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The burden of tobacco The burden of tobacco

and how to help smokersand how to help smokers

Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM

PO Box 27121 – Riyadh 11417Tel: 4912326 – Fax: 4970847

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• 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

Objectives

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1.1. Tobacco 12.2%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%

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

World health report 2002. http://www.who.int/whr/2002/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/tfi.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/Saudi%20Arabia:

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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/Saudi%20Arabia:

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• 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

Health Effects of Smoking

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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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Period studied Prob. survival from 70-90(& mean birth year) Non-smoker Cigt Smoker

1950s (1875) 12% 10%

1970s 20% 7%

1990s (1915) 33% 7%

Doll, Peto et al. BMJ 26/06/04

Smoking & death in British doctors aged 70-89 during the 1950s, 1970s & 1990s:

large improvement among non-smokers wholly nullified among cigarette smokers

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

What’s in a cigarette?

What's in a cigarette? Terry Martin, http://quitsmoking.about.com/cs/nicotineinhaler/a/cigingredients.htm (2004)

Smoking Cessation

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• Physical

• Psychological

• Behavioral

Three Aspects of Addiction

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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.

Common Concerns

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“Genes load the gun.Lifestyle pulls the trigger”

Dr. Elliot Joslin

Lifestyle Factors

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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

Behavior modification

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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

Pharmacological treatment

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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

Health benefits after quitting

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COST!!! inconvenience self-esteem role model

Non-health reasons for quitting

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CONTROLCONTROL

1. Education of public, anti-smoking campaigns; especially

for children

2. Restriction of cigarette advertising.

3. Restriction of cigarette smoking in public place.

4. 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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• All smoking patients should be counseled

• Always use pharmacological interventions

• Be public health advocates

Conclusions

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Thanks