Isuisu semasa tentang merokok

1
Isu-isu semasa tentang merokok
Kempen Kesedaran Bahaya Merokok

• Oleh
• En. Razak Hj. Lajis
• Pusat Racun Negara

2
Tobacco Arrives in the Old World

• 1492 Columbus brought tobacco back to Europe
  from his first voyage
• 155659 Tobacco introduced into France, Spain
  and Portugal
• 1560s Jean Nicot praised tobaccos medicinal
  properties to the French queen

National Archives and Records Administration
3
Smokeless Tobacco

• Chewing tobacco
• looseleaf
• plug
• twist
• Snuff
• moist
• dry

RM Davis, M.D.
4
The Tobacco Plant
Plants in the Solanaceae family 2 major subgenera
N. tabacum cultivated tobacco
N. rustica wild tobacco
Encyclopedia Britannica Online
Encyclopedia Britannica Online
domesticated plant
higher nicotine content
cultivated in Russia and South America
cultivated worldwide
5
The Manufactured Cigarette
Tipping paper
Monogram Ink
Cigarette paper
Filter
Tobacco and additives
Cigarette Paper Adhesive
Plugwrap Paper
Ventilation holes
6
Trade in Manufactured Tobacco
Top Ten Importing and Exporting Countries ( of
world total)
Importers Exporters Japan 14.9 US 28.4 France 10.
8 Netherlands 14.9 Hong Kong 8.9 UK 9.5 Italy 7.0
Hong Kong 7.9 Singapore 5.2 Germany 7.2 Germany 4.
4 Singapore 5.4 Russian Fed. 4.2 China 4.9 Iran 3.
9 Switzerland 2.0 Netherlands 3.5 Belgium /
Luxembourg 1.8 US 1.3 Canada 0.4
Yach, 1998
7
World Brand Ranking 1996
Ranking
Brand name
Main manufacturer(s)
Cigarette sales (billions)
1 Marlboro 363.0
Philip Morris Inc. 2 Mild Seven 114.5
Japan Tobacco Co.
3 Derby 53.4 AT Souza Cruz
4 Winston 43.5 R.J. Reynolds
Internat. 5 Cleopatra 42.2
Eastern Tobacco Co. 6 Camel 42.9
R.J. Reynolds Internat 7 Virginia
Slims 40.5 Japan Tobacco Co.
8 Long Life 33.9 TTWTB
9 Benson Hedges 32.3 Gallaher
P1c/Philip Morris/BAT 10 Krong Thip 31.9
Thai Tobacco Monopoly
Marketfile, Tobacco
8
Smoking is Increasing in the Developing World
(Trends in per capita adult cigarette consumption)
3000
Developed
2500
Developing World
2000
Annual cigarette consumption per adult (in
cigarettes)
1500
1000
500
1970-72
1980-82
1990-92
Year
9
Trends in World Cigarette Production 19901997
5800
5700
5600
5500
Cigarette production (billions)
5400
5300
5200
5100
1990
1991
1992
1993
1994
1995
1996
1997
Year
World Tobacco from USDA
10
According to the Worldwatch Institute based on US
Department of Agriculture figures, world
cigarette production has been as follows
1950 - 1,868 billion 1960 - 2,150 billion 1970 -
3,112 billion 1980 - 4,388 billion 1990 - 5,419
billion 1991 - 5,351 billion 1992 - 5,363
billion 1993 - 5,300 billion 1994 - 5,478
bilion 1995 - 5,599 billion 1996 - 5,681
billion 1997 - 5,643 billion 1998 - 5,609
billion (note 1,000 billion 1 trillion or
1,000,000,000,000)
Brown and Williamson Tobacco Corporation website
11
Uptake of Smoking

• Each Day
• 14,000 to 15,000 young people become smokers in
  high-income countries
• 68,000 to 84,000 young people become smokers in
  low and middle-income countries

SourceA World Bank Publication
World Bank Report, 1999
12
Masalah Merokok
Dunia
1998
4 juta kematian
2030
10 juta kematian
Malaysia
3.6 juta perokok
2000
2025
4.6 juta perokok
13
Profil Perokok di Malaysia
Perokok berusia lebih 15 tahun
2025
2000
Perokok lelaki
49
30
Perokok wanita
4
10
14
Perokok Malaysia
Seorang rakyat Semenanjung Malaysia puratanya
membelanjakan sebanyak RM 1.50 sehari.
RM
Jumlah perbelanjaan membeli rokok bagi
Semenanjung Malaysia ialah RM4.6 juta sehari atau
RM1.69 bilion setahun. Jumlah ini adalah hampir
dengan perbelanjaan pertanian dan pembangunan
luar bandar iaitu sebanyak RM1,693,000,000. Malah
perbelanjaan untuk membeli rokok melebihi
sebanyak RM4,000,000.
Kerajaan mengutip RM337.6 juta hasil duti import
dan cukai eksais ke atas tembakau, rokok dan
cerut.
Hampir 7,500 orang mati setiap tahun akibat barah
paru-paru 90 peratus daripadanya perokok.
Sumber Dewan Masyarakat, Julai 1990, hal. 11
15
Health Consequences of Tobacco Use

• Each year tobacco kills 3 million people
  worldwide
• WHO estimates that by 20202030, tobacco will be
  responsible for 10 million deaths per year
• 70 will occur in developing countries
• Half of all long-term smokers will be killed by
  tobacco
• half of these will die in middle age, losing
• 2025 years of life

16
Current and Estimated Future Deaths from Tobacco
(millions per year)
Number of tobacco deaths in 2000
Number of tobacco deaths projected for 2030
Developed
2
3
Developing
2
7
Source World Health Organization, 1999. Making a
Diffrence. World Health report, 1999. Geneva,
Switzerland.
17
Pola Menghisap Rokok Mengikut Paras Nikotin dalam
Badan
Minit
0
10
20
30
40
50
Paras NIKOTIN menurun
Mula nyalakan rokok pertama
18
Nicotine Releases Chemicals in the Brain
Pleasure, appetite suppression
Dopamine
Norepinephrine
Arousal, appetite suppression
Arousal, cognitive enhancement
Acetylcholine
Nicotine
Vasopressin
Memory improvement
Serotonin
Mood modulation, appetite suppression
Beta-endorphin
Reduction of anxiety and tension
Benowitz, 1999
19
Jadual Menunjukkan Tanda-tanda Selepas Seminggu
Tidak Merokok
Tanda-tanda gian
Peratusan berlaku
Gelisah Tidur tidak cukup Kerengsaan Tidak
sabar Sukar memberi tumpuan Keresahan Kemaruk
tembakau Lapar Masalah perut-usus Sakit
kepala Pening-pening
87 84 80 76 73 71 62 53 33 24 22
Sumber Hughes Hatsukami, Arch. Gen.
Psychiatry, 1986.
20
From the Horses Mouth The Tobacco Industry Speaks
I do not believe that nicotine is
addictive Thomas Sandefur, Chief Executive of
Brown Williamson
I believe that nicotine is not
addictive William Campbell, Philip Morris
And I too believe that nicotine is not
addictive James Johnston, R.J. Reynolds
CEO testifying under oath before Congressional
Health and Environment Subcommittee, 1994
Nicotine is addictive. We are, then, in the
business of selling nicotine, an addictive
drug Addison Yeaman, Brown Williamson, 1963
21
Source J. Henningfield
22
Mengandungi lebih 4000 bahan kimia dan racun
23
Additives

• Adding flavor to tobacco has been a common
  practice, most flavorants were incorporated after
  1970
• Additives are used to
• provide higher levels of nicotine
• enhance the taste of smoke making
• cigarettes more palatable
• mask the smell and visibility of side-stream
• smoke
• Additives are screened for their toxicity but no
  assessment is required on the impact additives
  have on smoking behavior or addictive properties

24
Some of the Types of Carcinogens in Cigarette
Smoke

• Polynuclear aromatic hydrocarbons
  (benzo(a)pyrene)
• Aromatic amines (2-naphthylamine,
  4-aminobiphenyl)
• N-nitrosamines
• Tobacco specific N-nitrosamines
• Radioactive alpha-particle emitters (polonium)

25
The Causes of Cancer
40
35
30
25
20
15
10
5
0
Food
Viruses
Alcohol
Hazards at work
Radiation sunlight
Tobacco
Possibly preventable cancer deaths
Definitely preventable cancer deaths
26
Smoking-Caused Diseases
Cancers
Chronic Diseases
Stroke Coronary heart disease Aortic
aneurysm Atherosclerotic peripheral vascular
disease Chronic obstructive pulmonary disease
(COPD)
Oral pharynx
Larynx
Esophagus
Lung
Pancreas
Kidney and Ureter
Bladder
27
Lung Cancer International Trends
Estimated Age-standardized Rates (ASRs) of Lung
Cancer Mortality by Gender and Area, 1990

• Males Females
• Developing Countries 21.9 7.1
• Developed Countries 55.3 12.4
• All Areas 33.7 9.2

Pisani et al, 1999
28
Perbandingan Bahan dalam Asap Sampingan Rokok
Bahan-bahan dalam asap puntung
Anggaran lebih banyak daripada asap rokok biasa
Dadah nikotin Aseton Tar Hidrogen sianid Karbon
monoksida Toluen Benzen Anilin Nitrosamin (bahan
karsinogen)
2 kali ganda 2-5 kali ganda 3 kali ganda 4-6 kali
ganda 5 kali ganda 6-8 kali ganda 10 kali
ganda 30 kali ganda 50 kali ganda
29
A list of those who say it is harmful
Passive Smoking

• Health Education Authority

• British Heart Foundation

A list of those who say it is not harmful

• Imperial Cancer Research Fund

• National Asthma Campaign

• The Tobacco Industry

• Department of Health

• Cancer Research Campaign

• British Medical Association

• Coronary Prevention Group

• Department of Health and Social
• Services, Northern Ireland

• Medical Practitioners Union

• Action on Smoking and Health

• The Society of Health
• Education/Promotion Specialists

• Independent Scientific
• Committee on Smoking and Health

• International Union Against Cancer

30
Our Children Dont Need to Breathe Smoke
Parents, Friends and Relatives Who Smoke Around
Children Increase Their Childrens Risks of

• Asthma
• Colds
• Ear infections
• Allergies and bronchitis
• Visiting the emergency room
• Becoming smokers

ASTHMA affects children more than any other
disease!
Declare your HOME a Smoke Free Zone to prevent
asthma.
31
Asthma Attacks

• Smoking or being exposed to cigarette smoke
  contributes
• to the high rate of asthma.

• Cigarette smoking by parents can lead to asthma
  in
• their children.

Childhood Illnesses

• Children exposed to secondhand
• smoke are more likely to suffer
• respiratory problems, middle ear
• infections, heart problems or even
• death during the first year of life.

• Children who are exposed to
• cigarette smoke may develop
• lung problems.

Spoil them, not their lungs!
32
Cigarette Smoking and Being Exposed to Smoke
Causes Lung Cancer
Cigarette smoke damages the walls of the lungs
making them weak.
Cigarette smoke causes emphysema infection and
swelling of the smallest air ways in the lungs.
This causes shortness of breath and feelings of
suffocation.
Cigarette smoke causes bronchitis a continuous
cough which creates mucus and swelling of the
airways, making it harder to breathe.
33
When You Breathe Someone Elses Cigarette Smoke,
You Are a Secondhand Smoker
Secondhand Smoke Causes
Lung Cancer

• 3,000 adults die of lung cancer
• annually due to secondhand
• smoking.

Bronchitis and pneumonia

• African Americans suffer frequent respiratory
  problems
• because they are exposed to cigarette smoke.

• Children up to 18 months of age are twice as
  likely to get
• sick if their parents smoke.

34
Pengharaman Merokok
35
Pengharaman Merokok
36
Pengharaman Merokok Mengikut Islam

• Bahaya kepada kesihatan keluarga
• dan masyarakat

• Membazir wang

• Nafas berbau

37
Women Smokers

• Overall, women smoke less than men
• Market prevalences differ between
• countries
• In many developed countries smoking is the
  single most preventable cause of premature death
  in women
• Issues like social status and weight concern may
  play a role

38
When You Smoke Cigarettes Your Baby Smokes Too!
If You Smoke During Pregnancy, Your Baby May

• Be born underweight (under 5 lbs.) and this
  is not healthy!
• Die before being born
• Be born premature
• Have small lungs and die
• Suffer respiratory problems
• Have learning problems later on

If You Smoke During Pregnancy, You May

• Have difficulty delivering your baby
• Go to premature labor
• Bleed excessively during pregnancy
• Your baby may die during its first year of life!

39
Filter Ventilation
Type filter ventilation Full
flavor 12.7 Light 27.3 Ultra light 53.4
40
Cigarette Filters
Light brands
Full flavor brands
Perforations
Perforations
Photographs courtesy of J Henningfield
filter ventilation 12.65
filter ventilation 27.27
41
Health Warning Labels

• To be effective warnings should
• contain clear unambiguous messages
• warn about risk and also about relative size of
  the risk
• include graphics or symbols for those who cannot
  read
• apply to all tobacco products
• be prominent at the top of the package covering a
  minimum 25 of space
• disclose all harmful constituents and additives
• exclude misleading names such as light or
  ultra-light
• require manufacturers to rotate a series of
  warnings

Health Canada, 2000
Health Canada, 2000
42
Modern Efforts to Control Tobacco Use

• 1970 US ban on TV and radio advertisement also
  ends free counter advertisement
• 1970 Singapore bans smoking in buses, cinemas,
  theatres and specified buildings
• 1971 Singapore bans tobacco advertising
• 1975 Norway bans tobacco advertising
• 1987 Hong Kong bans smokeless tobacco
• 1987 US Congress bans smoking on domestic
  flights of less than two hours
• 1998 California is the first state in the US to
  ban smoking in bars

Borio G. Tobacco Timeline, 1998
43
Economic Consequences of Tobacco Use

• Medical costs
• Productivity losses due to
• morbidity
• disability
• premature mortality
• Global net loss of US 200 billion per year

44
Leading Causes of Death Worldwide in 1990 and
Estimated in 2020
Tobacco
Lower respiratory tract infections
Diarrhoeal disease
Perinatal conditions
1990
2020
Tuberculasis
0
2
4
6
8
10
Number of Deaths (millions)
WHO,1996