Tobacco and Public Health

7/30/2019 Tobacco and Public Health

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Tobacco and Public HealthPrevention, Intervention, Treatment

Deirdre A. Dingman, MPH, CHES, CTTS

Created: September 2012


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Science

Disease

Addiction

Prevalence

Incidence Trends Treatment

Deirdre A Dingman, MPH


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TobaccoDeirdre A Dingman, MPH


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Tobacco ProductsDeirdre A Dingman, MPH


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DISEASESmokeless Vs. Cigarettes



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Smokeless Tobacco Outcomes Oral malignancy - Cancer

Bad breath

Cardiovascular disease (outcomes)

Stained Teeth

Gingival recession/periodontal disease

Abrasion of teethWe do not know about potentially reduced harm products

yet. Including the E cig. See also Modified Tobacco Risk

Products and Potentially Reduced Exposure Products .

See Research and Review by T. Eissenberg, PhD.



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Lung and other cancers: oxidative stress, DNA damage

Breathing problems/COPD: TAR

Heart disease: oxidant gasses

Stroke: oxidant gasses Recently the government reported a link between

smoking, passive and active, with at least 25 diseases:chemicals impact all cells, tissues and organs

Reproductive problems and infant mortality: oxygenflow, hormone levels, toxic chemicals

It also effects young persons athletic performance, lungcapacity and immune systems.

ALSOSecond Hand or Environmental Smoke

Health Effects of Smoking

http://localhost/var/www/apps/conversion/tmp/scratch_2/newSponge_Lge.mpeghttp://localhost/var/www/apps/conversion/tmp/scratch_2/bubblewrap%20convert.MPGhttp://localhost/var/www/apps/conversion/tmp/scratch_2/Artery%20fear%20convert.mpghttp://localhost/var/www/apps/conversion/tmp/scratch_2/Artery%20fear%20convert.mpghttp://localhost/var/www/apps/conversion/tmp/scratch_2/bubblewrap%20convert.MPGhttp://localhost/var/www/apps/conversion/tmp/scratch_2/newSponge_Lge.mpeg


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Carbon Monoxide, Tar, and Nicotine

Tar (T.A.R.) Sticky brown substance that condenses on filter and lungs

Contains carcinogens

Comes from the burning of a smokable plant product

Carbon monoxide

Main contributor to coronary heart diseaseBinds to hemoglobin and leads to arthrosclerosis

Nicotine

Addictive component

Increases heart rate, blood pressure and pulse, vasoconstriction

Causes glucose release, higher blood sugar levels than would have if didntuse

Oxidant gasses

Thrombogenic effects



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What part of the cigarettecauses disease?Deirdre A Dingman, MPH


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The SmokeDeirdre A Dingman, MPH


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NicotineIs what keeps a person smoking


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Dopamine pleasure, appetite suppression

GABA reduce anxiety and tension

Norepinephrine arousal, appetite suppression

Nicotine Beta endorphins reduce anxiety and tension

Glutamate learning, memory enhance

Acetylcholine arousal, cognitive enhancement

Serotonin mood modulation, appetite suppression

Neurotransmitters Activated

Adapted from N. Benowitz, Am Jour of Med; 2008



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PrevalenceWho is using tobacco and how do we know?


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WHOOne Billion SmokersDeirdre A Dingman, MPH


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Self Report(operationalization)

Sample? Written? Telephone?

Have you smoked at least 100 cigarettes in

your entire life?Smoked cigarettes on 20 or more days, in last 30

days. US6.4%, NC 6.8% Males higher than females

Do you now smoke cigarettes every day, some

days, or not at all? (2010) 19.3% US Adults

On any day, in the last 30 days, have you smoked one

cigarette? (2009) 18% Youth smokers

Similar Qs for smokeless, less useregionaleffect!

Independent research also

adds to the numbers



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Cessation and Trends

First Surgeon GeneralReport1965

Prevalence was 42% 2005 20.6%

2010 19.3%

Quitters: White 6%

Black 3% (the menthol theory)

68% desire to quit!

During the past 12 months, have you stopped smoking for

one day or longer because you were trying to quit smoking?(BRFSS)



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INCIDENCEAt what age are people most likely to startsmoking or using tobacco?



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Who does this capture?(sample wise)

In a nationwideMonitoring the Futuresurvey,

8.8 percent of eighthgrade students reportedhaving first smoked bythe fifth grade (ages 10and 11), and

22.3 percent of eighthgraders tried smokingby the eighth grade.

Two out of three 12th-graders who werecurrent smokers hadstarted smoking by theend of ninth grade.

4000 teens try cigarettes every day

and 1000 become smokers.



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Public Health and Tobacco

Prevention

Intervention

Treatment



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Health Education/Promotion

Prevention - Keeping people

(youth) from ever starting.

Intervention - Behavior

Change TheoryStages of

Change. Quitting!

Treatment- Evidence based

cessation methods.



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Counter the MarketingGlamor and

Branding

{note: blank labels and display bans}



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CDCQuit SmokingDeirdre A Dingman, MPH
http://www.cdc.gov/tobacco/campaign/tips/resources/videos/


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Stages of change

Copyright 2004 BMJ Publishing Group Ltd.

Stages of change in process of stopping smoking. Adapted from Prochaska et al. Clin Chest Med 1991;12: 727-35 West, R. BMJ2004;328:338-339

Pre-Contemplation Contemplation

Maintenance Action

Preparatio

n

Termination

I Cant /I Wont

I May

I Will

I Am

I Still Am

I Did

Relapsing

Stages of Changean Intervention Model



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Motivational Interviewing with SOC

I Cant Efficacy

I Wont Relevance

I May Decisional Balance

I Will Quit Date/Meds/Tools

I Am Follow up/Support

I Still Am Monitor



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ClinicalEvidence Based

Treatment

Minimally Effective



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Non-NRT Quit Meds Bupropion SR (Zyban, Wellbutrin)

Varenicline (Chantix)

NRT Nicotine gum

Nicotine inhaler

Nicotine nasal spray Nicotine lozenge

Nicotine patch

First-line Pharmacotherapy



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Other Methods

The following do not have evidence-based efficacy

Hypnosis

Acupuncture

Anticholinergic shots

Laser therapy



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Set a Quit Date

Tell Others

Anticipate theChallenges

Remove TobaccoProducts

STARmethod



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We must be anti-tobacco use,

anti-disease, and anti-disability,

but never anti-smoker.


Tobacco and Public Health

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