevated risk for lung cancer, and
those exposed to their spouse’s smoke have only a
slight increase.
Passive smoking and breast cancer
Although some early research showed that passive
smoking was a risk factor for breast cancer, more recent
and better research indicated women are not under the
elevated risk from their smoking husbands.
Regarding of the husband’s level of smoking, the death
rate of women married to smokers for 30 years or more
was not more than the death rate of women married to
nonsmokers.
Passive smoking and CVD
A meta-analysis of researches indicated that the excess
risk of heart disease for passive smokers is about 25%.
Although passive smoking kills thousands of people
each year, the risk from passive smoking is only about
1/10 the risk from active smoking.
Passive smoking and the health of
children
Infants whose mother smoke have an increased risk for
dying sudden infant death syndrome (SIDS), and the
more cigarettes mothers smoke, the greater their infants’
risk for SIDS.
increased risk of bronchitis, pneumonia, asthma, lower
respiratory tract illnesses, low birth weight and childhood
cancer
Smokeless tobacco
Snuffing or chewing tobacco
Although the risk of smokeless tobacco is not as great as
cigarette smoking, smokeless tobacco has significant
health hazards.
Increased rate of cancer of the oral cavity, periodontal
disease and heart disease
People who use smokeless tobacco have a twofold risk
for high cholesterol.
Interventions for reducing smoking
rates
Deterring smoking
Quitting smoking
Deterring smoking
Information alone is not an effective way to change
behavior.
Smoking prevention programs that use lectures, posters,
pamphlets, articles in school newspapers etc. are almost
universally ineffective in preventing young people from
starting to smoke.
Inoculation programs aimed at buffering young
adolescents against the social pressures to smoke have
been more effective than educational programs.
buffering techniques + communitywide antismoking
campaign
long-term positive results
Quitting smoking
The decline in smoking rates is not due to fewer people
starting to smoke but in large part to increased cessation
rates.
Long-term smokers refuse to believe reports of negative
effects of smoking.
Optimistic bias and high self-esteem may contribute to
the difficulty of quitting smoking.
Addictive qualities of smoking
people seeking treatment for alcohol or drug
dependence who also smoked reported that cigarettes
would be the most difficult to quit.
Quitting smoking
Quitting without therapy
Using nicotine replacement therapy
Receiving psychological intervention
Participating in a community campaign
Quitting without therapy
Schacter (1987) found that nearly a third of the heavy
smokers who quit said they had no problems in quitting.
Schacter’s research suggest that people who quit
smoking on their own largely succeed and never attend
a clinic.
People who attend clinics are atypical group and their
failure rates are too high.
Using nicotine replacement therapy
Nicotine patch and nicotine gum are the two most
common nicotine replacement therapies.
The nicotine patch maintained 22% success versus 9%
for a placebo patch.
Nicotine gum produced 17-18% success versus 11% for
a placebo.
The effectiveness of both nicotine patch and nicotine
gum is increased when combined with psychological
interventions.
Nicotine patch may cause skin reaction and nicotine gum
may cause mouth soreness, hiccups, and jaw ache.
Nausea, light headedness, and sleep disturbances are
other possible side effects.
Receiving a psychological intervention
Behavior moditification, cognitive behavioral approaches,
contracts made by smoker and a therapist in which the
smoker agrees to stop smoking, group therapy, social
support, relaxation training, stress management, booster
sessions to prevent relapse are psychological
approaches aimed at smoking cessation.
The stages of change model of James Prochaska
Precontemplation stage: no intention to quit
Contemplation stage: aware of the problem-consider
quitting sometime in the future.
Receiving a psychological
intervention
Going from precontemplation to preparation for quitting is
more effective than moving only to next step.
Supportive practitioners increase smokers’ self-efficacy.
Verbal persuasion is one of the method for enhancing a
smoker’s self-efficacy. It has only limited influence.
Previous successful performance
the strongest source
of self-efficacy
Smokers who trained stress-coping skills are more likely to
quit than those who have not learned these techniques.
Counseling + nicotine replacement therapy
the most effective
Participating a community
campaign
The percentage of people who quit smoking as a result
of health campaign is usually quite small, however if their
messages reaches people, then thousands of lives may
be saved.
Monetary incentives along with telephone counseling to
smokers are not effective.
Who Quits and Who Does Not?
Gender
Men have had higher quit rates than women over the
past 40 years.
Do women have more difficulty quitting than men?
NO! Because women who try to quit have more
obstacles to overcome.
Women more participate quitting programs voluntarily.
When women decide to quit, they are as likely as men to
quit.
Women have more difficulty during the first 24 hours, but
after that they are equal to men.
Who quits and who does not?
Age
Younger smokers who smoke at high level are less likely to quit
than older smokers who smoke at a low level.
Educational level
1)
2)
3)
4)
Because smokers with lower levels of education
Begin smoking earlier
Have higher scores on neuroticism
Have lower scores on emotional support
Have low levels of perceived personal control
Lower educational level is related to higher smoking rates.
Who quits and who does not?
A supportive social network may also help people quit
smoking.
Moreover, some researches suggests that problem
drinkers who able to stop drinking are also able to quit
smoking.
Many people quit both simultaneously.
Relapse prevention
Abstinence violation effect
one cigarette creates a
full relapse, complete with feelings of total failure.
1/4 of successful self-quitters slip at one time or another.
Thus, a single slip shouldn’t discourage people from
continuing their effort to quitting!
2/3 of self-quitters relapsed after only 2 days and 92%
had resumed smoking after 6 months.
Formal smoking cessation programs’ relapse rate is
about 70 to 80%.
Quitting and Weight Gain
Middle-aged people will gain weight whether they are
smokers, have quit, or have never smoked.
The average weight gain for most men and women is
relatively modest- about 9 to 11 pounds.
However, some people gain large amounts of weight.
Women are more concerned about weight gain than are
men, but their total weight gain after quitting is about the
same as that of men. Their percentage of weight gain is
more than men because men are heavier than women at
baseline.
Quitting and weight gain
Exercise can prevent weight gain in both women and
men.
Quitting smoking is much more beneficial to health than
maintaining lower weight...
Health benefits of quitting
After both female and male smokers have quit smoking
for 16 years, they had about the same rate of mortality
as people who have never smoked.
Smokers who quit can eventually reduce their risk of
CVD to that of a nonsmokers, BUT their risk of lung
cancer does not change.