Smoking quiz

1
Smoking quiz

• Robert West
• University College London
• Rio de Janeiro 2006

2
Introduction

• Any fool can ask a question that a wise person
  cannot answer
• An idiot is someone who doesnt know something
  that one has just learned oneself
• The answers to some of these questions are very
  well known, some are less well known and some may
  seem surprising. If you know the answer to a
  question it may seem trivially easy but remember
  that what is obvious to a pharmacologist may not
  be known to an epidemiologist and vice versa.

3
The questions

• For each statement just state whether it is
  True or False or leave it blank if you do not
  know

4
Smoking and Health

• More than 4 million people will die prematurely
  in 2006 as a result of smoking
• The British Doctors study found that stopping
  smoking at age 40 increased life expectancy by
  about 9 years
• The British Doctors study found that stopping
  smoking at age 60 increased life expectancy by 1
  year
• Smoking has been found to increase risk of stroke
• In terms of lung cancer risk, working full time
  in a smoky bar is equivalent to smoking about
  five cigarettes per day

5
Smoking and health

• Smokeless tobacco (chewing tobacco and snus) is
  just as harmful as smoking
• Smokers are more likely to suffer from
  pre-eclampsia (dangerously high blood pressure
  during pregnancy) than non-smokers
• Resting blood pressure typically goes down when
  people stop smoking
• The weight gain that many smokers experience when
  they stop usually lasts less than a year
• Nicotine has been found to cause fetal
  abnormalities in animals

6
Clinical issues

• The nicotine withdrawal symptom, irritability,
  usually last about 8 weeks
• Nicotine gum was the first medication licensed as
  an aid to smoking cessation
• Being exposed to paint stripper fumes can lead to
  high levels of expired-air carbon monoxide
• Brief opportunistic advice from a GP leads about
  5 of smokers to stop for at least 6 months
• Acute forms of nicotine delivery such as gum,
  lozenge and nasal spray have been found to reduce
  urges to smoke but nicotine patches have not

7
Clinical issues

• The threshold for expired-air carbon monoxide
  concentration to detect smoking is usually set at
  3 ppm
• Clinical trials have found that face-to-face
  counselling helps an average of 10 of smokers to
  stop for at least 6 months
• The more smokers enjoy smoking the less likely
  they are to succeed in their attempts to stop
• Trials directly comparing varenicline and
  bupropion to aid smoking cessation have found
  varenicline to yield higher 12-month continuous
  abstinence rates
• Trials of nicotine patches for smoking cessation
  have been found to increase 12-month continuous
  abstinence rates by 5-7 compared with placebo

8
Pharmacology

• The plasma half life of nicotine is typically
  less than 3 hours
• Nicotine binds with greater affinity to the
  alpha4-beta2 NAch receptor than the alpha7
  receptor
• Stopping smoking is associated with an increase
  in adrenaline output
• Smokers typically ingest between 1.0 and 1.5mg of
  nicotine per cigarette
• Studies have failed to find that nicotine reduces
  anxiety in non-smokers

9
Economics

• In most economies putting the price of cigarettes
  up by 10 in real terms would be expected to lead
  to an approximate 4 reduction in quantity of
  cigarettes sold
• Population studies have found that low income
  smokers are less likely to try to stop smoking
  than more affluent smokers
• Pregnant smokers have been found to be more
  responsive to increases in the price of
  cigarettes than other women of the same age
• Stopping smoking results in less use of
  healthcare resources even within the first year
• Adolescents are less responsive to cigarette
  price rises than adults

10
The answers

• RedTrue
• BlackFalse

11
Smoking and Health

• More than 4 million people will die prematurely
  in 2006 as a result of smoking
• The British Doctors study found that stopping
  smoking at age 40 increased life expectancy by
  about 9 years
• The British Doctors study found that stopping
  smoking at age 60 increased life expectancy by 1
  year (it was 3 years)
• Smoking has been found to increase risk of stroke
• In terms of lung cancer risk, working full time
  in a smoky bar is equivalent to smoking about
  five cigarettes per day (it is much less, though
  still significant)

12
Smoking and health

• Smokeless tobacco (chewing tobacco and snus) is
  just as harmful as smoking (it is much less
  harmful)
• Smokers are more likely to suffer from
  pre-eclampsia (dangerously high blood pressure
  during pregnancy) than non-smokers (paradoxically
  smokers are LESS likely to suffer pre-eclampsia)
• Resting blood pressure typically goes down when
  people stop smoking (it actually goes up
  slightly)
• The weight gain that many smokers experience when
  they stop usually lasts less than a year (it is
  normally permanent)
• Nicotine has been found to cause fetal
  abnormalities in animals

13
Clinical issues

• The nicotine withdrawal symptom, irritability,
  usually last about 8 weeks (it usually lasts up
  to 4 weeks)
• Nicotine gum was the first medication licensed as
  an aid to smoking cessation (Tabex cytisine
  was licensed in Soviet bloc countries in the
  1960s)
• Being exposed to paint stripper fumes can lead to
  high levels of expired-air carbon monoxide
• Brief opportunistic advice from a GP leads about
  5 of smokers to stop for at least 6 months (the
  effect is about 2)
• Acute forms of nicotine delivery such as gum,
  lozenge and nasal spray have been found to reduce
  urges to smoke but nicotine patches have not
  (they have all been shown to reduce urges)

14
Clinical issues

• The threshold for expired-air carbon monoxide
  concentration to detect smoking is usually set at
  3 ppm (it is usually set at 8 or 10)
• Clinical trials have found that face-to-face
  counselling helps an average of 10 of smokers to
  stop for at least 6 months (the effect is about
  5)
• The more smokers enjoy smoking the less likely
  they are to succeed in their attempts to stop (we
  have found no relationship at all in clinic
  studies)
• Trials directly comparing varenicline and
  bupropion to aid smoking cessation have found
  varenicline to yield higher 12-month continuous
  abstinence rates
• Trials of nicotine patches for smoking cessation
  have been found to increase 12-month continuous
  abstinence rates by 5-7 compared with placebo

15
Pharmacology

• The plasma half life of nicotine is typically
  less than 3 hours
• Nicotine binds with greater affinity to the
  alpha4-beta2 NAch receptor than the alpha7
  receptor
• Stopping smoking is associated with an increase
  in adrenaline output (adrenaline output decreases
  for up to 10 days)
• Smokers typically ingest between 1.0 and 1.5mg of
  nicotine per cigarette
• Studies have failed to find that nicotine reduces
  anxiety in non-smokers

16
Economics

• In most economies putting the price of cigarettes
  up by 10 in real terms would be expected to lead
  to an approximate 4 reduction in quantity of
  cigarettes sold
• Population studies have found that low income
  smokers are less likely to want to stop smoking
  than more affluent smokers (in the UK at least
  they want to stop just as much as high income
  smokers)
• Pregnant smokers have been found to be more
  responsive to increases in the price of
  cigarettes than other women of the same age
• Stopping smoking results in less use of
  healthcare resources even within the first year
  (use of healthcare resources goes up and it is
  not clear why)
• Adolescents are less responsive to cigarette
  price rises than adults (they are MORE responsive)

17
Your score

• Add 1 for every correct answer
• Deduct 1 for every incorrect answer