Institute for Oncology and Radiology of SerbiaAna JovićevićInstitute for Oncology and Radiology of SerbiaAna Jovićević

HEALTH EFFECTSHEALTH EFFECTSHEALTH EFFECTSHEALTH EFFECTS

OFOFOFOFSMOKINGSMOKING

Belive it or not

• Tobacco causes 5 million deaths per year

•In the 20th century, 100 milion people were killed by tobacco • In the 21st century, 1 billion peole will be killed

Smoking kills ½ of smokers! Smoking kills ½ of smokers! HHalf alf of them will die of them will die in middle agein middle age

The only legal produt that kills when used as prescibed

6000 BC: first cultivation of the tobacco plant in the Americas

Around 1 BC: use of tobacco by natives of Americas

For ceremonial and religious purposes, as hallucinogen

Chewing, smoking, drinking syrup, licking paste, snuff, rubbing into skin/eyes, tobacco enemas… trance-like state (nicotine intoxication)

How did we end up here?How did we end up here?

History of tobacco useHistory of tobacco use

Columbus is to blame for everything

1492: Columbus brings tobacco back to Europe

1614: tobacco shops opened in England

1788: tobacco reaches Australia with the convicts

Rodrigo de Jerez, crew member of Columbus’s ship, became addicted to smoking; on return to England, he was imprisoned and killed by the Inquisition which believed he was possessed by the devil

The Tobacco Epidemic, Gary HuberNational Archives and Records Administration

Epidemic of cigarette smoking

At the end of 18th century, tobacco chewing became unpopular – fear of TB transmission through spitting

Tobacco industry reacted quickly – they increased the production of “practical and safe” cigarettes

Cigarettes included in

rations during: WW I and II

up to 80% smokers among men serving in military (Great Britain, US)

Practicing marketing on women…

Smoking was considered unacceptable for women

1920s: women first became the targets of the tobacco companies

“To keep an slender figure, reach for a Lucky instead for a sweet”

1968, Philip Morris links cigarettes with women's liberation: ”You’ve come a long way, baby !”

…and on youth

1913 R.J. Reynolds Tobacco Company: Camel

1964: Marlboro Man

Early Efforts to Control Tobacco Use

1604 King James I of England: “Counterblast to tobacco”

1633 Sultan Murad IV , Turkey: tobacco and coffee users to be executed as infidelsDuring the night, he would disguise himself and wander around looking for people smoking or drinking coffee and executing them

1638 Quing dynasty: decapitation for use/distribution

1771 France: hanging for tobacco users

1624 Pope Urban VIII: threatened to excommunicate snuff users

Since 1950: over 60,000 studies confirming impact of tobacco use on morbidity and mortality

British doctors study

Sir Richard Doll, Austin Bradford Hill, Richard Peto

34.439 british doctors followed-up from 1951 to 2001Evaluating and publishing results ≈ every 10 years Irrefutable scientific evidence for harmful effects of

smoking and benefits of quitting smoking

Tremendous effects on smoking prevalence in GB

“It became serious when doctors realized that not only patients die from tobacco but doctors as well...”

Richard Doll (1912-2005) presented his 50-year results at a press conference in 2004

Decrease in number of smokers in GB

Prevalence of smokers:

• 1950: 80% men

• 1970: 50% women

• 2002:

27% men

25% women

1950 1960 1970 1980 1990 2002

0

20

40

60

80

%

80%

50% 27%

25%

% smokers

“Mortality in relation to smoking:50 years’ observations on male British doctors”Doll R, Peto R et al. BMJ 2004; 328: 1519-28

1964 US Surgeon General’s Report on Smoking and Health

Based on the analysis of 7,000 studies

Conclusion: smoking is the main cause of lung cancer

Impact on tobacco consumption in the US

14

12

10

8

6

4

2

Cigarette consumption

per adultper day (m+f)

1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2003

100

80

60

40

20

0

US: cigarette consummation and LC mortality

LC mortality rates

www.deathsfromsmoking.net

1964 US Surgeon General's Report

LC – rare disease until the 30’s

Latent period

Tobacco smoke: 7.537 componds -tobacco constituents (1/2)-- combustion products

-- aditives Numerous toxic compound and 70 carcinogens!

h.cyanide – death penaltymetanol -rocket fuelleadpolonijum 210propilen glicol –antifreeze radoncarbon monoxide

amonic aceton e arsenbenzen - napalmbutan (lighter)cadmium - bateriesDDT – pesticide phenol – toilet dezinfectionformaldehyde- balming

THERE IS NO TRESHOLD !

NICOTINE

Smoking and cancer

Lung cancer – 90% of cases Lung cancer – 90% of cases

cancers of...cancers of...•ooralral cavity cavity•nasal cavitynasal cavity•larynx, pharynxlarynx, pharynx•oesophagusoesophagus•sstomachtomach•large bowelbladderlarge bowelbladder•KidneyKidney•pancreas pancreas •lliveriver•ccerviervix uteryx utery

Ishaemic heart diseaseHeart attack StrokeVascular dementia

PPeripheripheraleral vascular disease vascular diseaseProlonged would healingProlonged would healing......

Cardiovascular diseases

• Chronic obstructive lung disease

• EmphisemaEmphisema• Chronic bronchitisChronic bronchitis• Ear infectionsEar infections• PneumoniaPneumonia• AsthmaAsthma

Respiratory diseases

Reproductive health

MEN: reduced fertility , impotenceWOMEN: reduced fertility, earlier menopause

PREGNANCYPregnancy complicationsSpontaneus abortionPreterm delivery

BABYLower birth weightSudden infant death syndrome Reduced pulmonary functions

Passive smoking

Immediate effects• Irritation of airways • Difficult breathig• Cough, sneezing• Eye iritation• Headache• Nausea• Vertigo • Lower concentration• Odour

LongtermCancerCardiovascular diseasesRespiratory diseasePregnancy complicationsFetal growth, chilhood health

Benefits of quitting

At 20 minutes after quitting:Blood pressure decreases, pulse rate dropsBody temperature of hands and feet increases

At 8 hours: Carbon monoxide level in blood drops to normalOxygen level in blood increases to normal

At 48 hours: Ability to smell and taste improves

Between 2 to 9 weeks: circulation improves, walking and exercise easier , lung function increases.

By 3 months: fertility improves

By 9 months: no shortness of breath, or coughingfatigue improved

By 1 year : risk of coronary heart disease is already at half

By 10 years: risk for lung cancer similar to the risk in nonsmokers

Prevalence of smoking in men (2009)2008 ili poslednji raspoloživi podaci

Kiribati 71%

Greece 63%, Albania 60%, Russia 59%

Niger 7%, Gana 8%The Tobacco Atlas 2012, ACS / WLF

Sweeden 13%

The Tobacco Atlas 2012, ACS / WLF

Učestalost pušenja kod žena

Nauru 50%, Kiribati 43%

x

Nigeria... 0,2% Azerbaijan 0,6%

Austria 45%, Greece 41%,B&H 36%

Belarus 9%

Prevalence of smoking in women

What about Serbia ?

Institute for Public Health of Serbia survey

Smoking prevalence in adults 2000.g. 2006.g.

48 % 38 % in men (↓ 10%)

34 % 30 % in women (↓ 4%)

Exposure to secondhand smoke

66% 62% at home (↓ 4%)

56% 45% at work (↓ 11%) 31% AFTER THE NEW LAW!

In Serbia, tobacco kills 4 times more people than all the accidents and injuries togeather!

Smoking:

16 016death

per year

3 809

Deaths due to:InjuriesPoisoningMurderSuicideTrafic accidentsAccidents at workplaceAccidents at homePlaincrashDrowningFireFlood....

Do you mind if I...

... burn a hole in your shirt, spill ashes in your coffee, cough on your food, smell up your hair and clothes, and double your chance of getting cancer?