The burden of tobacco

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The burden of tobacco and how to help smokers
Introduction to Primary Care a course of the
Center of Post Graduate Studies in FM
PO Box 27121 Riyadh 11417 Tel [phone] Fax
4970847
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Objectives

• review information on tobacco.
• recognize the dangers of using tobacco in any
  form.
• explain some of the legal, social, financial, and
  health issues related to tobacco use.
• discuss tobacco cessation methods
• explain the quit process
• describe the withdrawal symptoms
• discuss the pharmacological treatment for tobacco
  cessation

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The ten leading risk factors for high mortality
diseases in Developed countries

1. Tobacco 12.2
2. Blood pressure 10.9
3. Alcohol 9.2
4. Cholesterol 7.6
5. Overweight 7.4
6. Low fruit and vegetable intake 3.9
7. Physical inactivity 3.3
8. Illicit drugs 1.8
9. Unsafe sex 0.8
10. Iron deficiency 0.7

World health report 2002. http//www.who.int/whr/2
002/en/whr2002_annex14_16.pdf
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What is the Prevalance in Saudi Arabia?

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Profile of smoking amongst health staff in a
primary care unit at a general hospital in Riyadh

• Adult (30-70 Year Olds), 1996-2001
• Males 19.1
• Females 8.3
• Overall 13.4
• Youth, 2001
• Males 20.2
• Hospital Staff, 1999-2000
• Nursing 8.6
• Doctors 20
• Pharmacy 14.3

Al-Kharj Military Hospital Siddiqui, S. and
Ogbeide, D.O. (2001). Profile of smoking amongst
health staff in a primary care unit at a general
hospital in Riyadh, Saudi Arabia. Saudi Medical
Journal 22(12) 1101-1104.
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Some interesting facts about KSA physicians about
smoking counseling

• Among those who reported feeling well prepared
  to give counseling, 69 used counseling.
• That figure drops to 39 among those who reported
  feeling not at all prepared to give counseling
• Only 6 of the physicians said that they do not
  use any of the techniques available to them.

World Health Organization, Regional Office for
the. Eastern Mediterranean www.emro.who.int/tfi/tf
i.htm
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Economic Burden of smoking

• 17 November 2008JEDDAH Smokers in Saudi Arabia
  spend a whopping SR 5 billion every year on
  40,000 tons of tobacco, according to a top
  medical executive. "The amount is equivalent to
  the total sum spent by the Kingdom on the import
  of rice," Dr. Magdi Mohsen, public affairs
  manager at Pfizer Inc., Saudi Arabia, said at the
  launch of an anti-smoking clinic at the Crowne
  Plaza Hotel

http//zawya.com/Story.cfm/sidZAWYA20081117033620/
Saudi20Arabia
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Economic Burden of smoking

• The number of smoking-related deaths in the
  Kingdom has exceeded 30,000 in 2008
• Between 2000 and 2004, the expenses
• incurred on the treatment of smoking-related
• diseases in the Kingdom soared to some SR12
• Billion..!!!!

http//zawya.com/Story.cfm/sidZAWYA20081117033620/
Saudi20Arabia
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Health Effects of Smoking

• Heart disease
• Lung disease COPD, asthma
• Cancer
• Lung, ENT, pancreas
• Cervix, colorectal
• Skin (squamous cell)
• Vascular disease - impotence
• Stroke
• Cataracts
• Gum disease
• Dementia
• Early menopause

• Osteoporosis
• Delayed wound healing
• Anxiety
• Miscarriage
• Sudden infant death s.
• Hearing loss
• Rheumatoid arthritis
• Macular degeneration
• Tooth decay
• Depression
• Multiple sclerosis

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An interesting study

• Mortality in relation to
• smoking 50 years
• observations on male
• British doctors
• Richard Doll, Richard
• Peto, Jillian Boreham and
• Isabelle Sutherland

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Smoking death in British doctors aged 70-89
during the 1950s, 1970s 1990slarge
improvement among non-smokers wholly nullified
among cigarette smokers

• Period studied Prob. survival from 70-90
• ( mean birth year) Non-smoker Cigt
  Smoker
• 1950s (1875) 12
  10
• 1970s 20
  7
• 1990s (1915) 33
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• Doll, Peto et al. BMJ 26/06/04

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Whats in a cigarette?

• 4,000 chemicals
• tar
• carbon monoxide
• nicotine

What's in a cigarette? Terry Martin,
http//quitsmoking.about.com/cs/nicotineinhaler/a/
cigingredients.htm (2004)
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Smoking Cessation
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Three Aspects of Addiction

• Physical
• Psychological
• Behavioral

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Common Concerns

• Withdrawal
• short lived
• Cravings
• last 3-5 minutes, diminish rapidly
• Tension
• validate, normalize
• find other ways to cope
• Weight gain - not inevitable!
• 1/3 gain 5-8 lbs.

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Lifestyle Factors
Genes load the gun.Lifestyle pulls the trigger
Dr. Elliot Joslin
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Behavior modification

• review reasons for quitting (index card)
• identify triggers (4 day diary)
• plans to avoid or cope with each trigger
• change habit packs only, different brands
• develop support system (tell everyone)
• self rewards (day, week, month, year)
• written commitment to quit day

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Pharmacological treatment

• nicotine replacement - methadone for the smoker
• gum
• patches
• nasal spray
• inhaler
• Bupropion
• Varenicline (Champix)
• all decrease cravings, withdrawal
• 20-25 quit rates at 1 year

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Health benefits after quitting

• Chronic Cough resolve in weeks
• exercise tolerance improves rapidly
• bladder cancer 50 reduction in 5 years
• lung cancer 50 reduction in 10 years
• heart disease 50 reduction in 1 year!
• No excess risk of heart disease by 10-15 years
• vascular disease 50 reduction in 5 years
• mortality - same as never smokers by 10-15 yrs

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Non-health reasons for quitting

• COST!!!
• inconvenience
• self-esteem
• role model

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• CONTROL
• Education of public, anti-smoking campaigns
  especially for children
• Restriction of cigarette advertising.
• Restriction of cigarette smoking in public place.
• Programs to help smokers to stop, or if they must
  continue, to smoke fewer cigarettes, inhale less,
  and smoke brand low in tar and nicotine.

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Conclusions

• All smoking patients should be counseled
• Always use pharmacological interventions
• Be public health advocates

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• Thanks

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